The Critical Relationship Between Anxiety and Depression

Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

BACKGROUND

Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity.

METHODS

This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions.

RESULTS

Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR.

CONCLUSIONS

Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

Prevalence of anxiety disorders in Latin America: a systematic review and meta-analysis

Background

The prevalence of anxiety disorders among the adult population in Latin America (LATAM) and its association with development indicators is insufficiently characterised. We estimated pooled regional, country, and sex-specific prevalence rates of anxiety disorders in LATAM based on International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. Additionally, we examined the association between its prevalence and four country-level development indicators: Human Development Index (HDI), income inequality (Gini coefficient), Gender Inequality Index (GII), and Intentional Homicide Rate (IHR).

Methods

We conducted a systematic review and meta-analysis of population-based studies on the prevalence of ICD/DSM anxiety disorders in LATAM from 1990 to 2024, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO, LILACS, and grey literature. Study quality was assessed using JBI's critical appraisal tools. Pooled estimates were generated using random-effects meta-analysis, and heterogeneity was evaluated using the I-squared (I 2) statistic. Meta-regression analyses were performed to examine the ecological association between anxiety disorders prevalence and four development indicators. The study was registered with PROSPERO (CRD42020190238).

Findings

Using data from 36 studies in LATAM, we calculated the lifetime, 12-month, and current prevalence of ICD/DSM anxiety disorders at 14.55% (95% Confidence Interval 12.32%-17.11%; I 2 = 97.9%); 6.61% (5.20-8.37; I 2 = 98.1%), and 3.27% (2.34-4.56; I 2 = 97.5%), respectively. Heterogeneity was high across prevalence periods, sexes, and countries (all I 2 ≥ 91.4%), warranting caution in interpreting pooled estimates. Elevated 12-month and current prevalence rates of anxiety disorders were associated with higher Gini coefficients (p ≤ 0.0013). Additionally, higher current prevalence was associated with lower HDI (p = 0.0103) and higher GII (p = 0.0023), while elevated 12-month prevalence was associated with higher IHR (p = 0.011).

Interpretation

This study shows that approximately one in seven people in LATAM experience anxiety disorders at some point in their lives. These findings highlight the need to strengthen mental health systems in the region, and evidence the association between prevalence of anxiety disorders and development indicators. Our results can serve as a baseline for tracking anxiety disorders and for informed decision-making at the national and regional levels. The substantial heterogeneity between studies and the underrepresentation of some countries underscore the imperative for enhancing regional mental health capacities.

Funding

Pfizer Independent Medical Education Grant (69879319).

Association between handgrip strength, handgrip strength asymmetry, and anxiety in Korean older adults: The Korean National Health and Nutrition Examination Survey 2022

Low handgrip strength (HGS) and HGS asymmetry are associated with age-related physical and mental disorders in older adults. This study aimed to examine the association between HGS-related factors and anxiety to evaluate whether HGS assessments can assist in identifying anxiety risk. In total, 1,750 participants from the Korea National Health and Nutrition Examination Survey of 2022 were included in this study. Individuals whose HGS values were below the 20th percentile of the study population stratified by sex were classified into the low-HGS group. Anxiety was assessed using the generalized anxiety disorder with a 7-item scale. Multiple logistic regression was used to analyze the relationship between HGS level and asymmetry and anxiety, adjusting for covariates. Overall, 70 (8.7%) men and 123 (13.0%) women had anxiety. Elevated odds of anxiety were observed in older women with low HGS (adjusted odds ratio: 2.17, 95% confidence interval: 1.31-3.61). There was a positive correlation between the degree of asymmetrical HGS and anxiety among women. This study found positive associations between low HGS, HGS asymmetry, and anxiety in older Korean women. This population may require specific interventions to help maintain good mental health.

Healthier together. How arts on prescription can promote psychosocial wellbeing: a qualitative study

BACKGROUND

Mental health problems are an increasing challenge for primary healthcare. It puts strain on the healthcare professionals with limited time and resources. In several countries, healthcare professionals can refer patients with mental health issues to structured arts programmes, namely Arts on Prescription (AoP). This study explores the qualitative findings from a 3-year study on Arts on Prescription.

METHODS

Primary healthcare patients were recruited to participated in a 10-week group-based arts programme, twice a week for 2 h (22 sessions over 10 weeks, comprising a mixture of arts and cultural activities facilitated by arts professionals) referred from 18 different primary healthcare centres. Twenty-eight participants volunteered to be interviewed using a semi-structured one-to-one approach. The transcribed interviews were analysed using a thematic analysis.

RESULTS

Three themes were identified as Social community & Connectedness, Self-efficacy and Routine & Structure. Through the identified themes positive effects of psychosocial wellbeing is described as reported by the participants connecting to their experiences of participating in the Arts on Prescription programme including finding common grounds, feeling healthier and more human, connecting with inner resources, and establishing new routines.

CONCLUSIONS

The findings highlight the potential of Arts on Prescription programmes to promote holistic psychosocial wellbeing, and to facilitate personal growth through community engagement and structured arts activities with salutogenic approaches.

The prospective association of adolescent loneliness and low resilience with anxiety and depression in young adulthood: The HUNT study

BACKGROUND

Loneliness is a recognized risk factor for anxiety and depression, yet research on its interaction with low resilience remains sparse, particularly across the adolescent-to-adult transition. This study investigates how adolescent loneliness, both independently and in interaction with low resilience, influences anxiety and depression in young adulthood.

METHODS

This study utilized longitudinal data from The Trøndelag Health Study (HUNT) to track adolescents (13-19 years) from Young-HUNT3 (2006-08) through to HUNT4 (2017-19). Loneliness was assessed via a single-item measure, while resilience was estimated using the Resilience Scale for Adolescents. Anxiety and depression outcomes at the 11-year follow-up were measured using the Hospital Anxiety and Depression Scale. Multivariable logistic regression analyses were done to analyze the associations. Moreover, interaction effects were evaluated using relative excess risk due to interaction (RERI).

RESULTS

Loneliness during adolescence independently predicted anxiety and depression in young adulthood. Adolescents experiencing both loneliness and low resilience showed notably higher risks compared to other groups (highly resilient adolescents without loneliness [reference], highly resilient adolescents with loneliness, and adolescents with low resilience and low loneliness). The combined effect of loneliness and low resilience exhibited a synergistic interaction on the additive scale, although it was not statistically significant (RERI 0.13, 95% CI -2.39-2.65).

CONCLUSION

Adolescent loneliness and low resilience independently predict anxiety and depression in young adulthood. The interaction between loneliness and low resilience further heightens these risks. This underscores the importance of early interventions that focus on resilience-building during adolescence and reducing the impacts of loneliness on mental health.

System-based pain groups are uniquely associated with sociodemographic and psychiatric correlates among those with posttraumatic stress disorder (PTSD)

OBJECTIVE

Chronic pain is a prevalent comorbidity among those with posttraumatic stress disorder (PTSD). Chronic pain can be divided into specific pain (i.e., involving a single body system) and complex pain (i.e., involving multiple body systems). We explored sociodemographic and psychiatric differences between pain groups among those with PTSD.

METHOD

Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, N = 36,309). Pain groups were determined through health professional confirmed self-report of chronic pain conditions within three body systems (musculoskeletal, nerve or digestive conditions). Psychiatric conditions were identified with the Alcohol Use Disorder and Associated Disabilities Interview Schedule for DSM-5; suicide attempts were assessed via self-report.

RESULTS

Among our PTSD sub-sample (n = 1779; 4.7%), 53.9% had no conditions, 25.6% endorsed specific pain, and 19.1% endorsed complex pain. Multinomial logistic regressions revealed increased odds of certain sociodemographic correlates (e.g., older age) common to both pain groups when compared to those with PTSD alone, as well as decreased odds (e.g., being non-White) unique to those with complex pain. Multivariable logistic regressions revealed both specific pain and complex pain were associated with increased odds of any lifetime personality disorder relative to the no pain group (AOR = 1.56 and 2.38, respectively). Complex pain was uniquely associated with increased odds of any past-year anxiety disorder, past-year tobacco use disorder, and lifetime suicide attempts (AOR range = 1.46-1.69) relative to PTSD alone.

CONCLUSION

Findings indicate that those with PTSD and pain conditions impacting multiple body systems represent a particularly vulnerable group.

Mental healthcare utilisation among individuals with colorectal cancer: population-based cohort studies

Objective

Individuals with colorectal cancer (CRC) have an increased risk of mental disorders, yet mental healthcare utilisation has not been adequately examined. We evaluated mental healthcare utilisation and receipt of minimally adequate treatments for anxiety and/or depression among individuals with and without CRC.

Methods and analysis

We used administrative health databases from British Columbia, Canada, comprised of individuals with CRC and individuals without CRC, matched (1:1 ratio) on age, sex and incident mental disorder(s) (ie, occurring after CRC diagnosis/matched date). Primary outcomes were minimally adequate antidepressant pharmacotherapy (≥84 days' supply) and psychological (≥4 services) treatment.

Results

Among individuals with CRC, 1462 had incident anxiety (mean age 64.6±12.5 years, 59.2% females), 4640 had incident depression (mean age 66.3±12.3 years, 51.2% females). Approximately one in four individuals with CRC were diagnosed with anxiety (23.4%) and/or depression (23.2%) in the first year after CRC diagnosis. Minimally adequate antidepressant pharmacotherapy (36.2%) and psychological treatment (15.9%) for anxiety were significantly lower in CRC patients than in those without CRC (pharmacotherapy adjusted OR (aOR) 0.74; 95% CI 0.61, 0.88; psychological treatment aOR 0.74; 95% CI 0.58, 0.95). Similar findings were observed for depression (pharmacotherapy aOR 0.81; 95% CI 0.74, 0.90). Among individuals with CRC, mental healthcare utilisation persisted up to 10 years post-mental disorder diagnosis.

Conclusions

Individuals with CRC receive less mental health treatment for anxiety and/or depression, compared with those without CRC. Findings raise awareness for the need for ongoing mental healthcare throughout and beyond CRC.

The association between screen time trajectories and the comorbidity of depression and anxiety

Depression and anxiety are often comorbid among adolescents. Adolescent screen time changes over time. This study investigates the association between screen time trajectories and the comorbidity of depression and anxiety from a longitudinal perspective. The data were collected from an ongoing prospective puberty cohort which was established in 2014 from Chongqing, China. 838 participants (52.03 % female; wave 1 mean age = 8.62, SD = 1.15) were followed up from 2014 to 2020. Questions about screen time were administered every six months. Trajectories of screen time were identified using latent class growth analysis. Children's Depression Inventory (CDI) and Screen for Child Anxiety Related Disorders (SCARED) were used to measure depression and anxiety. Latent profile analysis was used to identify the subtypes of comorbidity of depression and anxiety. Logistic regression was used to explore the association between screen time trajectory and the comorbidity of depression and anxiety. Three distinct trajectories of screen time were identified: Group Low (68.26 %) had consistently low screen time, Group High (26.37 %) had high screen time and Group Increasing (5.37 %) was characterized by an increasing screen time. Four subtypes of the comorbidity of depression and anxiety were fitted ("High comorbidity", "Low comorbidity", "Low depression symptoms" and "No symptoms"). Group Increasing and Group High were associated with "Low comorbidity" and "Low depression symptoms". Group Increasing was more likely to be the "high comorbidity" both boys and girls. However, Group High was associated with "high comorbidity" only in girls. The results of this study may inform future research and provide possible intervention targets.

The role of isolated diffuse axonal brain injury on post-traumatic depressive- and anxiety-like behavior in rats

Traumatic brain injury (TBI) is a significant global health concern and is associated with short-term and long-term comorbidities such as mood disorders and reduced quality of life. Diffuse axonal brain injury (DABI) is a common but severe type of TBI. The role of DABI in the development of psychiatric sequelae after TBI is not well understood due to the challenge of isolating DABI from general TBI in the human population. Here we investigate the role of DABI in the occurrence of post-TBI depressive- and anxiety-like behaviors in a rat model. Forty rats were randomly assigned to two groups, with 20 receiving DABI and 20 receiving sham treatment. We used a magnetic resonance imaging (MRI) protocol developed for DABI using a 3-T clinical scanner to confirm DABI. We then compared neuroimaging, neurological and behavioral assessments across experimental groups. There was a significant difference between DABI and sham groups on sucrose preference, a measurement of depressive-like behavior (p < 0.012), and time spent on open arms on a plus maze test, a measurement of anxiety-like behavior (p < 0.032). For MRI-detected injury, there was a difference in diffusion-weighted imaging with relative anisotropy (p < 0.001) and fractional anisotropy (p < 0.001) mapping. We found that isolated DABI in our model led to post-traumatic depressive-like behavior in 30% of cases and anxiety-like behavior in 35%. Additionally, we established diagnostic cut-offs for depressive-like and anxiety-like behaviors in injured rats. We also documented comorbidity between the development of depression and anxiety in DABI-exposed rats. We anticipate that this study will greatly enhance the understanding of the relationship between DABI, TBI, and mood disorders like depression and anxiety, and aid in developing treatment options for these interconnected conditions.

Exploring the effects of aerobic and resistance exercise on mood-related symptoms and EEG activity

Introduction

Anxiety and depression are psychiatric disorders that have a deleterious effect on human mental health. Meanwhile, various forms of exercise have been demonstrated to have beneficial effects on the reduction of symptoms of anxiety and depression. However, the disparate effects of each exercise on mood symptoms remain to be elucidated. This research examines the different effects of each type of exercise on mood symptoms and electroencephalography (EEG) activity.

Methods

Accordingly, subjects engaged in six weeks of aerobic and resistance exercises with a 3-week washout period between each intervention. The Score of Hospital Anxiety and Depression Scale (HADS) was employed to assess the severity of both anxiety and depression. For the purposes of EEG analysis, we calculated the values of theta/beta ratio (TBR), Higuchi Fractal Dimension (HFD), and frontal alpha asymmetry (FAA).

Results

Both types of exercise resulted in the alleviation of both anxiety and depression. Notably, aerobic exercise significantly decreased the score of HADS-A (anxiety), while resistance exercise significantly improved HADS-D (depression). In the context of EEG analysis, a significant decrease of TBR in the left frontal region was observed after aerobic exercise.

Discussion

Therefore, these findings emphasize the importance of personalized exercise strategies for those suffering from anxiety and depression. Furthermore, further investigation into the impact of exercise on brain wave activities associated with anxiety and depression are needed.

Participants' evaluation of an internet-based group compassion-focused therapy program for young people in Sweden

Introduction

Online group compassion-focused therapy (CFT) has not been thoroughly studied in young people, and the participants' perspectives on the treatment are highly relevant.

Methods

A seven-session internet-based group CFT program was evaluated for young people aged 15-20 (n = 42, females = 37). A self-report evaluation questionnaire, specifically designed for this study, was administered post-intervention. The current study investigated: (1) Potential factors influencing the treatment program goals (increase self-compassion, reduce self-criticism and increase affect-regulation abilities) and the participants' overall experience of the treatment; and (2) The effect each intervention exercise had on the program goals according to the participants' ratings.

Results

Participants generally reported high satisfaction and had a high attendance rate. Only 2.4% of the participants completed less than half of the sessions and 71% of the participants attended at least six of the seven sessions. Exercises that integrated traditional cognitive-behavioral therapy (CBT) and Compassion-Focused Therapy (CFT) principles received high ratings, whereas breathing and mindfulness exercises were rated lower in many cases. Several compassion exercises were also highly rated, such as the Threat-drive and security system, based on CFT affect-regulation theory. The majority did not find home assignments helpful.

Discussion

The findings suggest that internet-based group CFT could be an easily accessible and acceptable intervention for young people in primary care, though further research is warranted.

Psychoneuroendocrine stress response in female and male youth with major depressive disorder

BACKGROUND

Exposure to psychosocial stress is one of the strongest risk factors for major depressive disorder (MDD) in youth, but underlying neurobiological mechanisms are poorly understood. Previous studies on the neuroendocrine stress response in youth with MDD are scarce, limited to cortisol, and rarely considered sex differences. Due to puberty-associated neuroendocrine transitions increasing the risk for MDD onset in adolescence, this study aimed to investigate sex-specific stress responses of stress and sex hormones as well as of neuropeptides.

METHODS

In 103 pubertal youths with MDD and 72 healthy controls (HCs; 62% females, 12-18 years), psychological stress as well as salivary cortisol, testosterone, and oxytocin reactivity to a standardized psychosocial stress test (Trier Social Stress Test, TSST) were assessed. Effects of group and sex, and their interactions were analyzed using hierarchical linear models, while controlling for potentially confounding factors (such as age and pubertal status).

RESULTS

Females and males with MDD showed a stronger psychological stress response than HCs. In contrast, both female and male youth with MDD showed blunted cortisol, testosterone, and oxytocin stress responses compared to HCs. In addition, baseline testosterone was elevated in MDD compared to HCs.

CONCLUSIONS

Results indicate a discrepant stress reactivity in youth with MDD, with increased psychological, but decreased neuroendocrine responses to psychosocial stress. Blunted neuroendocrine stress responses in youth with MDD were found across different neuroendocrine systems and in both females and males with MDD. These novel findings point to a fundamentally changed stress response in youth with MDD irrespective of sex, which may influence successful stress regulation in the affected adolescents.

Impact of post-traumatic stress disorder symptoms, childhood adversities and stressful life events on depressive and anxiety symptoms: insights from the UK Biobank

Background

Childhood adversities (CAs) and stressful life events (SLEs) are linked to depressive, anxiety, and PTSD symptoms. However, their interrelationships are not well studied. We aimed to examine the potential role of PTSD symptoms as risk factors for both outcomes, test the stress sensitization hypothesis, and investigate the pathways linking CAs, stressful life events (SLEs) and PTSD symptoms, and depressive and anxiety symptoms.

Methods

We conducted a cross-sectional study using data from adult participants at baseline (2006-2010) and online follow-up (2016) in the UK Biobank. Data analysis was performed from February 24, 2023, to July 12, 2023. Linear regression and serial mediation analyses were performed.

Results

PTSD symptoms was significantly associated with depressive (β = 0.567, p<.001) and anxiety symptoms (β = 0.558, p<.001). The interaction between CAs and SLEs was still significantly associated with depressive symptoms when accounting for those of PTSD as covariates (β = 0.017, p<.001), but not for anxiety symptoms. The serial mediation analyses revealed that SLEs and PTSD symptoms were both significant sequential mediators between CAs and symptoms of depression and anxiety (proportion mediated: 75.14% and 84.27%, respectively, p< 0.05).

Conclusions

Our study provided further evidence for stress sensitization hypothesis only among participants with depressive symptoms and found that SLEs and PSTD symptoms partly mediated the association between CAs and depressive and anxiety symptoms. These findings may provide new evidence to better understand the pathogenesis of depression and anxiety and will help to guide future prevention and intervention for both diseases.

From anxiety to depression: A longitudinal investigation into the role of anhedonia

Anxiety and depression are highly comorbid with each other, warranting a need to better understand transdiagnostic mechanisms. Anhedonia has been hypothesized as a transdiagnostic mechanism but has often been investigated as a unidimensional factor. Thus, the current study examined how anticipatory and consummatory anhedonia, including how they interact with anxiety, predict next-week depression. Participants (N = 101) completed weekly assessments of anxiety, depression, and anhedonia. Using an iterative approach, we constructed four models to investigate independent and interactive effects of prior-week anxiety and anhedonia on next-week depression, as well as the effects of depression and anhedonia on anxiety. Our results indicate that anticipatory anhedonia is associated with next-week depression, and the association between anxiety and depression is greater when anticipatory anhedonia is high. The current findings provide insight into the transdiagnostic nature of anticipatory anhedonia between anxiety and depression. Future work should investigate how these associations may unfold over shorter time periods.

Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma-Insights from the Network Approach

Background

Childhood trauma can have a long-lasting influence on individuals and contribute to mental disorders, including depression and anxiety. Depression, anxiety, and stress are highly comorbid among adolescents with the trauma experience. Yet, the evolution of comorbidity remains unclear. To fill this gap, the current study aimed to explore the symptomatic and changing patterns of depression, anxiety, and stress among adolescents exposed to childhood trauma.

Methods

A total of 1548 college students (females = 782 (50.98%), Meanage = 19.59, SDage = 1.14) in China completed the Childhood Trauma Questionnaire (CTQ) and the Depression, Anxiety, and Stress Scales (DASS-21), and 942 students (Females = 516 (54.78%), Meanage = 19.57, SDage = 1.16) met the selection standard based on the cut-off scores of the CTQ. The symptomatic network and directed acyclic graph (DAG) network approaches were used.

Results

The results revealed that males reported experiencing significantly more physical abuse, physical neglect, emotional neglect, and sexual abuse compared to females. However, females scored significantly higher than males on "Worried" (DASS9), "Agitated" (DASS11), "Panic" (DASS15), and "Scared" (DASS20). No significant difference between genders was observed in the network structure and global strength. Meanwhile, among all participants, "Down-hearted" and "Agitated" appeared to be the most interconnected symptoms, the bridge symptoms in the symptom network, as well as the most vital symptoms in the directed acyclic graph network. Apart from that, "Panic" also served as the most prominent symptom in the directed acyclic graph network.

Conclusion

The results suggested that intervention targeted at assisting adolescents in developing more adaptive coping strategies with stress and regulating emotion could benefit the alleviation of comorbid depression, anxiety, and stress.

Lost connection? Comparing group cohesion and treatment outcomes between videoconference and in-person cognitive behavioural group therapy for social anxiety disorder and other anxiety disorders

BACKGROUND

One of the most effective treatments for social anxiety disorder (SAD) is cognitive behavioural therapy (CBT). Prior research indicates group cohesion is connected to treatment success in group CBT for SAD (CBGT). Videoconference CBGT delivery is now common following the COVID-19 pandemic; however, research investigating treatment outcomes and group cohesion in videoconference CBGT for SAD is limited.

AIMS

The present study aimed to compare group cohesion in videoconference CBGT for SAD to group cohesion in both in-person CBGT for SAD and videoconference CBGT for other anxiety and related disorders. A secondary aim was to compare symptom reduction across all three groups.

METHOD

Patients completed a 12-week CBGT program for SAD in-person (n=28), SAD via videoconference (n=46), or for another anxiety or related disorder via videoconference (n=100). At mid- and post-treatment patients completed the Group Cohesion Scale Revised (GCS-R), and at pre- and post-treatment patients completed the Social Phobia Inventory (SPIN, only in the SAD groups) and the Depression Anxiety Stress Scales (DASS-21).

RESULTS

Over the course of treatment, all three groups showed a significant increase in cohesion and a significant decrease in symptoms (ηp2 ranged from .156 to .562, all p<.001). Furthermore, analyses revealed no significant difference in cohesion scores between groups at both mid- and post-treatment.

CONCLUSIONS

These results suggest that videoconference CBGT for SAD is similarly effective in facilitating cohesion and reducing symptoms compared with in-person delivery. Limitations of the study and implications for treatment are discussed.

Treating anxiety comorbidity: Lessons from exposure generalization studies

Comorbidity is a characteristic hallmark of anxiety disorders. Presence of comorbid anxiety and depression is challenging to the diagnosis and treatment. Conventional and transdiagnostic treatment options for anxiety disorders strongly depend on the use of exposure. Recent compelling evidence suggests that the beneficial effects of exposure therapy are transferable across different fear- and anxiety provoking situations and might even affect depressive symptomatology. We provide an overview of findings on existing studies on generalization of exposure effects to untreated stimuli and depression. Potential mechanisms which contribute to generalization of beneficial exposure therapy effects, such as extinction generalization, mastery-related increases in self-efficacy and underlying neural changes are presented and discussed. Understanding and promoting mechanisms related to exposure therapy efficacy and generalization can expedite and enhance the development of more effective transdiagnostic therapy approaches for comorbid anxiety disorders.

Exploring the relation between media usage frequency and anxiety among Chinese residents: a latent profile analysis

Objective

This study investigates the relationship between media usage patterns and anxiety levels, specifically examining how different media usage profiles influence anxiety across various demographic groups.

Methodology

A total of 11,031 respondents from 120 cities across China were classified into three media usage profiles-Traditional Media-Dominant Users, New Media-Dominant Users, and Omni-Media Users-using Latent Profile Analysis (LPA) based on their media usage frequency. Demographic covariates were excluded during the initial profiling to ensure the analysis focused solely on media usage patterns. Multiple linear regression analyses were then conducted to examine the relationship between media usage types and anxiety levels. Finally, factors influencing anxiety across the different media usage profiles were explored separately.

Results

The analysis revealed that both Traditional Media-Dominant and Omni-Media Users exhibited significantly higher levels of anxiety compared to New Media-Dominant Users. Factors such as geographic region, health literacy, income, debt, employment stability, and property ownership showed varying effects on anxiety across the profiles. Additionally, perceived stress and depression were identified as consistent, positive predictors of anxiety in all media usage groups.

Conclusions

Compared to New Media-Dominant Users, both Traditional Media-Dominant and Omni-Media Users exhibited stronger associations with anxiety. These findings suggest that anxiety is influenced by multiple intersecting factors across media usage profiles, highlighting the need for tailored interventions that consider individuals' specific media engagement patterns.

The Identification and Management of Subthreshold Depression and Anxiety in Primary Care for People With Long-Term Conditions

Background: Subthreshold depression (sDep) and anxiety (sAnx) are common conditions and are associated with significant suffering, impaired functioning, increased healthcare utilisation and economic costs. Furthermore, they are risk factors for crossing the clinical threshold and developing mental health disorders. Subthreshold conditions are associated with long-term conditions (LTCs). This scoping review aimed to explore the identification and management of sDep and sAnx in primary care for patients with LTCs. Methods: We conducted a scoping review, following the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Medline, PsycInfo, CINAHL and International Pharmaceutical Abstracts were searched for articles prior to September 2023. We included studies written in English that were conducted among the adult population. All studies that aimed to identify and manage sDep and anxiety in patients with LTC in primary care have been included. Results: Thirty-three articles were included in this scoping review, of which seven studies incorporated an intervention component for sDep and sAnx in patients with LTCs. A variety of definitions and screening tools were used to identify sDep and sAnx. Problem-solving therapy (PST) and behavioural activation (BA) were the most common intervention components and showed promising results. Limitations: We excluded studies that did not explicitly state the terms 'subthreshold', 'subclinical' or 'subsyndromal' depression or anxiety which may be relevant. Conclusion: There is currently limited evidence regarding the identification and management of sDep and sAnx in patients with LTCs, warranting further research.

The Potential of Selected Plants and Their Biologically Active Molecules in the Treatment of Depression and Anxiety Disorders

The incidence of anxiety and depression disorders is increasing worldwide. There is an increasing incidence of hard-to-treat depression with various aspects of origin. Almost 80% of people prefer to use natural remedies and supplements as their primary healthcare solution. Not surprisingly, around one-third of drugs were inspired by nature. Over the past three decades, the use of such remedies has increased significantly. Synthetic antidepressants may cause various negative side effects, whereas herbal medicines are favored because of their ability to relieve symptoms with minimal to no side effects and lower financial burden. This review provides an overview of herbs and biologically active compounds used to treat depression.

Anhedonia in flux: Understanding the associations of emotion regulation and anxiety with anhedonia dynamics in a sample with major depressive disorder

Negative rumination and emotion regulation difficulties have been consistently linked with depression. Despite anhedonia-the lack of interest in pleasurable experiences-being a cardinal symptom of depression, emotion regulation of positive emotions, including dampening, are considered far less in the literature. Given that anhedonia may manifest through blunted responses to previously positive or enjoyable experiences, it is vital to understand how different positive emotion regulation strategies impact anhedonia symptom severity and how it can vary or change over time. Moreover, understanding the detrimental or protective nature of positive emotion regulation on anhedonia can aid with future anhedonia-focused treatments. Therefore, the current study examined the temporal association between anhedonia dynamics and two different emotion rumination strategies in response to positive emotions: dampening and positive rumination. Depressed persons (N = 137) completed baseline measures of positive emotion regulation, difficulties regulating negative emotions, and anxiety, and completed ecological momentary assessments three times per day for 90 days regarding their depressive symptoms, including anhedonia. We assessed baseline dampening and amplifying scores to predict anhedonia dynamics through four linear models with interactions. Providing partial support for our hypotheses, results indicate that amplifying positivity is positively associated with fluctuations, instability, and acute changes in anhedonia over the course of 90 days; however, neither dampening, difficulties regulating negative emotions, nor anxiety were related to anhedonia dynamics. The current findings suggest that amplifying positivity may be able to predict changes in anhedonia over time and should further be examined as a potential protective factor of anhedonia.

Anxiety Symptoms Predict Subsequent Depressive Symptoms in Neurodivergent Youth: A 10-Year Longitudinal Study

Neurodivergent youth often experience anxiety and depressive symptoms that may hamper adaptive functioning and well-being. There is little knowledge of how anxiety and depression are related in neurodivergent youth. Therefore, we aimed to examine whether the relationship between anxiety and depressive symptoms is uni- or bidirectional in neurodiverse youth. We assessed self-reported anxiety and depressive symptoms over time in 173 youth (Mbaseline age = 11.7 years, SD = 2.1, 64% males, 36% females). The sample comprised 38 autistic youth, 85 youth diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 50 comparison youth assessed at baseline (T1), 2-year follow-up (T2, 97% retention), and 10-year follow-up (T3, 73% retention). We used cross-lagged models to analyze the data. In neurodivergent youth, more anxiety symptoms at T1 and T2 predicted more depressive symptoms at T2 and T3. Preceding anxiety symptoms were linked with later depressive symptoms, even after accounting for autoregressive effects of depressive symptoms. The results are consistent with a prodromal model in which anxiety symptoms can independently foreshadow the emergence of depressive symptoms over the course of development among neurodivergent youth. Potentially, addressing anxiety symptoms among youth with autism or ADHD could play a role in preventing the onset of youth depression.

Longitudinal association of exposure to work-related stress with major depressive disorder and the role of occupational burnout in this association in the general population

PURPOSE

To prospectively assess (1) the associations of Effort-Reward Imbalance (ERI), its individual components, and over-commitment with (a) the onset of a Major Depressive Episode (MDE) during a 3.6-year follow-up in a population-based cohort in participants with no current Major Depressive Disorder (MDD) in the beginning of the follow-up (n = 959), (b) incidence of MDD in the subsample of participants exempt from lifetime MDD (n = 490), and (c) the onset of a new MDE (i.e. recurrence) in the subsample of participants with remitted but no current MDD (n = 485), and (2) potential effect modification of burnout on these associations.

METHODS

DSM-IV Axis-I disorders were elicited using the semi-structured Diagnostic Instrument for Genetic Studies at each investigation. The ERI Questionnaire was used to measure ERI and overcommitment. Burnout was measured with the Maslach Burnout Inventory General Survey. Serially adjusted logistic regression models were used. The effect of burnout dimensions on these associations was assessed by testing interactions between the ERI and burnout dimensions.

RESULTS

(1) ERI was prospectively associated with the onset of MDE, even after adjustment for burnout [OR (95CI) = 1.22 (1.003-1.49)]. (2) The association between ERI and MDD incidence became non-significant after adjusting for burnout. (3) ERI was not associated with recurrence of pre-existing MDD. (4) burnout did not interact with ERI.

CONCLUSIONS

Our results support a longitudinal association between ERI and the risk of onset of MDE in the community. Burnout did not modify this effect, but it may partially account for the association between ERI and MDD incidence.

Resting State Cortical Network and Subcortical Hyperconnectivity in Youth With Generalized Anxiety Disorder in the ABCD Study

INTRODUCTION

Generalized anxiety disorder (GAD) frequently emerges during childhood or adolescence, yet, few studies have examined functional connectivity differences in youth GAD. Functional MRI studies of adult GAD have implicated multiple brain regions; however, frequent examination of individual brain seed regions and/or networks has limited a holistic view of GAD-associated differences. The current study therefore used resting-state fMRI data from the Adolescent Brain Cognitive Development study to investigate connectivity in youth with GAD across multiple cortical networks and subcortical regions implicated in adult GAD, considering diagnosis changes across two assessment periods.

METHODS

Within- and between-network connectivity in 164 youth with GAD and 3158 healthy controls for 6 cortical networks and 6 subcortical regions was assessed using linear mixed effect models. Changes in GAD-associated connectivity between baseline and 2-year follow-up were then compared for subjects with: continuous GAD, GAD at baseline and not follow-up (GAD-remitters), GAD at follow-up and not baseline (GAD-converters), and controls.

RESULTS

Youth with GAD showed greater within-ventral attention network (VAN) connectivity, and hyperconnectivity between the amygdala and cingulo-opercular network, and between striatal regions and the cingulo-opercular, default mode, and salience networks (FDR p<0.05). Within-VAN connectivity decreased for GAD-remitters between baseline and follow-up. Sensitivity analyses revealed that these hyperconnectivity patterns were not observed in major depressive disorder (n=19), separation anxiety (n=33), or social anxiety disorder (n=111) without GAD.

DISCUSSION

Results indicate that GAD in childhood and adolescence is associated with altered subcortical to cortical network connectivity, and that within-VAN hyperconnectivity, in particular, is associated with clinically-significant GAD-specific symptoms.

The Roles of Anxiety and Depressive Symptoms in the Relationship Between School Bullying Victimization and Suicidal Ideation Among South Korean College Students: A Serial Multiple Mediation Model

This study examined the sequential mediating roles of anxiety and depressive symptoms in the effect of school bullying victimization on suicidal ideation. This study utilized a convenience sample of college students across South Korea, and an online survey was conducted. This quantitative research analyzed data collected from 1037 participants. The sample consisted of an equal gender distribution, with a mean age of 23.65 years (range: 18-30). Additionally, 30% of participants reported a household income of four million won or less (approximately USD $3076). More than half of the participants' parents had attained a college education or higher. Also, multiple mediation analyses were conducted to examine whether anxiety and depressive symptoms mediated the relationship between school bullying victimization and suicidal ideation. In the results, multiple mediation analyses showed that school bullying victimization does not have a direct effect on suicidal ideation. On the other hand, school bullying victimization has an indirect effect on suicidal ideation through anxiety and depressive symptoms, controlling for covariates. Based on these research results, implications for school bullying prevention and intervention were discussed.

Somatization and Body Composition: Findings from a Cross-Sectional Study on Non-Clinical Young Adults

BACKGROUND/OBJECTIVES

Lifestyle is a significant, common, and easily modifiable factor capable of increasing or reducing the risk of acquiring many diseases. Currently, there is a research gap as too little scientific attention has been focused on exploring the relationship between mental health and nutritional status in various populations. Moreover, the association between body composition and somatization has not been fully disclosed. Therefore, this study aimed to assess the associations of body composition with the symptomatology of somatization in an environmentally vulnerable sample of young adults.

METHODS

A single cross-sectional study included young non-clinical Lithuanian students (n = 1223) aged 21.7 ± 3.9. The body adiposity status of the study participants was estimated using both the body mass index (BMI) and the Body Adiposity Estimator (CUN-BAE) method. Fat-free mass was evaluated via the adjusted fat-free mass index equation (FFMIadj). The Patient Health Questionnaire (PHQ-15) was applied to assess the severity of the perceived symptoms of a somatic symptom disorder (SSD).

RESULTS

The CUN-BAE was considered to be a better predictor of adiposity than the BMI because 14.7% of females and 6.2% of males were interpreted as obese using the CUN-BAE, while the BMI equation identified participants as having a normal body weight. The highest rates of somatization were found in 18.6% of the cohort. Young adults with higher amounts of body fat mass (β: 0.050, 95% confidence interval (95% CI): 0.013; 0.084, p = 0.007) and lower FFMI are prone to a higher risk for developing somatization (β: -0.429, 95% CI: -0.597; -0.260, p < 0.001).

CONCLUSIONS

Our study revealed that body composition is significantly related to multiple somatic complaints throughout a range of measurements. However, in contrast to the CUN-BAE tool, the BMI equation underestimated the relationship between body fat and mental health outcomes in young adults. Even though nutritional status along with targeted physical load, as the mediators, are likely to play a significant role in the maintenance of optimal body composition and mental health outcomes, healthcare providers are recommended to advise individuals to lower their body fat percentage and increase fat-free mass in order to reduce the risk of somatization.

Non-invasive neuromodulation treatment for depression in adolescents: A systematic review and meta-analysis

BACKGROUND

Synthesized evidence regarding the effectiveness of non-invasive neuromodulation treatment for adolescents remains scarce. This study aimed to perform the first meta-analysis of the impact of neuromodulation treatment on depressive symptoms in adolescents.

METHODS

According to the PRISMA guidelines, a comprehensive review covering databases in English and Chinese from their inception to November 30, 2023, was conducted. Data were pooled to compute the standardized mean difference (SMD) and risk ratio (RR), along with their respective 95 % confidence intervals (CI).

RESULTS

A total of 27 studies involving 2075 participants were included and examined. Noninvasive neuromodulation treatment demonstrated significant positive effects on depression symptoms compared with controlled conditions (Hamilton Depression Scale (HAMD) 17: SMD = 3.503, 95 % CI = 2.404-4.602, p < 0.001; HAMD 24: SMD = 3.375, 95 % CI = 2.437-4.314, p < 0.001). High heterogeneity was observed (I2 = 95.2 % and 97.2 %, p < 0.01), along with a substantial risk of publication bias (p < 0.05). In terms of the treatment response, the RR reached 1.39 (95 % CI = 1.29-1.50, p < 0.001), with low heterogeneity (I2 = 35 %, p = 0.07).

CONCLUSIONS

Noninvasive neuromodulation treatment significant alleviated depressive symptoms in adolescents. Future research should prioritize conducting high-quality clinical trials to determine the suitable selection of adolescent patients for this treatment. In addition, these trials can help guide precision medicine approaches for stimulation protocols.

Factorial invariance of the generalized anxiety disorder scale (GAD-7) in Latin America and the Caribbean

Introduction

The prevalence of Generalized Anxiety Disorder (GAD) has increased rapidly, highlighting the importance of its detection using quick tools applicable to men and women from different countries.

Objective

To analyze the psychometric properties of the Generalized Anxiety Disorder Test (GAD-7) by gender and country in Latin America and the Caribbean (LAC).

Method

A cross-sectional e-health study with 12,124 participants from 15 LAC countries (54.32% women, 45.68% men) was conducted, including participants from Argentina (7.3%), Bolivia (6.7%), Colombia (10.3%), Chile (6.9%), Costa Rica (4.9%), El Salvador (5.7%), Ecuador (7.2%), Guatemala (4.7%), Panama (5.1%), Paraguay (5.7%), Peru (8.6%), Puerto Rico (5.8%), the Dominican Republic (6.6%), Uruguay (6.3%), and Venezuela (8.2%). All participants completed the GAD-7 scale digitally.

Results

A unidimensional structure of the GAD-7 was confirmed, explaining 70% of the variance. The model fit indices were adequate (RMSEA = 0.062; CFI = 0.997; TLI = 0.995; SRMR = 0.017; p < 0.001), and the factor loadings for each item were satisfactory (> 0.70). Additionally, the factor structure showed measurement invariance between genders and countries, with adequate fit indices at all levels (configural, metric, scalar, and strict), suggesting that the measurements are equivalent in both contexts. Finally, the internal consistency of the GAD-7 was high, with a McDonald's Omega coefficient of 0.91.

Conclusions

The GAD-7 exhibits a factor structure that is equivalent across genders and countries, demonstrating its validity and reliability for the rapid detection of GAD symptoms in different countries within the region.

Mental health in children with and without ADHD: the role of physical activity and parental nativity

BACKGROUND

Physical activity (PA) can improve mental health, including anxiety/depression, in individuals with attention-deficit/hyperactivity disorder (ADHD) with minimal side effects, unlike pharmacotherapy that can result in significant side effects. However, the influence of PA on mental health among children with ADHD is understudied. Also, immigrants tend to have better mental health, but the influence of parental nativity on children's mental health is unknown. We examined the relationship between PA, parental nativity, and current anxiety/depression among U.S. children with and without ADHD. We also analyzed whether ADHD diagnosis status moderates the relationship between anxiety/depression and PA or parental nativity.

METHODS

We used national annual cross-sectional data from the 2016 to 2021 National Survey of Children's Health to conduct weighted multivariable logistic regression and moderation analyses, with current anxiety/depression status as the outcome variable. The sampling involves selecting households with children and rostering children in the household from each state and the District of Columbia. A parent or caregiver of the selected child completes the surveys. We restricted the analysis to children aged 6-17 years (N = 140,977).

RESULTS

The prevalence of current anxiety/depression was higher in children with ADHD diagnosis (37.34%) than those without ADHD diagnosis (7.42%). Children with ADHD (versus no ADHD) had higher odds of anxiety/depression. Engaging in PA (versus no PA) and having immigrant parents (versus non-immigrant parents) were associated with lower anxiety/depression odds. ADHD diagnosis status significantly moderated the association between anxiety/depression and PA or parental nativity. However, the three-way interaction between ADHD status, parental nativity, and physical activity was not statistically significant. Stratified by ADHD diagnosis status, those who engaged in PA (versus did not) for 1 to 3 days, 4 to 6 days, and daily were less often diagnosed with anxiety/depression disorder among those with or without ADHD, especially children without ADHD. The odds were also lower for children with or without ADHD whose parents were immigrants than children with non-immigrant parents, particularly children without ADHD who had immigrant parents. Parental nativity did not significantly moderate the association between PA and anxiety/depression among children with and without ADHD.

CONCLUSIONS

Physical activity was associated with lower risks of diagnosed with anxiety/depression disorder among children, especially children without ADHD and those with immigrant parents. Considering parental nativity and incorporating personalized PA in ADHD and anxiety/depression management can improve mental illness and ADHD symptoms among children.

Meta analysis of resting frontal alpha asymmetry as a biomarker of depression

This meta-analysis investigated resting frontal alpha asymmetry (FAA) as a potential biomarker for major depressive disorder (MDD). Studies included articles utilizing FAA measure involving EEG electrodes (F3/F4, F7/F8, or Fp1/Fp2) and covering both MDD and controls. Hedges' d was calculated from FAA means and standard deviations (SDs). A systematic search of PubMed through July 2023 identified 23 studies involving 1928 MDD participants and 2604 controls. The analysis revealed a small but significant grand mean effect size (ES) for FAA (F4 - F3), suggesting limited diagnostic value of FAA in MDD. Despite the presence of high heterogeneity across studies, subgroup analyses did not identify significant differences based on calculation formula, reference montage, age, or depression severity. The findings indicate that FAA may have limited standalone diagnostic utility but could complement existing clinical assessments for MDD, highlighting the need for a multifaceted approach to depression diagnosis and prognosis.

Efficacy of Polyunsaturated Fatty Acids as a Treatment for Post-traumatic Stress Disorder: A Systematic Review

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a prevalent health condition among members of the military. Although the efficacy of pharmacological and psychiatric interventions for PTSD has been well studied, there are limited data on the effects of omega-3 (n-3) polyunsaturated fatty acid (PUFA) interventions on PTSD. The use of PUFAs shows promise because of their neuroprotective effects. Thus, this systematic review will synthesize the current state of the evidence regarding the effectiveness of PUFA treatment for PTSD.

MATERIALS AND METHODS

Using the PubMed, PsychINFO, Embase, and CINAHL databases, a search of the literature was conducted using the search terms "posttraumatic-stress-disorder, combat disorders, trauma-related-stress-disorder, omega-3, fatty acid, and polyunsaturated fatty acids" to identify articles published from January 1, 2008, to January 1, 2024, that focused on PUFA interventions for PTSD. A total of 281 articles were identified. Following exclusions and quality assessments using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria proposed by Cochrane, 6 randomized controlled trials (RCTs) and preclinical studies were chosen for inclusion, and data were then extracted into a data matrix for final synthesis and analysis.

RESULTS

The RCTs (n = 3) showed no significant effect of PUFAs in the prevention of PTSD symptom onset. Among preclinical studies (n = 3), PUFAs resulted in a significant decrease in anxiety-like behavior and fear memory and an increase in spatial learning and memory. The quality of evidence among the 6 RCTs and preclinical studies using the Cochrane GRADE criteria ranged from low to high.

CONCLUSIONS

The results from this systematic review suggest that more evidence is needed before making any recommendations for the clinical use of dietary PUFAs in the management of PTSD symptoms.

Photopsias are associated with greater levels of depression and anxiety

CLINICAL RELEVANCE

Vitreous floaters have been associated with depressive and anxiety symptoms. However, there is a scarcity in the literature regarding the possible impact of vitreous flashes on the psychological status of the patients.

BACKGROUND

Photopsias and vitreous floaters frequently co-exist. Floaters have been accompanied by exacerbated levels of depression and anxiety. The aim of this study was to examine whether the presence of photopsias in patients suffering from vitreous floaters is accompanied by exacerbated levels of anxiety and depression.

METHODS

One hundred and four patients complaining of floaters were included in the study; 51 experienced also photopsias and 53 did not. A comprehensive ocular examination, including funduscopy and optical coherence tomography scans was performed to every patient, while their clinical and demographic data were also assessed. Every participant completed the PHQ-9, the Zung SDS, and the HADS anxiety and depression questionnaires.

RESULTS

The clinical and demographic data did not differ significantly between the study groups (p > 0.05).The scores of every questionnaire were significantly higher among the patients with vitreous flashes (p < 0.05 for all). After adjustment for several confounders, the values remained significantly impaired.

CONCLUSION

Photopsias negatively affect the psychological and mental well-being of the patients, by the terms of amplified levels of depression and anxiety. These findings underscore the necessity for a more holistic approach to managing patients presenting with vitreous flashes.

Mother's little helper turned a foe: Alprazolam use, misuse, and abuse

Benzodiazepines are effective in managing anxiety and related disorders when used properly (short-term). Their inappropriate use, however, carries significant risks, involving amnesia, rebound insomnia, rebound anxiety, depression, dependence, abuse, addiction, and an intense and exceedingly prolonged withdrawal, among other complications. Benzodiazepines also amplify the effects of opioids and, consequently, have been implicated in approximately 30 % of opioid overdose deaths. Despite their unfavorable profile, sharp increases in medical and non-medical use of benzodiazepines have been steadily reported worldwide. Alprazolam (Xanax®), a potent, short-acting benzodiazepine, is among the most prescribed and abused anxiolytics in the United States. This medication is commonly co-abused with opioids, increasing the likelihood for oversedation, overdose, and death. Notwithstanding these risks, it is surprising that research investigating how benzodiazepines, such as alprazolam, interact with opioids is severely lacking in clinical and preclinical settings. This review therefore aims to present our current knowledge of benzodiazepine use and misuse, with an emphasis on alprazolam when data is available, and particularly in populations at higher risk for developing substance use disorders. Additionally, the potential mechanism(s) surrounding tolerance, dependence and abuse liability are discussed. Despite their popularity, our understanding of how benzodiazepines and opioids interact is less than adequate. Therefore, it is now more important than ever to understand the short- and long-term consequences of benzodiazepine/alprazolam use.

Investigating the causal effects of childhood and adulthood adiposity on later life mental health outcome: a Mendelian randomization study

BACKGROUND

Obesity particularly during childhood is considered a global public health crisis and has been linked with later life health consequences including mental health. However, there is lack of causal understanding if childhood body size has a direct effect on mental health or has an indirect effect after accounting for adulthood body size.

METHODS

Two-sample Mendelian randomization (MR) was performed to estimate the total effect and direct effect (accounting for adulthood body size) of childhood body size on anxiety and depression. We used summary statistics from a genome-wide association study (GWAS) of UK Biobank (n = 453,169) and large-scale consortia of anxiety (Million Veteran Program) and depression (Psychiatric Genomics Consortium) (n = 175,163 and n = 173,005, respectively).

RESULTS

Univariable MR did not indicate genetically predicted effects of childhood body size with later life anxiety (beta = - 0.05, 95% CI = - 0.13, 0.02) and depression (OR = 1.06, 95% CI = 0.94, 1.20). However, using multivariable MR, we observed that the higher body size in childhood reduced the risk of later life anxiety (beta = - 0.19, 95% CI = - 0.29, - 0.08) and depression (OR = 0.83, 95% CI = 0.71, 0.97) upon accounting for the effect of adulthood body size. Both univariable and multivariable MR indicated that higher body size in adulthood increased the risk of later life anxiety and depression.

CONCLUSIONS

Higher body size in adulthood may increase the risk of anxiety and depression, independent of childhood higher body size. In contrast, higher childhood body size does not appear to be a risk factor for later life anxiety and depression.

Anxiety symptoms are distinctly related to working memory deficits in adults with ADHD

Working memory (WM), the cognitive system that briefly stores and updates information during complex tasks, is one of the most consistently identified neurocognitive deficits in individuals with ADHD. WM deficits are linked to significant challenges in daily life. Adults with ADHD often experience co-occurring anxiety and mood disorders, which are associated with more severe clinical presentations and greater WM deficits. Disentangling how co-occurring depression and anxiety symptoms uniquely contribute to WM deficits in individuals with ADHD is critical for tailoring effective, evidence-based interventions and treatments. This study used a regression approach to explore the relationships among anxiety, depression symptoms, and WM performance in adults with ADHD (n = 439) referred for neuropsychological evaluation at a Midwestern academic medical center. ADHD diagnostic group (ADHD-I and ADHD-C; Predominately Inattentive presentation, and Combined presentation, respectively), depression symptoms, and anxiety symptoms were modeled as predictors of WM performance, with education as a covariate, as education is linked to better cognitive performance. Anxiety and education significantly predicted WM performance, while depression did not, highlighting distinct effects. Anxiety was associated with poorer WM performance, whereas education was linked to better WM. These results emphasize the need for clinical assessments that account for the impacts of specific symptoms on WM in adults with ADHD.

Preoperative predictors of acute postoperative anxiety and depression using ecological momentary assessments: a secondary analysis of a single-centre prospective observational study

BACKGROUND

Postoperative anxiety and depression can negatively affect surgical outcomes and patient wellbeing. This study aimed to quantify the incidence of postoperative worsening anxiety and depression symptoms and to identify preoperative predictors of these conditions.

METHODS

This prospective, observational cohort study included 1168 patients undergoing surgery lasting >1 h with overnight admission at a university-affiliated quaternary referral centre. Postoperative anxiety and depression symptoms were measured using standardised, thrice-daily ecological momentary assessments (EMAs) for 30 days. Co-primary outcomes were worsening anxiety and depression symptoms, each defined as a slope >0 when EMA was modelled as a linear function of time. Multivariable logistic regression was performed to identify independent preoperative predictors of each outcome.

RESULTS

Postoperative worsening anxiety occurred in 60 patients (5%), and postoperative worsening depression occurred in 86 patients (7%). Predictors of postoperative worsening of anxiety symptoms included preoperative Patient-Reported Outcome Measurement Information System (PROMIS) anxiety symptoms (adjusted odds ratio [aOR] 2.48, 95% credible interval [CI] 1.29-4.79, for mild symptoms; aOR 2.22, 95% CI 1.10-4.51, for moderate to severe symptoms), and preoperative pain (aOR 3.46, 95% CI 1.32-9.12). Predictors of postoperative worsening depression symptoms included preoperative PROMIS depression symptoms (aOR 2.26, 95% CI 1.24-4.14, for mild symptoms; aOR 3.79, 95% CI 2.10-6.81, for moderate to severe symptoms). Self-reported history of anxiety or depression did not independently predict either outcome.

CONCLUSIONS

Postoperative worsening anxiety and depression appear to be associated more closely with preoperative active mental health or pain symptoms rather than self-reported history of these conditions. Preoperative identification of at-risk patients will require screening for symptoms rather than simple history taking.

Psychological Mediators of Reduced Distress: Preregistered Analyses from a Randomized Controlled Trial of a Smartphone-Based Well-Being Training

Understanding why interventions work is essential to optimizing them. Although mechanistic theories of meditation-based interventions (MBIs) exist, empirical evidence is limited. We randomly assigned 662 adults (79.9% reported clinical levels of anxiety or depressive symptoms) to a four-week smartphone-based MBI or wait-list control condition early in the COVID-19 pandemic. Psychological distress and four theory driven preregistered psychological mediators of well-being (mindful action, loneliness, cognitive defusion and purpose) were assessed five times during the intervention period and at three-month follow-up. In preregistered analyses, assignment to the intervention predicted significant gains on all mediators which in turn significantly mediated follow-up distress (21.9%-62.5% of intervention effect on distress). No significant mediation pathway was observed in an exploratory multiple mediator analysis, but reduced loneliness accounted for 61.7% of the combined indirect effect. Multiple psychological pathways may mediate reduced distress in a digital MBI.

Racial Discrimination and Mental Health: Analyzing the Impact of Discrimination, Stress, Depressive Symptoms and Self-Esteem on Anxiety Experiences

BACKGROUND

Existing research demonstrates that racial inequity influences mental health outcomes. However, few studies simultaneously analyze the multiple factors influencing racial disparities regarding these outcomes. Our study addresses this gap by analyzing the impact of discrimination, stress, self-esteem, racial identity, depressive symptoms, and demographic factors on anxiety symptoms.

METHODS

Participants were adults recruited from a primary care clinic in the Southeastern region of the United States. We utilized a stratified random sampling strategy to select 383 participants. Participants completed a survey designed to assess levels of anxiety, depression, perceived stress, self-esteem, racial identity, experiences with discrimination, and demographic information. A hierarchical regression analyzed which factors most impact symptoms of anxiety.

RESULTS

Of the 363 participants in our study, the majority were female (71.3%), 57% were White identifying, 43% were Black identifying, and the average age was 54.4 (SD = 12.3). Model 4 accounted for 58% of the variance of anxiety symptoms and included a combination of depressive symptoms, perceived stress, self-esteem, experiences of everyday discrimination, and interaction terms. Within this model, perceived stress (t = 3.81, p < .01), experiences of everyday discrimination, (t = 2.33, p < .01), and income (t = -1.96, p < .01) were significantly associated with increased anxiety.

CONCLUSIONS AND IMPLICATIONS

Multiple contextual factors influence the relationship between race and anxiety. In particular, anxiety increases with lower rates of self-esteem and income. Conversely, anxiety increases with higher rates of stress, discrimination, and depressive symptoms. Social workers should consider each of these factors when treating patients presenting with symptoms of anxiety.

How strongly are trait positive and negative affectivity associated with anxiety symptoms? A multilevel meta-analysis of cross-sectional studies in anxiety disorders

There are well-established theoretical and empirical foundations for a negative association between trait positive affectivity and anxiety symptoms in anxiety disorders and a positive association between trait negative affectivity and anxiety symptoms, respectively. However, no previous meta-analysis systematically estimated to what extent trait positive and negative affectivity are associated with anxiety symptoms in anxiety disorders. The aim of this study was to conduct a systematic review and meta-analysis to obtain an evidence-based estimate of the associations between trait positive and negative affectivity with anxiety symptoms in anxiety disorders. We performed a systematic search including studies reporting estimates of the associations between trait positive and negative affectivity measures and anxiety measures in clinical populations that suffer from at least one anxiety disorder. We identified 13 and 14 eligible studies, documenting 19 and 21 mainly unpublished effect sizes from 1489 individuals that suffer from an anxiety disorder. We estimated an overall correlational effect size (r) using multilevel meta-analytic models accounting for within- and between-study variance components. The results of the omnibus models showed a small to moderate negative association between positive affectivity and anxiety symptoms (r = -0.19, 95 % CI [-0.30, -0.09]) and a strong positive association between negative affectivity and anxiety symptoms respectively (r = 0.53, 95 % CI [0.44, 0.61]). These associations are different from each other (r = .35, p < .001). The results are consistent with theoretical claims that anxiety disorders are highly associated with negative affectivity but to a lesser extent with positive affectivity. More research and systematic documentation are necessary to determine moderators of these overall associations.

Multiple chronic diseases and psychological distress among adults in the United States: the intersectionality of chronic diseases, race/ethnicity, immigration, sex, and insurance coverage

PURPOSE

Psychological distress significantly contributes to the burdens of morbidity and mortality in the United States (U.S.), but our understanding is limited with regards to the risk factors associated with psychological distress. We used nationally representative data to examine (1) the comorbidities of chronic diseases and their risks for psychological distress and (2) the ways in which chronic diseases combine with demographic factors such as sex, race/ethnicity, immigration status, and health insurance coverage to affect the patterning of psychological distress.

METHODS

We analyzed the 2005-2018 National Health Survey Interview cross-sectional data on U.S. adults aged ≥ 18 years (n = 351,457). We fitted sequential multivariable logistic regression models.

RESULTS

There was a dose-response relationship between the number of chronic diseases and psychological distress, with increased number of chronic diseases associated with increased psychological distress risk. Females (vs. males) and those without health insurance (vs. insured) were more likely to experience psychological distress. Immigrants (vs. non-immigrants) and racial/ethnic minorities (vs. White individuals) were less likely to experience psychological distress. There were significant interactions between chronic diseases and insurance coverage, immigration status, and race/ethnicity, but the three-way interactions were not statistically significant with psychological distress: chronic disease status vs. immigration status vs. health insurance coverage, and chronic disease vs. race/ethnicity vs. immigration status.

CONCLUSION

The findings suggest a critical need to consider the complex ways in which chronic diseases and psychosocial factors combine to affect psychological distress and their implications for tailoring mental health screening, initiatives to reduce distress, and prevention strategies for effectively addressing health-related disparities in the general population.

The network analysis of anxiety, depression and academic burnout symptom relationships throughout early, middle, and late adolescence

BACKGROUND

Previous research has explored the associations between anxiety, depression, and academic burnout primarily from a variable-level perspective. However, there is limited understanding of which symptoms might play a significant role in anxiety, depression, and academic burnout among adolescents at different stages.

METHODS

This study included 7,286 adolescents aged 10 to 18. Questionnaires assessed participants' anxiety, depression, and academic burnout. Network analysis was conducted on the overall sample and segmented by early, middle, and late adolescence to explore relationships between symptoms and variations in symptom expression across these stages, aiming to propose effective interventions targeting anxiety, depression, and academic burnout symptoms in early, middle, and late adolescence.

RESULTS

The study found that "feeling that studying is meaningless" emerged as a core symptom in the overall sample. Additionally, "acting or speaking slowly" emerged as a core symptom in early adolescence, while "the thought of dying or hurting" and "feeling bad about yourself, letting your family down" were prominent in middle adolescence, and "easily annoyed or irritable" and "feeling tired" may be prioritized in late adolescence. The varying central symptoms across different adolescent stages suggest the need for targeted interventions.

CONCLUSION

These findings underscore the importance of interventions tailored to specific symptoms to meet the unique needs of adolescents at different developmental stages.

Family intimacy and depression: a comparative study among adolescents in Finland

BACKGROUND

Substantial research has demonstrated the strong influence of family factors on adolescent depressive symptoms. However, the mechanisms underlying this relationship, particularly the moderating effects of sex and sexual orientation, remain unclear.

OBJECTIVES

This study aimed to investigate the direct and indirect effects of family intimacy on depressive symptoms among adolescents, while examining the mediating role of social inclusion and anxiety disorders. Furthermore, it explored how these effects are moderated by sex and sexual orientation.

METHOD

Data from the nationwide School Health Promotion Study in Finland were used (N = 155,166; adolescents aged 14-17 years). The analysis included a multiple mediation model to evaluate the pathways linking family intimacy to depressive symptoms, through social inclusion and anxiety disorders. Moderation analyses were conducted to explore the moderating effects of sex and sexual orientation on these pathways.

RESULTS

Family intimacy had a significant direct negative effect on depressive symptoms. Social inclusion and anxiety disorders were identified as mediators, with social inclusion serving as a significant buffer to depression. Moderation analysis revealed that these effects were stronger for non-heterosexual adolescents and varied by sex, with females showing a stronger impact of social inclusion on depressive symptoms, whereas males were more influenced by the pathway through anxiety disorders.

CONCLUSION

The findings highlight the crucial roles of social inclusion and family intimacy in mitigating depressive symptoms among adolescents. Interventions should prioritize enhancing social inclusion, particularly for non-heterosexual adolescents, and tailor strategies based on sex differences to optimize outcomes.

Screening social anxiety with the Social Artificial Intelligence Picture System

Social anxiety disorder (SAD) is a prevalent anxiety disorder marked by strong fear and avoidance of social scenarios. Early detection of SAD lays the foundation for the introduction of early interventions. However, due to the nature of social avoidance in social anxiety, the screening is challenging in the clinical setting. Classic questionnaires also bear the limitations of subjectivity, memory biases under repeated measures, and cultural influence. Thus, there exists an urgent need to develop a reliable and easily accessible tool to be widely used for social anxiety screening. Here, we developed the Social Artificial Intelligence Picture System (SAIPS) based on generative multi-modal foundation artificial intelligence (AI) models, containing a total of 279 social pictures and 118 control pictures. Social scenarios were constructed to represent core SAD triggers such as fear of negative evaluation, social interactions, and performance anxiety, mapping to specific dimensions of social anxiety to capture its multifaceted nature. Pictures devoid of social interactions were included as a control, aiming to reveal response patterns specific to social scenarios and to improve the system's precision in predicting social anxiety traits. Through laboratory and online experiments, we collected ratings on SAIPS from five dimensions. Machine learning results showed that ratings on SAIPS robustly reflected and predicted an individual's trait of social anxiety, especially social anxiety and arousal ratings. The prediction was reliable, even based on a short version with less than 30 pictures. Together, SAIPS may serve as a promising tool to support social anxiety screening and longitudinal predictions.

Factors Associated with Nonspecialist Quality of Delivery within a Family Strengthening Intervention in Rwanda: a Parallel Latent Growth Model

In task-shared, mental health, and psychosocial support interventions, monitoring the quality of delivery (fidelity and competence) of nonspecialist providers is critical. Quality of delivery is frequently reported in brief, summary statistics, and while both fidelity and competence scores tend to be high, rarely have factors associated with quality of delivery in low-resource, mental health, and psychosocial support interventions been examined using inferential statistics. Understanding both modifiable and non-modifiable predictors of quality of delivery is important for adapting training and supervision approaches throughout intervention delivery. In this study, we use a parallel process latent growth model to examine the association of non-modifiable, demographic characteristics of nonspecialists and changes in both fidelity and competence over time. We find that nonspecialist age is significantly associated with higher initial fidelity and competence scores and smaller improvements in fidelity and competence over time, although this finding is interpreted in the presence of ceiling effects. In addition, nonspecialists in a certain district were more likely to have higher initial fidelity and competence scores but also see smaller changes over time. Fidelity and competence were found to significantly co-vary. This study provides conceptual and measurement guidance regarding quality of delivery, suggesting that fidelity and competence are theoretically distinct and must be measured separately, but linked together under the umbrella of quality of delivery. This study also has implications for recruiting, training, and supporting nonspecialists delivering behavioral interventions, suggesting that future implementation teams can further contribute to research on how to better support high-quality training, supervision, and personal and professional growth among the growing nonspecialist workforce globally.

Associations Between the Neural Stress Response and Symptoms of Anxiety and Depression

Anxiety and depression disorders show high prevalence rates, and stress is a significant risk factor for both. However, studies investigating the interplay between anxiety, depression, and stress regulation in the brain are scarce. The present manuscript included 124 law students from the LawSTRESS project. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), and psychosocial stress was induced with the imaging stress paradigm ScanSTRESS. Anxiety, but not depression scores, were significantly related to neural stress responses in a striato-limbic cluster. Moreover, relative to women, men showed stronger associations between anxiety scores and activation in striatal and temporal clusters. A bifactor model of the HADS suggested a general factor characterized by tension, nervousness, and cheerlessness, which was associated with activation changes in a similar but more circumscribed cluster than anxiety. In the LawSTRESS project, the HADS was assessed at five sampling points (1 year, 3 months, 1 week prior exam, 1 week, and 1 month thereafter), and thus an exploratory trajectory analysis could be performed. It confirmed the relationship between anxiety scores and striatal stress responses at baseline but revealed no predictive value of the neural measure across the sampling points. Our results suggest that-in healthy young participants-neural acute psychosocial stress responses in striato-limbic structures are associated with anxiety, supporting the assumption that these regions are related to individual differences in vulnerability to stress-related disorders. A correlation with depression scores could not be found, and possible explanations are discussed.

Learned phenotypes emerge during social stress modifying hippocampal orexin receptor gene expression

Psychological distress, including anxiety or mood disorders, emanates from the onset of chronic/unpredictable stressful events. Symptoms in the form of maladaptive behaviors are learned and difficult to treat. While the origin of stress-induced disorders seems to be where learning and stress intersect, this relationship and molecular pathways involved remain largely unresolved. The hippocampus, studied for its role in learning, is divided into regions that designate the passage of neuronal signaling during memory formation, including dentate gyrus (DG), CA3, CA2, and CA1. Inputs into these hippocampal subregions, like those from hypothalamic orexinergic neurons, may modify learning outcomes. We have previously shown the orexin system to balance stress states, where receptor subtypes prompt opposing actions on behavior. Here, we explore the connection between hippocampal orexin receptors and learning during stress. In a social stress/learning paradigm separating mice into stress resilient and vulnerable populations, hippocampal Orx1R and Orx2R transcription is regulated in a phenotype-dependent fashion. We further identified Orx1R as highly expressed in the hilus of DG, while Orx2R is abundant in CA2. Finally, we designed an experiment where mice were provided prior exposure to a stressful environment, which ultimately modified behavior, as well as transcription of hippocampal orexin receptors.

The effects of interactive video games combined with LEGO game therapy on social anxiety in rural left-behind children

Background

China has a significant population of left-behind children, defined as those whose parents have migrated away from their home for at least six months. This situation arises when one or both parents leave to seek work in urban areas. Among the various challenges faced by left-behind children, social anxiety has emerged as one of the most pressing issues.

Objective

This study aims to deeply explore the impact of interactive video games and LEGO games on the social anxiety of rural left-behind children, with the aim of providing a more comprehensive and effective solution to the mental health problems they encounter.

Methods

Eighty-four rural left-behind children were randomly assigned to four groups: interactive video game group, LEGO game group, combined intervention group, and the control group, using a single-blind randomized controlled experiment. All participants underwent the intervention three times a week for 12 weeks. Social anxiety levels were assessed at three points: before the intervention (T0), immediately after the intervention (T1), and 6 weeks post-intervention (T2).

Results

The effects of different intervention strategies on the social anxiety of left-behind children showed significant group-time interaction effects. As the intervention progressed, the total score of social anxiety and the scores of various dimensions among participants in different intervention groups showed a gradual decreasing trend. The combined intervention group scored significantly lower at T1 and T2 than both the interactive video game group and the LEGO group.

Conclusion

Our findings indicate that social anxiety in left-behind children can be significantly mitigated through both LEGO therapy and interactive video games, with a combined approach yielding the most pronounced effects. These results underscore the importance of a multifaceted intervention strategy that addresses the unique social needs of this vulnerable population. Importantly, our study suggests that effective interventions should not only focus on symptom reduction but also foster environments that enhance social skills and build confidence. Future research should investigate the scalability of these interventions across diverse contexts and their potential integration into existing mental health services to better support left-behind children.

Intricate mechanism of anxiety disorder, recognizing the potential role of gut microbiota and therapeutic interventions

Anxiety is a widespread psychological disorder affecting both humans and animals. It is a typical stress reaction; however, its longer persistence can cause severe health disorders affecting the day-to-day life activities of individuals. An intriguing facet of the anxiety-related disorder can be addressed better by investigating the role of neurotransmitters in regulating emotions, provoking anxiety, analyzing the cross-talks between neurotransmitters, and, most importantly, identifying the biomarkers of the anxiety. Recent years have witnessed the potential role of the gut microbiota in human health and disorders, including anxiety. Animal models are commonly used to study anxiety disorder as they offer a simpler and more controlled environment than humans. Ultimately, developing new strategies for diagnosing and treating anxiety is of paramount interest to medical scientists. Altogether, this review article shall highlight the intricate mechanisms of anxiety while emphasizing the emerging role of gut microbiota in regulating metabolic pathways through various interaction networks in the host. In addition, the review will foster information about the therapeutic interventions of the anxiety and related disorder.

Edge-centric connectome-genetic markers of bridging factor to comorbidity between depression and anxiety

Depression-anxiety comorbidity is commonly attributed to the occurrence of specific symptoms bridging the two disorders. However, the significant heterogeneity of most bridging symptoms presents challenges for psychopathological interpretation and clinical applicability. Here, we conceptually established a common bridging factor (cb factor) to characterize a general structure of these bridging symptoms, analogous to the general psychopathological p factor. We identified a cb factor from 12 bridging symptoms in depression-anxiety comorbidity network. Moreover, this cb factor could be predicted using edge-centric connectomes with robust generalizability, and was characterized by connectome patterns in attention and frontoparietal networks. In an independent twin cohort, we found that these patterns were moderately heritable, and identified their genetic connectome-transcriptional markers that were associated with the neurobiological enrichment of vasculature and cerebellar development, particularly during late-childhood-to-young-adulthood periods. Our findings revealed a general factor of bridging symptoms and its neurobiological architectures, which enriched neurogenetic understanding of depression-anxiety comorbidity.