Anxiety Disorders in Patients With Somatic Diseases

Trajectories of depressive and anxiety symptoms and associated risk factors during the COVID-19 pandemic in Germany: A longitudinal cohort study

BACKGROUND

Most COVID-19-related mental health research focused on average levels of mental health parameters in the general population. However, considering heterogeneous groups and their long-term responses could deepen our understanding of mental health during community crises. This four-wave study aimed to (1) identify subgroups with different trajectories of depressive and anxiety symptoms in the German general population, and (2) investigate associated risk factors.

METHODS

We analyzed self-report data from N = 1257 German adults participating in a European cohort study, assessed in summer 2020 (T1), and at 6 (T2), 12 (T3), and 30 months (T4). Depressive and anxiety symptoms were measured using the PHQ-4. Sociodemographic, health-related, and pandemic-related variables were assessed at baseline. We applied growth mixture modeling to identify subgroups of symptom trajectories and conducted multinomial logistic regression to examine factors associated with class membership.

RESULTS

We identified six symptom trajectories: Low-stable (n = 971, 77.2 %), Continuous deterioration (n = 30, 2.4 %), Transient deterioration (n = 75, 6.0 %), Continuous improvement (n = 97, 7.7 %), Transient improvement (n = 38, 3.0 %) and Chronicity (n = 46, 3.7 %). Age, education, work status, mental health diagnoses, self-reported health, and pandemic-related news consumption were significantly associated with subgroup membership.

LIMITATIONS

The generalizability of the study is constrained by an unrepresentative sampling method, a notable dropout rate, and limited consideration of risk factors.

CONCLUSION

Most people experienced low symptoms or improvement during the pandemic, while others experienced chronic or transient symptoms. Specific risk factors were associated with these trajectories, revealing nuanced mental health dynamics.

Global Trends in the Incidence of Anxiety Disorders From 1990 to 2019: Joinpoint and Age-Period-Cohort Analysis Study

BACKGROUND

Anxiety disorders (ADs) are the most common mental illness with high prevalence, chronicity, and comorbidity. Despite rapid economic and cultural development, the global incidence of ADs continues to increase, with predominance in male individuals.

OBJECTIVE

To address the above issues, we analyzed the dynamic trends of the global incidence and disease burden of ADs from 1990 to 2019 and their different effects on age, period, and birth cohort and predicted the future trend of AD incidence.

METHODS

The data were obtained from the Global Burden of Disease study in 2019. A joinpoint regression model was used to calculate the annual percent change in AD incidence, and age-period-cohort analysis was used to estimate the independent effects of age, period, and cohort. Nordpred age-period-cohort analysis was used to predict the incidence of ADs from 2020 to 2044.

RESULTS

The age-standardized incidence rate of ADs increased by 1.06% for both sexes, and the age-standardized disability-adjusted life-year (DALY) rate (ASDR) decreased by 0.12%. Joinpoint regression indicated that increments in average annual percent changes in the age-standardized incidence rate (0.068 vs 0.012) and ASDR (0.035 vs -0.015) for ADs globally were higher among male individuals than female individuals. The age-period-cohort analyses revealed that the relative risk (RR) of the incidence and DALYs of ADs among people of different sexes increased with age in adolescence and middle age and then decreased. For the period effect, the RR of incidence decreased, whereas the RR of DALYs increased in both sexes. Moreover, the RR of the incidence gradually increased and DALYs slowly decreased with birth year for both male and female individuals. New cases of ADs in male individuals are predicted to increase in the coming 25 years.

CONCLUSIONS

This study provided the changing trend of the global incidence and disease burden of ADs in the past 3 decades, indicating that early prevention and effective control cannot be ignored. We analyzed the age-period-cohort effect of potential trends in ADs and predicted future incidence trends. The results suggest that we should take active intervention measures, focusing on high-risk groups and developing effective management and control policies to reduce the global burden of disease.

Understanding Alveolar echinococcosis patients' psychosocial burden and coping strategies-A qualitative interview study

BACKGROUND

Alveolar echinococcosis (AE) is a serious parasitic zoonotic disease that resembles malignancy with clinically silent infiltrative growth predominantly involving the liver. AE patients show high levels of comorbid psychological burden and fear of disease progression. This study aimed to examine AE patients' perspective on their disease-related psychosocial burden using qualitative methods.

METHODS

We conducted N = 12 semi-structured interviews with AE patients focusing on their disease-related psychosocial burden, coping strategies, information seeking behavior, and subjective illness concepts. To this end, AE patients from a previous quantitative cross-sectional study were invited to participate. After verbatim transcription, interviews were analyzed thematically.

RESULTS

After analysis, data was grouped into five main themes: A) Perceived disease-related burden, B) Coping with disease-related burden, C) Disease-related impact on their social environment, D) Facing the future with the disease, and E) Disease-related information seeking behavior and subjective illness concepts. All participants perceived AE as a severe disease with inextricably linked biological, psychological, and social effects. Key positive influences reported included the provision of information and access to informal and formal support, including the ability to lead active personal and professional lives for as long as possible. Self-directed, web-based information seeking often led to increased feelings of hopelessness and anxiety.

CONCLUSION

Our findings underscore the need to consider psychosocial morbidity in AE patient management. To reduce psychological burden, address disease-related apprehensions, and to prevent stigmatization, health professionals need to provide AE patients with comprehensive disease-related information to improve patient and social awareness.

Biofeedback Training to Increase P co2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?

OBJECTIVE

Anxiety is highly prevalent in individuals with asthma. Asthma symptoms and medication can exacerbate anxiety, and vice versa. Unfortunately, treatments of comorbid anxiety and asthma are largely lacking. A problematic feature common to both conditions is hyperventilation. It adversely affects lung function and symptoms in asthma and anxiety. We examined whether a treatment to reduce hyperventilation, shown to improve asthma symptoms, also improves anxiety in asthma patients with high anxiety.

METHOD

One hundred twenty English- or Spanish-speaking adult patients with asthma were randomly assigned to either Capnometry-Assisted Respiratory Training (CART) to raise P co2 or feedback to slow respiratory rate (SLOW). Although anxiety was not an inclusion criterion, 21.7% met clinically relevant anxiety levels on the Hospital Anxiety and Depression Scale (HADS). Anxiety (HADS-A) and depression (HADS-D) scales, anxiety sensitivity (Anxiety Sensitivity Index [ASI]), and negative affect (Negative Affect Scale of the Positive Affect Negative Affect Schedule) were assessed at baseline, posttreatment, 1-month follow-up, and 6-month follow-up.

RESULTS

In this secondary analysis, asthma patients with high baseline anxiety showed greater reductions in ASI and PANAS-N in CART than in SLOW ( p values ≤ .005, Cohen d values ≥ 0.58). Furthermore, at 6-month follow-up, these patients also had lower ASI, PANAS-N, and HADS-D in CART than in SLOW ( p values ≤ .012, Cohen d values ≥ 0.54). Patients with low baseline anxiety did not have differential outcomes in CART than in SLOW.

CONCLUSIONS

For asthma patients with high anxiety, our brief training designed to raise P co2 resulted in significant and sustained reductions in anxiety sensitivity and negative affect compared with slow-breathing training. The findings lend support for P co2 as a potential physiological target for anxiety reduction in asthma.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT00975273 .

Nutrient combinations exhibit universal antianxiety, antioxidant, neuro-protecting, and memory-improving activities

Anxiety disorders are the most common mental disorders and, without proper treatment, may lead to severe conditions: e.g., somatic disorders or permanent damage to central nervous system. Although there are drugs in clinical trials, this study focuses on exploring the efficacy of nutrients in treating these diseases. We built different zebrafish models and screened several nutrient combinations for their antianxiety, antioxidant, neuro-protecting, and memory-improving activities. Our results showed that the combinations of nutrients (e.g., Walnut Peptides + Theanine at 14.2 + 33.3 μg/ml) have similar or better activities than the positive control drugs. In addition, we discovered that the effects of the nutrients in the above four aspects were universal and highly related. This study is noteworthy as it suggested that nutrients could be healthier and greener drug alternatives and provide similar or better universal treatments for anxiety and related conditions.

Assessment of anxiety disorders in students starting work with coronavirus patients during a pandemic in Podlaskie Province, Poland

Background

Anxiety disorders are considered the sixth most important factor resulting in non-fatal health loss in the world. Moreover, they are among the first ten causes of years lived with disability (YLD) across the globe. Important clinical disorders include e.g., panic disorder, social anxiety disorder, generalized anxiety disorder and specific phobia.

Objectives

The study aimed to analyse the occurrence of level anxiety in students who start work at the time of the COVID-19 pandemic, with relation to the socio-demographic factors and health status, vaccination, conovirus infection, assistance of a psychologist or psychiatrist in the past, and using tranquilizers.

Methods

The study involved 255 students from Poland starting work with coronavirus patients during the pandemic. It was conducted using our own questionnaire, the Liebowitz Social Anxiety Scale (LSAS) and the State-Trait Anxiety Inventory (STAI).

Results

Fifty-one percent of subjects demonstrated symptoms of mild to severe social phobia. Level of trait anxiety among students correlated significantly with age and gender (females). The level of social anxiety in the evaluated students was significantly correlated with marital status, the self-assessment of the experienced fear, self-perceived health status, having had a coronavirus infection, fear of deterioration of one's health after starting work with coronavirus patients, and fear of contracting the disease while working with coronavirus patients, and using tranquilizers. Level of state anxiety significantly correlated with state anxiety, the self-assessment of professional preparedness for work with coronavirus patients, self-perceived health status, vaccination against coronavirus, and the assistance of a psychiatrist in the past.

Conclusions

The proportion of students showing social anxiety is alarming. Anxiety among the evaluated students during the COVID-19 pandemic was correlated with many factors.

Anxiety and Sleep Quality Amelioration in College Students: A Comparative Study between Team Sports and Individual Sports

Background: Anxiety is one of the most common mental disorders and is often accompanied by sleep disturbances. Studies have focused on the ameliorative effect of sports games on anxiety and its subsidiary issues. However, the effect on the improvement of such mental and physical disorders between individual sports and team group sports is not yet clear, especially regarding their effects on anxiety and sleep quality improvement. Therefore, this paper explores the improvement effects of individual sports and team sports participation on anxiety symptoms and sleep quality amelioration. Objective: To explore the effects of individual and team group sports participation on ameliorating college students’ anxiety symptoms and sleep quality. Methods: A total of 197 college students were sampled in the study. The self-rating anxiety scale (SAS) and Pittsburgh sleep quality index (PSQI) were used to assess the severity of anxiety symptoms and level of sleep quality. Participants were randomly divided into three groups: team sports, individual sports, and control groups. The distribution ratio of these groups was 1:1:1. Results: Generally, compared with the control group, the subjects in the team sports group and individual sports group had greater improvements in anxiety amelioration and sleep quality improvements. Specifically, the improvement effect between individual and team sports groups was different. To assess the resulting differences, improvements in anxiety symptoms and sleep quality were compared between the team sports group and the individual sports group with reference to the mean change in the control group. In the corrected model, the odds advantage ratio (OR) of anxiety symptom improvement after individual sports was 3.18 (CI 2.87–11.21), and the advantage OR of anxiety symptom improvement after team sports was 4.99 (CI 4.06–14.87). The advantage OR of sleep quality improvement after individual sports was 7.32 (CI 5.53–18.22), and the advantage OR of anxiety symptom improvement after team sports was 7.98 (CI 6.69–19.98). Conclusion: After 6 weeks of intervention, it was found that both team sports and individual sports improved anxiety symptoms and sleep quality with different effects. Team sports were better at improving anxiety, while individual sports and team sports shared the same improvement effect with no significant difference in sleep quality improvement.

Cerebral Perfusion Patterns of Anxiety State in Patients With Pulmonary Nodules: A Study of Cerebral Blood Flow Based on Arterial Spin Labeling

Background and Purpose

The proportion of patients with somatic diseases associated with anxiety is increasing each year, and pulmonary nodules have become a non-negligible cause of anxiety, the mechanism of which is unclear. The study focus on the cerebral blood flow (CBF) of anxiety in patients with pulmonary nodules to explore the cerebral perfusion pattern of anxiety associated with pulmonary nodules, blood perfusion status and mode of pulmonary nodule induced anxiety state.

Materials and Methods

Patients with unconfirmed pulmonary nodules were evaluated by Hamilton Anxiety Scale (HAMA). The total score > 14 was defined as anxiety group, and the total score ≤ 14 points was defined as non-anxiety group. A total of 38 patients were enrolled, of which 19 patients were the anxiety group and 19 were the non-anxiety group. All subjects underwent arterial spin labeling imaging using a 3.0 T MRI. A two-sample t-test was performed to compare the CBF between the two groups. The CBF was extracted in brain regions with difference, and Spearman correlation was used to analyze the correlation between CBF and HAMA scores; ROC was used to analyze the performance of CBF to distinguish between the anxiety group and the non-anxiety group.

Results

The CBF in the right insula/Heschl’s cortex of the anxiety group decreased (cluster = 109, peak t = 4.124, and P < 0.001), and the CBF in the right postcentral gyrus increased (cluster = 53, peak t = −3.912, and P < 0.001) in the anxiety group. But there was no correlation between CBF and HAMA score. The ROC analysis of the CBF of the right insula/Heschl’s cortex showed that the AUC was 0.856 (95%CI, 0.729, 0.983; P < 0.001), the optimal cutoff value of the CBF was 50.899, with the sensitivity of 0.895, and specificity of 0.789. The ROC analysis of CBF in the right postcentral gyrus showed that the AUC was 0.845 (95%CI, 0.718, 0.972; P < 0.001), the optimal cutoff value of CBF was 43.595, with the sensitivity of 0.737, and specificity of 0.842.

Conclusion

The CBF of the right insula/Heschl’s cortex decreased and the CBF of the right postcentral gyrus increased in patients with pulmonary nodules under anxiety state, and the CBF of the aforementioned brain regions can accurately distinguish the anxiety group from the non-anxiety group.

Anxiety and depression in school-age patients with spinal muscular atrophy: a cross-sectional study

BACKGROUND

Spinal muscular atrophy (SMA) is a rare neurogenetic disease which involves multisystem dysfunctions such as respiratory, digestive, and motor disorders. Anxiety, depression and other psychological disorders often accompany severe chronic physical diseases. The aim of this study was to investigate the prevalence of anxiety and depression along with their influencing factors among school-age patients with SMA.

METHODS

We conducted a cross-sectional study on school-age SMA patients in China. Patients aged 8-18 years with a genetic diagnosis of 5qSMA were invited to answer a questionnaire composed of sociodemographic and clinical questions, then to complete the Screen for Child Anxiety-Related Emotional Disorders and Depression Self-Rating Scale for depression and anxiety level evaluation. At the end of the questionnaire, further questions assessed the subjective anxiety and subjective depression of patients' caregivers and their expectations for their child's future.

RESULTS

Complete data were available for 155 patients. The sample included 45.8% boys and 54.2% girls; 65.2% were type II, 27.1% were type III, and the remainder were type I SMA. Rates of anxiety and depression in these school-age SMA patients were 40.0% and 25.2%, respectively. Gender, age, and disease type were not associated with anxiety or depression, but respiratory system dysfunction, digestive system dysfunction, skeletal deformity, rehabilitation exercise, academic delay, specialized support from school, household income level, caregivers' subjective anxiety, and caregivers' expectations were significantly related to both anxiety and depression.

CONCLUSIONS

There was a high prevalence of anxiety and depression in school-age SMA patients in China. Professional psychological care maybe included in the standard of care. These results also call for possible targets for intervention such as reducing complications, improving drug accessibility, retaining normal schooling, strengthening school support, and enhancing the ability of the caregivers of SMA patients to assist in the diagnosis and treatment of the disease, so improving the mental health of SMA patients.

The impact of pre-existing conditions and perceived health status on mental health during the COVID-19 pandemic

BACKGROUND

Patients with pre-existing conditions and poor health status are vulnerable for adverse health sequalae during the COVID-19 pandemic. We investigated the association of pre-existing medical conditions and self-perceived health status with the risk of mental health complications during the COVID-19 pandemic.

METHODS

In October-December, 2020, 1036 respondents completed online survey that included assessment of pre-existing conditions, self-perceived health status, depressive (Patient Health Questionnaire-8 score ≥ 10), anxiety (Generalized Anxiety Disorders-7 score ≥ 10) and post-traumatic stress (Impact of Events Scale Revised) symptoms, alcohol use (AUDIT), and COVID-19 fear (COVID-19 Fears Questionnaires for Chronic Medical Conditions).

RESULTS

Study participants were predominantly women (83%), younger than 61 years of age (94%). Thirty-six percent of respondents had a pre-existing condition and 5% considered their health status as bad or very bad. Pre-existing conditions and poor perceived health status were associated with increased risk for moderate to severe depressive and anxiety symptoms, fear of COVID-19 and post-traumatic stress symptoms, independently from respondents' age, gender, living area, smoking status, exercise, alcohol consumption and diet.

CONCLUSIONS

Pre-existing medical conditions and poor perceived health status are associated with increased risk of poor mental health status during the COVID-19 pandemic.

Future Trends in Disability and Its Determinants Among Chinese Community Patients With Anxiety Disorders: Evidence From a 5-Year Follow-Up Study

Background: Anxiety disorders (ADs) are a group of disorders with a high disability rate and bring a huge social burden. In China, information on future trends in the disability among community ADs patients and its determinants are rare. The objectives of this study are to describe the future trends in the disability among ADs patients living in community and to investigate the determinants of the disability. Methods: Participants diagnosed with 12-month ADs in the China Mental Health Survey (CMHS) were followed up by telephone from April to June 2018 to assess the future trends in the disability in a 5-year interval using the World Health Organization's Disability Assessment Schedule 2.0. The disability rate was reported and its determinants were analyzed by complex sample design multivariate logistic regression. Results: Totally 271 patients were interviewed by telephone and 33 informants finished proxy interviews. The disability rates were 45.9% and 14.3% among ADs patients at baseline and during the follow-up. Patients with general anxiety disorder (GAD) or agoraphobia with/without panic disorder (AGP) had the lower decrease and higher disability during the follow-up than patients with other subtypes. Patients aged in middle age (aged 40-49 years old, OR = 11.12, 95% CI: 4.16-29.72), having disability at baseline (OR = 7.18, 95% CI: 1.37-37.73), having comorbidity with three or more physical diseases (OR = 9.27, 95% CI: 2.48-34.71), and having comorbidity with other mental disorders (OR = 3.97, 95% CI: 1.13-13.96) had higher disability during the follow-up. Conclusions: The disability rate tends to decrease among ADs patients living in communities. Treatment priority should be given for ADs patients with disability and those in middle age. Treatments for the comorbidity of other mental disorders or physical diseases should be considered when treating anxiety.