Comparison of the Penn State Worry Questionnaire (PSWQ) and abbreviated version (PSWQ-A) in a clinical and non-clinical population of older adults

Normative Values and Psychometric Properties of the Penn State Worry Questionnaire in Substance Use Disorder Treatment Population

This study evaluated the Penn State Worry Questionnaire (PSWQ) as a tool for measuring worry and anxiety levels among individuals entering treatment for substance use disorders (SUDs). The sample included 75,047 individuals admitted to SUD treatment centers, with assessments conducted weekly. Individuals entering SUD treatment exhibited higher baseline levels of worry; however, worry levels declined over the course of treatment. The PSWQ demonstrated good internal consistency, high test-retest reliability, and good discriminant validity when correlated with measures of depression and stress. The factor structure analysis confirmed that the PSWQ measures the same underlying construct of worry in the SUD treatment population, with a single-factor model showing satisfactory fit. This extends the reach of the PSWQ to the SUD treatment population by reaffirming its reliability, validity, and factor structure, with the expectation of higher levels of worry compared to a non-SUD population at the beginning of treatment, which decline over time.

Compensatory strategy use in diverse older adults with subjective cognitive complaints

OBJECTIVES

The current study aimed to evaluate the relationship between subjective cognitive complaints (SCC) and compensatory strategy (CS) use in a diverse sample of non-Latinx White (NLW), Black, and Latinx American older adults.

METHOD

807 older adults (Mage = 65.38, 62.7% female) were recruited through Amazon's Mechanical Turk (MTurk) and Qualtrics Panel to complete questionnaires on SCC and CS use. Kruskall-Wallis tests were used to evaluate differences in SCC across groups given non-normal distributions. Analysis of variance (ANOVA) was used to evaluate group differences in CS use. The PROCESS macro for SPSS was used to examine whether demographic factors moderated the relationship between SCC and CS use.

RESULTS

NLWs reported higher levels of SCC and greater overall use of CS in comparison to Latinx and Black individuals. Several demographic and psychosocial factors including age, ethno-racial group, education, and anxiety level were found to be associated with CS use. Education was found to moderate the association between SCC and CS use.

CONCLUSION

Inconsistent with prior studies, our study found that NLWs reported the highest levels of SCC. CS were used across all racial/ethnic groups, but the frequency of CS use may be impacted by education level. While all education groups increased their CS in response to higher levels of SCC, this increase was more substantial for those with lower levels of education. Future work should consider individuals' cultural and educational background when examining SCC and/or developing CS-based intervention for the aging population.

Remote cognitive behavioral therapy for older adults with anxiety symptoms: A systematic review and meta-analysis

INTRODUCTION

In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults.

METHODS

We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire - Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively.

RESULTS

Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: -0.63; 95% CI: -0.99 to -0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: -0.74; 95% CI: -1.24 to -0.25).

DISCUSSION

Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults.

Detection of anxiety symptoms and disorders in older adults: a diagnostic accuracy systematic review

BACKGROUND

Anxiety symptoms and disorders are common in older adults and often go undetected. A systematic review was completed to identify tools that can be used to detect anxiety symptoms and disorders in community-dwelling older adults.

METHODS

MEDLINE, Embase and PsycINFO were searched using the search concepts anxiety, older adults and diagnostic accuracy in March 2023. Included articles assessed anxiety in community-dwelling older adults using an index anxiety tool and a gold standard form of anxiety assessment and reported resulting diagnostic accuracy outcomes. Estimates of pooled diagnostic accuracy outcomes were completed.

RESULTS

Twenty-three anxiety tools were identified from the 32 included articles. Pooled diagnostic accuracy outcomes were estimated for the Geriatric Anxiety Inventory (GAI)-20 [n = 3, sensitivity = 0.89, 95% confidence interval (CI) = 0.70-0.97, specificity = 0.80, 95% CI = 0.67-0.89] to detect generalized anxiety disorder (GAD) and for the GAI-20 (n = 3, cut off ≥ 9, sensitivity = 0.74, 95% CI = 0.62-0.83, specificity = 0.96, 95% CI = 0.74-1.00), Beck Anxiety Inventory (n = 3, sensitivity = 0.70, 95% CI = 0.58-0.79, specificity = 0.60, 95% CI = 0.51-0.68) and Hospital Anxiety and Depression Scale (HADS-A) (n = 3, sensitivity = 0.78, 95% CI = 0.60-0.89, specificity = 0.76, 95% CI = 0.60-0.87) to detect anxiety disorders in clinical samples.

CONCLUSION

The GAI-20 was the most studied tool and had adequate sensitivity while maintaining acceptable specificity when identifying GAD and anxiety disorders. The GAI-20, GAI-Short Form and HADS-A tools are supported for use in detecting anxiety in community-dwelling older adults. Brief, self-rated and easy-to-use tools may be the best options for anxiety detection in community-dwelling older adults given resource limitations. Clinicians may consider factors including patient comorbidities and anxiety prevalence when selecting a tool and cut off.

The lived experience of frailty: beyond classification and towards a holistic understanding of health

PURPOSE

Frailty is characterised by decreased physiological reserves and vulnerability to stressors. Although scales, such as the Fried's Frailty Phenotype (FP), Frailty Index (FI), and Clinical Frailty Scale (CFS), are used to identify frailty, the lived experience of frailty remains understudied.

METHODS

This cross-sectional observational research involved participants aged 65 years and older from Wave 1 of The Irish Longitudinal Study on Ageing (TILDA). Participants were categorised into four independent groups: three frail groups based on the aforementioned scales and a non-frail group. Quantitative variables, including self-rated health, CASP-19 quality-of-life score, and frequency of social activities, were analysed and described.

RESULTS

The study encompassed 1999 participants with an average age of 72 years, of whom 51% were women. FP exclusively identified 1.6% as frail (n = 32), FI 11.7% (n = 233), and CFS 6.8% (n = 135). More than 60% of all those classified as frail reported their health as good, very good, or excellent, with the lowest proportion (64%) being among frail by FI participants. Frail by FI participants exhibited the lowest mean average CASP-19 score, yet it remained relatively high at 39 out of 57 points. Over 77% of all frail individuals engaged in active leisure activities at least once a month.

CONCLUSION

This study underscores the need to comprehend frailty holistically beyond its mere identification. It challenges the prevailing belief that frailty inevitably leads to impaired quality of life and limited social engagement. The findings advocate for a reassessment of how both the general public and healthcare professionals perceive frailty.

Associations Between Repetitive Negative Thinking and Objective and Subjective Sleep Health in Cognitively Healthy Older Adults

Objective

Poor sleep and high levels of repetitive negative thinking (RNT), including future-directed (ie, worry) and past-directed (ie, brooding) negative thoughts, have been associated with markers of dementia risk. The relationship between RNT and sleep health in older adults is unknown. This study aimed to investigate this association and its specificities including multiple dimensions of objective and subjective sleep.

Methods

This study used a cross sectional quantitative design with baseline data from 127 cognitively healthy older adults (mean age 69.4 ± 3.8 years; 63% female) who took part in the Age-Well clinical trial, France. RNT (ie, worry and brooding) levels were measured using the Penn State Worry Questionnaire and the Rumination Response Scale (brooding subscale). Polysomnography was used to assess sleep objectively, and the Pittsburgh Sleep Quality Index and the St. Mary's Hospital Sleep Questionnaire were used to measure sleep subjectively. In primary analyses the associations between RNT and sleep (ie, objective sleep duration, fragmentation and efficiency and subjective sleep disturbance) were assessed via adjusted regressions.

Results

Higher levels of RNT were associated with poorer objective sleep efficiency (worry: β=-0.32, p<0.001; brooding: β=-0.26, p=0.002), but not objective sleep duration, fragmentation, or subjective sleep disturbance. Additional analyses, however, revealed differences in levels of worry between those with short, compared with typical and long objective sleep durations (p < 0.05).

Conclusion

In cognitively healthy older adults, RNT was associated with sleep characteristics that have been implicated in increased dementia risk. It will take additional research to ascertain the causal link between RNT and sleep characteristics and how they ultimately relate to the risk of developing dementia.

Examining Differences in Behavioural Avoidance Between Younger and Older Adults

OBJECTIVES

Studies have found older adults report fewer anxiety symptoms than younger adults. As behavioral avoidance is theoretically associated with maintaining anxiety, this study sought to examine age-related differences in avoidance and anxiety in a cross-cultural sample of older (n = 60, 60-92 years) and younger adults (n = 70; 17-24 years).

METHODS

Community dwelling participants from Australia and the United States of America completed self-report measures of anxiety, worry, and depression. Participants also self-rated levels of avoidance to 133 common fearful situations using a card sort task.

RESULTS

Older adults reported significantly less avoidance of age-adjusted social and medical scenarios, more avoidance of aggressive scenarios, with no significant difference for animal or agoraphobic scenarios when compared to younger adults. Age-related effects were no longer significant in full models, in which the main effect of anxiety explained variance in avoidance for social, medical, animal, agoraphobic, but not aggression scenarios.

CONCLUSIONS

Age differences in avoidance behavior were accounted for by differences in anxiety symptoms, except for avoidance of aggressive scenarios, which was not associated with anxiety. CLINICAL IMPLICATIONS: Age differences in levels of avoidance of common fearful situations were found, and may be associated with differences in anxiety symptom severity.

The effect of uncertainty on attentional bias in subclinical worriers: Evidence from reaction time and eye-tracking

BACKGROUND AND OBJECTIVES

High-worry individuals have been assumed to show attentional bias towards threat, particularly under high uncertainty. This study experimentally investigated the effect of uncertainty on attentional bias in subclinical worriers.

METHODS

A visual dot-probe task combined with eye-tracking was used to assess participants' attentional bias towards blurred and unfiltered stimuli. Fifty high-worry and 47 low-worry participants were randomly assigned to either the high- or low-uncertainty threat condition. Aversive noise bursts were delivered either unpredictably (the high-uncertainty threat condition) or predictably (the low-uncertainty threat condition) during the visual dot-probe task.

RESULTS

In the low-uncertainty threat condition, high-worry participants exhibited enhanced attentional engagement towards blurred pictures compared to low-worry participants. They also had shorter initial fixation latencies on blurred pictures than on unfiltered pictures. In the high-uncertainty threat condition, high-worry participants demonstrated more difficulty in disengaging from threatening pictures compared to low-worry participants.

LIMITATION

First, this study used a nonclinical sample. Second, the power was limited with regard to the analysis of eye-movement data. Third, anxiety and worry induced by noise bursts were measured using subjective rating scales only. Fourth, some picture characteristics, such as luminosity and complexity, were not controlled. Finally, uncertainty related to delivery of noise bursts and pictures were both manipulated dichotomously.

CONCLUSION

This study highlights the importance of uncertainty in the maintenance of attentional bias towards threat-related pictures in high-worry individuals.

A replication and extension of bifactor modelling of perseverative thought in an at-risk community sample: Exploring sex differences in the structure of PT

BACKGROUND

Perseverative thought (PT) is a transdiagnostic construct associated with internalizing disorders. Bifactor models have shown that PT can be split into a general PT factor and lower-order factors for specific forms of PT, such as rumination and worry. No bifactor study to date has investigated if the structure of PT differs across sexes.

METHODS

The study consisted of 280 individuals recruited for a larger study targeting risk factors for suicidal ideation and behaviours. Participants completed a diagnostic interview and self-report questionnaires.

RESULTS

A two-factor model of PT fit best in males, whereas a bifactor model fit best in females. In a structural equation model, worry was associated with generalized anxiety disorder diagnoses in females, but not males. Rumination was associated with depressive disorder diagnoses in females, but not males.

CONCLUSIONS

The present study contributes to a growing literature on PT; we found that dimensionality of PT varied by sex. We also found that relations between PT factors and generalized anxiety disorder differed by sex. Sex differences in the internalizing spectrum and related risk factors need to be considered when examining the structure and function of risk factors.

Trajectories of generalized anxiety disorder, major depression and change in quality of life in adults aged 50 + : findings from a longitudinal analysis using representative, population-based data from Ireland

PURPOSE

To investigate the longitudinal association between trajectories (incidence, remission) of generalized anxiety disorder (GAD), major depression (MD) and change in quality of life (QoL) in adults aged 50 + , and to assess the symmetry in these relationships using observational study data.

METHODS

Data were derived from two waves of The Irish Longitudinal Study on Aging (2014-2015, wave 3: n = 6400; 2016, wave 4: n = 5715), a nationally representative cohort of community-dwelling adults aged 50 +. GAD and MD were assessed by means of the short form of the Composite International Diagnostic Interview. QoL outcomes were assessed using the Control, Autonomy, Self-realization, and Pleasure scale (CASP-12 with two domains control/autonomy and self-realization/pleasure). Covariate-adjusted, asymmetric fixed effects panel regressions and post-estimation Wald tests were used for statistical analysis.

RESULTS

Regarding incident disorders, only incident MD was significantly associated with a reduction in QoL over time (control/autonomy domain: b = - 0.74, SE: 0.30). Regarding remission, both remission of MD (b = 0.61, SE: 0.20) and remission of GAD (b = 0.61, 0.26) were significantly associated with an increase in the self-realization/pleasure domain over time. Subsequent Wald tests of the estimates were not significant, indicating symmetric effects.

CONCLUSION

Particularly the remission of GAD and MD was associated with a significant improvement in one of the QoL domains, indicating domain- and trajectory-specific differences. However, symmetric effects observed in this study indicate that gains and losses in QoL associated with remission and incidence of GAD and MD are of similar magnitude in adults aged 50 +.

A single-blind, parallel-group randomised trial of a Technology-assisted and remotely delivered Cognitive Behavioural Therapy intervention (Tech-CBT) versus usual care to reduce anxiety in people with mild cognitive impairment and dementia: study protocol for a randomised trial

BACKGROUND

Anxiety is commonly experienced by people living with mild cognitive impairment (MCI) and dementia. Whilst there is strong evidence for late-life anxiety treatment using cognitive behavioural therapy (CBT) and delivery via telehealth, there is little evidence for the remote delivery of psychological treatment for anxiety in people living with MCI and dementia. This paper reports the protocol for the Tech-CBT study which aims to investigate the efficacy, cost-effectiveness, usability and acceptability of a technology-assisted and remotely delivered CBT intervention to enhance delivery of anxiety treatment for people living with MCI and dementia of any aetiology.

METHODS

A hybrid II single-blind, parallel-group randomised trial of a Tech-CBT intervention (n = 35) versus usual care (n = 35), with in-built mixed methods process and economic evaluations to inform future scale-up and implementation into clinical practice. The intervention (i) consists of six weekly sessions delivered by postgraduate psychology trainees via telehealth video-conferencing, (ii) incorporates voice assistant app technology for home-based practice, and (iii) utilises a purpose-built digital platform, My Anxiety Care. The primary outcome is change in anxiety as measured by the Rating Anxiety in Dementia scale. Secondary outcomes include change in quality of life and depression, and outcomes for carers. The process evaluation will be guided by evaluation frameworks. Qualitative interviews will be conducted with a purposive sample of participants (n = 10) and carers (n = 10), to evaluate acceptability and feasibility, as well as factors influencing participation and adherence. Interviews will also be conducted with therapists (n = 18) and wider stakeholders (n = 18), to explore contextual factors and barriers/facilitators to future implementation and scalability. A cost-utility analysis will be undertaken to determine the cost-effectiveness of Tech-CBT compared to usual care.

DISCUSSION

This is the first trial to evaluate a novel technology-assisted CBT intervention to reduce anxiety in people living with MCI and dementia. Other potential benefits include improved quality of life for people with cognitive impairment and their care partners, improved access to psychological treatment regardless of geographical location, and upskilling of the psychological workforce in anxiety treatment for people living with MCI and dementia.

TRIAL REGISTRATION

This trial has been prospectively registered with ClinicalTrials.gov: NCT05528302 [September 2, 2022].

Abbreviated version of Penn State Worry Questionnaire for Chinese adolescents: Age, gender and longitudinal invariance

The abbreviated version of Penn State Worry Questionnaire (PSWQ-A) has been widely used to assess worry. However, its measurement invariance has been not yet warranted. With a cross-sectional and a longitudinal sample of Chinese adolescents (N1 = 1,329, N2 = 408), this study examined age, gender, and longitudinal invariance of PSWQ-A. Results supported strict invariance, including configural, metric, scalar, and error level, across gender and age in the cross-sectional sample; strict longitudinal measurement invariance was also supported in the longitudinal sample. This study suggests the application of the PSWQ-A in measuring adolescent worry and a basis for comparisons of different populations and occasions for worry.

Stress and Stressors: The Impact of the COVID-19 Pandemic on Students, Faculty and Staff at a Historically Black College/University

Due to COVID-19 restrictions, academic institutions have changed their modus operandi, particularly in adopting distance learning in lieu of face-to-face instruction. This has sometimes produced unanticipated effects on students. The purpose of this study was to determine COVID-19 pandemic stressors and coping mechanisms utilized as relief measures by students, faculty, and staff in the College of Health Sciences at a historically Black institution. Cross-sectional study.

SAMPLING

A convenience sample of 209 students, 34 faculty, and 9 staff from the College of Health Sciences at a historically Black institution participated in this study.

INSTRUMENT

A 32-item Qualtrics survey was utilized to gather demographic data, COVID-19-related stressors, and coping mechanisms.

ANALYSIS

Descriptive statistics, Chi-square test for categorical variables, and Cochran-Mantel-Haenszel tests for ordinal variables were used. Female students, African American students (AAS), and undergraduates perceived stress related to the risk of contagion during the pandemic higher than the male students (P-value = 0.0096), other races (P-value = 0.0249) and graduate students (P-value = 0.0141) respectively. Female students perceived more stress related to relationships with relatives (P-value = 0.0128). Caucasian students compared to others (P-value = 0.0240) and graduate students compared to undergraduate students (P-value = 0.0011) reported less perceived stress related to the relationships with other colleagues. Top coping strategies of students and staff included interaction with family and friends, social media, hand hygiene, and meditation/spiritualty. Except for "avoidance of public spaces/transportation", all other mechanisms were the same for faculty.

Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire - Abbreviated (PSWQ-A)

OBJECTIVE

The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A).

DESIGN

Longitudinal assessment of GAD symptoms pre- and posttreatment.

PARTICIPANTS

Participants were 259 older adults aged 60-86 years with a diagnosis of GAD who were assessed before and after treatment.

INTERVENTION

Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions.

MEASUREMENTS

Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A.

RESULTS

Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status.

CONCLUSIONS

Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

Face-to-face versus Video Teleconference Group Cognitive Behavioural Therapy for Anxiety and Related Disorders: A Preliminary Comparison

OBJECTIVE

Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face.

METHOD

Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures.

RESULTS

Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats.

CONCLUSIONS

Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.

Plasma Total Tau and Neurobehavioral Symptoms of Cognitive Decline in Cognitively Normal Older Adults

Depression and related neurobehavioral symptoms are common features of Alzheimer’s disease and other dementias. The presence of these potentially modifiable neurobehavioral symptoms in cognitively intact older adults may represent an early indication of pathophysiological processes in the brain. Tau pathology is a key feature of a number of dementias. A number of studies have found an association between tau and neurobehavioral symptoms. The current study investigated the relationship of a blood-based biomarker of tau and symptoms of depression, anxiety, worry, and sleep disturbances in 538 community based, cognitively normal older adults. Logistic regression revealed no significant relationship between plasma total tau and any measures of neurobehavioral symptoms. To assess the impact of level of tau on these relationships, participants were divided into those in the highest quintile of tau and those in the lower four quintiles. Regression analyses showed a significant relationship between level of plasma total tau and measures of depression, apathy, anxiety, worry and sleep. The presence of higher levels of plasma tau and elevated neurobehavioral symptoms may be an early indicator of cognitive decline and prodromal Alzheimer’s disease. Longitudinal research is needed to evaluate the impact of these factors on the development of dementia and may suggest areas for early intervention.

The Impact of COVID-19 Pandemic on University Faculty, Staff, and Students and Coping Strategies Used During the Lockdown in the United Arab Emirates

Introduction: The COVID-19 pandemic and the subsequent lockdown instigated serious mental health conditions. So far, the UAE data on mental health problems due to this pandemic outbreak is still scarce. The objective of this study was to identify the prevalent psychological difficulties experienced by university students, faculty members, and staff during COVID-19 lockdown and the coping strategies used.

Methods: A cross-sectional design was used to collect data from 737 participants using an online electronic survey. Participants included students, faculty members, and staff from universities in the UAE. The General Health Questionnaire (GHQ-12) was used to measure general distress, Penn State Worry Questionnaire (PSWQ-16) was used to measure worry, and the Coping Inventory for Stressful Situations (CISS-48) was administered to measure coping strategies used by participants during the COVID-19 pandemic lockdown. Data were collected during May to June 2020.

Results: The results indicated that 60.4% of students, 57.4% of the faculty members, and 52.3% of the staff experienced mild psychiatric problems. About 32.9% of students, 33.7% of the faculty members, and 25% of the staff experienced high levels of worry during the COVID-19 lockdown. Changes in eating patterns, worsening chronic health problems, change in sleep patterns, and concentration difficulties were reported. Furthermore, significant differences were observed in worry and coping strategies among participants. Women use more avoidance and emotion-focused coping compared to men.

Conclusion: It was concluded that COVID-19 lockdown has negatively impacted university faculty, staff, and students in terms of health behavior, psychological and physical health.

Freely Generated Word Responses Analyzed With Artificial Intelligence Predict Self-Reported Symptoms of Depression, Anxiety, and Worry

BACKGROUND

Question-based computational language assessments (QCLA) of mental health, based on self-reported and freely generated word responses and analyzed with artificial intelligence, is a potential complement to rating scales for identifying mental health issues. This study aimed to examine to what extent this method captures items related to the primary and secondary symptoms associated with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We investigated whether the word responses that participants generated contained information of all, or some, of the criteria that define MDD and GAD using symptom-based rating scales that are commonly used in clinical research and practices.

METHOD

Participants (N = 411) described their mental health with freely generated words and rating scales relating to depression and worry/anxiety. Word responses were quantified and analyzed using natural language processing and machine learning.

RESULTS

The QCLA correlated significantly with the individual items connected to the DSM-5 diagnostic criteria of MDD (PHQ-9; Pearson's r = 0.30-0.60, p < 0.001) and GAD (GAD-7; Pearson's r = 0.41-0.52, p < 0.001; PSWQ-8; Spearman's r = 0.52-0.63, p < 0.001) for respective rating scales. Items measuring primary criteria (cognitive and emotional aspects) yielded higher predictability than secondary criteria (behavioral aspects).

CONCLUSION

Together these results suggest that QCLA may be able to complement rating scales in measuring mental health in clinical settings. The approach carries the potential to personalize assessments and contributes to the ongoing discussion regarding the diagnostic heterogeneity of depression.

I am Worried: Do the PSWQ and PSWQ-A Display Measurement Invariance Across Four Racial Groups?

The issue of race within the context of psychological assessment is important, but often overlooked. Many self-report measures of psychopathology have been developed and validated using primarily White samples. Research regarding the Penn State Worry Questionnaire (PSWQ) and race has produced mixed results, which in turn may present challenges when comparing scores across racial groups. The current article sought to investigate the measurement invariance of the PSWQ and PSWQ-A (an abbreviated version) across four racial groups (White, Black, Asian, and Hispanic) in a sample of 2,489 undergraduate students. Confirmatory factor analysis of a one-factor structure illustrated poor fit across all racial groups for the full-length PSWQ. Two-factor and one-factor with method effects models of the full-length PSWQ each improved on the previous model fit, although the one-factor method effects model was limited by nonsalient factor loadings. Additionally, a separate confirmatory factor analysis indicated good fit for the PSWQ-A. Further analysis of the PSWQ-A suggested measurement invariance across all racial groups, as well as configural, metric, and scalar invariance. These findings advance the literature on the relationship between worry and race, suggesting that direct comparisons on the PSWQ-A between racial groups is appropriate.

Psychological distress and substance use among young adults with comorbid asthma and obesity

This study examined psychosocial distress and substance use in young adults with asthma (A), obesity (O), comorbid asthma and obesity (AO), or neither (controls). Participants: Eight hundred eighty-one young adults were included in the A, O, AO, or control group. Methods: ANCOVA and logistic regression analyses were performed to compare responses to screeners for psychological distress and substance use among the four groups. Results: Levels of depressive symptoms, worry, nonsuicidal self-injury, emotion dysregulation, and chronic pain symptoms differed across groups, with the A and AO groups showing greater psychological distress than the O and control groups. The AO group exhibited the highest levels of cigarette and smokeless tobacco use, while the O group exhibited the least frequent binge drinking behaviors. Conclusions: Individuals with asthma or comorbid asthma and obesity appear to experience the poorest psychosocial functioning and highest use of tobacco products. Potential mechanisms and implications of these relationships are discussed.

Structure and Psychometric Properties of the Penn State Worry Questionnaire for Children in Chinese Adolescents

The present research introduced the Penn State Worry Questionnaire for Children (PSWQ-C) to China and evaluated its structure and psychometric properties in Chinese adolescent samples. The PSWQ-C is a 14-item self-report questionnaire designed to measure the generality, excessiveness, and uncontrollability aspects of pathological worries in children and adolescents. Factor analysis results suggested that the three reverse-scored items represented one or more unknown factors rather than worry; thus, they were discarded and the remaining 11 positively worded items formed the Chinese version of the PSWQ-C (CH-PSWQ-C). The CH-PSWQ-C was found to have acceptable internal consistency reliability and favorable convergent and divergent validity by examining its correlations with measures of anxiety, depression, and some personality characteristics. To illustrate the utility of the CH-PSWQ-C in Chinese adolescent samples, we used the CH-PSWQ-C to explore the moderating effect of neuroticism on the relationship between earthquake experiences and worry; the results suggested that adolescents with high neuroticism were more vulnerable to worry after experiencing serious disasters.

Free GP care and psychological health: Quasi-experimental evidence from Ireland

There is considerable ambiguity in the literature on the effect of health insurance on health. While the majority of previous analyses have examined physical health outcomes, analyses of the broader dimensions of health such as psychological health and wellbeing have been less frequent. Using data from the Irish Longitudinal Study on Ageing (TILDA) and a difference-in-differences research design, we examine the impact of free general practitioner (GP) care on psychological health among the older population and explore potential mechanisms. While we find no impact of public health insurance expansions on quality of life, life satisfaction, depression, and worry, the removal of GP fees for all those 70+ leads to a significantly lower level of perceived stress. The impact is mainly driven by poorer, sicker and single individuals. Further analyses show that removing GP fees leads to greater access to GP services and lower levels of financial stress.

What worries first-year students? Psychometric properties of the Student Worry Scale

The transition to university can be stressful for first-year university students. Despite the fact where the feeling of worry is a shared symptom by various mental health issues, there is a lack of studies that investigate into this matter. As worry is a domain-specific construct, there is a need for a valid and reliable measure of worry specifically for university students. Hence, this study aimed to evaluate the psychometric properties of the Student Worry Scale (SWS), particularly in terms of its validity and reliability. For this purpose, the current study recruited a sample of 295 first-year students to evaluate the psychometric properties of SWS. Exploratory factor analysis yielded a five-factor structure of SWS, which explained 55.7% of the total variance. The yielded five factors were general worries, financial-related concerns, significant other's well-being, academic concerns, and social adequacy concerns. Inter-correlations between the five factors were all significant (r ranged between 0.395 and 0.625). The SWS demonstrated good internal consistency in this study (Cronbach's alpha ranged between 0.786 and 0.941). Overall, the SWS is psychometrically evidenced to be a reliable and valid content-based worry measure specifically for university students.

Assessing repetitive negative thinking in daily life: Development of an ecological momentary assessment paradigm

Repetitive negative thinking (RNT) is a transdiagnostic process and a promising target for prevention and treatment of mental disorders. RNT is typically assessed via self-report questionnaires with most studies focusing on one type of RNT (i.e., worry or rumination) and one specific disorder (i.e., anxiety or depression). However, responses to such questionnaires may be biased by memory and metacognitive beliefs. Recently, Ecological Momentary Assessment (EMA) has been employed to minimize these biases. This study aims to develop an EMA paradigm to measure RNT as a transdiagnostic process in natural settings. Based on empirical and theoretical considerations, an item pool was created encompassing RNT content and processes. We then (1) tested model fit of a content-related and a process-related model for assessing RNT as an individual difference variable, (2) investigated the reliability and construct validity of the proposed scale(s), and (3) determined the optimal sampling design. One hundred fifty healthy participants aged 18 to 40 years filled out baseline questionnaires on rumination, worry, RNT, symptoms of depression, anxiety, and stress. Participants received 8 semi-random daily prompts assessing RNT over 14 days. After the EMA phase, participants answered questionnaires on depression, anxiety, and stress again. Multilevel confirmatory factor analysis revealed excellent model fit for the process-related model but unsatisfactory fit for the content-related model. Different hybrid models were additionally explored, yielding one model with satisfactory fit. Both the process-related and the hybrid scale showed good reliability and good convergent validity and were significantly associated with symptoms of depression, anxiety, and stress after the EMA phase when controlling for baseline scores. Further analyses found that a sampling design of 5 daily assessments across 10 days yielded the best tradeoff between participant burden and information retained by EMA. In sum, this paper presents a promising paradigm for assessing RNT in daily life.

Psychometric properties of worry and anxiety measures in a sample of african american and caucasian older adults

Objective: The aim of our study was to examine the psychometric properties of commonly used anxiety and worry assessment measures in a community-based, low-income sample of African American and Caucasian older adults.Method: African American and Caucasian participants from three community-based clinical trials testing treatments for late-life worry/anxiety were pooled to examine the factor structure, internal consistency reliability, and convergent, discriminant, and predictive validity of the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Generalized Anxiety Disorder-7 (GAD-7) and Geriatric Anxiety Inventory-short form (GAI-SF).Results: All three measures demonstrated an adequate fit to a one-factor structure. Internal consistency reliability was adequate for the PSWQ-A and GAD-7 in the total sample and racial subgroups but was acceptable for the GAI-SF only in the African American subgroup. The PSWQ-A and GAD-7 demonstrated good convergent, discriminant, and predictive validity. The GAI-SF has adequate convergent and divergent validity in the African American subgroup.Conclusion: Our study offers preliminary evidence for use of the PSWQ-A and GAD-7 for assessment of anxiety in a sample of low-income, predominantly African American participants. These measures may facilitate identification of anxiety symptoms, which are often overlooked in this population. More research is needed to examine the accuracy of these measures in other racial/ethnic groups.

Comorbid anxiety in late-life depression: Relationship with remission and suicidal ideation on venlafaxine treatment

OBJECTIVE

The purpose of this study was to examine the influence of comorbid anxiety symptoms on antidepressant treatment remission in older adults with major depressive disorder (MDD).

METHOD

In this multisite clinical trial, 468 older adults aged 60 years or older with MDD received open-label protocolized treatment with venlafaxine extended release (ER) titrated to a maximum of 300 mg daily. At baseline, anxiety was assessed with the Anxiety Sensitivity Index, the Brief Symptom Inventory (BSI) anxiety subscale, and the Penn State Worry Questionnaire. To measure treatment response, depressive symptoms and suicidality were assessed every 1-2 weeks with the Montgomery-Asberg Depression Rating Scale and the 19-item Scale for Suicide Ideation; anxiety was assessed with the BSI. Logistic regression and survival analysis were used to evaluate whether anxiety symptoms predicted depression remission. We also examined the relationships between anxiety scores and suicidality at baseline.

RESULTS

Baseline anxiety symptoms did not predict remission or time to remission of depressive symptoms. Depressive, worry, and panic symptoms decreased in parallel in patients with high anxiety. Anxiety symptoms were associated with the severity of depression and with suicidality.

CONCLUSION

In older adults with MDD, comorbid anxiety symptoms are associated with symptom severity but do not affect antidepressant remission or time to remission.

Associations between grip strength and generalized anxiety disorder in older adults: Results from the Irish longitudinal study on ageing

BACKGROUND

Associations between grip strength and mental health disorders have been established; however, associations between grip strength and Generalized Anxiety Disorder (GAD) remain unstudied. Therefore, this study investigates associations between grip strength and prevalent and incident GAD.

METHODS

A prospective cohort design was utilized. At baseline, participants aged ≥50 years (N = 3,952) completed a hand grip strength assessment and abbreviated Penn State Worry Questionnaire (PSWQ) and were divided into sex-specific tertiles based on strength. A score of ≥23 on the PSWQ defined caseness of GAD. At two-year follow-up, GAD was assessed with the Composite International Diagnostic Interview-Short Form.

RESULTS

Prevalence and incidence of GAD were 18.2% (N = 718) and 0.9% (N = 29), respectively. Adjusting for age, sex, waist circumference, social class, smoking status, and physical activity, a one-standard-deviation (1-SD) increase in strength was associated (OR, 95%CI) with 12.1% (OR = 0.88, 0.80-0.96; p < 0.01) lower odds of prevalent GAD, and middle and high strength tertiles were associated with 27.3% (OR = 0.73, 0.59-0.89; p < 0.01) and 23.1% (OR = 0.77, 0.62-0.95; p < 0.05) lower odds, respectively. A 1-SD increase in strength was non-significantly associated with 24.2% (OR = 0.76, 0.50-1.14) lower odds of incident GAD, and middle and high strength tertiles were non-significantly associated with 31.4% (OR = 0.69, 0.30-1.58) and 66.5% (OR = 0.34, 0.11-1.00) lower odds, respectively (all p > 0.05). There was no significant interaction between strength tertiles and sex.

LIMITATIONS

The observational nature of the study limits inferring causality.

CONCLUSIONS

Increased hand grip strength may be associated with lower odds of developing GAD in older adults. Larger investigations of prospective associations are needed.

Physical activity correlates among older adults with probable generalized anxiety disorder: Results from The Irish Longitudinal Study on Ageing

OBJECTIVES

This study assessed physical activity (PA) correlates among 1237 (69.0% female; age ≥ 50 years) community-dwelling adults with probable-generalized anxiety disorder (GAD).

METHODS

Wave 1 data from The Irish Longitudinal Study on Ageing were analysed. PA was measured using the short-form International PA Questionnaire. Probable-GAD caseness was indicated by a score of ≥23 on the abbreviated Penn State Worry Questionnaire. Potential correlates were analysed using binomial logistic regression. Hierarchical logistic regression consisting of three blocks (sociodemographic variables; quality of life (QoL) variables; physical health and performance variables) examined the proportion of the variance for PA that was explained at each step of the regression model.

RESULTS

Five hundred thirty-five participants (43.2%) met PA guidelines. After adjustment for age and sex, younger age and being male were associated with increased likelihood of meeting PA guidelines. Significant correlates of PA were in employment, higher QoL (CASP-19), social connectedness, and grip-strength. Additionally, polypharmacy (i.e., taking ≥five medications), antidepressant use, at-risk waist circumference (i.e., Males: >94 cm; Females >80 cm), up-and-go time, and number of self-reported physical limitations were significantly negatively associated with meeting PA guidelines. Physical health and performance variables explained significant variation (8.4%) in meeting physical activity guidelines beyond that of sociodemographics, and QoL variables.

CONCLUSIONS

This study identified a range of sociodemographic, physical, and psychological variables that were associated with meeting or not meeting PA guidelines among older adults with probable-GAD.

Physical activity and generalized anxiety disorder: results from The Irish Longitudinal Study on Ageing (TILDA)

Background

Generalized anxiety disorder (GAD) is prevalent and costly. Physical activity (PA) may protect against other mental health disorders, including depression, but its protective effect on GAD remains under-studied in the general population and unstudied among older adults. Therefore, the present study examines associations between meeting World Health Organization PA guidelines (i.e. ≥150 min of moderate PA, ≥75 min of vigorous PA or ≥600MET min of moderate and vigorous PA weekly) and the prevalence of probable GAD and incidence of GAD.

Methods

Participants (n  =  3950; 56.2% female) aged ≥50 years completed the short-form International Physical Activity Questionnaire and the abbreviated Penn State Worry Questionnaire at baseline and the Composite International Diagnostic Interview - Short Form to clinically assess GAD 2 years later. Prospective analyses included participants without probable GAD at baseline (n  =  3236).

Results

Prevalence and incidence of GAD were 18.1% (n  =  714) and 0.9% (n  =  29), respectively. More respondents with GAD were female (72.2% vs 52.7%), aged 50-59 years (51.7% vs 38.7%), had normal waist circumference (52.7% vs 47.8) and smoked (20.4% vs 13.3%; all P <0.05). Meeting PA guidelines was associated with 25% and 63% lower odds of prevalent [odds ratio (OR)  =  0.75, 95% confidence interval: 0.64 to 0.88] and incident (OR  =  0.37, 0.17 to 0.85) GAD, respectively, in crude models, and 17% and 57% lower odds of prevalent (OR  =  0.83, 0.70 to 0.98) and incident (OR  =  0.43, 0.19 to 0.99) GAD, respectively, following adjustment for age, sex, waist circumference, social class and smoking.

Conclusions

In addition to established physical health benefits of PA, the present findings support the importance of increasing PA at the population-level for mental health.

Politically-focused intrusive thoughts and associated ritualistic behaviors in a community sample

A significant proportion of the U.S. population report increased stress attributed to the political climate following the controversial 2016 United States (U.S.) Presidential election. The political stressors paired with the growth in news consumption and social media-use could be a potential trigger for obsessive-compulsive-like symptoms specific to politics in some individuals. This study aimed to elucidate the rate of Politically-focused Intrusive Thoughts and associated Ritualistic Behaviors (PITRB), their demographic and clinical correlates, and the degree of association with political ideology. Survey data were collected using the crowdsourcing platform Mechanical Turk. A total of N = 484 individuals completed the survey. Measures of politically-focused intrusive thoughts and ritualistic behaviors, general obsessive-compulsive symptoms, depression, anxiety, anxiety control, worry, and disability were administered, as well as a measure of social and economic conservative affiliation. Results showed that a quarter of the sample (25.2%) had at least one PITRB more than once a day. PITRB was associated with all measures of psychopathology and disability. Finally, anxiety control moderated the relationship between PITRB and both anxiety and depression. No differences in psychopathology were found between major party affiliations. The findings suggest that politically-focused intrusive thoughts and ritualistic behaviors are associated with psychopathology domains in a manner comparable to general obsessive-compulsive symptoms.

An internet-based intervention for people with psychosis (EviBaS): study protocol for a randomized controlled trial

BACKGROUND

Evidence shows that internet-based self-help interventions are effective in reducing symptoms for a wide range of mental disorders. To date, online interventions treating psychotic disorders have been scarce, even though psychosis is among the most burdensome disorders worldwide. Furthermore, the implementation of cognitive-behavioral therapy (CBT) for psychosis in routine health care is challenging. Internet-based interventions could narrow this treatment gap. Thus, a comprehensive CBT-based online self-help intervention for people with psychosis has been developed. The aim of this study is the evaluation of the feasibility and efficacy of the intervention compared with a waiting list control group.

METHODS

The intervention includes modules on delusion, voice hearing, social competence, mindfulness, and seven other domains. Participants are guided through the program by a personal moderator. Usage can be amended by an optional smartphone app. In this randomized controlled trial, participants are allocated to a waiting list or an intervention of eight weeks. Change in positive psychotic symptoms of both groups will be compared (primary outcome) and predictors of treatment effects will be assessed.

DISCUSSION

To our knowledge, this project is one of the first large-scale investigations of an internet-based intervention for people with psychosis. It may thus be a further step to broaden treatment options for people suffering from this disorder.

TRIAL REGISTRATION

NCT02974400 (clinicaltrials.gov), date of registration: November 28th 2016.

Assessment of anxiety in older adults: a review of self-report measures

With increasing numbers of older adults in the general population, anxiety will become a widespread problem in late life and one of the major causes of health care access contributing to high societal and individual costs. Unfortunately, the detection of anxiety disorders in late life is complicated by a series of factors that make it different from assessment in younger cohorts, such as differential symptom presentation, high comorbidity with medical and mental disorders, the aging process, and newly emergent changes in life circumstances. This review covers commonly and currently used self-report inventories for assessing anxiety in older adults. For each tool, psychometric data is investigated in depth. In particular, information about reliability, validity evidence based on data from clinical and nonclinical samples of older adults, and availability of age-appropriate norms are provided. Finally, guidance for clinical evaluation and future research are proposed in an effort to highlight the importance of clinical assessment in the promotion of clinically relevant therapeutic choices.

Older adults report more sadness and less jealousy than young adults in response to worry induction

OBJECTIVES

The present study examined age differences in descriptions of the experience of worry and worry content.

METHOD

Twenty-eight older and 25 younger adults participated in an experimental manipulation of worry (i.e. 5-minute worry induction). Participants identified their three main worries and completed an emotion checklist before and after the induction.

RESULTS

After the induction, younger adults endorsed feeling fearful, impatient, and irritated, whereas older adults endorsed feeling tense or worrying. Older adults were more likely than younger adults to report feeling sad (χ²(53) = 7.52, p = .01), whereas younger adults were marginally more likely to report feeling jealous (χ²(53) = 4.34, p = .05). With regards to worry content, older adults worried more about community/world affairs (χ² = 6.59, p = .01), whereas younger adults worried more about school (χ² = 17.61, p < .001). Only age differences in worry about school remained significant after applying the Holm-Bonferroni correction.

CONCLUSION

Following a worry induction, older and younger adults endorsed a wide variety of negative affect beyond the typical emotions associated with worry. Greater sadness experienced by older compared with younger adults highlights the importance of considering negative affect states, particularly depression, when working with older adult worriers.

Symptom correspondence between clinicians and patients on the Yale-Brown Obsessive Compulsive Scale

The present study examined concordance between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and its self-report version (Y-BOCS-SR), as well as theoretically derived moderators. Sixty-seven adults (ages 18-67) with obsessive-compulsive disorder (OCD) were administered the Y-BOCS prior to completing self-report measures. The Y-BOCS-SR generated lower scores relative to the clinician-administered Y-BOCS (5.3 points lower). Strong correspondence was shown between the Y-BOCS and Y-BOCS-SR; however, many items exhibited fair to moderate agreement, particularly the resistance and control against obsessions/compulsions items. Depression significantly moderated correspondence such that Y-BOCS-SR scores significantly predicted Y-BOCS scores in the presence of low and average depression levels in our sample, but not for patients with high levels of depression relative to the rest of our sample; gender, generalized anxiety and obsessionality did not significantly impact agreement. Synthesizing the present data, the Y-BOCS-SR demonstrates modest agreement with the Y-BOCS and may underestimate clinical severity especially for those with high levels of depression.

Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression

OBJECTIVE

Generalized anxiety disorder (GAD) is a common disorder in older adults producing functional impairment, and psychotherapy is the preferred treatment option. Meta-analytic methods sought to determine the efficacy of outpatient cognitive behavioral therapy (CBT) with respect to the hallmark feature of GAD-uncontrolled and excessive worry. In order to optimize clinical applicability, variables associated with GAD treatment outcomes were also examined.

METHODS

Systematic search of relevant databases and iterative searches of references from articles retrieved. All studies were required to have been a randomized control trial (RCT), to have used the Penn State Worry Questionnaire (PSWQ) or its abbreviated version (PSWQ-A) as an outcome measure, and to have conducted CBT with outpatient older adults. Fourteen RCTs (N = 985) were suitable and random-effects meta-analyses and univariate meta-regressions were conducted.

RESULTS

At the end of treatment, and at 6-month follow-up, significant treatment effects favoring CBT were found in comparison to a waitlist or treatment-as-usual. When CBT was compared with active controls, a small nonsignificant treatment advantage was found for CBT at the end of treatment, with equivalence of outcomes at follow-up. Treatment effect size of CBT for GAD was significantly associated with attrition rates and depression outcomes.

CONCLUSIONS

CBT is more helpful than having no treatment for GAD in later life. Nevertheless, whether CBT shows long-term durability, or is superior to other commonly available treatments (such as supportive psychotherapy), remains to be tested. The relationship between treatment effects for GAD and depression following CBT warrants further research.

Calmer Life: A Culturally Tailored Intervention for Anxiety in Underserved Older Adults

OBJECTIVES

To evaluate the feasibility of the Calmer Life and Enhanced Community Care interventions delivered by community and expert providers and test their preliminary effectiveness on worry, generalized anxiety disorder (GAD) severity, anxiety, depression, sleep, health-related quality of life, and satisfaction.

DESIGN

Small randomized trial, with measurements at baseline and 3 months.

SETTING

Underserved, low-income, mostly minority communities in Houston, TX.

PARTICIPANTS

Forty underserved adults 50 years and older, with significant worry and principal or coprincipal GAD or anxiety disorder not otherwise specified.

INTERVENTION

Combination of person-centered, flexible skills training to reduce worry; resource counseling to target unmet basic needs; and facilitation of communication with primary care providers developed through a community-academic partnership with social service and faith-based organizations. Religion/spirituality may be incorporated.

PRIMARY OUTCOMES

worry (Penn State Worry Questionnaire-Abbreviated), GAD severity (GAD-7), anxiety (Geriatric Anxiety Inventory-Short Form).

SECONDARY OUTCOMES

depression (Patient Health Questionnaire-8 and Geriatric Depression Scale-Short Form), sleep (Insomnia Severity Index), health-related quality of life (12-item Medical Outcomes Study Short Form), satisfaction (Client Satisfaction Questionnaire and exit interviews).

RESULTS

Provider training was valid; mean ratings for community providers were well above average, with none less than adequate. Reach was excellent. Participants receiving the Calmer Life intervention had greater improvement in GAD severity and depression than those receiving Enhanced Community Care. Satisfaction with both treatments was equivalent.

CONCLUSIONS

A larger comparative-effectiveness trial needs to examine outcomes following the Calmer Life intervention relative to standard community-based care and to evaluate more fully issues of implementation potential.

Emotional distress tolerance across anxiety disorders

Emotional distress tolerance (EDT) has increasingly been recognized as a transdiagnostic vulnerability factor. However, research assessing EDT in anxiety disorder populations is lacking. The current study addressed this gap in the literature by examining EDT in a sample of outpatients with panic, social anxiety, generalized anxiety, or obsessive compulsive disorders (n=674), and by assessing its relationship to symptom severity and impairment. Results showed that poor EDT was common across diagnostic groups. However, correlation and regression analyses suggested that although EDT was associated with symptom severity and impairment, it did not account for unique variance in scores beyond the effect of negative affect, stress, intolerance of uncertainty (IU) and anxiety sensitivity (AS). IU and AS had a stronger relationship with overall symptom severity and impairment in the regression models. Together, findings suggest that although EDT may be transdiagnostic, IU and AS are more relevant to our understanding of anxiety disorders.

Dispositional Affect in Unique Subgroups of Patients with Rheumatoid Arthritis

Background. Patients with rheumatoid arthritis may experience increased negative outcomes if they exhibit specific patterns of dispositional affect. Objective. To identify subgroups of patients with rheumatoid arthritis based on dispositional affect. The secondary objective was to compare mood, pain catastrophizing, fear of pain, disability, and quality of life between subgroups. Methods. Outpatients from a rheumatology clinic were categorized into subgroups by a cluster analysis based on dispositional affect. Differences in outcomes were compared between clusters through multivariate analysis of covariance. Results. 227 patients were divided into two subgroups. Cluster 1 (n = 85) included patients reporting significantly higher scores on all dispositional variables (experiential avoidance, anxiety sensitivity, worry, fear of pain, and perfectionism; all p < 0.001) compared to patients in Cluster 2 (n = 142). Patients in Cluster 1 also reported significantly greater mood impairment, pain anxiety sensitivity, and pain catastrophizing (all p < 0.001). Clusters did not differ on quality of life or disability. Conclusions. The present study identifies a subgroup of rheumatoid arthritis patients who score significantly higher on dispositional affect and report increased mood impairment, pain anxiety sensitivity, and pain catastrophizing. Considering dispositional affect within subgroups of patients with RA may help health professionals tailor interventions for the specific stressors that these patients experience.

Measuring anxiety in the elderly: psychometric properties of the state trait inventory of cognitive and somatic anxiety (STICSA) in an elderly Italian sample

BACKGROUND

Despite its increasing personal and societal impact, assessment of late-life anxiety has received relatively little attention in psychiatric research. Differential symptom presentation and physical comorbidities among the elderly, relative to younger cohorts creates a need for anxiety measures that are psychometrically validated in the elderly.

METHODS

The present study examined the factor structure and discriminant validity of the state-trait inventory for cognitive and somatic anxiety (STICSA) in a sample of Italian middle-aged and older adults. Participants were 396 community-dwelling middle-aged (50-64 years) and older (≥65 years) adults. In addition to the STICSA, participants completed two depression measures and a general well-being survey with physical and mental health subscales.

RESULTS

Factor analysis supported the validity of both state-trait and cognitive-somatic distinctions underlying the STICSA, all dimensions exhibited excellent internal consistency (Cronbach's α coefficients ≥ 0.86), and correlations with depression measures provided limited evidence for differentiation of anxious and depressive symptoms. The STICSA also showed evidence of discriminating anxious symptoms from physical health symptoms, a particularly relevant feature of a valid anxiety measure in elderly samples.

CONCLUSIONS

The STICSA appears to be a valid measure of cognitive and somatic anxiety in the elderly.

Worry and Depression in the Old and Young: Differences and Mediating Factors

Objective: This study examined whether differences in habitual negative self-thinking and coping strategies might contribute to the age differences in worry and depression. Method: 60 undergraduate students (age range: 18–24 years, M = 19.10, SD = 1.3) and 45 community-dwelling older adults (age range: 60–89 years, M = 73.5, SD = 7.5) participated. Participants completed self-report measures of worry, depression, negative self-thinking, and coping styles. Results: We replicated previous findings that older adults were less worried and less depressed than younger adults. Older adults also reported engaging in less habitual negative thinking and using more problem solving as a coping strategy than younger adults. Furthermore, negative self-thinking and problem-solving skills were found to partially mediate age differences in worry and fully mediate depression scores. Conclusions: These results suggest that habitual negative thinking and problem-solving skills play a role in explaining the lower rates of worry and depression in older populations.