Impact of stressful life events on the course of panic disorder in adults

A new, brief measure of college students' academic stressors

Objective: The purpose of this study was to evaluate the psychometric properties of a new measure of academic stressors (the ASM) in college students. Participants: The ASM was given to 677 undergraduate students at three universities along with measures of anxiety/depression, Big Five personality traits, and study skills. Methods: Tests of factorability and an exploratory factor analysis were completed. The internal and test-retest reliability of the measure was also evaluated. Results: The ASM is a concise, valid, and reliable tool for assessing college students' academic stressors. Conclusions: ASM scores predicted anxiety and depression symptoms. Therefore, the ASM can be used by colleges and university to assess students' levels of academic stressors to identify meaningful resources for support.

Role of Traumatic Events and Motivational Structure in Ambiguity Tolerance of Irritable Bowel Syndrome

Background: The main purpose of this study was to delineate the role of motivational structure and traumatic events in the prediction of ambiguity tolerance in patients with irritable bowel syndrome (IBS). Methods: A total of 200 patients with the diagnosis of IBS, referred to the Shariati hospital in 2018, were enrolled using a correlational design and convenience sampling. All participants were asked to complete the ambiguity tolerance questionnaire, the life event checklist, and the personal concerns inventory. Data analysis was performed by Pearson correlation method and regression analysis test in SPSS software. Results: Findings showed that there was a significant relationship between traumatic events (r=- 0.66, P=0.01) and adaptive (r=0.24, P=0.01) and non-adaptive motivational structure (non-AMS) (r=- 0.10, P=0.01) with tolerance of ambiguity (P<0.05). With increasing non-AMS and with decreasing non-AMS and traumatic events, the tolerance of ambiguity is increased. Moreover, the motivational structure (adaptive and non-adaptive) and traumatic events could define and predict 43% of the variance in ambiguity tolerance. Conclusion: Thus, regarding the important role of motivational structure and traumatic events in predicting ambiguity tolerance in IBS patients, it is prudent to put emphasis on these measures to improve patients' overall health and probably alleviate symptoms and provide psychologic rehabilitation.

Comparison of depression and anxiety symptom networks in reporters and non-reporters of lifetime trauma in two samples of differing severity

BACKGROUND

Reported trauma is associated with differences in the course and outcomes of depression and anxiety. However, no research has explored the association between reported trauma and patterns of clinically relevant symptoms of both depression and anxiety.

METHODS

We used network analysis to investigate associations between reported trauma and depression and anxiety symptom interactions in affected individuals from the Genetic Links to Anxiety and Depression (GLAD) Study (n = 17720), and population volunteers from the UK Biobank (n = 11120). Participants with current moderate symptoms of depression or anxiety were grouped into reporters and non-reporters of lifetime trauma. Networks of 16 depression and anxiety symptoms in the two groups were compared using the network comparison test.

RESULTS

In the GLAD Study, networks of reporters and non-reporters of lifetime trauma did not differ on any metric. In the UK Biobank, the symptom network of reporters had significantly greater density (7.80) than the network of non-reporters (7.05).

LIMITATIONS

The data collected in the GLAD Study and the UK Biobank are self-reported with validated or semi-validated questionnaires.

CONCLUSIONS

Reported lifetime trauma was associated with stronger interactions between symptoms of depression and anxiety in population volunteers. Differences between reporters and non-reporters may not be observed in individuals with severe depression and/or anxiety due to limited variance in the presentation of disorder.

Serious mental illness, other mental health disorders, and outpatient health care as predictors of 30-day readmissions following medical hospitalization

OBJECTIVE

Prior research has not addressed whether both serious mental illness (SMI) and other mental health (OMH) disorders affect the likelihood of 30-day readmissions after medical hospitalizations, or whether post-discharge use of outpatient medical, mental health, and pharmacy services is associated with readmission likelihood.

METHODS

Using the Truven Health Analytics MarketScan® Medicaid Multi-State Database, we studied 43,817 Medicaid beneficiaries, age 18-64, following discharge from medical hospitalizations in 2011. Logistic regression models compared all-cause, 30-day readmissions among those with SMI, OMH, and no psychiatric diagnosis, and examined associations of 30-day outpatient service use with 30-day readmissions.

RESULTS

Thirty-day readmission rates were 15.9% (SMI), 13.8% (OMH), and 11.7% (no mental illness). In multivariable analysis, compared to patients without mental illness, odds of readmission were greater for those with SMI (aOR = 1.43, 95%CI:1.32-1.51) and OMH (aOR = 1.21, 95%CI:1.12-1.30), and lower among those using outpatient mental health services (aOR = 0.50, 95%CI: 0.44-0.56).

CONCLUSION

The adult Medicaid population disproportionately includes patients with SMI and OMH disorders, both of which were found to be associated with 30-day hospital readmissions. Receiving outpatient mental health services after hospital discharge may be protective against readmission following medical hospitalizations, suggesting the need for further research on these topics.

Identification of psychological features and development of an assessment tool for event-related psychological distress after experiencing non-traumatic stressful events

Stressful events in daily life that are non-traumatic (e.g., family-, school-, work-, interpersonal-, and health-related problems) frequently cause various mood disturbances. For some people, being exposed to non-traumatic but stressful events could trigger the onset and relapse of mood disorders. Furthermore, non-traumatic stressful events also cause event-related psychological distress (ERPD), similar to that of post-traumatic stress disorder (PTSD; i.e., intense intrusive imagery or memory recall, avoidance, and hyperarousal) in the general population and individuals with mood disorders. However, previous ERPD studies only showed that people with ERPD display PTSD-like symptoms after non-traumatic experiences; they failed to get to the crux of the matter by only utilizing trauma- or PTSD-related assessment tools. We thus aimed to identify the psychological phenomena and features of ERPD after individuals experienced non-traumatic stressful events, and to develop and validate an appropriate ERPD assessment tool. First, we conducted a qualitative study to obtain the psychological features through interviews with 22 individuals (mean age = 41.50 years old, SD = 12.24) with major depressive disorder or bipolar disorder. Second, in the quantitative component, we implemented a web-based survey with 747 participants of the general population (mean age = 41.96 years old, SD = 12.64) by using ERPD-related questionnaires created based on the qualitative study; then, we examined the reliability and validity of the ERPD assessment tool. Results yielded that the psychological features of ERPD comprised four factors: feelings of revenge, rumination, self-denial, and mental paralysis. These were utilized in the developed 24-item measure of ERPD-a novel self-report assessment tool. For various professionals involved in mental healthcare, this tool can be used to clarify and assess psychological phenomena in people with ERPD.

A study to assess the effect of stressful life events on psychological distress levels of participants living in an urban area

Context:

Stressful life events affect the psychological wellbeing of individuals. Through this study, we aim to understand this effect and various other factors affecting the psychological wellbeing of the study participants.

Aims:

To determine the vulnerability of study participants to psychological distress following stressful life events

Settings and Design:

Cross-sectional observational study in an urban setting

Methods and Materials:

Systematic random sampling with a sample size of 178.

Statistical Analysis Used:

Analysis is done using SPSS version 22. Tests used are chi square test, Spearman's rank correlation test.

Results:

The number of life events and psychological distress scores had a positive correlation.The events that occurred in one month before history taking, a correlation was found to be strongest and no correlation was found between the events which occurred more than one year before study enrolment and the psychological distress. Factors like sleeping patterns, exercise, and marital status also had a significant correlation with the psychological distress score of participants.

Conclusions:

Mental health is dependent on many parameters with life events being a major factor at a given point of time. However, different factors apart from life events will affect psychological wellbeing, and mental health is an interplay of all those factors.

Differences in cytokines between patients with generalised anxiety disorder and panic disorder

OBJECTIVE

The purpose of this study was to evaluate the differences among panic disorder (PD), generalised anxiety disorder (GAD) and controls in inflammatory cytokines. We also analysed the correlation between inflammatory cytokines and response to escitalopram in PD and GAD patients.

METHODS

Eighty-six patients with PD, 86 patients with GAD and 86 healthy controls were recruited for this study. All participants were, respectively, assessed for severity of anxiety and panic symptoms using the Hamilton Anxiety Rating Scale (HAMA) and the Panic Disorder Severity Scale (PDSS); all patients in the study were also assessed after 4 weeks of treatment. The serum levels of cytokines were measured using a flow fluorescence microsphere assay.

RESULTS

Both PD and GAD patients had higher serum levels of interleukin 6 (IL-6) than controls, and patients with PD showed significantly higher IL-6 than GAD patients. Significant positive correlations were found between the IFN-γ levels and the severity of anxiety in GAD patients. Higher level of IL-6 was associated with better response to escitalopram treatment in PD patients. However, the baseline levels of cytokines were not associated with treatment responses in GAD patients.

CONCLUSION

The present findings suggest that patients with PD may have higher levels of IL-6 than GAD, and higher baseline levels of IL-6 may be a better response to escitalopram in the treatment of PD.

Longitudinal association between panic disorder and health care costs in older adults

BACKGROUND

To analyze whether probable panic disorder (PD) is associated with health care costs in older age over time.

METHODS

Data regarding individuals aged 65 and over were derived from two waves of the ESTHER cohort study (n_t1  = 2,348, n_t2  = 2,090). Probable PD was assessed using the panic screening module from the Patient Health Questionnaire. Health care costs were obtained through monetary valuation of self-reported health care use data. Fixed effects regressions analyzed the association between transitions in probable PD status and change in health care costs, while adjusting for potential confounders.

RESULTS

On a descriptive level, study participants with a positive PD screening displayed higher three-month health care costs compared to those without (incremental costs: € 259 for t₁ , € 1,544 for t₂ ). Transitions in probable PD were associated with an approximate increase of 65% in outpatient health care costs (β = 0.50, p < .05). There was no significant association between probable PD transition and change in any other cost category.

CONCLUSIONS

Using longitudinal data, our results highlight the economic consequences of probable PD in older adults. Future research should address whether reducing PD in older adults may reduce the associated economic burden and analyze underlying mechanisms.

Stressful life events, relationship stressors, and cortisol reactivity: The moderating role of suppression

Stressful life events (SLEs) are exceedingly common and have been associated with a range of psychological disorders, perhaps through dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis. The use of certain emotion regulation strategies in response to stress, such as expressive suppression and cognitive reappraisal, has additionally been linked to heightened HPA axis reactivity to acute stress. However, it is unclear how emotion regulation may interact with SLEs to affect HPA axis reactivity, particularly concerning relationship stressors (RSs). Using cross-sectional data from 117 men and 85 women aged 18-55 years old (M = 39.9 ± 10.7), we investigated whether trait use of suppression or reappraisal interacted with recent negatively perceived SLEs and relationship stressors to impact HPA axis response to an acute stressor. Separate area under the curve and linear mixed models revealed that trait suppression interacted with SLEs and RSs to predict cortisol response to stress, while reappraisal did not. Findings indicate higher trait expressive suppression may influence the cortisol response to acute stress after exposure to more recent stressful events, particularly when those stressful events include relationship stress.

Distinct responses to predictable and unpredictable threat in anxiety pathologies: effect of panic attack

Background

Delineating specific clinical phenotypes of anxiety disorders is a crucial step toward better classification and understanding of these conditions. The present study sought to identify differential aversive responses to predictable and unpredictable threat of shock in healthy comparisons and in non-medicated anxiety patients with and without a history of panic attacks (PAs).

Method

143 adults (72 healthy controls; 71 patients with generalized anxiety disorder (GAD) or/and social anxiety disorder (SAD), 24 with and 47 without PAs) were exposed to three conditions: 1) predictable shocks signaled by a cue, 2) unpredictable shocks, and 3) no shock. Startle magnitude was used to assess aversive responses.

Results

Across disorders, a PA history was specifically associated with hypersensitivity to unpredictable threat. By disorder, SAD was associated with hypersensitivity to predictable threat, whereas GAD was associated with exaggerated baseline startle.

Conclusions

These results identified three physiological patterns. The first is hypersensitivity to unpredictable threat in individuals with PAs. The second is hypersensitivity to predictable threat, which characterizes SAD. The third is enhanced baseline startle in GAD, which may reflect propensity for self-generated anxious thoughts in the absence of imminent danger. These results inform current thinking by linking specific clinical features to particular physiology profiles.

Gender Differences of Stressful Life Events, Coping Style, Symptom Severity, and Health-Related Quality of Life in Patients With Panic Disorder

Although affective disorders have been known to have sex differences in the associated clinical characteristics and quality of life (QOL), sex differences among patients with panic disorder (PD) have remained relatively unexplored in Korea. We examined the sex differences in different types of stressful life events (SLEs), coping styles, symptom severity, and health-related QOL (HRQOL) in patients with PD. Data from 291 female and 254 male participants diagnosed with PD were analyzed using a structured clinical interview following the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. Females with PD reported more SLEs including separation issues, physical illness or disability, and pregnancy-related problems than males. They also reported lower levels of confrontation and help-seeking coping strategies and higher levels of agoraphobia in symptom severity than males. The HRQOL of females with PD was significantly lower than male in physical functioning of HRQOL. This study suggests that the patient's sex is relevant to the assessment and treatment of PD.

Qualidade de vida em pacientes da atenção primária do Rio de Janeiro e São Paulo, Brasil: associações com eventos de vida produtores de estresse e saúde mental

Resumo A qualidade de vida (QV) é um constructo subjetivo, que pode ser associado negativamente a fatores como os transtornos mentais e os eventos de vida produtores de estresse (EVPE). O objetivo deste artigo é identificar a associação entre variáveis demográficas, socioeconômicas, transtorno mental comum, sintomas sugestivos de ansiedade e depressão, EVPE com QV na Atenção Primária (AP). Estudo transversal realizado com 1.466 pacientes atendido na AP, nos munícipios de São Paulo e Rio de Janeiro, em 2009 e 2010. Realizou-se análise bivariada por meio do Teste-t e regressão linear múltipla para cada domínio de QV. Os escores de QV para os domínios físico, psicológico, relações sociais e meio ambiente foram, respectivamente de, 64,7, 64,2, 68,5 e 49,1. Pela análise multivariada foram encontradas associações do domínio físico com os problemas de saúde e discriminação, do psicológico com discriminação, das relações sociais com problemas financeiros/estruturais, causas externas e problemas de saúde, e do meio ambiente com problemas financeiros/estruturais, causas externas e discriminação. As variáveis de saúde mental, os problemas de saúde e os problemas/financeiros estruturais foram os que se associaram negativamente à QV.

Booster Sessions after Cognitive-Behavioural Group Therapy for Panic Disorder: Impact on Resilience, Coping, and Quality of Life

BACKGROUND

Panic disorder (PD) has a chronic nature, especially as a result of maladaptive coping strategies to deal with stressful events.

AIMS

To evaluate the impact of booster sessions with cognitive techniques on coping strategies, resilience, and quality of life (QoL) in patients previously submitted to standard cognitive-behavioural group therapy (CBGT) for PD.

METHOD

A controlled clinical trial with 44 patients with PD (intervention = 20; control = 24) who had previously completed a 12-week CBGT protocol. PD, anxiety, and depression severity symptoms were assessed at baseline and 1, 6, and 12 months after the booster sessions. Coping strategies, resilience, and QoL were assessed by Coping Strategies Inventory (CSI), Resilience Scale, and WHOQOL-BREF respectively.

RESULTS

Over time, a significant improvement in PD and depression symptoms was observed in both groups. A significant increase in the QoL social relations domain was found in the booster group, considering a time/group interaction. Coping and other QoL domains did not change after the booster sessions. Changes in resilience were dependent on the intensity of symptoms, with negative but non-significant correlations.

CONCLUSIONS

The improvement in PD and depression symptoms for both groups may be a result of the group format of the intervention. Group booster sessions after CBGT are useful to maintain the benefits obtained with CBGT.

Perievent panic attacks and panic disorder after mass trauma: a 12-month longitudinal study

Panic attacks frequently lead to psychopathological disorders, including panic disorder. Even though panic disorder is a highly comorbid and disabling mental health problem associated with stressful life or traumatic events, perievent panic attacks and their association with panic disorder have hardly been investigated as a central topic after mass trauma. Using data from a longitudinal population-based assessment of Madrid residents after the March 11, 2004 train bombings (N = 1,589), with assessments conducted 1, 6, and 12 months after the attacks, the rate of perievent panic attacks was 10.9%. Level of exposure, previous life stressors, and negative emotionality were associated with perievent panic attacks (β = .12, .15, and .10, respectively), which in turn mediated the relationship between exposure to the terrorist event and panic disorder in the following year. Previous life stressors (β = .15) and low social support (β = -.14) were directly associated with panic disorder during the subsequent year. The most vulnerable individuals who experienced perievent panic attacks were 3.7 times, 95% confidence interval [CI] = [2.1, 6.4], more likely to suffer from panic disorder in the following year. Results suggest that early identification of perievent panic attacks following mass trauma may be helpful for reducing panic disorder.

The anxiety spectrum and the reflex physiology of defense: from circumscribed fear to broad distress

Guided by the diagnostic nosology, anxiety patients are expected to show defensive hyperarousal during affective challenge, irrespective of the principal phenotype. In the current study, patients representing the whole spectrum of anxiety disorders (i.e., specific phobia, social phobia, panic disorder with or without agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder (GAD), posttraumatic stress disorder(PTSD)), and healthy community control participants, completed an imagery-based fear elicitation paradigm paralleling conventional intervention techniques. Participants imagined threatening and neutral narratives as physiological responses were recorded. Clear evidence emerged for exaggerated reactivity to clinically relevant imagery--most pronounced in startle reflex responding. However, defensive propensity varied across principal anxiety disorders. Disorders characterized by focal fear and impairment (e.g., specific phobia) showed robust fear potentiation. Conversely, for disorders of long-enduring, pervasive apprehension and avoidance with broad anxiety and depression comorbidity (e.g., PTSD secondary to cumulative trauma, GAD), startle responses were paradoxically diminished to all aversive contents. Patients whose expressed symptom profiles were intermediate between focal fearfulness and broad anxious-misery in both severity and chronicity exhibited a still heightened but more generalized physiological propensity to respond defensively. Importantly, this defensive physiological gradient--the inverse of self-reported distress--was evident not only between but also within disorders. These results highlight that fear circuitry could be dysregulated in chronic, pervasive anxiety, and preliminary functional neuroimaging findings suggest that deficient amygdala recruitment could underlie attenuated reflex responding. In summary, adaptive defensive engagement during imagery may be compromised by long-term dysphoria and stress-a phenomenon with implications for prognosis and treatment planning.