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Klein AM, Van Niekerk RE, Allart Van Dam E, Rinck M, Verbraak MJPM, Hutschemaekers GJM, Becker ES. Fear-related associations in children of parents with an anxiety disorder. J Behav Ther Exp Psychiatry 2024; 84:101953. [PMID: 38593495 DOI: 10.1016/j.jbtep.2024.101953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/27/2023] [Accepted: 02/19/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVES Children of parents with an anxiety disorder are at elevated risk for developing an anxiety disorder themselves. According to cognitive theories, a possible risk factor is the development of schema-related associations. This study is the first to investigate whether children of anxious parents display fear-related associations and whether these associations relate to parental anxiety. METHODS 44 children of parents with panic disorder, 27 children of parents with social anxiety disorder, and 84 children of parents without an anxiety disorder filled out the SCARED-71, and the children performed an Affective Priming Task. RESULTS We found partial evidence for disorder-specificity: When the primes were related to their parent's disorder and the targets were negative, the children of parents with panic disorder and children of parents with social anxiety disorder showed the lowest error rates related to their parents' disorder, but they did not have faster responses. We did not find any evidence for the expected specificity in the relationship between the parents' or the children's self-reported anxiety and the children's fear-related associations, as measured with the APT. LIMITATIONS Reliability of the Affective Priming Task was moderate, and power was low for finding small interaction effects. CONCLUSIONS Whereas clearly more research is needed, our results suggest that negative associations may qualify as a possible vulnerability factor for children of parents with an anxiety disorder.
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Affiliation(s)
- Anke M Klein
- Developmental and Educational Psychology, Leiden University, the Netherlands; Behavioural Science Institute, Radboud University Nijmegen, the Netherlands.
| | - Rianne E Van Niekerk
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands; Centre for Anxiety Disorders Overwaal, Pro Persona, the Netherlands
| | | | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands
| | | | | | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, the Netherlands
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Knihs de Camargo C, Falkstedt D, Pan KY, Almroth M, Nevriana A. Diagnoses of common mental disorders among social workers in Sweden: A register-based cohort study. J Affect Disord 2024; 355:415-421. [PMID: 38570040 DOI: 10.1016/j.jad.2024.03.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Little is known about common mental disorders (CMD) diagnoses among social workers, i.e., depression, anxiety, or stress-related disorders. This study aims to examine the risk of CMD among social workers in comparison to other workers and to further investigate differences between men and women and specific occupational titles. METHODS This register-based cohort study consists of 3,034,304 persons, of which 26,610 were social workers (0.9 % of all workers), aged 30-64 years, living in Sweden in 2015. The risk of diagnosed CMDs was followed up until 2020. Cox regression models were used to calculate hazard ratios (HR) and 95 % confidence intervals (CI), adjusting for sex, birth country, education, and birth year. RESULTS The participants were followed up by a total of 16,833,742.9 person-years, with an average follow-up of 5.5 years. Social workers, compared to other workers, were at a higher risk of CMD (HR 1.3, 95 % CI 1.2-1.4) after adjustment. The HR was equal, 1.3, for depression (95 % CI 1.2-1.5) and anxiety or stress-related disorder (95 % CI 1.2-1.4). The association between social work and CMD was stronger among men (HR 1.7, 95 % CI 1.6-1.9) compared to women (HR 1.2, 95 % CI 1.1-1.3). Further, men working as assistance analysts had the highest risk among the occupational categories (HR 2.2, 95 % CI 1.2-3.9). LIMITATIONS CMD diagnoses only included cases treated in secondary care. CONCLUSIONS Social workers, especially male social workers, had a higher risk of CMD. This deserves attention for future research and interventions aimed at improving the mental health of social workers.
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Affiliation(s)
- Carolina Knihs de Camargo
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset, Entrance 10, 75185 Uppsala, Sweden
| | - Daniel Falkstedt
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Kuan-Yu Pan
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Melody Almroth
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Alicia Nevriana
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.
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Vigerland S, Fredlander S, Aspvall K, Jolstedt M, Lenhard F, Mataix-Cols D, Ljótsson B, Serlachius E. Effectiveness of internet-delivered cognitive behavioural therapy for anxiety and obsessive-compulsive disorders within routine clinical care in rural Sweden. Internet Interv 2024; 36:100738. [PMID: 38617387 PMCID: PMC11015440 DOI: 10.1016/j.invent.2024.100738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024] Open
Abstract
Few studies have evaluated the implementation of ICBT in regular child and adolescent mental health services (CAMHS). This study aimed to explore the acceptability, feasibility, and effectiveness of ICBT for children and adolescents with anxiety disorders and obsessive-compulsive disorder (OCD) within a rural CAMHS. The study also explored outcome predictors and long-term outcomes. Eighty-three participants were consecutively recruited from a non-specialized CAMHS in Region Jämtland Härjedalen in northern Sweden. Therapist-guided ICBT was offered during 12 weeks to children aged 8-17 with an anxiety disorder or OCD. Acceptability and feasibility measures included treatment adherence, treatment satisfaction, and adverse events. The primary outcome measure was the Clinical Global Impression-Severity. Secondary measures of effectiveness included clinician-, self-, and parent-ratings of symptom severity and functional impairment. Assessments were completed at baseline, post-treatment, and three-month follow-up (primary endpoint). A two-year follow up was conducted using medical records. Potential predictors included both patient characteristics and treatment variables. Results indicated that ICBT was both acceptable and feasible according to study measures. Statistically significant improvements were found from baseline to the three-month follow-up on clinician rated severity (B [SE] = -0.92 [0.09]; p < .001), as well as on all secondary measures. Forty-three percent of participants no longer fulfilled criteria for their principal disorder at the three-month follow-up. No serious adverse events were reported. Clinical improvement was highest among children with higher functioning at baseline (B [SE] = -0.05 [0.02]; p < .05). Forty-six percent of participants had been in contact with CAMHS during the two-year follow-up period, mainly for reasons other than their initial diagnosis. Findings suggest that ICBT could be an acceptable and feasible treatment option for young people with anxiety disorders and OCD in rural non-specialized CAMHS settings. Further studies are needed to confirm treatment effectiveness in this setting. Trial registration: NCT02926365.
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Affiliation(s)
- Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 113 64 Stockholm, Sweden
- Stockholm, CAP Research Centre, Stockholm Health Care Services, Region Stockholm, Gävlegatan 22, 113 30 Stockholm, Sweden
| | - Sandra Fredlander
- Barn-och ungdomspsykiatrins mottagning, Region Jämtland Härjedalen, Östersunds sjukhus, 831 83 Östersund, Sweden
| | - Kristina Aspvall
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 113 64 Stockholm, Sweden
- Stockholm, CAP Research Centre, Stockholm Health Care Services, Region Stockholm, Gävlegatan 22, 113 30 Stockholm, Sweden
| | - Maral Jolstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 113 64 Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 113 64 Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 113 64 Stockholm, Sweden
- Stockholm, CAP Research Centre, Stockholm Health Care Services, Region Stockholm, Gävlegatan 22, 113 30 Stockholm, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Section of Child and Adolescent Psychiatry, Lund University, Baravägen 1, Forskningsenheten, 221 85 Lund, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 65 Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 113 64 Stockholm, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Section of Child and Adolescent Psychiatry, Lund University, Baravägen 1, Forskningsenheten, 221 85 Lund, Sweden
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Musicaro RM, Yeguez CE, Rey Y, Silverman WK, Pettit JW. Anxious Bullies: Parent Distress and Youth Anxiety Interact to Predict Bullying Perpetration. Child Psychiatry Hum Dev 2024; 55:812-818. [PMID: 36222997 PMCID: PMC10090230 DOI: 10.1007/s10578-022-01443-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 01/25/2023]
Abstract
Early studies conceptualized the "anxious bully" as different from typical bullies due to their anxiety and home problems. Yet, empirical findings are mixed, and no study has reported associations between youth bullying perpetration, youth anxiety, and parent distress in a clinically anxious sample. We assessed 220 youths' anxiety symptom severity, frequency of the bullying perpetration in the past month, and parent levels of distress. Fifty percent of youths endorsed at least one perpetration act and 17% endorsed six or more. Youth anxiety, but not parent distress, was significantly associated with perpetration. We also found a significant interaction such that youth anxiety was positively associated with bullying perpetration when parent distress was high, but not low. Findings fill a glaring knowledge gap regarding this overlooked group of youth, anxious bullies, and provide novel insights into the interplay between youth distress and parent distress in predicting bullying perpetration.
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Affiliation(s)
- Regina M Musicaro
- Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06519, USA.
| | - Carlos E Yeguez
- Department of Psychology and Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Yasmin Rey
- Department of Psychology and Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06519, USA
| | - Jeremy W Pettit
- Department of Psychology and Center for Children and Families, Florida International University, 11200 SW 8th St, Miami, FL, 33199, USA
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van Steensel FJA, Telman LGE, Maric M, Bögels SM. Modular CBT for Childhood Anxiety Disorders: Evaluating Clinical Outcomes and its Predictors. Child Psychiatry Hum Dev 2024; 55:790-801. [PMID: 36192529 PMCID: PMC11061043 DOI: 10.1007/s10578-022-01437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
This study examined clinical outcomes of a modular individual CBT for children with anxiety disorders (AD), and predictors of outcomes, in usual clinical practice. Participants were 106 children with ADs (7-17 years), and parents. Assessments were pre-, mid-, post-test, and 10 weeks after CBT (follow-up). Predictors (measured pre-treatment) were child characteristics (gender, age, type of AD, comorbid disorders), fathers' and mothers' anxious/depressive symptoms, and parental involvement (based on parents' presence during treatment sessions and the use of a parent module in treatment). At follow-up, 59% (intent-to-treat analyses) to 70% (completer analysis) of the children were free from their primary anxiety disorder. A significant decrease in anxiety symptoms was found. Higher parental involvement was related to lower child anxiety at follow-up, but only for children with comorbid disorders. Findings suggest that it is beneficial to treat anxiety with modular CBT. Future steps involve comparisons of modularized CBT with control conditions.
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Affiliation(s)
- Francisca J A van Steensel
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, 1018 WS, Amsterdam, The Netherlands.
| | - Liesbeth G E Telman
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, 1018 WS, Amsterdam, The Netherlands
- Department of Clinical Child and Family Studies, Utrecht University, P.O. Box 80140, TC 3508, Utrecht, The Netherlands
| | - M Maric
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, 1018 WS, Amsterdam, The Netherlands
- Department of Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, 1018 WS, Amsterdam, The Netherlands
- Department of Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
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Brouwer JMJL, Wardenaar KJ, Liemburg EJ, Doornbos B, Mulder H, Cath DC. High persistence and low treatment rates of metabolic syndrome in patients with mood and anxiety disorders: A naturalistic follow-up study. J Affect Disord 2024; 354:451-462. [PMID: 38494132 DOI: 10.1016/j.jad.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with affective and anxiety disorders are at risk of metabolic syndrome (MetS) and, consequently, cardiovascular disease and premature death. In this study, the course and treatment of MetS was investigated using longitudinal data from a naturalistic sample of affective- and anxiety-disordered outpatients (Monitoring Outcome of psychiatric PHARmacotherapy [MOPHAR]). METHODS Demographics, clinical characteristics, medication use, and MetS components were obtained for n = 2098 patients at baseline and, in a FU-subsample of n = 507 patients, after a median follow-up (FU) of 11 months. Furthermore, pharmacological treatment rates of MetS were investigated at baseline and FU. Finally, demographic and clinical determinants of change in MetS (component) scores were investigated. RESULTS At baseline, 34.6 % of n = 2098 patients had MetS, 41.4 % of whom received treatment. Of patients with persisting MetS, 46.1 % received treatment for one (or more) MetS component(s) at baseline, and 56.6 % received treatment at FU. Treatment rates of solely elevated blood pressure and reduced HDL-cholesterol did significantly, but modestly, improve. Higher age, male sex, smoking behavior, low education, diabetes, and depressive versus anxiety disorder were predictors of worse outcome at FU on at least one MetS component. LIMITATIONS We did not have data on lifestyle interventions as a form of treatment, which might partly have explained the observed low pharmacotherapeutic treatment rates. CONCLUSION MetS (components) show high persistence rates in affective- and anxiety-disordered patients, and are, despite adequate monitoring, undertreated over time. This indicates that adherence and implementation of monitoring protocols should be crucially improved in psychiatric outpatients in secondary care.
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Affiliation(s)
- Jurriaan M J L Brouwer
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands; GGZ Drenthe Mental Health Services, Assen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Klaas J Wardenaar
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, Groningen, the Netherlands; Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Edith J Liemburg
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bennard Doornbos
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands
| | - Danielle C Cath
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Kong Q, Han B. Pharmacotherapy and cognitive bias modification for the treatment of anxiety disorders. Expert Rev Neurother 2024; 24:517-525. [PMID: 38557434 DOI: 10.1080/14737175.2024.2334847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Anxiety disorders are characterized by widespread and persistent anxiety or recurrent panic attacks. As a result of their high prevalence, chronicity, and comorbidity, patients' quality of life and functioning are severely compromised. However, several patients do not receive treatment. AREAS COVERED This review discusses the effectiveness, safety, and limitations of major medications and cognitive bias modification (CBM) for treating anxiety disorders. The possibility of combined treatment is also discussed in the literature. Furthermore, drawing on Chinese cultural perspectives, the authors suggest that anxiety can be recognized, measured, and coped with at three levels of skill (), vision (), and Tao (). EXPERT OPINION The combination of pharmacotherapy and CBM is possibly more effective in treating anxiety disorders than either treatment alone. However, clinicians and patients should participate in the joint decision-making process and consider comprehensive factors. Moderate anxiety has adaptive significance. In the coming years, by combining the downward analytical system of western culture with the upward integrative system of Chinese culture, a comprehensive understanding of anxiety and anxiety disorders should be established, rather than focusing only on their treatment.
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Affiliation(s)
- Qingyan Kong
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Buxin Han
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Chen L, Lu J, Li Q, Shi Y, Liu S, He Y, Zheng G, Xiang Y, Xiao Y. Childhood maltreatment, parenting style and anxiety in Chinese youths: A case-control study. Child Abuse Negl 2024; 153:106807. [PMID: 38677178 DOI: 10.1016/j.chiabu.2024.106807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Although evidence in supporting the associations between childhood maltreatment (CM), parenting style and anxiety in children and adolescents exists, few high-quality analytical epidemiological studies which focusing on clinically diagnosed anxiety disorders (AD) had been published. OBJECTIVE The aim of this study was to further corroborate the associations between CM, parenting style, and AD in a large representative sample of Chinese children and adolescents. PARTICIPANTS AND SETTING Study subjects were derived from the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a population-based cross-sectional program. METHODS Individually matched case-control study design was adopted. Univariate and multivariate conditional binary logistic regression models were used to estimate the associations between CM, parenting style and AD. Dose-response trends were estimated using the Cochran-Armitage Chi-square test. A series of stratified analyses were conducted to explore effect modification on exposure-outcome association by some important features. RESULTS Totally we screened out 202 cases and 404 matched controls, with an age mean of 14.43 years. Conditional logistic regression models revealed that EA and a higher level of parental over-protection were significantly associated with increased risk of AD, with adjusted ORs of 3.39 (95 % CI: 2.07-5.56) and 1.93 (95 % CI: 1.28-2.90). Stratified analysis identified noticeable effect modification by sex, age, and whether the only child in the family. CONCLUSIONS Major findings of this study suggested that children and adolescents who had experienced EA or raised up by over-protective parents are at increased risk of AD. Targeted intervention measures should be developed and implemented for these high-risk youths.
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Affiliation(s)
- Lin Chen
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Jin Lu
- Psychiatry Department, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China; Mental Health Institute of Yunnan, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China; Yunnan Clinical Research Center for Mental Health, Kunming, Yunnan, China
| | - Qiongxian Li
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yuanyu Shi
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Shuqing Liu
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yandie He
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Guiqing Zheng
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yi Xiang
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yuanyuan Xiao
- NHC Key Laboratory of Drug Addiction Medicine, Division of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, Yunnan, China; Key Library in Public Health and Disease Prevention and Control, Yunnan Provincial Department of Education, China.
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Husain S, Rao S, Suresh S, Jesudoss KVA, Krishna B, Raj JP. Screening for those at risk for anxiety and depression warranting further clinical evaluation among patients presenting to breast services: a single-centre, cross-sectional study. BMJ Open 2024; 14:e080216. [PMID: 38670606 PMCID: PMC11057253 DOI: 10.1136/bmjopen-2023-080216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES Studies show that anxiety and depression are widespread across patients presenting to outpatient services for medical illnesses. We expect similar or even higher prevalence in patients with breast complaints owing to the relevance of breasts in terms of sexuality, identity and confidence. Thus, this study was proposed to estimate the prevalence and identify risk factors for being at risk for anxiety and depression in patients seeking breast services. DESIGN Descriptive, cross-sectional study. SETTING Tertiary care teaching hospital in Mumbai, Western India. PARTICIPANTS Patients seeking breast services for either benign or malignant conditions. OUTCOME MEASURES Proportion of those at risk for clinical depression (defined as a score of ≥10 on Patient Health Questionnaire-9) and proportion of those at risk for clinical anxiety warranting further clinical evaluation (defined as a score of ≥10 on Generalized Anxiety Disorder-7) and their predictors. RESULTS A total of 208 patients were screened, and 192 consenting patients were enrolled. The prevalence of those at risk for anxiety requiring further clinical evaluation was 46.4% (95% CI 39.2% to 53.7%) and for those at risk for major depression that warrants further clinical evaluation by a mental health provider was 29.7% (95% CI 23.3% to 36.7%). The predictors of anxiety were age (adjusted odds ratio (aOR) 1.053; 95% CI 1.024 to 1.083; p<0.001) and postmenopausal status (aOR 2.475; 95% CI 1.200 to 5.103; p=0.014). The predictors of depression were age (aOR 0.954; 95% CI 1.927 to 0.981; p=0.001) and rural place of residence (aOR 2.362; 95% CI 1.023 to 5.433; p=0.044). CONCLUSIONS There is a high prevalence of being at risk for anxiety and depression among patients who seek breast services warranting further clinical evaluation. The predictors of being at risk for anxiety were higher age and postmenopausal status, and for those at risk for depression were young age and residing in rural areas.
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Affiliation(s)
- Sakina Husain
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shilpa Rao
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sridhar Suresh
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | | | - Jeffrey Pradeep Raj
- Pharmacology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Zainal NH, Soh CP, Van Doren N. Daily stress reactivity and risk appraisal mediates childhood parental abuse predicting adulthood psychopathology severity: An 18-year longitudinal mediation analysis. J Affect Disord 2024; 358:138-149. [PMID: 38663555 DOI: 10.1016/j.jad.2024.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/07/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024]
Abstract
Identifying mechanisms of childhood abuse-adulthood psychopathology relations could facilitate preventive efforts, but most prior studies used cross-sectional or two-wave designs and did not test the effects of childhood maternal and paternal abuse separately. Our 18-year three-wave study thus determined if Wave 2 daily stress reactivity and risk appraisal severity mediated Wave 1 retrospectively-reported childhood maternal and paternal abuse on Wave 3 generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD), alcohol (AUD), and substance use disorder (SUD) self-rated symptom severity. Longitudinal structural equation modeling was employed, adjusting for Wave 1 psychopathology severity. Higher childhood maternal and paternal abuse consistently predicted greater future daily stress reactivity and risk appraisal, and these mediators subsequently predicted increased GAD, MDD, and PD, but not AUD and SUD severity. Daily stress reactivity and risk appraisal consistently mediated the pathways between childhood maternal and paternal abuse predicting heightened adulthood GAD, MDD, and PD (Cohen's d = 0.333-0.888) but not AUD and SUD severity. Mediation effect sizes were stronger for childhood maternal (24.5-83.0%) than paternal (19.5-56.0%) abuse as the predictor. The latent interaction between Wave 1 childhood maternal and paternal abuse did not moderate the effect of Wave 1 maternal or paternal abuse on any Wave 3 adulthood psychopathology severity through Wave 2 daily stress reactivity and risk appraisal. Our research emphasizes the urgent requirement for continuous evaluation and intervention initiatives in trauma-informed care, both in inpatient and outpatient treatment settings.
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Affiliation(s)
- Nur Hani Zainal
- Harvard Medical School, Department of Health Care Policy, United States of America; National University of Singapore, Department of Psychology, Singapore.
| | - Chui Pin Soh
- National University of Singapore, Department of Psychology, Singapore
| | - Natalia Van Doren
- University of California at San Francisco, Department of Psychiatry and Behavioral Sciences, United States of America
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Faiman I, Hodsoll J, Jasani I, Young AH, Shotbolt P. Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study. BMJ Ment Health 2024; 27:e300957. [PMID: 38642918 PMCID: PMC11033658 DOI: 10.1136/bmjment-2023-300957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND People with functional/dissociative seizures (FDS) are at elevated suicidality risk. OBJECTIVE To identify risk factors for suicidality in FDS or epilepsy. METHODS Retrospective cohort study from the UK's largest tertiary mental healthcare provider, with linked national admission data from the Hospital Episode Statistics. Participants were 2383 people with a primary or secondary diagnosis of FDS or epilepsy attending between 01 January 2007 and 18 June 2021. Outcomes were a first report of suicidal ideation and a first hospital admission for suicide attempt (International Classification of Diseases, version 10: X60-X84). Demographic and clinical risk factors were assessed using multivariable bias-reduced binomial-response generalised linear models. FINDINGS In both groups, ethnic minorities had significantly reduced odds of hospitalisation following suicide attempt (OR: 0.45-0.49). Disorder-specific risk factors were gender, age and comorbidity profile. In FDS, both genders had similar suicidality risk; younger age was a risk factor for both outcomes (OR: 0.16-1.91). A diagnosis of depression or personality disorders was associated with higher odds of suicidal ideation (OR: 1.91-3.01). In epilepsy, females had higher odds of suicide attempt-related hospitalisation (OR: 1.64). Age had a quadratic association with both outcomes (OR: 0.88-1.06). A substance abuse disorder was associated with higher suicidal ideation (OR: 2.67). Developmental disorders lowered the risk (OR: 0.16-0.24). CONCLUSIONS This is the first study systematically reporting risk factors for suicidality in people with FDS. Results for the large epilepsy cohort complement previous studies and will be useful in future meta-analyses. CLINICAL IMPLICATIONS Risk factors identified will help identify higher-risk groups in clinical settings.
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Affiliation(s)
- Irene Faiman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Hodsoll
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iman Jasani
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Shotbolt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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Lester KJ, Michelson D. Perfect storm: emotionally based school avoidance in the post-COVID-19 pandemic context. BMJ Ment Health 2024; 27:e300944. [PMID: 38580437 PMCID: PMC11021743 DOI: 10.1136/bmjment-2023-300944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/16/2024] [Indexed: 04/07/2024]
Abstract
School absences have risen following the COVID-19 pandemic and persistent absenteeism remains high in primary and secondary schools in England compared with pre-pandemic levels. This coincides with an upward trend in emotionally based school avoidance (EBSA). EBSA adversely affects children's educational attainment, health, social functioning and life prospects and warrants early intervention before a pattern of absenteeism becomes entrenched. In this article, we consider how the COVID-19 pandemic and its sequelae have created a 'perfect storm' of conditions, amplifying known school, family and child-based risk factors for EBSA while simultaneously reducing access to support services. We then outline priorities for developing new EBSA interventions and argue for a multi-component approach, which works across education, health and social care, and voluntary sectors to address the complex interplay between risk factors. Given the difficulties that families often face in obtaining timely support for EBSA, it is also essential that new interventions are accessible, resource-efficient and scalable. To this end, we specifically discuss the potential for contextually-sensitive, parent-focused interventions that can be delivered online with minimal synchronous support from a trained coach or facilitator.
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Affiliation(s)
- Kathryn J Lester
- School of Psychology, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Daniel Michelson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College, London, UK
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13
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Ozturk HM, Erdogan M, Turan Y, Celik IE, Ozturk S. Left atrial function index and left atrial electromechanical functions in anxiety disorders. Acta Cardiol 2024:1-9. [PMID: 38572756 DOI: 10.1080/00015385.2024.2336345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND There is a close linkage between anxiety disorders (ADs), and development of cardiovascular disease (CVD) and atrial fibrillation (AF). We aimed to investigate left atrial function index (LAFI) and its components, LA mechanical functions and atrial conduction times in AD patients and age- and gender-matched control group patients for the first time in the literature. METHODS A total of 48 AD patients and 33 healthy subjects were enrolled to the study prospectively. Echocardiographic parameters including two-dimensional conventional echocardiography, diastolic functions, LA mechanical functions, LAFI, atrial conduction times and atrial electromechanical delay (AEMD) were calculated. RESULTS The velocity-time integral of the LV outflow tract (LVOT-VTI), LAFI and LA conduit volume were significantly lower in AD patients. Atrial electromechanical coupling as established from lateral mitral annulus (PA lateral) was significantly higher in AD group than control group. Inter-AEMD and left intra-AEMD were also higher in AD group compared to control group. Age, gender, body surface area (BSA), conduit volume, LVOT-VTI and LAFI were significant factors associated with AD in univariate analysis. However, only BSA and LVOT-VTI (Odds ratio [OR]: 0.79, 95 CI%: 0.66-0.95, p = 0.013) were independently associated with AD in multivariate analysis. Age, gender, conduit volume and LAFI (OR: 0.25, 95 CI%: 0.03-2.12, p = 0.204) were not found to be independent associates of AD. CONCLUSION LAFI is impaired in patients suffering from AD compared to their age- and gender-matched counterparts but this impairment originates from lower levels of LVOT-VTI calculations in AD patients. Thus, LVOT-VTI, but not LAFI, is independently associated with AD.
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Affiliation(s)
| | - Mehmet Erdogan
- Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Yasar Turan
- Department of Cardiology, Istanbul Yeni Yuzyıl University Faculty of Medicine, Istanbul, Turkey
| | - Ibrahim Etem Celik
- Department of Cardiology, Ankara Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Selcuk Ozturk
- Department of Cardiology, Kırıkkale Yuksek Ihtisas Hospital, Kırıkkale, Turkey
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14
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Hammoud RA, Ammar LA, McCall SJ, Shamseddeen W, Elbejjani M. Brain volumes, behavioral inhibition, and anxiety disorders in children: results from the adolescent brain cognitive development study. BMC Psychiatry 2024; 24:257. [PMID: 38575908 PMCID: PMC10996182 DOI: 10.1186/s12888-024-05725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) studies have identified brain changes associated with anxiety disorders (ADs), but the results remain mixed, particularly at a younger age. One key predictor of ADs is behavioral inhibition (BI), a childhood tendency for high avoidance of novel stimuli. This study aimed to evaluate the relationships between candidate brain regions, BI, and ADs among children using baseline data from the Adolescent Brain Cognitive Development (ABCD) study. METHODS We analyzed global and regional brain volumes of 9,353 children (9-10 years old) in relation to BI and current ADs, using linear mixed models accounting for family clustering and important demographic and socioeconomic covariates. We further investigated whether and how past anxiety was related to brain volumes. RESULTS Among included participants, 249 (2.66%) had a current AD. Larger total white matter (Beta = -0.152; 95% CI [-0.281, -0.023]), thalamus (Beta = -0.168; 95% CI [-0.291, -0.044]), and smaller hippocampus volumes (Beta = 0.094; 95% CI [-0.008, 0.196]) were associated with lower BI scores. Amygdala volume was not related to BI. Larger total cortical (OR = 0.751; 95% CI [0.580;0.970]), amygdala (OR = 0.798; 95%CI [0.666;0.956]), and precentral gyrus (OR = 0.802; 95% CI [0.661;0.973]) volumes were associated with lower odds of currently having ADs. Children with past ADs had smaller total white matter and amygdala volumes. CONCLUSIONS The results show associations between brain volumes and both BI and ADs at an early age. Importantly, results suggest that ADs and BI have different neurobiological correlates and that earlier occurrences of ADs may influence brain structures related to BI and ADs, motivating research that can better delineate the similarities and divergence in the neurobiological underpinnings and building blocks of BI and ADs across their development in early life.
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Affiliation(s)
- Rawan A Hammoud
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lara Abou Ammar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Stephen J McCall
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Wael Shamseddeen
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Martine Elbejjani
- Clinical Research Institute, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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15
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Kolaas K, Berman AH, Hedman-Lagerlöf E, Lindsäter E, Hybelius J, Axelsson E. Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e075796. [PMID: 38569713 PMCID: PMC11015301 DOI: 10.1136/bmjopen-2023-075796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both. DESIGN Systematic review with meta-analysis. DATA SOURCES Medline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023. ELIGIBILITY CRITERIA Randomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups. DATA EXTRACTION AND SYNTHESIS In random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges' g with 95% CIs. Absolute and relative heterogeneity was quantified as the τ2 and I 2. RESULTS We included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (g=0.90; 95% CI 0.81 to 0.99) and anxiety (g=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression: g=0.52; 95% CI 0.42 to 0.63; anxiety: g=0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression: g=0.30; 95% CI 0.07 to 0.53; anxiety: g=0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results. CONCLUSION Internet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults. PROSPERO REGISTRATION NUMBER CRD42021243172.
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Affiliation(s)
- Karoline Kolaas
- Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Department of Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Gustavsberg University Primary Health Care Center, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Elin Lindsäter
- Division of Psychology, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Gustavsberg University Primary Health Care Center, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Jonna Hybelius
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Erland Axelsson
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm, Sweden
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16
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Bua A, Moirano G, Pizzi C, Rusconi F, Migliore E, Richiardi L, Popovic M. Maternal antenatal mental health and its associations with perinatal outcomes and the use of healthcare services in children from the NINFEA birth cohort study. Eur J Pediatr 2024:10.1007/s00431-024-05525-3. [PMID: 38564067 DOI: 10.1007/s00431-024-05525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
To investigate the associations between maternal mental health disorders before and during pregnancy and perinatal outcomes and child healthcare utilization between 6 and 18 months of age. Among the 6814 mother-child pairs from the Italian Internet-based NINFEA birth cohort, maternal depression, anxiety, and sleep disorders diagnosed by a physician before and during pregnancy were assessed through self-reported questionnaires completed during pregnancy and 6 months after delivery. Perinatal outcomes (preterm birth, birth weight, small for gestational age, congenital anomalies, and neonatal intensive care unit (NICU)) and children's healthcare utilization (emergency department (ED) visits, hospitalizations, and outpatient visits) were reported by mothers at 6 and 18 months postpartum. We used regression models adjusted for maternal age, education, parity, country of birth, region of delivery, and household income. Maternal mental health disorders were not associated with perinatal outcomes, except for depression, which increased the risk of offspring admission to NICU, and anxiety disorders during pregnancy, which were associated with preterm birth and lower birth weight. Children born to mothers with depression/anxiety disorders before pregnancy, compared to children of mothers without these disorders, had an increased odds of a visit to ED for any reason (odds ratio (ORadj) = 1.26, 95% confidence interval (CI): 1.02-1.54), of an ED visit resulting in hospitalization (ORadj = 1.75, 95%CI: 1.27-2.42), and of planned hospital admissions (ORadj = 1.55, 95%CI: 1.01-2.40). These associations with healthcare utilization were similar for mental disorders also during pregnancy. The association pattern of maternal sleep disorders with perinatal outcomes and child healthcare utilization resembled that of maternal depression and/or anxiety disorders with these outcomes. Conclusion: Antenatal maternal mental health is a potential risk factor for child-health outcomes and healthcare use. Early maternal mental health interventions may help to promote child health and reduce healthcare costs. What is Known: • Poor maternal mental health affects pregnancy outcomes and child health, and children of mothers with mental health conditions tend to have increased healtcare utilization. • Parents with poor mental health often face challenges in caring for their children and have less parenting self-efficacy, which could potentially lead to frequent medical consultations for minor health issues. What is New: • Maternal pre-pregnancy mental disorders were not associated with preterm birth, low birth weight, SGA, and congenital anomalies, except for depression, which increased the risk of offspring admission to NICU. Anxiety disorders during pregnancy were associated with lower birth weight and an increased odds of preterm birth. • Maternal depression and/or anxiety and sleep disorders, both before and during pregnancy, were associated with an increase in children's healthcare utilization between 6 and 18 months of life.
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Affiliation(s)
- Adriana Bua
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Franca Rusconi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- CPO Piemonte, Turin, Italy
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17
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Nguyen AW, Hope MO, Qin W, Cobb N, Ding K, Taylor HO, Mitchell UA. "So, Do Not Fear": Religion and the prevalence, persistence, and severity of anxiety disorders among Black Americans. J Affect Disord 2024; 350:247-254. [PMID: 38232778 DOI: 10.1016/j.jad.2024.01.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There is a dearth of scholarship that explicates the effects of religious participation on anxiety disorders among Black Americans. A better understanding of the links between religious participation, a coping resource, and anxiety disorders among Black Americans remains essential, given Black Americans are less likely than their white counterparts to seek professional treatment for mental health problems, leading to greater unmet mental health needs. The aim of this study was to investigate whether religious participation is associated with the prevalence, persistence, and severity of anxiety disorders among Black adults. METHODS We used a national sample of Black adults (N = 4999) from the National Survey of American Life, a cross-sectional study conducted from 2001 to 2003. Five anxiety disorders were assessed: posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, and agoraphobia. Three dimensions of religious participation were assessed: organizational, non-organizational, and subjective religious participation. Weighted logistic and linear regressions were estimated to examine the associations between religious participation and anxiety disorders. RESULTS Findings indicate that organizational religious participation and subjective religiosity were associated with lower odds of anxiety disorders and decreased severity. Findings for non-organizational religious participation in relation to the prevalence, persistence, and severity of anxiety disorders were mixed. LIMITATIONS The study limitations include the utilization of self-reported measures, cross-sectional study design, and age of the data set. CONCLUSIONS Different dimensions of religious participation have differing effects on anxiety disorders. Religious participation may be an important resource for Black Americans in coping and preventing anxiety disorders.
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Affiliation(s)
- Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America.
| | | | - Weidi Qin
- Sandra Rosenbaum School of Social Work, University of Wisconsin, Madison, United States of America
| | - Nichole Cobb
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Kedong Ding
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Harry O Taylor
- Factor Inwentash Faculty of Social Work, University of Toronto, Canada
| | - Uchechi A Mitchell
- School of Public Health, University of Illinois at Chicago, United States of America
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18
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Drzewiecki CM, Fox AS. Understanding the heterogeneity of anxiety using a translational neuroscience approach. Cogn Affect Behav Neurosci 2024; 24:228-245. [PMID: 38356013 PMCID: PMC11039504 DOI: 10.3758/s13415-024-01162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024]
Abstract
Anxiety disorders affect millions of people worldwide and present a challenge in neuroscience research because of their substantial heterogeneity in clinical presentation. While a great deal of progress has been made in understanding the neurobiology of fear and anxiety, these insights have not led to effective treatments. Understanding the relationship between phenotypic heterogeneity and the underlying biology is a critical first step in solving this problem. We show translation, reverse translation, and computational modeling can contribute to a refined, cross-species understanding of fear and anxiety as well as anxiety disorders. More specifically, we outline how animal models can be leveraged to develop testable hypotheses in humans by using targeted, cross-species approaches and ethologically informed behavioral paradigms. We discuss reverse translational approaches that can guide and prioritize animal research in nontraditional research species. Finally, we advocate for the use of computational models to harmonize cross-species and cross-methodology research into anxiety. Together, this translational neuroscience approach will help to bridge the widening gap between how we currently conceptualize and diagnose anxiety disorders, as well as aid in the discovery of better treatments for these conditions.
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Affiliation(s)
- Carly M Drzewiecki
- California National Primate Research Center, University of California, Davis, CA, USA.
| | - Andrew S Fox
- California National Primate Research Center, University of California, Davis, CA, USA.
- Department of Psychology, University of California, Davis, CA, USA.
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19
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Peng B, Meng H, Guo L, Zhu J, Kong B, Qu Z, Shuai W, Huang H. Anxiety disorder and cardiovascular disease: a two-sample Mendelian randomization study. ESC Heart Fail 2024; 11:1174-1181. [PMID: 38279876 DOI: 10.1002/ehf2.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/29/2024] Open
Abstract
AIMS Cardiovascular disease is the leading cause of death worldwide. Anxiety disorders are common psychiatric conditions associated with cardiovascular outcomes. This two-sample Mendelian randomization (MR) study investigated the causal relationship between anxiety disorders and coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF), and atrial fibrillation (AF). METHODS Single nucleotide polymorphisms (SNPs) associated with anxiety disorders (16 730 cases; 101 021 controls) were obtained from the UK Biobank genome-wide association study (GWAS). Cardiovascular outcome data were derived from the FinnGen study (CHD: 21 012 cases and 197 780 controls; MI: 12 801 cases and 187 840 controls; HF: 23 397 cases and 194 811 controls; and AF: 22 068 cases and 116 926 controls). Inverse variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode analyses examined causality. RESULTS IVW analysis demonstrated significant causal relationships between anxiety disorders and increased risk of CHD [odds ratio (OR): 4.496; 95% confidence interval (CI): 1.777-11.378; P = 0.002], MI (OR: 5.042; 95% CI: 1.451-17.518; P = 0.011), and HF (OR: 3.255; 95% CI: 1.461-7.252; P = 0.004). No relationship was observed with AF (OR: 1.775; 95% CI: 0.612-5.146; P = 0.29). Other methods showed non-significant associations. Two-way analysis indicated no reverse causality. CONCLUSIONS Anxiety disorders were causally associated with greater risk of CHD, MI, and HF but not AF among individuals of European descent. Further research on mediating mechanisms and in diverse populations is warranted.
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Affiliation(s)
- Bo Peng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Hong Meng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Liang Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jun Zhu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Bin Kong
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zongze Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Wei Shuai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Cardiovascular Research Institute of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Cardiology, Wuhan, China
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20
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Halaj A, Strauss AY, Zlotnick E, Zalaznik D, Fradkin I, Andersson G, Ebert DD, Huppert JD. Clinical and cognitive insight in panic disorder: phenomenology and treatment effects in internet cognitive behavior therapy. J Psychiatr Res 2024; 172:164-170. [PMID: 38387117 DOI: 10.1016/j.jpsychires.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024]
Abstract
Clinical observations suggest that individuals with panic disorder (PD) vary in their beliefs about the causes of their panic attacks. Some attribute these attacks to psychological factors, while others to physiological or medical factors. These beliefs also extend to whether individuals perceive panic attacks as dangerous. In other areas of psychiatric nosology, these phenomena are commonly called clinical insight (recognition of disorder and the need for treatment) and cognitive insight (the ability to reflect on one's beliefs). Despite its importance, limited research exists on insight in PD and its relation to symptoms and treatment outcomes. This study examines clinical and cognitive insight in 83 patients with PD who received internet-based cognitive behavioral therapy, investigating their relationship with symptoms, treatment outcomes, and changes in insight. We assessed patients using interview and self-report measures of insight and symptoms. Clinical and cognitive insight were correlated and both constructs improved significantly during treatment. Good clinical insight pretreatment was positively correlated with more severe pretreatment symptoms. Pretreatment clinical and cognitive insight were not correlated with symptom change or attrition. Greater change in clinical and cognitive insight was related to greater change in symptoms. The findings highlight the significance of clinical and cognitive insight in PD, and the importance of distinguishing between them. This suggests the need to develop interventions according to patients' level of insight, particularly focusing on those lacking insight. Further research is essential to advance our understanding of the relationship between insight and the phenomenology and treatment of PD.
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Affiliation(s)
| | | | | | | | | | | | - David Daniel Ebert
- Department for Sport and Health Sciences, Technical University Munich, Germany
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21
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Caudle MM, Dugas NN, Patel K, Moore RC, Thomas ML, Bomyea J. Repetitive negative thinking as a unique transdiagnostic risk factor for suicidal ideation. Psychiatry Res 2024; 334:115787. [PMID: 38367453 DOI: 10.1016/j.psychres.2024.115787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/27/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Repetitive negative thinking (RNT) is a transdiagnostic symptom observed across mood and anxiety disorders and is characterized by frequent, distressing thoughts that are perceived as uncontrollable. Specific forms of RNT have been linked to increased suicide risk. However, most work examining links between RNT and suicide has been conducted within specific disorders and subtypes of RNT (e.g., rumination in individuals with depression). The present study aimed to investigate associations between transdiagnostic RNT and suicidal ideation. We hypothesized RNT would be associated with suicide risk beyond disorder-specific clinical symptoms. Fifty-four participants with mood, anxiety, and/or traumatic stress disorders completed an interview assessing suicidal risk (Columbia-Suicide Severity Rating Scale (C-SSRS)) and self-report questionnaires assessing transdiagnostic RNT, depression, and anxiety. Based on C-SSRS, we divided participants into high or low suicide risk groups. We analyzed the relationship between suicidal risk group and RNT and found that RNT was uniquely associated with suicidal risk group, controlling for depression and anxiety severity. Our results suggest including assessments of RNT may have clinical utility for understanding the degree of suicide risk in individuals and point to the potential utility of including clinical interventions to target this symptom for those at high risk of suicide.
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Affiliation(s)
- M M Caudle
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, United States
| | - N N Dugas
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - K Patel
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - R C Moore
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States
| | - M L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO 80525, United States
| | - J Bomyea
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA 92161, United States; Department of Psychiatry, University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States.
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22
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Huneke NTM, Cross C, Fagan HA, Molteni L, Phillips N, Garner M, Baldwin DS. Placebo Effects Are Small on Average in the 7.5% CO2 Inhalational Model of Generalized Anxiety. Int J Neuropsychopharmacol 2024; 27:pyae019. [PMID: 38577951 PMCID: PMC11059817 DOI: 10.1093/ijnp/pyae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/10/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and socio-economically costly. Novel pharmacological treatments for these disorders are needed because many patients do not respond to current agents or experience unwanted side effects. However, a barrier to treatment development is the variable and large placebo response rate seen in trials of novel anxiolytics. Despite this, the mechanisms that drive placebo responses in anxiety disorders have been little investigated, possibly due to low availability of convenient experimental paradigms. We aimed to develop and test a novel protocol for inducing placebo anxiolysis in the 7.5% CO2 inhalational model of generalized anxiety in healthy volunteers. METHODS Following a baseline 20-minute CO2 challenge, 32 healthy volunteers were administered a placebo intranasal spray labelled as either the anxiolytic "lorazepam" or "saline." Following this, participants surreptitiously underwent a 20-minute inhalation of normal air. Post-conditioning, a second dose of the placebo was administered, after which participants completed another CO2 challenge. RESULTS Participants administered sham "lorazepam" reported significant positive expectations of reduced anxiety (P = .001), but there was no group-level placebo effect on anxiety following CO2 challenge post-conditioning (Ps > .350). Surprisingly, we found many participants exhibited unexpected worsening of anxiety, despite positive expectations. CONCLUSIONS Contrary to our hypothesis, our novel paradigm did not induce a placebo response, on average. It is possible that effects of 7.5% CO2 inhalation on prefrontal cortex function or behavior in line with a Bayesian predictive coding framework attenuated the effect of expectations on subsequent placebo response. Future studies are needed to explore these possibilities.
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Affiliation(s)
- Nathan T M Huneke
- Southern Health National Health Service Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
| | - Cosmina Cross
- Southern Health National Health Service Foundation Trust, Southampton, UK
| | - Harry A Fagan
- Southern Health National Health Service Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
| | - Laura Molteni
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
| | | | - Matthew Garner
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
| | - David S Baldwin
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Southern Health National Health Service Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- University Department of Psychiatry, Academic Centre, College Keep, Southampton, UK
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23
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Lord KA, Tolin DF. Symptom distress and psychosocial functioning improve bidirectionally during cognitive-behavioral therapy for anxiety disorders. J Anxiety Disord 2024; 103:102843. [PMID: 38310753 DOI: 10.1016/j.janxdis.2024.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/30/2023] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
The efficacy of cognitive-behavioral therapy (CBT) for reducing anxiety disorder symptoms is well documented. However, limited research has investigated how symptom amelioration is temporally associated with changes in psychosocial functioning, such as interpersonal and social role functioning, during CBT. Participants were 288 (M age = 37.00 [SD = 14.41]; 59.0% female; 69.0% White; 6.6% Hispanic/Latino) outpatients diagnosed with an anxiety disorder who received CBT at a specialized hospital-based clinic. Participants completed the Outcome Questionnaire-45, a measure of symptom distress, social role performance, and interpersonal problems, at initial assessment and prior to each treatment session. Symptom distress and indicators of psychosocial functioning were robustly related during 25 sessions of CBT. Cross-lagged analyses revealed that reductions in symptom distress predicted subsequent improvements in psychosocial functioning during treatment, and vice versa. Associations from symptom distress to subsequent psychosocial functioning evidenced larger effect sizes than the reverse. Lower levels of severity at intake and presence of comorbid depression attenuated the association between symptom reduction and subsequent social role performance improvement. In sum, anxiety symptoms and psychosocial functioning bidirectionally improve during CBT for anxiety disorders. Maximally effective treatments may be those that simultaneously ameliorate symptoms and focus on improving functioning in key domains.
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Affiliation(s)
- Kayla A Lord
- Anxiety Disorders Center, Institute of Living, Hartford, USA.
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, USA; Department of Psychiatry, Yale School of Medicine, New Haven, USA
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Kwee CMB, van der Flier FE, Duits P, van Balkom AJLM, Cath DC, Baas JMP. Effects of cannabidiol on fear conditioning in anxiety disorders: decreased threat expectation during retention, but no enhanced fear re-extinction. Psychopharmacology (Berl) 2024; 241:833-847. [PMID: 38044339 DOI: 10.1007/s00213-023-06512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
RATIONALE Preclinical research suggests that pharmacologically elevating cannabinoid levels may attenuate fear memory expression and enhance fear extinction. OBJECTIVES We studied the effects of cannabidiol (CBD) on fear memory expression and fear re-extinction in 69 patients with panic disorder with agoraphobia or with social anxiety disorder. Moderation by sex, diagnosis, and serotonergic antidepressant (AD) use was explored. METHODS A cued fear conditioning paradigm was applied before the first treatment session with 300 mg CBD/placebo augmented exposure therapy. Study medication was administered orally preceding 8 weekly sessions. Fear acquisition and suboptimal extinction took place prior to the first medication ingestion (T0). After the first medication ingestion (T1), we investigated effects on fear memory expression at retention and fear re-extinction. Subjective fear, shock expectancy, skin conductance, and startle responses to conditioned (CS+) and safety stimulus (CS-) were measured. RESULTS Across the sample, CBD reduced shock expectancy at retention under low and ambiguous threat of shock, but fear re-extinction at T1 was unaffected by CBD. However, in AD users, re-extinction of subjective fear was impaired in the CBD condition compared to placebo. In female AD users, CBD interfered with safety learning measured with fear-potentiated startle. CONCLUSIONS The current findings provide no evidence for enhanced fear re-extinction by CBD. However, CBD acutely decreased threat expectation at retention, without affecting other indices of fear. More studies are needed to elucidate possible interactions with AD use and sex, as well as potential effects of CBD on threat expectancies.
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Affiliation(s)
- C M B Kwee
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands.
- Altrecht Academic Anxiety Center, Utrecht, The Netherlands.
| | - F E van der Flier
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | - P Duits
- Altrecht Academic Anxiety Center, Utrecht, The Netherlands
| | - A J L M van Balkom
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands
| | - D C Cath
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Specialist Trainings, GGZ Drenthe, Assen, The Netherlands
| | - J M P Baas
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
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Liu N, Sun H, Yang C, Li X, Gao Z, Gong Q, Zhang W, Lui S. The difference in volumetric alternations of the orbitofrontal-limbic-striatal system between major depressive disorder and anxiety disorders: A systematic review and voxel-based meta-analysis. J Affect Disord 2024; 350:65-77. [PMID: 38199394 DOI: 10.1016/j.jad.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) and anxiety disorders (ANX) are psychiatric disorders with high mutual comorbidity rates that might indicate some shared neurobiological pathways between them, but they retain diverse phenotypes that characterize themselves specifically. However, no consistent evidence exists for common and disorder-specific gray matter volume (GMV) alternations between them. METHODS A systematic review and meta-analysis on voxel-based morphometry studies of patients with MDD and ANX were performed. The effect of comorbidity was explicitly controlled during disorder-specific analysis and particularly investigated in patient with comorbidity. RESULTS A total of 45 studies with 54 datasets comprising 2196 patients and 2055 healthy participants met the inclusion criteria. Deficits in the orbitofrontal cortex, striatum, and limbic regions were found in MDD and ANX. The disorder-specific analyses showed decreased GMV in the bilateral anterior cingulate cortex, right striatum, hippocampus, and cerebellum in MDD, while decreased GMV in the left striatum, amygdala, insula, and increased cerebellar volume in ANX. A totally different GMV alternation pattern was shown involving bilateral temporal and parietal gyri and left fusiform gyrus in patients with comorbidity. LIMITATIONS Owing to the design of included studies, only partial patients in the comorbid group had a secondary comorbidity diagnosis. CONCLUSION Patients with MDD and ANX shared a structural disruption in the orbitofrontal-limbic-striatal system. The disorder-specific effects manifested their greatest severity in distinct lateralization and directionality of these changes that differentiate MDD from ANX. The comorbid group showed a totally different GMV alternation pattern, possibly suggesting another illness subtype that requires further investigation.
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Affiliation(s)
- Naici Liu
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Hui Sun
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Chengmin Yang
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xing Li
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ziyang Gao
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China
| | - Wenjing Zhang
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
| | - Su Lui
- Department of Radiology, and Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
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26
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Liu X, Fan J, Leong II, Lu W, Zhang Y, Gong M, Zhuang L. Efficacy of acupuncture (Jin's three-needle) on motor symptoms and anxiety in patients with Parkinson's disease: protocol for a multicentre, randomised, assessor-blinded clinical trial. BMJ Open 2024; 14:e081312. [PMID: 38548359 PMCID: PMC10982807 DOI: 10.1136/bmjopen-2023-081312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Parkinson's disease (PD) has a significant impact on a substantial number of individuals in China. Notably, 31% of patients with PD also grapple with the additional burden of anxiety. This dual challenge of managing both PD and anxiety underscores the complexity of the condition and the diverse range of symptoms patients may experience. Considering the circumstances, the cost and potential drawbacks associated with traditional antiparkinsonian drugs become increasingly relevant. Acupuncture emerges as a significant non-pharmacological adjunct therapy. Offering a potentially safer and more cost-effective option, acupuncture addresses the pressing need for holistic and complementary treatments that may alleviate both the motor symptoms of PD and the accompanying anxiety. METHODS AND ANALYSIS This is a multicentre, randomised controlled and assessor-blind trial. A total of 210 eligible patients with PD will be randomly assigned (1:1) to Jin's three-needle (JTN) acupuncture group or waitlist (WL) group. Patients in the JTN group will receive acupuncture therapy three times per week for 4 weeks. Patients in the WL group will maintain their original dosage of antiparkinsonian drugs and receive acupuncture therapy after the observation period. The primary outcome measure will be the Unified Parkinson's Disease Rating Scale score. The secondary outcome measures will be the scores of the Hoehn-Yahr Rating Scale, Unified Dyskinesia Rating Scale, Non-Motor Symptoms Scale, 39-item Parkinson's Disease Questionnaire, Parkinson Anxiety Scale, Hamilton Anxiety Scale, Hamilton Depression Scale, Zarit burden interview and the level of cortisol and adrenocorticotropic hormone. The evaluation will be executed at baseline, the end of the treatment and a follow-up period. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (K[2023]014). All patients have to provide written, informed consent. The study will be disseminated through presentations in peer-reviewed international journals and at national and international conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry; ChiCTR2300074675.
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Affiliation(s)
- Xin Liu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingqi Fan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ian I Leong
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Weijing Lu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yifan Zhang
- Lingnan Institute of Acupuncture and Rehabilitation, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Mengjiao Gong
- Lingnan Institute of Acupuncture and Rehabilitation, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lixing Zhuang
- Lingnan Institute of Acupuncture and Rehabilitation, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Mantua J, Symonette SA, Eldringhoff HP, Overman GA, Chaudhury S. Concerns about the future linked with poor sleep quality in US army special operations soldiers withdrawing from Afghanistan. BMJ Mil Health 2024; 170:183-184. [PMID: 35654470 DOI: 10.1136/bmjmilitary-2022-002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Janna Mantua
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - S A Symonette
- United States Army Special Operations Command, Ft. Benning, Georgia, USA
| | - H P Eldringhoff
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - G A Overman
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - S Chaudhury
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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Fennig M, Agali U, Looby M, Gilbert K. Telehealth-Delivered Radically Open Dialectical Behavior Therapy for Adolescents (RO DBT-A): A Pilot Mixed-Methods Study. Am J Psychother 2024:appipsychotherapy20230025. [PMID: 38507336 DOI: 10.1176/appi.psychotherapy.20230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Disorders related to overcontrol frequently first appear during adolescence, are highly comorbid, and show limited treatment response, necessitating the adaptation of radically open dialectical behavior therapy (RO DBT; a transdiagnostic treatment targeting overcontrol) for adolescents (RO DBT-A). This study tested the preliminary efficacy of telehealth-delivered RO DBT-A in a heterogeneous clinical sample of youths. METHODS The sample consisted of 20 female participants ages 13-21 with elevated overcontrol; most were White (75%) and non-Hispanic/Latino (80%). RO DBT-A was provided over 20 weeks via skills group and individual sessions (N=13 participants). Participants seeking other treatment or no treatment formed the control group (N=7). Outcomes included self-reported symptoms and overcontrol. Follow-up interviews were analyzed by using inductive, contextualist thematic analysis to examine participant perceptions and reasons for dropout. RESULTS The RO DBT-A group showed significant improvements in depression (t=-1.78, df=10, p=0.011) and quality of life (QOL; Wilcoxon W=75, p=0.021) compared with the control group. From baseline to posttreatment, youths receiving RO DBT-A demonstrated significant improvements in maladaptive overcontrol (t=2.76, df=12, p=0.043), anxiety (t=2.91, df=12, p=0.043), depression (Wilcoxon signed rank V=82.5, p=0.043), and QOL (t=-3.01, df=12, p=0.043). Qualitative analysis revealed themes related to treatment barriers, facilitators, and timing. CONCLUSIONS The findings provide preliminary evidence supporting telehealth-delivered RO DBT-A in targeting overcontrol, decreasing symptomatology, and improving QOL in a heterogeneous clinical sample of youths. Qualitative follow-ups highlighted that dropout was driven by barriers related to therapy (e.g., structure- and therapist-related issues) and the timing of RO DBT-A compared with other treatments.
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Affiliation(s)
- Molly Fennig
- Department of Psychological and Brain Sciences, Washington University in St. Louis (Fennig); Department of Psychiatry, Washington University School of Medicine, St. Louis (Agali, Looby, Gilbert)
| | - Uchechukwu Agali
- Department of Psychological and Brain Sciences, Washington University in St. Louis (Fennig); Department of Psychiatry, Washington University School of Medicine, St. Louis (Agali, Looby, Gilbert)
| | - Melinda Looby
- Department of Psychological and Brain Sciences, Washington University in St. Louis (Fennig); Department of Psychiatry, Washington University School of Medicine, St. Louis (Agali, Looby, Gilbert)
| | - Kirsten Gilbert
- Department of Psychological and Brain Sciences, Washington University in St. Louis (Fennig); Department of Psychiatry, Washington University School of Medicine, St. Louis (Agali, Looby, Gilbert)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fan H, Han Z, Gong X, Wu Y, Fu Y, Zhu T, Li H. Prevalence and predictors of depression and anxiety in patients with chronic rhinosinusitis: a systematic review and meta-analysis. BMJ Open 2024; 14:e079273. [PMID: 38490652 PMCID: PMC10946353 DOI: 10.1136/bmjopen-2023-079273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a persistent inflammation of the sinuses. As a result of long-term discomfort, patients may experience symptoms of common mental disorders such as anxiety and depression. This may affect the quality of life and disease progression. However, there is still uncertainty about the extent of the problem. OBJECTIVE This meta-analysis aimed to determine the prevalence of depression and anxiety symptoms in patients with CRS. SEARCH STRATEGY We searched PubMed, Embase, Web of Science, Cochrane Library, and CBM databases for relevant studies published before 15 July 2022 in patients with CRS with concomitant depression and anxiety symptoms. DATA COLLECTION AND ANALYSIS Two authors independently performed screening and quality assessment using validated tools. Extraction of data using predefined standardised data collection spreadsheets. Heterogeneity and inconsistency were checked using the I² statistic. RESULTS The meta-analysis included 32 articles involving 56 933 patients. The prevalence of depression and anxiety symptoms was estimated at 24.7% (95% CI, 21.3% to 28. 1%) and 29.7% (95% CI, 19.3% to 40.2%). Subgroup analysis revealed the following: (1) CRS without nasal polyps (CRSsNP): 26.2% (95% CI, 21.9% to 30.5%), CRS with nasal polyps(CRSwNP): 20% (95% CI, 15.9% to 24%); (2) Female patients: 36. 1% (95% CI, 25.3% to 46.9%), male patients: 24.3% (95% CI, 12. 1% to 36.6%); and (3) The average age≤50 years patients: 29.8% (95% CI, 21.3% to 38.2%), the average age>50 years patients: 22. 1% (95% CI, 17.1% to 27%). CONCLUSION A significant proportion of people with CRS have symptoms of depression and anxiety, and early screening for depression and anxiety in people with CRS is critical. And, more attention needs to be given to females and patients with CRSsNP during screening. PROSPERO REGISTRATION NUMBER CRD42022345959).
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Affiliation(s)
- Hongli Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhoutong Han
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xinru Gong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuqi Wu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yijie Fu
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, China
| | - Tianmin Zhu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Li
- School of Preclinical Medicine, Chengdu University, Chengdu, Sichuan, China
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Wang W, Zhou L, Hu Q, Gao Y, Wei Y, Tang X, Hu Y, Xu L, Liu H, Wang Z, Chen T, Li C, Wu H, Wang J, Zhang T. Correlative relationship between body mass index and heart rate variability in psychiatric disorders. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01768-1. [PMID: 38470538 DOI: 10.1007/s00406-024-01768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/19/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Indicators of heart rate variability (HRV) have been used to assess the autonomic activity. However, the influence of obesity on HRV in these patients remains to be determined. This study aimed to examine how obesity (measured with the body mass index [BMI]) affects HRV and determine whether the effect varies among different psychiatric disorders. We recruited 3159 consecutive patients, including 1744 with schizophrenia, 966 with mood disorders, and 449 with anxiety disorders. Patients were divided into four groups based on BMI: underweight (< 18.5), normal weight (18.5-23.9), overweight (24-27.9), and obese (≥ 28). The cardiovascular status was assessed using several time- and frequency-based HRV indicators, measured via electrocardiogram signals recorded for 5 min. The mean BMI of the participants was 23.6 ± 4.0. The patients in the overweight and obese groups were 29.4% and 13.6% of the total, respectively. The HRV indicators were higher in underweight and normal-weight patients than in the overweight and obese ones. After stratification based on the psychiatric diagnosis, the patients with mood disorders showed lower HRV than those with schizophrenia or anxiety disorder in the normal-weight group. In contrast, in the overweight and obese groups the patients with mood disorders showed higher HRV than those with the other disorders. The HRV variables were significantly associated with BMI, and higher BMI was associated with higher heart rates and lower HRV. These results indicate that weight gain in psychiatric disorders is associated with an imbalance in autonomic nerve activity. However, the relationship between autonomic activity, weight gain, and psychiatric disorders warrants further investigation.
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Affiliation(s)
- WenZheng Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China
| | - LinLin Zhou
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China
| | - Qiang Hu
- Department of Psychiatry, Zhen Jiang Mental Health Center, Zhenjiang, People's Republic of China
| | - YuQing Gao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - ZiXuan Wang
- Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada
- Labor and Worklife Program, Harvard University, Massachusetts, USA
| | - ChunBo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China
| | - HaiSu Wu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China.
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China.
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Beijing, People's Republic of China.
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, China.
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32
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Diemer J, Kothgassner OD, Herrmann MJ, Zwanzger P. [VR-supported therapy for anxiety and posttraumatic stress disorder: current possibilities and limitations]. Nervenarzt 2024; 95:223-229. [PMID: 38051348 DOI: 10.1007/s00115-023-01570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Virtual reality (VR) is increasingly used in psychotherapy, and the speed of development of therapeutic VR tools is continuously increasing. OBJECTIVE This narrative review provides an overview of the state of the art regarding VR applications for psychotherapy. MATERIAL AND METHODS The current state of VR therapy research for anxiety disorders and posttraumatic stress disorder (PTSD) is summarized. The focus lies on VR exposure therapy. Current developments in the field are outlined. RESULTS For anxiety disorders, especially phobic disorders, there are already positive recommendations in the current German S3 guidelines. For PTSD, the development of VR therapy tools is still in a relatively early stage. CONCLUSION The development of mobile cost-effective VR solutions in recent years has enabled entirely new applications for VR. The empirical challenges of these new developments are considerable. Nevertheless, the chances for an improvement of psychotherapeutic routine care are good.
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Affiliation(s)
- Julia Diemer
- Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg am Inn, Deutschland
- Department Psychologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Oswald D Kothgassner
- Stress in Childhood & Adolescence Research Unit (SCAR-Unit), Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Wien, Österreich
| | - Martin J Herrmann
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Peter Zwanzger
- Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg am Inn, Deutschland.
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland.
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Gómez-Gómez I, Barquero-Jiménez C, Johnson E, Conejo-Cerón S, Moreno-Peral P, Bellón JÁ, Motrico E. Effectiveness of multiple health behavior change interventions in reducing symptoms of anxiety in the adult population: A systematic review and meta-analysis of randomized controlled trials. Prev Med 2024; 180:107847. [PMID: 38199592 DOI: 10.1016/j.ypmed.2024.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/30/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
There is limited evidence regarding the effectiveness of preventive interventions for anxiety disorders. We aim to test the effectiveness of multiple health behavior change (MHBC) interventions in the reduction of symptoms of anxiety in the adult population. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching the most relevant databases and registry platforms in the area. Reference lists of included articles and relevant systematic reviews and meta-analyses of MHBC interventions that examined anxiety or depression as outcomes were also manually searched. To identify RCTs that evaluated preventive interventions, we excluded studies in which the target population included only patients meeting the diagnostic criteria for anxiety disorders. To pool results, the standardized mean difference (SMD) was calculated using the random effects model. Sensitivity, subgroup and meta-regression analyses were performed. Forty-six RCTs were included in the qualitative synthesis, and 34 RCTs were included in the meta-analysis. Thirty RCTs were focused on promoting healthy diet and physical activity, whereas the other 16 studies also focused on smoking cessation. The pooled SMD was small (-0.183; 95% CI -0.276 to -0.091) but significant (p < 0.001). The effect became non-significant when only studies with a low risk of bias were included. There was substantial and significant heterogeneity between the studies. There is currently insufficient evidence regarding the effectiveness of MHBC interventions to reduce symptoms of anxiety in the adult population.
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Affiliation(s)
- Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucía, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | | | - Emma Johnson
- Centre for Applied Psychology, School of Psychology, University of Birmingham, UK
| | - Sonia Conejo-Cerón
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Patricia Moreno-Peral
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; Department of Personality, Assessment and Psychological Treatment, University of Malaga (UMA), Spain
| | - Juan Ángel Bellón
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Spain; El Palo Health Centre, Andalusian Health Service (SAS), Spain; Department of Public Health and Psychiatry, University of Málaga (UMA), Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
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van Dis EAM, Hagenaars MA, Engelhard IM. Mental threat rehearsal increases fear generalization. J Behav Ther Exp Psychiatry 2024; 82:101917. [PMID: 37984086 DOI: 10.1016/j.jbtep.2023.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Fear generalization to harmless stimuli characterizes anxiety-related disorders, but much remains unknown about its determinants. Based on studies showing that mental imagery of threat can increase conditioned fear responding, we tested whether it also facilitates fear generalization, and whether threat inflation moderates this effect. METHODS In a fear conditioning study, 120 participants first completed an acquisition phase, in which one of two pictures was followed by an aversive sound (human scream). Then, the sound was presented 11 times at an increasing (threat inflation) or constant volume (no threat inflation). Finally, a generalization stimulus was presented, and some participants were asked to imagine the last sound (threat rehearsal) and others were not (no threat rehearsal). RESULTS Bayesian informative hypotheses tests indicated that imagery-based threat rehearsal increased generalization of threat expectancy, and, combined with threat inflation, it also resulted in stronger generalized distress. LIMITATIONS due to the absence of a test phase, it is unclear whether our effects would transfer to other GSs and whether they would persist beyond the manipulation phase. CONCLUSIONS Mental imagery of threat may put individuals at risk for fear generalization. Future studies should examine whether modulating imagery may prevent clinical anxiety.
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Affiliation(s)
- Eva A M van Dis
- Department of Clinical Psychology, Utrecht University, the Netherlands.
| | | | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, the Netherlands
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35
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He ZQ, Wang Q, Xu CY, Yang J, Huang YJ. Depression and anxiety symptom network structure among patients with coronary heart disease and association with quality of life: protocol for a multicentre cross-sectional and prospective longitudinal study. BMJ Open 2024; 14:e079298. [PMID: 38418239 PMCID: PMC10910689 DOI: 10.1136/bmjopen-2023-079298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/13/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Anxiety and depression are critical mental health problems among persons with coronary heart disease (CHD). The range of symptoms is an important stressor for adverse cardiovascular events, and these symptoms can be involved in various ways during the course of CHD. However, the characteristics and mechanisms of comorbidity between the two mental states from the viewpoint of symptom interactions in patients with CHD remain unclear. Therefore, we aim to apply a symptom-oriented approach to identify core and bridge symptoms between anxiety and depression in a population with CHD and to identify differences in network structure over time and symptomatic link profiles. METHODS AND ANALYSIS We designed a multicentre, cross-sectional, longitudinal study of anxiety and depression symptoms among patients with CHD. We will evaluate degrees of symptoms using the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire and the WHO Quality of Life-Brief version. Patients will be followed up for 1, 3 and 6 months after baseline measurements. We will analyse and interpret network structures using R software and its packages. The primary outcomes of interest will include centrality, bridge connections, estimates, differences in network structures and profiles of changes over time. The secondary outcome measures will be the stability and accuracy of the network. By combining cross-sectional and longitudinal analyses, this study should elucidate the central and potential causative pathways among anxiety and depression symptom networks as well as their temporal stability in patients with CHD. ETHICS AND DISSEMINATION The project conforms to the ethical principles enshrined in the Declaration of Helsinki (2013 amendment) and all local ethical guidelines. The ethics committee at the University of South China approved the study (Approval ID: 2023-USC-HL-414). The findings will be published and presented at conferences for widespread dissemination. TRIAL REGISTRATION NUMBER ChiCTR2300075813.
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Affiliation(s)
- Zhi-Qing He
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Qi Wang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Chao-Yue Xu
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Jing Yang
- The Second Affiliated Hospital of the University of South China, Hengyang, Hunan, China
| | - Yan-Jin Huang
- School of Nursing, University of South China, Hengyang, Hunan, China
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36
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Keyan D, Habashneh R, Akhtar A, El-Dardery H, Faroun M, Abualhaija A, Aqel IS, Dardas LA, Bryant R. Evaluating a stepped care model of psychological support for adults affected by adversity: study protocol for a randomised controlled trial in Jordan. BMJ Open 2024; 14:e078091. [PMID: 38413156 PMCID: PMC10900353 DOI: 10.1136/bmjopen-2023-078091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The burden of common mental disorders in low and middle-income countries (LMICs) is growing with little known about how to allocate limited resources to reach the greatest number of people undergoing instances of significant psychological distress. We present a study protocol for a multicentre, parallel-group, superiority, randomised controlled trial. METHODS AND ANALYSIS Adults with significant psychological distress (K10 score ≥20) will be randomised to receive a stepped care programme involving a self-guided course (Doing What Matters) followed by a more intensive group programme (Problem Management Plus) or the self-guided course alone, both of which will take place in addition to enhanced treatment as usual comprising of a follow-up referral session to available services within the community. We will include 800 participants. An intent-to-treat and completer analysis will explore the impact of the stepped model of care on anxiety and depression symptoms (as measured by the Hopkins Symptom Checklist; HSCL-25) at 24 weeks from baseline. Secondary outcomes include positive psychological well-being, agency, changes in patient-identified problems, quality of life and cost-effectiveness. Linear mixed models will be used to assess the differential impact of the conditions over time. Analyses will focus on the primary outcome (HSCL-25) and secondary outcomes (agency subscale, WHO Well-Being Index, WHO Disability Assessment Schedule V.2.0, EQ-5D, Psychological Outcomes Profiles Scale) for both conditions, with the main outcome time point being the 3-month follow-up, relative to baseline. ETHICS AND DISSEMINATION This will be the first randomised controlled trial to assess the benefits of a stepped model of care to addressing psychological distress in a LMIC setting. Results will provide important insights for managing limited resources to mental healthcare in these settings and will be accordingly disseminated to service providers and organisations via professional training and meetings, and via publication in relevant journals and conference presentations. We will also present these findings to the Jordanian Ministry of Health, where this institute will guide us on the most appropriate format for communication of findings, including written reports, verbal presentations and/or brochures. Ethical approval was obtained from the University of Jordan School of Nursing Research Ethics Committee (number: PF.22.10). TRIAL REGISTRATION NUMBER ACTRN12621000189820p; Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Dharani Keyan
- School of Psychology, UNSW, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | - Richard Bryant
- School of Psychology, UNSW, Sydney, New South Wales, Australia
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De Bandt D, Haile SR, Devillers L, Bourrion B, Menges D. Prescriptions of antidepressants and anxiolytics in France 2012-2022 and changes with the COVID-19 pandemic: interrupted time series analysis. BMJ Ment Health 2024; 27:e301026. [PMID: 38413052 PMCID: PMC10900346 DOI: 10.1136/bmjment-2024-301026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Depression and anxiety have increased in prevalence since the start of the COVID-19 pandemic. OBJECTIVE To evaluate the consumption of antidepressants and anxiolytics from 2012 to 2022 and the pandemic's potential impact in France. METHODS We conducted an interrupted time series analysis of routine drug sales data (Medic'AM) from all French outpatient pharmacies from 2012 to 2022. We investigated trends in defined daily doses of antidepressants and anxiolytics sold per 1000 inhabitants (DDD/TID) and related expenditures before and after pandemic onset and in relation with stringency of pandemic mitigation measures. Analyses were performed descriptively and using segmented linear regression, autoregressive and autoregressive integrated moving average models. FINDINGS From 2012 to 2019, overall monthly antidepressant sales increased (+0.02 DDD/TID) while monthly anxiolytic sales decreased (-0.07 DDD/TID). With pandemic onset, there was a relevant and persisting trend increase (+0.20 DDD/TID per month) for antidepressant sales overall, with an estimated excess of 112.6 DDD/TID sold from May 2020 until December 2022. Anxiolytic sales were elevated from February 2020 throughout the pandemic but returned to expected levels by December 2022, with an estimated excess of 33.8 DDD/TID. There was no evident association between stringency and antidepressant or anxiolytic sales. CONCLUSIONS This study showed a protracted trend increase in the consumption of antidepressants since pandemic onset, while increases in anxiolytic consumption were temporary. CLINICAL IMPLICATIONS We provide evidence that the COVID-19 pandemic may have had long-lasting consequences on the prevalence and treatment of depression and anxiety disorders, requiring further actions by researchers and policy-makers to address this potential public mental health crisis.
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Affiliation(s)
- David De Bandt
- General Practice, Versailles Saint-Quentin-en-Yvelines University Faculty of Science, Montigny le Bretonneux, France
- Center for Research in Epidemiology and Population Health, The French National Institute of Health and Medical Research, INSERM U1018 Equipe 11, Villejuif, Île-de-France, France
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Louise Devillers
- General Practice, Versailles Saint-Quentin-en-Yvelines University Faculty of Science, Montigny le Bretonneux, France
- Center for Research in Epidemiology and Population Health, The French National Institute of Health and Medical Research, INSERM U1018 Equipe 11, Villejuif, Île-de-France, France
| | - Bastien Bourrion
- General Practice, Versailles Saint-Quentin-en-Yvelines University Faculty of Science, Montigny le Bretonneux, France
- Center for Research in Epidemiology and Population Health, The French National Institute of Health and Medical Research, INSERM U1018 Equipe 11, Villejuif, Île-de-France, France
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Fairbrother N, Stagg B, Scoten O, Keeney C, Cargnelli C. Perinatal anxiety disorders screening study: a study protocol. BMC Psychiatry 2024; 24:162. [PMID: 38395837 PMCID: PMC10893673 DOI: 10.1186/s12888-024-05575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The anxiety and their related disorders (AD) are the most common of all mental health conditions, and affect approximately 20% of pregnant and postpartum people. They are associated with significant distress and life interference for sufferers, as well as negative consequences for fetal and infant development. At present, little if any routine screening for prenatal AD is being conducted and data regarding the most effective tools to screen for these disorders is lacking. The majority of screening studies suffer from methodological difficulties which undermine the confidence needed to recommend measures for population distribution. The primary purpose of this research is to identify the most accurate self-report tool(s) to screen for perinatal AD. METHODS A large, prospective cohort of pregnant people (N = 1,000) is being recruited proportionally across health service delivery regions in British Columbia (BC). The screening accuracy of a broad range of perinatal AD self-report measures are being assessed using gold standard methodology. Consenting individuals are administered online questionnaires followed by a semi-structured diagnostic interview between 16- and 36-weeks' gestation, and again between 6 and 20 weeks postpartum. Questionnaires include all screening measures, measures of sleep and unpaid family work, and questions pertaining to demographic and reproductive history, COVID-19, gender role burden, and mental health treatment utilization. Interviews assess all current anxiety disorders, as well as obsessive-compulsive disorder, and posttraumatic stress disorder. DISCUSSION This research is in response to an urgent demand for accurate perinatal AD screening tools based on high quality evidence. AD among perinatal people often go unidentified and untreated, resulting in continued suffering and life impairment. Findings from this research will inform healthcare providers, policymakers, and scientists, about the most effective approach to screening for anxiety and related disorders in pregnancy in the postpartum period.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, Canada.
| | - Bryn Stagg
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Olivia Scoten
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Claudia Cargnelli
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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McAusland L, Burton CL, Bagnell A, Boylan K, Hatchard T, Lingley-Pottie P, Al Maruf A, McGrath P, Newton AS, Rowa K, Schachar RJ, Shaheen SM, Stewart S, Arnold PD, Crosbie J, Mattheisen M, Soreni N, Stewart SE, Meier S. The genetic architecture of youth anxiety: a study protocol. BMC Psychiatry 2024; 24:159. [PMID: 38395805 PMCID: PMC10885620 DOI: 10.1186/s12888-024-05583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric problems among Canadian youth and typically have an onset in childhood or adolescence. They are characterized by high rates of relapse and chronicity, often resulting in substantial impairment across the lifespan. Genetic factors play an important role in the vulnerability toward anxiety disorders. However, genetic contribution to anxiety in youth is not well understood and can change across developmental stages. Large-scale genetic studies of youth are needed with detailed assessments of symptoms of anxiety disorders and their major comorbidities to inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. METHODS The Genetic Architecture of Youth Anxiety (GAYA) study is a Pan-Canadian effort of clinical and genetic experts with specific recruitment sites in Calgary, Halifax, Hamilton, Toronto, and Vancouver. Youth aged 10-19 (n = 13,000) will be recruited from both clinical and community settings and will provide saliva samples, complete online questionnaires on demographics, symptoms of mental health concerns, and behavioural inhibition, and complete neurocognitive tasks. A subset of youth will be offered access to a self-managed Internet-based cognitive behavioral therapy resource. Analyses will focus on the identification of novel genetic risk loci for anxiety disorders in youth and assess how much of the genetic risk for anxiety disorders is unique or shared across the life span. DISCUSSION Results will substantially inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. Given that the GAYA study will be the biggest genomic study of anxiety disorders in youth in Canada, this project will further foster collaborations nationally and across the world.
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Affiliation(s)
- Laina McAusland
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada.
| | - Christie L Burton
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Khrista Boylan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Center for Child Studies, Hamilton, ON, Canada
- Child and Youth Mental Health Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Taylor Hatchard
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Youth Wellness Center, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Patricia Lingley-Pottie
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, IWK Health Centre, Halifax, NS, Canada
| | - Abdullah Al Maruf
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Patrick McGrath
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Karen Rowa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Russell J Schachar
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - S-M Shaheen
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Sam Stewart
- Department of Epidemiology and Community Health, Dalhousie University, Halifax, NS, Canada
| | - Paul D Arnold
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jennifer Crosbie
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Manuel Mattheisen
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Epidemiology and Community Health, Dalhousie University, Halifax, NS, Canada
- Department of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Noam Soreni
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Center for Child Studies, Hamilton, ON, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Pediatric OCD Consultation Service, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Epidemiology and Community Health, Dalhousie University, Halifax, NS, Canada
- Department of Computer Science, Dalhousie University, Halifax, NS, Canada
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Teixeira MJC, Ahmed R, Tehrany R, Jaggi A, Ramanuj P. Collaborative care model versus usual care for the management of musculoskeletal and co-existing mental health conditions: a randomised feasibility mixed-methods study. BMJ Open 2024; 14:e079707. [PMID: 38387980 PMCID: PMC10882312 DOI: 10.1136/bmjopen-2023-079707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE This study aimed to assess the feasibility of a future trial comparing the collaborative care model with usual care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression. DESIGN A single-centre, parallel-arm, one-to-one, randomised controlled trial design using a mixed-methods approach was used. semistructured interviews and focus groups were conducted post intervention with all participants and staff respectively to explore acceptability towards the model and identify recommendations for improvements. SETTING An orthopaedic rehabilitation outpatient tertiary hospital. PARTICIPANTS Adult patients with musculoskeletal conditions and co-existing moderate or severe symptoms of anxiety and depression attending outpatient therapy appointments. INTERVENTION The collaborative care model consisted of a tailored management programme to facilitate the integration of care provided by physical and mental healthcare professionals. A case manager screened and coordinated targeted mental health support for participants. Participants allocated to usual care had no support from the case manager. MAIN OUTCOMES MEASURE Feasibility indicators (rates of recruitment, randomisation and retention), acceptability of clinical outcome measures, usage of additional resources and cost of intervention implementation. RESULTS Of the 89 patients who provided consent to take part, 40 participants who matched the eligibility criteria were randomised to either the intervention (n=20) or usual care arm (n=20). Overall adherence to the intervention was 58.82%, while the withdrawal rate was 37.5% at 6 months. All of the 27 participants who were retained completed self-reported outcomes. Qualitative data highlighted that integrated mental health support was favourably perceived. In addition to prenegotiating protected psychology time, the need for operationalised communication between the case manager and clinicians was identified as a recommendation for a future trial. CONCLUSIONS The trial and intervention were acceptable to patients and healthcare professionals. While the findings demonstrate the feasibility of trial recruitment, a future trial will require optimised retention strategies to improve adherence and withdrawal rates. TRIAL REGISTRATION NUMBER NCT05018039.
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Affiliation(s)
| | - Refah Ahmed
- East London NHS Foundation Trust, London, UK
| | - Rokhsaneh Tehrany
- Therapies Departament, Royal National Orthopaedic Hospital NHS Trust, London, UK
- University College London, London, UK
| | - Anju Jaggi
- Therapies Departament, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
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41
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Zhi Z, Yan S, Yijuan H, Jiahuan Z, Xiaohan J, Dandan C. Trends in the disease burden of anxiety disorders in middle-aged and older adults in China. BMC Psychol 2024; 12:83. [PMID: 38373999 PMCID: PMC10877872 DOI: 10.1186/s40359-024-01575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Anxiety disorders in middle-aged and older adults are an important public health concern in China. Based on the data in the global disease burden (GDB) research database, this study evaluated and analyzed the trend of the disease burden of middle-aged and older patients living with anxiety in China in the past 30 years. METHODS The incidence and disability-adjusted life years (DALYs) data of anxiety disorders in China for individuals aged 45-89 years were collected from the Global Burden of Disease Study 2019, and the effects of age, period, and cohort on the incidence of and DALY rate for anxiety disorders were analysed using an age-period-cohort model. Because of the COVID-19 pandemic, the global disease burden research database has not been updated since 2019. However, this did not affect the analysis of future trends in this study, which combined data in the past three decades from 1990 to 2019. RESULTS (1) The overall age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) for anxiety disorders in middle-aged and older adults in China decreased by 4.0 and 7.7% from 1990 to 2019, respectively, and the ASIR and ASDR were always higher in women than in men. (2)Age-period-cohort analysis showed that the net drifts for incidence and DALY rate were - 0.27% and - 0.55% per year, respectively. For both genders, the local drifts for incidence were lower than zero in those aged 45-79 years and higher than zero in those aged 80-89 years; the local drifts for the DALY rate were lower than zero in all groups. (3) From the 1990-1994 to 2015-2019, the relative risks of anxiety disorder incidence and DALY decreased by 5.6 and 7.3% in men and 4.3 and 11.7% in women, respectively. CONCLUSION The disease burden of anxiety disorders in middle-aged and older adults in China has been relieved over the past 30 years; however, recent ASDR, ASDR, period, and cohort effects have shown adverse trends. The incidence and DALY rate decreased with age in women, while men showed a trend of increasing first and decreasing afterwards.
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Affiliation(s)
- Zeng Zhi
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Shi Yan
- Pukou Hospital of Traditional Chinese Medicine in Nanjing, Nanjing, 211899, China.
| | - He Yijuan
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China
- Science and Education Department, Taicang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215400, Jiangsu Province, China
| | - Zheng Jiahuan
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Jiang Xiaohan
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Chen Dandan
- School of Health and Economics Management, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
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Cohen SE, Zantvoord JB, Storosum BWC, Mattila TK, Daams J, Wezenberg B, de Boer A, Denys DAJP. Influence of study characteristics, methodological rigour and publication bias on efficacy of pharmacotherapy in obsessive-compulsive disorder: a systematic review and meta-analysis of randomised, placebo-controlled trials. BMJ Ment Health 2024; 27:e300951. [PMID: 38350669 PMCID: PMC10862307 DOI: 10.1136/bmjment-2023-300951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
QUESTION We examined the effect of study characteristics, risk of bias and publication bias on the efficacy of pharmacotherapy in randomised controlled trials (RCTs) for obsessive-compulsive disorder (OCD). STUDY SELECTION AND ANALYSIS We conducted a systematic search of double-blinded, placebo-controlled, short-term RCTs with selective serotonergic reuptake inhibitors (SSRIs) or clomipramine. We performed a random-effect meta-analysis using change in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) as the primary outcome. We performed meta-regression for risk of bias, intervention, sponsor status, number of trial arms, use of placebo run-in, dosing, publication year, age, severity, illness duration and gender distribution. Furthermore, we analysed publication bias using a Bayesian selection model. FINDINGS We screened 3729 articles and included 21 studies, with 4102 participants. Meta-analysis showed an effect size of -0.59 (Hedges' G, 95% CI -0.73 to -0.46), equalling a 4.2-point reduction in the YBOCS compared with placebo. The most recent trial was performed in 2007 and most trials were at risk of bias. We found an indication for publication bias, and subsequent correction for this bias resulted in a depleted effect size. In our meta-regression, we found that high risk of bias was associated with a larger effect size. Clomipramine was more effective than SSRIs, even after correcting for risk of bias. After correction for multiple testing, other selected predictors were non-significant. CONCLUSIONS Our findings reveal superiority of clomipramine over SSRIs, even after adjusting for risk of bias. Effect sizes may be attenuated when considering publication bias and methodological rigour, emphasising the importance of robust studies to guide clinical utility of OCD pharmacotherapy. PROSPERO REGISTRATION NUMBER CRD42023394924.
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Affiliation(s)
- Sem E Cohen
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Jasper Brian Zantvoord
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Bram W C Storosum
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | | | - Joost Daams
- Medical Library, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Babet Wezenberg
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Anthonius de Boer
- Medicines Evaluation Board, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Damiaan A J P Denys
- Psychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
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Peng X, Zhang S, You L, Hu W, Jin S, Wang J. Prevalence and correlates of depression and anxiety symptoms among older adults in Shenzhen, China: a cross-sectional population-based study. BMJ Open 2024; 14:e077078. [PMID: 38341212 PMCID: PMC10862290 DOI: 10.1136/bmjopen-2023-077078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To investigate the prevalence of depression and anxiety symptoms among older adults in an urban district in China, as well as their associated factors. DESIGN Cross-sectional study. SETTING General communities in Shenzhen, Guangdong, China. PARTICIPANTS A total of 5372 community-dwelling older adults aged 65 years or older were initially recruited. Ultimately, 5331 participants met the inclusion criteria and were included in this study. METHODS Participants completed a sociodemographic questionnaire, along with assessments including the Patient Health Questionnaire-9, Generalised Anxiety Scale-7, UCLA Loneliness Simplification Scale, Insomnia Severity Index Scale (ISI), Community Dementia Brief Screening Scale and the 8-item Dementia Screening Questionnaire. Statistical analyses included the Shapiro-Wilk test, independent t-test, Wilcoxon rank test, χ2 test and univariate and multivariate linear regression analysis. RESULTS The prevalence of depression and anxiety symptoms among older adults in Shenzhen communities was 10.4% and 11.3%, respectively. In multivariate analysis, age (B=-0.01, p<0.05), relatively poor health status in the past year (B=1.00, p<0.01), poor health status in the past year (B=2.40, p<0.01), ISI score (B=0.21, p<0.01), -item Ascertain Dementia Questionnaire (AD8) score (B=0.22, p<0.01), UCLA Loneliness Scale (ULS) score (B=0.24, p<0.01) were significantly associated with the severity of depression symptom, Compared with their respective reference categories, relatively poor health status in the past year (B=0.50, p<0.01), poor health status in the past year (B=1.32, p<0.01), ISI score (B=0.23, p<0.01), sleep duration (B=0.05, p<0.01), AD8 score (B=0.21, p<0.01), Community Screening Instrument for Dementia score (B=0.13, p<0.01), ULS score (B=0.22, p<0.01) were significantly associated with the severity of anxiety symptom. CONCLUSIONS We observed a high prevalence of depression and anxiety symptoms among older adults in this study. The existing welfare system and infrastructure should remain and targeted mental health programmes addressing the identified risk factors should be proposed.
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Affiliation(s)
- Xiaodong Peng
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Shengming Zhang
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
- Affiliated Mental Health Centers, Southern University of Science and Technology School of Medicine, Shenzhen, Guangdong, China
| | - Liqin You
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Wenxuan Hu
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Shan Jin
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Jianhong Wang
- Affiliated Mental Health Centers, Southern University of Science and Technology School of Medicine, Shenzhen, Guangdong, China
- Shenzhen Kangning Hospital, Shenzhen, China
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Moreira H, Skvarc D, Gomes-Pereira B, Albuquerque A, Góis AC, Fonseca A, Pereira AM, Caiado B, Paulino B, Santos C, Ehrenreich-May J, Canavarro MC, Saraiva M, Vicente VN, Pereira AI. Study protocol for a randomized controlled trial testing the efficacy of Emotion Detectives In-Out: a blended version of the unified protocol for transdiagnostic treatment of emotional disorders in Portuguese children. BMC Psychol 2024; 12:63. [PMID: 38326847 PMCID: PMC10851582 DOI: 10.1186/s40359-024-01532-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways. METHODS This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention. DISCUSSION We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families. TRIAL REGISTRATION The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).
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Affiliation(s)
- Helena Moreira
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal.
| | - Dave Skvarc
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Bárbara Gomes-Pereira
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | | | - Ana Carolina Góis
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | - Ana Fonseca
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | - Ana Maria Pereira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Brígida Caiado
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
- Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Bruna Paulino
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Catarina Santos
- Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | | | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | - Mariana Saraiva
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Vitória Nunes Vicente
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua Do Colégio Novo, 3030-115, Coimbra, Portugal
| | - Ana Isabel Pereira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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Zhang F, Xu H, Liu Q, Sun Y, Yan W, Ouyang H, Liu W. Single session of interpretation bias modification helped to improve fear of COVID-19 and COVID-19-related post-traumatic stress symptoms. BMJ Ment Health 2024; 27:e300871. [PMID: 38302409 PMCID: PMC10836354 DOI: 10.1136/bmjment-2023-300871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are frequently observed in those who have experienced trauma events like the COVID-19 outbreak. The cognitive model of PTSS highlights the relationship between PTSS and negative interpretation bias. OBJECTIVE The present study aimed to modify interpretation bias and to improve PTSS as well as PTSS-related fear. METHODS 59 participants with high PTSS levels were recruited and randomly allocated to either the interpretation modification programme (IMP) intervention group or the interpretation control condition (ICC) control group. PTSS, negative interpretation bias, fear of COVID-19, and depression and anxiety symptoms were assessed before and after training. FINDINGS Intention-to-treat analyses showed that compared with ICC, participants receiving IMP generated fewer negative interpretations for ambiguous scenarios, and the group-by-time interaction effect was significant. IMP also illustrated a more significant change in fear after training compared with ICC. Although no effects of training conditions were found on PTSS, the interaction of training conditions with fear reduction could predict PTSS improvement. CONCLUSIONS IMP could improve negative interpretations and fear related to COVID-19 and might help to ameliorate PTSS. CLINICAL IMPLICATIONS The role of PTSS-related emotion should be considered when exploring the effectiveness of IMP. IMP is a flexible approach that can be tailored to the specific characteristics of the traumatic event, which makes it suitable for a broader range of traumatised individuals.
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Affiliation(s)
- Fan Zhang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Huijing Xu
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Qian Liu
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Yingchao Sun
- Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Wenjie Yan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Hui Ouyang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
- The Emotion & Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, People's Republic of China
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Wang Q, Ren Z, Yue M, Zhao Y, Wang B, Zhao Z, Wen B, Hong Y, Chen Y, Zhao T, Wang N, Zhao P, Hong Y, Han X. A model for the diagnosis of anxiety in patients with epilepsy based on phase locking value and Lempel-Ziv complexity features of the electroencephalogram. Brain Res 2024; 1824:148662. [PMID: 37924926 DOI: 10.1016/j.brainres.2023.148662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/09/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Anxiety disorders (AD) are critical factors that significantly (about one-fifth) impact the quality of life (QoL) in patients with epilepsy (PWE). Objective diagnostic methods have contributed to the identification of PWE susceptible to AD. This study aimed to identify AD in PWE by constructing a diagnostic model based on the phase locking value (PLV) and Lempel-Ziv Complexity (LZC) features of the electroencephalogram (EEG). METHODS EEG data from 131 patients with epilepsy (PWE) were enrolled in this study. Patients were divided into two groups, anxiety disorder (AD, n = 61) and non-anxiety disorder (NAD, n = 70), according to the Hamilton Rating Scale for Anxiety (HAM-A). Support vector machine (SVM) and K-Nearest-Neighbor(KNN) algorithms were used to construct three models - the PLVEEG, LZCEEG, and PLVEEG + LZCEEG feature models. Finally, the area under the receiver operating characteristic curve (AUC) and statistical analyses were performed to evaluate the model performance. RESULTS The efficiency of the KNN-based PLCEEG + LZCEEG feature model was the best, and the accuracy, precision, recall, F1-score, and AUC of the model after five-fold cross-validations scores were 87.89 %, 82.27 %, 98.33 %, 88.95 %, and 0.89, respectively. When the model efficiency was optimal, 29 EEG features were suggested. Further analysis of these features indicated 22 EEG features that were significantly different between the two groups, including 50 % features of the alpha (α)-band. CONCLUSIONS The PLVEEG + LZCEEG model features can identify AD in PWE. The PLVEEG and LZCEEG characteristics of the α-band may further be explored as potential biomarkers for AD in PWE.
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Affiliation(s)
- Qi Wang
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Zhe Ren
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Mengyan Yue
- Department of Rehabilitation, The First Hospital of Shanxi Medical University, Shanxi Province, Taiyuan 030000, China
| | - Yibo Zhao
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Bin Wang
- Department of Neurology, Henan Provincial People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Zongya Zhao
- School of Medical Engineering, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Bin Wen
- School of Life Sciences and Technology, Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
| | - Yang Hong
- Department of Neurology, People's Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Yanan Chen
- Department of Neurology, Henan Provincial People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Yingxing Hong
- Department of Neurology, People's Hospital of Henan University, Zhengzhou 450003, Henan Province, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, Henan Province, Zhengzhou 450003, China.
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Williams M, Honan C, Skromanis S, Sanderson B, Matthews AJ. Psychological and attentional outcomes following acute mindfulness induction among high anxiety individuals: A systematic review and meta-analysis. J Psychiatr Res 2024; 170:361-374. [PMID: 38215647 DOI: 10.1016/j.jpsychires.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 08/19/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Training outcomes of mindfulness interventions for anxiety have been extensively researched. Less is known about the acute effects of mindfulness induction and associated mechanisms. This systematic review aimed to identify 1) the effect of mindfulness induction on pre-post measures of state anxiety and attention among adults experiencing high levels of anxiety; and 2) the impact of predictors, mediators and moderators on post-induction changes in anxiety and attention. State distress and mindfulness were included as secondary outcomes. METHODS A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Five studies (four randomised controlled trials and one non-randomised controlled trial) were included, comprising a total of 277 participants with elevated trait/generalised anxiety. Each study used a brief audio-based mindfulness induction exercise. RESULTS The meta-analysis indicated mindfulness induction had medium and large effects on state anxiety (k = 3, n = 100, g = -0.60, 95%CI [-1.04, -0.16]; p = .008) and state mindfulness (k = 2, n = 110, g = 0.91, 95%CI [0.52, 1.30], p < .001), respectively, when compared with non-therapeutic control conditions. Furthermore, two studies showed small and moderate effects of mindfulness on state anxiety when compared to therapeutic active controls, but were not pooled in a meta-analysis. While results could not be pooled for attention, there was limited evidence of behavioural improvements on tasks measuring aspects of attention following mindfulness induction. However, one study found an increase in Low Beta to High Beta ratio and a reduction in Beta activity in the Anterior Cingulate Cortex following mindfulness induction. Moreover, another study found aspects of state mindfulness mediated reductions in state anxiety. LIMITATIONS A small number of studies were included in the review, with high risk of bias and low certainty of evidence present. CONCLUSION The findings support the use of mindfulness induction to reduce state anxiety in anxious individuals but suggest gains in state mindfulness may be a more realistic expected outcome. Further controlled trials are needed to delineate the relative effects of objectively assessed anxiety outcomes from mindfulness induction in clinically defined samples.
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Affiliation(s)
- Monique Williams
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, Tasmania, Australia, 7001.
| | - Cynthia Honan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia, 7250
| | - Sarah Skromanis
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia, 7250
| | - Ben Sanderson
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, Tasmania, Australia, 7001
| | - Allison J Matthews
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, Tasmania, Australia, 7001
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Rakotobe M, Fjerdingstad N, Ruiz-Reig N, Lamonerie T, D'Autréaux F. Central role of the habenulo-interpeduncular system in the neurodevelopmental basis of susceptibility and resilience to anxiety in mice. Neurobiol Dis 2024; 191:106392. [PMID: 38145853 DOI: 10.1016/j.nbd.2023.106392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023] Open
Abstract
Having experienced stress during sensitive periods of brain development strongly influences how individuals cope with later stress. Some are prone to develop anxiety or depression, while others appear resilient. The as-yet-unknown mechanisms underlying these differences may lie in how genes and environmental stress interact to shape the circuits that control emotions. Here, we investigated the role of the habenulo-interpeduncular system (HIPS), a critical node in reward circuits, in early stress-induced anxiety in mice. We found that habenular and IPN components characterized by the expression of Otx2 are synaptically connected and particularly sensitive to chronic stress (CS) during the peripubertal period. Stress-induced peripubertal activation of this HIPS subcircuit elicits both HIPS hypersensitivity to later stress and susceptibility to develop anxiety. We also show that HIPS silencing through conditional Otx2 knockout counteracts these effects of stress. Together, these results demonstrate that a genetic factor, Otx2, and stress interact during the peripubertal period to shape the stress sensitivity of the HIPS, which is shown to be a key modulator of susceptibility or resilience to develop anxiety.
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Affiliation(s)
- Malalaniaina Rakotobe
- Université Côte d'Azur, CNRS, Inserm, iBV, Institut de Biologie Valrose, 06108 Nice, France
| | - Niels Fjerdingstad
- Université Côte d'Azur, CNRS, Inserm, iBV, Institut de Biologie Valrose, 06108 Nice, France
| | - Nuria Ruiz-Reig
- Université Côte d'Azur, CNRS, Inserm, iBV, Institut de Biologie Valrose, 06108 Nice, France
| | - Thomas Lamonerie
- Université Côte d'Azur, CNRS, Inserm, iBV, Institut de Biologie Valrose, 06108 Nice, France.
| | - Fabien D'Autréaux
- Université Côte d'Azur, CNRS, Inserm, iBV, Institut de Biologie Valrose, 06108 Nice, France. Fabien.D'
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49
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McDonald AJ, Kurdyak P, Rehm J, Roerecke M, Bondy SJ. Youth cannabis use and subsequent health service use for mood and anxiety disorders: A population-based cohort study. Psychiatry Res 2024; 332:115694. [PMID: 38176165 DOI: 10.1016/j.psychres.2023.115694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/16/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024]
Abstract
Epidemiologic research suggests a modest association between youth cannabis use and mood and anxiety disorders (MADs). However, current evidence is based mostly on cohort studies using data from the 20th century when cannabis was significantly less potent than today. We linked population-based survey data from 2009 to 2012 with administrative records of health services covered under universal healthcare up to 2017. The cohort included youth aged 12 to 24 years at baseline living in Ontario, Canada with no prior MAD health service use (n = 8,252). We conducted a multivariable Cox model to estimate the association between cannabis use frequency (never,
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Affiliation(s)
- André J McDonald
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada.
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research (ZIS), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Michael Roerecke
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Susan J Bondy
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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50
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Domschke K, Seuling PD, Schiele MA, Bandelow B, Batelaan NM, Bokma WA, Branchi I, Broich K, Burkauskas J, Davies SJC, Dell'Osso B, Fagan H, Fineberg NA, Furukawa TA, Hofmann SG, Hood S, Huneke NTM, Latas M, Lidbetter N, Masdrakis V, McAllister-Williams RH, Nardi AE, Pallanti S, Penninx BWJH, Perna G, Pilling S, Pini S, Reif A, Seedat S, Simons G, Srivastava S, Steibliene V, Stein DJ, Stein MB, van Ameringen M, van Balkom AJLM, van der Wee N, Zwanzger P, Baldwin DS. The definition of treatment resistance in anxiety disorders: a Delphi method-based consensus guideline. World Psychiatry 2024; 23:113-123. [PMID: 38214637 PMCID: PMC10785995 DOI: 10.1002/wps.21177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Anxiety disorders are very prevalent and often persistent mental disorders, with a considerable rate of treatment resistance which requires regulatory clinical trials of innovative therapeutic interventions. However, an explicit definition of treatment-resistant anxiety disorders (TR-AD) informing such trials is currently lacking. We used a Delphi method-based consensus approach to provide internationally agreed, consistent and clinically useful operational criteria for TR-AD in adults. Following a summary of the current state of knowledge based on international guidelines and an available systematic review, a survey of free-text responses to a 29-item questionnaire on relevant aspects of TR-AD, and an online consensus meeting, a panel of 36 multidisciplinary international experts and stakeholders voted anonymously on written statements in three survey rounds. Consensus was defined as ≥75% of the panel agreeing with a statement. The panel agreed on a set of 14 recommendations for the definition of TR-AD, providing detailed operational criteria for resistance to pharmacological and/or psychotherapeutic treatment, as well as a potential staging model. The panel also evaluated further aspects regarding epidemiological subgroups, comorbidities and biographical factors, the terminology of TR-AD vs. "difficult-to-treat" anxiety disorders, preferences and attitudes of persons with these disorders, and future research directions. This Delphi method-based consensus on operational criteria for TR-AD is expected to serve as a systematic, consistent and practical clinical guideline to aid in designing future mechanistic studies and facilitate clinical trials for regulatory purposes. This effort could ultimately lead to the development of more effective evidence-based stepped-care treatment algorithms for patients with anxiety disorders.
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Affiliation(s)
- Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrik D Seuling
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | - Neeltje M Batelaan
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Wicher A Bokma
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Igor Branchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Karl Broich
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Simon J C Davies
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Harry Fagan
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A Fineberg
- University of Hertfordshire & Hertfordshire Partnership, University NHS Foundation Trust, Hatfield, UK
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps University Marburg, Marburg, Germany
| | - Sean Hood
- Division of Psychiatry, Medical School, University of Western Australia, Perth, WA, Australia
| | - Nathan T M Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Milan Latas
- Clinic for Psychiatry, University Clinical Center of Serbia, Belgrade, Serbia
- Belgrade University School of Medicine, Belgrade, Serbia
| | | | - Vasilios Masdrakis
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - R Hamish McAllister-Williams
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle, UK
| | - Antonio E Nardi
- Panic & Respiration Laboratory, Institute of Psychiatry, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stefano Pallanti
- Institute of Neuroscience, Florence, Italy
- Albert Einstein College of Medicine, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Giampaolo Perna
- Department of Biological Sciences, Humanitas University, Milan, Italy
| | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Stefano Pini
- University of Pisa School of Medicine, Pisa, Italy
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology, Frankfurt am Main, Germany
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gemma Simons
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | | | - Vesta Steibliene
- Neuroscience Institute and Clinic of Psychiatry, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Murray B Stein
- Department of Psychiatry and School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Anton J L M van Balkom
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Nic van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Peter Zwanzger
- Clinical Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Kbo-Inn-Salzach Hospital, Wasserburg am Inn, Germany
- Department of Psychiatry and Psychotherapy, Ludwigs-Maximilians-University Munich, Munich, Germany
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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