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Rask CU, Duholm CS, Poulsen CM, Rimvall MK, Wright KD. Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences. J Child Psychol Psychiatry 2024; 65:413-430. [PMID: 37909255 DOI: 10.1111/jcpp.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/03/2023]
Abstract
Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, SK, Canada
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Guan M. Could the Associations of Changes in Living Arrangement with Mental Disorders Be Moderated or Mediated During COVID-19 Pandemic? Psychol Res Behav Manag 2021; 14:769-779. [PMID: 34168508 PMCID: PMC8216724 DOI: 10.2147/prbm.s302729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/22/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Changes in living arrangement was one of the most well-established risk factors for mental disorders, but little evidence came from moderating or mediating effect during COVID-19 pandemic. This study aimed to determine whether associations of changes in living arrangement with mental disorders could be moderated or mediated during COVID-19 pandemic. METHODS Data were a cross-sectional and international population-based survey data collected as part of theCOVID-19 pandemic. Participants included nationally representative general population probability samples of adults (≥18 years) during COVID-19 pandemic (N=16,784). Main mental measures were reflected by loneliness assessed by UCLA Loneliness Scale Version 3, anxiety assessed by Generalised Anxiety Disorder 2-item, and depressed mood assessed by The Patient Health Questionnaire-2 in the survey. With control variables, all the mediation models were conducted by Stata mode. Potential influencing effects of social contact and social support as moderators were analyzed using Hayes's PROCESS macro. RESULTS Among the participants, prevalence of mental disorders was high. Logistic regression indicated that changes in living arrangement had significant associations with anxiety (AOR=1.127, 95% CI: 1.018-1.249) and depression (AOR =1.142, 95% CI: 1.027-1.269). Mediation models indicated that indirect, direct, and total effects of changes in living arrangement on mental disorders through COVID-symptoms; change in alcohol use; and social contact were significant. Indirect, direct, and total effects of changes in living arrangement on loneliness and depression through social support were significant. Moderation analysis indicated that moderation model 1 in AF Hayes Process procedure was accepted. CONCLUSION This study indicated that associations of changes in living arrangement with mental disorders could be mediated by COVID-symptoms, changes in alcohol use, social contact, and social support and moderated by social support during COVID-19 pandemic. The finding in this study might provide better understanding of the mechanisms by which social support might contribute to the resolving mental disorders.
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Affiliation(s)
- Ming Guan
- International Issues Center, Xuchang University, Xuchang, 461000, People’s Republic of China,Family Issues Center, Xuchang University, Xuchang, 461000, People’s Republic of China,School of Business, Xuchang University, Xuchang, 461000, People’s Republic of China,Correspondence: Ming Guan International Issues Center, Xuchang University, 88 Bayi Road, Xuchang, People’s Republic of ChinaTel +86 1340 9360 114 Email
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The Association Between Chronic Disease and Psychological Distress: An Australian Twin Study. Twin Res Hum Genet 2021; 23:322-329. [PMID: 33509319 DOI: 10.1017/thg.2020.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a commonly observed association between chronic disease and psychological distress, but many potential factors could confound this association. This study investigated the association using a powerful twin study design that can control for unmeasured confounders that are shared between twins, including genetic and environmental factors. We used twin-paired cross-sectional data from the Adult Health and Lifestyle Questionnaire collected by Twins Research Australia from 2014 to 2017. Linear regression models fitted using maximum likelihood estimations (MLE) were used to test the association between self-reported chronic disease status and psychological distress, measured by the Kessler Psychological Distress Scale (K6). When comparing between twin pairs, having any chronic disease was associated with a 1.29 increase in K6 (95% CI: 0.91, 1.66; p < .001). When comparing twins within a pair, having any chronic disease was associated with a 0.36 increase in K6 (95% CI: 0.002, 0.71; p = .049). This within-pair estimate is of most interest as comparing twins within a pair naturally controls for shared factors such as genes, age and shared lived experiences. Whereas the between-pair estimate does not. The weaker effect found within pairs tells us that genetic and environmental factors shared between twins confounds the relationship between chronic disease and psychological distress. This suggests that associations found in unrelated samples may show exaggerated estimates.
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Croghan A, Brunette A, Holm KE, Kozora E, Moser DJ, Wamboldt FS, Meschede K, Make BJ, Crapo JD, Weinberger HD, Moreau KL, Bowler RP, Hoth KF. Reduced Attention in Former Smokers with and without COPD. Int J Behav Med 2019; 26:600-607. [PMID: 31732904 PMCID: PMC7269072 DOI: 10.1007/s12529-019-09826-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention difficulties are often reported by patients with chronic obstructive pulmonary disease (COPD); however, limited research exists using objective tests designed specifically to measure attention in this population. This study aimed to (1) identify specific attention deficits in COPD and (2) determine which demographic/clinical characteristics are associated with reduced attention. METHODS Eighty-four former smokers (53 COPD, 31 no COPD) completed questionnaires, pulmonary function testing, and the Conner's Continuous Performance Test II (CPT-II). Participants with and without COPD were compared on CPT-II measures of inattention, impulsivity, and vigilance. CPT-II measures that differed significantly between the two groups were further examined using hierarchical regression modeling. Demographic/clinical characteristics were entered into models with attention as the dependent variable. RESULTS Participants with COPD performed worse than those without COPD on CPT measures of inattention and impulsivity (i.e., detectability [discrimination of target from non-target stimuli], perseverations [reaction time under 100 ms], omissions [target stimuli response failures], and commissions [responses to non-target stimuli]). More severe COPD (measured by greater airflow limitation) was associated with poorer ability to detect targets vs. foils and perseverative responding after adjusting for age and other covariates in the model. CONCLUSION Former smokers with COPD experience problems with attention that go beyond slowed processing speed, including aspects of inattention and impulsivity. Clinicians should be aware that greater airflow limitation and older age are associated with attention difficulties, as this may impact functioning.
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Affiliation(s)
- Anna Croghan
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Amanda Brunette
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - David J Moser
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | | | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center Aurora, Denver, CO, USA
| | - Russell P Bowler
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA.
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Shin JA, Kosiba JD, Traeger L, Greer JA, Temel JS, Pirl WF. Dyspnea and panic among patients with newly diagnosed non-small cell lung cancer. J Pain Symptom Manage 2014; 48:465-70. [PMID: 24766738 PMCID: PMC4163506 DOI: 10.1016/j.jpainsymman.2013.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/21/2013] [Accepted: 10/30/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT Among patients with lung cancer, dyspnea is associated with psychological distress, fatigue, and poor coping. Respiratory symptoms are also a common trigger for panic attacks in the general population. Minimal research has addressed the prevalence of panic disorder or the association of dyspnea with the risk of panic disorder in lung cancer. OBJECTIVES We explored the frequency of panic disorder symptoms and the association of dyspnea with the risk of panic disorder symptoms among patients with newly diagnosed non-small cell lung cancer. METHODS During 2006-2010, consecutive patients presenting for initial consultation at a thoracic oncology clinic completed a survey of current symptoms, including dyspnea and panic disorder symptoms. We evaluated the frequency of panic disorder symptoms. Logistic regression was used to test the association of dyspnea with the risk of panic disorder symptoms, adjusting for age, gender, disease stage, performance status, and major depression symptoms. RESULTS Among 624 patients (mean age=63.7; standard deviation=12.1; 52.6% female), 48.1% reported that breathing was at least somewhat difficult and 11.2% endorsed panic disorder symptoms. Dyspnea was independently associated with higher risk of panic disorder symptoms (odds ratio=2.19, 95% confidence interval=1.11-4.31, P=0.02). Younger age and major depression symptoms also were associated with higher risk (P<0.01). CONCLUSION Almost half of the patients with newly diagnosed non-small cell lung cancer reported dyspnea, and patients with dyspnea were more than twice as likely to endorse panic disorder symptoms relative to patients without dyspnea. Results highlight the need to differentiate panic disorder symptoms among patients who report dyspnea, particularly those who are younger or experiencing major depression symptoms.
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Affiliation(s)
- Jennifer A Shin
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Jesse D Kosiba
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William F Pirl
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Carter JS, Grant KE. A prospective comparison of moderating relationships among stressors, hopelessness, and internalizing symptoms in low-income urban youth with asthma. J Urban Health 2012; 89:598-613. [PMID: 22674462 PMCID: PMC3535141 DOI: 10.1007/s11524-011-9635-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
There are many risk factors associated with the development of internalizing symptoms in low-income urban youth, and youth with asthma appear to be at greater risk for experiencing stressors in multiple domains. The purpose of the current study was to examine stressors, hopelessness, and the interaction between them, as predictors of trajectories of anxious/depressed and withdrawn symptoms over a 4-year period of adolescence. Participating in the study were 53 youth from Chicago public schools, the majority of whom identified themselves as African American or Latino. Multi-level modeling was used to examine major life events, daily hassles, exposure to violence, poverty, and hopelessness as predictors of both types of symptoms. Major life events and exposure to violence predicted anxious/depressed symptoms but not withdrawn symptoms. Hopelessness predicted both types of symptoms and further interacted with major life events to predict both anxious/depressed and withdrawn symptoms. Hopelessness also moderated the effects of daily hassles on anxious/depressed symptoms and poverty on withdrawn symptoms. Results of this study provide insight into the psychosocial risk factors associated with the experience of asthma in urban adolescents.
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Goral A, Lipsitz JD, Muhsen K, Gross R. Depressive symptoms, risk factors and sleep in asthma: results from a national Israeli health survey. Gen Hosp Psychiatry 2012; 34:17-23. [PMID: 22018770 DOI: 10.1016/j.genhosppsych.2011.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 09/08/2011] [Accepted: 09/10/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to assess the association between asthma and depressive symptoms (DS) and to evaluate the relationship between DS and risk factors [smoking, physical inactivity, body mass index (BMI) and sleep duration] in asthmatic individuals. METHODS We analyzed data from the Israeli National Health Interview Survey, conducted among 9509 participants aged ≥21 years in 2003-2004. Data on sociodemographic factors, chronic respiratory disorders, DS and risk factors were obtained through telephone interviews. DS were measured using Short Form 36 mental health items. Analyses were performed using multivariate logistic regression models. RESULTS A total of 393 participants (4.2%) reported chronic asthma in the 12 months previous to the interview. Of those, 37.4% had DS, compared with 21.8% of nonasthmatic participants [odds ratio (OR), 1.84; 95% confidence interval (CI), 1.47-2.30; P<.001]. DS in asthmatic individuals were significantly associated with physical inactivity [adjusted OR (AOR), 2.01; 95% CI, 1.12-3.61; P=.02], with smoking (AOR 1.80; 95% CI, 1.04-3.12; P=.04) and with less sleep (AOR, 1.81; 95% CI, 1.03-3.19; P=.04). DS in asthmatic participants were not associated with BMI. CONCLUSIONS DS are common in asthmatic individuals and are significantly associated with physical inactivity, with smoking and with less hours of sleep. Such health-related risk factors may impact on the course of asthma and on overall health.
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Affiliation(s)
- Aviva Goral
- Unit of Mental Health Epidemiology and Psychosocial Aspects of Illness, Tel Hashomer 52621, Israel.
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Slattery MJ, Essex MJ. Specificity in the association of anxiety, depression, and atopic disorders in a community sample of adolescents. J Psychiatr Res 2011; 45:788-95. [PMID: 21111430 PMCID: PMC3079801 DOI: 10.1016/j.jpsychires.2010.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 11/02/2010] [Indexed: 02/02/2023]
Abstract
The specificity of relationships between anxiety and depressive symptoms, with each of the major atopic disorders of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) was systematically investigated within a single study sample. Participants included 367 adolescents who participated in a community, longitudinal study investigating risk factors for the development of psychiatric and physical health problems. Mental health symptoms were assessed at 7, 9, 11, and 13 years of age. Lifetime history of atopic disorders was assessed by parent report at age 13. Analysis of variance was used to investigate the specificity of the associations between anxiety and depression, and each of the atopic disorders. Results indicated that anxiety was associated with a lifetime history of atopic disorders as a group. The association was significantly strengthened when controlling for depression and externalizing psychiatric symptoms. Among atopic disorders, "pure" anxiety was associated with asthma and AR, and having both asthma and AR strengthened the association compared to having either disorder alone. The association of "pure" anxiety with asthma and AR is consistent with existing data suggesting a relationship between anxiety and respiratory disorders. Having both asthma and AR appeared to confer an additive "dose effect" on the strength of the association. The lack of an association with depression suggests that other factors may contribute to the differential expression of anxiety and depression with atopic disorders. Findings demonstrate the importance of assessing the impact of co-morbid psychiatric symptoms and atopic disorders within individual studies to determine the specificity of underlying relationships between these conditions.
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Affiliation(s)
- Marcia J. Slattery
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA,Corresponding author. . Tel.: +1 608 263 6100; fax +1 608 262 9246
| | - Marilyn J. Essex
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Buckner JD, Silgado J, Lewinsohn PM. Delineation of differential temporal relations between specific eating and anxiety disorders. J Psychiatr Res 2010; 44:781-7. [PMID: 20185151 PMCID: PMC2895008 DOI: 10.1016/j.jpsychires.2010.01.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 01/18/2010] [Accepted: 01/26/2010] [Indexed: 10/19/2022]
Abstract
This study examined the temporal sequencing of eating and anxiety disorders to delineate which anxiety disorders increase eating disorder risk and whether individuals with eating disorders are at greater risk for particular anxiety disorders. The sample was drawn from the Oregon Adolescent Depression Project. Temporal relations between specific eating and anxiety disorders were examined after controlling for relevant variables (e.g., mood disorders, other anxiety disorders) over 14 years. After excluding those with anorexia nervosa (AN) in adolescence (T1), OCD was the only T1 anxiety disorder to predict AN by age 30 (T4). No T1 anxiety disorder was associated with T4 bulimia nervosa (BN). Although T1 AN did not increase risk of any T4 anxiety disorder, T1 BN appeared to increase risk for social anxiety and panic disorders. Evidence that eating disorders may have differential relations to particular anxiety disorders could inform prevention and treatment efforts.
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Affiliation(s)
- Julia D. Buckner
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA,Corresponding Author: Telephone: 1-225-578-4096, Fax: 1-225-578-4125,
| | - Jose Silgado
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA
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Breathing and temporomandibular joint disease. J Bodyw Mov Ther 2010; 15:291-7. [PMID: 21665104 DOI: 10.1016/j.jbmt.2010.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 05/26/2010] [Accepted: 05/31/2010] [Indexed: 11/20/2022]
Abstract
Temporomandibular joint disease (TMD) refers to a collection of pain related conditions in the masticatory muscles and temporomandibular joint. Occlusal factors have been implicated in TMD pathogenesis, yet despite decades of research no causal relationship between occlusion and TMD has been found. The significance of psychosocial factors in both the assessment and the long-term management of patients with TMD is receiving increased recognition. The teaching of relaxation skills and coping strategies are effective, proven TMD therapies. The role of breathing re-education in temporomandibular joint (TMJ) disorders is rarely mentioned. A focus on breathing patterns and their disorders potentially explains how biomechanical factors associated with psychosocial influences might lead to pathophysiological changes within the TMJ as well as in the associated muscles. Attention to factors such as breathing and postural rehabilitation provides health professionals valuable, additional tools to help care for patients with TMD.
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Ghandour RM, Kogan MD, Blumberg SJ, Perry DF. Prevalence and correlates of internalizing mental health symptoms among CSHCN. Pediatrics 2010; 125:e269-77. [PMID: 20083529 DOI: 10.1542/peds.2009-0622] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study provides nationally representative prevalence estimates of internalizing mental health symptoms among children with special health care needs (CSHCN) and identifies significant covariates of these symptoms by using multivariate regression. Internalizing symptoms include feeling anxious and depressed. METHODS Data were obtained from the 2005-2006 National Survey of Children with Special Health Care Needs, a nationally representative, parent-reported, cross-sectional survey of 40 465 CSHCN. The presence of internalizing mental health symptoms was assessed by using 2 binary items capturing whether a child had or experienced difficulty with depression, anxiety, disordered eating, or other emotional problems. The odds of experiencing internalizing symptoms were assessed by using multivariate regression, controlling for sociodemographic, health-related, and burden-related covariates. RESULTS A total of 31.9% of CSHCN 3 to 17 years of age experienced internalizing mental health symptoms. Multivariate logistic regression showed internalizing symptoms to be strongly associated with female gender, older age, and frequent activity limitations, as well as externalizing mental health symptoms and conditions with behavioral components. Children with behavior problems had 6 times the odds of internalizing symptoms (adjusted odds ratio [aOR]: 5.95 [95% confidence interval [CI]: 5.30-6.69]), whereas children with autism spectrum disorder had 3 times the odds (aOR: 3.00 [95% CI: 2.39-3.77]). Increased odds of symptoms also were associated with frequent headaches (aOR: 1.76 [95% CI: 1.45-2.13]) and chronic pain (aOR: 1.46 [95% CI: 1.22-1.75]). Odds of symptoms were greater for children living in households that experienced employment changes or financial burdens resulting from the children's needs. CONCLUSIONS Internalizing mental health symptoms are common among CSHCN. Findings may help caregivers focus screening and prevention efforts for high-risk groups in this heterogeneous population.
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Affiliation(s)
- Reem M Ghandour
- DrPH, MPA, Maternal and Child Health Bureau, Office of Data and Program Development, Parklawn Building, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA.
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Allergic rhinitis induces anxiety-like behavior and altered social interaction in rodents. Brain Behav Immun 2009; 23:784-93. [PMID: 19268702 PMCID: PMC2743459 DOI: 10.1016/j.bbi.2009.02.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 02/24/2009] [Accepted: 02/24/2009] [Indexed: 12/29/2022] Open
Abstract
Epidemiological and clinical studies report higher incidences of anxiety and increased emotional reactivity in individuals suffering from respiratory allergies. To evaluate if respiratory allergies are capable of promoting anxiety-like behavior in rodents, we used models of allergic rhinitis and behavioral evaluations followed by assessment of mRNA for cytokines in relevant brain regions. Mice and rats were sensitized to ovoalbumin or pollen, respectively, following standard sensitization and challenge protocols. After challenge, the animals were evaluated in the open field, elevated plus-maze and resident-intruder tests. Cytokines and corticotropin-releasing factor expression were assessed in several brain regions by real-time RT-PCR and plasma corticosterone concentrations by radioimmunoassay. Mice and rats sensitized and exposed to allergen showed increased anxiety-like behavior and reduced social interaction without any overt behavioral signs of sickness. T-helper type 2 (T(H)2) cytokines were induced in both rats and mice in the olfactory bulbs and prefrontal cortex and remained unchanged in the temporal cortex and hypothalamus. The same results were found for CRF mRNA expression. No differences were observed in corticosterone concentrations 1h after the last behavioral test. These results show that sensitization and challenge with allergens induce anxiety across rodent species and that these effects were paralleled by an increased expression of T(H)2 cytokines and CRF in the prefrontal cortex. These studies provide experimental evidence that sensitized rodents experience neuroimmune-mediated anxiety and reduced social interaction associated with allergic rhinitis.
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Goodwin RD. Intergenerational transmission of chronic physical disease via chronic mental disorders: the potential role of addictive behaviors. Addict Behav 2008; 33:1432-1440. [PMID: 18657913 PMCID: PMC3340905 DOI: 10.1016/j.addbeh.2008.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 05/22/2008] [Accepted: 05/28/2008] [Indexed: 10/22/2022]
Abstract
There has been growing evidence of a link between chronic respiratory diseases, asthma in particular, and mental disorders among youth. The mechanism for this link remains unknown. Several studies have empirically addressed the question of this pathway, and accumulating results may shed new light on the nature of this association. The goal of the current paper is to provide an integrative summary of the literature to date and to present a new interdisciplinary hypothesis for one possible mechanism explaining the link between asthma and anxiety/depression among youth. This hypothesis posits that comorbid anxiety/depression and nicotine dependence among adults, may be one pathway leading to the comorbidity of asthma and anxiety/depression among youth. We propose this mechanism operates via exposure to environmental tobacco smoke and/or prenatal tobacco use, which confers an increased risk for asthma, and parental anxiety/depression which confers increased risk of anxiety/depression among offspring via familial transmission. We predict that further testing of this hypothesis will help to reveal the largely neglected problem of nicotine dependence especially among women - and the far-reaching impact of this addiction on the health of children.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Rm 1706, New York, New York 10032, United States.
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Aarons GA, Monn AR, Leslie LK, Garland A, Lugo L, Hough RL, Brown SA. Association between mental and physical health problems in high-risk adolescents: a longitudinal study. J Adolesc Health 2008; 43:260-7. [PMID: 18710681 PMCID: PMC2768339 DOI: 10.1016/j.jadohealth.2008.01.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 11/16/2007] [Accepted: 01/25/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE This longitudinal study examined the relationship between mental and physical health problems in a sample of high-risk youth served in the public sector. METHODS Participants included youth aged 9-18 years at baseline, randomly sampled from one of five public service sectors in San Diego County, California, and youths may have been active to more than one sector. Diagnoses for mood, anxiety, and disruptive disorders based on structured diagnostic interviews were determined at baseline and data regarding health-related problems were collected 2 years post-baseline. RESULTS Mood and disruptive behavior disorders were related to cumulative health problem incidence, as well as aggregate measures of health problems and severe health problems. In addition mood disorder diagnosis was associated with higher rates of infectious diseases, respiratory problems, and weight problems. Disruptive disorder diagnosis was related to higher rates of risk behavior-related health problems. CONCLUSIONS The present work extends the research on the relationship between mental and physical health problems to adolescents served in the public sector, who are at especially high risk for behavioral and emotional problems. Potential mechanisms by which mental health problems may impact health problems are discussed. We suggest the development of effective interagency cooperation between medical and mental health systems to improve the care of youth with comorbid mental and physical disorders.
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Affiliation(s)
- Gregory A. Aarons
- Child & Adolescent Services Research Center, Rady Children's Hospital, San Diego,Department of Psychiatry; University of California, San Diego
| | - Amy R. Monn
- Child & Adolescent Services Research Center, Rady Children's Hospital, San Diego,University of Minnesota
| | - Laurel K. Leslie
- Child & Adolescent Services Research Center, Rady Children's Hospital, San Diego,Center on Child and Family Outcomes; Tufts University
| | - Ann Garland
- Child & Adolescent Services Research Center, Rady Children's Hospital, San Diego,Department of Psychiatry; University of California, San Diego
| | - Lindsay Lugo
- Child & Adolescent Services Research Center, Rady Children's Hospital, San Diego
| | - Richard L. Hough
- Child & Adolescent Services Research Center, Rady Children's Hospital, San Diego,Department of Family and Community Medicine and the Department of Psychiatry; University of New Mexico, Albuquerque
| | - Sandra A. Brown
- Child & Adolescent Services Research Center, Rady Children's Hospital, San Diego,Department of Psychiatry; University of California, San Diego
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Marshall EC, Zvolensky MJ, Sachs-Ericsson N, Schmidt NB, Bernstein A. Panic attacks and physical health problems in a representative sample: singular and interactive associations with psychological problems, and interpersonal and physical disability. J Anxiety Disord 2008; 22:78-87. [PMID: 17275252 DOI: 10.1016/j.janxdis.2006.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 09/27/2006] [Accepted: 10/10/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Panic attacks may be a risk marker for a variety of psychological problems and are associated with increased impairment in a host of domains. However, previous studies have not investigated the role of physical illness in the panic attack-disability relations, which is striking due to findings that physical illness is linked to both panic attacks and disability. The present investigation examined the singular and interactive effects of panic attacks and physical illness in relation to psychological, interpersonal, and physical types of impairment. METHOD Adult participants (4,745) recruited from the statewide Colorado Social Health Survey were administered the diagnostic interview schedule. RESULTS As predicted, main effects of panic attacks and physical illness were significantly related to psychiatric comorbidity, depressive symptoms, interpersonal functioning, physical functioning, and perceived general health (p<.05 for all associations). Also as predicted, interaction of panic attacks and physical illness was significantly related to all of the outcome variables (p<.05 for all associations). CONCLUSIONS These findings suggest that individuals with both panic attacks and physical illness experience elevated disability across a variety of dimensions.
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Affiliation(s)
- Erin C Marshall
- University of Vermont, Department of Psychology, United States
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16
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Buckner JD, Schmidt NB, Lang AR, Small JW, Schlauch RC, Lewinsohn PM. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res 2008; 42:230-9. [PMID: 17320907 PMCID: PMC2254175 DOI: 10.1016/j.jpsychires.2007.01.002] [Citation(s) in RCA: 328] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 01/03/2007] [Accepted: 01/05/2007] [Indexed: 11/24/2022]
Abstract
Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUDs) and cannabis dependence. However, the temporal sequencing of these disorders has not been extensively studied to determine whether SAD serves as a specific risk factor for problematic substance use. The present study examined these relationships after controlling for theoretically-relevant variables (e.g., gender, other Axis I pathology) in a longitudinal cohort over approximately 14 years. The sample was drawn from participants in the Oregon Adolescent Depression Project. After excluding those with substance use disorders at baseline, SAD at study entry was associated with 6.5 greater odds of cannabis dependence (but not abuse) and 4.5 greater odds of alcohol dependence (but not abuse) at follow-up after controlling for relevant variables (e.g., gender, depression, conduct disorder). The relationship between SAD and alcohol and cannabis dependence remained even after controlling for other anxiety disorders. Other anxiety disorders and mood disorders were not associated with subsequent cannabis or alcohol use disorder after controlling for relevant variables. Among the internalizing disorders, SAD appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Florida State University, Tallahassee, FL 32306-1270, USA
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17
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Goodwin RD, Keyes K, Simuro N. Mental disorders and nicotine dependence among pregnant women in the United States. Obstet Gynecol 2007; 109:875-83. [PMID: 17400849 DOI: 10.1097/01.aog.0000255979.62280.e6] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between mental disorders and cigarette use and nicotine dependence among pregnant women in the United States. METHODS A face-to-face general population survey was conducted on participants in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. One thousand five hundred sixteen women reporting a pregnancy in the past year were captured. Primary outcomes were seven Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined mood and anxiety disorders and eight personality disorders, which were measured with the Alcohol Use Disorder and Associated Disabilities Interview Schedule. RESULTS Among pregnant women, 21.7% reported cigarette use and 12.4% met the criteria for nicotine dependence. Among pregnant women with cigarette use, 45.1% met criteria for at least one mental disorder, and among those with nicotine dependence, 57.5% met criteria for at least one other mental disorder. After adjusting for demographics and comorbidity, nicotine dependence during pregnancy significantly predicted any mental disorder (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.1-5.1), any mood disorder (OR 2.5, 95% CI 1.5-4.0), major depression (OR 2.07, 95% CI 1.3-3.4), dysthymia (OR 6.2, 95% CI 2.9-13.1), and panic disorder (OR 3.1, 95% CI 1.6-6.1) in the past year. No significant associations were found between nondependent cigarette use and mental disorders. CONCLUSION Our results suggest an association between mental disorders and nicotine dependence among pregnant women in the United States. This association has far-reaching implications for both the mental and physical health of women and potentially for their children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
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18
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Waxmonsky J, Wood BL, Stern T, Ballow M, Lillis K, Cramer-Benjamin D, Mador J, Miller BD. Association of depressive symptoms and disease activity in children with asthma: methodological and clinical implications. J Am Acad Child Adolesc Psychiatry 2006; 45:945-954. [PMID: 16865037 DOI: 10.1097/01.chi.0000222789.34229.21] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was designed to assess the prevalence of depressive symptoms in children with asthma and the association between depression and asthma activity. METHOD Children ages 7 to 17 (n = 129) were recruited from a hospital emergency department after presenting for asthma symptoms. The majority of subjects were from disadvantaged, inner city families. Subjects' asthma disease activity was assessed using the revised National Heart, Lung, and Blood Institute guidelines, and subjects' emotional status was assessed by a combination of self-, parent-, and clinician-reported measures. Parental emotional status was assessed by self-report. RESULTS Depressive symptoms within the clinical range were reported in 26% of subjects and 43% of mothers, although symptom severity varied across scales. Self-reported depressive symptoms were more strongly correlated with asthma activity (r = 0.25) than clinician-reported (r = 0.14) or parent-reported symptoms (r = 0.12/0.18). Depressive symptoms in parents were correlated with child's depression scores but not with their asthma activity. CONCLUSIONS Depressive symptoms were common and associated with asthma activity in this inner city population of asthmatic children. Self-reported depressive symptoms were more strongly associated with child's asthma activity than either parental depression or parental/clinician ratings of the child's depression.
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Affiliation(s)
- James Waxmonsky
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo..
| | - Beatrice L Wood
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Trudy Stern
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Mark Ballow
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Kathleen Lillis
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Darci Cramer-Benjamin
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Jeffrey Mador
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Bruce D Miller
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
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19
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van Beek N, Schruers KRJ, Griez EJL. Prevalence of respiratory disorders in first-degree relatives of panic disorder patients. J Affect Disord 2005; 87:337-40. [PMID: 15979152 DOI: 10.1016/j.jad.2005.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Revised: 05/09/2005] [Accepted: 05/12/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Panic Disorder (PD) patients often report a history of respiratory pathology, such as asthma. It is known that both PD and respiratory disorders, like asthma, run in families. A common diathesis for PD and some respiratory disorders may be present both in PD patients and their first-degree relatives. We examined whether the lifetime prevalence of respiratory disorders is higher in first-degree relatives of PD patients than in first-degree relatives of patients with other anxiety disorders. METHODS The lifetime history of respiratory pathology was assessed in 379 first-degree relatives of patients with an anxiety disorder by means of a questionnaire. RESULTS We found the first-degree relatives of PD patients to report more chronic obstructive pulmonary diseases (COPD) in general (24.8%) and asthma (10.5%) in particular than the comparison group (13.2% and 3.3%, respectively). LIMITATIONS Our data rely on retrospective self-reports. CONCLUSIONS Our findings are consistent with and extend previous studies suggesting a specific association between COPD, asthma in particular, and PD.
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Affiliation(s)
- Nicole van Beek
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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