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Zhao Q, Wang Z, Yang C, Chen H, Zhang Y, Zeb I, Wang P, Wu H, Xiao Q, Xu F, Bian Y, Xiang N, Qiu M. Anxiety symptoms without depression are associated with cognitive control network (CNN) dysfunction: An fNIRS study. Psychophysiology 2024; 61:e14564. [PMID: 38487932 DOI: 10.1111/psyp.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/21/2023] [Accepted: 01/20/2024] [Indexed: 06/06/2024]
Abstract
Anxiety is a common psychological disorder associated with other mental disorders, with depression being the most common comorbidity. Few studies have examined the neural mechanisms underlying anxiety after controlling for depression. This study aimed to explore whether there are differences in cortical activation in anxiety patients with different severities whose depression are normal. In the current study, depression levels were normal for 366 subjects-139 healthy subjects, 117 with mild anxiety, and 110 with major anxiety. Using the Hospital Anxiety and Depression Scale (HADS) and a verbal fluency task (VFT) to test subjects' anxiety and depression and cognitive function, respectively. A 53-channel guided near-infrared spectroscopic imaging technology (fNIRS) detected the concentration of oxyhemoglobin (oxy-Hb). Correlation analysis between anxiety severity and oxy-Hb concentration in the brain cortex was performed, as well as ANOVA analysis of oxy-Hb concentration among the three anxiety severity groups. The results showed that anxiety severity was significantly and negatively correlated with oxy-Hb concentrations in the left frontal eye field (lFEF) and in the right dorsolateral prefrontal area (rDLPFC). The oxy-Hb concentration in the lFEF and the rDLPFC were significantly lower in the major anxiety disorder group than that in the control group. This suggests that decreased cortical activity of the lFEF and rDLPFC may be neural markers of anxiety symptoms after controlling for depression. Anxiety symptoms without depression may be result from the dysfunction of the cognitive control network (CCN) which includes the lFEF and rDLPFC.
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Affiliation(s)
- Qinqin Zhao
- Dean's Office, MianYang Teachers' College, Mianyang, China
| | - Zheng Wang
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Caihong Yang
- School of Psychology, Central China Normal University, Wuhan, China
| | - Han Chen
- President Office, MianYang Teachers' College, Mianyang, China
| | - Yan Zhang
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Irum Zeb
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, China
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
| | - Huifen Wu
- School of education, Hubei Engineering University, Xiaogan, Hubei, China
| | - Qiang Xiao
- Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Fang Xu
- Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Yueran Bian
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Nian Xiang
- Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Min Qiu
- Hospital of Huazhong University of Science and Technology, Wuhan, China
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De Luca R, Calderone A, Gangemi A, Rifici C, Bonanno M, Maggio MG, Cappadona I, Veneziani I, Ielo A, Corallo F, Quartarone A, Cardile D, Calabrò RS. Is Virtual Reality Orientation Therapy Useful to Optimize Cognitive and Behavioral Functioning Following Severe Acquired Brain Injury? An Exploratory Study. Brain Sci 2024; 14:410. [PMID: 38790389 PMCID: PMC11119343 DOI: 10.3390/brainsci14050410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Severe acquired brain injury (SABI) is a leading cause of death and disability, and it is defined as a brain injury that occurs after birth due to traumatic or non-traumatic causes. Reality orientation therapy (ROT) uses repeated time-place-person orientation and meaningful stimuli to develop a better understanding of the environment and has great potential as an effective strategy to improve cognitive and behavioral functioning. OBJECTIVE This study aims to investigate the feasibility and potential effects of virtual reality orientation therapy (VR-rot) on optimizing cognitive and behavioral functioning and depressive symptoms post-SABI. METHOD Forty patients with SABI were enrolled from October 2022 to December 2023 and divided into two groups: the experimental group (EG, n = 20) received VR_rot, while the control group (CG, n = 20) received standard ROT (S_rot). All patients were evaluated with a psychometric battery, including the Mini-Mental State Examination (MMSE) and the Hamilton Rating Scale for Depression (HRS-D), administered before (T0) and after the end (T1) of rehabilitation. RESULTS Within-group comparisons indicated a statistically significant change in MMSE scores from T0 to T1 in the EG and CG, with the EG showing a greater improvement than the CG. Regarding HRS-D scores, the EG showed a statistically significant change. VR-ROT could be a valuable tool for improving cognitive-behavioral functioning in SABI patients. CONCLUSIONS The VRRS can help reduce depressive symptoms and improve the reality orientation deficit caused by traumatic brain injury and stroke on brain tissue. This study highlights the benefits of virtual reality.
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Affiliation(s)
- Rosaria De Luca
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Andrea Calderone
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Antonio Gangemi
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Carmela Rifici
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Irene Cappadona
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Isabella Veneziani
- Department of Nervous System and Behavioural Sciences, Psychology Section, University of Pavia, Piazza Botta, 11, 27100 Pavia, Italy
| | - Augusto Ielo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza, 98124 Messina, Italy
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Patlan I, Gamelin G, Khalaj K, Castonguay T, Dover G. Athlete Fear Avoidance, Depression, and Anxiety Are Associated with Acute Concussion Symptoms in Athletes. J Clin Med 2024; 13:2401. [PMID: 38673675 PMCID: PMC11050826 DOI: 10.3390/jcm13082401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Assessing sport-related concussions in athletes presents challenges due to symptom variability. This study aimed to explore the relationship between acute concussion symptoms and athlete fear avoidance, pain catastrophizing, depression, and anxiety. Anxiety and depression have previously been associated with the number of symptoms after a concussion, but no prior research has examined the possible link between athlete fear avoidance and acute concussion symptoms. Methods: Thirty-four collegiate athletes (mean age = 20.9 ± 1.8 years) were assessed within 48 h of a concussion using the Sport Concussion Assessment Tool 5, Athlete Fear Avoidance Questionnaire (AFAQ), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. Results: Results showed a significant association between the athlete fear avoidance and the number of concussion symptoms (r = 0.493, p = 0.003), as well as depression and anxiety measured by HADS (r = 0.686, p < 0.001). Athlete fear avoidance and HADS scores were predictors of symptom severity, explaining 41% of the variance (p = 0.001). Athletes with higher fear avoidance tended to report more symptoms post concussion. Conclusions: This study underscores the link between athlete fear avoidance, anxiety, depression, and the severity of concussion symptoms. Administering the AFAQ to assess athlete fear avoidance at the initial assessment of a concussion may be helpful in interpreting the symptoms of an acute concussion.
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Affiliation(s)
| | | | | | | | - Geoffrey Dover
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (I.P.); (G.G.); (K.K.); (T.C.)
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Wu H, Lu B, Zhang Y, Li T. Differences in prefrontal cortex activation in Chinese college students with different severities of depressive symptoms: A large sample of functional near-infrared spectroscopy (fNIRS) findings. J Affect Disord 2024; 350:521-530. [PMID: 38237870 DOI: 10.1016/j.jad.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/23/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Previous studies proposed that functional near-infrared spectroscopy (fNIRS) can be used to distinguish between not only different severities of depressive symptoms but also different subgroups of depression, such as anxious and non-anxious depression, bipolar and unipolar depression, and melancholia and non-melancholia depression. However, the differences in brain haemodynamic activation between depression subgroups (such as confirmed depression [CD] and suspected depression [SD]) with different symptom severities and the possible correlation between symptom severity and haemodynamic activation in specific brain regions using fNIRS have yet to be clarified. METHODS The severity of depression symptoms was classified using the Hospital Anxiety and Depression scale (HADS) and the Mini International Neuropsychiatric Interview by psychiatrists. We recruited 654 patients with depression who had varying severities of depressive symptoms, including 276 with SD and 378 with CD, and 317 with HCs from among Chinese college students. The 53-channel fNIRS was used to detect the cerebral hemodynamic difference of the three groups during the VFT (verbal fluency task). RESULTS Compared with the HC, region-specific fNIRS leads indicate CD patients had significant lower haemodynamic activation in three particular prefrontal regions: 1) right dorsolateral prefrontal cortex (DLPFC), 2) bilateral frontopolar cortex (FPC), and 3) right Broca's area (BA). SD vs. HC comparisons revealed only significant lower haemodynamic activation in the right FPC area. Compared to SD patients, CD patients exhibited decreased hemodynamic activation changes in the right DLPFC and the right BA. Correlation analysis established a significant negative correlation between the hemodynamic changes in the bilateral FPC and the severity of depressive symptoms. CONCLUSIONS The right DLPFC and right BA are expected to be physiological mechanisms to distinguish depression subgroups (CD, SD) with different symptom severities. The haemodynamic changes in the bilateral FPC was nagatively associated with the symptom severity of depression.
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Affiliation(s)
- Huifen Wu
- School of Education and psychology, Hubei Engineering University, Xiaogan, China
| | - Baoquan Lu
- School of Education and psychology, Hubei Engineering University, Xiaogan, China.
| | - Yan Zhang
- School of Education, Huazhong University of Science and Technology, Wuhan, China.
| | - Taiping Li
- School of Education and psychology, Hubei Engineering University, Xiaogan, China.
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Li D, Zhang X, Lu Y, Jing L, Hu H, Song Y, Wu S, Zhu W. Post-sepsis psychiatric disorder: Pathophysiology, prevention, and treatment. Neurol Sci 2024:10.1007/s10072-024-07409-8. [PMID: 38381393 DOI: 10.1007/s10072-024-07409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
Post-sepsis psychiatric disorder, encompassing anxiety, depression, post-traumatic stress disorder and delirium, is a highly prevalent complication secondary to sepsis, resulting in a marked increase in long-term mortality among affected patients. Regrettably, psychiatric impairment associated with sepsis is frequently disregarded by clinicians. This review aims to summarize recent advancements in the understanding of the pathophysiology, prevention, and treatment of post-sepsis mental disorder, including coronavirus disease 2019-related psychiatric impairment. The pathophysiology of post-sepsis psychiatric disorder is complex and is known to involve blood-brain barrier disruption, overactivation of the hypothalamic-pituitary-adrenal axis, neuroinflammation, oxidative stress, neurotransmitter dysfunction, programmed cell death, and impaired neuroplasticity. No unified diagnostic criteria for this disorder are currently available; however, screening scales are often applied in its assessment. Modifiable risk factors for psychiatric impairment post-sepsis include the number of experienced traumatic memories, the length of ICU stay, level of albumin, the use of vasopressors or inotropes, daily activity function after sepsis, and the cumulative dose of dobutamine. To contribute to the prevention of post-sepsis psychiatric disorder, it may be beneficial to implement targeted interventions for these modifiable risk factors. Specific therapies for this condition remain scarce. Nevertheless, non-pharmacological approaches, such as comprehensive nursing care, may provide a promising avenue for treating psychiatric disorder following sepsis. In addition, although several therapeutic drugs have shown preliminary efficacy in animal models, further confirmation of their potential is required through follow-up clinical studies.
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Affiliation(s)
- Dayong Li
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Xujie Zhang
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Yuru Lu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Liang Jing
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Hongjie Hu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Yaqin Song
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Shuhui Wu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Wei Zhu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China.
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Pasam T, Dandekar MP. Insights from Rodent Models for Improving Bench-to-Bedside Translation in Traumatic Brain Injury. Methods Mol Biol 2024; 2761:599-622. [PMID: 38427264 DOI: 10.1007/978-1-0716-3662-6_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Road accidents, domestic falls, and persons associated with sports and military services exhibited the concussion or contusion type of traumatic brain injury (TBI) that resulted in chronic traumatic encephalopathy. In some instances, these complex neurological aberrations pose severe brain damage and devastating long-term neurological sequelae. Several preclinical (rat and mouse) TBI models simulate the clinical TBI endophenotypes. Moreover, many investigational neuroprotective candidates showed promising effects in these models; however, the therapeutic success of these screening candidates has been discouraging at various stages of clinical trials. Thus, a correct selection of screening model that recapitulates the clinical neurobiology and endophenotypes of concussion or contusion is essential. Herein, we summarize the advantages and caveats of different preclinical models adopted for TBI research. We suggest that an accurate selection of experimental TBI models may improve the translational viability of the investigational entity.
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Affiliation(s)
- Tulasi Pasam
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India
| | - Manoj P Dandekar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, India.
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Huynh TNT, Hartel G, Janda M, Wyld D, Merrett N, Gooden H, Neale RE, Beesley VL. The Unmet Needs of Pancreatic Cancer Carers Are Associated with Anxiety and Depression in Patients and Carers. Cancers (Basel) 2023; 15:5307. [PMID: 38001567 PMCID: PMC10670364 DOI: 10.3390/cancers15225307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Pancreatic cancer has one of the lowest survival rates, and patients experience debilitating symptoms. Family carers provide essential daily care. This study determined the prevalence of and risk factors for unmet supportive care needs among carers for pancreatic cancer patients and examined which carer needs were associated with anxiety and depression in carers and patients. Eighty-four pancreatic cancer patients and their carers were recruited. The carers completed a needs survey (SCNS-P&C). Both carers and patients completed the Hospital Anxiety and Depression Scale. Log binomial regression was used to identify associations between carer needs and anxiety and depression among carers and patients. The top 10 moderate-to-high unmet needs reported by ≥28% of carers were related to healthcare (e.g., discussing concerns with doctors) and information need domains (e.g., information about a patient's physical needs), plus one other item related to hospital parking. Being male or caring for a patient within 4 months of their diagnosis were associated with greater unmet needs. Some unmet needs, including 'accessing information about treatments' and 'being involved in patient care', were associated with both carers and patients having anxiety and depression. Carers should be involved in health care consultations and provided with information and opportunities to discuss concerns.
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Affiliation(s)
- Thi N. T. Huynh
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.N.T.H.); (G.H.); (R.E.N.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
| | - Gunter Hartel
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.N.T.H.); (G.H.); (R.E.N.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Monika Janda
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
| | - David Wyld
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
| | - Neil Merrett
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia;
| | - Helen Gooden
- School of Nursing and Midwifery, University of Sydney, Sydney, NSW 2006, Australia;
| | - Rachel E. Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.N.T.H.); (G.H.); (R.E.N.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
| | - Vanessa L. Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.N.T.H.); (G.H.); (R.E.N.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
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Boyko M, Gruenbaum BF, Oleshko A, Merzlikin I, Zlotnik A. Diet's Impact on Post-Traumatic Brain Injury Depression: Exploring Neurodegeneration, Chronic Blood-Brain Barrier Destruction, and Glutamate Neurotoxicity Mechanisms. Nutrients 2023; 15:4681. [PMID: 37960334 PMCID: PMC10649677 DOI: 10.3390/nu15214681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Traumatic brain injury (TBI) has a profound impact on cognitive and mental functioning, leading to lifelong impairment and significantly diminishing the quality of life for affected individuals. A healthy blood-brain barrier (BBB) plays a crucial role in guarding the brain against elevated levels of blood glutamate, making its permeability a vital aspect of glutamate regulation within the brain. Studies have shown the efficacy of reducing excess glutamate in the brain as a treatment for post-TBI depression, anxiety, and aggression. The purpose of this article is to evaluate the involvement of dietary glutamate in the development of depression after TBI. We performed a literature search to examine the effects of diets abundant in glutamate, which are common in Asian populations, when compared to diets low in glutamate, which are prevalent in Europe and America. We specifically explored these effects in the context of chronic BBB damage after TBI, which may initiate neurodegeneration and subsequently have an impact on depression through the mechanism of chronic glutamate neurotoxicity. A glutamate-rich diet leads to increased blood glutamate levels when contrasted with a glutamate-poor diet. Within the context of chronic BBB disruption, elevated blood glutamate levels translate to heightened brain glutamate concentrations, thereby intensifying neurodegeneration due to glutamate neurotoxicity.
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Affiliation(s)
- Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion of the Negev, Beer-Sheva 84101, Israel
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna Oleshko
- Department of Biology and Methods of Teaching Biology, A. S. Makarenko Sumy State Pedagogical University, Sumy 40002, Ukraine
| | - Igor Merzlikin
- Department of Biology and Methods of Teaching Biology, A. S. Makarenko Sumy State Pedagogical University, Sumy 40002, Ukraine
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion of the Negev, Beer-Sheva 84101, Israel
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Anderson C, Hicks AJ, Carmichael J, Burke R, Ponsford J. COMT Val158Met and BDNF Val66Met Single-Nucleotide Polymorphisms Are Not Associated With Emotional Distress One Year After Moderate-Severe Traumatic Brain Injury. Neurotrauma Rep 2023; 4:495-506. [PMID: 37636335 PMCID: PMC10457651 DOI: 10.1089/neur.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Emotional distress is a common, but poorly addressed, feature of moderate-severe traumatic brain injury (TBI). Previously identified sociodemographic, psychological, and injury-related factors account for only a small proportion of the variability in emotional distress post-TBI. Genetic factors may help to further understand emotional distress in this population. The catechol-O-methyltransferase (COMT) Val158 and brain-derived neurotrophic factor (BDNF) 66Met single-nucleotide polymorphisms (SNPs) have been identified as possible contributory factors to outcomes after TBI. We investigated whether the COMT Val158 and BDNF 66Met SNPs were associated with emotional distress 1 year after moderate-severe TBI, and whether these associations were moderated by age, sex, and TBI severity (as measured by the duration of post-traumatic amnesia [PTA]). Moderate-severe TBI survivors (COMT, n = 391; BDNF, n = 311) provided saliva samples after admission to a TBI rehabilitation hospital. At a follow-up interview ∼1 year after injury, participants completed a self-report measure of emotional distress (Hospital Anxiety and Depression Scale; HADS). Multiple linear regression models were constructed for each SNP to predict total scores on the HADS. Neither COMT Val158 nor BDNF 66Met carriage status (carrier vs. non-carrier) significantly predicted emotional distress (COMT, p = 0.49; BDNF, p = 0.66). Interactions of SNP × age (COMT, p = 0.90; BDNF, p = 0.93), SNP × sex (COMT, p = 0.09; BDNF, p = 0.60), SNP × injury severity (COMT, p = 0.53; BDNF, p = 0.87), and SNP × sex × age (COMT, p = 0.08; BDNF, p = 0.76) were also non-significant. Our null findings suggest that COMT Val158 and BDNF 66Met SNPs do not aid the prediction of emotional distress 1 year after moderate-severe TBI, neither in isolation nor in interaction with age, sex and injury severity. The reporting of null findings such as ours is important to avoid publication bias and prompt researchers to consider the challenges of single-gene candidate studies in understanding post-TBI outcomes. Analyses in larger samples that incorporate multiple genetic factors and their relevant moderating factors may provide a greater understanding of the role of genetics in post-TBI emotional distress.
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Affiliation(s)
- Chloe Anderson
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Amelia J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Richard Burke
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Carmichael J, Hicks AJ, Gould KR, Spitz G, Ponsford J. Network analysis of anxiety and depressive symptoms one year after traumatic brain injury. Psychiatry Res 2023; 326:115310. [PMID: 37356251 DOI: 10.1016/j.psychres.2023.115310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
We used network analysis to explore interrelationships between anxiety and depressive symptoms after traumatic brain injury (TBI). At one year post-injury, 882 adult civilians who received inpatient rehabilitation for moderate-severe TBI self-reported anxiety and depressive symptoms (Hospital Anxiety and Depression Scale). The severity of TBI was characterized acutely by the duration of post-traumatic amnesia (PTA), and TBI-related functional disability was rated by an examiner at one year post-injury using a structured interview (Glasgow Outcome Scale - Extended). We estimated two cross-sectional, partial correlation networks. In the first network, anxiety and depressive symptoms were densely interconnected yet formed three distinct, data-driven communities: Hyperarousal, Depression, and General Distress. Worrying thoughts and having difficulty relaxing were amongst the most central symptoms, showing strong connections with other symptoms within and between communities. In the second network, TBI severity was directly negatively associated with hyperarousal symptoms but indirectly positively associated with depressive symptoms via greater functional disability. The results highlight the potential utility of simultaneous, transdiagnostic assessment and treatment of anxiety and depressive symptoms after moderate-severe TBI. Worrying thoughts, having difficulty relaxing, and the experience of disability may be important targets for treatment, although future studies examining symptom dynamics within individuals and over time are required.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia; Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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Carmichael J, Spitz G, Gould KR, Johnston L, Samiotis A, Ponsford J. Bifactor analysis of the Hospital Anxiety and Depression Scale (HADS) in individuals with traumatic brain injury. Sci Rep 2023; 13:8017. [PMID: 37198250 DOI: 10.1038/s41598-023-35017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
Anxiety and depression symptoms are commonly experienced after traumatic brain injury (TBI). However, studies validating measures of anxiety and depression for this population are scarce. Using novel indices derived from symmetrical bifactor modeling, we evaluated whether the Hospital Anxiety and Depression Scale (HADS) reliably differentiated anxiety and depression in 874 adults with moderate-severe TBI. The results showed that there was a dominant general distress factor accounting for 84% of the systematic variance in HADS total scores. The specific anxiety and depression factors accounted for little residual variance in the respective subscale scores (12% and 20%, respectively), and overall, minimal bias was found in using the HADS as a unidimensional measure. Further, in a subsample of 184 participants, the HADS subscales did not clearly discriminate between formal anxiety and depressive disorders diagnosed via clinical interview. Results were consistent when accounting for degree of disability, non-English speaking background, and time post-injury. In conclusion, variance in HADS scores after TBI predominately reflects a single underlying latent variable. Clinicians and researchers should exercise caution in interpreting the individual HADS subscales and instead consider using the total score as a more valid, transdiagnostic measure of general distress in individuals with TBI.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia.
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Lisa Johnston
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Alexia Samiotis
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
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Marzolla MC, Wijenberg M, Stapert S, Hurks P, Schepers J, van Heugten C. Hypersensitivity to Noise and Light Over 1 Year After Mild Traumatic Brain Injury: A Longitudinal Study on Self-Reported Hypersensitivity and Its Influence on Long-Term Anxiety, Depression, and Quality of Life. J Head Trauma Rehabil 2023; 38:259-267. [PMID: 35997762 DOI: 10.1097/htr.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate (1) the prevalence of self-reported sensory hypersensitivity (noise [NS] and light [LS]) over 1 year after mild traumatic brain injury (mTBI) in adults and (2) the impact of NS and LS measured 2 weeks after injury on long-term outcomes 12 months postinjury, while controlling for postconcussion symptoms. SETTING Participants were recruited from 6 hospitals in the south of the Netherlands and were tested 4 times (2 weeks, 3 months, 6 months, and 12 months postinjury), using self-report questionnaires. PARTICIPANTS In total, 186 mTBI participants (diagnosed using WHO [World Health Organization]/EFNS [European Federation of Neurological Societies] criteria at the neurology/emergency department) and 181 participants with a minor orthopedic injury in their extremities (control group). DESIGN An observational, longitudinal, multicenter cohort study. MAIN MEASURES NS and LS items (Rivermead Post-Concussion Symptoms Questionnaire) were used as main outcome variables to determine sensory hypersensitivity symptoms. Additional outcomes included anxiety, depression, health-related quality of life (HRQoL), and life satisfaction. RESULTS There was an elevated prevalence of NS and LS between 2 weeks and 3 months after injury in the mTBI group compared with controls. Approximately 3% of mTBI patients had persistent hypersensitivity symptoms during the whole course of the study. At 12 months postinjury, the mTBI and control groups did not differ in the prevalence of persistent hypersensitivity symptoms. There was no evidence of a predictive value of hypersensitivity within 2 weeks postinjury on anxiety, depression, HRQoL, or life satisfaction, 12 months later after controlling for postconcussion symptoms. CONCLUSIONS These results not only confirm the presence of hypersensitivity symptoms after mTBI in the subacute stage but also provide assurance about the small size of the group that experiences persistent symptoms. Furthermore, there was no evidence that early NS and LS are uniquely associated with long-term emotional and quality-of-life outcomes, over and above general levels of postconcussion symptoms.
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Affiliation(s)
- Marilien C Marzolla
- Department of Neuropsychology and Psychopharmacology (Ms Marzolla and Drs Stapert, Hurks, and van Heugten), Section of Teaching and Innovation of Learning (Dr Wijenberg), and Department of Methodology and Statistics (Dr Schepers), Faculty of Psychology and Neuroscience, and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (Dr van Heugten), Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands (Ms Marzolla and Dr van Heugten); Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands (Dr Wijenberg); and Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (Dr Stapert)
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Wu H, Li T, Peng C, Yang C, Bian Y, Li X, Xiao Q, Wang P, Zhang Z, Zhang Y. The right prefrontal cortex (PFC) can distinguish anxious depression from non-anxious depression: A promising functional near infrared spectroscopy study (fNIRS). J Affect Disord 2022; 317:319-328. [PMID: 36007594 DOI: 10.1016/j.jad.2022.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Anxious depression is a serious mental disorder characterized by comorbidity of anxiety and depression, and its symptoms are similar to those of non-anxious depression. This study aimed to use functional near-infrared spectroscopy (fNIRS) as a tool to distinguish between patients with anxious and non-anxious depression based on differences in hemodynamic changes in the right prefrontal cortex during the verbal fluency task. It is helpful to improve the diagnostic accuracy of the two disorders to further promote their therapeutic effect and prognosis. METHODS A total of 105 subjects, comprising 39 patients with anxious depression, 32 patients with non-anxious depression, and 32 healthy controls, were evaluated using 53-channel fNIRS and the Depression and Anxiety Clinical Scale. RESULTS Hemodynamic activation was significantly enhanced in the right dorsolateral prefrontal cortex (DLPFC) and right frontopole cortex (FPC) in the anxious depressed group compared with the non-anxious depressed and healthy groups. LIMITATIONS First, Hospital Anxiety and Depression Scale (HADS) was used to evaluate the scores of anxiety and depression among the three groups in our study. Different scales may result in different research results. Therefore, other scales (HAM, the Montgomery Asberg Depression Rating Scale, or the Beck Depression Inventory) should be used for further verification. Second, although all the samples we have chosen were patients with the diagnosis of anxious depression or no-anxious depression, we did not distinguish between different severity of anxious depression or no-anxious depression. Third, pure anxiety was not included as the control condition in our study. CONCLUSIONS There are significant differences in activation patterns of the right DLPFC and right FPC areas between patients with and without anxious depression. Moreover, the right FPC area is promising as a brain region to assess the severity of anxious depression. fNIRS may be a potential tool to improve diagnostic accuracy for both disorders.
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Affiliation(s)
- Huifen Wu
- School of Education, Huazhong University of Science and Technology, Wuhan, China; School of Education, Hubei Engineering University, Xiaogan, China
| | - Taiping Li
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Peng
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Caihong Yang
- School of Psychology, Central China Normal University, Wuhan, China
| | - Yueran Bian
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqin Li
- School of Education, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Xiao
- Department of Psychiatry, Huazhong University of Science and Technology Hospital, Wuhan, China
| | - Pu Wang
- Department of Rehabilitation Medicine in The Seventh Affiliated Hospital (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Zhe Zhang
- Department of Humanities and Social Sciences, Huazhong University of Science and Technology, Wuhan, China.
| | - Yan Zhang
- School of Education, Huazhong University of Science and Technology, Wuhan, China.
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Zhang Y, Li X, Guo Y, Zhang Z, Xu F, Xiang N, Qiu M, Xiao Q, Wang P, Shi H. Dorsolateral Prefrontal Activation in Emotional Autobiographical Task in Depressed and Anxious College Students: An fNIRS Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14335. [PMID: 36361214 PMCID: PMC9657988 DOI: 10.3390/ijerph192114335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The dorsolateral prefrontal cortex (dlPFC) is strongly associated with mood symptoms. This study used functional near-infrared spectroscopy (fNIRS) technology to explore the features of brain neural activity in the dlPFC of anxious and depressed college students, during an emotional autobiographical memory task, and to understand the differences in brain cognitive mechanisms caused by anxiety and depression. METHODS A simple random sampling method was used to test 440 college students at a university with a healthy control group (HC, 220 participants), a pure depression group (PD, 92 participants), and a pure anxiety group (PA, 128 participants). The average oxyhemoglobin in the dlPFC of the subjects during the emotional autobiographical memory task was collected by a 53-channel functional near-infrared spectroscopy imaging device. RESULTS The activation of the left dlPFC (ch13) in the pure depression group was significantly higher than in the pure anxiety group. The activation of the right dlPFC (ch48) was significantly higher under positive emotions than under negative emotions. The interaction between emotion valence and group was marginally significant, and the activation of the right dlPFC (ch41) in the pure depression group was significantly higher under positive emotion than in negative emotion. The activation of the pure depression group under positive emotions was significantly higher than that of the pure anxiety group. In comparison, the activation of the pure depression group under negative emotions was significantly lower than that of the healthy control group. The results of correlation analysis showed that the activation of the left dlPFC (ch13) was significantly negatively correlated with anxiety in positive emotions, but the activation of the right dlPFC (ch34, ch42) was significantly positively correlated with anxiety in positive and negative emotions. CONCLUSIONS The right dlPFC was insensitive to positive emotions in college students with high-anxiety symptoms, whereas this region was insensitive to negative emotions in college students with high depressive symptoms, which might be one of the critical differences in the cognitive mechanisms of anxiety and depression. Furthermore, left and right dlPFC activation correlated differently with anxiety. The higher the anxiety level, the lower the activation on the left side, and the higher the activation on the right side. The results suggested that anxiety might reduce the function of the left dlPFC.
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Affiliation(s)
- Yan Zhang
- School of Educational Science, Huazhong University of Science and Technology, Luoyu Road No. 1037, Hongshan, Wuhan 430074, China
| | - Xiaoqin Li
- School of Educational Science, Huazhong University of Science and Technology, Luoyu Road No. 1037, Hongshan, Wuhan 430074, China
| | - Ying Guo
- School of Psychology, Sichuan Normal University, Chengdu 610021, China
| | - Zhe Zhang
- Humanities Department, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Fang Xu
- Department of Neurology, Hospital of Huazhong University of Science and Technology, Wuhan 430074, China
| | - Nian Xiang
- Department of Neurology, Hospital of Huazhong University of Science and Technology, Wuhan 430074, China
| | - Min Qiu
- Department of Neurology, Hospital of Huazhong University of Science and Technology, Wuhan 430074, China
| | - Qiang Xiao
- Department of Neurology, Hospital of Huazhong University of Science and Technology, Wuhan 430074, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China
| | - Hui Shi
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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Zupan B, Hutchings SM, Everitt LE, Gupta C. Language disorder and internalizing mental health problems in youth offenders: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1207-1228. [PMID: 35841339 PMCID: PMC9796836 DOI: 10.1111/1460-6984.12759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prevalence of language disorder in youth offenders far exceeds rates reported in community samples. Youth involved in the justice system are also at increased risk of a range of psychiatric disorders, including internalizing mental health problems (i.e., anxiety, depression). However, the frequency with which these co-occur in this population is not known. Understanding the co-occurrence of language disorder with anxiety and depression in youth offenders may contribute to more coordinated and targeted support for these vulnerable youth. AIMS To explore the co-occurrence of language disorder and anxiety and depression in youth offenders. METHODS & PROCEDURES A systematic literature search of six databases (CINAHL, ERIC, Medline, PyscINFO, PubMED, Scopus) was conducted (September 2021) using key search terms relevant to the systematic review question. Study inclusion criteria were: (1) original research published in English; (2) youth up to 21 years of age involved in the justice system; and (3) reported outcomes on language and anxiety and/or depression. All included studies were appraised using the Joanna Briggs Critical Appraisal tool checklist relevant to study design. Due to the heterogeneity of included studies, data synthesis was narrative. MAIN CONTRIBUTION Eight studies met the eligibility criteria. A range of measures was used to assess language abilities across samples. Only two studies directly addressed the relationship between language disorder and internalizing mental health problems; both found no significant correlation. CONCLUSIONS & IMPLICATIONS Although the results did not support a significant relationship between language disorder and internalizing mental health problems in youth offenders, the two appear to occur comorbidly as evidenced by heightened rates of both in the included samples. This review highlights the need for more robust studies aimed to better understand this relationship. Stronger evidence may contribute to increased collaborative speech pathology and psychology services which might increase youth offenders' accessibility and engagement in intervention programmes (e.g., cognitive-behaviour therapy; interpersonal skills training; individual counselling). WHAT THIS PAPER ADDS What is already known on this subject The markedly high rates of language disorder in youth involved in the justice system have been widely reported. It is also known that externalizing mental health problems often bring youth in contact with the justice system. Though there is some information about the prevalence of internalizing mental health problems in this population, the co-occurrence of language disorder and internalizing mental health problems has not been examined as widely. What this study adds to existing knowledge This study aimed to identify the frequency of co-occurrence of language disorder and anxiety and/or depression in youth offenders. Although the results did not support a significant relationship between language disorder and internalizing mental health problems in this population, results of the review provide evidence of heightened rates of both. This study also provides a summary of the various measures used to assess language and internalizing mental health in youth offenders across the eight studies included in this review. What are the potential or actual clinical implications of this work? It is possible that the tests and sub-tests used to identify language disorders and internalizing mental health problems were not sensitive enough to identify the full extent of youth offenders' needs. Identifying the presence of language disorders and internalizing mental health problems and recognizing the impact these may have on the communication and behaviours of an individual can better inform staff and therapists as they engage and interact with youth in the justice system.
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Affiliation(s)
- Barbra Zupan
- College of Health SciencesSchool of Health Medical and Applied SciencesCentral Queensland UniversityRockhamptonQLDAustralia
| | - Suzanne M. Hutchings
- College of Health SciencesSchool of Health Medical and Applied SciencesCentral Queensland UniversityRockhamptonQLDAustralia
| | - Lucy E. Everitt
- College of Health SciencesSchool of Health Medical and Applied SciencesCentral Queensland UniversityRockhamptonQLDAustralia
| | - Charlotte Gupta
- Appleton InstituteSchool of Health Medical and Applied SciencesCentral Queensland UniversityWayvilleSAAustralia
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Howell DR, Hunt DL, Oldham JR, Aaron SE, Meehan WP, Tan CO. Postconcussion Exercise Volume Associations With Depression, Anxiety, and Dizziness Symptoms, and Postural Stability: Preliminary Findings. J Head Trauma Rehabil 2022; 37:249-257. [PMID: 34320557 PMCID: PMC8789955 DOI: 10.1097/htr.0000000000000718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between postconcussion exercise volume and changes in depression, anxiety, dizziness, and postural stability. DESIGN Secondary analysis of a single-site prospective clinical trial. SETTING Cerebrovascular research laboratory. PARTICIPANTS Participants completed questionnaires and underwent tests of gait and balance within 2 weeks of a concussion (mean = 11 ± 3 days postconcussion) and approximately 1 month later (mean = 41 ± 7 days postconcussion). Exercise volume was tracked by weekly exercise logs. INTERVENTIONS On the basis of a previous work classifying exercise volume following concussion, we grouped participants according to self-reported exercise volume between visits as high exercise volume (≥150 min/wk) or low exercise volume (<150 min/wk). MAIN OUTCOME MEASURES Participants completed assessments evaluating anxiety and depression (Hospital Anxiety and Depression Scale), dizziness (Dizziness Handicap Inventory), and postural stability (tandem gait and modified Balance Error Scoring System). RESULTS Thirty-eight participants completed the study, of which 22 were in the high exercise volume group (mean = 71 ± 40 min/wk; 16.8 ± 2.1 years; 59% female) and 16 were in the low exercise volume group (mean = 379 ± 187 min/wk; 17.5 ± 2.1 years; 31% female). Although depression symptoms were not significantly different initially (mean difference = 1.5; 95% CI, -0.68 to 3.68; P = .24), the high exercise volume group had significantly lower depression symptom scores at follow-up (mean difference = 3.0; 95% CI, 1.40 to 4.47; P < .001). Anxiety symptoms (mean difference = 2.8; 95% CI, 0.3 to 5.4; P = 0.03), dizziness symptoms (mean difference = 10.9; 95% CI, 0.2 to 21.5; P = .047), single-task tandem gait (mean difference = 3.1 seconds; 95% CI, 0.2 to 6.0; P = .04), and dual-task tandem gait (mean difference = 4.2 seconds; 95% CI, 0.2 to 8.2; P = .04) were significantly better among the high exercise volume group. CONCLUSION Greater exercise volumes were associated with lower depression, anxiety, and dizziness symptoms, and faster tandem gait performance. These preliminary findings suggest a potentially beneficial role for exercise within several different domains commonly affected by concussion.
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Affiliation(s)
- David R Howell
- Children's Hospital Colorado and Department of Orthopedics, University of Colorado School of Medicine, Aurora (Dr Howell); Boston Children's Hospital, Boston, Massachusetts (Ms Hunt and Drs Oldham and Meehan); and Spaulding Rehabilitation Hospital, Cambridge, Massachusetts (Drs Aaron and Tan)
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Sex differences in outcomes from mild traumatic brain injury eight years post-injury. PLoS One 2022; 17:e0269101. [PMID: 35622845 PMCID: PMC9140230 DOI: 10.1371/journal.pone.0269101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
The long-term effects of mild TBI (mTBI) are not well understood, and there is an ongoing debate about whether there are sex differences in outcomes following mTBI. This study examined i) symptom burden and functional outcomes at 8-years post-injury in males and females following mTBI; ii) sex differences in outcomes at 8-years post-injury for those aged <45 years and ≥45 years and; iii) sex differences in outcomes for single and repetitive TBI. Adults (≥16 years at injury) identified as part of a population-based TBI incidence study (BIONIC) who experienced mTBI 8-years ago (N = 151) and a TBI-free sample (N = 151) completed self-report measures of symptoms and symptom burden (Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Post-traumatic Stress Disorder Checklist), and functional outcomes (Participation Assessments with Recombined Tools, Work Limitations Questionnaire). The mTBI group reported significantly greater post-concussion symptoms compared to the TBI-free group (F(1,298) = 26.84, p<.01, ηp2 = .08). Females with mTBI were twice as likely to exceed clinical cut-offs for post-concussive (X2 (1)>5.2, p<.05, V>.19) and PTSD symptoms (X2(1) = 6.10, p = .014, V = .20) compared to the other groups, and reported their health had the greatest impact on time-related work demands (F(1,171) = 4.36, p = .04, ηp2 = .03. There was no interaction between sex and age on outcomes. The repetitive mTBI group reported significantly greater post-concussion symptoms (F(1,147) = 9.80, p<.01, ηp2 = .06) compared to the single mTBI group. Twice the proportion of women with repetitive mTBI exceeded the clinical cut-offs for post-concussive (X2(1)>6.90, p<.01, V>.30), anxiety (X2(1)>3.95, p<.05, V>.23) and PTSD symptoms (X2(1)>5.11, p<.02, V>.26) compared with males with repetitive TBI or women with single TBI. Thus, at 8-years post-mTBI, people continued to report a high symptom burden. Women with mTBI, particularly those with a history of repetitive mTBI, had the greatest symptom burden and were most likely to have symptoms of clinical significance. When treating mTBI it is important to assess TBI history, particularly in women. This may help identify those at greatest risk of poor long-term outcomes to direct early treatment and intervention.
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Changes in Cognitive Functioning After Surgical Resection of Language-related, Eloquent-area, High-grade Gliomas Under Awake Craniotomy. Cogn Behav Neurol 2022; 35:130-139. [PMID: 35486526 DOI: 10.1097/wnn.0000000000000307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dominant-hemisphere tumors, especially gliomas, as infiltrative tumors, frequently affect cognitive functioning. Establishing a balance between extensive resection, which is proven to result in longer survival, and less extensive resection, in order to maintain more cognitive abilities, is challenging. OBJECTIVE To evaluate changes in cognitive functioning before and after surgical resection of language-related, eloquent-area, high-grade gliomas under awake craniotomy. METHOD We provided individuals with newly diagnosed high-grade gliomas of the language-related eloquent areas with the same standard of care, including surgical resection of the glioma using intraoperative sensory-motor and cognitive mapping under awake craniotomy, and the same protocol for chemoradiotherapy. Cognitive functioning was assessed using Addenbrooke's Cognitive Examination-Revised (ACE-R) at four time points (preoperatively, early after surgery, and 3 and 6 months postoperatively). RESULTS The preoperative evaluation revealed a range of cognitive impairments in 70.7% of the individuals, affecting all of the cognitive subdomains (mostly attention and visuospatial abilities). Overall cognitive functioning (ie, ACE-R score) dropped by 13.5% (P= 0.169) early postoperatively. At the 3-month evaluation, an average of 15.3% (P= 0.182) recovery in cognitive functioning was observed (mostly in verbal fluency: 39.1%). This recovery improved further, reaching 29% (P< 0.001) at the 6-month evaluation. The greatest improvement occurred in verbal fluency: 68.8%,P= 0.001. CONCLUSION Extensive resection of eloquent-area gliomas with the aid of modern neuroimaging and neuromonitoring techniques under awake craniotomy is possible without significant long-term cognitive sequela.
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Mureșanu IA, Grad DA, Mureșanu DF, Dobran SA, Hapca E, Strilciuc Ș, Benedek I, Capriș D, Popescu BO, Perju-Dumbravă L, Cherecheș RM. Evaluation of post-traumatic stress disorder (PTSD) and related comorbidities in clinical studies. J Med Life 2022; 15:436-442. [PMID: 35646173 PMCID: PMC9126456 DOI: 10.25122/jml-2022-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/25/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with traumatic brain injury (TBI) of varying severities are experiencing adverse outcomes during and after rehabilitation. Besides depression and anxiety, post-traumatic stress disorder (PTSD) is highly encountered in civilian and military populations. As more prospective and retrospective studies - focused on evaluating new or old psychological therapies in inpatient, outpatient, or controlled environments, targeting patients with PTSD with or without a history of TBI - are carried out, researchers are employing various scales to measure PTSD as well as other psychiatric diagnoses or cognitive impairments that might appear following TBI. We aimed to explore the literature published between January 2010 and October 2021 by querying three databases. Our preliminary results showed that several scales - such as the Clinician-Administered PTSD Scale (CAPS), the Posttraumatic Stress Disorder Checklist Military Version (PCL-M) as well as Specific Version (PCL-S), and Civilian Version (PCL-C) - have been frequently used for PTSD diagnosis and symptom severity. However, heterogeneity in the scales used when assessing and evaluating additional psychiatric comorbidities and cognitive impairments are due to the study aim and therapeutic approaches. Therefore, conducting an intervention focusing on post-TBI PTSD patients requires increased attention to patients' medical history in capturing multiple cognitive impairments and affected neuropsychological processes when designing the study and including validated instruments for measuring primary and secondary neuropsychological outcomes.
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Affiliation(s)
- Ioana Anamaria Mureșanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,Corresponding Author: Ioana Anamaria Mureșanu, RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Cluj, Romania. Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail:
| | - Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Dafin Fior Mureșanu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Elian Hapca
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ștefan Strilciuc
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Irina Benedek
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David Capriș
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Bogdan Ovidiu Popescu
- Department of Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Răzvan Mircea Cherecheș
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania,Department of Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
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20
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Rauwenhoff JCC, Bol Y, Peeters F, van den Hout AJHC, Geusgens CAV, van Heugten CM. Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases. Neuropsychol Rehabil 2022:1-31. [PMID: 35332849 DOI: 10.1080/09602011.2022.2053169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patients with acquired brain injury (ABI) often experience symptoms of anxiety and depression. Until now, evidence-based treatment is scarce. This study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) for patients with ABI. To evaluate the effect of ACT for people with ABI, a non-concurrent multiple baseline design across four cases was used. Participants were randomly assigned to a baseline period, followed by treatment and then follow-up phases. Anxiety and depressive symptoms were repeatedly measured. During six measurement moments over a year, participants filled in questionnaires measuring anxiety, depression, stress, participation, quality of life, and ACT-related processes. Randomization tests and NAP scores were used to calculate the level of change across phases. Clinically significant change was defined with the Reliable Change Index. Three out of four participants showed medium to large decreases in anxiety and depressive symptoms (NAP = 0.85 till 0.99). Furthermore, participants showed improvements regarding stress, cognitive fusion, and quality of life. There were no improvements regarding psychological flexibility, value-driven behaviour, or social participation. This study shows that ACT is possibly an effective treatment option for people experiencing ABI-related anxiety and depression symptoms. Replication with single case or large scale group studies is needed to confirm these findings.
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Affiliation(s)
- Johanne C C Rauwenhoff
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Limburg Brain Injury Centre, Maastricht, Netherlands
| | - Yvonne Bol
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, Netherlands
| | - Frenk Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Anja J H C van den Hout
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, Netherlands
| | - Chantal A V Geusgens
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Limburg Brain Injury Centre, Maastricht, Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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21
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Schanz CG, Equit M, Schäfer SK, Michael T. Self-directed passive-aggressive behaviour as an essential component of depression: findings from two cross-sectional observational studies. BMC Psychiatry 2022; 22:200. [PMID: 35303807 PMCID: PMC8933131 DOI: 10.1186/s12888-022-03850-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The self-control model of depression suggests depressive symptoms to derive from distorted self-monitoring, dysfunctional self-evaluation and reduced self-reward as well as increased self-punishment. Building on this model a relationship between self-directed passive-aggressive behaviour, that is, harmful inactivity, and depression has been assumed. This association has been supported by a recent study in an inpatient sample. However, it remains unclear if patients with depressive disorders report more self-directed passive-aggressive behaviour than patients without depressive disorders and if self-directed passive aggression mediates the associations between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. METHODS Study 1 compared self-directed passive-aggressive behaviour levels between 220 psychotherapy outpatients with (n = 140; 67.9% female; Mage = 40.0) and without (n = 80; 65.0% female; Mage = 36.2) depressive disorders. Diagnoses were made based on the Structured Clinical Interview for DSM-IV. Study 2 examined self-directed passive-aggressive behaviour as a mediator of the relationship between distorted self-monitoring and dysfunctional self-evaluation and self-reported depressive symptoms in 200 undergraduate Psychology students. RESULTS Compared to outpatients without depressive disorders, outpatients with depressive disorder reported significantly more self-directed passive aggression (d = 0.51). Furthermore, Study 2 verified self-directed passive-aggressive behaviour as a partial mediator of the relationship between dysfunctional attitudes (abcs = .22, 95%-CI: .14, .31), attributional style (abcs = .20, 95%-CI: .13, .27), ruminative response style (abcs = .15, 95%-CI: .09, .21) and depressive symptoms. CONCLUSION Self-directed passive-aggressive behaviour partially mediates the association between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. Future longitudinal studies need to examine a potential causal relationship that would form a base to include interventions targeting self-directed passive-aggressive behaviour in prevention and treatment of depression. TRIAL REGISTRATION Both studies were preregistered at the German Clinical Trials Register ( DRKS00014005 and DRKS00019020 ).
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Affiliation(s)
- C. G. Schanz
- grid.11749.3a0000 0001 2167 7588Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - M. Equit
- grid.11749.3a0000 0001 2167 7588Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - S. K. Schäfer
- grid.11749.3a0000 0001 2167 7588Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - T. Michael
- grid.11749.3a0000 0001 2167 7588Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
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22
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Hellstrøm T, Andelic N, Holthe ØØ, Helseth E, Server A, Eiklid K, Sigurdardottir S. APOE-ε4 Is Associated With Reduced Verbal Memory Performance and Higher Emotional, Cognitive, and Everyday Executive Function Symptoms Two Months After Mild Traumatic Brain Injury. Front Neurol 2022; 13:735206. [PMID: 35250800 PMCID: PMC8888909 DOI: 10.3389/fneur.2022.735206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Substantial variance exists in outcomes after mild traumatic brain injury (MTBI), and these differences are not fully explained by injury characteristics or severity. Genetic factors are likely to play a role in this variance. Objectives The aim of this study was to examine associations between the apolipoprotein (APOE)-ε4 allele and memory measures at two months post-MTBI and to evaluate whether subjective cognitive and affective symptoms were associated with APOE-ε4 status. Based on previous research, it was hypothesized that APOE-ε4 carriers would show poorer verbal memory performance compared to APOE-ε4 non-carriers. Methods Neuropsychological data at two months post-injury and blood samples that could be used to assess APOE genotype were available for 134 patients with MTBI (mean age 39.2 years, 62% males, 37% APOE-ε4 carriers). All patients underwent computed tomography at hospital admission and magnetic resonance imaging four weeks post-injury. Results The APOE-ε4 + status was associated with decreased immediate memory recall (p = 0.036; β = −0.10, 95% CI [−0.19, −0.01]). Emotional, cognitive, and everyday executive function symptoms at two months post-injury were significantly higher in APOE-ε4 carriers compared to non-carriers. Conclusion The APOE-ε4+ allele has a negative effect on verbal memory and symptom burden two months after MTBI.
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Affiliation(s)
- Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- *Correspondence: Torgeir Hellstrøm
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Øyvor Øistensen Holthe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Andres Server
- Section of Neuroradiology, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristin Eiklid
- Department of Medical Genetic, Oslo University Hospital, Oslo, Norway
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23
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The Interpersonal Dimension of Pandemic Fear and the Dual-Factor Model of Mental Health: The Role of Coping Strategies. Healthcare (Basel) 2022; 10:healthcare10020247. [PMID: 35206862 PMCID: PMC8871641 DOI: 10.3390/healthcare10020247] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: Current COVID-19 research has mainly focused on negative outcomes associated with fear of the pandemic with the examination of potentially positive outcomes remaining underexplored. Based on the dual-factor model of mental health, which postulates positive and negative dimensions, we assessed the influence of COVID-19 fear on both negative and positive mental health outcomes and examined the mediational role of coping strategies. (2) Methods: A convenience sample of 231 respondents participated in an online survey reporting on measures of pandemic fear (SFS), distress (HADS), post-traumatic growth (PTGI) and individual differences in terms of coping strategies (CSI-SF). (3) Results: Respondents’ main concerns related with the pandemic highlighted the interpersonal and social dimensions implicated in fear of COVID-19. As expected, fear of the pandemic was associated not just with negative but also positive outcomes, while different coping strategies played a role in determining such effects. More specifically, disengagement coping mediated the effects of fear on anxiety and depression, whereas engagement coping was the only mediator of the relationship between COVID-19 fear and post-traumatic growth. (4) Conclusions: Approaches to promote psychological wellbeing in the context of the COVID-19 pandemic should on the one hand be sensitive to the needs of the more vulnerable population groups, while on the other leverage existing resources to harness the potential for growth. Strengthening engagement coping in the context of fears triggered by the pandemic may constitute a valuable target to protect against negative and optimize positive mental health outcomes in the general population.
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24
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Visser E, Den Oudsten BL, Lodder P, Gosens T, De Vries J. Psychological risk factors that characterize acute stress disorder and trajectories of posttraumatic stress disorder after injury: a study using latent class analysis. Eur J Psychotraumatol 2022; 13:2006502. [PMID: 35087642 PMCID: PMC8788340 DOI: 10.1080/20008198.2021.2006502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/13/2021] [Accepted: 11/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background The course and different characteristics of acute and posttraumatic stress disorder (ASD, PTSD) in trauma populations are unclear. Objective The aims were to identify longitudinal trajectories of PTSD, to establish a risk profile for ASD and PTSD based on patients' sociodemographic, clinical, and psychological characteristics, and to study the effect of ASD and dissociation on PTSD during 12 months after trauma. Method Patients completed questionnaires after inclusion and at 3, 6, 9, and 12 months afterwards. Trajectories were identified using repeated measures latent class analysis (RMLCA). The risk profile was based on a ranking of importance of each characteristic using Cohen's d effect sizes and odds ratios. The impact of ASD and dissociation on PTSD was examined using logistic regression analyses. Results Altogether, 267 patients were included. The mean age was 54.0 (SD = 16.1) and 62% were men. The prevalence rate of ASD was approximately 21.7% at baseline, and 36.1% of trauma patients exhibited PTSD at 12 months after injury. Five trajectories were identified: (1) no PTSD symptoms, (2) mild, (3) moderate, (4) subclinical, and (5) severe PTSD symptoms. These trajectories seemed to remain stable over time. Compared with patients in other trajectories, patients with ASD and (subclinical) PTSD were younger and scored higher on anxiety, depressive symptoms, neuroticism, and trait anxiety. Regarding dissociation symptoms, inability to recall memories about the event was significantly more present than an altered sense of reality, (105 (40.7%) versus 56 (21.7%), p = .031), although that symptom had the strongest likelihood for PTSD. Patients with dissociation were significantly at risk for PTSD than patients without dissociation (OR = 4.82; 95%CI: 1.91-12.25). Conclusions Psychological factors characterized ASD and trajectories of PTSD during 12 months post-trauma. Healthcare providers who are aware of these findings could early identify patients at risk for ASD and PTSD and refer them for patient-centred interventions.
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Affiliation(s)
- Eva Visser
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
- Department of Medical Psychology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | | | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopaedics, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Jolanda De Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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25
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Ayalew M, Deribe B, Duko B, Geleta D, Bogale N, Gemechu L, Gebretsadik A, Bedaso A. Prevalence of depression and anxiety symptoms and their determinant factors among patients with cancer in southern Ethiopia: a cross-sectional study. BMJ Open 2022; 12:e051317. [PMID: 35063957 PMCID: PMC8785168 DOI: 10.1136/bmjopen-2021-051317] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The study was aimed to assess the prevalence of depression and anxiety symptoms and their determinant factors among patients with cancer attending follow-up at Hawassa University Comprehensive Specialized Hospital cancer treatment centre, Ethiopia. DESIGN Institution-based cross-sectional study design was implemented. SETTING Patients with cancer at Hawassa University Comprehensive Specialized Hospital cancer treatment centre from October 2019 to December 2019. PARTICIPANTS Randomly selected 415 patients with cancer who had follow-up at cancer treatment centre. MAIN OUTCOME MEASURES Anxiety and depression symptoms were assessed using Hospital Anxiety and Depression Scale. RESULT The prevalence rates of depression and anxiety symptoms were found to be 244 (58.8%) and 249 (60.0%), respectively. Older age (>50 years) (AOR (adjusted OR)=2.24, 95% CI=1.14 to 4.40), being unemployed (AOR=1.96, 95% CI=1.08 to 3.56), advanced stage of cancer such as stage III (AOR=5.37, 95% CI=1.34 to 21.45) and stage IV (AOR=4.55, 95% CI=1.12 to 18.44), comorbid psychotic symptoms (AOR=1.67, 95% CI=1.07 to 2.61) and eating problem in the past 2 weeks (AOR=6.16, 95% CI=1.98 to 19.11) were independent factors significantly associated with depressive symptoms. In addition, cancer stage such as stage II (AOR=3.92, 95% CI=1.07 to 14.36) and stage IV (AOR=5.04, 95% CI=1.44 to 17.59) and comorbid psychotic symptoms (AOR=1.73, 95% CI=1.12 to 2.66) were significantly associated with anxiety symptoms. CONCLUSION Depression and anxiety symptoms among patients with cancer were considerably high. Age, occupation, cancer stage, comorbid psychotic symptoms and eating problem were determinant factors of depressive symptoms among patients with cancer. Moreover, cancer stage and comorbid psychosis were determinants of anxiety symptoms. Healthcare professionals working in the oncology unity need to conduct routine screening and treatment of depression and anxiety symptoms for patients with cancer.
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Affiliation(s)
- Mohammed Ayalew
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Bedilu Deribe
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Bereket Duko
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
- Curtin School of Population Health, Curtin University, Bentley, Perth, Australia
| | - Dereje Geleta
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Netsanet Bogale
- Faculty of Medicine, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Lalisa Gemechu
- Environmental Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Achamyelesh Gebretsadik
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Asres Bedaso
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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26
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The Relationship Between Cognitive Functioning and Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder in Adults with a Traumatic Brain Injury: a Meta-Analysis. Neuropsychol Rev 2021; 32:758-806. [PMID: 34694543 DOI: 10.1007/s11065-021-09524-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
A thorough understanding of the relationship between cognitive test performance and symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD) in people with traumatic brain injury (TBI) is important given the high prevalence of these emotional symptoms following injury. It is also important to understand whether these relationships are affected by TBI severity, and the validity of test performance and symptom report. This meta-analysis was conducted to investigate whether these symptoms are associated with cognitive test performance alterations in adults with a TBI. This meta-analysis was prospectively registered on the PROSPERO International Prospective Register of Systematic Reviews website (registration number: CRD42018089194). The electronic databases Medline, PsycINFO, and CINAHL were searched for journal articles published up until May 2020. In total, 61 studies were included, which enabled calculation of pooled effect sizes for the cognitive domains of immediate memory (verbal and visual), recent memory (verbal and visual), attention, executive function, processing speed, and language. Depression had a small, negative relationship with most cognitive domains. These relationships remained, for the most part, when samples with mild TBI (mTBI)-only were analysed separately, but not for samples with more severe TBI (sTBI)-only. A similar pattern of results was found in the anxiety analysis. PTSD had a small, negative relationship with verbal memory, in samples with mTBI-only. No data were available for the PTSD analysis with sTBI samples. Moderator analyses indicated that the relationships between emotional symptoms and cognitive test performance may be impacted to some degree by exclusion of participants with atypical performance on performance validity tests (PVTs) or symptom validity tests (SVTs), however there were small study numbers and changes in effect size were not statistically significant. These findings are useful in synthesising what is currently known about the relationship between cognitive test performance and emotional symptoms in adults with TBI, demonstrating significant, albeit small, relationships between emotional symptoms and cognitive test performance in multiple domains, in non-military samples. Some of these relationships appeared to be mildly impacted by controlling for performance validity or symptom validity, however this was based on the relatively few studies using validity tests. More research including PVTs and SVTs whilst examining the relationship between emotional symptoms and cognitive outcomes is needed.
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27
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AlSwailem S, Fortini S, Ahmed A, Mariotti SP, Shahwan S, Khandekar R. Ophthalmologists perceived usefulness of Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) for evaluating the mental health of patients with chronic eye diseases. Eur J Ophthalmol 2021; 32:1966-1970. [PMID: 34516321 DOI: 10.1177/11206721211044634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the awareness of ophthalmologists about assessing the mental health of patients and usefulness of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) survey. METHODS This web-based survey was performed in 2020 at an eye hospital in Saudi Arabia. Participants included ophthalmologists and physicians. Participants were queried on the need to assess mental health of patients, usefulness of the screening tool, and barriers to assessment. Their responses were graded on a Likert scale and Rasch analysis was performed. RESULTS Of the 100 participants, 72 were aware of assessing mental health of eye patients and 82 expressed about limited skills for such assessment. The median score for perceived usefulness of the PHQ-9 as screening tool to suspect depression was -1.0 (inter quartile range, -1.0: 0.0) [Mean Rasch score = -0.735]. The median score of perceived usefulness for the GAD-7 as screening tool to suspect anxiety was -1.0 (inter quartile range, -1.0: 0.0) [Mean Rasch score = -0.695]. The PHQ-9 related score was significantly correlated to "30-39 years" age group (Kruskal Wallis p = 0.04) and non-Saudi professionals (Mann Whitney p = 0.005). The GAD-7 related score was significantly correlated to non-Saudi professionals (Mann Whitney p = 0.04). The mental health related score was significantly and negatively correlated to the "40-59 years" age group (Kruskal Wallis p = 0.04). CONCLUSIONS Although awareness of mental health assessment was high, eyecare professionals felt with inadequate training for performing the screening. PHQ-9 seems to be more acceptable to screen for depression than GAD-7 for screening anxiety.
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Affiliation(s)
| | | | - Anwar Ahmed
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Silvio P Mariotti
- Prevention of Blindness & Deafness, World Health Organization (HQ), Geneva, Switzerland
| | - Sami Shahwan
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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28
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Sathananthan N, Dimech-Betancourt B, Morris E, Vicendese D, Knox L, Gillanders D, Das Nair R, Wong D. A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma). Neuropsychol Rehabil 2021; 32:2170-2202. [PMID: 34433379 DOI: 10.1080/09602011.2021.1971094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adjustment to life with acquired brain injury (ABI) requires self-identity and behaviour to be updated, incorporating injury-related changes. Identifying and enabling new values-consistent behaviours could facilitate this process. We evaluated the feasibility, acceptability, and preliminary efficacy of VaLiANT, a new group intervention that aims to enhance "valued living" following ABI. We used a non-concurrent multiple baseline single-case experimental design (SCED) with an 8-week follow-up phase and randomization to multiple baseline lengths (5-7 weeks). Eight participants (50% women, aged 26-65; 4 Stroke, 3 Traumatic Brain Injury, 1 Epilepsy) attended eight group sessions with assessments before, during, and after the group. Target behaviour was valued living, assessed weekly by the Valued Living Questionnaire. Secondary outcomes included measures of wellbeing, mood, psychological acceptance, self-efficacy regarding ABI consequences, cognitive complaints, and intervention acceptability. Target behaviour was analysed through visual and statistical analysis while secondary outcome data were analysed via reliable change indices and descriptive statistics. Target behaviour data displayed no convincing patterns of improvement. Reliable improvements were found for most participants on secondary outcomes, particularly subjective wellbeing and anxiety. Intervention delivery was feasible with high acceptability ratings. Further investigation of VaLiANT is warranted, based on the feasibility and acceptability of intervention delivery and signals of efficacy identified across adjustment-related secondary outcomes.
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Affiliation(s)
- Nick Sathananthan
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Eric Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Don Vicendese
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Lucy Knox
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Roshan Das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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29
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Rauwenhoff J, Peeters F, Bol Y, Van Heugten C. Measuring psychological flexibility and cognitive defusion in individuals with acquired brain injury. Brain Inj 2021; 35:1301-1307. [PMID: 34487472 PMCID: PMC10791065 DOI: 10.1080/02699052.2021.1972155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Acceptance and Commitment Therapy (ACT) is used increasingly for individuals with psychological distress following acquired brain injury (ABI) in different countries. However, questionnaires measuring ACT-processes are often not validated for this patient group and need cross-cultural validation. This study investigated the psychometric properties of the Acceptance and Action Questionnaire for Acquired Brain Injury (AAQ-ABI; measuring psychological flexibility related to thoughts and feelings about ABI) and the Cognitive Fusion Questionnaire (CFQ-7; measuring cognitive defusion). MATERIALS AND METHODS Score distribution, reliability, and convergent validity of the AAQ-ABI and the CFQ-7 were examined in Dutch individuals with ABI. RESULTS Seventy-three patients with ABI were included. The AAQ-ABI showed good reliability (Cronbach's α = 0.87) and the CFQ-7 excellent reliability (Cronbach's α = 0.97). Both did not show a floor or ceiling effect, nor a skewed distribution. There were strong to moderate correlations between the questionnaires and measures of psychological flexibility, mood, quality of life, and value-driven behavior (AAQ-ABI: r = -0.70-0.81; CFQ-7 = -0.67-0.84). Inter-item total correlations indicate that the questions within each questionnaire measured the same construct (AAQ-ABI: r = 0.40-0.78; CFQ-7: r = 0.84-0.93). CONCLUSIONS The current study shows that the Dutch AAQ-ABI and CFQ-7 have acceptable to good psychometric properties when measuring psychological flexibility and cognitive defusion in patients with ABI.
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Affiliation(s)
- Johanne Rauwenhoff
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht University Medical Centre, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Frenk Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Yvonne Bol
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Caroline Van Heugten
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht University Medical Centre, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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30
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Jones KM, Starkey N, Barker-Collo S, Ameratunga S, Theadom A, Pocock K, Borotkanics R, Feigin VL. Parent and Teacher-Reported Child Outcomes Seven Years After Mild Traumatic Brain Injury: A Nested Case Control Study. Front Neurol 2021; 12:683661. [PMID: 34367050 PMCID: PMC8342814 DOI: 10.3389/fneur.2021.683661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Increasing evidence suggests potential lifetime effects following mild traumatic brain injury (TBI) in childhood. Few studies have examined medium-term outcomes among hospitalized and non-hospitalized samples. Study aims were to describe children's behavioral and emotional adjustment, executive function (EF), quality of life, and participation at 7-years following mild TBI using parents' and teachers' reports. Methods: Nested case control study of 86 children (68% male, mean age at assessment = 11.27 years; range 7–17 years) who sustained a mild TBI 7-years previously, identified from a prospective, population-based study. They were compared to 69 children free from TBI (61% male, mean age at assessment = 11.12 years; range 5–17 years). In addition to parent-reported socio-demographic details, parents (mild TBI n = 86, non-TBI n = 69) completed age-appropriate standardized questionnaires about children's health-related quality of life, behavioral and emotional adjustment, EF, and social participation. Parents own mood was assessed using the Hospital Anxiety and Depression Scale. Teachers (mild TBI n = 53, non-TBI n = 42) completed questionnaires about children's behavioral and emotional adjustment, and EF. Results: Parent reports showed median group-level scores for cases were statistically significantly greater than controls for emotional symptoms, conduct problems, hyperactivity/inattention, total behavioral difficulties, inhibitory control, shifting, planning/organizing, and Global Executive Composite (total) EF difficulties (p-values 0.001–0.029). Parent reports of child quality of life and social participation were similar, as were teacher reports of child behavioral and emotional adjustment, and EF (p > 0.05). When examining clinical cut-offs, compared to controls, cases had a higher risk of parent-reported total EF difficulties (odds ratio = 3.00) and, to a lesser extent, total behavior problems (odds ratio = 2.51). Conclusions: As a group, children with a history of mild TBI may be at elevated risk for clinically significant everyday EF difficulties in the medium-term compared to non-TBI controls, as judged by their parents. Further multi-informant longitudinal research is required, following larger samples. Aspects requiring particular attention include pre-injury characteristics, such as sleep disturbances and comorbidities (e.g., headaches), that may act as potential confounders influencing the association between mild TBI and child behavioral problems.
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Affiliation(s)
- Kelly M Jones
- School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Starkey
- Division of Arts, Law, Psychology & Social Sciences, School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Suzanne Barker-Collo
- Faculty of Science, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Faculty of Science, School of Psychology, The University of Auckland, Auckland, New Zealand.,UCL Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Alice Theadom
- School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Katy Pocock
- School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Robert Borotkanics
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- School of Clinical Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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Little A, Byrne C, Coetzer R. The effectiveness of cognitive behaviour therapy for reducing anxiety symptoms following traumatic brain injury: A meta-analysis and systematic review. NeuroRehabilitation 2021; 48:67-82. [PMID: 33361617 DOI: 10.3233/nre-201544] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anxiety is a common neuropsychological sequela following traumatic brain injury (TBI). Cognitive Behaviour Therapy (CBT) is a recommended, first-line intervention for anxiety disorders in the non-TBI clinical population, however its effectiveness after TBI remains unclear and findings are inconsistent. OBJECTIVE There are no current meta-analyses exploring the efficacy of CBT as an intervention for anxiety symptoms following TBI, using controlled trials. The aim of the current study, therefore, was to systematically review and synthesize the evidence from controlled trials for the effectiveness of CBT for anxiety, specifically within the TBI population. METHOD Three electronic databases (Web of Science, PubMed and PsycInfo) were searched and a systematic review of intervention studies utilising CBT and anxiety related outcome measures in a TBI population was performed through searching three electronic databases. Studies were further evaluated for quality of evidence based on Reichow's (2011) quality appraisal tool. Baseline and outcome data were extracted from the 10 controlled trials that met the inclusion criteria, and effect sizes were calculated. RESULTS A random effects meta-analysis identified a small overall effect size (Cohen's d) of d = -0.26 (95%CI -0.41 to -0.11) of CBT interventions reducing anxiety symptoms following TBI. CONCLUSIONS This meta-analysis tentatively supports the view that CBT interventions may be effective in reducing anxiety symptoms in some patients following TBI, however the effect sizes are smaller than those reported for non-TBI clinical populations. Clinical implications and limitations of the current meta-analysis are discussed.
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Affiliation(s)
- Alice Little
- North Wales Clinical Psychology Programme, School of Psychology, Bangor University, UK
| | - Christopher Byrne
- North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, NHS Wales, UK.,School of Psychology, Bangor University, UK
| | - Rudi Coetzer
- North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, NHS Wales, UK.,School of Psychology, Bangor University, UK
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Jones KM, Ameratunga S, Starkey NJ, Theadom A, Barker-Collo S, Ikeda T, Feigin VL. Psychosocial functioning at 4-years after pediatric mild traumatic brain injury. Brain Inj 2021; 35:416-425. [PMID: 33539250 DOI: 10.1080/02699052.2021.1878553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Behavioral and emotional difficulties are reported following pediatric mild traumatic brain injury (TBI). But few studies have used a broad conceptual approach to examine children's long-term psychosocial outcomes. This study examines children's psychosocial outcomes at 4-years after mild TBI and associated factors.Methods: Parents of 93 children (<16 years) with mild TBI completed subscales of age-appropriate versions of the Strengths and Difficulties Questionnaire, the Behavior Rating Inventory of Executive Function, the Pediatric Quality of Life Inventory, and the Adolescent Scale of Participation questionnaire at 4-years post-injury.Results: Mean group-level scores were statistically significantly higher for hyperactivity/inattention and lower for emotional functioning than published norms. Levels of participation were greater compared to those observed in normative samples. More than 19% met published criteria for clinically significant hyperactivity/inattention, emotional functioning problems, peer relationship problems, and social functioning difficulties. Lower family socio-economic status and greater parental anxiety and depression were associated with overall psychosocial difficulties.Conclusions: Findings indicate that as a group, children with mild TBI are characterized by elevated rates of behavioral, emotional, and social difficulties at 4-years post-injury. Parent mental health may be an untapped opportunity to support children's psychosocial development following mild TBI, with replication required in larger samples.
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Affiliation(s)
- Kelly M Jones
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nicola J Starkey
- School of Psychology, Division of Arts, Law, Psychology & Social Sciences, The University of Waikato, Hamilton, New Zealand
| | - Alice Theadom
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Takayoshi Ikeda
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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Visser E, Oudsten BLD, Gosens T, Lodder P, De Vries J. Psychological risk factors that characterize the trajectories of quality of life after a physical trauma: a longitudinal study using latent class analysis. Qual Life Res 2021; 30:1317-1335. [PMID: 33447963 PMCID: PMC8068651 DOI: 10.1007/s11136-020-02740-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The course and corresponding characteristics of quality of life (QOL) domains in trauma population are unclear. Our aim was to identify longitudinal QOL trajectories and determine and predict the sociodemographic, clinical, and psychological characteristics of trajectory membership in physical trauma patients using a biopsychosocial approach. METHODS Patients completed a questionnaire set after inclusion, and at 3, 6, 9, and 12 months follow-up. Trajectories were identified using repeated-measures latent class analysis. The trajectory characteristics were ranked using Cohen's d effect size or phi coefficient. RESULTS Altogether, 267 patients were included. The mean age was 54.1 (SD = 16.1), 62% were male, and the median injury severity score was 5.0 [2.0-9.0]. Four latent trajectories were found for psychological health and environment, five for physical health and social relationships, and seven trajectories were found for overall QOL and general health. The trajectories seemed to remain stable over time. For each QOL domain, the identified trajectories differed significantly in terms of anxiety, depressive symptoms, acute stress disorder, post-traumatic stress disorder, Neuroticism, trait anxiety, Extraversion, and Conscientiousness. DISCUSSION Psychological factors characterized the trajectories during 12 months after trauma. Health care providers can use these findings to identify patients at risk for impaired QOL and offer patient-centered care to improve QOL.
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Affiliation(s)
- Eva Visser
- Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Brenda Leontine Den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopaedics, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Jolanda De Vries
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
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Abstract
BACKGROUND Impaired psychological state, such as anxiety and depressive symptoms, occurs in up to 40% of patients hospitalized for traumatic injury. These symptoms, in the acute period, may delay engagement in activity, such as ambulation, following injury. The purpose of this study was to determine whether baseline anxiety and depressive symptoms predicted delayed (>48 hr from admission) ambulation in patients hospitalized for major traumatic injury. METHODS Adults (n = 19) admitted for major trauma (Injury Severity Score [ISS] = 15) provided a baseline measure of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]). Logistic regression was used to determine the predictive power of baseline HADS Anxiety and HADS Depression subscale scores for delayed ambulation while controlling for ISS. RESULTS At baseline, anxiety was present in 32% of patients; 21% reported depressive symptoms. Baseline HADS Anxiety score did not predict the ambulation group. However, for each 1 point increase in baseline HADS Depression score, the likelihood of patients ambulating after 48 hr from admission increased by 67% (odds ratio = 1.67; 95% CI [1.02, 2.72]; p = .041). CONCLUSION Worsening depressive symptoms were associated with delayed ambulation in the acute period following injury. Future, larger scale investigations are needed to further elucidate the relationship between psychological symptoms and the acute recovery period from trauma to better inform clinicians and guide development of interventions to improve patient outcomes.
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Cheng YS, Tseng PT, Wu YC, Tu YK, Wu CK, Hsu CW, Lei WT, Li DJ, Chen TY, Stubbs B, Carvalho AF, Liang CS, Yeh TC, Chu CS, Chen YW, Lin PY, Wu MK, Sun CK. Therapeutic benefits of pharmacologic and nonpharmacologic treatments for depressive symptoms after traumatic brain injury: a systematic review and network meta-analysis. J Psychiatry Neurosci 2021; 46:E196-E207. [PMID: 33497170 PMCID: PMC7955847 DOI: 10.1503/jpn.190122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Depression is a common morbidity after traumatic brain injury. This network meta-analysis investigated the efficacy and tolerability of pharmacologic and nonpharmacologic interventions for depression after traumatic brain injury. METHODS We extracted randomized controlled trials examining pharmacologic or nonpharmacologic interventions with placebo- or active-controlled designs from PubMed, the Cochrane Library and ScienceDirect, from inception to October 30, 2018. We based study selection and extraction of a predefined list of variables on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and conducted meta-analysis procedures using random effects modelling. Primary outcomes were changes in depressive symptom severity after pharmacologic or nonpharmacologic treatment; the secondary outcome was tolerability, reflected in overall patient dropout rates. RESULTS Our analysis of 27 randomized controlled trials (10 pharmacologic, total n = 483, mean age = 37.9 yr; 17 nonpharmacologic, total n = 1083, mean age = 38.0 yr) showed that methylphenidate had significantly superior efficacy compared to placebo or control (standardized mean difference -0.91, 95% confidence interval [CI] -1.49 to -0.33). Sertraline was associated with significantly lower tolerability (i.e., a higher dropout rate) compared to placebo or control (odds ratio 2.65, 95% CI 1.27 to 5.54). No nonpharmacologic treatment was more effective than the others, and we found no significant differences in tolerability (i.e., dropout rates) among the nonpharmacologic treatments. LIMITATIONS Heterogeneity in participant characteristics (e.g., comorbidities), study designs (e.g., trial duration) and psychopathology assessment tools, as well as small trial numbers for some treatment arms, could have been confounders. CONCLUSION The present network meta-analysis suggests that methylphenidate might be the best pharmacologic intervention for depressive symptoms related to traumatic brain injury. None of the nonpharmacologic interventions was associated with better improvement in depressive symptoms than the others or than control conditions. None of the pharmacologic or nonpharmacologic treatments had inferior tolerability compared to placebo or controls except for sertraline, which had significantly lower tolerability than placebo.
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Affiliation(s)
- Yu-Shian Cheng
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Ping-Tao Tseng
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Yi-Cheng Wu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Yu-Kang Tu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Ching-Kuan Wu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Chih-Wei Hsu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Wei-Te Lei
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Dian-Jeng Li
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Tien-Yu Chen
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Brendon Stubbs
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Andre F Carvalho
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Chih-Sung Liang
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Ta-Chuan Yeh
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Che-Sheng Chu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Yen-Wen Chen
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Pao-Yen Lin
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Ming-Kung Wu
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
| | - Cheuk-Kwan Sun
- From the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan (Cheng, Wu); the Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City, Taiwan (Cheng, Tseng); the WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan (Tseng); the Prospect Clinic for Otorhinolaryngology & Neurology (Tseng, Chen); the Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan (Wu); the Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Tu); the Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan (Hsu, Wu, Lin); the Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan (Lei); the Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Lei Taiwan (Li); the Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (Li); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Chen); the Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan (Chen); the Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK (Stubbs); Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK (Stubbs); the Department of Psychiatry, University of Toronto, Toronto, ON (Carvalho); the Centre for Addiction & Mental Health (CAMH), Toronto, ON (Carvalho); the Department of Psychiatry, Beitou branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Liang); the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan (Liang); the Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan (Yeh); the Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Chu); the Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Chu); the Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (Lin); the Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan (Wu); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the I-Shou University School of Medicine for International Students, Kaohsiung, Taiwan (Sun)
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McDonald S, Genova H. The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:235-260. [PMID: 34389120 DOI: 10.1016/b978-0-12-822290-4.00011-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
| | - Helen Genova
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States
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Relevance of the Fear-Avoidance Model for Chronic Disability after Traumatic Brain Injury. J Neurotrauma 2020; 37:2639-2646. [DOI: 10.1089/neu.2020.7135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Understanding the Multidimensional Nature of Sexuality After Traumatic Brain Injury. Arch Phys Med Rehabil 2020; 101:2080-2086. [DOI: 10.1016/j.apmr.2020.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/11/2023]
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Kusec A, Murphy FC, Peers PV, Lawrence C, Cameron E, Morton C, Bateman A, Watson P, Manly T. Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): a randomised controlled pilot feasibility trial for low mood in acquired brain injury. Pilot Feasibility Stud 2020; 6:135. [PMID: 32974044 PMCID: PMC7507282 DOI: 10.1186/s40814-020-00660-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Acquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood. Existing methods for treating depression in ABI have shown mixed efficacy. Behavioural activation (BA) is a potentially promising intervention. Its premise is that individuals with low mood avoid planning and engaging in activities due to low expectations of a positive outcome. Consequently, their exposure to positive reinforcement is reduced, exacerbating low mood. BA aims to break this cycle by encouraging activity planning and engagement. It is unknown whether cognitive demands of traditional BA may undermine efficacy in ABI. Here, we assess the feasibility and acceptability of two groups designed to increase activity engagement. In the activity planning group (traditional BA), the importance of meaningful and positive activity will be discussed and participants encouraged to plan/engage in activities in everyday life. The activity engagement group (experiential BA) instead focuses on engagement in positive experiences (crafts, games, discussion) within the group. The primary aims are to evaluate the feasibility and acceptability of the two groups in ABI. A secondary aim is to explore relative efficacy of the groups compared to an equivalent period of waitlist controls. Method This study outlines a parallel-arm pilot feasibility trial for individuals with low mood and ABI that compares a traditional vs experiential BA group vs waitlist controls. Adults (≥ 18 years) will be recruited from local ABI services and randomised to condition. Feasibility and acceptability will be assessed via recruitment, retention, attendance and participant feedback. Groups will be compared (pre- and post-intervention and 1 month follow-up) by assessing self-reported activity engagement. Secondary outcomes include self-report measures of depression, anxiety, post-traumatic distress related to the ABI, motivation, participation and sense of control over one’s life. Ethics and dissemination The trial has been approved by the Health Research Authority of the NHS in the UK (East of England—Cambridge Central, REF 18/EE/0305). Results will inform future research on interventions for mood in ABI and be disseminated broadly via peer-reviewed journals, conference presentations and social media. Trial registration ClinicalTrials.gov, NCT03874650 pre-results. Protocol version 2.1, March 5, 2019
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Affiliation(s)
- Andrea Kusec
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF UK
| | - Fionnuala C Murphy
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF UK
| | - Polly V Peers
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF UK
| | - Cara Lawrence
- Evelyn Community Head Injury Services, Cambridgeshire Community Services, Dynamic Health Building, Brookfields Hospital, 351 Mill Road, Cambridge, CB1 3DF UK
| | - Emma Cameron
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, Post Box 113, Queen Square, London, WC1N 3BG UK
| | - Claire Morton
- Evelyn Community Head Injury Services, Cambridgeshire Community Services, Dynamic Health Building, Brookfields Hospital, 351 Mill Road, Cambridge, CB1 3DF UK
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ UK
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF UK
| | - Tom Manly
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF UK
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Baseotto MC, Morris PG, Gillespie DC, Trevethan CT. Post-traumatic growth and value-directed living after acquired brain injury. Neuropsychol Rehabil 2020; 32:84-103. [PMID: 32715913 DOI: 10.1080/09602011.2020.1798254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Traumatic events can be associated with positive change, termed "post-traumatic growth." Existing resesarch suggests some overlap between post-traumatic growth and value-directed living. This study sought to explore the relationship between post-traumatic growth and value-directed living after acquired brain injury. Self-report questionnaires including the Posttraumatic Growth Inventory, Valued Living Questionnaire, Engaged Living Scale, Valuing Questionnaire, Hospital Anxiety and Depression Scale, World Health Organization Well-Being Index, Brief Resilience Scale, Trauma Screening Questionnaire and Glasgow Outcome Scale were posted to 317 individuals who had experienced a head injury, stroke or subarachnoid haemorrhage in the previous 3-13 years, with a hospital admission of minimum 7 days. Questionnaires were completed by 81 participants. Post-traumatic growth was significantly positively associated with two measures of value-directed living (VLQ, r = .269; VQ, r = .215). Higher levels of value-directed living were significantly associated with increased positive outcomes (wellbeing) and reduced negative outcomes (distress, post-traumatic stress symptoms). There was no significant association between post-traumatic growth and any of these outcomes. The association between post-traumatic growth and value-directed living indicates possible common underlying processes. Value-directed living appears to be a more useful concept, as it was associated with clinically relevant outcomes. It is recommended that value-directed living interventions are considered in brain injury rehabilitation.
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de Munter L, Polinder S, Haagsma JA, Kruithof N, van de Ree CL, Steyerberg EW, de Jongh M. Prevalence and Prognostic Factors for Psychological Distress After Trauma. Arch Phys Med Rehabil 2020; 101:877-884. [DOI: 10.1016/j.apmr.2019.10.196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
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Factorial Structure and Validity of Depression (PHQ-9) and Anxiety (GAD-7) Scales after Traumatic Brain Injury. J Clin Med 2020; 9:jcm9030873. [PMID: 32210017 PMCID: PMC7141536 DOI: 10.3390/jcm9030873] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The dimensionality of depression and anxiety instruments have recently been a source of controversy. OBJECTIVES AND DESIGN In a European-wide sample of patients after Traumatic Brain Injury (TBI), we aim to examine the factorial structure, validity, and association of the Patient Health Questionnaire for depression (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) instruments. This study is based on longitudinal observational data. We conducted analyses of factorial structure and discriminant validity of outcomes six-months after TBI. We also examined the prevalence, co-occurrence, and changes of scores on the PHQ-9 and GAD-7 at 3-, 6-, and 12-month post-TBI assessments. PARTICIPANTS At six-months post-TBI assessment, 2137 (738 (34.5%) women) participants completed the PHQ-9 and GAD-7 questionnaires. For the longitudinal analysis, we had 1922 participants (672 (35.0%) women). RESULTS The results of exploratory factor analysis suggested a general latent construct underlying both PHQ-9 and GAD-7 measures. Confirmatory factor analyses showed a slight improvement in the fit indices for the bifactorial model. The Omega hierarchical test clearly differentiated two subfactors of PHQ-9 and GAD-7 items over and above the underlying general factor; however, most of the variance (85.0%) was explained by the general factor and the explained variance of the subfactors was small. The PHQ-9 and GAD-7 performed similarly in detecting post-traumatic stress disorder (PTSD). As defined by conventional cut-offs, depression and anxiety have different prevalence rates in the sample. The scales also differed in their relationships with the short form of health survey (SF-36v2) subscales. The longitudinal analysis showed high stability of depression and anxiety symptoms: 49-67% of the post-TBI patients with comorbid depression and anxiety reported the persistence of the symptoms over time. DISCUSSION The factorial structure analysis favors a general latent construct underlying both depression and anxiety scales among patients after TBI. We discuss the implications our findings and future research directions.
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Rushby JA, De Blasio FM, Logan JA, Wearne T, Kornfeld E, Wilson EJ, Loo C, Martin D, McDonald S. tDCS effects on task-related activation and working memory performance in traumatic brain injury: A within group randomized controlled trial. Neuropsychol Rehabil 2020; 31:814-836. [PMID: 32114899 DOI: 10.1080/09602011.2020.1733620] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Non-invasive transcranial direct current stimulation (tDCS) has been reported to facilitate working memory in normal adults. There is some evidence in people with Traumatic Brain Injury (TBI) but overall evidence is mixed. This study aimed to address shortcomings of prior study designs in TBI to examine whether a single dose of tDCS would lead to benefits in working memory. Thirty people with severe, chronic TBI were administered a single session of either anodal tDCS (2 mA for 20 min) or sham tDCS (2 mA for 30 s), in a counterbalanced order, over the left parietal cortex while performing 1-back and 2-back working memory tasks. Skin conductance levels were examined as a measure of task activated arousal, a possible functional analogue of cortical excitability. We found that tDCS led to no improvements in accuracy on the working memory tasks. A slight increase in variability and reaction time with tDCS was related to decreased task activated arousal. Overall, this study yielded no evidence that a single session of tDCS can facilitate working memory for people with TBI.
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Affiliation(s)
| | | | - Jodie A Logan
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Travis Wearne
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emma Kornfeld
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily Jane Wilson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Colleen Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Donel Martin
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
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Kelly-Pettersson P, Samuelsson B, Unbeck M, Muren O, Magnéli M, Gordon M, Stark A, Sköldenberg O. The influence of depression on patient-reported outcomes for hip-fracture patients 1 year after surgery: a prospective cohort study. Aging Clin Exp Res 2020; 32:247-255. [PMID: 31028625 PMCID: PMC7033144 DOI: 10.1007/s40520-019-01207-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is common in elderly hip-fracture patients and together with cognitive impairment is associated with increased risk of mortality. AIM We aimed to examine the influence depression has on patient-reported outcome up to 1 year after acute hip fracture. METHODS 162 hip-fracture patients participated in the prospective observational cohort study and were followed up at baseline, and 3 and 12 months using patient-reported outcome scores. Patients with cognitive impairment were excluded. Depression was defined as a score ≥ 8 on the depression subscale of the Hospital Anxiety Depression Scale (HADS D), having a diagnosis of depression or being treated with anti-depressant medication. Hip function was assessed using Harris Hip Score (HHS), EQ-5D was used to assess health status and Quality of life, and the Pain Numerical Rating Scale (PRNS) was used to assess pain levels. A linear regression model adjusted for group, age, sex, and ASA class was used to identify risk factors for functional outcome 12 months after fracture. RESULTS 35 patients were included in the depression group versus 127 in the control group. No statistical differences were found in the demographic data (age, sex, ASA class, fracture type, operation method, living situation, activities of daily living ADL and clinical pathway) between the groups. In the regression model, we found no correlation between depression and the patient-reported outcome. CONCLUSION In young elderly hip fracture patients without cognitive dysfunction, depression may not be of major importance for the rehabilitation of hip function in the short term.
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Affiliation(s)
- Paula Kelly-Pettersson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bodil Samuelsson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olav Muren
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Martin Magnéli
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Max Gordon
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - André Stark
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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von Steinbüchel N, Meeuwsen M, Zeldovich M, Vester JC, Maas A, Koskinen S, Covic A. Differences in Health-Related Quality of Life after Traumatic Brain Injury between Varying Patient Groups: Sensitivity of a Disease-Specific (QOLIBRI) and a Generic (SF-36) Instrument. J Neurotrauma 2020; 37:1242-1254. [PMID: 31801408 DOI: 10.1089/neu.2019.6627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Factors associated with health-related quality of life (HRQOL) in patients after traumatic brain injury (TBI) include severity of initial injury, different grades of trauma recovery, sociodemographic status, and psychological characteristics. Yet, sensitivity of HRQOL instruments to such effects is often underexplored. Thus, we aimed to compare the capacity of the disease-specific QOLIBRI (Quality of Life after Brain Injury) and the generic Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey(SF-36) to detect significant differences in HRQOL between patients. Patients (n = 795) completed HRQOL, sociodemographic, clinical, psychological, and health status questionnaires. Univariate (Wilcoxon-Mann-Whitney) and multi-variate (Wei-Lachin) non-parametric analyses were conducted using the Wilcoxon-Mann-Whitney approach to compare the sensitivity of the QOLIBRI and the SF-36. For both instruments, HRQOL was particularly influenced by patients' reliance on others, depression, anxiety, and recovery status, whereas smaller effects were found for living arrangements and participation in leisure activities. Both HRQOL instruments were sensitive to group differences, but the QOLIBRI was able to detect a greater number of and finer differences between specific patient groups, which is particularly important in clinical and therapeutic contexts. This finding is likely explained by the QOLIBRI's greater specificity to disease-specific aspects of consequences of TBI. This head-to-head HRQOL instrument comparison resulted in a recommendation for the use of the QOLIBRI when detailed insight in the subjective consequences and impact of TBI on patients is required.
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Affiliation(s)
- Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Mirjam Meeuwsen
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Sanna Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
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Colyer SP, Moore DM, Cui Z, Zhu J, Armstrong HL, Taylor M, Edward J, Howard T, Dickie C, Olarewaju G, Montaner JSG, Hogg RS, Roth EA, Lachowsky NJ. Crystal Methamphetamine Use and Initiation among Gay, Bisexual, and Other Men Who Have Sex with Men Living with HIV in a Treatment as Prevention Environment. Subst Use Misuse 2020; 55:2428-2437. [PMID: 33059493 PMCID: PMC7657389 DOI: 10.1080/10826084.2020.1833925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Risk compensation in an HIV Treatment as Prevention (TasP) environment may increase high-risk sexual and substance use behaviors among people living with HIV. Objective: To examine recent crystal methamphetamine (CM) use/initiation in a longitudinal cohort of gay, bisexual, and other men who have sex with men (GBMSM) living with HIV in Metro Vancouver, Canada. Methods: Eligible participants were GBMSM aged >15 years who reported sex with another man in the past six months. Participants were recruited using respondent-driven sampling and self-completed a computer questionnaire every six months. We used multi-level generalized mixed-effect models to evaluate trends in recent CM use (past six months), multivariable logistic regression to identify covariates of recent CM use, and multivariable survival analysis to identify predictors of CM initiation. Results: Of 207 GBMSM living with HIV at enrollment, 44.3% reported recent CM use; there was a statistically non-significant decrease over the study period (41% in first period to 25% in final period, p = 0.087). HIV treatment optimism was not associated with CM use/initiation. CM use was positively associated with depressive symptomology, sexual escape motivation, transactional sex, number of anal sex partners, condomless anal sex with seroconcordant partners, STIs, and other substance use. Recent CM use was negatively associated with viral load sorting. CM initiation was predicted by escape motivation, transactional sex, and group sex participation. Conclusion: Results suggest that CM use among GBMSM living with HIV is prevalent and increased CM use/initiation is not a consequence of TasP public policy.
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Affiliation(s)
- Sean P Colyer
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, McGill University, Montreal, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Zishan Cui
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julia Zhu
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Heather L Armstrong
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada.,Department of Psychology, University of Southampton, Southampton, UK
| | | | - Joshua Edward
- Health Initiative for Men Society, Vancouver, Canada
| | - Terry Howard
- Community Advisory Board, Momentum Health Study, Vancouver, Canada
| | - Chad Dickie
- Community Advisory Board, Momentum Health Study, Vancouver, Canada
| | - Gbolahan Olarewaju
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio S G Montaner
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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The BrainACT study: acceptance and commitment therapy for depressive and anxiety symptoms following acquired brain injury: study protocol for a randomized controlled trial. Trials 2019; 20:773. [PMID: 31881916 PMCID: PMC6935100 DOI: 10.1186/s13063-019-3952-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/03/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Following an acquired brain injury, individuals frequently experience anxiety and/or depressive symptoms. However, current treatments for these symptoms are not very effective. A promising treatment is acceptance and commitment therapy (ACT), which is a third-wave behavioural therapy. The primary goal of this therapy is not to reduce symptoms, but to improve psychological flexibility and general well-being, which may be accompanied by a reduction in symptom severity. The aim of this study is to investigate the effectiveness of an adapted ACT intervention (BrainACT) in people with acquired brain injury who experience anxiety and/or depressive symptoms. METHODS The study is a multicenter, randomized, controlled, two-arm parallel trial. In total, 94 patients who survive a stroke or traumatic brain injury will be randomized into an ACT or control (i.e. psycho-education and relaxation) intervention. The primary outcome measures are the Hospital Anxiety and Depression Scale and the Depression Anxiety Stress Scale. Outcomes will be assessed by trained assessors, blinded to treatment condition, pre-treatment, during treatment, post-treatment, and at 7 and 12 months. DISCUSSION This study will contribute to the existing knowledge on how to treat psychological distress following acquired brain injury. If effective, BrainACT could be implemented in clinical practice and potentially help a large number of patients with acquired brain injury. TRIAL REGISTRATION Dutch Trial Register, NL691, NTR 7111. Registered on 26 March 2018. https://www.trialregister.nl/trial/6916.
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Anthony RE, Paine AL, Shelton KH. Depression and Anxiety Symptoms of British Adoptive Parents: A Prospective Four-Wave Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5153. [PMID: 31861100 PMCID: PMC6949987 DOI: 10.3390/ijerph16245153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022]
Abstract
The mental health of birth parents has gained attention due to the serious negative consequences for personal, family, and child outcomes, but depression and anxiety in adoptive parents remains under-recognized. Using a prospective, longitudinal design, we investigated anxiety and depression symptoms in 96 British adoptive parents over four time points in the first four years of an adoptive placement. Depression and anxiety symptom scores were relatively stable across time. Growth curve analysis showed that higher child internalizing scores and lower parental sense of competency at five months post-placement were associated with higher initial levels of parental depressive symptoms. Lower parental sense of competency was also associated with higher initial levels of parental anxiety symptoms. Parents of older children and those with higher levels of parental anxiety and sense of competency at five months post-placement had a steeper decrease in depressive symptoms over time. Support for adoptive families primarily focuses on child adjustment. Our findings suggest that professional awareness of parental mental health post-placement may be necessary, and interventions aimed at improving parents' sense of competency may be beneficial.
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Affiliation(s)
- Rebecca E. Anthony
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK;
| | - Amy L. Paine
- School of Psychology, Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3BD, UK;
| | - Katherine H. Shelton
- School of Psychology, Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3BD, UK;
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Correlation between Preoperative Anxiety and ABO Blood Types: Evidence from a Clinical Cross-Sectional Study. DISEASE MARKERS 2019; 2019:1761693. [PMID: 31871497 PMCID: PMC6913271 DOI: 10.1155/2019/1761693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/27/2019] [Indexed: 01/28/2023]
Abstract
Gene-environment interaction is identified as the determinant in anxiety. ABO blood types represent a part of the genetic phenotype. Therefore, we assume ABO blood types correlate with preoperative anxiety. This cross-sectional study enrolled 352 patients with different ABO blood types, scheduled for elective surgery between 2018 and 2019 in the First Affiliated Hospital of Shihezi University. HADS (hospital anxiety and depression scale) scores and VA (visual analogue scales for anxiety) scores were all used to assess the preoperative anxiety in the A, B, AB, and O groups. Bivariate correlation and logistic regression were performed to identify relationships between preoperative anxiety and related variables. A significant difference in VA and HADS-A (anxiety) scores was found between the AB and other groups. The ratio of preoperative anxiety was 3.73 (95% CI [confidence interval]: 2.32-6.00, P < 0.001) times in female than in male; 0.36 (95% CI: 0.21-0.63, P < 0.001) times in ASA (American Society of Anesthesiologists) grade II than in grade I; 0.41 (95% CI: 0.20-0.86, P < 0.05) times in ASA grade III than in grade I; 1.25 (95% CI: 1.1-1.41, P < 0.001) times in higher VAS (visual analogue scales for pain) scores than in lower VAS scores; and 0.28 (95% CI: 0.16-0.49, P < 0.01) times in non-AB blood type than in AB blood type. Differences in ABO blood types were found in preoperative anxiety, and the AB group displayed a high preoperative anxiety level. ABO blood types, sex, ASA grade, and VAS were associated with preoperative anxiety. This trial is registered with ChiCTR1800019390.
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50
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Fang S, Wang XQ, Yang BX, Liu XJ, Morris DL, Yu SH. Survey of Chinese persons managing depressive symptoms: Help-seeking behaviours and their influencing factors. Compr Psychiatry 2019; 95:152127. [PMID: 31669791 DOI: 10.1016/j.comppsych.2019.152127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/24/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To explore help-seeking behaviours of Chinese persons managing depressive symptoms and factors that influence these behaviours. METHODS A survey of residents living in communities in Wuhan, China was conducted using stratified random sampling. The Patient Health Questionnaire (PHQ-2), the Actual Help-Seeking Questionnaire (AHSQ) and a socio-demographic questionnaire were completed by participants. Descriptive statistics were analyzed. A multiple linear regression model was used to explore factors associated with help-seeking behaviours. RESULTS Of the 1785 respondents, 672 (37.6%) reported that they experienced depressive symptoms during the past year, and of these respondents, 517 (76.9%) indicated that they sought assistance. Among help-seeking sources utilized by participants, informal help was sought most frequently (72.9%), followed by hotline/Internet assistance (14.3%), mental health professionals (MHPs) (7.9%) and general physicians (GPs) (3.7%). The results of multilinear regression analysis showed that participants who were adults (aged 25-64 years), attended junior and high school (7-12 years education), and lived in urban areas were more likely to seek additional assistance for their depressive symptoms. CONCLUSION Mental health promotion and education efforts are needed to improve the public's mental health literacy and to promote appropriate utilization of informal sources of assistance in managing depressive symptoms such as a hotline or the Internet. Further interventions need to be considered to reinforce use of social supports and mental health professionals, especially in rural areas.
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Affiliation(s)
- Shu Fang
- School of Health Sciences, Wuhan University, China
| | | | | | - Xiu Jun Liu
- Affiliated Mental Health Center, Tongji Medical College of Huazhong, University of Science & Technology, China
| | - Diana L Morris
- Florence Cellar Associate Professor of Gerontological Nursing, Frances Payne Bolton School of Nursing, University Center on Aging & Health, Case Western Reserve University, USA
| | - Si Hong Yu
- School of Health Sciences, Wuhan University, China
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