Genetic and environmental sources of covariation between generalized anxiety disorder and neuroticism

A genome-wide investigation into the underlying genetic architecture of personality traits and overlap with psychopathology

Personality is influenced by both genetic and environmental factors and is associated with other psychiatric traits such as anxiety and depression. The 'big five' personality traits, which include neuroticism, extraversion, agreeableness, conscientiousness and openness, are a widely accepted and influential framework for understanding and describing human personality. Of the big five personality traits, neuroticism has most often been the focus of genetic studies and is linked to various mental illnesses, including depression, anxiety and schizophrenia. Our knowledge of the genetic architecture of the other four personality traits is more limited. Here, utilizing the Million Veteran Program cohort, we conducted a genome-wide association study in individuals of European and African ancestry. Adding other published data, we performed genome-wide association study meta-analysis for each of the five personality traits with sample sizes ranging from 237,390 to 682,688. We identified 208, 14, 3, 2 and 7 independent genome-wide significant loci associated with neuroticism, extraversion, agreeableness, conscientiousness and openness, respectively. These findings represent 62 novel loci for neuroticism, as well as the first genome-wide significant loci discovered for agreeableness. Gene-based association testing revealed 254 genes showing significant association with at least one of the five personality traits. Transcriptome-wide and proteome-wide analysis identified altered expression of genes and proteins such as CRHR1, SLC12A5, MAPT and STX4. Pathway enrichment and drug perturbation analyses identified complex biology underlying human personality traits. We also studied the inter-relationship of personality traits with 1,437 other traits in a phenome-wide genetic correlation analysis, identifying new associations. Mendelian randomization showed positive bidirectional effects between neuroticism and depression and anxiety, while a negative bidirectional effect was observed for agreeableness and these psychiatric traits. This study improves our comprehensive understanding of the genetic architecture underlying personality traits and their relationship to other complex human traits.

Common genetic and environmental bases of the mental disorders and personality traits: Special focus on the hierarchical model of psychopathology and NEO-PI-R facets

OBJECTIVE

This study examined whether phenotypic correlations between psychopathological dimensions and personality traits of different hierarchical levels originate from common genetic and environmental sources of variance.

METHOD

Participants were 386 monozygotic and 204 dizygotic twins. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) was applied along with the Revised NEO Personality Inventory (NEO-PI-R). The results of the CFA confirmed the hypothesis of the internalizing and externalizing dimensions underlying PDSQ scales.

RESULTS

The results indicated a significantly greater role of genetic compared to environmental factors in the relationship between internalizing psychopathology and personality traits. Facets of neuroticism showed positive genetic links with internalizing disorders, while negative genetic links were shown for all facets of extraversion except excitement-seeking, competence, self-discipline, achievement striving, actions, and trust. Lower-order personality traits were shown to be associated with internalizing disorders more intensively than the broader domains to which they belong, both at the phenotypic and genetic levels.

CONCLUSIONS

High neuroticism, together with several facets from the domain of extraversion and conscientiousness seems to represent an increased genetic susceptibility to the disorders from the internalizing spectrum. Results also suggest that specific environmental factors which are not shared with personality traits contribute to the internalizing symptoms.

Predictive modeling of neuroticism in depressed and non-depressed cohorts using voice features

BACKGROUND

Neuroticism's impact on psychopathological and physical health issues has significant public health implications. Multiple studies confirm its predictive effect on suicide risk among depressed patients. However, previous research lacks a standardized criterion for assessing neuroticism through speech, often relying on simple features (such as pitch, loudness and MFCCs). This study aims to improve upon this by extracting features using advanced pre-trained speaker embedding models (i-vector and x-vector extractors). Additionally, unlike prior studies utilizing general population data, we explore neuroticism prediction in depressed and non-depressed subgroups.

METHODS

We collected edited discourse data from clinical interviews of 3580 depressed individuals and 4016 healthy individuals from the CONVERGE study. Instead of solely extracting Low-Level Acoustic Descriptors, we incorporated i-vector and x-vector features. We compared the performance of three different features in predicting neuroticism and explored their combination to enhance model accuracy.

RESULTS

The SVR model, combining three speech features with downscaled features to 300, exhibited the highest performance in predicting neuroticism scores. It achieved a coefficient of determination (R-squared) of 0.3 or higher and a correlation of 0.56 between predicted and actual values. The predictive classification accuracy of speech features for neuroticism in specific populations (healthy and depressed) exceeded 60 %.

LIMITATIONS

This study included only women.

CONCLUSION

Combining diverse speech features enhances the predictive capacity of models using speech features to assess neuroticism, particularly in specific populations. This study lays the foundation for future exploration of speech features in neuroticism prediction.

A genome-wide investigation into the underlying genetic architecture of personality traits and overlap with psychopathology

Personality is influenced by both genetic and environmental factors and is associated with other psychiatric traits such as anxiety and depression. The "Big Five" personality traits, which include neuroticism, extraversion, agreeableness, conscientiousness, and openness, are a widely accepted and influential framework for understanding and describing human personality. Of the big five personality traits, neuroticism has most often been the focus of genetic studies and is linked to various mental illnesses including depression, anxiety, and schizophrenia. Our knowledge of the genetic architecture of the other four personality traits is more limited. Utilizing the Million Veteran Program (MVP) cohort we conducted a genome-wide association study (GWAS) in individuals of European and African ancestry. Adding other published data, we performed GWAS meta-analysis for each of the five personality traits with sample sizes ranging from 237,390 to 682,688. We identified 158, 14, 3, 2, and 7 independent genome-wide significant (GWS) loci associated with neuroticism, extraversion, agreeableness, conscientiousness, and openness, respectively. These findings represent 55 novel loci for neuroticism, as well as the first GWS loci discovered for extraversion and agreeableness. Gene-based association testing revealed 254 genes showing significant association with at least one of the five personality traits. Transcriptome-wide and proteome-wide analysis identified altered expression of genes and proteins such as CRHR1, SLC12A5, MAPT, and STX4. Pathway enrichment and drug perturbation analyses identified complex biology underlying human personality traits. We also studied the inter-relationship of personality traits with 1,437 other traits in a phenome-wide genetic correlation analysis, identifying new associations. Mendelian randomization showed positive bidirectional effects between neuroticism and depression and anxiety while a negative bidirectional effect was observed for agreeableness and these psychiatric traits. This study improves our comprehensive understanding of the genetic architecture underlying personality traits and their relationship to other complex human traits.

Brain-gut microbiome profile of neuroticism predicts food addiction in obesity: A transdiagnostic approach

Neuroticism is one of the most robust risk factors for addictive behaviors including food addiction (a key contributor to obesity), although the associated mechanisms are not well understood. A transdiagnostic approach was used to identify the neuroticism-related neuropsychological and gut metabolomic patterns associated with food addiction. Predictive modeling of neuroticism was implemented using multimodal features (23 clinical, 13,531 resting-state functional connectivity (rsFC), 336 gut metabolites) in 114 high body mass index (BMI ≥25 kg/m2) (cross-sectional) participants. Gradient boosting machine and logistic regression models were used to evaluate classification performance for food addiction. Neuroticism was significantly associated with food addiction (P < 0.001). Neuroticism-related features predicted food addiction with high performance (89% accuracy). Multimodal models performed better than single-modal models in predicting food addiction. Transdiagnostic alterations corresponded to rsFC involved in the emotion regulation, reward, and cognitive control and self-monitoring networks, and the metabolite 3-(4-hydroxyphenyl) propionate, as well as anxiety symptoms. Neuroticism moderated the relationship between BMI and food addiction. Neuroticism drives neuropsychological and gut microbial signatures implicated in dopamine synthesis and inflammation, anxiety, and food addiction. Such transdiagnostic models are essential in identifying mechanisms underlying food addiction in obesity, as it can help develop multiprong interventions to improve symptoms.

Personality, Preoperative Anxiety, and Postoperative Outcomes: A Review

Research has shown that personality is associated with anxiety levels in the general population. However, little is known about the relationship between personality and preoperative anxiety and the subsequent health outcomes in patients undergoing surgery. Therefore, this review aimed to identify studies that explored the relationship between personality traits and preoperative anxiety, as well as their association with postoperative outcomes. Existing literature shows that anxiety may play an intermediary role in the relationship between personality and postoperative outcomes. Severe anxiety may partially explain the adverse effects of certain personality traits, such as neuroticism, on postoperative outcomes. However, the relationship between personality traits, preoperative anxiety, and postoperative outcomes remains unclear. Interventions such as clinical evaluation, preoperative counseling, and management strategies can be of great value in identifying and resolving patients' anxiety and negative emotions to improve postoperative outcomes.

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.

Anxiety Screening among the General Population of Latvia and Associated Factors

Background and Objectives: The aim of this study was to determine the point prevalence of at least mild anxiety symptoms and symptoms of generalized anxiety disorder in the Latvian general population, and to analyze the associated factors. Materials and Methods: A computer-assisted face-to-face survey was conducted in 2019−2020 with a multistage stratified probability sample of the Latvian general adult population (n = 2687). Anxiety was assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale; a score of ≥5 was defined as indicating the presence of mild symptoms of anxiety, and a score of ≥10 as the cutoff for identifying cases of generalized anxiety disorder. The Patient Health Questionnaire 9 (PHQ-9) and MINI International Neuropsychiatric Interview (M.I.N.I.) modules were used for assessing comorbid conditions. Multinomial logistic regression was conducted. Results: The point prevalence of mild anxiety symptoms was 10.9%. The point prevalence of generalized anxiety disorder symptoms was 3.9%. Higher odds of mild anxiety symptoms were detected in respondents of a young age (vs. 65 y.o. and older, aOR 3.1, p < 0.001), unmarried respondents (vs. married/cohabiting, aOR 1.5, p = 0.02), those living in the capital city (aOR 1.6, p = 0.008) or rural areas (aOR 1.5, p = 0.03) (vs. other towns), respondents with poor self-rated health (vs. good, aOR 2.6, p < 0.001), and diagnosed alcohol use disorder (aOR 1.9, p < 0.001), suicidal behavior (aOR 2.4, p < 0.001), and symptoms of depression (aOR 6.4, p < 0.001) (vs. no such conditions). As for symptoms of generalized anxiety disorder, female sex (vs. males, aOR 2.5, p = 0.003), age below 44 years (vs. 65+, aOR 6.2, p = 0.002), average self-rated health (vs. good, aOR 2.6, p = 0.005), and poor self-rated health (vs. good, aOR 5.3, p < 0.001), together with comorbid suicidal behavior (aOR 6.1, p < 0.001) and symptoms of depression (aOR 43.4, p < 0.001) (vs. no such conditions), increased the odds. Conclusions: Young age, poor self-rated health, and comorbid symptoms of depression and suicidal behavior were significant factors associated with symptoms of both mild anxiety and generalized anxiety disorder. Being unmarried, living in the capital city or rural areas, and alcohol use disorder were associated with mild anxiety symptoms alone. Female sex was associated with generalized anxiety disorder symptoms alone.

Systematic review of genome-wide association studies of anxiety disorders and neuroticism

OBJECTIVES

To summarise SNP associations identified by genome-wide association studies (GWASs) of anxiety disorders and neuroticism; to appraise the quality of individual studies, and to assess the ancestral diversity of study participants.

METHODS

We searched PubMed, Scopus, PsychInfo and PubPsych for GWASs of anxiety disorders, non-diagnostic traits (such as anxiety sensitivity), and neuroticism, and extracted all SNPs that surpassed genome-wide significance. We graded study quality using Q-genie scores and reviewed the ancestral diversity of included participants.

RESULTS

32 studies met our inclusion criteria. A total of 563 independent significant variants were identified, of which 29 were replicated nominally in independent samples, and 3 were replicated significantly. The studies had good global quality, but many smaller studies were underpowered. Phenotypic heterogeneity for anxiety (and less so for neuroticism) seemed to reflect the complexity of capturing this trait. Ancestral diversity was poor, with 70% of studies including only populations of European ancestry.

CONCLUSION

The functionality of genes identified by GWASs of anxiety and neuroticism deserves further investigation. Future GWASs should have larger sample sizes, more rigorous phenotyping and include more ancestrally diverse population groups.

Analysis of Relationships between DAT1 Polymorphism Variants, Personality Dimensions, and Anxiety in New Psychoactive Substance (Designer Drug) (NPS) Users

The use of ‘new psychoactive substances’ appears to be increasingly common. The aim of this study was to examine biological and personality determinants in individuals who choose to use these substances, which may help in the prevention and treatment of psychoactive substance use disorders. The study group consisted of 374 male volunteers; all were users of ‘new psychoactive substances’ (NPS). The NPS users were recruited after they had abstained—for at least 3 months—from any substance of abuse in addiction treatment facilities. The NPS patients and the control subjects were examined by a psychiatrist using the Mini-International Neuropsychiatric Interview (M.I.N.I.), the NEO Five-Factor Personality Inventory (NEO-FFI), and the State-Trait Anxiety Inventory (STAI) scales. The real-time PCR method was used for genotyping. When we compared the controls with the study group, statistically significant interactions were found between DAT1 polymorphism, neuroticism, and NPS use. NPS use and DAT1 polymorphism were associated with a higher level of neuroticism on the NEO-FFI scale. The study group of NPS users showed a higher severity of anxiety symptoms, both in terms of trait and state, compared to the control group. The results may support the idea that neuroticism and anxiety correlate strongly with coping motives for using NPS.

The Mediating Effects of Diabetes Distress, Anxiety, and Cognitive Fusion on the Association Between Neuroticism and Fear of Hypoglycemia in Patients With Type 2 Diabetes

Purpose: To explore the relationship between neuroticism and fear of hypoglycemia (FoH) among patients with type 2 diabetes (T2D), as well as the mediating effects of diabetes distress, anxiety, and cognitive fusion on the relationship between neuroticism and FoH.

Methods: A total of 494 patients with T2D (39.9% females, n = 197) were analyzed using the neuroticism scale of the Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RS), the Fear of Hypoglycemia-15 Scale (FH-15), the Diabetes Distress Scale (DDS), the Self-Rating Anxiety Scale (SAS), and the Cognitive Fusion Questionnaire (CFQ). The bootstrapping method was used to test the separate and parallel mediation models.

Results: FoH was noted in 17.4% (n = 86) of patients. The correlations between neuroticism, diabetes distress, anxiety, cognitive fusion, and FoH were positive. Diabetes distress, anxiety, and cognitive fusion were significant mediators in the association between neuroticism and FoH in both separate and parallel mediation models. In the parallel mediation model, the mediating effect of anxiety was the highest, and the mediating effect of diabetes distress was the lowest, but no significant differences were found in the comparison of these three indirect effects.

Conclusion: This study indicated that neuroticism not only directly affected FoH, but also indirectly influenced FoH via the increase of diabetes distress, anxiety, and cognitive fusion in patients with T2D. The results provide a theoretical basis for the development of intervention programs to ameliorate patients’ FoH directly and indirectly. Healthcare providers should be encouraged to develop appropriate programs based on improving diabetes distress, anxiety, and cognitive fusion to help patients with T2D improve FoH.

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.

Genetic contributions to anxiety disorders: where we are and where we are heading

Anxiety disorders are among the most common psychiatric disorders worldwide. They often onset early in life, with symptoms and consequences that can persist for decades. This makes anxiety disorders some of the most debilitating and costly disorders of our time. Although much is known about the synaptic and circuit mechanisms of fear and anxiety, research on the underlying genetics has lagged behind that of other psychiatric disorders. However, alongside the formation of the Psychiatric Genomic Consortium Anxiety workgroup, progress is rapidly advancing, offering opportunities for future research.Here we review current knowledge about the genetics of anxiety across the lifespan from genetically informative designs (i.e. twin studies and molecular genetics). We include studies of specific anxiety disorders (e.g. panic disorder, generalised anxiety disorder) as well as those using dimensional measures of trait anxiety. We particularly address findings from large-scale genome-wide association studies and show how such discoveries may provide opportunities for translation into improved or new therapeutics for affected individuals. Finally, we describe how discoveries in anxiety genetics open the door to numerous new research possibilities, such as the investigation of specific gene-environment interactions and the disentangling of causal associations with related traits and disorders.We discuss how the field of anxiety genetics is expected to move forward. In addition to the obvious need for larger sample sizes in genome-wide studies, we highlight the need for studies among young people, focusing on specific underlying dimensional traits or components of anxiety.

Systematic Review and Meta-analysis of Genetically Informed Research: Associations Between Parent Anxiety and Offspring Internalizing Problems

OBJECTIVE

Parent anxiety is associated with offspring internalizing problems (emotional problems related to anxiety and depression). This may reflect causal processes, whereby exposure to parent anxiety directly influences offspring internalizing (and/or vice versa). However, parent-offspring associations could also be attributable to their genetic relatedness. A systematic review and meta-analysis were conducted to investigate whether exposure to parent anxiety is associated with offspring internalizing after controlling for genetic relatedness.

METHOD

A literature search across 5 databases identified 429 unique records. Publications were retained if they used a quasi-experimental design in a general population sample to control for participant relatedness in associations between parent anxiety and offspring internalizing outcomes. Publications were excluded if they involved an experimental exposure or intervention. Studies of prenatal and postnatal anxiety exposure were meta-analyzed separately. Pearson's correlation coefficient estimates (r) were pooled using multilevel random-effects models.

RESULTS

Eight publications were retained. Data were drawn from 4 population cohorts, each unique to a quasi-experimental design: adoption, sibling-comparison, children-of-twins or in vitro fertilization. Cohorts were located in northern Europe or America. Families were predominantly of European ancestry. Three publications (Nfamilies >11,700; offspring age range, 0.5-10 years) showed no association between prenatal anxiety exposure and offspring internalizing outcomes after accounting for participant relatedness (r = .04; 95% CI: -.07, .14). Six publications (Nfamilies >12,700; offspring age range, 0.75-22 years) showed a small but significant association between concurrent symptoms in parents and offspring after accounting for participant relatedness (r = .13; 95% CI: .04, .21).

CONCLUSION

Initial literature, derived from homogeneous populations, suggests that prenatal anxiety exposure does not cause offspring internalizing outcomes. However, postnatal anxiety exposure may be causally associated with concurrent offspring internalizing via nongenetic pathways. Longitudinal stability, child-to-parent effects, and the role of moderators and methodological biases require attention.

A bioinformatic study revealed serotonergic neurons are involved in the etiology and therapygenetics of anxiety disorders

Genetic factors contribute to the susceptibility of anxiety disorders (ADs) and responses to associated cognitive-behavioral therapy (CBT). However, the type of brain cell affected by the related genes remains unclear. Previous studies have indicated various important brain neurons associated with psychiatric disorders, highlighting the necessity to study the cellular basis of anxiety. We assembled 37 AD-related genes and 23 CBT-related genes from recent large-scale genome-wide association studies, and then investigated their cell-type specificity in single-cell transcriptome data via an expression weighted cell type enrichment method. Additionally, to investigate the cellular differences between ADs and other psychiatric disorders, we excluded the genes associated with major depressive disorder, bipolar disorder, and neuroticism, resulting in 29 AD-specific genes. Remarkably, results indicate that serotonergic neurons are significantly associated with both AD-related and CBT-related genes, despite the two gene sets showing no overlap. These observations provide evidence that serotonergic neurons are involved in the etiology and therapygenetics of ADs. Moreover, results also showed that serotonergic neurons are associated with AD-specific genes, providing a supplementary finding that is in opposition to previous studies that found no evidence for the association between serotonergic neurons and psychiatric disorders via the same strategy. In summary, the current study found that serotonergic neurons are involved in the etiology and therapygenetics of ADs, providing insights into their genetic and cellular basis. Further, this cellular difference study may deepen our understanding of ADs and other psychiatric disorders.

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.

Thirty-year outcome of anxiety and depressive disorders and personality status: comprehensive evaluation of mixed symptoms and the general neurotic syndrome in the follow-up of a randomised controlled trial

BACKGROUND

Cohort studies of the long-term outcome of anxiety, depression and personality status rarely join together.

METHODS

Two hundred and ten patients recruited with anxiety and depression to a randomised controlled trial between 1983 and 1987 (Nottingham Study of Neurotic Disorder) were followed up over 30 years. At trial entry personality status was assessed, together with the general neurotic syndrome, a combined diagnosis of mixed anxiety-depression (cothymia) linked to neurotic personality traits. Personality assessment used a procedure allowing conversion of data to the ICD-11 severity classification of personality disorder. After the original trial, seven further assessments were made. Observer and self-ratings of psychopathology and global outcome were also made. The primary outcome at 30 years was the proportion of those with no Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis.Data were analysed using multilevel repeated measures models that adjusted for age and gender. Missing data were assumed to be missing at random, and the models allowed all subjects to be included in the analysis with missing data automatically handled in the model estimation.

RESULTS

At 30 years, 69% of those with a baseline diagnosis of panic disorder had no DSM diagnosis compared to 37-47% of those with generalised anxiety disorder, dysthymia or mixed symptoms (cothymia) (p = 0.027). Apart from those with no personality dysfunction at entry all patients had worse outcomes after 30 years with regard to total psychopathology, anxiety and depression, social function and global outcome.

CONCLUSIONS

The long-term outcome of disorders formerly called 'neurotic' is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.

Exploring the autism spectrum: Moderating effects of neuroticism on stress reactivity and on the association between social context and negative affect

Neuroticism is associated with increased stress reactivity. In autism spectrum disorders (ASD), emotional stress reactivity is increased and there is some evidence for an increased negative affect (NA) when with less familiar people. The aim of this study was to compare adults with ASD and controls on levels of neuroticism and on interactions between neuroticism and appraised stress or social context in models of NA. This is a cross-sectional observational study comprising a group of 50 adults with ASD and 51 controls. Experience sampling method (ESM) reports were collected for 10 days to measure daily life stress, mood, and social context. Multilevel regression analyses revealed significantly higher neuroticism levels in ASD than in controls. Adults with ASD who scored high on neuroticism showed a significantly stronger association between activity/social stress and NA (i.e., higher stress reactivity) than those with low scores. Furthermore, the association between neuroticism and NA was stronger when adults with ASD were with less familiar people compared with being alone or with familiar people. No consistent corresponding significant interactions were found in the control group. In conclusion, in ASD, neuroticism moderates the association between appraised stress and NA as well as the association between social context and NA.

The Mediating Effect of Insomnia on the Relationship between Panic Symptoms and Depression in Patients with Panic Disorder

BACKGROUND

This study aimed to determine if sleep disturbances may mediate the relationship between panic symptoms and depression in patients with panic disorder (PD).

METHODS

Electronic medical records were retrospectively reviewed for 110 consecutive patients with diagnosed PD in an outpatient clinic between October 2018 and December 2019. Measurements include the PD Severity Scale, Beck Depression Inventory-II (BDI-II) and Insomnia Severity Index (ISI). Statistical analyses were performed to assess any potential relationship between PD, insomnia and depression.

RESULTS

Of the PD patients, 88 (80%) and 89 (80.9%) had comorbid depression (BDI-II ≥ 14) and insomnia (Korean version of the ISI ≥ 8), respectively. In a mediation model using insomnia as the mediating variable, the total effect of panic symptom severity on depression was significant (t = 7.23, P < 0.001). There were significant effects of panic symptoms on insomnia (t = 4.62, P < 0.001) and of insomnia on depression (t = 6.69, P < 0.001). The main effect of panic symptom severity on depression was also significant, after controlling for the effect of insomnia (t = 5.10, P < 0.001), suggesting partial mediation.

CONCLUSION

Both depressive symptoms and insomnia are common in patients with PD and depression was partially mediated by insomnia in these patients. These results suggest that an intervention for insomnia in patients with PD might help prevent the development of depression.

Familial aggregation of anxiety disorder subtypes and anxious temperament in the NIMH Family Study of Affective Spectrum Disorders

BACKGROUND

Evidence from family and twin studies suggests that mood and anxiety disorders, and related temperamental factors may share common etiologic factors. We examine the familial aggregation and coaggregation of anxiety disorder subtypes and anxiety-related temperamental traits, and their association with mood disorders.

METHODS

A total of 477 probands and 549 first-degree adult relatives from a large community based family study of affective spectrum disorders completed semi-structured diagnostic interviews and self-reported assessments of temperamental traits including: negative affectivity on the 'Positive and Negative Affect Schedule' (PANAS), neuroticism anxiety on the 'Zuckerman-Kuhlman Personality Questionnaire' (ZKPQ), and anxiety sensitivity on the 'Anxiety Sensitivity Index' (ASI).

RESULTS

The anxiety-related temperamental traits of negative affectivity, neuroticism anxiety and anxiety sensitivity had significant familial specificity, even after controlling for comorbid mood and anxiety disorders in probands and relatives. Yet, these traits in probands did not predict anxiety disorders in relatives. Although some anxiety subtypes were familial, there were no longer familial links between anxiety disorder subtypes (generalized anxiety disorder, social anxiety or panic disorder) after controlling for mood disorder subtypes in probands and relatives.

LIMITATIONS

Cross-sectional interviews were used to estimate disorders, and self-report measures were used for temperamental traits.

CONCLUSIONS

These results confirm previous research regarding familial overlap between anxiety subtypes and mood disorders, however their shared liability cannot be fully explained by anxiety-related temperamental traits. These findings suggest that anxiety-related temperamental traits may indicate a vulnerability for mood and anxiety disorders or a potential consequence of these conditions.

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 (ncase = 25 453, ncontrol = 58 113) and an additional analysis of Current Anxiety Symptoms (ncase = 19 012, ncontrol = 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.

Mediation model of comorbid anxiety disorders in late-life depression

BACKGROUND

A number of studies have been conducted on risk factors of comorbid anxiety disorders regarding late-life depression (LLD). This study investigated the associated factors and their relationship to comorbid anxiety disorders in LLD.

METHODS

Participants included 190 elderly Thais (73.2% female, with a mean age of 68.39 ± 6.74 years) with depressive disorders, diagnosed according to DSM-IV Diagnosis Axis I disorders assessed by Mini-International Neuropsychiatric Interview. Demographic data, medical and psychiatric history, family psychiatric history, past depression, family history of depression, Neuroticism Inventory and 7-Item Hamilton Depression Rating Scale (HAMD-7) were analyzed for path analysis using Structural Equation Model framework. The bootstrapping method was used for testing indirect effects.

RESULTS

Being female was associated with comorbid anxiety disorders with an indirect effect (β = - 0.032, P = 0.018) through neuroticism, depression severity, history and family history of depression. Family history of depression had no effect on comorbidity (P = 0.090). Neuroticism had an indirect effect on comorbid anxiety disorders (β = 0.075, P = 0.019) via depression severity as reflected by HAMD-7 score (β = 0.412, P =  < 0.001). Total variance explained from this model was 11%. This model had good-fit index with Chi-square > 0.05, CFI and TLI > 0.95 and RMSEA < 0.06.

CONCLUSION

Neuroticism mediates the effect of relationship between sex, family history and history of depressive disorders and comorbid anxiety disorders in LLD. Moreover, depression severity is a mediator for neuroticism and comorbid anxiety disorders. Longitudinal studies are warranted to indicate the importance of effective treatment of depression to lower the risk of developing comorbid anxiety disorders among depressed elderly.

Sex-specific pathways among tri-allelic serotonin transporter polymorphism, trait neuroticism and generalized anxiety disorder

BACKGROUND

Neuroticism personality trait is recognized as an important endophenotypic predictor of generalized anxiety disorder (GAD). Furthermore, endophenotype-based pathway approaches have recently been shown to have greater advantages for gene-finding strategies than traditional case-control studies. In the present study, in addition to conventional case-control methods, we used pathway analyses to test whether the tri-allelic serotonin transporter promoter polymorphism (combining 5-HTTLPR and rs25531) is associated with risk of GAD through its effects on trait neuroticism.

METHODS

We included 2236 Han Chinese adults in this study, including 736 patients with GAD and 1500 healthy participants. We genotyped the 5-HTTLPR and rs25531 polymorphisms using the polymerase chain reaction restriction fragment length polymorphism method. We used the Neuroticism scale of the Maudsley Personality Inventory (MPI) short version (MPI-Neuroticism) to measure participants' tendency toward neuroticism.

RESULTS

Using endophenotype-based path analyses, we found significant indirect effects of the tri-allelic genotype on risk of GAD, mediated by MPI-Neuroticism in both men and women. Compared to women carrying the S'S' genotype, women carrying the L' allele had higher levels of MPI-Neuroticism, which in turn were associated with higher risk of GAD. Men, however, showed the opposite pattern. Using traditional case-control comparisons, we observed that the effect of tri-allelic genotype on GAD was significant, but only in women.

LIMITATIONS

Participants were restricted to Han Chinese, and we used only 1 questionnaire to assess neuroticism.

CONCLUSION

These findings are the first to show that the triallelic 5-HTTLPR polymorphism is associated with elevated risk of GAD, and that this effect is mediated via increased trait neuroticism, a sex-dependent risk pathway.

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.

Distinct Risk Profiles in Social Anxiety Disorder

Using a factor mixture model (FMM) approach, this study examined if SAD could be subtyped by distinct risk profiles, and whether these subtypes predicted different manifestations of the disorder. We derived risk profiles from neurotic temperament (NT), positive temperament (PT), and autonomic arousability (AA), which are hypothesized to be important in the maintenance of anxiety disorders such as SAD. In our sample of 758 SAD outpatients, a two-class FMM solution fit the data best. Class 1 was characterized by very low PT whereas PT in Class 2 was substantially higher. The two classes differed to a lesser extent on NT, but were virtually equivalent on AA. Class 1 had significantly more males, individuals with depressive disorders, generalized SAD, and higher SAD severity. Class 2 had more individuals with performance subtype SAD. These findings provide initial support for distinct risk profiles within SAD that may be predictive of its clinical expression.

Use of an estradiol-based combined oral contraceptives has no influence on attentional bias or depressive symptoms in healthy women

Combined oral contraceptive (COC) use is associated with small, albeit significant, increases in mental symptom scores, predominantly irritability, depressed mood, and anxiety. Yet, randomized prospective trials are needed to better characterize the women at risk for COC-induced negative mood change. Thus, the primary aim of this sub-study to a placebo-controlled randomized trial was to determine whether COC use influences emotional interference by negative and positive stimuli. Secondly, we wanted to evaluate what factors would predict depressive symptoms at the end of the trial, taking personality factors, history of mental disorders and other demographic factors into account. Sixty-nine women were included, randomized to three cycles of treatment with a COC (1.5 mg estradiol and 2.5 mg nomegestrolacetate) or placebo. An emotional verbal Stroop task was used to measure interference of emotional stimuli, in which participants were asked to only name the color of a presented word, while ignoring the meaning of the word. Four different word categories were used; neutral, positive, depression, and anxiety. For the second aim of the study, rating on the Montgomery-Åsberg Depression Rating Scale during the final days of the trial was used as outcome. We found no interaction between emotional verbal Stroop word category and treatment, indicating that COC treatment did not evoke any differences in emotional interference to the three word categories. Significant predictors for depressive symptoms at the end of the trial were trait anxiety at baseline and prior adverse mood effects by hormonal contraceptive use. Treatment (i.e. whether women had been treated with the COC or placebo) did not play a role in predicting depression scores at the end of the trial. In conclusion, we found no evidence that combined oral contraceptive use is associated with impaired cognitive-emotional processing. Instead, the main predictors of self-rated depression at the end of the trial were baseline trait anxiety and previous mental symptoms during hormonal contraceptive use.

Investigating the association between neuroticism and adverse obstetric and neonatal outcomes

Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.

Prevalence and associated factors of comorbid anxiety disorders in late-life depression: findings from geriatric tertiary outpatient settings

PURPOSE

The study evaluated the prevalence of comorbid anxiety disorders in late-life depression (LLD) and identified their associated factors.

PATIENTS AND METHODS

This study involved 190 elderly Thais with depressive disorders diagnosed according to the Mini-International Neuropsychiatric Interview (MINI). Anxiety disorders were also diagnosed by the MINI. The 7-item Hamilton Depression Rating Scale (HAMD-7), Montreal Cognitive Assessment, Geriatric Depression Scale (GDS), Core Symptoms Index, Neuroticism Inventory, Perceived Stress Scale and Multidimensional Scale for Perceived Social Support were completed. Descriptive statistics and ORs were used for analysis.

RESULTS

Participants included 139 females (73.2%) with a mean age of 68.39±6.74 years. The prevalence of anxiety disorders was 7.4% for generalized anxiety disorder (GAD), 4.7% for panic disorder, 5.3% for agoraphobia, 1.1% for social phobia, 2.1% for obsessive-compulsive disorder and 3.7% for post-traumatic stress disorder, with an overall prevalence of 16.84%. The comorbidity of anxiety disorders was associated with gender (P=0.045), history of depressive disorder (P=0.040), family history of depressive disorder (P=0.004), GDS (P=0.037), HAMD-7 (P=0.001), suicidality (P=0.002) and neuroticism (P=0.003). History of alcohol use was not associated.

CONCLUSION

The prevalence of anxiety in LLD was comparable to other studies, with GAD and agoraphobia being the most prevalent. This study confirmed the role of depression severity and neuroticism in developing comorbid anxiety disorders.

Negative Affect Mediates Impulsivity in Generalized Anxiety Disorder

INTRODUCTION

Although anxiety and impulsivity are intuitively thought to be inversely correlated, increased impulsivity has been associated both with generalized anxiety disorder (GAD) diagnosis and GAD symptoms in non-clinical samples. The emotional dysregulation model of GAD posits that patients experience more frequent and intense negative emotions while having poor regulatory control over emotional states and greater negative reactivity to their emotions. We hypothesized that poor regulatory control in the presence of negative emotions might explain the increased impulsivity found in GAD patients. In this study, we examined if negative affect mediates the relationship between GAD and impulsivity.

METHODS

Thirty-four GAD patients and 35 healthy controls were included, and evaluated with measurements of impulsivity, negative and positive emotions, the severity of worrying and GAD symptoms, depression, and 5-factor personality traits.

RESULTS

Global impulsivity scores and the attentional facet of impulsivity were higher in the patient group when compared to the controls. Negative affect was correlated with global impulsivity in the patient group only and explained impulsivity in our regression model while worrying and depressive symptoms did not. An indirect relationship was found between diagnosis and impulsivity through negative affect.

CONCLUSION

Our study showed that the cardinal symptom of GAD - worrying - was not independently related to impulsivity in our sample. Increased impulsivity in GAD seems to be mediated by the increased presence of negative emotions, as it is common in mood and impulse-control disorders, indicating an unspecific shared vulnerability factor to psychopathology.

The Multidimensional Emotional Disorder Inventory (MEDI): Assessing transdiagnostic dimensions to validate a profile approach to emotional disorder classification

There has been limited progress evaluating the validity of dimensional approaches to emotional disorder classification. This has occurred in part because of a lack of standardized assessment tools developed with the specific intent of studying dimensional classification. The goal of the current study was to develop and validate the Multidimensional Emotional Disorder Inventory (MEDI) to efficiently assess nine empirically supported transdiagnostic dimensions proposed in the Brown and Barlow (2009) profile approach to emotional disorder classification: neurotic temperament, positive temperament, depression, autonomic arousal, somatic anxiety, social anxiety, intrusive cognitions, traumatic reexperiencing, and avoidance. The MEDI factor structure, reliability, and convergent/discriminant validity was evaluated in outpatients with emotional disorders (pilot sample = 227; validation sample = 780). The final 9-factor solution fit the data well. Intercorrelations among MEDI factors were consistent with previous research, and all MEDI dimensions had acceptable reliability. Correlations with common self-report questionnaires and DSM-5 diagnoses supported the convergent/discriminant validity of all nine MEDI dimensions. Collectively, these results support the use of 49-item MEDI in clinical research samples. The MEDI should be used in future research to evaluate the validity of the Brown and Barlow (2009) approach to emotional disorder classification. Because it provides an efficient assessment of several well-established emotional disorder traits and phenotypes, the MEDI also may have utility for general research or clinical purposes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Extraversion and behavioural approach system in stimulus analysis and motor response initiation

In this study, we attempt to validate previous findings on extraversion-related differences in speed of sensorimotor processing and to extend them into Behavioural Approach System (BAS) subtraits within the framework of the revised Reinforcement Sensitivity Theory (rRST) of personality. Here, we assessed psychological traits of extraversion (E), four BAS facets (Goal-Drive Persistence, BAS-GDP; Reward Interest, BAS-RI; Reward Reactivity, BAS-RR; Impulsivity, BAS-I), Behavioural Inhibition System (BIS), and Fight-Flight-Freeze System (FFFS) in 51 volunteers (28 women). Stimulus-locked lateralized readiness potential (S-LRP), response-locked LRP (R-LRP), stimulus-locked and response-locked forearm electromyogram (S-EMG and R-EMG), and P3 components of the event-related potentials (ERPs), were recorded during the performance of a two-choice Go/NoGo visual letter-digit discrimination task varying in task difficulty. High extraverts, relative to introverts and individuals high relative to low on BAS-RI, were more likely to exhibit shorter S-LRP latencies and stimulus- and response-locked EMG latencies. Additionally, high BAS-I had a shorter R-RLP latency than low BAS-I participants for the difficult task. High FFFS levels were associated with longer S-LRP and S-EMG latencies, while high BIS levels had larger response accuracy. Extraverts, relative to introverts, along with those high relative to low on BAS-RR and BAS-I, exhibited smaller P3 amplitudes. The faster cortical premotor initiation, found in individuals high on extraversion, BAS-RI and low on FFFS, may account for their faster peripheral motor response initiation and execution. Smaller P3 amplitudes in extraverts and individuals high on BAS-RR and BAS-I may indicate reduced perceptual processing capacity in these individuals.

Genetics of generalized anxiety disorder and related traits

This review serves as a systematic guide to the genetics of generalized anxiety disorder (GAD) and further focuses on anxiety-relevant endophenotypes, such as pathological worry fear of uncertainty, and neuroticism. We inspect clinical genetic evidence for the familialityl heritability of GAD and cross-disorder phenotypes based on family and twin studies. Recent advances of linkage studies, genome-wide association studies, and candidate gene studies (eg, 5-HTT, 5-HT1A, MAOA, BDNF) are outlined. Functional and structural neuroimaging and neurophysiological readouts relating to peripheral stress markers and psychophysiology are further integrated, building a multilevel disease framework. We explore etiologic factors in gene-environment interaction approaches investigating childhood trauma, environmental adversity, and stressful life events in relation to selected candidate genes (5-HTT, NPSR1, COMT, MAOA, CRHR1, RGS2), Additionally, the pharmacogenetics of selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor treatment are summarized (5-HTT, 5-HT2A, COMT, CRHR1). Finally, GAD and trait anxiety research challenges and perspectives in the field of genetics, including epigenetics, are discussed.

Genome-wide meta-analyses of stratified depression in Generation Scotland and UK Biobank

Few replicable genetic associations for Major Depressive Disorder (MDD) have been identified. Recent studies of MDD have identified common risk variants by using a broader phenotype definition in very large samples, or by reducing phenotypic and ancestral heterogeneity. We sought to ascertain whether it is more informative to maximize the sample size using data from all available cases and controls, or to use a sex or recurrent stratified subset of affected individuals. To test this, we compared heritability estimates, genetic correlation with other traits, variance explained by MDD polygenic score, and variants identified by genome-wide meta-analysis for broad and narrow MDD classifications in two large British cohorts - Generation Scotland and UK Biobank. Genome-wide meta-analysis of MDD in males yielded one genome-wide significant locus on 3p22.3, with three genes in this region (CRTAP, GLB1, and TMPPE) demonstrating a significant association in gene-based tests. Meta-analyzed MDD, recurrent MDD and female MDD yielded equivalent heritability estimates, showed no detectable difference in association with polygenic scores, and were each genetically correlated with six health-correlated traits (neuroticism, depressive symptoms, subjective well-being, MDD, a cross-disorder phenotype and Bipolar Disorder). Whilst stratified GWAS analysis revealed a genome-wide significant locus for male MDD, the lack of independent replication, and the consistent pattern of results in other MDD classifications suggests that phenotypic stratification using recurrence or sex in currently available sample sizes is currently weakly justified. Based upon existing studies and our findings, the strategy of maximizing sample sizes is likely to provide the greater gain.

A translational approach to the genetics of anxiety disorders

There have been important advances in our understanding of the genetic architecture of anxiety disorders. At the same time, relatively few genes have reached genome wide significance in anxiety disorders, and there is relatively little work on how exposure to an adverse environment impacts on gene expression in either animal models or human clinical populations. Here we assessed differential expression of genes of the dorsal striatum involved in synaptic transmission in an animal models of early adversity (maternal separation followed by restraint stress), and investigated whether variants in these genes were associated with risk for anxiety disorders, particularly in the presence of environmental stressors. Fifty-two male Sprague Dawley rats underwent maternal separation, and gene expression was studied using array technology. The human homologues of the differentially expressed genes were screened and analysed in a DSM-IV anxiety disorders cohort, and healthy controls (patients, n = 92; controls, n = 194), using blood. Two candidate genes (Mmp9 and Bdnf) were aberrantly expressed in the experimental rodent group relative to controls. Four single nucleotide polymorphisms (SNPs) in the human homologues of these genes were significantly associated with susceptibility for anxiety disorders (MMP9: rs3918242 and BDNF: rs6265, rs10835210 and rs11030107). Three of these (BDNF: rs6265, rs10835210, rs11030107) were found to interact significantly with childhood trauma severity resulting in increased likelihood of an anxiety disorder diagnosis. This study provides insights into the utility of rat models for identifying molecular candidates for anxiety disorders in humans.

Modeling prior information of common genetic variants improves gene discovery for neuroticism

Neuroticism reflects emotional instability, and is related to various mental and physical health issues. However, the majority of genetic variants associated with neuroticism remain unclear. Inconsistent genetic variants identified by different genome-wide association studies (GWAS) may be attributable to low statistical power. We proposed a novel framework to improve the power for gene discovery by incorporating prior information of single nucleotide polymorphisms (SNPs) and combining two relevant existing tools, relative enrichment score (RES) and conditional false discovery rate (FDR). Here, SNP's conditional FDR was estimated given its RES based on SNP prior information including linkage disequilibrium (LD)-weighted genic annotation scores, total LD scores and heterozygosity. A known significant locus in chromosome 8p was excluded before estimating FDR due to long-range LD structure. Only one significant LD-independent SNP was detected by analyses of unconditional FDR and traditional GWAS in the discovery sample (N = 59 225), and notably four additional SNPs by conditional FDR. Three of the five SNPs, all identified by conditional FDR, were replicated (P < 0.05) in an independent sample (N = 170 911). These three SNPs are located in intronic regions of CADM2, LINGO2 and EP300 which have been reported to be associated with autism, Parkinson's disease and schizophrenia, respectively. Our approach using a combination of RES and conditional FDR improved power of traditional GWAS for gene discovery providing a useful framework for the analysis of GWAS summary statistics by utilizing SNP prior information, and helping to elucidate the links between neuroticism and complex diseases from a genetic perspective.

Examining the Behavioural Sleep-Wake Rhythm in Adults with Autism Spectrum Disorder and No Comorbid Intellectual Disability

This study aimed to examine the behavioural sleep-wake rhythm in 36 adults with autism spectrum disorder (ASD) and to determine the prevalence of circadian sleep-wake rhythm disorders compared to age- and sex-matched controls. Participants completed an online questionnaire battery, a 14-day sleep-wake diary and 14-day actigraphy assessment. The results indicated that a higher proportion of adults with ASD met criteria for a circadian rhythm sleep-wake disorder compared to control adults. In particular, delayed sleep-wake phase disorder was particularly common in adults with ASD. Overall the findings suggest that individuals with ASD have sleep patterns that may be associated with circadian rhythm disturbance; however factors such as employment status and co-morbid anxiety and depression appear to influence their sleep patterns.

Neuroticism-related personality traits are associated with posttraumatic stress after abortion: findings from a Swedish multi-center cohort study

Background

Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion.

Methods

A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion.

Results

Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2–5.6) and 2.9 (CI 95% 1.3–6.6), respectively.

Conclusion

High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status.

The Role of Neuroticism and Experiential Avoidance in Predicting Anxiety and Depression Symptoms: Mediating Effect of Emotion Regulation

Background

Preliminary evidence supports the role of neuroticism, experiential avoidance and emotion regulation in anxiety and depression; however, the mechanism of these relationships is not known well.

Objectives

The present study mainly aimed to assess the mediating role of emotion regulation in the relationship between neuroticism and experiential avoidance and anxiety and depression symptoms.

Materials and Methods

By convenient sampling, 316 students from Tehran University of Medical Sciences, Iran University of Social Welfare and Rehabilitation Sciences and University of Tehran were selected and measures of experiential avoidance, neuroticism, emotion regulation, worry, anxiety and depression were administered among them, 2014-2015. Path analysis via regression according to Baron and Kenny evaluative criteria was used for data analysis.

Results

Experiential avoidance and neuroticism predicted anxiety, and depression symptoms and the predictions were mediated by emotion regulation and worry.

Conclusions

Emotion regulation deficits have an outstanding role in the mechanism of anxiety and depression which are so comorbid and further studies are needed to evaluate emotion regulation with more advanced methods and along with other transdiagnostic components.

The nosologic relationship between generalized anxiety disorder and major depression

Generalized anxiety disorder (GAD) has undergone a series of revisions in its diagnostic criteria that has moved it, nosologically, away from its original affiliation with panic disorder (PD) and closer to major depressive disorder (MDD). This, together with its high comorbidity and putative shared genetic risk with MDD, has brought into question its place in future psychiatric nosology, prompting the planners of Diagnostic and Statistical Manual-V (DSM-V) and International Classification of Diseases-11 (ICD-11) to set up a workgroup tasked to better understand the relationship between GAD and MDD. This review attempts to summarize the extant data to compare GAD and MDD on a series of research validators to explore this relationship. Although insufficient data currently exist for GAD in several key validator classes, tentative conclusions can be drawn on the diagnostic status of GAD in relation to MDD. Although GAD possesses substantial overlap with MDD in the areas of genetics, childhood environment, demographics, and personality traits, this tends to hold true for other anxiety disorders (ADs) as well, with the strongest evidence for PD. Data from life events, personality disorders, biology, comorbidity, and pharmacology are mixed, showing some areas of similarity between GAD and MDD but some clear differences, again with a moderate degree of nonspecificity. Thus, although the bulk of evidence supports a close underlying relationship between them, the relatively nonspecific nature of these findings provides little more reason to question the nosologic validity of GAD in relation to MDD than that of some other anxiety disorders.

Emotional Consequences of Finasteride: Fool's Gold

Androgenetic alopecia, the gradual, progressive loss of hair frequently results in psychological despair, in part related to changes in self-image. Current androgenetic alopecia treatments are limited to hair transplantation and medications that inhibit dihydrotestosterone, a potent androgen associated with follicular micronization. Users of finasteride, which prevents dihydrotestosterone production, report serious physical and emotional adverse effects, collectively known as post-finasteride syndrome. Psychiatric illnesses and personality traits, specifically neuroticism influence emotional well-being. Limited research exists exploring the psychological corollaries of post-finasteride syndrome and preexisting Axis I and Axis II mental health conditions. The aim of this study was to explore how having a preexisting personal and/or familial history of a psychiatric diagnosis and certain personality traits may influence anxiety and depression among finasteride users. Participants in this online survey completed the Beck Depression Inventory, the Beck Anxiety Inventory, and Ten-Item Personality Inventory. An important finding in this study was that almost 57% ( n = 97) of men reported a psychiatric diagnosis and 28% ( n = 27) had a first-degree relative with a mental health disorder, of this group 17 only had a family history. Nearly 50% of the men surveyed reported clinically significant depression as evidenced by Beck Depression Inventory score and 34% experienced anxiety on the Beck Anxiety Inventory. There were no statistically significant trends in personality traits reported. Results provide evidence on the need to screen for psychiatric history and counseling patients about the potential psychological consequences of finasteride. Prescribing clinicians should carefully weigh the risk/benefit ratio with these patients.

The many faces of anxiety-neurobiological correlates of anxiety phenotypes

Anxiety is an all-inclusive concept incorporating somatic symptoms (palpitations, dizziness, dyspnea), emotional and cognitive elements (negative affect, fear, worry, rumination) and behavioral components (e.g., avoidance). The aim of this study was to examine the specific neural correlates associated with anxiety phenotypes (worry, rumination, somatic anxiety) and negative affect (neuroticism). Twenty-nine anxious participants and 30 healthy controls were included in the study. We analyzed seed-based intrinsic connectivity and used correlation maps in a multivariable regression model to describe the specific effect of each anxiety phenotype independently of the effects of age and the other measures of anxiety. Worry severity was uniquely correlated with increased intrinsic connectivity between right anterior insula (RAI) and the precuneus. Global and somatic anxiety were associated with the limbic and paralimbic structures (increased connectivity between the amygdala, PVN, and hippocampus), while neuroticism was correlated with increased connectivity between limbic and prefrontal structures. Rumination severity did not correlate significantly with any measures of functional connectivity once we controlled for other clinical measures of anxiety. Measures of worry, global anxiety, somatic anxiety, and neuroticism have distinct 'neural signatures'. These results advocate for a fine-grain approach when analyzing the neural substrates of clinical samples with various anxiety disorders.

Mental and Physical Symptoms of Female Rural Workers: Relation between Household and Rural Work

This study aimed to investigate the relations among mental disorders, physical discomfort, household work and farm work among women. We conducted a cross-sectional study based on the administration of a structured questionnaire to 182 female farm workers. The data were analyzed by means of Poisson regression, where the significance level was set to 5%. Results indicated that 111 (61%) participants reported work-related mental disorders and physical discomfort was reported by 160 (87.9%). The participants with mental disorders and at least moderate levels of physical discomfort reported significantly higher levels of physical demand, time working (temporal demand), total effort and frustration with regard to farm work, in addition to significantly higher levels of frustration with regard to housework. Women with moderate or greater levels of both physical discomfort and frustration with farm work increased the chances of mental disorders. The results illustrate the complex challenge for health professionals in caring for women with mental disorders and physical discomforts related to their farm work, in the context of both the farm and domestic work demands these workers experience.

Secondary depression in severe anxiety disorders: a population-based cohort study in Denmark

BACKGROUND

Depression and anxiety disorders are highly comorbid conditions and a worldwide disease burden; however, large-scale studies delineating their association are scarce. In this retrospective study, we aimed to assess the effect of severe anxiety disorders on the risk and course of depression.

METHODS

We did a population-based cohort study with prospectively gathered data in Denmark using data from three Danish population registers: The Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Registry. We selected the cohort from people born in Denmark between Jan 1, 1955, and Dec 31, 2002, who we followed up from Jan 1, 1994, to Dec 31, 2012. The cohort was restricted to individuals with known parents. First, we investigated the effect of specific anxiety diagnoses on risk of single depressive episodes and recurrent depressive disorder. Second, we investigated the effect of comorbid anxiety on risk of readmission for depression, adjusting for sex, age, calendar year, parental age, place at residence at time of birth, and the interaction of age with sex.

FINDINGS

We included 3,380,059 individuals in our study cohort. The adjusted incidence rate ratio (IRR) for single depressive episodes was 3·0 (95% CI 2·8-3·1, p<0·0001) and for recurrent depressive disorder was 5·0 (4·8-5·2) in patients with severe anxiety disorders compared with the general population. Compared with control individuals, the offspring of parents with anxiety disorders were more likely to be diagnosed with single depressive episodes (1·9, 1·8-2·0) or recurrent depressive disorder (2·1, 1·9-2·2). Comorbid anxiety increased the readmission rates in both patients with single depressive episodes and patients with recurrent depressive disorder.

INTERPRETATION

Severe anxiety constitutes a significant risk factor for depression. Focusing on specific anxiety disorders might help to identify individuals at risk of depression, thereby providing new insights for prevention and treatment.

FUNDING

The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH).

Neuroticism and stress: the role of displacement behavior

BACKGROUND AND OBJECTIVES

Neuroticism is linked with an impaired ability to cope with stress and is an important risk factor for stress-related disorders. Hence, there is interest in exploring the behavioral correlates of neuroticism and how such behaviors may moderate the link between neuroticism and the response to stress. Displacement behavior - activity such as face touching and scratching - is important to investigate in this respect, as recent studies indicate that such behavior is linked to negative emotional states and has an important stress coping function. Here, we explored the relationship between neuroticism, displacement behavior, and stress in a healthy population of men.

DESIGN

This was a cross-sectional, quasiexperimentally controlled study.

METHODS

We assessed participants' levels of neuroticism, and then during a Trier Social Stress Test quantified displacement behavior, physiological, and cognitive indices of the stress response; after the test we measured the self-reported experience of stress.

RESULTS

Displacement behavior was negatively correlated with self-reported experience, physiological, and cognitive measures of stress and moderated the relationships between neuroticism, self-reported experience, and cognitive index of stress.

CONCLUSIONS

Our results suggest displacement behavior plays an important role in shaping the link between neuroticism and the response to stress.

A longitudinal examination of psychosocial impairment across the anxiety disorders

BACKGROUND

Anxiety disorders are highly prevalent disorders associated with substantial psychosocial impairment, but few studies have examined impairment within specific anxiety disorders. Furthermore, it is unclear how change in different types of anxiety has an impact on change in impairment, particularly given high rates of co-morbidity. The current study assessed the temporal associations of impairment and symptoms of three common anxiety disorders in a large, diagnostically heterogeneous clinical sample.

METHOD

Data were collected from 606 treatment-seeking individuals at an anxiety clinic, most of whom subsequently enrolled in cognitive-behavioral therapy. Symptoms of panic, social anxiety and generalized anxiety disorder (GAD), as well as levels of impairment, were assessed three times over 2 years. In addition to examining levels of impairment across diagnostic groups, latent growth modeling was used to evaluate the longitudinal associations of anxiety symptoms and impairment.

RESULTS

Those with a principal diagnosis of GAD reported higher levels of impairment in some domains at baseline; however, at follow-up assessments individuals with social anxiety disorder reported greater impairment than those with panic disorder. Anxiety symptoms and impairment both declined over time. Change in all three anxiety symptoms was closely associated with change in impairment, but only GAD remained a significant (positive) predictor of change in impairment after accounting for co-morbidity.

CONCLUSIONS

Impairment and all three anxiety disorders were closely associated, both cross-sectionally and longitudinally. Because change in GAD was most specifically related to change in impairment, treatment for those with multiple anxiety disorders could focus on treating GAD symptoms first or treating transdiagnostic processes.

The latent structure of generalized anxiety disorder in midlife adults

Generalized anxiety disorder (GAD) is identified as a discrete disorder in the DSM-5, but evidence suggests that GAD and the related construct of pathological worry possesses a dimensional latent structure. The objective of this study was to ascertain the latent structure of GAD using taxometric methods. A subsample of adults (N=2061) from the Midlife in the United States Study, a national sample of Americans, provided the data. Additional data from individuals who were re-interviewed 10 year later (n=1228) were also analyzed. Items corresponding to the DSM-IV-TR diagnostic criteria for GAD were used to generate indicators for the taxometric analyses. Multiple taxometric procedures provided no evidence that GAD has a categorical or taxonic latent structure. Instead, the results were more consistent with the proposition that GAD exists on a continuum. Evidence that GAD is dimensional suggests that dichotomizing individuals into GAD versus non-GAD groups will typically result in decreased statistical power. They also suggest that any diagnostic thresholds for identifying GAD are likely to be arbitrary. The findings are consistent with models that locate GAD within the framework of extant dimensional models of personality and with research that emphasizes a multifactorial etiology for GAD.

Construction of anxiety and dimensional personality model in college students

A sample of 402 volunteer male (n = 156) and female (n = 246) Kuwaiti undergraduates responded to the Arabic versions of the Kuwait University Anxiety Scale and the Eysenck Personality Questionnaire. The latter questionnaire has four subscales: Psychoticism, Extraversion, Neuroticism, and Lie. Women obtained a higher mean score on Kuwait University Anxiety Scale and Neuroticism than did men, while men had a higher mean score on Psychoticism than did women. Factor analysis of the intercorrelations between the five variables, separately conducted for men and women, gave rise to two orthogonal factors called Anxiety-and-Neuroticism vs Extraversion, and Psychoticism vs Lie. Stepwise regression revealed that Neuroticism was the main predictor of anxiety. It was concluded that persons with high Neuroticism scores may be more vulnerable to anxiety than those with low scores.