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Saulnier KG, Ganoczy D, Grau PP, Sripada RK, Zivin K, Piette JD, Pfeiffer PN. Generalized anxiety disorder screening scores are associated with greater treatment need among Veterans with depression. J Psychiatr Res 2024; 177:31-38. [PMID: 38971054 DOI: 10.1016/j.jpsychires.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024]
Abstract
Comorbid anxiety and depression predict a poorer prognosis than either disorder occurring alone. It is unclear whether self-reported anxiety symptom scores identify patients with depression in need of more intensive mental health services. This study evaluated how anxiety symptoms predicted treatment receipt and outcomes among patients with new depression diagnoses in the Veterans Health Administration (VHA). Electronic medical record data from 128,917 VHA patients (71.6% assessed for anxiety, n = 92,237) with new diagnoses of depression were analyzed to examine how Generalized Anxiety Disorder-7 (GAD-7) scores predicted psychotropic medication prescriptions, psychotherapy receipt, acute care service utilization, and follow-up depression symptoms. Patients who reported severe symptoms of anxiety were significantly more likely to receive adequate acute phase and continuation phase antidepressant treatment, daytime anxiolytics/sedatives, nighttime sedative/hypnotics, and endorse more severe depression symptoms and suicidal ideation at follow-up. Patients who reported severe symptoms of anxiety at baseline were less likely to initiate psychotherapy. The GAD-7 may help identify depressed patients who have more severe disease burden and require additional mental health services.
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Affiliation(s)
- K G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA.
| | - D Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - P P Grau
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - R K Sripada
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - K Zivin
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - J D Piette
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - P N Pfeiffer
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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2
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Baussay A, Di Lodovico L, Poupon D, Doublet M, Ramoz N, Duriez P, Gorwood P. The capacity of cognitive tests to detect generalized anxiety disorder (GAD): A pilot study. J Psychiatr Res 2024; 174:94-100. [PMID: 38626566 DOI: 10.1016/j.jpsychires.2024.04.006] [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: 09/15/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
Cognitive impairment remains understudied in generalized anxiety disorder (GAD), despite the high prevalence and substantial burden associated with this disorder. We aimed to assess cognitive impairment in patients with GAD and evaluate the ability of cognitive tests to detect this disorder. Because of its high rate of comorbidity, we also examined how other anxiety disorders and current major depressive episodes affected our results. We tested 263 consecutive general practice outpatients. We used the GAD-7 and the Mini International Neuropsychiatric Interview (MINI) to detect anxiety and mood disorders. We assessed cognitive performance with the Stroop test, a facial emotion recognition test, and the trail-making test (TMT). Compared to patients without GAD, patients with GAD were significantly slower to complete the TMT(B-A) and faster to recognize emotions, especially negative ones such as disgust and anger. When controlling for other anxiety disorders and current major depressive episode, GAD retained a significant effect on the TMT(B-A), but not on the emotion recognition test. The TMT(B-A) could detect GAD with good accuracy (area under the curve (AUC) = 0.83, maximal Youden's index = 0.56), which was by no means comparable to the GAD-7 (AUC = 0.97, Youden's index = 0.81). While it is not efficient enough to replace the GAD-7 as a diagnostic tool, the capacity of the TMT(B-A) to detect GAD emphasizes the importance of cognitive flexibility impairment in GAD.
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Affiliation(s)
- Axel Baussay
- Université de Versailles Saint-Quentin-en-Yvelines. 2 Av. de La Source de La Bièvre, 78180, Montigny-le-Bretonneux, France
| | - Laura Di Lodovico
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 100 Rue de La Santé, F-75014, Paris, France; Université Paris Cité, INSERM, UMR1266, F-75013, Paris, France
| | - Daphnee Poupon
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 100 Rue de La Santé, F-75014, Paris, France
| | | | - Nicolas Ramoz
- Université Paris Cité, INSERM, UMR1266, F-75013, Paris, France
| | - Philibert Duriez
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 100 Rue de La Santé, F-75014, Paris, France; Université Paris Cité, INSERM, UMR1266, F-75013, Paris, France
| | - Philip Gorwood
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 100 Rue de La Santé, F-75014, Paris, France; Université Paris Cité, INSERM, UMR1266, F-75013, Paris, France.
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3
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Basile VT, Newton-John T, Wootton BM. Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder. J Clin Psychol 2024; 80:1286-1305. [PMID: 38384113 DOI: 10.1002/jclp.23665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 11/20/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
Generalized anxiety disorder (GAD) is a prevalent and chronic mental health condition, associated with considerable individual and economic burden. Despite the availability of effective treatments, many individuals do not access support. The current study explores treatment histories, barriers to help-seeking, and cognitive behavioral therapy (CBT) treatment preferences for individuals with clinically significant GAD symptoms. The utility of Health Belief Model (HBM) in predicting help-seeking is also examined. A cross-sectional design with 127 participants (Mage = 29.17; SD = 11.86; 80.3% female) was used. Sixty-two percent of participants reported previously seeking psychological treatment, and approximately 28% received CBT in the first instance. The most influential treatment barriers were a desire to solve the problem on one's own (M = 1.96, SD = 0.96), followed by affordability (M = 1.75, SD = 1.15) and feeling embarrassed or ashamed (M = 1.75, SD = 1.06). The most preferred treatment modes were in-person individual treatment (M = 7.59, SD = 2.86) followed by remote treatment via videoconferencing (M = 4.31, SD = 3.55). Approximately 38% of the variance in intention to seek treatment was associated with the HBM variables, with perceived benefit of treatment being the strongest predictor. Results have the potential to inform mental health service delivery by reducing treatment barriers and aligning public health campaigns with benefits of psychological treatments.
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Affiliation(s)
- Vesna Trenoska Basile
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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4
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Hood SD, Odufowora-Sita O, Briere JB, Lucchino M, Khrouf F, Olewinska E, Pierzchala P, Mezghani M, Nikodem M, Lévy P. Systematic review and network meta-analysis of agomelatine for the treatment of generalized anxiety disorder in adult patients. Int Clin Psychopharmacol 2024:00004850-990000000-00139. [PMID: 38804215 DOI: 10.1097/yic.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
This systematic literature review aimed to assess the efficacy and tolerability of agomelatine versus approved medications for the treatment of generalized anxiety disorder (GAD) in adult patients. We selected randomized controlled trials on various medications used to treat GAD in adult patients. An existing systematic literature review (Kong et al., 2020) was used to identify relevant studies published before 2020. Outcomes of remission and discontinuation due to adverse events (AEs) were analyzed, following a random-effects network meta-analysis approach. Of 25 identified studies, 20 and 22 studies were included in the network meta-analysis for studying the remission and discontinuation (due to AEs) outcomes, respectively. A statistically significant difference in the remission rate was observed between agomelatine and pregabalin [odds ratio (OR), 2.22; 95% confidence interval (CI), 1.19-4.21]. For the other comparators, the results were nonsignificant; however, all the point estimates were in favor of agomelatine. Similarly, for discontinuation because of AEs, the point estimates leaned consistently toward agomelatine suggesting its higher tolerability. The probabilities of agomelatine having the highest remission rate and lowest discontinuation (due to AEs) rate were 67% and 68%, respectively. Based on its demonstrated effectiveness and tolerability, agomelatine can be considered as a drug of choice for the treatment of GAD.
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Affiliation(s)
- Sean D Hood
- Divsion of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | | | | | - Marco Lucchino
- Servier International, Global Value &Access, Suresnes, France
| | | | | | | | | | | | - Pierre Lévy
- Université Paris-Dauphine, Université PSL, LEDA, [LEGOS], Paris, France
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5
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Roberge P, Hudon C, Courteau J, Courteau M, Dufour I, Chiu YM. Care trajectories of individuals with anxiety disorders: A retrospective cohort study. J Affect Disord 2024; 349:604-616. [PMID: 38151164 DOI: 10.1016/j.jad.2023.12.043] [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: 03/17/2023] [Revised: 11/23/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Anxiety disorders (ADs) are associated with increased healthcare use (HCU), and individuals may seek healthcare through various pathways according to clinical and individual characteristics. This study aimed to characterize care trajectories (CTs) of individuals with ADs. METHODS This is a retrospective cohort study using the Care Trajectories - Enriched Data cohort, a linkage between the Canadian Community Health Surveys (CCHS), and health administrative data from Quebec. The cohort included 5143 respondents reporting ADs to the CCHS between 2009 and 2016. We measured CTs over 5 years before CCHS using a state sequence analysis. RESULTS The cohort was categorized into five types of CTs. Type 1 (52.7 %) was the lowest care-seeking group, with fewer comorbidities. Type 2 (24.0 %) had higher levels of physical and mental health comorbidities and moderate HCU, mainly ambulatory visits to general practitioners. Type 3 (13.1 %) represented older patients with the highest level of physical illnesses and high HCU, predominantly ambulatory consultation of specialists other than psychiatrists. Types 4 and 5 combined young and middle-aged patients suffering from severe psychological distress. HCU of type 4 (6.7 %) was high, mainly consultations of ambulatory psychiatrists, and HCU of type 5 (3.5 %), was the highest and mostly in acute care. LIMITATIONS Administrative and survey data may have coding errors, missing data and self-report biases. CONCLUSION Five types of CTs showed distinct patterns of HCU often modulated by physical and mental health comorbidities, which emphasizes the importance of considering ADs when individuals seek care for other mental health conditions or physical illness.
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Affiliation(s)
- Pasquale Roberge
- Département de Médecine de Famille et de Médecine d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada.
| | - Catherine Hudon
- Département de Médecine de Famille et de Médecine d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Canada
| | | | | | - Isabelle Dufour
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche sur le vieillissement, CIUSSS Estrie-CHUS, Sherbrooke, Québec, Canada
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6
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Vasiliadis HM, Lamoureux-Lamarche C, Chapdelaine A, Provencher MD, Norton PJ, Berbiche D, Roberge P. Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:43-53. [PMID: 37461378 PMCID: PMC10867409 DOI: 10.1177/07067437231187459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
AIM To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. METHODS Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. RESULTS The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. CONCLUSION tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Catherine Lamoureux-Lamarche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Alexandra Chapdelaine
- PRIMUS Research Group, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Djamal Berbiche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Pasquale Roberge
- Département de médecine familiale et d’urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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7
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Barry MJ, Nicholson WK, Silverstein M, Coker TR, Davidson KW, Davis EM, Donahue KE, Jaén CR, Li L, Ogedegbe G, Pbert L, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM, Wong JB. Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2023; 329:2163-2170. [PMID: 37338866 DOI: 10.1001/jama.2023.9301] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Importance Anxiety disorders are commonly occurring mental health conditions. They are often unrecognized in primary care settings and substantial delays in treatment initiation occur. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in asymptomatic adults. Population Asymptomatic adults 19 years or older, including pregnant and postpartum persons. Older adults are defined as those 65 years or older. Evidence Assessment The USPSTF concludes with moderate certainty that screening for anxiety disorders in adults, including pregnant and postpartum persons, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety disorders in older adults. Recommendation The USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults. (I statement).
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Affiliation(s)
| | | | | | | | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- The University of Texas Health Science Center, San Antonio
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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8
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Af Winklerfelt Hammarberg S, Toth-Pal E, Jansson-Fröjmark M, Lundgren T, Westman J, Bohman B. Intolerance-of-uncertainty therapy versus metacognitive therapy for generalized anxiety disorder in primary health care: A randomized controlled pilot trial. PLoS One 2023; 18:e0287171. [PMID: 37315099 DOI: 10.1371/journal.pone.0287171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE This randomized controlled pilot study investigated the feasibility of a future full-scale RCT to compare the effects of intolerance-of-uncertainty therapy (IUT) and metacognitive therapy (MCT) in primary health care patients with generalized anxiety disorder (GAD). Preliminary treatment effects were also evaluated. MATERIALS AND METHODS 64 patients with GAD at a large primary health care center in Stockholm, Sweden, were randomized to IUT or MCT. Feasibility outcomes included participant recruitment and retention, willingness to receive psychological treatment, and therapists' competence in and adherence to treatment protocols. Self-reported scales were used to assess treatment outcomes, including worry, depression, functional impairment, and quality of life. RESULTS Recruitment was satisfactory, and dropout was low. On a scale from 0 to 6, participants were satisfied with participating in the study (M = 5.17, SD = 1.09). Following brief training, therapists' competence was rated as moderate, and adherence was rated as weak to moderate. From pre- to post-treatment, reductions on the primary treatment outcome measure of worry were of a large effect size and statistically significant in both the IUT and MCT conditions (Cohen's d for IUT = -2.69, 95% confidence interval [-3.63, -1.76] and d for MCT = -3.78 [-4.68, -2.90]). The between-group effect size from pre- to post-treatment was large and statistically significant (d = -2.03 [-3.31, -0.75]), in favor of the MCT condition. CONCLUSION It is feasible to carry out a full-scale RCT to compare the effects of IUT to MCT for patients with GAD in primary health care. Both protocols seem effective, and MCT seems superior to IUT, but a full-scale RCT is needed to confirm these conclusions. TRIAL REGISTRATION ClinicalTrials.gov (no. NCT03621371).
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Affiliation(s)
- Sandra Af Winklerfelt Hammarberg
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Eva Toth-Pal
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jeanette Westman
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- The Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Benjamin Bohman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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9
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Pauley D, Cuijpers P, Papola D, Miguel C, Karyotaki E. Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness. Psychol Med 2023; 53:567-579. [PMID: 34047264 PMCID: PMC9899576 DOI: 10.1017/s0033291721001999] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. METHODS A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. RESULTS A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68-0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: -0.01 to 0.30]. CONCLUSION The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.
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Affiliation(s)
- Darin Pauley
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
| | - Davide Papola
- Department of Neuroscience, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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10
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Xie Q, Xu YM, Zhong BL. Anxiety symptoms in older Chinese adults in primary care settings: Prevalence and correlates. Front Public Health 2022; 10:1009226. [PMID: 36267994 PMCID: PMC9577322 DOI: 10.3389/fpubh.2022.1009226] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023] Open
Abstract
Background Integrating mental health services into primary care is a potentially cost-effective way to decrease the treatment gap for anxiety in older adults but data on the epidemiology of anxiety symptoms in older Chinese adults in primary care settings have been very limited. This study investigated the prevalence and correlates of anxiety symptoms in Chinese older primary care patients. Methods A total of 753 older primary care patients (≥65 years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the short form of the Geriatric Anxiety Inventory (GAI-SF). Results The prevalence of anxiety symptoms (GAI-SF ≥ 3) in older primary care patients was 21.1%. Statistically significant correlates of anxiety symptoms were female sex (vs. male, OR = 1.85, P = 0.002), poor economic status (vs. good, OR = 2.31, P = 0.013), fair and poor family relationship (vs. good, OR = 1.85, P = 0.006), hypertension (OR = 2.01, P < 0.001), chronic gastric ulcer (OR = 6.82, P < 0.001), and Parkinson's disease (OR = 7.83, P = 0.031). Conclusions Anxiety symptoms are prevalent among older adults attending primary care clinics. Efforts for preventing or reducing anxiety symptoms in older primary care patients may be more useful to target those who are women, have poor financial status, don't have a good family relationship, suffer from hypertension, have chronic gastric ulcer, and suffer from Parkinson's disease.
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Affiliation(s)
- Qin Xie
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
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11
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Choudhary S, Thomas N, Alshamrani S, Srinivasan G, Ellenberger J, Nawaz U, Cohen R. A Machine Learning Approach for Continuous Mining of Nonidentifiable Smartphone Data to Create a Novel Digital Biomarker Detecting Generalized Anxiety Disorder: Prospective Cohort Study. JMIR Med Inform 2022; 10:e38943. [PMID: 36040777 PMCID: PMC9472035 DOI: 10.2196/38943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anxiety is one of the leading causes of mental health disability around the world. Currently, a majority of the population who experience anxiety go undiagnosed or untreated. New and innovative ways of diagnosing and monitoring anxiety have emerged using smartphone sensor-based monitoring as a metric for the management of anxiety. This is a novel study as it adds to the field of research through the use of nonidentifiable smartphone usage to help detect and monitor anxiety remotely and in a continuous and passive manner. OBJECTIVE This study aims to evaluate the accuracy of a novel mental behavioral profiling metric derived from smartphone usage for the identification and tracking of generalized anxiety disorder (GAD). METHODS Smartphone data and self-reported 7-item GAD anxiety assessments were collected from 229 participants using an Android operating system smartphone in an observational study over an average of 14 days (SD 29.8). A total of 34 features were mined to be constructed as a potential digital phenotyping marker from continuous smartphone usage data. We further analyzed the correlation of these digital behavioral markers against each item of the 7-item Generalized Anxiety Disorder Scale (GAD-7) and its influence on the predictions of machine learning algorithms. RESULTS A total of 229 participants were recruited in this study who had completed the GAD-7 assessment and had at least one set of passive digital data collected within a 24-hour period. The mean GAD-7 score was 11.8 (SD 5.7). Regression modeling was tested against classification modeling and the highest prediction accuracy was achieved from a binary XGBoost classification model (precision of 73%-81%; recall of 68%-87%; F1-score of 71%-79%; accuracy of 76%; area under the curve of 80%). Nonparametric permutation testing with Pearson correlation results indicated that the proposed metric (Mental Health Similarity Score [MHSS]) had a colinear relationship between GAD-7 Items 1, 3 and 7. CONCLUSIONS The proposed MHSS metric demonstrates the feasibility of using passively collected nonintrusive smartphone data and machine learning-based data mining techniques to track an individuals' daily anxiety levels with a 76% accuracy that directly relates to the GAD-7 scale.
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Affiliation(s)
- Soumya Choudhary
- Department of Research, Behavidence, Inc., New York, NY, United States
| | - Nikita Thomas
- Department of Data Science, Behavidence, Inc., New York, NY, United States
| | - Sultan Alshamrani
- Department of Data Science, Behavidence, Inc., New York, NY, United States
| | - Girish Srinivasan
- Department of Data Science, Behavidence, Inc., New York, NY, United States
| | | | - Usman Nawaz
- Department of Data Science, Behavidence, Inc., New York, NY, United States
| | - Roy Cohen
- Department of Research, Behavidence, Inc., New York, NY, United States
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Decision aids linked to the recommendations in clinical practice guidelines: results of the acceptability of a decision aid for patients with generalized anxiety disorder. BMC Med Inform Decis Mak 2022; 22:171. [PMID: 35773665 PMCID: PMC9243714 DOI: 10.1186/s12911-022-01899-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/08/2022] [Indexed: 12/23/2022] Open
Abstract
Background Generalized anxiety disorder (GAD) is one of the most prevalent mental health problems. Patients with GAD have unmet needs related to the information received about their disorder, its treatments and their participation in the decision-making process. The aim of this study is to develop and assess the acceptability of a patient decision aid (PtDA) for patients with GAD. Method The PtDA was developed following the International Patient Decision Aid Standards. The recommendations of the Spanish clinical practice guideline (CPG) for patients with GAD were used as the basis. The first prototype was developed by an expert committee, further improvements were made with patients (n = 2), clinical experts (n = 13) and the project management group (n = 7). The acceptability of this second draft was assessed by patients non-involved in the previous phases (n = 11). Results The final PtDA version included a brief description of GAD and its treatments. Most participants agreed that the PtDA was easy to use, visually appealing and useful. At least half of the participants learned new things about treatments and adverse effects. Conclusions A PtDA was developed for patients with GAD based on recommendations from the Spanish CPG. It was improved and accepted by patients and clinical experts involved. An evaluation of its effectiveness on the shared decision-making process during the clinical encounter is planned.
Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01899-2.
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Bujold A, Pariseau-Legault P, de Montigny F. [Understanding the lived experiences of undergraduate nursing students during a mental health practicum. An interpretive phenomenological analysis]. Rech Soins Infirm 2021; 145:22-37. [PMID: 34372649 DOI: 10.3917/rsi.145.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In a global context where populations' mental health needs are growing rapidly, recruiting the next generation of nurses to work in these care settings is particularly problematic. Because of their negative views on mental health issues, nursing students reject such a career path. According to the literature, training programs, particularly clinical immersions, are the main way of mitigating the unpopularity of mental health care among this new generation of nurses. Through an interpretive phenomenological analysis of semi-structured interviews conducted with eleven undergraduate nursing students, this research studied their learning experience during a clinical immersion in mental health care. Anchored in Parse's humanbecoming theory, this study explores the meaning that students attribute to such an experience, the experiential negotiation processes of the practicum setting, and the participants' ability to project themselves beyond the learning experience itself. These results raise various issues related to mental health nursing education, such as the importance of having a nursing role model, as well as various influencing factors related to the rejection of a career in mental health care by the next generation, such as the perception that working in these care settings involves an increased risk of aggression.
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Bhowmick S, Parolia S, Jana S, Kundu D, Choudhury D, Das N, Ray K, KarPurkaysatha S. A study on the anxiety level and stress during Covid19 lockdown among the general population of West Bengal, India- A must know for primary care physicians. J Family Med Prim Care 2021; 10:978-984. [PMID: 34041108 PMCID: PMC8138382 DOI: 10.4103/jfmpc.jfmpc_1385_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Covid19 pandemic has resulted in drastic changes in human lives across the globe in the form of lockdown and an uncertain future. Information regarding the COVID-19-related anxiety and well-being among the public in India is very limited, especially from the state of West Bengal. We conducted this e-survey among the general population of West Bengal to assess the anxiety levels and the well-being status during lockdown. This information would be helpful to guide family physicians to screen patients for anxiety from the primary care level. Aims: The main aim of this questionnaire based study was to assess the levels of anxiety and well-being status among the public including the frontline workers in West Bengal, India. Materials and Methods: A prospective study was conducted with a validated e-questionnaire after Institutional Ethics committee approval, from 18th April, 2020 to 3rd May, 2020. The questionnaire had 12 questions which included the Generalized Anxiety disorder (GAD)-7 scale and the WHO-5 scale (5 question-items) to assess the well-being of the participants. The survey link was distributed through the social networking sites of WhatsApp, LinkedIn, Facebook and Twitter and e-mails within West Bengal. Microsoft Excel (version 2016) was used to analyse the data. Results: A total of 355 responses were received 15.49% responders were observed to have anxiety and 37.74% participants had low well-being scores. Majority of healthcare workers (89.47%) were seen to have anxiety and a significant (52.03%) had a low well-being status. Conclusions: We report the presence of anxiety and low well-being among the general population of West Bengal. It is important to understand the current psychological status of the public for the family physicians as many would visit them with vague symptoms. There is a dire need to screen all patients including front line workers visiting primary care physicians for mental health to ensure better clinical outcome.
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Affiliation(s)
- Subhrojyoti Bhowmick
- Associate Professor, Department of Pharmacology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Saksham Parolia
- Student, PharmD, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shubham Jana
- Ex-executive, Clinical Research Department, Peerless Hospitex Hospital and Research Center Ltd, Kolkata, West Bengal, India
| | - Debarati Kundu
- Executive, Clinical Research Department, Peerless Hospitex Hospital and Research Center Ltd, Kolkata, West Bengal, India
| | - Digbijoy Choudhury
- Associate Consultant, Family Medicine, Ruby General Hospital, Kolkata, West Bengal, India, & Spice Route India, State Lead (WB), India
| | - Nina Das
- Head, Department of Pharmacology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Krishnanghsu Ray
- Medical Director, Peerless Hospitex Hospital and Research Centre Ltd, Kolkata, West Bengal, India
| | - Sujit KarPurkaysatha
- Senior Consultant, Department of Gastroenterology, Peerless Hospitex Hospital and Research Centre Ltd, Kolkata, West Bengal, India
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Nyongesa MK, Mwangi P, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. The reliability, validity and factorial structure of the Swahili version of the 7-item generalized anxiety disorder scale (GAD-7) among adults living with HIV from Kilifi, Kenya. Ann Gen Psychiatry 2020; 19:62. [PMID: 33133222 PMCID: PMC7594456 DOI: 10.1186/s12991-020-00312-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 10/19/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Generalized Anxiety Disorder (GAD) is under-investigated in people living with HIV/AIDS from sub-Saharan Africa. In part, this is due to paucity of culturally appropriate measures for GAD which are psychometrically robust. This study aimed to evaluate the reliability, factorial structure, and validity of Swahili version of the 7-item GAD questionnaire (GAD-7) among adults living with HIV. STUDY DESIGN Descriptive cross-sectional study. METHODS 450 adults receiving comprehensive care from an HIV specialized clinic in Kilifi County, coastal Kenya, were consecutively recruited. Swahili versions of GAD-7, Patient Health Questionnaire (PHQ-9) and a 12-item HIV stigma scale were administered alongside measures of psychosocial and health-related characteristics. Internal consistency, test-retest reliability, factorial structure, convergent validity, and discriminant validity of Swahili GAD-7 were examined using Cronbach's alpha (α), intra-class correlation coefficient (ICC), Confirmatory Factor Analysis (CFA), Pearson's correlation, and analysis of covariance (ANCOVA), respectively. RESULTS Internal consistency of Swahili GAD-7 was good, α = 0.82 (95% CI 0.78, 0.85). Its test-retest reliability (2 weeks apart) was acceptable, ICC = 0.70 (95% CI 0.55, 0.81). A confirmatory analysis of a one-factor solution indicated an excellent fit to the hypothesized structure (RMSEA = 0.00 [95% confidence interval 0.00, 0.05], CFI = 1.00, TLI = 1.00). Multi-group CFA substantiated factorial invariance for sex and age for the one-factor structure of Swahili GAD-7. Scores of GAD-7, Swahili version, significantly correlated with those of PHQ-9 (r = 0.73; p < 0.001) and the HIV stigma scale (r = 0.36; p < 0.001) suggesting good convergent validity. Statistically significant differences were observed between participants on first-line antiretroviral therapy compared to those on second-line treatment (F [1, 441] = 5.55, p = 0.02) indicative of good discriminant validity of Swahili GAD-7. CONCLUSION GAD-7 Swahili version retained its original unidimensional latent structure with good psychometric properties among adults living with HIV from Kilifi, Kenya. It can be used to identify symptoms of GAD in similar research settings. However, to confidently identify those in need of mental health treatment or referral services in HIV primary care clinics, more research on the validity of Swahili GAD-7 is needed especially its discriminant validity and diagnostic accuracy at different cut-off scores.
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Affiliation(s)
- Moses K. Nyongesa
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul Mwangi
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Hans M. Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R. J. C. Newton
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Bujold A, Pariseau-Legault P, de Montigny F. [The unpopularity of mental health/psychiatry care settings among nursing students: A systematic review]. Rech Soins Infirm 2020; 141:17-37. [PMID: 32988187 DOI: 10.3917/rsi.141.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In every population and country around the world, mental health needs are great and are on the rise. Through their training and their vast field of expertise, nurses are an important lever for addressing the issue of accessibility in these care settings. While the increase in the number of new nursing graduates should have helped this issue, recent data show a sharp increase in the shortage of nurses in these care settings. This systematic review (n=40) using the CINAHL, MEDLINE, PsycArticles, and Scopus databases aims to explore why psychiatric and mental health care settings are unpopular with the next generation of nurses. Guided by Parse's theory, this review identifies three major themes : (1) nursing students' perspectives on mental health issues, (2) the influences of educational interventions on these perspectives, and (3) the factors facilitating and constraining a career in these care settings for new nursing graduates. These results enable a better understanding of what can affect the recruitment of new graduate nurses in mental health/psychiatry, while proposing various levers of intervention to specifically address this issue.
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Serowik KL, Roemer L, Suvak M, Liverant G, Orsillo SM. A randomized controlled pilot study evaluating Worry Less, Live More: The Mindful Way Through Anxiety Workbook. Cogn Behav Ther 2020; 49:412-424. [PMID: 32508277 DOI: 10.1080/16506073.2020.1765858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Effective interventions for generalized anxiety exist, but barriers to treatment prevent their broad dissemination. Commercially available self-help materials may help bridge this gap, but few have been empirically evaluated. This study compared self-reported change in generalized anxiety symptomology and associated problems between community members with excessive worry who were randomly assigned to receive the Worry Less, Live More: The Mindful Way through Anxiety Workbook (n = 35) and those in a delayed condition (n = 29). Participants in the workbook condition reported significantly greater reductions between baseline and 11-week follow-up in self-reported worry (η 2 =.15), general anxiety/tension (η 2 =.13), and anxiety (η 2 =.24) than those in the delayed condition, although no statistically significant differences across condition on changes in depression, functional impairment or acceptance were detected. This pilot study provides support for continued research examining the efficacy of acceptance-based behavioral therapy delivered in a self-help format.
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Affiliation(s)
- Kristin L Serowik
- Psychology Service, VA Connecticut Healthcare System, Department of Psychiatry, Yale University School of Medicine , New Haven, CT, USA
| | - Lizabeth Roemer
- Psychology Department, University of Massachusetts , Boston, MA, USA
| | - Michael Suvak
- Psychology Department, Suffolk University , Boston, MA, USA
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Hurtado MM, Villena A, Vega A, Amor G, Gómez C, Morales-Asencio JM. 'I have anxiety, but I have values and preferences' Experiences of users with generalized anxiety disorder: A qualitative study. Int J Ment Health Nurs 2020; 29:521-530. [PMID: 31908140 DOI: 10.1111/inm.12690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 12/12/2022]
Abstract
To understand the experience and perceptions of people diagnosed with generalized anxiety disorder, along the whole process and their role through the decision-making process for their treatment. A qualitative study through focus groups composed of people diagnosed with generalized anxiety disorder was carried out. Content analysis was carried out to explore the most representative issues. Five thematic categories were identified: onset of the disorder, symptoms and course; daily life with the disorder; coping with the disorder; demand of healthcare for anxiety, and treatment options and decision-making. Most of the patients reported physical symptoms of anxiety. The majority of participants perceived little social support from their environment and occupational interferences. Coping seems to differ among participant that have recovered or not recovered. The involvement of users with generalized anxiety disorder was scarce, and pharmacological treatment was always the first option offered. There is scarce orientation to elicit preferences and values of patients across the process of care for people with generalized anxiety disorder. The consequence is a biased predisposition of the healthcare system to provide pharmacological treatment as the first option and ignore the perspective of patients on how to cope with their illness.
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Affiliation(s)
- María M Hurtado
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | - Amelia Villena
- Mental Health Unit, Valle de los Pedroches Hospital, Pozoblanco, Spain
| | - Amanda Vega
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | - Gisela Amor
- Mental Health Unit, Regional University Hospital, Málaga, Spain
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Mohammadi MR, Pourdehghan P, Mostafavi SA, Hooshyari Z, Ahmadi N, Khaleghi A. Generalized anxiety disorder: Prevalence, predictors, and comorbidity in children and adolescents. J Anxiety Disord 2020; 73:102234. [PMID: 32470794 DOI: 10.1016/j.janxdis.2020.102234] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/24/2022]
Abstract
UNLABELLED Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders among children and adolescents. OBJECTIVES The purpose of this study is to determine the prevalence, sociodemographic variables, and comorbidity of GAD among children and adolescents to suggest the main predictors, using an analytical cross-sectional study. METHOD Data were collected via a multistage random-cluster sampling method from 29,709 children and adolescents aged 6-18 years old in Iran. We used the Persian present and lifetime version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). Then, we analyzed the data via descriptive analysis and multivariate logistic regression analysis methods. RESULTS The lifetime prevalence rate for GAD was 2.6 % (95 % Cl, 2.4%-2.8%). Overall, logistic regression analyses revealed five variables with significant unique contributions to the prediction of GAD. Significant predictors were: age, sex, mother history of psychiatric hospitalization, mother education, and residence. Participants with these risk factors were between 0.23-2.91 times more likely to present with GAD. Besides, the highest and lowest comorbidity rates of psychiatric disorder with GAD was 57.6 % and 0.3 % related to anxiety and eating disorders, respectively. Age or sex also affects the comorbidity of GAD and some mental disorders including behavioral, neurodevelopmental, elimination, and mood disorders. CONCLUSION This study, which was conducted in Iran, is located at the low end of the range of international estimates for GAD. Awareness of the predictors and comorbidity of GAD could be used in the prevention of GAD in children and adolescents.
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Affiliation(s)
- Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Roozbeh HospitalTehran University of Medical Sciences, Tehran, Iran
| | - Parandis Pourdehghan
- Psychiatry and Psychology Research Center, Roozbeh HospitalTehran University of Medical Sciences, Tehran, Iran.
| | - Seyed-Ali Mostafavi
- Psychiatry and Psychology Research Center, Roozbeh HospitalTehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hooshyari
- Psychiatry and Psychology Research Center, Roozbeh HospitalTehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Roozbeh HospitalTehran University of Medical Sciences, Tehran, Iran
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Rodrigues-Amorim D, Olivares JM, Spuch C, Rivera-Baltanás T. A Systematic Review of Efficacy, Safety, and Tolerability of Duloxetine. Front Psychiatry 2020; 11:554899. [PMID: 33192668 PMCID: PMC7644852 DOI: 10.3389/fpsyt.2020.554899] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Abstract
Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved for the treatment of patients affected by major depressive disorder (MDD), generalized anxiety disorder (GAD), neuropathic pain (NP), fibromyalgia (FMS), and stress incontinence urinary (SUI). These conditions share parallel pathophysiological pathways, and duloxetine treatment might be an effective and safe alternative. Thus, a systematic review was conducted following the 2009 Preferred Reporting Items (PRISMA) recommendations and Joanna Briggs Institute Critical (JBI) Appraisals guidelines. Eighty-five studies focused on efficacy, safety, and tolerability of duloxetine were included in our systematic review. Studies were subdivided by clinical condition and evaluated individually. Thus, 32 studies of MDD, 11 studies of GAD, 19 studies of NP, 9 studies of FMS, and 14 studies of SUI demonstrated that the measured outcomes indicate the suitability of duloxetine in the treatment of these clinical conditions. This systematic review confirms that the dual mechanism of duloxetine benefits the treatment of comorbid clinical conditions, and supports the efficacy, safety, and tolerability of duloxetine in short- and long-term treatments.
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Affiliation(s)
- Daniela Rodrigues-Amorim
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - José Manuel Olivares
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain.,Head of Department of Psychiatry, Health Area of Vigo, Servizo Galego de Saúde (SERGAS), Vigo, Spain.,Director Neuroscience Area, Galicia Sur Health Research Institute (IISGS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - Carlos Spuch
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - Tania Rivera-Baltanás
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
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Fleury MJ, Rochette L, Grenier G, Huỳnh C, Vasiliadis HM, Pelletier É, Lesage A. Factors associated with emergency department use for mental health reasons among low, moderate and high users. Gen Hosp Psychiatry 2019; 60:111-119. [PMID: 31404825 DOI: 10.1016/j.genhosppsych.2019.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study identified factors associated with frequency of emergency department (ED) use for mental health (MH) reasons in Quebec during 2015-2016. METHODS Participants (n = 115,066) were categorized as: 1) low (1 visit/year; 76%); 2) moderate (2 visits/year; 14%); and 3) high (3+ visits/year; 10%) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Variables significantly associated with frequency of ED use were entered into a multinomial logistic regression. RESULTS Patients with mental illness (MI), especially substance-related disorders (SRD) and schizophrenia spectrum disorders; bipolar, depressive, anxiety or personality disorders; and those with severe chronic physical illness (needs factors) were more likely to use ED for MH reasons, as were male participants 18-64 years old, and those living in metropolitan areas with high social or material deprivation (predisposing factors). Regarding enabling factors, consultations with outpatient psychiatrists and not seeing a general practitioner (GP) in the year prior to ED visit were associated with high ED use. CONCLUSION The severity of MI/SRD contributed most to frequent ED use, while social and material deprivation in metropolitan areas, and intensity of medical care also influenced ED use for MH reasons.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Montréal, QC, Canada.
| | - Louis Rochette
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Christophe Huỳnh
- University Institute on Addictions, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada; Department of Psychiatry, University of Montreal, Montréal, QC, Canada; School of Psychoeducation, University of Montreal, Montréal, QC, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche Charles LeMoyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC, Canada
| | - Éric Pelletier
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montréal, QC, Canada; Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
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Goossen B, van der Starre J, van der Heiden C. A review of neuroimaging studies in generalized anxiety disorder: "So where do we stand?". J Neural Transm (Vienna) 2019; 126:1203-1216. [PMID: 31222605 DOI: 10.1007/s00702-019-02024-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022]
Abstract
Generalized anxiety disorder (GAD) is a prevalent anxiety disorder, but is still poorly recognized in clinical practice. The aim of this review is to provide a coherent understanding of the functional neuroanatomy of GAD; second, to discuss the current theoretical cognitive models surrounding GAD; and finally to discuss the discrepancy between fundamental research and clinical practice and highlight several potential directions for future research in this domain. A systematic review of original papers investigating the neural correlates of DSM-IV and DSM-5 defined GAD samples was undertaken in Ovid literature search, PubMed, Medline, EMbase, PsycINFO, Google Scholar, and TRIP databases. Articles published between 2007 and 2018 were included. First, GAD seems to be characterized by limbic and (pre)frontal abnormalities. More specifically, GAD patients show difficulties in engaging the prefrontal cortex (PFC) and anterior cingulate cortex (ACC) during emotional regulation tasks. Second, the involved brain areas appear to be characterized by heterogeneity possibly due to a variety of experimental designs and test subjects. Third, regarding the discrimination between GAD and other anxiety disorders via fMRI, results appear to be mixed. Studies report both GAD-specific activity and an inability to differentiate between GAD and other anxiety or mood disorders. The usage of different experimental tasks, test subjects, outcome measures and experimental designs limits the possibilities of generalizing results as well as conducting meta-analytical research. Certain theoretical models of GAD describe our understanding of this disorder and form the basis for treatment interventions. However, fMRI research thus far has failed to validate these models. To bridge the gap between fundamental research and clinical practice in GAD, we propose that fMRI researchers make an effort to validate the existing cognitive model of GAD. An alternative approach could be that new models would be based on current neuroimaging research as well as convergent research methods such as Heart Rate Variability (a bottom up approach).
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Affiliation(s)
- Bastiaan Goossen
- Outpatient Treatment Center GGZ Delfland, Sint Jorisweg 2, 2612 GA, Delft, The Netherlands.
| | | | - Colin van der Heiden
- Outpatient Treatment Center Indigo, Spijkenisse, The Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Efficacy of venlafaxine extended release in major depressive disorder patients: effect of baseline anxiety symptom severity. Int Clin Psychopharmacol 2019; 34:110-118. [PMID: 30870236 PMCID: PMC6445597 DOI: 10.1097/yic.0000000000000256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Effects of baseline anxiety on the efficacy of venlafaxine extended release versus placebo were examined in a post hoc pooled subgroup analysis of 1573 patients enrolled in eight short-term studies of major depressive disorder. Anxiety subgroups were defined based on baseline 17-item Hamilton Rating Scale for Depression Item 10 score <3 (low) versus ≥3 (high). Change from baseline to final visit in Montgomery-Åsberg Depression Rating Scale total score and Montgomery-Åsberg Depression Rating Scale response and remission rates were analyzed. Change from baseline in Montgomery-Åsberg Depression Rating Scale total score and response and remission rates was significantly greater for venlafaxine extended release versus placebo in both low and high anxiety subgroups (all P < 0.0001). A statistically significant baseline anxiety by treatment interaction was observed for Montgomery-Åsberg Depression Rating Scale total score only (P = 0.0152). The adjusted mean change from baseline in Montgomery-Åsberg Depression Rating Scale total score was significantly greater in the high anxiety subgroup versus low anxiety subgroup for patients treated with venlafaxine extended release (-6.27 versus -3.89; P = 0.0440) but not placebo. These results support the efficacy of venlafaxine extended release for major depressive disorder treatment in patients with anxiety symptoms.
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Chapdelaine A, Carrier JD, Fournier L, Duhoux A, Roberge P. Treatment adequacy for social anxiety disorder in primary care patients. PLoS One 2018; 13:e0206357. [PMID: 30395608 PMCID: PMC6218038 DOI: 10.1371/journal.pone.0206357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/11/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES There is a gap between clinical practice guidelines for social anxiety disorder and clinical practice that needs to be addressed to ensure the delivery of evidence-based treatments. The objectives of this study were: 1) to describe mental health service utilization in a cohort of primary care patients with social anxiety disorder; 2) to examine treatment adequacy for pharmacotherapy and psychotherapy according to indicators based on clinical practice guidelines; and 3) to explore correlates of treatment adequacy. METHOD The "Dialogue" project (Quebec, Canada) is a large study conducted in 67 primary care clinics. After a mental health screening in primary care (n = 14 833), participants with anxiety or depressive symptoms took part in a telephone/web structured interview on mental health symptoms and service utilization (n = 1956). This study included 289 participants meeting DSM-IV criteria for social anxiety disorder. RESULTS Overall, 86.2% of participants reported consulting for mental health reasons over the past 12 months. Only 23.6% of our sample reported the detection of social anxiety disorder by a healthcare professional in the past 12 months. Approximately 2 in 5 respondents with social anxiety disorder reported receiving pharmacotherapy or psychotherapy meeting our treatment adequacy indicators. Antidepressant medication was the most common treatment. Logistic regression models showed that the detection of major depression (OR = 4.651; 95% CI: 2.559-8.453) or other anxiety disorder(s) (OR = 2.957; 95% CI: 1.555-5.625) were associated with receiving any adequate treatment, but the detection of social anxiety disorder itself was not (OR = 1.420; 95% CI: 0.696-2.899). CONCLUSION Low rates of detection and treatment adequacy based on our indicators demonstrate that efforts must be made to ensure the quality of care for individuals with social anxiety disorder in primary care.
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Affiliation(s)
- Alexandra Chapdelaine
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jean-Daniel Carrier
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
- Department of Psychiatry, Université de Sherbrooke, Québec, Canada
| | - Louise Fournier
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), School of Public Health, Université de Montréal, Québec, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Québec, Canada
| | - Pasquale Roberge
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Québec, Canada
- Research Centre of the Centre Hospitalier de l’Université de Sherbrooke (CRCHUS), Québec, Canada
- * E-mail:
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25
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Patterns of Health Care Service Utilization by Individuals with Mental Health Problems: a Predictive Cluster Analysis. Psychiatr Q 2018; 89:675-690. [PMID: 29430590 DOI: 10.1007/s11126-018-9568-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed at identifying and characterizing clusters of mental health service users based on various characteristics in a sample of individuals with mental health problems. Data were collected in the epidemiological catchment area of South-West Montreal, Quebec in 2011 and 2014. Among the 746 participants who reported experiencing a mental health problem (high psychological distress and/or a mental disorder), 29% had used mental health services. A Two-Step cluster analysis was carried out to generate participant profiles based on their visit to mental health professional. Four clusters were identified: 1) young males with high quality of life and social support and who were less likely to have mental health problems and to utilize mental health services; 2) older females living with a partner and having a family doctor who were less likely to have mental health problems and to utilize mental health services; 3) single females with generalized anxiety disorder and somatic illness who were more likely to utilize mental health services, and 4) depressed females with high psychological distress, low quality of life and social support who were likely to utilize mental health services. The results reinforce the importance to develop programs that target the specific needs of subgroups of people experiencing mental health problems, given their considerable heterogeneity.
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26
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Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, Abdulmalik J, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Bruffaerts R, Cardoso G, Cia A, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, de Jonge P, Karam EG, Kawakami N, Kovess-Masfety V, Lee S, Levinson D, Medina-Mora ME, Navarro-Mateu F, Pennell BE, Piazza M, Posada-Villa J, Have MT, Zarkov Z, Kessler RC, Thornicroft G. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety 2018; 35:195-208. [PMID: 29356216 PMCID: PMC6008788 DOI: 10.1002/da.22711] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/20/2017] [Accepted: 11/25/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. METHODS Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). RESULTS Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. CONCLUSIONS Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, China
| | - Sara Evans-Lacko
- Kings College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom,PSSRU, London School of Economics and Political Science, London, United Kingdom
| | - Ekaterina Sadikova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Somnath Chatterji
- Department of Information, Evidence and Research,World Health Organization, Geneva, Switzerland
| | - Jibril Abdulmalik
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Graça Cardoso
- Department of Mental Health, Faculdades de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alfredo Cia
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS-St. John of God Clinical Research Centre, Brescia, Italy
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Yanling He
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon,Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Marina Piazza
- Universidad Cayetano Heredia, Lima, Peru; National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Zahari Zarkov
- Directorate of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Graham Thornicroft
- Kings College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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Abstract
Generalized anxiety disorder (GAD) is a prevalent and highly disabling mental health condition; however, there is still much to learn with regard to pertinent biomarkers, as well as diagnosis, made more difficult by the marked and common overlap of GAD with affective and anxiety disorders. Recently, intensive research efforts have focused on GAD, applying neuroimaging, genetic, and blood-based approaches toward discovery of pathogenetic and treatment-related biomarkers. In this paper, we review the large amount of available data, and we focus in particular on evidence from neuroimaging, genetic, and neurochemical measurements in GAD in order to better understand potential biomarkers involved in its etiology and treatment. Overall, the majority of these studies have produced results that are solitary findings, sometimes inconsistent and not clearly replicable. For these reasons, they have not yet been translated into clinical practice. Therefore, further research efforts are needed to distinguish GAD from other mental disorders and to provide new biological insights into its pathogenesis and treatment.
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Affiliation(s)
- Eduard Maron
- Faculty of Medicine, Department of Medicine, Center for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK ; Department of Psychiatry, University of Tartu, Tartu, Estonia ; North Estonia Medical Center, Department of Psychiatry, Tallinn, Estonia
| | - David Nutt
- Faculty of Medicine, Department of Medicine, Center for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
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Butnoriene J, Steibliene V, Saudargiene A, Bunevicius A. Does presence of metabolic syndrome impact anxiety and depressive disorder screening results in middle aged and elderly individuals? A population based study. BMC Psychiatry 2018; 18:5. [PMID: 29310620 PMCID: PMC5759833 DOI: 10.1186/s12888-017-1576-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 12/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive and anxiety disorders are common in primary care setting but often remain undiagnosed. Metabolic syndrome (MetS) is also prevalent in the general population and can impair recognition of common mental disorders due to significant co-morbidity and overlap with psychiatric symptoms included in self-reported depression/anxiety screening tools. We investigated if MetS has an impact on the accuracy of current major depressive disorder (MDD) and generalized anxiety disorder (GAD) screening results using the Hospital Anxiety and Depression scale (HADS). METHODS A total of 1115 (562 men; mean age 62.0 ± 9.6 years) individuals of 45+ years of age were randomly selected from the general population and evaluated for current MetS; depressive and anxiety symptoms (HADS); and current MDD and GAD (Mini International Neuropsychiatric Interview [MINI]). RESULTS The MetS was diagnosed in 34.4% of the study participants. Current MDD and GAD were more common in individuals with MetS relative to individuals without MetS (25.3% vs 14.2%, respectively, p < 0.001; and 30.2% vs 20.9%, respectively, p < 0.001). The ROC analyses demonstrated that optimal thresholds of the HADS-Depression subscale for current MDE were ≥9 in individuals with MetS (sensitivity = 87%, specificity = 73% and PPV = 52%) and ≥8 in individuals without MetS (sensitivity = 81%, specificity = 78% and PPV = 38%). At threshold of ≥9 the HADS-Anxiety subscale demonstrated optimal psychometric properties for current GAD screening in individuals with MetS (sensitivity = 91%, specificity = 85% and PPV = 72%) and without MetS (sensitivity = 84%, specificity = 83% and PPV = 56%). CONCLUSIONS The HADS is a reliable screening tool for current MDE and GAD in middle aged and elderly population with and without MetS. Optimal thresholds of the HADS-Depression subscale for current MDD is ≥9 for individuals with MetS and ≥8 - without MetS. Optimal threshold of the HADS-Anxiety subscale is ≥9 for current GAD in individuals with and without MetS. The presence of MetS should be considered when interpreting depression screening results.
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Affiliation(s)
- Jurate Butnoriene
- Institute of Endocrinology, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50161, Kaunas, Lithuania.
| | - Vesta Steibliene
- 0000 0004 0432 6841grid.45083.3aPsychiatry Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ausra Saudargiene
- 0000 0004 0432 6841grid.45083.3aLithuanian University of Health Sciences, Kaunas, Lithuania ,0000 0004 0432 6841grid.45083.3aNeuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Adomas Bunevicius
- 0000 0004 0432 6841grid.45083.3aNeuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
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