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Himle JA, LeBeau RT, Jester JM, Kilbourne AM, Weaver A, Brydon DM, Tucker KM, Hamameh N, Castriotta N, Craske MG. Work-Related Cognitive Behavioral Therapy for racially and economically diverse unemployed persons with social anxiety: A randomized clinical trial. J Anxiety Disord 2024; 104:102875. [PMID: 38763062 DOI: 10.1016/j.janxdis.2024.102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
Individuals with Social Anxiety Disorder (SAD) are at risk for employment problems. This multi-site trial examined the efficacy of Work-Related Cognitive Behavioral Therapy provided alongside vocational services as usual (WCBT+VSAU), a group-based treatment designed to improve mental health and employment outcomes for individuals with SAD. Vocational service-seeking participants with SAD (N = 250) were randomized to either WCBT+VSAU or VSAU-alone. Hypotheses were that participants randomized to WCBT+VSAU would report less social anxiety, less depression, and more hours worked than participants randomized to VSAU-alone. WCBT+VSAU participants had significantly greater improvements on the Liebowitz Social Anxiety Scale (LSAS; d=-.25, CI=-0.49 to -0.02, p = .03) at post-assessment compared to VSAU-alone. The conditions did not differ on any variable at later time points or on secondary outcomes. Unexpectedly, participants randomized to VSAU-alone experienced LSAS improvements, similar to WCBT+VASU at later timepoints. Baseline psychological flexibility (beta=-.098 [-0.19-0.008]) and depression (beta=-0.18 [-0.34-0.009]) moderated change in social anxiety. Participants with lower psychological flexibility and higher depression responded more strongly to WCBT+VSAU than VSAU-alone over the duration of the study, suggesting that WCBT+VSAU may particularly benefit those with greater psychopathology. Results indicate that vocational centers are promising settings for treating SAD and employment-focused refinements are likely needed to improve work outcomes.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, USA; Department of Psychiatry, Medical School, University of Michigan, USA.
| | - Richard T LeBeau
- Department of Psychology, University of California Los Angeles, USA
| | - Jennifer M Jester
- Department of Psychiatry, Medical School, University of Michigan, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, Medical School, University of Michigan, USA; Quality Enhancement Research Initiative, US Department of Veterans Affairs, Washington, DC, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, USA
| | | | | | | | - Natalie Castriotta
- University of California, San Diego, USA; VA San Diego Healthcare System, USA
| | - Michelle G Craske
- Department of Psychology, University of California Los Angeles, USA; Department of Psychiatry & Biobehavioral Sciences, USA
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2
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Kamhout S, Olivier JM, Morris J, Brimhall HR, Black BL, Gabrielsen TP, South M, Lundwall RA, Nielsen JA. Binocular rivalry in autistic and socially anxious adults. Front Psychiatry 2023; 14:1181797. [PMID: 37547197 PMCID: PMC10400451 DOI: 10.3389/fpsyt.2023.1181797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Social anxiousness is a pervasive symptom in both social anxiety disorder and autism spectrum conditions. Binocular rivalry, which occurs when different images are presented to each eye, has been used to explore how visual and cognitive processing differs across various clinical diagnoses. Previous studies have separately explored whether individuals with autism or anxiety experience binocular rivalry in ways that are different from neurotypical individuals. Methods We applied rivalry paradigms that are similar to those used in previous studies of autism and general anxiety to individuals experiencing symptoms of social anxiousness at clinical or subclinical levels. We also incorporated rivalrous stimuli featuring neutral and emotional facial valances to explore potential overlap of social processing components in social anxiety and autism. Results We hypothesized that higher levels of social anxiousness would increase binocular rivalry switch rates and that higher levels of autistic traits would decrease switch rates. However, stimulus condition did not affect switch rates in either diagnostic group, and switch rate was not significantly predictive of dimensional measures of either autism or social anxiety. Discussion This may suggest a common mechanism for atypical visual cognition styles previously associated with social anxiety and autism. Alternatively, differences in switch rates may only emerge at higher trait levels than reported by the participants in our studies. Furthermore, these findings may be influenced by sex differences in our unique sample.
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Affiliation(s)
- Sarah Kamhout
- Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Joshua M. Olivier
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Jarom Morris
- Neuroscience Center, Brigham Young University, Provo, UT, United States
| | | | - Braeden L. Black
- Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Terisa P. Gabrielsen
- Department of Counseling Psychology and Special Education, Brigham Young University, Provo, UT, United States
| | - Mikle South
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Rebecca A. Lundwall
- Neuroscience Center, Brigham Young University, Provo, UT, United States
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Jared A. Nielsen
- Neuroscience Center, Brigham Young University, Provo, UT, United States
- Department of Psychology, Brigham Young University, Provo, UT, United States
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3
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Hellström L, Christensen TN, Bojesen AB, Eplov LF. Predictors of Return to Work for People with Anxiety or Depression Participating in a Randomized Trial Investigating the Effect of a Supported Employment Intervention. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:61-70. [PMID: 35612640 DOI: 10.1007/s10926-022-10046-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Purpose Common mental disorders have a severe impact on society and individuals; rates of unemployment and disability pensions are high. Knowing which factors facilitate or hinder people's return to work is important when designing effective vocational rehabilitation interventions. Methods We conducted secondary analyses on data from 289 participants with depression or anxiety included in the Individual Placement and Support modified for people with mood and anxiety disorders (IPS-MA) trial. Associations of baseline characteristics and employment or education after 24 months were tested in univariate logistic regression analyses, variables with a p-value below 0.1 were included in multivariate analyses. Results In the univariate analyses, self-reported level of functioning (p = 0.032), higher age (p = 0.070), and higher level of readiness to change (p = 0.001) were associated with the outcome and included in the multivariate analysis. Only age (p = 0.030) and readiness to change (p = 0.003) remained significantly associated with return to work or education after 24 months in the multivariate analysis. Conclusion Higher age and lower readiness to change were associated with a lower chance of having returned to work or education. Factors modifying the effect of higher age should be identified, just as vocational rehabilitation should focus on improving factors related to people's readiness to change.
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Affiliation(s)
- Lone Hellström
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark.
| | - Thomas Nordahl Christensen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
| | - Anders Bo Bojesen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
- Biostatistics (Insulin & Devices), Novo Nordisk A/S, Alfred Nobels Vej 27, 9220, Aalborg Øst, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
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Hellström L, Madsen T, Nordentoft M, Eplov LF. Trajectories of symptoms of anxiety and depression among people on sick leave with mood or anxiety disorders: Secondary analysis from a randomized controlled trial. J Psychiatr Res 2021; 137:250-257. [PMID: 33714077 DOI: 10.1016/j.jpsychires.2021.02.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 01/25/2021] [Accepted: 02/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Depression and anxiety are heterogenous disorders often combined into one entity in studies. Few studies have compared trajectories of depression and anxiety among clinically ill. We aimed to identify specific trajectories of depression, and anxiety and predictors of trajectory membership. METHODS Latent growth mixture modelling was carried out on data from the IPS-MA trial (n = 261), a supported employment intervention for people with mood or anxiety, to identify trajectories of depression and anxiety. Logistic regression was used to estimate predictors for trajectory membership. Associations between trajectory class and remission of comorbid depression or anxiety and return to work were also tested. RESULTS We identified three trajectories of depression and anxiety symptoms respectively; moderate-decreasing (60%), moderate-stable (26%), and low-stable (14%) depression and mild-decreasing (59%), moderate-decreasing (33%), and moderate-stable (8%) anxiety. The depression model showed low precision in class separation (entropy 0.66), hence, predictors of class membership were not estimated. For anxiety, lower age and higher levels of depressive symptoms were associated with a less desirable trajectory. Remission of comorbid depressive symptoms after two years differed significantly between classes (p < 0.000). Fewer had returned to work in the two moderate classes compared to the mild-decreasing anxiety class. LIMITATIONS Depression model not reliable. Only 80% of participants from original study included. Not able to distinguish between anxiety disorders. CONCLUSION Trajectories of anxiety confirm that, even after two years, a rather large proportion in the moderate-stable class had symptoms of moderate anxiety, moderate comorbid depressive symptoms, and less probability of having returned to work. TRIAL REGISTRATION ClinicalTrials.govNCT01721824.
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Affiliation(s)
- Lone Hellström
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark.
| | - Trine Madsen
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
| | - Merete Nordentoft
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
| | - Lene Falgaard Eplov
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
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Lecomte T, Giguère CÉ, Cloutier B, Potvin S. Comorbidity Profiles of Psychotic Patients in Emergency Psychiatry. J Dual Diagn 2020; 16:260-270. [PMID: 31983294 DOI: 10.1080/15504263.2020.1713425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: Individuals with psychotic symptoms presenting to emergency psychiatry often have comorbid symptoms, such as substance misuse, depression, and anxiety. Many will also have symptoms linked to previous traumatic experiences such as impulsivity, often found in comorbid personality disorders. Although various studies have looked at specific comorbid symptoms, little is known regarding how these symptoms co-exist in individuals with psychotic symptoms and their link with social functioning. The primary objective of the present study was to identify comorbidity profiles among individuals seeking emergency room services for psychotic symptoms. The secondary objective was to investigate the relationship between comorbid symptoms and social functioning deficits in this same population. Methods: Data from 546 individuals seeking psychiatric help for psychotic symptoms was collected within the Signature Project (large data bank) in a psychiatric emergency. Participants answered brief measures of symptoms of alcohol/substance misuse (AUDIT, DAST), depression (PHQ-9), anxiety (STAI-6), childhood trauma (CEVQ), impulsivity (UPPS) and social functioning deficits (WHODAS). For this study, symptom measures and social functioning at baseline were used. Results: Cluster analyses conducted using three different methods revealed a consensus of five classes of comorbid presentations. Class 1 (n = 90) grouped people who had a high score for childhood trauma, with fairly high scores for anxiety and depression. Class 2 (n = 176) included people with mostly psychotic symptoms with little comorbid presentation across other measures. Class 3 (n = 81) grouped people with the highest anxiety and depression scores as well as high drug use and impulsivity. Individuals in Class 4 (n = 87) had the highest scores on alcohol and substance abuse, as well as high impulsivity. Class 5 (n = 112) grouped people with very low anxiety and depression scores but average trauma, alcohol, and substance misuse scores. Linear regressions revealed an association between social functioning, and depression, anxiety, and childhood trauma. Conclusions: Comorbid presentations of individuals with psychosis are frequent and diverse. Depression and anxiety, in particular, worsen social functioning deficits in people with psychotic symptoms. Given their impact on functioning, psychiatric treatments should address these comorbidities during hospitalization, as well as when followed in the community.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, Canada.,Centre de recherche, Institut universitaire en santé mentale de Montréal, Montreal, Canada
| | | | - Briana Cloutier
- Department of Psychology, University of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Department of Psychology, University of Montreal, Montreal, Canada.,Centre de recherche, Institut universitaire en santé mentale de Montréal, Montreal, Canada
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Himle JA, LeBeau RT, Weaver A, Brydon DM, Bybee D, Kilbourne AM, Rose RD, Tucker KM, Kim R, Perez M, Smith FN, Sinco BR, Levine S, Hamameh N, Golenberg Z, McKiver M, Wierzbicki PT, Hasratian AM, Craske MG. Study protocol: A multisite trial of Work-Related Cognitive behavioral therapy for unemployed persons with social anxiety. Contemp Clin Trials Commun 2019; 16:100464. [PMID: 31701038 PMCID: PMC6831710 DOI: 10.1016/j.conctc.2019.100464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023] Open
Abstract
This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, USA.,Department of Psychiatry, Medical School, University of Michigan, USA
| | - Richard T LeBeau
- Department of Psychology, University of California Los Angeles, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, USA
| | | | - Deborah Bybee
- Department of Psychology, Michigan State University, USA
| | - Amy M Kilbourne
- Department of Psychiatry, Medical School, University of Michigan, USA.,Department of Learning Health Sciences, Medical School, University of Michgan, USA
| | - Raphael D Rose
- Department of Psychology, University of California Los Angeles, USA
| | | | - Richard Kim
- Department of Psychology, University of California Los Angeles, USA
| | - Marcelina Perez
- Department of Psychology, University of California Los Angeles, USA
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7
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Hellström L, Madsen T, Nordentoft M, Bech P, Eplov LF. Trajectories of Return to Work Among People on Sick Leave with Mood or Anxiety Disorders: Secondary Analysis from a Randomized Controlled Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:666-677. [PMID: 29282650 DOI: 10.1007/s10926-017-9750-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose The return to work (RTW) of people with mood and anxiety disorders is a heterogeneous process. We aimed to identify prototypical trajectories of RTW over a two-year period in people on sick leave with mood and anxiety disorders, and investigate if socio-demographic or clinical factors predicted trajectory membership. Methods We used data from the randomized IPS-MA trial (n = 283), evaluating a supported employment intervention for participants with recently diagnosed mood or anxiety disorders. Information on "weeks in employment in the past 6 months" was measured after 1/2, 1, 1 ½ and 2 years, using data from a nationwide Danish register (DREAM). Latent growth mixture modelling analysis was carried out to identify trajectories of RTW and logistic regression analyses were used to estimate predictors for trajectory membership. Results Four trajectory classes of RTW were identified; non-RTW [70% (196/283)] (practically no return to work); delayed-RTW [19% (56/283)] (6 months delay before full RTW); rapid-unstable-RTW [7% (19/283)] (members rapidly returned to work, but only worked half the time); and the smallest class, rapid-RTW [4% (12/283)] (members rapidly reached full employment, but later experienced a decrease in weeks of employment). Self-reported disability score according to the SDS, not living with a partner, and readiness to change on the CQ scale were found to be significantly associated with RTW. Conclusion The trajectories identified support that many do not benefit from vocational rehabilitation, or experience difficulties sustaining employment; enhanced support of this patient group is still warranted.Trial registration: http://www.clinicaltrials.gov (Identifier: NCT01721824).
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Affiliation(s)
- Lone Hellström
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark.
- Research Unit, Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark.
| | - Trine Madsen
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - Merete Nordentoft
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - Per Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Dyrehavevej 48, 3400, Hillerød, Denmark
| | - Lene Falgaard Eplov
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
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Blalock DV, Kashdan TB, McKnight PE. High risk, high reward: Daily perceptions of social challenge and performance in social anxiety disorder. J Anxiety Disord 2018; 54:57-64. [PMID: 29421373 DOI: 10.1016/j.janxdis.2018.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/07/2017] [Accepted: 01/26/2018] [Indexed: 12/01/2022]
Abstract
Individuals with Social Anxiety Disorder (SAD) have difficulty engaging in social situations because their actions are predicated on minimizing the subjectively biased high potential for rejection. That is, individuals with SAD frequently perceive social situations as challenging, and their performance as subpar. Yet when individuals perceive themselves as succeeding in challenging situations, they typically report these situations as enjoyable and rewarding. This subjective experience of succeeding in a challenging situation has been studied as flow (Csikszentmihalyi, 1975; 2000). Thirty-three adults with SAD and 34 matched healthy controls completed a baseline assessment, along with daily and experience sampling entries for 14 days. Results were analyzed using three-level generalized linear mixed effects models, with observations nested within days, nested within participants. Although individuals with and without SAD experienced the same frequency of flow in daily life, social situations led to proportionally more flow in participants with SAD than healthy controls. Both results were unexpected, and reasons for them are explored at length. Several experiential variables (positive emotions during and importance ascribed to the event) predicted the probability of flow during each situation. These results offer intervention-relevant suggestions for how individuals may benefit from seeking out challenging situations that offer maximal rewards.
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Affiliation(s)
- Dan V Blalock
- Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Todd B Kashdan
- Department of Psychology, George Mason University, Fairfax, VA, USA
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9
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Excess costs of social anxiety disorder in Germany. J Affect Disord 2017; 213:23-29. [PMID: 28188993 DOI: 10.1016/j.jad.2017.01.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Social anxiety disorder is one of the most frequent mental disorders. It is often associated with mental comorbidities and causes a high economic burden. The aim of our analysis was to estimate the excess costs of patients with social anxiety disorder compared to persons without anxiety disorder in Germany. METHODS Excess costs of social anxiety disorder were determined by comparing two data sets. Patient data came from the SOPHO-NET study A1 (n=495), whereas data of persons without anxiety disorder originated from a representative phone survey (n=3213) of the general German population. Missing data were handled by "Multiple Imputation by Chained Equations". Both data sets were matched using "Entropy Balancing". Excess costs were calculated from a societal perspective for the year 2014 using general linear regression with a gamma distribution and log-link function. Analyses considered direct costs (in- and outpatient treatment, rehabilitation, and professional and informal care) and indirect costs due to absenteeism from work. RESULTS Total six-month excess costs amounted to 451€ (95% CI: 199€-703€). Excess costs were mainly caused by indirect excess costs due to absenteeism from work of 317€ (95% CI: 172€-461€), whereas direct excess costs amounted to 134€ (95% CI: 110€-159€). LIMITATIONS Costs for medication, unemployment and disability pension was not evaluated. CONCLUSIONS Social anxiety disorder was associated with statistically significant excess costs, in particular due to indirect costs. As patients in general are often unaware of their disorder or its severity, awareness should be strengthened. Prevention and early treatment might reduce long-term indirect costs.
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Torvik FA, Reichborn-Kjennerud T, Gjerde LC, Knudsen GP, Ystrom E, Tambs K, Røysamb E, Østby K, Ørstavik R. Mood, anxiety, and alcohol use disorders and later cause-specific sick leave in young adult employees. BMC Public Health 2016; 15:702. [PMID: 27488425 PMCID: PMC4972995 DOI: 10.1186/s12889-016-3427-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders strongly influence work capability in young adults, but it is not clear which disorders that are most strongly associated with sick leave, and which diagnoses that are stated on the sick leave certificates. Better knowledge of the impairments associated with different mental disorders is needed for optimal planning of interventions and prioritization of health services. In the current study, we investigate the prospective associations between eight mood, anxiety, and alcohol use disorders, and later sick leave granted for mental, somatic, or any disorder. METHODS Lifetime mental disorders were assessed by structured diagnostic interviews in 2,178 young adults followed for eight years with registry data on sick leave. Relative risk ratios were estimated for the associations between each mental disorder and the different forms of sick leave. RESULTS All included diagnoses were associated with later sick leave. In adjusted analyses, major depressive disorder and generalized anxiety disorder were the strongest predictors of sick leave granted for mental disorders, whereas social anxiety disorder and specific phobia were the strongest predictors of sick leave granted for somatic disorders. Specific phobia and major depressive disorder had the highest attributable fractions for all-cause sick leave. CONCLUSIONS Mood and anxiety disorders constituted independent risk factors for all cause sick leave, whereas alcohol use disorders seemed to be of less importance in young adulthood. Disorders characterised by distress were most strongly associated with sick leave granted for mental disorders, whereas disorders characterised by fear primarily predicted sick leave granted for somatic conditions. A large part of all sick leave is related to specific phobia, due to the high prevalence of this disorder. The impairment associated with this common disorder may be under-acknowledged, and it could decrease work capacity among individuals with somatic disorders. This disorder has good treatment response and may be overlooked as a target for interventions aimed at prevention of sick leave.
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Affiliation(s)
- Fartein Ask Torvik
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Institute of Clinical Medicine, P.O. Box 1171, Blindern, 0318 Oslo Norway
| | - Line C. Gjerde
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Gun Peggy Knudsen
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Eivind Ystrom
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
- University of Oslo, School of Pharmacy, PharmacoEpidemiology and Drug Safety Research Group, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Kristian Tambs
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Espen Røysamb
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
- University of Oslo, Department of Psychology, Section of Health, Developmental and Personality Psychology, P.O. Box 1094, Blindern, 0317 Oslo Norway
| | - Kristian Østby
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
| | - Ragnhild Ørstavik
- Norwegian Institute of Public Health, Domain for Mental and Physical Health, P.O. Box 4404, Nydalen, 0403 Oslo Norway
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Jacobs AW, Hill TD, Tope D, O'Brien LK. Employment Transitions, Child Care Conflict, and the Mental Health of Low-Income Urban Women With Children. Womens Health Issues 2016; 26:366-76. [DOI: 10.1016/j.whi.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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12
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Farmer AS, Kashdan TB. Stress sensitivity and stress generation in social anxiety disorder: a temporal process approach. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 124:102-14. [PMID: 25688437 PMCID: PMC4376480 DOI: 10.1037/abn0000036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dominant theoretical models of social anxiety disorder (SAD) suggest that people who suffer from function-impairing social fears are likely to react more strongly to social stressors. Researchers have examined the reactivity of people with SAD to stressful laboratory tasks, but there is little knowledge about how stress affects their daily lives. We asked 79 adults from the community, 40 diagnosed with SAD and 39 matched healthy controls, to self-monitor their social interactions, social events, and emotional experiences over 2 weeks using electronic diaries. These data allowed us to examine associations of social events and emotional well-being both within-day and from one day to the next. Using hierarchical linear modeling, we found all participants to report increases in negative affect and decreases in positive affect and self-esteem on days when they experienced more stressful social events. However, people with SAD displayed greater stress sensitivity, particularly in negative emotion reactions to stressful social events, compared to healthy controls. Groups also differed in how previous days' events influenced sensitivity to current days' events. Moreover, we found evidence of stress generation in that the SAD group reported more frequent interpersonal stress, though temporal analyses did not suggest greater likelihood of social stress on days following intense negative emotions. Our findings support the role of heightened social stress sensitivity in SAD, highlighting rigidity in reactions and occurrence of stressful experiences from one day to the next. These findings also shed light on theoretical models of emotions and self-esteem in SAD and present important clinical implications.
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Himle JA, Bybee D, Steinberger E, Laviolette WT, Weaver A, Vlnka S, Golenberg Z, Levine DS, Heimberg RG, O'Donnell LA. Work-related CBT versus vocational services as usual for unemployed persons with social anxiety disorder: A randomized controlled pilot trial. Behav Res Ther 2014; 63:169-76. [PMID: 25461793 DOI: 10.1016/j.brat.2014.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 10/14/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
Abstract
We designed and pilot-tested a group-based, work-related cognitive-behavioral therapy (WCBT) for unemployed individuals with social anxiety disorder (SAD). WCBT, delivered in a vocational service setting by vocational service professionals, aims to reduce social anxiety and enable individuals to seek, obtain, and retain employment. We compared WCBT to a vocational services as usual control condition (VSAU). Participants were unemployed, homeless, largely African American, vocational service-seeking adults with SAD (N = 58), randomized to receive either eight sessions of WCBT plus VSAU or VSAU alone and followed three months post-treatment. Multilevel modeling revealed significantly greater reductions in social anxiety, general anxiety, depression, and functional impairment for WCBT compared to VSAU. Coefficients for job search activity and self-efficacy indicated greater increases for WCBT. Hours worked per week in the follow-up period did not differ between the groups, but small sample size and challenges associated with measuring work hours may have contributed to this finding. Overall, the results of this study suggest that unemployed persons with SAD can be effectively treated with specialized work-related CBT administered by vocational service professionals. Future testing of WCBT with a larger sample, a longer follow-up period, and adequate power to assess employment outcomes is warranted.
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Himle JA, Weaver A, Bybee D, O'Donnell L, Vlnka S, Laviolette W, Steinberger E, Golenberg Z, Levine DS. Employment barriers, skills, and aspirations among unemployed job seekers with and without social anxiety disorder. Psychiatr Serv 2014; 65:924-30. [PMID: 24733524 PMCID: PMC4198508 DOI: 10.1176/appi.ps.201300201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The literature has consistently demonstrated that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examined the association between perceived barriers to employment, employment skills, and job aspirations and social anxiety among adults seeking vocational rehabilitation services. METHODS Data from intake assessments (June 2010-December 2011) of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan were examined to assess perceived barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who did or did not screen positive for social anxiety disorder. Bivariate and multiple logistic regression analyses were performed. RESULTS After adjustment for other factors, the multiple logistic regression analysis revealed that perceiving more employment barriers involving experience and skills, reporting fewer skills related to occupations requiring social skills, and having less education were significantly associated with social anxiety disorder. Participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. CONCLUSIONS Employment-related characteristics that were likely to have an impact on occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations revealed important information for designing psychosocial interventions for treatment of social anxiety disorder. The findings underscored the need for vocational services professionals to assess and address social anxiety among their clients.
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Affiliation(s)
- Joseph A Himle
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Addie Weaver
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Deborah Bybee
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Lisa O'Donnell
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Sarah Vlnka
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Wayne Laviolette
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Edward Steinberger
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Zipora Golenberg
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
| | - Debra Siegel Levine
- Dr. Himle, Dr. Weaver, Ms. O'Donnell, Ms. Vlnka, and Dr. Levine are with the Department of Psychiatry, University of Michigan, Ann Arbor (e-mail: ). Dr. Bybee is with the Department of Community Psychology, Michigan State University, East Lansing. Mr. Laviolette, Mr. Steinberger, and Ms. Golenberg are with JVS Detroit, Detroit, Michigan
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Pina AA, Little M, Wynne H, Beidel DC. Assessing social anxiety in African American youth using the social phobia and anxiety inventory for children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2014; 42:311-20. [PMID: 23872906 PMCID: PMC3864536 DOI: 10.1007/s10802-013-9775-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Examined measurement invariance and cut-off scores of the Social Phobia and Anxiety Inventory for Children (SPAI-C) using data corresponding to a convenience sample of 501 African American and Caucasian youth (M age = 11.62 years, 249 girls; 49% with social anxiety disorder) using exploratory structural equation modeling and a weighted least squares mean variance estimator. For the cut-off scores, Receiver Operator Characteristic analyses were used along with Youden’s index to evaluate the balance between sensitivity and specificity. Overall, results supported the SPAI-C’s cross-race invariance but a few items emerged as non-invariant. Compared to past research, lower SPAI-C cutoff scores were found (13 to 15 range). Findings support research showing that African American youth generally have significantly lower (or similar) social anxiety levels than their White counterparts. Suggestions for using the SPAI-C with African American under non-invariant conditions youth are provided and implications of using lower cutoff scores are discussed.
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Affiliation(s)
- Armando A Pina
- Department of Psychology, Arizona State University, P.O. Box 871104, Tempe, AZ, 85287, USA,
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Löhr HD, Rosenvinge JH, Wynn R. Integrating psychoeducation in a basic computer skills course for people suffering from social anxiety: participants' experiences. J Multidiscip Healthc 2011; 4:311-9. [PMID: 21966225 PMCID: PMC3180477 DOI: 10.2147/jmdh.s23691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We describe a psychoeducational program integrated in a basic computer skills course for participants suffering from social anxiety. The two main aims of the course were: that the participants learn basic computer skills, and that the participants learn to cope better with social anxiety. Computer skills were taught by a qualified teacher. Psychoeducation and cognitive therapy skills, including topics such as anxiety coping, self-accept, and self-regulation, were taught by a clinical psychologist. Thirteen of 16 participants completed the course, which lasted 11 weeks. A qualitative analysis was performed, drawing on observations during the course and on interviews with the participants. The participants were positive about the integration of psychoeducation sessions in the computer course, and described positive outcomes for both elements, including improved computer skills, improved self-esteem, and reduced social anxiety. Most participants were motivated to undertake further occupational rehabilitation after the course.
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Affiliation(s)
- Hildegard D Löhr
- Division of General Psychiatry, University Hospital of North Norway, Tromsø, Norway
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Werner KH, Jazaieri H, Goldin PR, Ziv M, Heimberg RG, Gross JJ. Self-compassion and social anxiety disorder. ANXIETY STRESS AND COPING 2011; 25:543-58. [PMID: 21895450 DOI: 10.1080/10615806.2011.608842] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Self-compassion refers to having an accepting and caring orientation towards oneself. Although self-compassion has been studied primarily in healthy populations, one particularly compelling clinical context in which to examine self-compassion is social anxiety disorder (SAD). SAD is characterized by high levels of negative self-criticism as well as an abiding concern about others' evaluation of one's performance. In the present study, we tested the hypotheses that: (1) people with SAD would demonstrate less self-compassion than healthy controls (HCs), (2) self-compassion would relate to severity of social anxiety and fear of evaluation among people with SAD, and (3) age would be negatively correlated with self-compassion for people with SAD, but not for HC. As expected, people with SAD reported less self-compassion than HCs on the Self-Compassion Scale and its subscales. Within the SAD group, lesser self-compassion was not generally associated with severity of social anxiety, but it was associated with greater fear of both negative and positive evaluation. Age was negatively correlated with self-compassion for people with SAD, whereas age was positively correlated with self-compassion for HC. These findings suggest that self-compassion may be a particularly important target for assessment and treatment in persons with SAD.
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Affiliation(s)
- Kelly H Werner
- Department of Psychology, Stanford University, 420 Jordan Hall, Stanford, CA 94305, USA.
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Moitra E, Beard C, Weisberg RB, Keller MB. Occupational impairment and Social Anxiety Disorder in a sample of primary care patients. J Affect Disord 2011; 130:209-12. [PMID: 20934220 PMCID: PMC3831271 DOI: 10.1016/j.jad.2010.09.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/07/2010] [Accepted: 09/18/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Social Anxiety Disorder (SAD) is the second most prevalent psychiatric condition in the US. Because of the inherent nature of SAD, it may cause impairments in workplace functioning, particularly compared to other anxiety disorders that do not necessarily lead to social impairments. In this study, we compared workplace functioning in primary care patients with SAD to patients with other anxiety disorders and comorbid Major Depressive Disorder (MDD). METHODS Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in 539 primary care patients. We examined intake demographic and interviewer-assessed ratings of workplace functioning. RESULTS Results revealed that patients with SAD and MDD had significantly decreased workplace functioning, compared to individuals with other anxiety disorders. Furthermore, results showed that patients with SAD were greater than two-times more likely to be unemployed, but expected to work, than all other patients. LIMITATIONS Workplace functioning was not measured objectively and the sample may not be representative of the general population. CONCLUSIONS These findings highlight the particular need to assess for the presence of undereducation and underperformance at work and/or underemployment in individuals with SAD, as they are at most risk for these impairments. Additionally, early detection and intervention in individuals with or at risk for SAD may curb the future impact of social anxiety on occupational attainment.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
| | - Courtney Beard
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Risa B. Weisberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Department of Family Medicine, Alpert Medical School of Brown University
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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