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Nakajima S, Kaneko Y, Fujii N, Kizuki J, Saitoh K, Nagao K, Kawamura A, Yoshiike T, Kadotani H, Yamada N, Uchiyama M, Kuriyama K, Suzuki M. Transdiagnostic association between subjective insomnia and depressive symptoms in major psychiatric disorders. Front Psychiatry 2023; 14:1114945. [PMID: 37168089 PMCID: PMC10165079 DOI: 10.3389/fpsyt.2023.1114945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
In psychiatric disorders, comorbid depressive symptoms are associated with clinically important issues such as reduced quality of life, a poor prognosis, and increased suicide risk. Previous studies have found a close relationship between insomnia and depressive symptoms in major depressive disorder (MDD), and that actively improving insomnia heightens the improvement of depressive symptoms. This study aimed to investigate whether the association between insomnia and depressive symptoms is also found in other psychiatric disorders besides MDD. The subjects were 144 patients with MDD (n = 71), schizophrenia (n = 25), bipolar disorder (n = 22), or anxiety disorders (n = 26). Sleep status was assessed subjectively and objectively using the Athens Insomnia Scale (AIS) and sleep electroencephalography (EEG), respectively. Sleep EEG was performed using a portable EEG device. Depressive symptoms were assessed using the Beck Depression Inventory. Subjective insomnia, as defined by the AIS, was associated with depressive symptoms in all disorders. Moreover, in schizophrenia, a relation between depressive symptoms and insomnia was also found by objective sleep assessment methods using sleep EEG. Our findings suggest that the association between subjective insomnia and depressive symptoms is a transdiagnostic feature in major psychiatric disorders. Further studies are needed to clarify whether therapeutic interventions for comorbid insomnia can improve depressive symptoms in major psychiatric disorders, similar to MDD.
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Affiliation(s)
- Suguru Nakajima
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Kaneko
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Nobukuni Fujii
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Jun Kizuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Kaori Saitoh
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kentaro Nagao
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Aoi Kawamura
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Takuya Yoshiike
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | | | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
- Tokyo Adachi Hospital, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
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Anxiety and Depression Signs Among Adolescents in 26 Low- and Middle-Income Countries: Prevalence and Association With Functional Difficulties. J Adolesc Health 2023; 72:S79-S87. [PMID: 36528385 PMCID: PMC9935490 DOI: 10.1016/j.jadohealth.2022.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 02/02/2022] [Accepted: 03/28/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study is to describe the occurrence of signs of depression and anxiety among adolescents from 26 low- and middle-income countries and explore the extent to which these are associated with difficulties across other functional domains. METHODS We analyzed randomly selected, nationally representative data from 26 countries with a total sample size of 123,975 adolescents aged 10-17 years. Data on functional difficulties, including signs of depression and anxiety, were collected by the Child Functioning Module, an instrument validated to identify the population of children with disabilities through household surveys. We estimated percentages and 95% confidence intervals of adolescents with difficulties across 11 domains of functioning, and of signs of depression and/or anxiety. We used multinomial regressions to estimate the association between difficulties in the different domains and having signs of depression only, signs of anxiety only, and signs of both depression and anxiety, relative to not presenting signs of depression or anxiety. RESULTS In total, 5.5% of adolescents were reported to have had signs of anxiety, 3.1% signs of depression, and 2.3% co-occurring signs of anxiety and depression. Compared to adolescents without functional difficulties, those with difficulties in one or more domains were three times more likely to have signs of depression and anxiety. The likelihood of presenting signs of depression only or signs of both depression and anxiety was significantly higher across all domains, and the highest among adolescent with difficulties to self-care and communicating. The likelihood of presenting signs of anxiety only was significantly higher across all domains except seeing and hearing, and the highest among adolescent with difficulties communicating and accepting changes. DISCUSSION Adolescents with functional difficulties in all domains analyzed, across different contexts, are more likely to experience depression and anxiety signs than those without such difficulties. Increasing the availability of population-level data on adolescent functional difficulties, including those related to depression and anxiety, is important in promoting inclusivity, participation, and the right of children to equal opportunities.
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The Impact of Emotion Regulation on the Relationship Between Momentary Negative Affect and End-of-Day Worry and Rumination. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kuzminskaite E, Vinkers CH, Milaneschi Y, Giltay EJ, Penninx BWJH. Childhood trauma and its impact on depressive and anxiety symptomatology in adulthood: A 6-year longitudinal study. J Affect Disord 2022; 312:322-330. [PMID: 35760192 DOI: 10.1016/j.jad.2022.06.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/27/2022] [Accepted: 06/20/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Childhood trauma (CT) is a risk factor for depressive and anxiety disorders. However, whether CT is more strongly linked to specific clinical features of these disorders remains inconclusive. The current study comprehensively examined cross-sectional and longitudinal associations between CT and depressive/anxiety symptomatology in a large adult sample with current and remitted depressive and/or anxiety disorders. METHODS Baseline (n = 1803), 2-year (n = 1735), 4-year (n = 1585), and 6-year follow-up (n = 1475) data from the Netherlands Study of Depression and Anxiety were used. CT (emotional neglect, emotional/physical/sexual abuse) was assessed at baseline, while depressive/anxiety symptomatology with relevant dimensions (e.g., mood/cognitive, melancholic, general distress, and somatic depression) was assessed at each wave using self-reported questionnaires. Linear regressions and linear mixed models determined cross-sectional and longitudinal associations. RESULTS Individuals with CT, especially, severe CT, compared to those without CT, had significantly higher scores in overall depressive symptomatology (Cohen's d = 0.674), mood/cognitive depression (d = 0.691), melancholic depression (d = 0.587), general distress (d = 0.561), and somatic depression severity (d = 0.549). Differences were lower, but still highly significant for anxiety (d = 0.418), worry (d = 0.362), and fear/phobic symptomatology (d = 0.359). Effects were consistent across CT types and maintained over six years. LIMITATIONS Retrospectively-reported CT. CONCLUSIONS CT is a risk factor for depressive and anxiety symptomatology across all dimensions and enduring over multiple years. Screening for CT is essential to identify individuals at risk for more severe and chronic manifestations of affective disorders.
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Affiliation(s)
- Erika Kuzminskaite
- Amsterdam UMC location Vrije University Amsterdam, Department of Psychiatry, Amsterdam Public Health (Mental Health program) and Amsterdam Neuroscience (Mood, Anxiety, Psychosis, Stress & Sleep program) research institutes, Amsterdam, the Netherlands.
| | - Christiaan H Vinkers
- Amsterdam UMC location Vrije University Amsterdam, Department of Psychiatry, Amsterdam Public Health (Mental Health program) and Amsterdam Neuroscience (Mood, Anxiety, Psychosis, Stress & Sleep program) research institutes, Amsterdam, the Netherlands; Amsterdam UMC location Vrije University Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, the Netherlands.
| | - Yuri Milaneschi
- Amsterdam UMC location Vrije University Amsterdam, Department of Psychiatry, Amsterdam Public Health (Mental Health program) and Amsterdam Neuroscience (Mood, Anxiety, Psychosis, Stress & Sleep program) research institutes, Amsterdam, the Netherlands.
| | - Erik J Giltay
- Leiden University Medical Center, Department of Psychiatry, Leiden, the Netherlands.
| | - Brenda W J H Penninx
- Amsterdam UMC location Vrije University Amsterdam, Department of Psychiatry, Amsterdam Public Health (Mental Health program) and Amsterdam Neuroscience (Mood, Anxiety, Psychosis, Stress & Sleep program) research institutes, Amsterdam, the Netherlands.
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Singham T, Saunders R, Brooker H, Creese B, Aarsland D, Hampshire A, Ballard C, Corbett A, Desai R, Stott J. Are subtypes of affective symptoms differentially associated with change in cognition over time: A latent class analysis. J Affect Disord 2022; 309:437-445. [PMID: 35490883 DOI: 10.1016/j.jad.2022.04.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/14/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the absence of disease-modifying treatments, identifying potential psychosocial risk factors for dementia is paramount. Depression and anxiety have been identified as potential risk factors. Studies however have yielded mixed findings, lending possibility to the fact that potential constellations of co-occurring depression and anxiety symptoms may better explain the link between affective symptoms and cognitive decline. METHODS Data from participants (aged 50 and above) of the PROTECT study was used. Latent Class Analysis (LCA) was conducted on 21,684 participants with baseline anxiety and depression measures. Multiple linear regressions models, using a subset of these participants (N = 6136) who had complete cognition data at baseline and at 2-year follow-up, were conducted to assess for associations between class membership and longitudinal changes in cognition. RESULTS The LCA identified a 5-class solution: "No Symptoms", "Sleep", "Sleep and Worry", "Sleep and Anhedonia", and "Co-morbid Depression and Anxiety". Class membership was significantly associated with longitudinal change in cognition. Furthermore, this association differed across different cognitive measures. LIMITATIONS Limitations included significant attrition and a generally healthy sample which may impact generalisability. CONCLUSIONS Substantial heterogeneity in affective symptoms could explain previous inconsistent findings concerning the association between affective symptoms and cognition. Clinicians should not focus solely on total symptom scores on a single affective domain, but instead on the presence and patterns of symptoms (even if sub-clinical) on measures across multiple affective domains. Identifying particular subgroups that are at greater risk of poor cognitive outcomes may support targeted prevention work.
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Affiliation(s)
- Timothy Singham
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK; Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, UK
| | - Dag Aarsland
- Department of Old age Psychiatry, IoPPN, Kings College London, UK; Centre for Age-related research, Stavanger University Hospital, Stavanger, Norway
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, UK
| | - Roopal Desai
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
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A Patient Stratification Approach to Identifying the Likelihood of Continued Chronic Depression and Relapse Following Treatment for Depression. J Pers Med 2021; 11:jpm11121295. [PMID: 34945767 PMCID: PMC8703621 DOI: 10.3390/jpm11121295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Subgrouping methods have the potential to support treatment decision making for patients with depression. Such approaches have not been used to study the continued course of depression or likelihood of relapse following treatment. Method: Data from individual participants of seven randomised controlled trials were analysed. Latent profile analysis was used to identify subgroups based on baseline characteristics. Associations between profiles and odds of both continued chronic depression and relapse up to one year post-treatment were explored. Differences in outcomes were investigated within profiles for those treated with antidepressants, psychological therapy, and usual care. Results: Seven profiles were identified; profiles with higher symptom severity and long durations of both anxiety and depression at baseline were at higher risk of relapse and of chronic depression. Members of profile five (likely long durations of depression and anxiety, moderately-severe symptoms, and past antidepressant use) appeared to have better outcomes with psychological therapies: antidepressants vs. psychological therapies (OR (95% CI) for relapse = 2.92 (1.24–6.87), chronic course = 2.27 (1.27–4.06)) and usual care vs. psychological therapies (relapse = 2.51 (1.16–5.40), chronic course = 1.98 (1.16–3.37)). Conclusions: Profiles at greater risk of poor outcomes could benefit from more intensive treatment and frequent monitoring. Patients in profile five may benefit more from psychological therapies than other treatments.
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Peng Y, Knotts JD, Taylor CT, Craske MG, Stein MB, Bookheimer S, Young KS, Simmons AN, Yeh HW, Ruiz J, Paulus MP. Failure to Identify Robust Latent Variables of Positive or Negative Valence Processing Across Units of Analysis. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:518-526. [PMID: 33676919 PMCID: PMC8113074 DOI: 10.1016/j.bpsc.2020.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/10/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The heterogeneous nature of mood and anxiety disorders highlights a need for dimensionally based descriptions of psychopathology that inform better classification and treatment approaches. Following the Research Domain Criteria approach, this investigation sought to derive constructs assessing positive and negative valence domains across multiple units of analysis. METHODS Adults with clinically impairing mood and anxiety symptoms (N = 225) completed comprehensive assessments across several units of analysis. Self-report assessments included nine questionnaires that assess mood and anxiety symptoms and traits reflecting the negative and positive valence systems. Behavioral assessments included emotional reactivity and distress tolerance tasks, during which skin conductance and heart rate were measured. Neuroimaging assessments included fear conditioning and a reward processing task. The latent variable structure underlying these measures was explored using sparse Bayesian group factor analysis. RESULTS Group factor analysis identified 11 latent variables explaining 31.2% of the variance across tasks, none of which loaded across units of analysis or tasks. Instead, variance was best explained by individual latent variables for each unit of analysis within each task. Post hoc analyses 1) showed associations with small effect sizes between latent variables that were derived separately from functional magnetic resonance imaging and self-report data and 2) showed that some latent variables are not directly related to individual valence system constructs. CONCLUSIONS The lack of latent structure across units of analysis highlights challenges of the Research Domain Criteria approach and suggests that while dimensional analyses work well to reveal within-task features, more targeted approaches are needed to reveal latent cross-modal relationships that could illuminate psychopathology.
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Affiliation(s)
- Yujia Peng
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Jeffrey D Knotts
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.
| | - Charles T Taylor
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
| | - Susan Bookheimer
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Katherine S Young
- Social, Genetic and Developmental Psychiatry Centre, King's College, London, United Kingdom
| | - Alan N Simmons
- Department of Psychiatry, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
| | - Hung-Wen Yeh
- Health Services & Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri
| | - Julian Ruiz
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Martin P Paulus
- Department of Psychiatry, University of California San Diego, La Jolla, California; Laureate Institute for Brain Research, Tulsa, Oklahoma
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Macedo I, Pasion R, Barbosa F, Ferreira-Santos F. A dimensional approach to the neuronal correlates of anxiety, depression, and perfectionism: A transdiagnostic dissociation of error-related brain activity. Behav Brain Res 2021; 408:113271. [PMID: 33811953 DOI: 10.1016/j.bbr.2021.113271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
Transdiagnostic approaches such as the Research Domain Criteria (RDoC) highlight the importance of addressing psychopathological constructs dimensionally, since comorbidity and heterogeneity represent prevalent issues in the available categorical diagnosis. The current study analyses distinct internalizing dimensions of depression and anxiety, and the transdiagnostic feature of perfectionism on the modulation of error-related brain activity (i.e., ERN). A sample of 125 participants completed self-reported measures of anxiety, depression, and perfectionism, and performed two versions of the Flanker Task (performance monitoring and sustained-threat) during an EEG recording. In the broad internalizing dimensions, anxiety predicted increased ERN amplitudes when controlling for the shared variance with depression and perfectionism. The narrower dimensions of anxiety and depression revealed a dissociative effect: cognitive anxiety explained blunted ERN amplitudes, while the physiological signs of anxiety and depression predicted increased amplitudes. For perfectionism, no significant results were found. Exploratory analyses further revealed that the Error Positivity component (Pe) was reduced in anxiety and physiological depression. We conclude that anxiety features emerge as the main explanation for the altered patterns of error monitoring in a transdiagnostic sample. Since anxiety is expected to co-occur with other disorders, the current findings suggest that altered patterns of error monitoring will be a transdiagnostic feature of various internalizing and anxiety-related disorders.
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Affiliation(s)
- Inês Macedo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - Rita Pasion
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Portugal.
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - Fernando Ferreira-Santos
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Portugal
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The importance of identifying functional Val158Met polymorphism in catechol-O- Methyltransferase when assessing MRI-based volumetric measurements in major depressive disorder. Brain Imaging Behav 2020; 14:2762-2770. [PMID: 31898087 DOI: 10.1007/s11682-019-00225-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many studies have shown volumetric differences in the hippocampus between COMT gene polymorphisms and other studies have shown differences between depressed patients and controls; yet, few studies have been completed to identify the volumetric differences when taking both factors into consideration. Using voxel-based morphology (VBM) we investigated, in major depressive disorder (MDD) patients and healthy controls, the relationship between COMT gene polymorphism and volumetric abnormalities. Data from 60 MDD patients and 25 healthy controls were included in this study. Volumetric measurements and genotyping of COMTval158met polymorphism were conducted to determine its impact on gray matter volume (GMV) in the hippocampus and amygdala using a Met dominant model (Val/Val vs Met/Val & Met/Met). In the analysis, a significant difference in the right hippocampus (p = 0.015), right amygdala (p = 0.003) and entire amygdala (p = 0.019) was found between the interaction of diagnosis and genotype after MRI scanner, age and sex correction. Healthy controls (HC) with the Met dominant genotype exhibited a larger right hippocampal, right amygdalar and entire amydgalar volume than MDD patients with the Met dominant genotype. Conversely, HC with the Val/Val genotype displayed a lower right hippocampal, right amygdalar and entire amygdalar volume than their MDD counterparts. This study shows that COMT polymorphism and depression may have a confounding effect on neuroimaging studies.
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Saunders R, Buckman JEJ, Pilling S. Latent variable mixture modelling and individual treatment prediction. Behav Res Ther 2020; 124:103505. [PMID: 31841709 PMCID: PMC7417810 DOI: 10.1016/j.brat.2019.103505] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 01/10/2023]
Abstract
Understanding which groups of patients are more or less likely to benefit from specific treatments has important implications for healthcare. Many personalised medicine approaches in mental health employ variable-centred approaches to predicting treatment response, yet person-centred approaches that identify clinical profiles of patients can provide information on the likelihood of a range of important outcomes. In this paper, we discuss the use of latent variable mixture modelling and demonstrate its use in the application of a patient profiling algorithm using routinely collected patient data to predict outcomes from psychological treatments. This validation study analysed data from two services, which included n = 44,905 patients entering treatment. There were different patterns of reliable recovery, improvement and clinical deterioration from therapy, across the eight profiles which were consistent over time. Outcomes varied between different types of therapy within the profiles: there were significantly higher odds of reliable recovery with High Intensity therapies in two profiles (32.5% of patients) and of reliable improvement in three profiles (32.2% of patients) compared with Low Intensity treatments. In three profiles (37.4% of patients) reliable recovery was significantly more likely if patients had CBT vs Counselling. The developments and potential application of latent variable mixture approaches are further discussed.
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Affiliation(s)
- Rob Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK
| | - Joshua E J Buckman
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 7HB, UK.
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Haller J, Krecsak L, Zámbori J. Double-blind placebo controlled trial of the anxiolytic effects of a standardized Echinacea extract. Phytother Res 2019; 34:660-668. [PMID: 31876052 DOI: 10.1002/ptr.6558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/30/2019] [Accepted: 11/08/2019] [Indexed: 01/12/2023]
Abstract
Earlier studies suggested that specific Echinacea preparations might decrease anxiety. To further study the issue, we performed a double blind, placebo controlled trial with a standardized Echinacea angustifolia root extract. Participants were volunteers scoring above 45 points on the state or on the trait subscale of the State Trait Anxiety Inventory (STAI). They were treated with 40 mg Echinacea or with placebo tablets twice daily for 7 days followed by a 3 week-long washout period. Participants were also administered the Beck Depression Inventory (BDI) and the Perceived Stress Scale (PSS). In the Echinacea group, state anxiety scores decreased by approximately 11 points by the end of the treatment period, whereas the decrease was around 3-points in the placebo group (p< 0.01). The effect maintained over the washout period. The difference from placebo was significant from the 7th day of treatment throughout. Changes were less robust with trait anxiety scores, but the preparation performed better than placebo in patients with high baseline anxiety. Neither BDI nor PSS scores were affected by the treatments. Adverse effects were rare and mild, and all were observed in the placebo group. These findings suggest that particular Echinacea preparations have significant beneficial effects on anxiety in humans.
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Affiliation(s)
- József Haller
- Institute of Experimental Medicine, Budapest, Hungary.,University of Public Service, Budapest, Hungary
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12
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Molecular programs underlying differences in the expression of mood disorders in males and females. Brain Res 2019; 1719:89-103. [DOI: 10.1016/j.brainres.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/20/2019] [Accepted: 05/13/2019] [Indexed: 01/13/2023]
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Esposito G, Azhari A, Borelli JL. Gene × Environment Interaction in Developmental Disorders: Where Do We Stand and What's Next? Front Psychol 2018; 9:2036. [PMID: 30416467 PMCID: PMC6212589 DOI: 10.3389/fpsyg.2018.02036] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/03/2018] [Indexed: 02/01/2023] Open
Abstract
Although the field of psychiatry has witnessed the proliferation of studies on Gene × Environment (G×E) interactions, still limited is the knowledge we possess of G×E interactions regarding developmental disorders. In this perspective paper, we discuss why G×E interaction studies are needed to broaden our knowledge of developmental disorders. We also discuss the different roles of hazardous versus self-generated environmental factors and how these types of factors may differentially engage with an individual's genetic background in predicting a resulting phenotype. Then, we present examplar studies that highlight the role of G×E in predicting atypical developmental trajectories as well as provide insight regarding treatment outcomes. Supported by these examples, we explore the need to move beyond merely examining statistical interactions between genes and the environment, and the motivation to investigate specific genetic susceptibility and environmental contexts that drive developmental disorders. We propose that further parsing of genetic and environmental components is required to fully understand the unique contribution of each factor to the etiology of developmental disorders. Finally, with a greater appreciation of the complexities of G×E interaction, this discussion will converge upon the potential implications for clinical and translational research.
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Affiliation(s)
- Gianluca Esposito
- Psychology Program, Nanyang Technological University, Singapore, Singapore
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Atiqah Azhari
- Psychology Program, Nanyang Technological University, Singapore, Singapore
| | - Jessica L. Borelli
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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Rudenstine S, Espinosa A. Latent comorbid depression and anxiety symptoms across sex and race/ethnic subgroupings in a national epidemiologic study. J Psychiatr Res 2018; 104:114-123. [PMID: 30029050 DOI: 10.1016/j.jpsychires.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/12/2018] [Accepted: 07/12/2018] [Indexed: 11/18/2022]
Abstract
The heterogeneity of mood and anxiety disorders has been widely documented and epidemiologic studies have found different prevalence rates for psychiatric disorders across subgroups (i.e. sex and race/ethnic). The current study compares the latent class structure across sex and race/ethnic groups to determine group differences in these latent class configurations. This study utilized data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample from the United States (N = 43,093). First, latent class analyses (LCAs) were used to assess subtypes of symptoms of depression and anxiety that characterize a latent class structure for the population represented by NESARC. Second, group LCAs were conducted across sex and race/ethnicity to compare the latent class structure across these groups. The results suggest a 7-class model is the best fit for the population as well as for the male, non-Hispanic White, and Black subgroups. Females fit best an 11-class model, Hispanics a 5-class model and Asian and American Indian subgroups a 4-class model. These results indicate that subgroups of sex and race/ethnicity do not share the same latent construct for symptoms of anxiety and depression. Understanding the variability in the presentation of comorbid mood and anxiety across subgroups has the potential to inform person-centered approaches to care as well as targeted and multicultural interventions to improve population health.
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Affiliation(s)
- Sasha Rudenstine
- City College of New York, CUNY, Department of Psychology, NY, USA; The Graduate Center, City University of New York, NY, USA.
| | - Adriana Espinosa
- City College of New York, CUNY, Department of Psychology, NY, USA
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Crouch TA, Lewis JA, Erickson TM, Newman MG. Prospective Investigation of the Contrast Avoidance Model of Generalized Anxiety and Worry. Behav Ther 2017; 48:544-556. [PMID: 28577589 DOI: 10.1016/j.beth.2016.10.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 11/29/2022]
Abstract
The factors that maintain generalized anxiety disorder (GAD) symptoms and worry over time are not entirely clear. The Contrast Avoidance Model (CAM) postulates that individuals at risk for pathological worry and GAD symptoms uniquely fear emotional shifts from neutral or positive emotions into negative emotional states, and consequently use worry to maintain negative emotion in order to avoid shifts or blunt the effect of negative contrasts. This model has received support in laboratory experiments, but has not been investigated prospectively in the naturalistic context of daily life. The present study tested the CAM in a longitudinal experience sampling study with a subclinical sample. Participants selected to represent a broad range of symptoms (N = 92) completed baseline measures of GAD and depression symptoms, and eight weekly assessments of worry, experiences of negative emotional contrasts during their worst event of the week, and situation-specific negative emotion. Consistent with the CAM, GAD symptoms prospectively predicted higher endorsement of negative contrast experiences as worst events, independent of depression symptoms. Unsurprisingly, higher negative contrasts predicted higher negative emotion. However, both higher baseline GAD symptoms and weekly worry uniquely moderated (reduced) this relationship, providing consistent support for the idea that worry may blunt the emotional effects of contrasts. Depression symptoms did not have the same moderating effect. These findings support the CAM in an ecologically valid context.
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Peiper N, Illback RJ, O'Reilly A, Clayton R. Latent class analysis of need descriptors within an Irish youth mental health early intervention program toward a typology of need. Early Interv Psychiatry 2017; 11:37-46. [PMID: 25640155 DOI: 10.1111/eip.12213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022]
Abstract
AIM Significant overlap and comorbidity has been demonstrated among young people with mental health problems. This paper examined demographic characteristics, heterogeneity of need descriptors and services provided among young people (12-25 years) engaging in brief interventions at Jigsaw in the Republic of Ireland. METHOD Between 1 January 2013 and 31 December 2013, a total of 2571 young people sought help from 1 of 10 Jigsaw sites. Of these, 1247 engaged in goal-focused brief interventions, typically consisting of one to six face-to-face sessions. Descriptive statistics were used to summarize social and demographic factors. Latent class analysis was used to cluster young people into relevant typologies of presenting issues. Multinomial logistic regression was then performed to determine significant predictors of class membership. RESULTS The most common age of young people was 16. More women (59.6%) than men engaged in brief interventions, 56% attended school, 74% lived with their family of origin or with one parent, and 54.2% came from families where parents were married. Using established fit criteria, four relevant typologies emerged: Developmental (26.8%), Comorbid (15.8%), Anxious (42.7%) and Externalising (14.6%). Predictors varied by class membership, but general family problems and lack of adult support emerged as the strongest predictors for all classes. CONCLUSION This study demonstrated that the mental health needs of young people in Ireland are significant and diverse. Because Jigsaw favours a more descriptive approach to problem identification, the four typologies suggest a need to determine program capacity in engaging youth with heterogeneous presenting issues and to tailor brief interventions to each group's clinical profiles.
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Affiliation(s)
| | - Robert J Illback
- REACH of Louisville, Louisville, USA.,Headstrong - The National Centre for Youth Mental Health, Dublin, Ireland
| | - Aileen O'Reilly
- Headstrong - The National Centre for Youth Mental Health, Dublin, Ireland
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Beard C, Millner AJ, Forgeard MJC, Fried EI, Hsu KJ, Treadway M, Leonard CV, Kertz S, Björgvinsson T. Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychol Med 2016; 46:3359-3369. [PMID: 27623748 PMCID: PMC5430082 DOI: 10.1017/s0033291716002300] [Citation(s) in RCA: 412] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Researchers have studied psychological disorders extensively from a common cause perspective, in which symptoms are treated as independent indicators of an underlying disease. In contrast, the causal systems perspective seeks to understand the importance of individual symptoms and symptom-to-symptom relationships. In the current study, we used network analysis to examine the relationships between and among depression and anxiety symptoms from the causal systems perspective. METHOD We utilized data from a large psychiatric sample at admission and discharge from a partial hospital program (N = 1029, mean treatment duration = 8 days). We investigated features of the depression/anxiety network including topology, network centrality, stability of the network at admission and discharge, as well as change in the network over the course of treatment. RESULTS Individual symptoms of depression and anxiety were more related to other symptoms within each disorder than to symptoms between disorders. Sad mood and worry were among the most central symptoms in the network. The network structure was stable both at admission and between admission and discharge, although the overall strength of symptom relationships increased as symptom severity decreased over the course of treatment. CONCLUSIONS Examining depression and anxiety symptoms as dynamic systems may provide novel insights into the maintenance of these mental health problems.
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Affiliation(s)
| | | | | | | | - Kean J. Hsu
- McLean Hospital/Harvard Medical School
- University of California, Los Angeles
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18
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Abstract
BACKGROUND A large and extensive body of research has examined comorbid anxiety and depression in adults. Children and adolescents also frequently present with comorbid anxiety and depression; however, research and treatment require unique environmental and neurodevelopmental considerations in children. As a result, our understanding of comorbid anxiety and depression in children and adolescents is limited. OBJECTIVE The goal of this systematic review was to examine the current literature focused on comorbid anxiety and depression in children and adolescents. The review included theoretical conceptualizations as well as diagnostic, neurobiological, prevention, and treatment considerations. In addition, a proposed algorithm for the treatment of comorbid anxiety and depression in children/adolescents is provided. METHODS This systematic literature review included 3 discrete searches in Ovid SP Medline, PsycInfo, and PubMed. RESULTS The review included and synthesized 115 articles published between 1987 and 2015. The available evidence suggests that anxiety and depression are common in clinical populations of children and adolescents, and that comorbidity is likely underestimated in children and adolescents. Children and adolescents with comorbid anxiety and depression have unique presentations, greater symptom severity, and treatment resistance compared with those who have either disease in isolation. A dimensional approach may be necessary for the future development of diagnostic strategies and treatments for this population. Nascent neuroimaging work suggests that anxiety and depression each represents a distinct neurobiological phenotype. CONCLUSIONS The literature that is currently available suggests that comorbid anxiety and depression is a common presentation in children and adolescents. This diagnostic picture underscores the importance of comprehensive dimensional assessments and multimodal evidence-based approaches given the high disease severity. Future research on the neurobiology and the treatment of these common clinical conditions is warranted.
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Moscati A, Flint J, Kendler K. CLASSIFICATION OF ANXIETY DISORDERS COMORBID WITH MAJOR DEPRESSION: COMMON OR DISTINCT INFLUENCES ON RISK? Depress Anxiety 2016; 33:120-7. [PMID: 26418316 PMCID: PMC4729582 DOI: 10.1002/da.22432] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/01/2015] [Accepted: 09/04/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Anxiety and depression display frequent comorbidity. Individuals with comorbid disorders also often have more extreme symptomatology than those with single disorders. This correlation between comorbidity and severity poses an interesting question: Are comorbid forms of anxiety and depression essentially just more severe versions of the pure disorders? METHODS In a large major depression (MD) case-control sample of individuals from the China, Oxford and VCU Experimental Research on Genetic Epidemiology project, we examined the patterns of lifetime anxiety comorbidity (including generalized anxiety disorder--GAD, panic disorder, and five phobia subtypes) among MD cases (N = 5,864) in this population. Binary and multinomial logistic regression was used to estimate associations between risk factors and outcomes including MD as well as latent class membership, which were compared using continuation ratios. RESULTS We found a five-class solution to fit best, and each resulting class had a distinct pattern of association with the tested risk factors. The use of continuation ratios suggests that a class characterized by high endorsement of GAD is comparable to a more severely affected "pure MD" group. The other three classes (characterized by agoraphobia, various specific phobias, and by high endorsement of all comorbid anxiety disorders, respectively) appear to differ meaningfully from MD alone. CONCLUSIONS Risk for MD resulting from environmental and psychosocial factors may also predispose individuals to GAD, and less consistently, other anxiety disorders. Presentations of MD with certain phobias display distinguishably different patterns of risk, however, and are therefore likely qualitatively distinct.
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Affiliation(s)
- A. Moscati
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA 23298-0126, United States
| | - J. Flint
- Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK
| | - K.S. Kendler
- Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA 23298-0126, United States
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One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain: A latent class growth analysis. J Psychosom Res 2015; 79:195-201. [PMID: 26070405 DOI: 10.1016/j.jpsychores.2015.05.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Distinguishing transient from persistent anxiety and depression symptoms in older people presenting to general practice with musculoskeletal pain is potentially important for effective management. This study sought to identify distinct post-consultation depression and anxiety symptom trajectories in adults aged over 50years consulting general practice for non-inflammatory musculoskeletal pain. METHODS Self-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1week of the consultation and at 3, 6 and 12months. Latent class growth analysis was used to identify anxiety and depression symptoms trajectories, which were ascertained with cut-off score ≥8 on Hospital Anxiety and Depression Scale subscales. Associations between baseline characteristics and cluster membership were examined using multivariate multinomial logistic regression analysis (the 3-step approach). RESULTS Latent class growth analyses determined a 3-cluster anxiety model (n=499) and a 3-cluster depression model (n=501). Clusters identified were: no anxiety problem (44.1%), persistent anxiety problem (33.9%) and transient anxiety symptoms (22.2%); no depression problem (74.1%), persistent depression problem (22.0%) and gradual depression symptom recovery (4.0%). Widespread pain, interference with valued activities, coping by increased behavioral activities, catastrophizing, perceived lack of instrumental support, age ≥70years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters. CONCLUSIONS Older people with non-inflammatory musculoskeletal pain are at high risk of persistent anxiety and/or depression problems. Biopsychosocial factors, such as pain status, coping strategies, instrumental support, performing manual/routine work, being female and age ≥70years, may help identify patients with persistent anxiety and/or depression.
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21
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Peiper N, Clayton R, Wilson R, Illback R, O'Brien E, Kerber R, Baumgartner R, Hornung C. Empirically derived subtypes of serious emotional disturbance in a large adolescent sample. Soc Psychiatry Psychiatr Epidemiol 2015; 50:983-94. [PMID: 25652591 DOI: 10.1007/s00127-015-1017-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 01/27/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE The heterogeneity of serious emotional disturbance has been thoroughly documented among adolescents with nationally representative data derived from structured interviews, although use of these interviews may not be feasible within the context of brief and self-administered school surveys. This study seeks to identify distinct subtypes of serious emotional disturbance in a large school-based sample. METHODS A total of 108,736 students fully completed the K6 scale that was included on the 2012 Kentucky Incentives for Prevention Survey. Latent class analysis was used to derive subtypes of serious emotional disturbance among students receiving a positive screen (n = 15,147). To determine significant predictors of class membership, adjusted rate ratios and 95 % confidence intervals were calculated using multinomial logistic regression. RESULTS A four-class model was the most parsimonious, with four distinct subtypes emerging that varied by both symptom type and severity: comorbid moderate severity, comorbid high severity, anxious moderate severity, and depressed high severity. Age, gender, race/ethnicity, family structure, substance use, antisocial behavior, role impairments, and peer victimization were significant predictors of class membership, although the magnitude of these effects was stronger for the two high severity groups. CONCLUSIONS Our results suggest heterogeneity of serious emotional disturbance by both symptom type and severity. Prevention programs may benefit by shifting focus from specific disorders to the core features of serious emotional disturbance, including psychological distress, high comorbidity, and role impairments.
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Affiliation(s)
- Nicholas Peiper
- Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA,
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22
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Factors of psychological distress: clinical value, measurement substance, and methodological artefacts. Soc Psychiatry Psychiatr Epidemiol 2015; 50:515-24. [PMID: 25682108 DOI: 10.1007/s00127-015-1022-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/07/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE Psychometric models and statistical techniques are cornerstones of research into latent structures of specific psychopathology and general mental health. We discuss "pivot points" for future research efforts from a psychometric epidemiology perspective, emphasising sampling and selection processes of both indicators that guide data collection as well as samples that are confronted with them. METHOD First, we discuss how a theoretical model of psychopathology determines which empirical indicators (questions, diagnoses, etc.) and modelling methods are appropriate to test its implications. Second, we deal with how different research designs introduce different (co-)variances between indicators, potentially leading to a different understanding of latent structures. Third, we discuss widening the range of statistical models available within the "psychometrics class": the inclusion of categorical approaches can help to enlighten the debate on the structure of psychopathology and agreement on a minimal set of models might lead to greater convergence between studies. Fourth, we deal with aspects of methodology that introduce spurious (co-)variance in latent structure analysis (response styles, clustered data) and differential item functioning to gather more detailed information and to guard against over-generalisation of results, which renders assessments unfair. CONCLUSIONS Building on established insights, future research efforts should be more explicit about their theoretical understanding of psychopathology and how the analysis of a given indicator-respondent set informs this theoretical model. A coherent treatment of theoretical assumptions, indicators, and samples holds the key to building a comprehensive account of the latent structures of different types of psychopathology and mental health in general.
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23
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Lee SY, Xue QL, Spira AP, Lee HB. Racial and ethnic differences in depressive subtypes and access to mental health care in the United States. J Affect Disord 2014; 155:130-7. [PMID: 24269002 DOI: 10.1016/j.jad.2013.10.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/22/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Racial and ethnic minorities in the U.S. underutilize mental health service for mood disorders. This study sought to identify depressive subtypes associated with low use of mental health services across racial and ethnic groups based on a large, nationally representative sample of adults in the U.S. METHODS Based on latent class analysis, we identified the latent profile of depressive symptoms among those who endorsed lifetime depressed mood or anhedonia in the 2001-2002 National Epidemiological Survey on Alcohol and Related Condition (302 Asian Americans; 8602 Whites; 2266 Blacks; 2254 Hispanics). Proportions and types of lifetime mental health service use across depressive symptom subtypes were assessed and compared across the racial and ethnic categories. RESULTS A four class model of depressive subtypes was examined across race and ethnicity ("mild," "cognitive," "psychosomatic," and "severe"). Asian Americans, blacks, and Hispanics with "severe" subtype of depression had significantly lower odds of mental health service use compared to whites with "severe" subtype of depression. While Asian Americans did not have higher proportion of "psychosomatic" subtype than other race and ethnic groups, Asian Americans with "cognitive" subtype of depression significantly underused mental health services compared to Asian Americans with "psychosomatic" subtype of depression (Odds ratio:0.34, 95% Confidence interval:0.13,0.91). LIMITATION We were unable to account for heterogeneity of the subethnic group compositions based on country of origin and other socio-demographic factors. CONCLUSIONS A targeted outreach intervention to raise awareness among Asian Americans, blacks, and Hispanics with "severe" subtype and Asian Americans with "cognitive" subtype of depression may reduce disparity in mental health service utilization across racial and ethnic groups.
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Affiliation(s)
- Su Yeon Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
| | - Qian-li Xue
- Department of Medicine Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Hochang B Lee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
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Balázs J, Miklósi M, Keresztény A, Hoven CW, Carli V, Wasserman C, Apter A, Bobes J, Brunner R, Cosman D, Cotter P, Haring C, Iosue M, Kaess M, Kahn JP, Keeley H, Marusic D, Postuvan V, Resch F, Saiz PA, Sisask M, Snir A, Tubiana A, Varnik A, Sarchiapone M, Wasserman D. Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry 2013; 54:670-7. [PMID: 23330982 DOI: 10.1111/jcpp.12016] [Citation(s) in RCA: 314] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Subthreshold-depression and anxiety have been associated with significant impairments in adults. This study investigates the characteristics of adolescent subthreshold-depression and anxiety with a focus on suicidality, using both categorical and dimensional diagnostic models. METHODS Data were drawn from the Saving and Empowering Young Lives in Europe (SEYLE) study, comprising 12,395 adolescents from 11 countries. Based on self-report, including Beck Depression Inventory-II (BDI-II), Zung Self-Rating Anxiety Scale (SAS), Strengths and Difficulties Questionnaire (SDQ) and Paykel Suicide Scale (PSS) were administered to students. Based on BDI-II, adolescents were divided into three groups: nondepressed, subthreshold-depressed and depressed; based on the SAS, they were divided into nonanxiety, subthreshold-anxiety and anxiety groups. Analyses of Covariance were conducted on SDQ scores to explore psychopathology of the defined groups. Logistic regression analyses were conducted to explore the relationships between functional impairments, suicidality and subthreshold and full syndromes. RESULTS Thirty-two percent of the adolescents were subthreshold-anxious and 5.8% anxious, 29.2% subthreshold-depressed and 10.5% depressed, with high comorbidity. Mean scores of SDQ of subthreshold-depressed/anxious were significantly higher than the mean scores of the nondepressed/nonanxious groups and significantly lower than those of the depressed/anxious groups. Both subthreshold and threshold-anxiety and depression were related to functional impairment and suicidality. CONCLUSIONS Subthreshold-depression and subthreshold-anxiety are associated with an increased burden of disease and suicide risk. These results highlight the importance of early identification of adolescent subthreshold-depression and anxiety to minimize suicide. Incorporating these subthreshold disorders into a diagnosis could provide a bridge between categorical and dimensional diagnostic models.
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Affiliation(s)
- Judit Balázs
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary.
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Swanson SA, Lindenberg K, Bauer S, Crosby RD. A Monte Carlo investigation of factors influencing latent class analysis: an application to eating disorder research. Int J Eat Disord 2012; 45:677-84. [PMID: 21882219 DOI: 10.1002/eat.20958] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Latent class analysis (LCA) has frequently been used to identify qualitatively distinct phenotypes of disordered eating. However, little consideration has been given to methodological factors that may influence the accuracy of these results. METHOD Monte Carlo simulations were used to evaluate methodological factors that may influence the accuracy of LCA under scenarios similar to those seen in previous eating disorder research. RESULTS Under these scenarios, the aBIC provided the best overall performance as an information criterion, requiring sample sizes of 300 in both balanced and unbalanced structures to achieve accuracy proportions of at least 80%. The BIC and cAIC required larger samples to achieve comparable performance, while the AIC performed poorly universally in comparison. Accuracy generally was lower with unbalanced classes, fewer indicators, greater or nonrandom missing data, conditional independence assumption violations, and lower base rates of indicator endorsement. DISCUSSION These results provide critical information for interpreting previous LCA research and designing future classification studies.
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Affiliation(s)
- Sonja A Swanson
- Harvard School of Public Health, Department of Epidemiology, Boston, MA 02115, USA.
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Petersen J, Bandeen-Roche K, Budtz-Jørgensen E, Larsen KG. PREDICTING LATENT CLASS SCORES FOR SUBSEQUENT ANALYSIS. PSYCHOMETRIKA 2012; 77:244-262. [PMID: 23653489 PMCID: PMC3644419 DOI: 10.1007/s11336-012-9248-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Latent class regression models relate covariates and latent constructs such as psychiatric disorders. Though full maximum likelihood estimation is available, estimation is often in three steps: (i) a latent class model is fitted without covariates; (ii) latent class scores are predicted; and (iii) the scores are regressed on covariates. We propose a new method for predicting class scores that, in contrast to posterior probability-based methods, yields consistent estimators of the parameters in the third step. Additionally, in simulation studies the new methodology exhibited only a minor loss of efficiency. Finally, the new and the posterior probability-based methods are compared in an analysis of mobility/exercise.
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Zhua T, De Luca V, Gallaugher LA, Woldeyohannes HO, Soczynska JK, Szymcowicz S, Muzina DJ, Kennedy SH, McIntyre RS. Admixture analysis of age at onset in major depressive disorder. Gen Hosp Psychiatry 2012; 34:686-91. [PMID: 22898442 PMCID: PMC3941474 DOI: 10.1016/j.genhosppsych.2012.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/09/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study aimed to determine the distributions of the age at onset (AAO) in patients with major depressive disorder (MDD) using admixture analysis and to determine the clinical differences between subgroups with different AAO. METHODS Participants were administered the Mini-International Neuropsychiatric Interview to obtain clinical data. Admixture analysis was performed using the STATA module DENORMIX to identify subgroups characterized by differences in AAO. RESULTS The best fit model was the three-component model with the following means, standard deviations and proportions: 14.60 (3.75) years (49.1%), 29.15 (6.75) years (34.1%) and 46.96 (6.06) years (16.8%) (χ(2)=3.64, 2 df, P=.162). The three subgroups were divided by AAO of 22 and 40. After controlling for duration of illness, there were no significant differences between the three AAO subgroups in terms of gender and psychiatric family history. However, the early-onset subgroup was significantly more likely to report being single compared to the intermediate- and late-onset groups. The proportion of individuals meeting criteria for lifetime comorbid panic disorders and obsessive-compulsive disorder did not differ significantly between the AAO groups. However, the early-onset group reported a higher incidence of attention-deficit/hyperactivity disorder (5.1% vs. 1.7% and 1.2%, P=.086), although this was not statistically significant. CONCLUSIONS Our study identified three characteristically different AAO subgroups in individuals suffering from MDD. The subgroups may reflect different underlying neurobiological mechanisms involved.
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Affiliation(s)
| | - Vincenzo De Luca
- Clinical Research Department, Centre for Addiction and Mental Health (CAMH) Toronto, Canada,Corresponding authors. R.S. McIntyre is to be contacted at the Department of Psychiatry and Pharmacology, University of Toronto, Mood Disorders Psychopharmacology, Toronto, ON, M5T2S8. V. De Luca, Department of Psychiatry, University of Toronto, Toronto ON, Canada M5T1R8. Tel.: +1 416 5358501x4421; fax: +1 416 979 4666. (V. De Luca), (R.S. McIntyre)
| | | | | | - Joanna K. Soczynska
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sarah Szymcowicz
- Center for Mood Disorders Treatment Research, Cleveland Clinic, Ohio, USA
| | - David J. Muzina
- Center for Mood Disorders Treatment Research, Cleveland Clinic, Ohio, USA
| | - Sidney H. Kennedy
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Department of Pharmacology, University of Toronto, Toronto, ON, Canada,Corresponding authors. R.S. McIntyre is to be contacted at the Department of Psychiatry and Pharmacology, University of Toronto, Mood Disorders Psychopharmacology, Toronto, ON, M5T2S8. V. De Luca, Department of Psychiatry, University of Toronto, Toronto ON, Canada M5T1R8. Tel.: +1 416 5358501x4421; fax: +1 416 979 4666. (V. De Luca), (R.S. McIntyre)
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Lewis-Fernández R, Hinton DE, Laria AJ, Patterson EH, Hofmann SG, Craske MG, Stein DJ, Asnaani A, Liao B. Culture and the anxiety disorders: recommendations for DSM-V. Depress Anxiety 2010; 27:212-29. [PMID: 20037918 PMCID: PMC4337390 DOI: 10.1002/da.20647] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent "over-specification" of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria. METHODS Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal applicability of the diagnostic criteria for six anxiety disorders. RESULTS Possible mismatches between the DSM criteria and the local phenomenology of the disorder in specific cultural contexts were found for three anxiety disorders in particular. These involve the unexpectedness and 10-minute crescendo criteria in Panic Disorder; the definition of social anxiety and social reference group in Social Anxiety Disorder; and the priority given to psychological symptoms of worry in Generalized Anxiety Disorder. Limited evidence was found throughout, particularly in terms of neurobiological markers, genetic risk factors, treatment response, and other DSM-V validators that could help clarify the cross-cultural applicability of criteria. CONCLUSIONS On the basis of the available data, options and preliminary recommendations for DSM-V are put forth that should be further evaluated and tested.
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Affiliation(s)
- Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, New York 10032, USA.
| | - Devon E. Hinton
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amaro J. Laria
- Massachusetts School of Professional Psychology, Boston, Massachusetts
| | | | | | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, California
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Anu Asnaani
- Department of Psychology, Boston University, Boston, Massachusetts
| | - Betty Liao
- Department of Psychology, University of California, Los Angeles, California
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