The vicious cycle of psychopathology and stressful life events: A meta-analytic review testing the stress generation model

Stress generation theory initially posited that depression elevates risk for some stressful events (i.e., dependent events) but not others (i.e., independent events). This preregistered meta-analytic review examined whether stress generation occurs transdiagnostically by examining 95 longitudinal studies with 38,228 participants (537 total effect sizes) from over 30 years of research. Our multilevel meta-analyses found evidence of stress generation across a broad range of psychopathology, as evidenced by significantly larger prospective effects for dependent (overall psychopathology: r = .23) than independent (overall psychopathology: r = .10) stress. We also identified unique patterns of effects across specific types of psychopathology. For example, effects were larger for depression than anxiety. Furthermore, effects were sometimes larger in studies with younger participants, shorter time lags between assessments, checklist measures of stress, and for interpersonal stressors. Finally, a multilevel meta-analytic structural equation model suggested that dependent stress exacerbates psychopathology symptoms over time (β = .04), possibly contributing to chronicity. Interventions targeting the prevention of stress generation may mitigate chronic psychopathology. Conclusions of this study are limited by the predominance of depression effect sizes in the literature and our review of only English language articles. On the other hand, the findings are strengthened by rigorous inclusion criteria, lack of publication bias, and absence of moderating effects by publication year. The latter underscores the replicability of the stress generation effect over the last 30 years. Taken together, the review provides robust evidence that stress generation is a cross-diagnostic phenomenon that contributes to a vicious cycle of increasing stress and psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Two-Year Safety and Efficacy Experience in Patients with Methotrexate-Resistant Active Rheumatoid Arthritis Treated with Etanercept and Conventional Disease-Modifying Anti-rheumatic Drugs in the Latin American Region

Background:

Although long-term data are available from biologic studies in North American/European populations with rheumatoid arthritis (RA), long-term findings in Latin American RA populations are limited.

Objective:

To examine long-term safety/efficacy of etanercept, methotrexate, and/or other disease-modifying anti-rheumatic drugs (DMARDs) in Latin American patients with moderate-to-severe active RA.

Methods:

In the first phase of this open-label study, patients were randomized to etanercept 50 mg weekly plus methotrexate or conventional DMARD (hydroxychloroquine or sulfasalazine) plus methotrexate for 24 weeks. At the start of the second phase (week 24), investigators selected a treatment regimen that included any combination/dosage of etanercept, methotrexate, hydroxychloroquine, or sulfasalazine based on previous treatment response, preference, and local product labeling, and was continued for the 104-week extension.

Results:

In the extension, in the group previously randomized to etanercept-plus-methotrexate therapy, etanercept was continued in 259/260 patients; methotrexate continued in 260/260; and hydroxychloroquine and sulfasalazine added in 8/260 and 3/260, respectively. In the group previously randomized to conventional DMARD-plus-methotrexate therapy, conventional DMARD was discontinued in 86/126 and etanercept added in 105/126. Among etanercept-exposed patients (total exposure, 798.1 patient-year [PY]), rates of adverse events, serious adverse events, and serious infections per PY were 1.7, 0.07, and 0.02 events per PY. In both groups, after treatment modification was permitted, clinical response rates and improvements in clinical/patient-reported outcomes from baseline were sustained to week 128.

Conclusion:

After investigators were permitted to modify treatment, etanercept was part of the treatment regimen in 95% of patients. Continuation or addition of etanercept in the 2-year extension resulted in a consistently good risk:benefit profile.

Trial Registration:

Open-Label Study Comparing Etanercept to Conventional Disease Modifying Antirheumatic Drug (DMARD) Therapy; ClinicalTrials.gov, number NCT00848354; https://clinicaltrials.gov/ct2/show/NCT00848354

Managing wastewater effluent to enhance aquatic receiving ecosystem productivity: a coastal lagoon in Western Australia

Large amounts of waste are generated in urban centers that if properly managed could promote ecological services. In order to promote nutrient cycling and productivity without endangering aquatic ecosystems, management of wastewater treatment and effluent discharges to receiving waters must be assessed on a case-by-case basis. We applied this premise to examine a municipal wastewater treated effluent discharge in a shallow oligotrophic coastal lagoon in Western Australia. Three-dimensional hydrodynamic-ecological modeling (ELCOM-CAEDYM) was used to assess the reaction of ecosystem for effluent quality. Two scenarios were evaluated for the summer 2000-2001 period, the actual or "current" (conventional secondary treatment) and an "alternative" (involving substitution of biological nutrient removal by advanced treatment). The residence time of the simulated numerical domain averaged 8.4 ± 1.3 days. For the current scenario the model successfully estimated phytoplankton biomass, as chlorophyll-a concentration (Chl-a), that is within field-measured ranges and previously recorded levels. The model was able to reproduce nitrogen as the main limiting nutrient for primary production in the coastal ecosystem. Simulated surface Chl-a means were 0.26 (range 0.19-0.38) μg Chl-a/L for the current scenario and 0.37 (range 0.19-0.67) μg Chl-a/L for the alternative one. Comparison of the alternative scenario with field-measured Chl-a levels suggests moderate primary production increase (16-42%), within local historical variability. These results, suggest that such a scenario could be used, as part of a comprehensive wastewater management optimization strategy, to foster receiving ecosystem's productivity and related ecological services maintaining its oligotrophic state.