A population-based twin study of the relationship between neuroticism and internalizing disorders

Rethinking trauma-related psychopathology in the Hierarchical Taxonomy of Psychopathology (HiTOP)

Research on trauma exposure and its consequences has made tremendous progress in elucidating the role of traumatic life events in the development and maintenance of psychopathology as well as in evaluating interventions aimed at addressing the personal and public burden of trauma-related psychopathology. However, there is growing concern that problems with predominant definitions of posttraumatic syndrome (e.g., content coverage and scope, within-category heterogeneity, excessive diagnostic comorbidity) limit further efforts to fully conceptualize trauma-related psychopathology and deliver appropriate, personalized interventions. As demonstrated by an impressive body of research over the past several years, the Hierarchical Taxonomy of Psychopathology (HiTOP) presents a compelling alternative to traditional nosologies in terms of empirically based characterizations of psychopathology phenotypes, with evidence of strong utility for research and clinical applications. However, HiTOP's primary focus on descriptive psychopathology has resulted in an unacceptable gap regarding the conceptualization of trauma-related psychopathology from a dimensional, transdiagnostic perspective. We see an important opportunity to clarify what HiTOP can offer the field of traumatic stress research and articulate a future for trauma-related psychopathology within HiTOP. We argue for disaggregating psychopathology symptoms from their purported causes and, instead, developing a detailed taxonomy of traumatic events alongside an ever-evolving HiTOP model. Doing so will help identify empirically based phenotypes of trauma-related psychopathology that (a) go beyond the traditional PTSD criterion sets and (b) allow for the possibility that different features of traumatic experiences (e.g., type, duration, subjective meaning) may be associated with different symptom sequelae across different psychopathology spectra.

Psychological Distress and Meniere's Disease: A Bidirectional Two-Sample Mendelian Randomization Study

OBJECTIVE

This study is aim to explore the causal relationship between anxiety, depression, neuroticism, and Meniere's disease (MD).

STUDY DESIGN

Two-sample bidirectional Mendelian randomization (MR) analyses.

SETTING

IEU, FinnGen, CTG, and UKB databases.

METHODS

The genome-wide association studies data for anxiety, depression, neuroticism, and MD involved over 357,957 participants. MR was performed to explore relationships between anxiety, depression, neuroticism, and MD. Sensitivity analyses were performed to assess the robustness of the MR results. Reverse MR was used to exclude the possibility of reverse causality. Finally, multivariate MR was performed to explore the collinear relationships between neuroticism subclusters.

RESULTS

MR results showed that anxiety and depression are not causes of MD, nor does MD cause anxiety and depression. Elevated neuroticism sum score is a cause of anxiety, depression, and MD, but MD does not lead to an increase in the level of neuroticism sum score. Further analysis showed that the 5 subclusters of neuroticism often feel lonely, mood often goes up and down, often feel fed-up, feelings easily hurt, and sensitivity to environmental stress and adversity are causes of MD. Multivariate MR analysis results suggested that the 5 neuroticism subclusters have a collinear relationship.

CONCLUSION

Anxiety and depression are not causative factors of MD, and vice versa. Elevated neuroticism levels serve as a shared causative factor for anxiety, depression, and MD. Identification and effective management of neuroticism is a potential target for preventing and treating MD.

Predicting treatment outcome based on resting-state functional connectivity in internalizing mental disorders: A systematic review and meta-analysis

Predicting treatment outcome in internalizing mental disorders prior to treatment initiation is pivotal for precision mental healthcare. In this regard, resting-state functional connectivity (rs-FC) and machine learning have often shown promising prediction accuracies. This systematic review and meta-analysis evaluates these studies, considering their risk of bias through the Prediction Model Study Risk of Bias Assessment Tool (PROBAST). We examined the predictive performance of features derived from rs-FC, identified features with the highest predictive value, and assessed the employed machine learning pipelines. We searched the electronic databases Scopus, PubMed and PsycINFO on the 12th of December 2022, which resulted in 13 included studies. The mean balanced accuracy for predicting treatment outcome was 77% (95% CI: [72%- 83%]). rs-FC of the dorsolateral prefrontal cortex had high predictive value in most studies. However, a high risk of bias was identified in all studies, compromising interpretability. Methodological recommendations are provided based on a comprehensive exploration of the studies' machine learning pipelines, and potential fruitful developments are discussed.

Association of temporal discounting with transdiagnostic symptom dimensions

Temporal discounting (TD), the tendency to devalue future rewards as a function of delay until receipt, is aberrant in many mental disorders. Identifying symptom patterns and transdiagnostic dimensions associated with TD could elucidate mechanisms responsible for clinically impaired decision-making and facilitate identifying intervention targets. Here, we tested in a general population sample (N = 731) the extent to which TD was related to different symptom patterns and whether effects of time framing (dates/delay units) and monetary magnitude (large/small) had particularly strong effects in people scoring higher on specific symptom patterns. Analyses revealed that TD was related to symptom patterns loading on anxious-depression and inattention-impulsivity-overactivity dimensions. Moreover, TD was lower in the date than the delay version and with higher magnitudes, especially in people scoring higher on the inattention-impulsivity-overactivity dimension. Overall, this study provides evidence for TD as a transdiagnostic process across affective and impulsivity-related dimensions. Future studies should test framing interventions in clinical populations characterized by impulsivity.Preregistration: This research was preregistered at https://osf.io/fg9sc .

Exploring the Relationship between Neuroticism and Perinatal Depressive Symptoms: Findings from a 2-Year, Multicenter Study in Italy

Neuroticism is a personality trait associated with the risk of affective disorders and perinatal depression. We investigated the relationship between different levels of neuroticism, psychological characteristics, and depressive symptoms in a sample of pregnant women (N = 2631) who accessed the gynecology departments in the Puglia Region (Italy) from July 2020 to November 2022. Women were assessed for depressive symptoms and associated risk factors in their third trimester of pregnancy (T0) and after childbirth (T1), and followed-up at 6 months and 1 year after delivery if presenting signs of depression (T2-T3). The Edinburgh Postnatal Depression Scale (EPDS) was used to screen depressive symptoms, and neuroticism was assessed through the subscales of the NEO Five Factor Inventory. Standardized measures of resilience, coping strategies, partner attachment, and quality of life were also employed. Higher levels of neuroticism were significantly associated with: (a) higher scores on the EPDS; (b) higher anxiety in the experience of close relationships; (c) lower psychological wellbeing; (d) lower levels of resilience; (e) lower levels of active coping; and (f) higher levels of self-blame. Our findings may suggest that neuroticism is a specific associated factor of perinatal depression and should be routinely assessed in the clinical screening of pregnant women in order to promote an early referral to psychological or psychiatric support services.

Multimodal Associations of FKBP5 Methylation with Emotion-Regulatory Brain Circuits

BACKGROUND

Understanding the biological processes underlying individual differences in emotion regulation and stress responsivity is a key challenge for translational neuroscience. The gene FKBP5 is a core regulator in molecular stress signaling that is implicated in the development of psychiatric disorders. Yet it remains unclear how FKBP5 DNA methylation (DNAm) in peripheral blood relates to individual differences in measures of neural structure and function, and their relevance to daily-life stress responsivity.

METHODS

Here, we characterize multimodal correlates of FKBP5 DNAm by combining epigenetic data with neuroimaging and Ambulatory Assessment in a sample of 395 healthy individuals.

RESULTS

First, we show that FKBP5 demethylation as a psychiatric risk factor relates to an anxiety-associated reduction of gray matter volume in the ventromedial prefrontal cortex (vmPFC), a brain area that is involved in emotion regulation and mental health risk and resilience. This effect of epigenetic upregulation of FKBP5 on neuronal structure is more pronounced where FKBP5 is epigenetically downregulated at baseline. Leveraging 208 functional MRI scans during a well-established emotion processing task we find that FKBP5 DNAm in peripheral blood is associated with functional difference of prefrontal-limbic circuits modulating affective responsivity to daily stressors, which we measured using ecological momentary assessment in daily life.

CONCLUSIONS

Overall, we demonstrate how FKBP5 contributes to interindividual differences in neural and real-life affect regulation via structural and functional changes in prefrontal-limbic brain circuits.

Disease trajectory of high neuroticism and the relevance to psychiatric disorders: A retro-prospective cohort study

BACKGROUND

Neuroticism is a psychological personality trait that has a significant impact on public health and is also a potential predisposing factor for adverse disease outcomes; however, comprehensive studies of the subsequently developed conditions are lacking. The starting point of disease trajectory in terms of genetic variation remains unclear.

METHOD

Our study included 344,609 adult participants from the UK Biobank cohort who were virtually followed up from January 1, 1997. Neuroticism levels were assessed using 12 items from the Eysenck Personality Questionnaire. We performed a phenome-wide association analysis of neuroticism and subsequent diseases. Binomial tests and logistic regression models were used to test the temporal directionality and association between disease pairs to construct disease trajectories. We also investigated the association between polygenic risk scores (PRSs) for five psychiatric traits and high neuroticism.

RESULTS

The risk for 59 diseases was significantly associated with high neuroticism. Depression, anxiety, irritable bowel syndrome, migraine, spondylosis, and sleep disorders were the most likely to develop, with hazard ratios of 6.13, 3.66, 2.28, 1.74, 1.74, and 1.71, respectively. The disease trajectory network revealed two major disease clusters: cardiometabolic and chronic inflammatory diseases. Medium/high genetic risk groups stratified by the PRSs of four psychiatric traits were associated with an elevated risk of high neuroticism. We further identified eight complete phenotypic trajectory clusters of medium or high genetic risk for psychotic, anxiety-, depression-, and stress-related disorders.

CONCLUSION

Neuroticism plays an important role in the development of somatic and mental disorders. The full picture of disease trajectories from the genetic risk of psychiatric traits and neuroticism in early life to a series of diseases later provides evidence for future research to explore the etiological mechanisms and precision management.

Abnormal multi-layered dynamic cortico-subcortical functional connectivity in major depressive disorder and generalized anxiety disorder

Comorbidity has been frequently observed between generalized anxiety disorder (GAD) and major depressive disorder (MDD), however, common and distinguishable alterations in the topological organization of functional brain networks remain poorly understood. We sought to determine a robust and sensitive functional connectivity marker for diagnostic classification and symptom severity prediction. Multi-layered dynamic functional connectivity including whole brain, network-node and node-node layers via graph theory and gradient analyses were applied to functional MRI resting-state data obtained from 31 unmedicated GAD and 34 unmedicated MDD patients as well as 33 age and education matched healthy controls (HC). GAD and MDD symptoms were assessed using Penn State Worry Questionnaire and Beck Depression Inventory II, respectively. Three network measures including global properties (i.e., global efficiency, characteristic path length), regional nodal property (i.e., degree) and connectivity gradients were computed. Results showed that both patient groups exhibited abnormal dynamic cortico-subcortical topological organization compared to healthy controls, with MDD > GAD > HC in degree of randomization. Furthermore, our multi-layered dynamic functional connectivity network model reached 77% diagnostic accuracy between GAD and MDD and was highly predictive of symptom severity, respectively. Gradients of functional connectivity for superior frontal cortex-subcortical regions, middle temporal gyrus-subcortical regions and amygdala-cortical regions contributed more in this model compared to other gradients. We found shared and distinct cortico-subcortical connectivity features in dynamic functional brain networks between GAD and MDD, which together can promote the understanding of common and disorder-specific topological organization dysregulations and facilitate early neuroimaging-based diagnosis.

Well-being spectrum traits are associated with polygenic scores for autism

Individuals with autism spectrum disorder (ASD) tend to experience lower well-being as demonstrated mostly for children and adolescents in epidemiological studies. A further investigation of inclusive well-being, in terms of five well-being spectrum (5-WBS) traits including neuroticism, depression, loneliness, life satisfaction, and positive affect, among adults with ASD may deepen our understanding of their well-being, and lead to the possibility to further modify societal supportive mechanisms for individuals with ASD. This study aims to investigate if a genetic predisposition for ASD is associated with 5-WBS traits using polygenic risk score (PRS) analysis. PRS for ASD were calculated based on the latest genome-wide association study of ASD by the Psychiatric Genetics Consortium (18,381 cases, 27,969 controls) and were created in the independent cohort UK Biobank. Regression analyses were performed to investigate the association between ASD PRS and 5-WBS traits in the UK Biobank population including 337,423 individuals. ASD PRS were significantly associated with all 5-WBS traits, showing a positive association with the negative WBS traits, neuroticism (max R2  = 0.04%, p < 1 × 10-4 ), depression (max R2  = 0.06%, p < 1 × 10-4 ), loneliness (max R2  = 0.04%, p < 1 × 10-4 ), and a negative association with the positive WBS traits, life satisfaction (max R2  = 0.08%, p < 1 × 10-4 ), positive affect (max R2  = 0.10%, p < 1 × 10-4 ). The findings suggest that adults carrying a high load of risk single nucleotide peptides (SNPs) for ASD are more likely to report decreased well-being. The study demonstrates a considerable connection between susceptibility to ASD, its underlying genetic etiology and well-being.

Association between Reaction Times in the Joint Simon Task and Personality Traits

Joint go and no-go effects (joint Simon effects; JSEs) are considered to have a stimulus-response compatibility effect on joint reaction time tasks (joint Simon task) caused by the presence of other people. Additionally, JSEs are known to be associated with various social factors and are therefore a potential clinical marker for communicative function; however, the relationship with the personality that is associated with communication skills remains unclear. In this study, we focused on the association between JSE and personality traits. Thirty Japanese participants (fifteen women) were recruited. First, personality trait scores were obtained using the Japanese version of the ten-item personality inventory before the experiment. Second, we measured reaction times in the joint Simon task and single go and no-go tasks with the go signal presented on the congruent and incongruent sides. At last, we analyzed the association between reaction times and personality traits by using Spearman's correlation analysis. As a result, we observed two pairs with significant correlations: JSE and neuroticism and short reaction times in the joint condition and agreeableness. In conclusion, we identified potential psychological markers associated with the joint Simon task. These findings may lead to an additional hypothesis regarding the neurobiological mechanisms of JSEs.

Preliminary Evidence for Genetic Nurture in Depression and Neuroticism Through Polygenic Scores

Importance

Modeling genetic nurture (ie, the effects of parental genotypes through influences on the environment experienced by their children) is essential to accurately disentangle genetic and environmental influences on phenotypic variance. However, these influences are often ignored in both epidemiologic and genetic studies of depression.

Objective

To estimate the association of genetic nurture with depression and neuroticism.

Design, Setting, and Participants

This cross-sectional study jointly modeled parental and offspring polygenic scores (PGSs) across 9 traits to test for the association of genetic nurture with lifetime broad depression and neuroticism using data from nuclear families in the UK Biobank, with data collected between 2006 and 2019. A broad depression phenotype was measured in 38 702 offspring from 20 905 independent nuclear families, with most of these participants also reporting neuroticism scores. Parental genotypes were imputed from sibships or parent-offspring duos and used to calculate parental PGSs. Data were analyzed between March 2021 and January 2023.

Main Outcomes and Measures

Estimates of genetic nurture and direct genetic regression coefficients on broad depression and neuroticism.

Results

This study of 38 702 offspring with data on broad depression (mean [SD] age, 55.5 [8.2] years at study entry; 58% female) found limited preliminary evidence for a statistically significant association of genetic nurture with lifetime depression and neuroticism in adults. The estimated regression coefficient of the parental depression PGS on offspring neuroticism (β = 0.04, SE = 0.02, P = 6.63 × 10-3) was estimated to be approximately two-thirds (66%) that of the offspring's depression PGS (β = 0.06, SE = 0.01, P = 6.13 × 10-11). Evidence for an association between parental cannabis use disorder PGS and offspring depression was also found (β = 0.08, SE = 0.03, P = .02), which was estimated to be 2 times greater than the association between the offspring's cannabis use disorder PGS and their own depression status (β = 0.04, SE = 0.02, P = .07).

Conclusions and Relevance

The results of this cross-sectional study highlight the potential for genetic nurture to bias results from epidemiologic and genetic studies on depression or neuroticism and, with further replication and larger samples, identify potential avenues for future prevention and intervention efforts.

Early Motor Developmental Milestones and Personality Traits in Midlife: A 50-Year Follow-Up Study

Background The purpose of this study was to investigate if infants' age at attaining motor developmental milestones is associated with the big five personality traits 50 years later. Methods Mothers of 8395 infants from the Copenhagen Perinatal Cohort recorded a total of 12 motor developmental milestones during the first year of their infant's life. Information on at least one milestone was available for 1307 singletons with adult follow-up scores on the NEO-Five-Factor Inventory. The mean age at personality testing was 50.1 years. Results Slower attainment of motor milestones was associated with increased neuroticism and lower conscientiousness in midlife. All 12 motor developmental milestones explained a total of 2.4% of the variance in neuroticism, while they explained 3.2% of the variance in conscientiousness. These results remained significant after adjustment for the included family and perinatal covariates, as well as adult intelligence. Discussion The personality trait of neuroticism is a general risk factor for psychopathology and has in young adulthood been found to be associated with early motor development. However, evidence on associations of motor developmental milestones with other personality traits has been non-existent. These findings suggest that delays in early motor development may not only characterise individuals with later psychopathology, including schizophrenia, but may also be associated with personality traits such as neuroticism and conscientiousness through the life course.

Common and exclusive spontaneous neural activity patterns underlying pure generalized anxiety disorder and comorbid generalized anxiety disorder and depression

BACKGROUND

This study aimed to identify common and exclusive neural substrates underlying pure generalized anxiety disorder (GAD, G0) and comorbid GAD and depression (G1), assess whether they could assist in diagnosis and prediction of treatment response, and determine whether comorbid depression in GAD patients would change their neural plasticity.

METHODS

A longitudinal study was conducted, involving 98 patients (40 in the G0 group and 58 in the G1 group) and 54 healthy controls (HCs). The fractional amplitude of low-frequency fluctuations (fALFF), support vector machine, and support vector regression were employed.

RESULTS

The shared neural underpinnings across the two subtypes of GAD were hyperactivity in the right cerebellar Crus II and inferior temporal gyrus and hypoactivity in the right postcentral gyrus. The G1 group showed hypoactivity in the frontal gyrus, compared with HCs, and hyperactivity in the middle temporal gyrus, compared with the G0 group or HCs. These alterations could aid in diagnosis and the prediction of treatment response with high accuracy. After treatment, both the G1 and G0 groups showed higher fALFF than those before treatment but were located in different brain regions.

LIMITATIONS

The study was performed in a single center and subjects showed a fairly homogeneous ethnicity.

CONCLUSIONS

Common and exclusive neural substrates underlying the two subtypes of GAD were identified, which could assist in diagnosis and the prediction of treatment response. Pharmacotherapy for the two subtypes of GAD recruited different pathways, suggesting that comorbid depression in GAD patients would change their neural plasticity.

An examination of sudden gain prevalence across cognitive-behavioural therapy for anxiety and depressive disorders: A quantitative analysis and meta-analytic review

Sudden gains, incidences of unexpectedly large and stable session to session symptom reductions during psychotherapy, have been shown in samples of individuals receiving treatment for both anxiety and depressive disorders, although seemingly more frequently in sample receiving treatment for depressive disorders. This may suggest that sudden gains are a function of depression, but the high comorbidity between anxiety and depressive disorders makes this difficult to assess. Study One utilised a sample of 117 adults undergoing CBT for a principal anxiety disorder to explore the effect of comorbid depression on sudden gain prevalence. Results indicated that sudden gains were not more prevalent in the comorbid depression group; however, the frequency of sudden gains was significantly related to comorbid depressive disorder severity. Study Two involved a meta-analysis of 48 studies to compare sudden gain prevalence between trials of CBT for depressive disorders versus anxiety-related disorders. The results of the meta-analysis indicated significantly higher rates of sudden gains in samples with a principal depressive disorder diagnosis, compared to a principal anxiety disorder diagnosis. Sudden gains may therefore be driven by depression, but only at the more severe level.

Stability of associations between neuroticism and microstructural asymmetry of the cingulum during late childhood and adolescence: Insights from a longitudinal study with up to 11 waves

Adolescence is characterized by significant brain development and marks a period of the life span with an increased incidence of mood disorders, especially in females. The risk of developing mood disorders is also higher in individuals scoring high on neuroticism, a personality trait characterized by a tendency to experience negative and anxious emotions. We previously found in a cross-sectional study that neuroticism is associated with microstructural left-right asymmetry of the fronto-limbic white matter involved in emotional processing, with opposite effects in female and male adolescents. We now have extended this work collecting longitudinal data in 76 typically developing children and adolescents aged 7-18 years, including repeated MRI sampling up to 11 times. This enabled us, for the first time, to address the critical question, whether the association between neuroticism and frontal-limbic white matter asymmetry changes or remains stable across late childhood and adolescence. Neuroticism was assessed up to four times and showed good intraindividual stability and did not significantly change with age. Conforming our cross-sectional results, females scoring high on neuroticism displayed increased left-right cingulum fractional anisotropy (FA), while males showed decreased left-right cingulum FA asymmetry. Despite ongoing age-related increases in FA in cingulum, the association between neuroticism and cingulum FA asymmetry was already expressed in females in late childhood and remained stable across adolescence. In males, the association appeared to become more prominent during adolescence. Future longitudinal studies need to cover an earlier age span to elucidate the time point at which the relationship between neuroticism and cingulum FA asymmetry arises.

Individual differences in naturalistic learning link negative emotionality to the development of anxiety

Organisms learn from prediction errors (PEs) to predict the future. Laboratory studies using small financial outcomes find that humans use PEs to update expectations and link individual differences in PE-based learning to internalizing disorders. Because of the low-stakes outcomes in most tasks, it is unclear whether PE learning emerges in naturalistic, high-stakes contexts and whether individual differences in PE learning predict psychopathology risk. Using experience sampling to assess 625 college students' expected exam grades, we found evidence of PE-based learning and a general tendency to discount negative PEs, an "optimism bias." However, individuals with elevated negative emotionality, a personality trait linked to the development of anxiety disorders, displayed a global pessimism and learning differences that impeded accurate expectations and predicted future anxiety symptoms. A sensitivity to PEs combined with an aversion to negative PEs may result in a pessimistic and inaccurate model of the world, leading to anxiety.

The impact of personality on the risk and survival of breast cancer: a Mendelian randomization analysis

BACKGROUND

It has long been hypothesized that personality plays a causative role in incidence and outcome of breast cancer (BC), but epidemiological evidence of association between personality and BC is inconsistent.

METHOD

We used two-sample Mendelian randomization analysis to estimate the impact of personality on the risk and survival of BC. In total, 109 single nucleotide polymorphisms (SNPs) were utilized as instruments of neuroticism from a large-scale Genome-Wide Association Studies (GWAS), and five SNPs were utilized as instruments of extraversion from Genetic of Personality Consortium and 23andMe. Genetic association with the risk and survival of overall and individual subtype BC were obtained from the Breast Cancer Association Consortium.

RESULT

Neuroticism is significantly associated with the risk of overall BC [odds ratio (OR) 1.06; 95% confidence interval (CI) 1.01-1.11; p = 0.015] and the risk of luminal A BC (OR 1.09; 95% CI 1.03-1.16; p = 0.004). Extraversion is not associated with the risk of BC. None of neuroticism or extraversion is associated with the survival of BC.

CONCLUSION

Neuroticism was associated with a modest increased risk of BC and particularly luminal A BC.

Internalizing and externalizing subtypes of alcohol misuse and their relation to drinking motives

BACKGROUND

Several typologies have proposed two etiological pathways involved in the development of alcohol misuse which are associated with the internalizing and externalizing domains of psychopathology, respectively. This study's aim was to investigate this typology in a young adult sample, and test whether drinking motives, specifically drinking for negative or positive reinforcement, may provide a plausible mechanism characterizing these pathways.

METHOD

Mixture modeling was conducted on a set of internalizing (anxiety, depression, neuroticism), externalizing (antisocial behavior, conscientiousness, sensation seeking, drug use), and alcohol misuse items (binge drinking, alcohol use disorder symptoms [AUDsx]) measured by self-report in a sample of 9,807 college students. Linear regression and chi-square tests were used to determine how latent class membership was associated with drinking motives, demographics, and personality characteristics.

RESULTS

The model identified 3 latent classes: a Low Risk class (70%), an Internalizing class (19%) with elevated levels of internalizing traits/symptoms and AUDsx, and an Externalizing class (10%) with elevated levels of externalizing traits/symptoms and both binge drinking and AUDsx. All drinking motives were substantially elevated in the Internalizing and Externalizing (vs Low Risk) classes (p < 3.0E-10), while positive reinforcement motives were specifically elevated in the Externalizing (vs Internalizing) class (p < 2.0E-55). Personality comparisons further emphasized the relevance of class distinctions.

CONCLUSIONS

These findings provide additional support for both a specific internalizing and a broadband externalizing association with subtypes of alcohol misuse. Drinking motives may be useful intermediate indicators of these different risk processes.

Is Anxiety Sensitivity Associated with COVID-19 Related Distress and Adherence among Emerging Adults?

We investigated whether anxiety sensitivity (AS) is associated with increased distress and adherence to public health guidelines during the COVID-19 pandemic among undergraduates, and whether increased distress mediates the relationship between AS and increased adherence. An online cross-sectional survey was conducted with 1318 first- and second-year undergraduates (mean age of 19.2 years; 79.5% females) from five Canadian universities. Relevant subscales of the Substance Use Risk Profile Scale (SURPS) and the Big Five Inventory-10 (BFI-10) were used to assess AS and neuroticism. Three measures tapped distress: the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, and the Brief COVID-19 Stress Scales (CSS-B) for COVID-19-specific distress. The COVID-19 Adherence scale (CAD) assessed adherence to COVID-19 containment measures. AS was significantly independently associated with higher general distress (both anxiety and depressive symptoms) and higher COVID-19-specific distress, after controlling age, sex, study site, and neuroticism. Moreover, AS indirectly predicted greater adherence to COVID-19 preventive measures through higher COVID-19-specific distress. Interventions targeting higher AS might be helpful for decreasing both general and COVID-19-specific distress, whereas interventions targeting lower AS might be helpful for increasing adherence to public health containment strategies, in undergraduates.

Design and implementation of an EEG-based recognition mechanism for the openness trait of the Big Five

The differentiation between the openness and other dimensions of the Big Five personality model indicates that it is necessary to design a specific paradigm as a supplement to the Big Five recognition. The present study examined the relationship between one's openness trait of the Big Five model and the task-related power change of upper alpha band (10–12 Hz). We found that individuals from the high openness group displayed a stronger alpha synchronization over a frontal area in symbolic reasoning task, while the reverse applied in the deductive reasoning task. The results indicated that these two kinds of reasoning tasks could be used as supplement of the Big Five recognition. Besides, we divided one's openness score into three levels and proposed a hybrid-SNN (Spiking Neural Networks)-ANN (Analog Neural Networks) architecture based on EEGNet to recognize one's openness level, named Spike-EEGNet. The recognition accuracy of the two tasks was 90.6 and 92.2%. This result was highly significant for the validation of using a model with hybrid-SNN-ANN architecture for EEG-based openness trait recognition.

An Extended Swedish Adoption Study of Anxiety Disorder and Its Cross-Generational Familial Relationship With Major Depression

OBJECTIVE

To clarify, using an extended adoption design, the sources of parent-offspring transmission for anxiety disorder (AD) and its major subforms and their familial cross-generational relationship with major depression (MD).

METHODS

Offspring (born 1960-1992) and their parents, from six family types (intact, not-lived-with biological father or mother, lived-with step-father or step-mother, and adoptive), were ascertained from Swedish national samples. Diagnoses were obtained from national medical registers. We assessed three sources of parent-child resemblance: genes plus rearing, genes only, and rearing only. To test comorbidity effects, single diagnoses were assigned in comorbid cases based on frequency and recency.

RESULTS

For AD to AD parent-child transmission, best-estimate tetrachoric correlations for the three types of parent-offspring relationships genes plus rearing, genes only, and rearing only-equaled +0.16 (95% CI=0.16, 0.16), +0.12 (95% CI=0.10, 0.13), and +0.06 (95% CI=0.04, 0.07), respectively, with broadly similar results for MD to MD transmission. Cross-disorder cross-generation correlations were modestly lower, with genetic and rearing correlations for AD and MD estimated at +0.83 (95% CI=0.76, 0.90) and +0.83 (95% CI=0.69, 0.96), respectively. Analyses for panic disorder and generalized anxiety disorder (GAD) produced comparable findings, with the genetic correlation with MD modestly higher for generalized anxiety disorder than panic disorder. Applying a diagnostic hierarchy to comorbid cases resulted in a decline in cross-disorder cross-generation transmission with the estimated genetic correlation equaling +0.46 (95% CI=0.30, 0.62).

CONCLUSIONS AND RELEVANCE

For AD and its major subforms, cross-generational transmission includes both genetic and rearing effects. In traditional analyses, AD and MD demonstrate highly correlated genetic and rearing effects. The genetic correlation weakened when applying a diagnostic hierarchy.

Association of the Val66Met polymorphism of the BDNF gene and the deletional mutation of CYP2D6 gene with the prevalence and severity of depressive disorder in an Eastern Indian population

BACKGROUND

The Val66Met single nucleotide polymorphism (SNP) of the brain-derived growth factor (BDNF) and deletional mutation of the cytochrome P4502D6 (CYP2D6) have been reported to be linked to the etiology and severity of depressive disorders (DD) in a variable manner among different ethnicities and populations.

AIMS

The present study was aimed to find the relationship of mutational variations of these two neurotrophins with the severity of DD and their serum cortisol levels as a marker of the stress factor.

METHODS

In 104 drug-naïve newly diagnosed cases of DD and 106 control subjects, the severity of depression was assessed using the HAM-D score. Val66Met SNP of the BDNF was analyzed in them using restriction digestion of its polymerase chain reaction (PCR) product. CYP2D6 deletional variants were detected by the absence of their PCR products. Serum cortisol levels were measured by the enzyme-linked immunosorbent assay (ELISA) technique.

RESULTS

The Chi-square test (Χ² = 1.42, P = 0.49) did not show any higher prevalence of Val66Met SNP of the BDNF gene in the case group. A correlation coefficient (R) of -0.14 for HAM-D score with a P value of 0.29 signified no direct link of the severity of DD with this SNP. However, a Χ² of 12.68 with P < 0.001 indicated a significantly higher prevalence of the CYP2D6 deletional mutants in DD cases, whereas an R-value of 0.39 for HAM-D score with P < 0.001 suggested a significantly higher severity of DD having with them. Serum cortisol level showed a significant positive correlation with the deletional variants of CYP2D6 (R = 0.198, P = 0.04) and the HAM-D score (R = 0.22, P = 0.025).

CONCLUSION

We conclude that CYP2D6 deletion significantly contributes to the severity and stress factor in the DD patients in our study population. Early identification of these mutations may provide important molecular and cellular predisposition for the disease and may lay the ground for possible more effective measures of intervention.

Flattening the quality of life curve? A prospective person-centred study from Norway amid COVID-19

Purpose

We examined multidimensional, heterogeneous reactions to the COVID-19 pandemic and associated measures to provide further insights into the developmental processes of risk and adaptation.

Method

We used three-wave questionnaire data from 8156 individuals participating in the Norwegian County Public Health Survey assessed 1–5 months before and three (June 2020) and nine (December 2020) months after the outbreak. Latent profile and latent transition analyses were used to identify latent quality of life (QoL) classes and multiform changes, their probabilities, and predictors.

Results

We identified five distinct QoL classes of varying proportions, namely Flourishing (i.e. 24–40%), Content (31–46%), Content-Symptomatic (8–10%), Languishing (14–20%), and Troubled (2–5%). Despite higher levels of negative affect and lower levels of life satisfaction and positive emotions, most individuals remained in their pre-pandemic QoL profiles. Yet, changes occurred for a meaningful proportion, with transition to a less favourable class more common than to a favourable. Between time 1 and 3, the flourishing and troubled groups decreased by 40% and 60%, while the content and languishing groups increased by 48% and 43%, respectively. Favourable pre-pandemic relational (marital status, support, interpersonal trust, and belonging), health, and economy-related status predicted significantly lower odds of belonging to the high-risk groups both pre-pandemic and during the pandemic.

Conclusions

Overall, this study shows lower levels of QoL amid the COVID-19 pandemic, but substantial stability in the QoL distribution, and an overall levelling of the QoL distribution. Our findings also underscore the importance of financial, health-related, and social capital to QoL.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-022-03113-2.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.

Genetic Dissection of Temperament Personality Traits in Italian Isolates

Human personality (i.e., temperament and character) is a complex trait related to mental health, influenced by genetic and environmental factors. Despite the efforts performed during the past decades, its genetic background is only just beginning to be identified. With the aim of dissecting the genetic basis of temperament, we performed a Genome-Wide Association Study (GWAS) on Cloninger’s Temperament and Character Inventory in 587 individuals belonging to different Italian genetic isolates. Data analysis led to the identification of four new genes associated with different temperament scales, such as Novelty Seeking (NS), Harm Avoidance (HA), and Reward Dependence (RD). In detail, we identified suggestive and significant associations between: MAGI2 (highest p-value = 9.14 × 10⁻⁸), a gene already associated with schizophrenia and depressive disorder, and the NS–Extravagance scale; CALCB (highest p-value = 4.34 × 10⁻⁶), a gene likely involved in the behavioral evolution from wild wolf to domestic dog, and the NS–Disorderliness scale; BTBD3 (highest p-value = 2.152 × 10⁻⁸), a gene already linked to obsessive–compulsive disorder, and the HA–Fatigability scale; PRKN (highest p-value = 8.27 × 10⁻⁹), a gene described for early onset Parkinson’s disease, and the RD scale. Our work provides new relevant insights into the genetics of temperament, helping to elucidate the molecular basis of psychiatric disorders.

Population modeling with machine learning can enhance measures of mental health

BACKGROUND

Biological aging is revealed by physical measures, e.g., DNA probes or brain scans. In contrast, individual differences in mental function are explained by psychological constructs, e.g., intelligence or neuroticism. These constructs are typically assessed by tailored neuropsychological tests that build on expert judgement and require careful interpretation. Could machine learning on large samples from the general population be used to build proxy measures of these constructs that do not require human intervention?

RESULTS

Here, we built proxy measures by applying machine learning on multimodal MR images and rich sociodemographic information from the largest biomedical cohort to date: the UK Biobank. Objective model comparisons revealed that all proxies captured the target constructs and were as useful, and sometimes more useful, than the original measures for characterizing real-world health behavior (sleep, exercise, tobacco, alcohol consumption). We observed this complementarity of proxy measures and original measures at capturing multiple health-related constructs when modeling from, both, brain signals and sociodemographic data.

CONCLUSION

Population modeling with machine learning can derive measures of mental health from heterogeneous inputs including brain signals and questionnaire data. This may complement or even substitute for psychometric assessments in clinical populations.

Symptom-level modelling unravels the shared genetic architecture of anxiety and depression

Depression and anxiety are highly prevalent and comorbid psychiatric traits that cause considerable burden worldwide. Here we use factor analysis and genomic structural equation modelling to investigate the genetic factor structure underlying 28 items assessing depression, anxiety and neuroticism, a closely related personality trait. Symptoms of depression and anxiety loaded on two distinct, although highly genetically correlated factors, and neuroticism items were partitioned between them. We used this factor structure to conduct genome-wide association analyses on latent factors of depressive symptoms (89 independent variants, 61 genomic loci) and anxiety symptoms (102 variants, 73 loci) in the UK Biobank. Of these associated variants, 72% and 78%, respectively, replicated in an independent cohort of approximately 1.9 million individuals with self-reported diagnosis of depression and anxiety. We use these results to characterize shared and trait-specific genetic associations. Our findings provide insight into the genetic architecture of depression and anxiety and comorbidity between them.

Polygenic risk for neuroticism moderates response to gains and losses in amygdala and caudate: Evidence from a clinical cohort

BACKGROUND

Neuroticism is a heritable trait that contributes to the vulnerability to depression. We used polygenic risk scores (PRS) to examine genetic vulnerability to neuroticism and its associations with reward/punishment processing in a clinical sample with mood, anxiety, and substance use disorders. It was hypothesized that higher PRS for neuroticism is associated with attenuated neural responses to reward/punishment.

METHOD

Four hundred sixty-nine participants were genotyped and their PRSs for neuroticism were computed. Associations between PRS for neuroticism and anticipatory processing of monetary incentives were examined using functional magnetic resonance imaging.

RESULTS

Individuals with higher PRS for neuroticism showed less anticipatory activation in the left amygdala and caudate region to incentives regardless of incentive valence. Further, these individuals exhibited altered sensitivity to gain/loss processing in the right anterior insula. Higher PRSs for neuroticism were also associated with reduced processing of gains in the precuneus.

LIMITATIONS

The study population consisted of a transdiagnostic sample with dysfunctions in positive and negative valence processing. PRS for neuroticism may be correlated with current clinical symptoms due to the vulnerability to psychiatric disorders.

CONCLUSIONS

Greater genetic loading for neuroticism was associated with attenuated anticipatory responsiveness in reward/punishment processing with altered sensitivity to valences. Thus, a higher genetic risk for neuroticism may limit the degree to which positive and/or negative outcomes influence the current mood state, which may contribute to the development of positive and negative affective dysfunctions in individuals with mood, anxiety, and addictive disorders.

Prevalence, Factor Structure, and Heritability of Avoidant Personality Disorder

ABSTRACT

To review the community prevalence, factor structure, and heritability of avoidant personality disorder (AVPD), we reviewed the literature of empirical studies reported between years 1980 and 2020. Community point prevalence rates ranged from 0.8% to 5%, with one study of women older than 25 years finding a lifetime rate of 9.3%. A weighted point prevalence for studies involving both men and women was 3.3%. All factor analytic studies indicated a one factor solution. The themes were social inadequacy, feeling inferior, and fears of social rejection. Family studies of heritability for AVPD ranged from 0.18 to 0.56. Twin studies ranged from 0.28 to 0.71. The weighted average for heritability was 0.55. AVPD is an important clinical issue because it is prevalent in the community and has high morbidity and high heritability. Its single factor seems to suggest evaluation and treatment should be straightforward, but despite this, it tends to be underdiagnosed and undertreated.

The predictive capacity of psychiatric and psychological polygenic risk scores for distinguishing cases in a child and adolescent psychiatric sample from controls

BACKGROUND

Psychiatric traits are heritable, highly comorbid and genetically correlated, suggesting that genetic effects that are shared across disorders are at play. The aim of the present study is to quantify the predictive capacity of common genetic variation of a variety of traits, as captured by their PRS, to predict case-control status in a child and adolescent psychiatric sample including controls to reveal which traits contribute to the shared genetic risk across disorders.

METHOD

Polygenic risk scores (PRS) of 14 traits were used as predictor phenotypes to predict case-control status in a clinical sample. Clinical cases (N = 1,402), age 1-21, diagnostic categories: Autism spectrum disorders (N = 492), Attention-deficit/ hyperactivity disorders (N = 471), Anxiety (N = 293), disruptive behaviors (N = 101), eating disorders (N = 97), OCD (N = 43), Tic disorder (N = 50), Disorder of infancy, childhood or adolescence NOS (N = 65), depression (N = 64), motor, learning and communication disorders (N = 59), Anorexia Nervosa (N = 48), somatoform disorders (N = 47), Trauma/stress (N = 39) and controls (N = 1,448, age 17-84) of European ancestry. First, these 14 PRS were tested in univariate regression analyses. The traits that significantly predicted case-control status were included in a multivariable regression model to investigate the gain in explained variance when leveraging the genetic effects of multiple traits simultaneously.

RESULTS

In the univariate analyses, we observed significant associations between clinical status and the PRS of educational attainment (EA), smoking initiation (SI), intelligence, neuroticism, alcohol dependence, ADHD, major depression and anti-social behavior. EA (p-value: 3.53E-20, explained variance: 3.99%, OR: 0.66), and SI (p-value: 4.77E-10, explained variance: 1.91%, OR: 1.33) were the most predictive traits. In the multivariable analysis with these eight significant traits, EA and SI, remained significant predictors. The explained variance of the PRS in the model with these eight traits combined was 5.9%.

CONCLUSION

Our study provides more insights into the genetic signal that is shared between childhood and adolescent psychiatric disorders. As such, our findings might guide future studies on psychiatric comorbidity and offer insights into shared etiology between psychiatric disorders. The increase in explained variance when leveraging the genetic signal of different predictor traits supports a multivariable approach to optimize precision accuracy for general psychopathology.

Etiological pathways of depressive and anxiety symptoms linked to personality traits: A genetically-informative longitudinal study

BACKGROUND

The comorbidity of depression and anxiety is associated with an increased risk of prolonged adverse mental health status. However, little is currently known about their genetic and environmental influences that help to explain both the comorbidity and distinctiveness. Using longitudinal twin data, the present study investigated both the overlapping and distinct relationships between depression and anxiety viewed from the perspective of Gray's Reinforcement Sensitivity Theory (RST): two personality traits of the Behavioral Inhibition and Activation Systems (BIS and BAS).

METHODS

A total of 422 twin pairs (298 monozygotic and 124 dizygotic pairs) participated by completing a personality questionnaire at wave 1, and mood symptoms questionnaires at wave 2. The waves were on average 2.23 years apart.

RESULTS

Multivariate Cholesky decomposition indicated that the genetic variance of the personality traits (BIS and BAS) explained all of the genetic variance in depressive and anxiety symptoms. Additionally, genetic factors related to the BIS positively explained depressive and anxiety symptoms, whereas genetic factors related to the BAS negatively explained only depressive symptoms.

LIMITATIONS

Limitations include shorter time interval and the reliance on self-reported data.

CONCLUSIONS

The present study provided evidence explaining the overlap and differentiation of depressive and anxiety symptoms by using data on personality traits in a longitudinal, genetically-informative design. The findings suggested the personality traits from Gray's RST model played an important role in the prediction, and clarified the description, of both depressive and anxiety symptoms.

Marital Satisfaction as a Moderator of Molecular Genetic Influences on Mental Health

The quality of one's romantic relationship is associated with mental health. Low levels of relationship quality may be a stressor that triggers a predisposition or diathesis to mental illness. Analyses were conducted to examine whether relationship quality moderated the association between polygenic risk scores (PRSs) for several mental health syndromes on phenotypic measures of those syndromes. Data were drawn from the Midlife in the United States (MIDUS) study of health and well-being. A subsample was genotyped, and PRSs were calculated. The PRS for anxiety was more strongly related to the anxiety phenotype when satisfaction was low than when satisfaction was high, providing evidence of a genetic susceptibility process between marital distress and anxiety. The expression of genetic influences on a phenotype in the presence of certain environmental stressors is complex and may depend on the specific phenotype and the methodology by which genetic influences are estimated.

Prevalence and psychosocial risk factors of nonsuicidal self-injury among adolescents during the COVID-19 outbreak

The research investigated the prevalence of nonsuicidal self-injury (NSSI) during the COVID-19 outbreak and identified the psychosocial risk factors among junior high school students in Taiwan. Cross-sectional design was applied and 1,060 participants (Mage = 14.66, SD = 0.86 years) were recruited into the study. The prevalence of NSSI was found to be 40.9% (95% confidence interval, 37.9%-43.9%) during the COVID-19 outbreak. The results suggested that the self-injurers group were mostly female, and scored significantly higher in neuroticism, depression, impulsivity, alexithymia, virtual social support, dissatisfaction with academic performance, and lower in subjective wellbeing, self-esteem, actual social support, and family function than the non-injurers group. In addition, high neuroticism, low self-esteem, high virtual social support, high impulsivity, and high alexithymia were independently predictive in the logistic regression analysis. The principal results of this study suggested that NSSI was extremely prevalent among adolescents during the COVID-19 outbreak, and in particularly, personality and virtual environment risk factors and enhancing self-esteem should be the focus of NSSI preventive strategies when targeting this age population. Our results provide a reference towards designing NSSI prevention programs geared toward the high school population during the COVID-19 pandemic.

Causal influences of neuroticism on mental health and cardiovascular disease

We investigated the relationship between neuroticism and 16 mental and 18 physical traits using summary results of genome-wide association studies for these traits. LD score regression was used to investigate genetic correlations between neuroticism and the 34 health outcomes. Mendelian randomization was performed to investigate mutual causal relationships between neuroticism and the 34 health outcomes. Neuroticism genetically correlates with a majority of health-related traits and confers causal effects on 12 mental traits (major depressive disorder (MDD), insomnia, subjective well-being (SWB, negatively), schizophrenia, attention-deficit/hyperactivity disorder, alcohol dependence, loneliness, anorexia nervosa, anxiety disorder, bipolar disorder, obsessive-compulsive disorder, and psychiatric disorders) and two physical diseases (cardiovascular disease and hypertensive disease). Conversely, MDD, SWB, and insomnia have a causal effect on neuroticism. We highlighted key genes contributing to the causal associations between neuroticism and MDD, including RBFOX1, RERE, SOX5, and TCF4, and those contributing to the causal associations between neuroticism and cardiovascular diseases, including MAD1L1, ARNTL, RERE, and SOX6. The present study indicates that genetic variation mediates the causal influences of neuroticism on mental health and cardiovascular diseases.

State anxiety influences P300 and P600 event-related potentials over parietal regions in the hollow-mask illusion experiment

The hollow-mask illusion is an optical illusion where a concave face is perceived as convex. It has been demonstrated that individuals with schizophrenia and anxiety are less susceptible to the illusion than controls. Previous research has shown that the P300 and P600 event-related potentials (ERPs) are affected in individuals with schizophrenia. Here, we examined whether individual differences in neuroticism and anxiety scores, traits that have been suggested to be risk factors for schizophrenia and anxiety disorders, affect ERPs of healthy participants while they view concave faces. Our results confirm that the participants were susceptible to the illusion, misperceiving concave faces as convex. We additionally demonstrate significant interactions of the concave condition with state anxiety in central and parietal electrodes for P300 and parietal areas for P600, but not with neuroticism and trait anxiety. The state anxiety interactions were driven by low-state anxiety participants showing lower amplitudes for concave faces compared to convex. The P300 and P600 amplitudes were smaller when a concave face activated a convex face memory representation, since the stimulus did not match the active representation. The opposite pattern was evident in high-state anxiety participants in regard to state anxiety interaction and the hollow-mask illusion, demonstrating larger P300 and P600 amplitudes to concave faces suggesting impaired late information processing in this group. This could be explained by impaired allocation of attentional resources in high-state anxiety leading to hyperarousal to concave faces that are unexpected mismatches to standard memory representations, as opposed to expected convex faces.

Aging faster: worry and rumination in late life are associated with greater brain age

Older adults with anxiety have lower gray matter brain volume-a component of accelerated aging. We have previously validated a machine learning model to predict brain age, an estimate of an individual's age based on voxel-wise gray matter images. We investigated associations between brain age and anxiety, depression, stress, and emotion regulation. We recruited 78 participants (≥50 years) along a wide range of worry severity. We collected imaging data and computed voxel-wise gray matter images, which were input into an existing machine learning model to estimate brain age. We conducted a multivariable linear regression between brain age and age, sex, race, education, worry, anxiety, depression, rumination, neuroticism, stress, reappraisal, and suppression. We found that greater brain age was significantly associated with greater age, male sex, greater worry, greater rumination, and lower suppression. Male sex, worry, and rumination are associated with accelerated aging in late life and expressive suppression may have a protective effect. These results provide evidence for the transdiagnostic model of negative repetitive thoughts, which are associated with cognitive decline, amyloid, and tau.

Gene-based association analysis identifies 190 genes affecting neuroticism

Neuroticism is a personality trait, which is an important risk factor for psychiatric disorders. Recent genome-wide studies reported about 600 genes potentially influencing neuroticism. Little is known about the mechanisms of their action. Here, we aimed to conduct a more detailed analysis of genes that can regulate the level of neuroticism. Using UK Biobank-based GWAS summary statistics, we performed a gene-based association analysis using four sets of within-gene variants, each set possessing specific protein-coding properties. To guard against the influence of strong GWAS signals outside the gene, we used a specially designed procedure called “polygene pruning”. As a result, we identified 190 genes associated with neuroticism due to the effect of within-gene variants rather than strong GWAS signals outside the gene. Thirty eight of these genes are new. Within all genes identified, we distinguished two slightly overlapping groups obtained from using protein-coding and non-coding variants. Many genes in the former group included potentially pathogenic variants. For some genes in the latter group, we found evidence of pleiotropy with gene expression. Using a bioinformatics analysis, we prioritized the neuroticism genes and showed that the genes that contribute to neuroticism through their within-gene variants are the most appropriate candidate genes.

The influence of X chromosome variants on trait neuroticism

Autosomal variants have successfully been associated with trait neuroticism in genome-wide analysis of adequately powered samples. But such studies have so far excluded the X chromosome from analysis. Here, we report genetic association analyses of X chromosome and XY pseudoautosomal single nucleotide polymorphisms (SNPs) and trait neuroticism using UK Biobank samples (N = 405,274). Significant association was found with neuroticism on the X chromosome for 204 markers found within three independent loci (a further 783 were suggestive). Most of the lead neuroticism-related X chromosome variants were located in intergenic regions (n = 397). Involvement of HS6ST2, which has been previously associated with sociability behaviour in the dog, was supported by single SNP and gene-based tests. We found that the amino acid and nucleotide sequences are highly conserved between dogs and humans. From the suggestive X chromosome variants, there were 19 nearby genes which could be linked to gene ontology information. Molecular function was primarily related to binding and catalytic activity; notable biological processes were cellular and metabolic, and nucleic acid binding and transcription factor protein classes were most commonly involved. X-variant heritability of neuroticism was estimated at 0.22% (SE = 0.05) from a full dosage compensation model. A polygenic X-variant score created in an independent sample (maximum N ≈ 7,300) did not predict significant variance in neuroticism, psychological distress, or depressive disorder. We conclude that the X chromosome harbours significant variants influencing neuroticism, and might prove important for other quantitative traits and complex disorders.

A major role for common genetic variation in anxiety disorders

Anxiety disorders are common, complex psychiatric disorders with twin heritabilities of 30-60%. We conducted a genome-wide association study of Lifetime Anxiety Disorder (n_case = 25 453, n_control = 58 113) and an additional analysis of Current Anxiety Symptoms (n_case = 19 012, n_control = 58 113). The liability scale common variant heritability estimate for Lifetime Anxiety Disorder was 26%, and for Current Anxiety Symptoms was 31%. Five novel genome-wide significant loci were identified including an intergenic region on chromosome 9 that has previously been associated with neuroticism, and a locus overlapping the BDNF receptor gene, NTRK2. Anxiety showed significant positive genetic correlations with depression and insomnia as well as coronary artery disease, mirroring findings from epidemiological studies. We conclude that common genetic variation accounts for a substantive proportion of the genetic architecture underlying anxiety.

A longitudinal study of personality traits, anxiety, and depressive disorders in young adults

BACKGROUND

How personality traits, anxiety, and depressive disorders relate longitudinally has implications for etiologic research and prevention. We sought to determine how neuroticism and extraversion relate to first-onset anxiety and depressive disorders in young adults.

DESIGN

An inception cohort of 489 university freshmen was followed for 6 years.

METHOD

Participants self-reported personality traits using the Eysenck Personality Questionnaire. Anxiety and depressive disorders were assessed using the Diagnostic Interview Schedule.

RESULTS

Baseline neuroticism predicted first-onset panic disorder, agoraphobia, generalized anxiety disorder (GAD), and major depressive disorder (MDD), while introversion predicted first-onset agoraphobia (moderate-large effects). Participants who developed panic disorder, agoraphobia, GAD, or MDD had increases in neuroticism if the disorder was current at follow-up (moderate-large effects). Participants who developed MDD but were in remission by follow-up had a moderate increase in neuroticism.

CONCLUSIONS

High neuroticism in young adulthood is either a true risk factor, or marker of risk, for first-onset anxiety and depressive disorders, as is low extraversion for agoraphobia. The current data suggest large neuroticism "state" effects for panic disorder, agoraphobia, and MDD, and moderate "scar" effects from MDD. Though many clinicians and researchers regard personality traits simply as "vulnerability" factors, longitudinal analyses suggest additional complexity.

Emergency department visits for panic attacks and ambient temperature: A time-stratified case-crossover analysis

BACKGROUND

Panic disorder is a common anxiety disorder affecting up to 5% of the population. Although its pathogenesis is unclear, evidence about its association with ambient temperature is limited. We aimed to investigate the association between short-term exposure to increased ambient temperature and exacerbation of panic attacks requiring emergency department visits.

METHODS

From the national emergency database of South Korea, we identified 1,926 patients who presented with panic attacks at the emergency department in Seoul from 2008 to 2014. Using a time-stratified case-crossover design and conditional logistic regression analysis, we compared ambient temperature levels on emergency department visits and correspondingly matched-control days.

RESULTS

Increased ambient temperature levels were significantly associated with panic attacks. The risk of a panic attack increased by 2.2% (95% confidence interval, 0.7-3.8%) per every 1°C increase in temperature. This association was significant after adjusting for air pollutants.

CONCLUSIONS

Our results provide new evidence that short-term exposure to increased ambient temperature may increase the risk of exacerbation of panic attacks. These findings may provide a basis for further research to establish the association between panic attacks and ambient temperature, thus establishing preventive measures for panic attacks.

Distress Tolerance as a Familial Vulnerability for Distress-Misery Disorders

Low perceived distress tolerance (DT), a trait-like individual difference factor reflecting one's perceived ability to withstand aversive affective states, has been linked with current internalizing and substance use disorders (SUDs). However, perceived DT has not been systematically evaluated as a familial, transdiagnostic vulnerability factor for internalizing and SUDs. The current study tested whether perceived DT runs in families and whether it is reduced among individuals with versus without remitted internalizing/SUD psychopathology. Perceived DT and internalizing/SUDs were measured in 638 individuals (nested within 256 families). Analyses also adjusted for the effects of neuroticism to test whether DT was a specific vulnerability factor independent of temperamental negative affect. Analyses revealed that perceived DT was lower in individuals with remitted distress (i.e., major depression, generalized anxiety disorder, posttraumatic stress disorder) but not fear disorders (i.e., panic disorder, social anxiety disorder, specific phobia, obsessive-compulsive spectrum disorders) relative to healthy controls, and the effect of distress-misery disorder history remained significant when adjusting for neuroticism. Perceived DT was not significantly different among individuals with versus without a remitted SUD. There were no effects for comorbid SUD and distress-misery disorders. Finally, perceived DT was also significantly correlated within families, suggesting that it runs in families. Overall, results suggest that independent of neuroticism, low perceived DT is a familial vulnerability for distress (but not fear or substance use) disorders.

Polygenic prediction of PTSD trajectories in 9/11 responders

BACKGROUND

Genetics hold promise of predicting long-term post-traumatic stress disorder (PTSD) outcomes following trauma. The aim of the current study was to test whether six hypothesized polygenic risk scores (PRSs) developed to capture genetic vulnerability to psychiatric conditions prospectively predict PTSD onset, severity, and 18-year course after trauma exposure.

METHODS

Participants were 1490 responders to the World Trade Center (WTC) disaster (mean age at 9/11 = 38.81 years, s.d. = 8.20; 93.5% male; 23.8% lifetime WTC-related PTSD diagnosis). Prospective longitudinal data on WTC-related PTSD symptoms were obtained from electronic medical records and modelled as PTSD trajectories using growth mixture model analysis. Independent regression models tested whether six hypothesized psychiatric PRSs (PTSD-PRS, Re-experiencing-PRS, Generalized Anxiety-PRS, Schizophrenia-PRS, Depression-PRS, and Neuroticism-PRS) are predictive of WTC-PTSD outcomes: lifetime diagnoses, average symptom severity, and 18-year symptom trajectory. All analyses were adjusted for population stratification, 9/11 exposure severity, and multiple testing.

RESULTS

Depression-PRS predicted PTSD diagnostic status (OR 1.37, CI 1.17-1.61, adjusted p = 0.001). All PRSs, except PTSD-PRS, significantly predicted average PTSD symptoms (β = 0.06-0.10, adjusted p < 0.05). Re-experiencing-PRS, Generalized Anxiety-PRS and Schizophrenia-PRS predicted the high severity PTSD trajectory class (ORs 1.21-1.28, adjusted p < 0.05). Finally, PRSs prediction was independent of 9/11 exposure severity and jointly accounted for 3.7 times more variance in PTSD symptoms than the exposure severity.

CONCLUSIONS

Psychiatric PRSs prospectively predicted WTC-related PTSD lifetime diagnosis, average symptom severity, and 18-year trajectory in responders to 9/11 disaster. Jointly, PRSs were more predictive of subsequent PTSD than the exposure severity. In the future, PRSs may help identify at-risk responders who might benefit from targeted prevention approaches.

Genetic heterogeneity in self-reported depressive symptoms identified through genetic analyses of the PHQ-9

BACKGROUND

Depression is a clinically heterogeneous disorder. Previous large-scale genetic studies of depression have explored genetic risk factors of depression case-control status or aggregated sums of depressive symptoms, ignoring possible clinical or genetic heterogeneity.

METHODS

We analyse data from 148 752 subjects of white British ancestry in the UK Biobank who completed nine items of a self-rated measure of current depressive symptoms: the Patient Health Questionnaire (PHQ-9). Genome-Wide Association analyses were conducted for nine symptoms and two composite measures. LD Score Regression was used to calculate SNP-based heritability (h2SNP) and genetic correlations (rg) across symptoms and to investigate genetic correlations with 25 external phenotypes. Genomic structural equation modelling was used to test the genetic factor structure across the nine symptoms.

RESULTS

We identified nine genome-wide significant genomic loci (8 novel), with no overlap in loci across symptoms. h2SNP ranged from 6% (concentration problems) to 9% (appetite changes). Genetic correlations ranged from 0.54 to 0.96 (all p < 1.39 × 10-3) with 30 of 36 correlations being significantly smaller than one. A two-factor model provided the best fit to the genetic covariance matrix, with factors representing 'psychological' and 'somatic' symptoms. The genetic correlations with external phenotypes showed large variation across the nine symptoms.

CONCLUSIONS

Patterns of SNP associations and genetic correlations differ across the nine symptoms, suggesting that current depressive symptoms are genetically heterogeneous. Our study highlights the value of symptom-level analyses in understanding the genetic architecture of a psychiatric trait. Future studies should investigate whether genetic heterogeneity is recapitulated in clinical symptoms of major depression.

Generalized Anxiety Disorder: Revisited

Generalized Anxiety Disorder (GAD) from an official recognition as a residual category in DSM-III has come a long way to be appreciated as a common underlying anxiety pathway in the literature. Despite still being defined as extreme anxiety and worry upon performance and about one's health, GAD seems to be a general umbrella of anxiety, covering even social anxiety and panic disorder (PD) and even when not treated and chronic, leading to major depressive disorder (MDD). Along the line of some other similar studies and contentions, in the present study we sought to validate the hypothesis of GAD encompassing social anxiety as well as performance anxiety and its extension to PD and MDD. We also examined the onset of each diagnostic category of GAD, PD and MDD and their developmental course in our clinical sample. 113 patients with Generalized Anxiety Disorder (GAD) out of 295 referrals to our mood and anxiety clinic during the three months of May-July 2019, were identified and included in this research. We expanded the definition of GAD as per our clinical observation to include any situations triggering the anxiety including any performance and social situations and did not exclude if the anxiety led to panic attacks. The results of our study showed that an encompassing GAD (including performance and social anxiety) has an early onset, recognized partially in childhood, but mostly during adolescence. An untreated GAD was complicated with panic disorder and episodes of major depression, each with an onset later in life. GAD in our study was also found to be familial and genetic, while its post-morbid depression seemed to be more a reaction to a long-standing untreated anxiety. The findings of our study if replicated has research implication of better understanding the developmental course of mood disorders and hold the promise of more targeted treatments of anxiety, panic and depression in clinical practice.

Integration of postmortem amygdala expression profiling, GWAS, and functional cell culture assays: neuroticism-associated synaptic vesicle glycoprotein 2A (SV2A) gene is regulated by miR-133a and miR-218

Recent genome-wide studies have begun to identify gene variants, expression profiles, and regulators associated with neuroticism, anxiety disorders, and depression. We conducted a set of experimental cell culture studies of gene regulation by micro RNAs (miRNAs), based on genome-wide transcriptome, proteome, and miRNA expression data from twenty postmortem samples of lateral amygdala from donors with known neuroticism scores. Using Ingenuity Pathway Analysis and TargetScan, we identified a list of mRNA-protein-miRNA sets whose expression patterns were consistent with miRNA-based translational repression, as a function of trait anxiety. Here, we focused on one gene from that list, which is of particular translational significance in Psychiatry: synaptic vesicle glycoprotein 2A (SV2A) is the binding site of the anticonvulsant drug levetiracetam ((S)-α-Ethyl-2-oxo-1-pyrrolidineacetamide), which has shown promise in anxiety disorder treatments. We confirmed that SV2A is associated with neuroticism or anxiety using an original GWAS of a community cohort (N = 1,706), and cross-referencing a published GWAS of multiple cohorts (Ns ranging from 340,569 to 390,278). Postmortem amygdala expression profiling implicated three putative regulatory miRNAs to target SV2A: miR-133a, miR-138, and miR-218. Moving from association to experimental causal testing in cell culture, we used a luciferase assay to demonstrate that miR-133a and miR-218, but not miR-138, significantly decreased relative luciferase activity from the SV2A dual-luciferase construct. In human neuroblastoma cells, transfection with miR-133a and miR-218 reduced both endogenous SV2A mRNA and protein levels, confirming miRNA targeting of the SV2A gene. This study illustrates the utility of combining postmortem gene expression data with GWAS to guide experimental cell culture assays examining gene regulatory mechanisms that may contribute to complex human traits. Identifying specific molecular mechanisms of gene regulation may be useful for future clinical applications in anxiety disorders or other forms of psychopathology.

Genome-wide association study of shared liability to anxiety disorders in Army STARRS

Anxiety disorders (ANX), namely generalized anxiety, panic disorder, and phobias, are common, etiologically complex syndromes that show increasing prevalence and comorbidity throughout adolescence and beyond. Few genome-wide association studies (GWAS) examining ANX risk have been published and almost exclusively in individuals of European ancestry. In this study, we phenotyped participants from the Army Study To Assess Risk and Resilience in Servicemembers (STARRS) to approximate DSM-based ANX diagnoses. We factor-analyzed those to create a single dimensional anxiety score for each subject. GWAS were conducted using that score within each of three ancestral groups (EUR, AFR, LAT) and then meta-analyzed across ancestries (N_Total = 16,510). We sought to (a) replicate prior ANX GWAS findings in ANGST; (b) determine whether results extended to other ancestry groups; and (c) meta-analyze with ANGST for increased power to identify novel susceptibility loci. No reliable genome-wide significant SNP associations were detected in STARRS. However, SNPs within the CAMKMT gene located in region 2p21 associated with shared ANX risk in ANGST were replicated in EUR soldiers but not other ancestry groups. Combining EUR STARRS and ANGST (N = 28,950) yielded a more robust 2p21 association signal (p = 9.08x10^-11 ). Gene-based analyses supported three genes within 2p21 and LBX1 on chromosome 10. More powerful ANX genetic studies will be required to identify further loci.