The CARE System in Its Importance in Dealing with Today's Crises1

The CARE system is a gift from Mother Nature, we have it in our biological heritage; it enables us humans-as a basic gift-to help each other in a large, life-serving context, and thus also to counterbalance destruction. It is about a basic human ability, linked to typical behaviour, but also about a basic human need for connectedness. In this paper, I would like to show how the CARE system can be activated as a collective attitude. The CARE system is strengthened by positive emotions. We are currently being affected by many crises and this triggers fear. How can we deal with this better? Fear is countered with hope and the associated positive emotions such as joy, awe, kama muta and others. These emotions and feelings can be consciously encouraged and placed alongside the feelings of fear. But also, when we share the feelings of grief with each other, it triggers an attitude of CARE. We can grieve together for the various experiences of loss that we go through-but we can also imagine together how we envisage a future that is worth living for everyone. An attitude in the sense of CARING has been practised in friendship for thousands of years. It would therefore be possible to move away from an attitude of competing and outdoing, to an attitude not only of recognition, care, and solidarity in human interaction, but also in our connection with nature.

Mental health and sleep quality of low-income mothers of one-year-olds during the COVID-19 pandemic

The COVID-19 pandemic and subsequent social restrictions created an unprecedented context for families raising young children. Although studies have documented detrimental effects of the pandemic on maternal well-being, less is known about how the pandemic specifically impacted low-income mothers. We examined depression, anxiety, and sleep quality among low-income mothers of one-year-olds during the early months of the pandemic using data from the Baby's First Years study. Focusing on the control group (n = 547), we compared mothers interviewed before March 14th, 2020 (n = 342) to mothers interviewed between March 14th and June 30th, 2020 (n = 205) to determine whether the pandemic was associated with differences in mental health and sleep quality. Mothers were recruited from four cities in the United States, and most of the sample identified as Hispanic (42.2%) or Black, non-Hispanic (38.6%). We found that mothers interviewed during the pandemic reported better mental health and sleep quality. While we cannot speak to longer-term impacts of the pandemic, it is possible low-income mothers experienced relief from daily stressors during the initial shelter-in-place orders, which may have led to improvements in well-being. These results have implications for understanding how complex life stressors influence mental health and sleep quality among low-income mothers raising young children.

Devouring and Asphyxia Symptoms of a Cultural Complex in Present Times

The article discusses dominance and oppression in society due to cultural complexes filled with collective memories of destructiveness and perpetration, implicit memories which have remained repressed. Individual personal complexes and traumas are intertwined with traumatizing historical circumstances, setting up pairs of perpetrator and victim. The metaphors of devouring and asphyxiation are used to denote interpersonal and group relationships in which feelings of imprisonment, suffocating anxiety and expulsion are predominant, all of which leads to painful projections and introjections, dissociation and suffering. Asphyxiating death symbolizes not only environmental devastation by fire, the pandemic and the plague, but is also seen as a symptom of acute anxiety in modern times. Devouring stands for the annulment of the objectified Other in a patriarchal society best revealed in fratricidal struggles, the oppression of women and, ultimately, wars.

The effects of COVID-19 stressors and family life on anxiety and depression one-year into the COVID-19 pandemic

The purpose of this study was to examine the effects of Coronavirus (COVID-19)-related stressors and family health on adult anxiety and depressive symptoms 1 year into the pandemic. The sample consisted of 442 adults living in the United States who were recruited via Amazon Mechanical Turk. Data were analyzed using multiple logistic regression. Results indicated that compared to a sample 1 month into the pandemic, participants in the current sample reported worse family health and increases in both positive and negative perceptions of the pandemic on family life and routines. COVID-19 stressors and perceived negative effects of the pandemic on family life increased the odds for moderate-to-severe depression and anxiety while having more family health resources decreased the odds for depression and anxiety symptoms. Participants reported lower odds for worse depression and anxiety since the beginning of the pandemic when they reported more positive family meaning due to the pandemic. The results suggest a need to consider the impact of family life on mental health in pandemics and other disasters.

Empirically-derived dimensions of childhood adversity and cumulative risk: associations with measures of depression, anxiety, and psychosis-spectrum psychopathology

Background: Investigating different approaches to operationalizing childhood adversity and how they relate to transdiagnostic psychopathology is relevant to advance research on mechanistic processes and to inform intervention efforts. To our knowledge, previous studies have not used questionnaire and interview measures of childhood adversity to examine factor-analytic and cumulative-risk approaches in a complementary manner.Objective: The first aim of this study was to identify the dimensions underlying multiple subscales from three well-established childhood adversity measures (the Childhood Trauma Questionnaire, the Childhood Experience of Care and Abuse Interview, and the Interview for Traumatic Events in Childhood) and to create a cumulative risk index based on the resulting dimensions. The second aim of the study was to examine the childhood adversity dimensions and the cumulative risk index as predictors of measures of depression, anxiety, and psychosis-spectrum psychopathology.Method: Participants were 214 nonclinically ascertained young adults who were administered questionnaire and interview measures of depression, anxiety, psychosis-spectrum phenomena, and childhood adversity.Results: Four childhood adversity dimensions were identified that captured experiences in the domains of Intrafamilial Adversity, Deprivation, Threat, and Sexual Abuse. As hypothesized, the adversity dimensions demonstrated some specificity in their associations with psychopathology symptoms. Deprivation was uniquely associated with the negative symptom dimension of psychosis (negative schizotypy and schizoid symptoms), Intrafamilial Adversity with schizotypal symptoms, and Threat with depression, anxiety, and psychosis-spectrum symptoms. No associations were found with the Sexual Abuse dimension. Finally, the cumulative risk index was associated with all the outcome measures.Conclusions: The findings support the use of both the empirically-derived adversity dimensions and the cumulative risk index and suggest that these approaches may facilitate different research objectives. This study contributes to our understanding of the complexity of childhood adversity and its links to different expressions of psychopathology.

Post-traumatic stress in war veterans and secondary traumatic stress among parents of war veterans five years after the 2014 Israel-Gaza military conflict

Secondary traumatic stress (STS) has been studied in therapists, spouses, and mainly in children of traumatised individuals. To date, the relationship between children's posttraumatic stress disorder (PTSD) symptoms and their parents' mental health outcomes have been understudied, and specifically, long term STS symptoms of parents of war veterans were not investigated. The current study examined PTSD symptoms among veterans of the 2014 Israel-Gaza war and STS among their parents, five years after the war. The control group consisted of veterans from combat military units who were on active duty at the time of the war but did not actively participate in the war (stand-by units) - providing a natural experiment condition. We found that PTSD symptoms were almost twice as high in the directly active war veterans (DAV, N = 32) group compared to the indirectly active war veterans (IAV, N = 26) group. Results showed that mothers had higher STS symptoms in general, and DAV PTSD symptoms correlated with their fathers STS symptoms. The current study provides novel evidence for: (a) subclinical PTSD symptoms in war veterans 5 years after the war, and (b) transmission of trauma from war veterans to their parents. The overall negative effect of sending a child to war on the parents are also discussed.

ICD-11 complex post-traumatic stress disorder and psychiatric comorbidity among UK Armed Forces veterans in Northern Ireland: a latent class analysis

Background: There is evidence to suggest that the experience of complex post-traumatic stress disorder (C-PTSD) may be commonly associated with elevated risk for several mental ill-health comorbidities.Objective: The current study seeks to contribute to the growing literature on C-PTSD comorbidity by examining the relationship between C-PTSD and other mental health disorders in a UK Armed Forces veteran sample.Method: This study used data from the Northern Ireland Veterans' Health and Wellbeing Study (NIVHWS). The effective sample consisted of 638 veterans (90.0% male). Tetrachoric correlations examined the relationship between C-PTSD caseness and other mental health outcomes. Latent class analysis was then conducted, determining the optimal number and nature of classes in the sample in relation to C-PTSD, depression, anxiety, and suicidality.Results: C-PTSD caseness (i.e. probable diagnosis) was found to be significantly associated with positive caseness of depression, anxiety, and suicidality. Overall, four latent classes emerged, with each of these classes characterized by varying degrees of comorbidity: a 'Resilient/Low Comorbidity' class, a 'Lifetime Suicidal' class, a 'PTSD Polymorbid' class, and a 'C-PTSD Polymorbid' class.Conclusions These findings support and extend previous results indicating the highly comorbid nature of C-PTSD. C-PTSD may be considered a highly polymorbid condition, increasing the risk for multiple mental health pathologies concurrently.

Examining the linkages between marital quality and anxiety: A meta-analytic review

This study examines the associations between marital quality and anxiety using meta-analytic techniques. A total of k = 151 effects published between the years 2000 and 2019 were analyzed. It was hypothesized that better overall marital quality would be associated with less anxiety. Results showed significant associations between marital quality and anxiety in such a way that higher overall marital quality was associated with lower anxiety. Post hoc analyses revealed that higher levels of positive marital behaviors (e.g., communication and intimacy) and fewer negative marital behaviors (e.g., criticism) were associated with lower anxiety. Additional results examined potential moderators of the association between marital quality and anxiety, including study design, direction of longitudinal associations (i.e., marital quality predicting anxiety or vice versa), gender, assessment of anxiety, and the use of control variables to account for comorbidities and demographic factors. Findings from this study provide a comprehensive review of the associations between marital quality and anxiety, which may be used to inform future research and treatment.

Longitudinal anxiety in couples during a global pandemic: Considering loss, attachment behaviors, and trauma coping self-efficacy

The COVID-19 (SARS-COV-2) pandemic has had a significant impact on multiple domains of daily functioning in communities, families, and couples. Research on couple dynamics amid mass stress events using dyadic data is still limited. As such, the current study employed a cross-lagged panel design with 535 cisgender, heterosexual couples to explore longitudinal paths between pandemic-related loss, attachment behaviors, trauma coping self-efficacy, and anxiety symptoms. Data were collected at three time points between April and October 2020. The findings demonstrated the potentially mobilizing nature of loss. Higher levels of loss associated with higher levels of attachment behaviors in partners later and higher levels of trauma coping self-efficacy for men in a partner effect at one lag. Higher levels of attachment behaviors generally associated with improved trauma coping self-efficacy at the next wave within and across partners, and higher levels of trauma coping self-efficacy appeared to offset later anxiety within partners. On the other hand, within partners, greater loss is associated with lower levels of attachment behaviors within partners across time. Furthermore, higher anxiety is associated with lower levels of TCSE and higher levels of loss within partners across most lags. Finally, higher trauma coping self-efficacy is associated with less loss within men at one lag, and greater loss within men at the later lag, which may demonstrate stress and efforts to mobilize to meet it. Indirect effects were found implying the intermediary nature of anxiety and trauma coping self-efficacy in explaining wave 3 anxiety. Implications for practice and further research are discussed.

Depression, anxiety, body image scores, and sexual dysfunction in patients with polycystic ovary syndrome according to phenotypes

Background: Polycystic ovary syndrome (PCOS) has been linked to both mental and metabolic disturbances. The purpose of this research was to investigate psychological features such as anxiety and depression, body image, sexual dysfunction, and associated factors among the PCOS phenotypes and to compare these with healthy controls. Methods: The study involved 167 reproductive-age women with PCOS and 73 healthy controls. Standardized scales assessing depression (the Beck Depression Inventory [BDI]), depression and anxiety (the Hospital Anxiety and Depression Scale [HADS] and the General Health Questionnaire [GHQ]), and body image scale (the Body Cathexis Scale [BCS]) were administered to all participants. Hirsutism scores, serum androgen levels, and metabolic parameters were recorded. Results: Significantly higher BDI, HADS depression, and GHQ scores, and a more negative body image in terms of BCS scores were observed in the women with PCOS than in the healthy controls. BDI scores were significantly higher in phenotypes A, B, and D compared with the healthy controls. No significant difference was observed in BDI and HADS depression scores among the phenotypes. Significant differences were observed only between phenotype A and the control group in terms of HADS depression and GHQ scores. BCS scores were significantly higher in phenotypes A, B, and C than in the healthy controls. No significant difference was determined in Female Sexual Function Index (FSFI) scores between the PCOS phenotypes and the healthy controls. When all participants were divided into three groups based on body mass index (BMI), a statistically significant difference was observed only between the phenotype A lean group (BMI: 18.5-24.9 kg/m²) and the control group in terms of BDI, HADS depression, and BCS scores. Conclusions: BDI, HADS depression scores, and GHQ scores were all higher in patients with PCOS compared with the healthy controls. These features were more pronounced in phenotypes A and B, including hyperandrogenism and oligo-anovulation. Physicians should be aware of the high risk of these disorders in women with PCOS.

Differential impact of stay-at-home orders on mental health in adults who are homeschooling or "childless at home" in time of COVID-19

The COVID-19 pandemic has forced the confinement of most populations worldwide, through stay-at-home orders. Children have continued their education process at home, supervised by parents, who, in most cases, have adopted the role of prime drivers of their learning processes. In this study, the psychological impact of confinement was explored, as well as the relationship of the forced homeschooling situation with psychological well-being. During their confinement, 400 individuals residing in Spain-165 without children at home (Group 1), 104 parents who dedicated little time to homeschooling (Group 2), and 131 who dedicated more time to homeschooling (Group 3)-responded to an online questionnaire. The results show that confinement threatened the mental health of all the participants but especially Group 3 individuals, who had the highest loneliness, anxiety, and stress levels. Moreover, loneliness, perception of discomfort due to homeschooling, and anxiety exacerbated the stress experienced during confinement. Discomfort due to the homeschooling situation was especially relevant in explaining anxiety and stress for Group 3 individuals. These results suggest that forced homeschooling could be associated with the negative consequences that confinement has on individuals' mental health. Moreover, the results suggest that parents who dedicate more time to homeschooling feel more unprotected and more stressed due to the homeschooling in comparison to Group 2 individuals. Health professionals must pay special attention to parents who dedicate more time to homeschooling, and governments and schools must emphasize social support provision to families during homeschooling situations.

Effect of support groups on caregiver's quality of life

The objective of this study was to evaluate the effect that participating in support groups for caregivers has on the quality of life and psychotropic drug use of family caregivers of adults with limitations in activities of daily living. A controlled quasi-experimental longitudinal design was used with 134 caregivers (64 in the experimental group and 70 in the control group). The outcomes were health-related quality of life (EuroQol 5D3L test) and psychotropic drug use (no/yes). The analyses were performed using SPSS and R statistical software. An interaction was observed between the condition and the level of limitations in activities of daily living of the care receiver, having an effect on the caregiver's psychotropic drug use (p = 0.003), with this use being lower among caregivers who attend support groups when their relatives present fewer limitations in activities of daily living. Moreover, the quality of life was higher in the post-test in the experimental group (B = 8.66, p = 0.015). In conclusion, support groups could improve the caregiver's quality of life and decrease psychotropic drug use when the care receiver has low limitations in activities of daily living.

Non-violent resistance and family accommodation: A trans-diagnostic solution to a highly prevalent problem

The goal of this study is to integrate two areas in recent clinical theory, research, and practice: family accommodation and non-violent resistance (NVR). Family accommodation describes changes that family members make to their own behavior, to help their relative who is dealing with psychopathology to avoid or alleviate distress related to the disorder. Rapidly growing research on family accommodation has established its high prevalence and negative impact across disorders and the life span. NVR is a trans-diagnostic treatment approach that helps parents to cope with child externalizing, internalizing, and other problems in non-escalatory ways. This study reviews empirical research on family accommodation and NVR, and argues that the anchoring function of NVR, a central concept reflecting the stabilization of the parent-child relationship, may provide a uniquely suited framework for reducing family accommodation across disorders and development. The study discusses how the anchoring function may be applied to promote accommodation reduction through a detailed description of SPACE (Supportive Parenting for Anxious Childhood Emotions), an NVR-informed treatment for childhood anxiety and obsessive-compulsive disorder.

Stress-Buffering Role of Social Support during COVID-19

In order to reduce the high infection rate of COVID-19, individuals began to engage in self-isolation amid a time of uncertainty and worry. Given that social support can be protective against the negative effects of distress on mental and physical health, the lack of support may negatively impact individuals during their self-isolation. Thus, the current study examined the role of self-isolation on feelings of stress, the perception and reception of social support, and mental health problems during the COVID-19 pandemic. A sample of 405 college students were asked to report on the amount of self-isolation in which they were engaging, worry about COVID-19, psychological health, and received and perceived social support. Results indicated that when the length of time in self-isolation was taken into account, perceived social support buffered the connection between worry about COVID-19 and psychological health. These results indicate that social support, worry about COVID-19, and self-isolation may influence individuals' psychological health during times of stress.

Essential anxiety: COVID-19 in analytic practice

This paper explores the impact of the COVID-19 pandemic on my relationship with analysands and my inner world. I reflect on the role of the archetypal Self during times of existential anxiety that may lead to an experience of 'essential anxiety'. This term refers to a meeting by a fearful ego with an inward recognition of the Self, when faced with threat. The efforts to curb the spread of the pandemic changed our ways of life, while the virus itself threatened our existence in debilitating or outright destructive ways. But what also came into view, in sessions of analysis and supervision, was the creative instinct, and a celebration of life. The soul-to-soul relationship, and the connection with images of the archetypal Self, made the experience of existential anxiety at times an essential experience that facilitated psychological growth. I discuss some advantages of on-line Jungian analysis where, despite distance and partial view, the body still serves as container to hold important psychological material, conferring a sense of wholeness for analyst and analysand. The COVID-19 crisis is terrible and terrifying but it also provides an opportunity for self-regulation and individuation.

Are psychiatric disorders associated with thyroid hormone therapy in adolescents and young adults with type 1 diabetes?

BACKGROUND

To evaluate the association between thyroid autoimmunity and psychiatric disorders (depression, anxiety, eating disorder, schizophrenia or attention-deficit/hyperactivity disorder) among adolescents and young adults with type 1 diabetes (11-25 years).

METHODS

We compared 9368 type 1 diabetes patients with thyroid autoimmunity (3789 of them treated with levothyroxine) with 62 438 type 1 diabetes patients without any thyroid disease from a multicentre diabetes patient follow-up registry (DPV) in terms of psychiatric disorders. Thyroid autoimmunity was defined as documented diagnosis of Hashimoto thyroiditis or positive antibodies against thyroid peroxidase or thyroglobulin. Multivariable logistic regression models were used to calculate odds ratios for the respective psychiatric disorders in type 1 diabetes patients with thyroid autoimmunity (overall and stratified by levothyroxine therapy) compared to type 1 diabetes patients without thyroid diseases (reference).

RESULTS

Of the 9368 patients with thyroid autoimmunity, 62% were female with a median (Q1-Q3) age of 16.3 (14.2-17.6) years. Thyroid autoimmunity (with or without levothyroxine therapy) revealed a slight, but significant higher chance for depression (odds ratio [OR], 1.35, 95% confidence interval [CI], 1.19, 1.52), eating disorder (OR, 1.25, CI, 1.03, 1.51), attention-deficit/hyperactivity disorder (OR, 1.22, CI, 1.07, 1.39) and schizophrenia (OR, 1.63, CI, 1.04, 2.56). In individuals with prescribed levothyroxine therapy because of thyroid dysfunction significantly higher odds for depression (OR, 1.63, CI, 1.34, 1.99), anxiety (OR, 1.60, CI, 1.18, 2.18), and attention-deficit/hyperactivity disorder (OR, 1.71, CI, 1.38, 2.12) were observed compared to reference. Thyroid autoimmunity without required levothyroxine therapy revealed no differences to the reference group.

CONCLUSIONS

Patients on levothyroxine had significantly higher odds for psychiatric disorders, but thyroid autoimmunity in terms of high antibody levels only did not show higher odds for any psychiatric disorder.

Maternal depressive symptoms, poverty, and young motherhood increase the odds of early depressive and anxiety disorders for children born prematurely

Children born preterm, compared to term, are at risk for behavioral problems. However, the prevalence and predictors of internalizing disorders among children born preterm are unclear. The purpose of this study was to identify the prevalence of depressive and anxiety disorders at 2 years of age among children born preterm and determine the extent to which poverty, maternal depressive symptoms, or young motherhood increase the likelihood of these disorders. Mothers and their infants (N = 105) were recruited from two neonatal intensive care units affiliated with a major U.S. university. A sociodemographic questionnaire, the Patient Health Questionnaire‐9, and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition scale scores from the Preschool Child Behavior Checklist were used to measure primary variables. We examined mothers’ family satisfaction and quality of caregiving as well as children's degree of prematurity, morbidity, gender, cognitive functioning, and motor function as covariates. Fifteen percent of children met criteria for an anxiety disorder and another 15% for depression. Maternal depressive symptoms increased the odds of children developing both anxiety and depression, whereas young motherhood was associated with child anxiety and poverty with child depression. Results indicate the need for mental health assessment of children born preterm during their first 2 years of life and the importance of early therapeutic and tangible support to vulnerable mothers and children.

The developmental cascade of early parenting, emergence of executive functioning, and emotional symptoms across childhood

Many studies focus on proximal associations between parental sensitivity and emotional well-being in early childhood, with less data examining how parenting in infancy predicts children's emotional trajectories across childhood, in particular negative emotional symptoms of anxiety and depression. Thus, this study utilized data from The Family Life Project (N = 1015), a prospective study of child development in rural poverty, and assessed whether sensitive parenting in the first 4 years of life predicted child internalizing emotional symptoms (i.e., anxiety and depression) from kindergarten to fifth grade and whether early child executive functioning mediated this relationship. Path models indicated that observation of sensitive parenting predicted a decrease in teachers' report of child negative emotional symptoms over time and predicted fewer negative emotional symptoms in fifth grade. Moreover, though executive functioning performance did not mediate change in symptoms over time, executive functioning did mediate the relationship between sensitive parenting and fifth-grade symptoms, suggesting that executive functioning is one mechanism by which early sensitive parenting buffers long-term emotional development. Findings highlight the importance of early parenting and executive functioning in development of anxiety and depression symptoms and suggests potential targets for transdiagnostic intervention.

Determinants of mental health outcomes among people with and without diabetes during the COVID-19 outbreak in the Arab Gulf Region

AIMS

To determine the prevalence and factors associated with depression and anxiety among people with and without diabetes during the coronavirus disease 2019 (COVID-19) outbreak.

METHODS

A cross-sectional questionnaire-based study collecting demographic and mental health data from 2166 participants living in the Arab Gulf region (568 with diabetes, 1598 without diabetes). Depression and anxiety were assessed using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale, respectively.

RESULTS

The prevalence of depression and anxiety symptoms were 61% and 45%, in people with diabetes (PWD) and 62% and 44%, respectively, in people without diabetes. PWD who have had their diabetes visit canceled by the clinic were more likely to report depression and anxiety symptoms than those without diabetes (odds ratio [95% confidence interval]: 1.37 [1.02, 1.84] and 1.37 [1.04, 1.80], for depression and anxiety; respectively). PWD who had no method of telecommunication with their health care providers (HCP) during the pandemic, PWD with A1C of ≥ 10%, women, employees (particularly HCPs), students, unmarried individuals, and those with lower income were more likely to report depression and/or anxiety symptoms (all P < 0.01). Fear of acquiring the coronavirus infection; running out of diabetes medications; or requiring hospitalization for hypoglycemia, hyperglycemia, or diabetic ketoacidosis; and lack of telecommunication with HCPs were all associated with significantly higher odds of having depression and anxiety symptoms among PWD.

CONCLUSIONS

The remarkably high prevalence of depression and anxiety symptoms during the COVID-19 pandemic, particularly among subgroups of PWD, calls for urgent public health policies to address mental health during the pandemic and reestablish health care access for PWD.

Grief reactions, depression, and anxiety following job loss: patterns and correlates

Background: Research on grief, depression, and anxiety reactions following job loss is sparse. More insight in this matter could be important for the development of preventive and curative interventions targeting different manifestations of emotional distress following job loss, including grief reactions.Objective: The aim of this study was to examine job loss-related grief reactions in relation to depression and anxiety symptoms.Method: A sample of 525 Dutch workers (59.8% women, mean age of 50.6 years) who had lost their job was recruited. Latent class analysis was used to examine whether separate classes could be distinguished based on the endorsement of grief reactions and symptoms of depression of anxiety. We also examined factors associated with class membership.Results: Four classes were identified, including a so-called 'mixed', a 'grieving', a 'depressed', and a 'resilient' class. Job loss circumstances and coping strategies (but not socio-demographic and work characteristics) were associated with class membership.Conclusion: These results shed light on unique characteristics that might be targeted with specific clinical methods to increase mental health of different subgroups of individuals confronted with job loss.

Feasibility and acceptability of Problem Management Plus with Emotional Processing (PM+EP) for refugee youth living in the Netherlands: study protocol

BACKGROUND

Refugee youth experience hardships associated with exposure to trauma in their homelands and during and after displacement, which results in higher rates of common mental disorders. The World Health Organization (WHO) developed Problem Management Plus (PM+), a non-specialist-delivered brief psychological intervention, for individuals who have faced adversity. PM+ comprises problem-solving, stress management, behavioural activation and strengthening social support. However, it does not include an emotional processing component, which is indicated in trauma-exposed populations.

OBJECTIVE

This pilot randomized controlled trial (RCT) aims to evaluate the feasibility and acceptability of PM+, adapted to Syrian, Eritrean and Iraqi refugee youth residing in the Netherlands, with and without a newly developed Emotional Processing (EP) Module.

METHODS

Refugee youth (N = 90) between 16 and 25 years of age will be randomized into PM+ with care-as-usual (CAU), (n = 30), PM+ with Emotional Processing (PM+EP) with CAU (n = 30) or CAU only (n = 30). Inclusion criteria are self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15) and impaired daily functioning (WHO Disability Assessment Schedule; WHODAS 2.0 > 16). Participants will be assessed at baseline, one-week post-intervention and three-month follow-up. The main outcome is the feasibility and acceptability of the adapted PM+ and PM+EP. The secondary outcomes are self-reported psychological distress, functional impairment, post-traumatic stress disorder (PTSD) symptom severity and diagnosis, social support, and self-identified problems. The pilot RCT will be succeeded by a process evaluation including trial participants, participants' significant others, helpers, and mental health professionals (n = 20) to evaluate their experiences with the PM+ and PM+EP programmes.

RESULTS AND CONCLUSION

This is the first study that evaluates the feasibility of PM+ for this age range with an emotional processing module integrated. The results may inform larger RCTs and implementation of PM+ interventions among refugee youth.

TRIAL REGISTRATION

Registered to Dutch Trial Registry, NL8750, on 3 July 2020. Medical Ethical Committee of the Amsterdam University Medical Centre, location Vrije Universiteit Medical Centre, Protocol ID: 2020.224, 1 July 2020.

[Moderated mediation analysis for symptoms of attention deficit/hyperactivity disorder with the symptoms of anxiety in children]

OBJECTIVE

To study the moderated mediation for attention deficit/hyperactivity disorder (ADHD) with the symptoms of anxiety in children.

METHODS

A total of 12 271 students were included with an average age of 8.9±1.9 years, including 6 743 male students and 5 508 female students, and 20 students with missing data on gender. Child psychological trauma questionnaires (parents version) and Conners questionnaires (parent version) were completed by the parents of primary school students. The data was studied by univariate analysis, multivariate analysis and moderated mediation analysis.

RESULTS

The results of the univariate analysis showed that in all subjects, boys, and girls, the scores of hyperactivity index and childhood trauma were positively correlated with the score of anxiety (P<0.01), and ADHD and childhood trauma positively predicted anxiety disorder (P<0.001). The results of the multivariate analysis showed that in all subjects, boys, and girls, the scores of hyperactivity index (ADHD symptoms) and childhood trauma positively predicted the score of anxiety (P<0.001), and both ADHD and childhood trauma positively predicted anxiety disorder (P<0.001). The results of the moderated mediation analysis showed that childhood trauma was a mediating factor for the relationship between hyperactivity index and anxiety index in boys and girls (P<0.05), and sex moderated the relationship between hyperactivity index and anxiety index (P<0.001).

CONCLUSIONS

ADHD symptoms/ADHD are closely associated with anxiety symptoms/anxiety disorder. Childhood trauma exerts a mediating effect on the relationship between ADHD symptoms and anxiety symptoms, and sex moderates the relationship between ADHD symptoms and anxiety symptoms.

慢性腰腿痛患者微创术前焦虑,抑郁状态及相关影响因素分析

OBJECTIVE

To investigate anxiety and/or depression status of patients with chronic lumbocrural pain, and to further analyze related risk factors of anxiety and/or depression .

METHODS

Retrospective analysis of the medical data of patients who suffered from chronic lumbocrural pain caused by lumbar disc herniation and/or lumbar spinal stenosis and received minimally invasive surgery from March 2018 to April 2018. General data (including age, gender, education levels, past history, sleep order and medical insurance), numeric rating scale(NRS), Japanese Orthopedic Association(JOA) back pain scale and hospital anxiety and depression scale(HADS) were collected for analysis. The basic demographic data and clinic data were analyzed, possible related risk factors associated were analyzed by univariate analysis, and multivariate Logistic regression analysis was further used to find the relative independent risk factors and included all the predictive variables with P values less than 0.05 as covariates.

RESULTS

A total of 91 patients met the inclusion criteria and finished this study, the mean HADS score for anxiety was 8.1±4.2, 48(52.7%) respondents were screened positive for anxiety, while the rest 43(47.3%) patients had negative anxiety state, the mean HDDS score for depression was 6.9±4.9, 38(41.8%) respondents were screened positive for depression, and the rest 53(58.2%) patients were not depressed, and 56(61.5%) patients experienced anxiety or depression. There were significant difference in sleep disorder, JOA score and leg NRS score between the patients with and without anxiety(P<0.05), and the significant differences were also found in age, sleep disorder and JOA score between the patients with and without depression(P<0.05), Logistic regression analysis further showed that the JOA score and sleep disorder were risk factors for anxiety, and the JOA score was risk factor for depression.

CONCLUSION

Patients with chronic lumbocrural pain are often accompanied by anxiety and/or depression before minimally surgery, the low JOA score and sleep disturbance increased the risk of presenting anxiety, and the low JOA score increased the risk of developing depression. It is necessary to evaluate mental status and related risk factors before surgery.

Parent-Child Attunement Moderates the Prospective Link between Parental Overcontrol and Adolescent Adjustment

Parental overcontrol (OC), behavior that intrusively or dominantly restricts child autonomy, has been identified as a transdiagnostic risk factor for youth. However, it is as yet unknown whether the association between parental OC and child maladjustment remains even when OC is exerted infrequently or by attuned parents. Rather, the selective use of OC might steer children away from danger. Taking a developmental psychopathology approach, this study focuses on the larger parent-child relationship context, testing whether either the dose at which parents demonstrate OC or the degree to which children perceive their parents as attuned determines whether OC is risky or protective for adolescents' adjustment. Among a community sample of 114 families of children followed from the ages of 12-18, we examine whether OC, behaviorally coded from triadic mother-father-child discussions in middle childhood, is associated with later risky behavior and anxiety symptoms in adolescence. Overcontrol exerted by either mothers or fathers had a curvilinear effect on adolescent risky behaviors, and this effect was moderated by children's perceived attunement. Although OC generally was associated with increased risky behaviors, low doses of OC or OC exerted by highly attuned parents protected against engagement in risky behaviors. No main effect of OC was observed on adolescent anxiety; however, mothers' OC interacted with perceived parental attunement, such that OC exerted by less attuned parents predicted greater anxiety. Results underscore that the effect of parenting behaviors depends on the larger parent-child relationship context.

肝郁脾虚型肠易激综合征患者应用中医护理效果分析

目的

观察肝郁脾虚型肠易激综合征(irritable bowel syndrome, IBS)应用中医护理效果分析.

方法

将90例肝郁脾虚型IBS患者随机分为对照组和观察组, 各45例. 对照组给予常规护理, 如心理护理、生活护理、饮食护理、健康宣教、运动干预等. 观察组在对照组基础上应用中医护理, 均护理2 wk, 观察生活质量评分, 心理状态评分和临床症状变化情况.

结果

2组生理功能、生理职能、躯体疼痛、总体健康、生命活力、社会功能、情感职能、精神健康等评分组内比较, 差异有统计学意义(P<0.05), 且护理后观察组评分明显高于对照组(P<0.05). 与护理前比较, 2组护理1、2 wk时焦虑自评量表(Self-rating Anxiety Scale, SAS)和抑郁自评量表(Self-rating Depression Scale, SDS)评分, 差异均有统计学意义(P<0.05); 且与对照组同期比较, 观察组SAS和SDS评分降低, 差异有统计学意义(P<0.05). 2组护理后腹痛、腹胀、大便次数、黏液便、大便性状等积分均低于治疗前(P<0.05); 且护理后观察组症状积分明显低于对照组(P<0.01).

结论

肝郁脾虚型IBS患者应用中医护理后能明显减轻患者焦虑、抑郁评分, 提高患者生活质量和改善临床症状.

Race, religion and a cat in the clinical hour

Racial and religious identities are complex, often mired in dynamics of 'othering'. Such dynamics easily become a means of distancing the pain, fear and rage of intergenerational traumas, thus undermining ways race and religion can be powerful vehicles for the transference and countertransference. Drawing from a history of race in America as well as Jung's anxiety when meeting the stranger within himself, this paper focuses on 17 years of work between a black female patient and white female clinician (me). Together we encountered themes of hatred, silence, guilt and intimacy in the transference and countertransference, themes eventually symbolized by the presence of my cat which was locked into the bathroom for each session. This cat came to represent a bridge through developmental traumas and wounds of racism.

Worried About us: Evaluating an Intervention for Relationship-Based Anxiety

Although romantic relationships are commonly a source of pleasure and comfort, for some individuals they can be a source of persistent anxiety. The aim of the current investigation was to explore the construct of relationship-based anxiety and to evaluate the effectiveness of a brief couple-based psychoeducational session for this issue. Common behavioral patterns and cognitive tendencies seen among individuals with relationship-based anxiety were examined, including excessive reassurance-seeking, self-silencing, and partner accommodation. In the current investigation, a single psychoeducational session was developed to address these maladaptive interactive patterns of behavior specifically. The session was administered to a sample of 21 couples and was found to decrease levels of reassurance-seeking and self-silencing significantly among individuals with relationship anxiety, and to decrease levels of maladaptive accommodation behaviors significantly in their partners.

Anxiety symptoms and functioning in a community sample of individuals with type 2 diabetes: A longitudinal study

BACKGROUND

Type 2 diabetes (T2D) is associated with limitations in day-to-day functioning and with symptoms of anxiety. Although cross-sectional associations between anxiety and functioning in individuals with T2D have been reported, the temporal dynamics of these associations are unclear. The present study examined the longitudinal cross-lagged associations between anxiety symptoms and functioning in a community sample of individuals with T2D.

METHODS

Data were from the Evaluation of Diabetes Treatment Study, a community-based observational study of 1691 adults with T2D. Anxiety symptoms and functioning were assessed with the Generalized Anxiety Disorder Scale-7 and the World Health Organization Disability Assessment Schedule 2.0, respectively, at baseline and every following year for 3 years. A cross-lagged path analysis accounting for autoregressive effects, sociodemographic factors, and health-related covariates was conducted using structural equation modeling.

RESULTS

The model demonstrated good fit with the data (comparative fit index >0.99, χ62 = 11.44, P = 0.08, root mean square error of approximation = 0.02). Path coefficients indicated that elevated anxiety was associated with subsequent poor functioning (β-values ranging from 0.05 to 0.16; P-values <0.04) and that poor functioning was associated with subsequent elevated anxiety (β-values ranging from 0.13 to 0.19; P-values <0.001). The addition of depressive symptoms as a covariate did not affect model fit, although not all cross-lagged path coefficients remained statistically significant; paths were strongest and most consistent between poor functioning and subsequent elevated anxiety.

CONCLUSIONS

Anxiety symptoms and functioning seem to be reciprocally related among individuals with T2D, independent of depressive symptoms.

[Effects of temporal lobe epilepsy and idiopathic epilepsy on cognitive function and emotion in children]

OBJECTIVE

To investigate the effects of temporal lobe epilepsy and idiopathic epilepsy on cognitive function and emotion in children and the risk factors for cognitive impairment.

METHODS

A retrospective analysis was performed for the clinical data of 38 children with temporal lobe epilepsy and 40 children with idiopathic epilepsy. The controls were 42 healthy children. All subjects received the following neuropsychological tests: Montreal Cognitive Assessment (MoCA) scale, verbal fluency test, digit span test, block design test, Social Anxiety Scale for Children (SASC), and Depression Self-rating Scale for Children (DSRSC).

RESULTS

Compared with the control group, the temporal lobe epilepsy and idiopathic epilepsy groups showed significantly lower scores of MoCA, verbal fluency, digit span, and block design (P<0.05) and significantly higher scores on SASC and DSRSC (P<0.05). Compared with the idiopathic epilepsy group, the temporal lobe epilepsy group showed significantly lower scores of MoCA, verbal fluency, digit span, and block design (P<0.05) and significantly higher scores on SASC and DSRSC (P<0.05). In the temporal lobe epilepsy group, MoCA score was negatively correlated with SASC score, DSRSC score, and seizure frequency (r=-0.571, -0.529, and -0.545 respectively; P<0.01). In the idiopathic epilepsy group, MoCA score was also negatively correlated with SASC score, DSRSC score, and seizure frequency (r=-0.542, -0.487, and -0.555 respectively; P<0.01).

CONCLUSIONS

Children with temporal lobe epilepsy and idiopathic epilepsy show impaired whole cognition, verbal fluency, memory, and executive function and have anxiety and depression, which are more significant in children with temporal lobe epilepsy. High levels of anxiety, depression, and seizure frequency are risk factors for impaired cognitive function.

[Effects of hypnotic and musical relaxation therapy on the treatment of the parents of children with cleft lip and/or palate]

OBJECTIVE

To evaluate the effectiveness of hypnotic and musical relaxation therapy and psychological consultation for parents of children with cleft lip and/or palate (CLP) and to provide a scientific basis of clinical-psychological treatment options.

METHODS

Sixty-six subjects with children with CLP participated in this study. The subjects were randomly assigned to a test group (n = 33) and a control group (n = 33). The test group was treated with hypnotic and musical relaxation therapy; the control group were subjected to psychological consultation. Anxiety and depression states were evaluated by using a self-rating anxiety scale (SAS) and a self-rating depression scale (SDS) before and after treatment was administered.

RESULTS

1) The test group demonstrated a significant decrease in SAS and SDS scores (t = 2.855, P < 0.01; t = 2.777, P < 0.01). The control group showed a significant decrease in the SAS score (t = 1.831, P < 0.05) but failed to show a significant change in the depression score (t = 0.909, P > 0.05). 2) The test group yielded a higher percentage of remission indicated by the SDS scores than the control group (test group = 75.76%; control group = 60.61%; P < 0.05). The test group also displayed a higher percentage of remission indicated by the SAS scores than the control group (test group = 78.79%, test group = 69.70%; P < 0.05).

CONCLUSION

Hypnotic and musical relaxation therapy can more effectively reduce the scores of the anxiety and depression states of the parents of patients with cleft lip and/or palate than psychological consultation.