Anxiety, depression, and comorbid anxiety and depression: risk factors and outcome over two years

'Mental health is a mystery': patient perspectives on treatment engagement in the referral process to specialty geriatric mental health services

OBJECTIVES

Raue and Sirey proposed a theoretical treatment engagement model for older adults outlining steps from identifying mental health problems, referral to specialty care, and involvement in treatment. Using this model as a guide, the current study aimed to explore patient perspectives of their experience in the process of referral and first meeting with geriatric mental health services. Furthermore, the current study aimed to identify opportunities to enhance patient engagement in these beginning steps of the treatment engagement process.

METHOD

Thirteen geriatric outpatients (7 psychology, 6 psychiatry) presenting with concerns of anxiety, depression, and/or stress were interviewed. Interviews were analyzed using the framework method.

RESULTS

Themes emerged as suggested by Raue and Sirey's model, including attitudes toward treatment (e.g. stigma), treatment expectations, and treatment preferences. In addition, new themes emerged related to modifiable individual factors (the patient as a passive recipient of care, mental health literacy, and ageism) as well as social influences on treatment engagement. Participants primarily noted opportunities for psychoeducation as a potential treatment engagement intervention to implement within the current referral system.

CONCLUSIONS

This is the first study to examine the applicability of Raue and Sirey's theoretical engagement model in a clinical sample. Findings both support and expand the model and offer several recommendations for improving treatment engagement for older patients.

Child and Adolescent Anxiety and Depression Prior to and During the COVID-19 Pandemic in the United States

Childhood anxiety and depression have been increasing for years, and evidence suggests the COVID-19 pandemic has exacerbated this trend. However, research has examined anxiety and depression primarily as exclusive conditions, overlooking comorbidity. This study examined relationships between the COVID-19 pandemic and anxiety and depression to clarify risk factors for singular and comorbid anxiety and depression in children. Using 2018-2019 and 2020-2021 samples from the National Survey of Children's Health, a nationally representative survey of children aged 0-17 in the United States, associations between the COVID-19 pandemic and child anxiety and depression were examined via survey-weights' adjusted bivariate and multiple regression analyses, controlling for demographic characteristics. The COVID-19 pandemic was associated with higher odds of having comorbid anxiety and depression but not singular anxiety or depression. Female sex, older age, having special healthcare needs, more frequent inability to cover basic needs on family income, and poorer caregiver mental health were associated with having been diagnosed with singular and comorbid anxiety and depression. Children that witnessed or were victims of violence in the neighborhood were also more likely to have comorbid anxiety and depression. Implications for prevention, intervention, and policy are discussed.

Psychometric assessment of the Beck anxiety inventory and key anxiety determinants among Ukrainian female refugees in the Czech Republic

Introduction

The full-scale Russian war has caused Ukrainian female refugees to experience many stressful events which may have an adverse impact on their mental health. Understanding the prevalence and determinants associated with anxiety is essential for psychosocial support. The study aimed: to evaluate the psychometric validity of the Ukrainian version of the Beck Anxiety Inventory (BAI) among Ukrainian female refugees in the Czech Republic, to determine the prevalence of anxiety, and to identify key determinants for anxiety in this population.

Methods

Anxiety was measured by BAI, which was validated by applying confirmatory factor analysis. Linear regressions were run to understand associations between social, physical and mental health determinants and anxiety, adjusted by socio-demographics.

Results

The BAI had a high level of internal consistency. External consistency was confirmed through: structural validity via CFA, indicating that a four-factor model, including cognitive, autonomic, neuromotor, and panic factors, were the most appropriate for the Ukrainian version of BAI; and convergent validity, shown by significant correlations between the total scores of the BAI and coping strategies, perceived stress, depression as well as self-reported physical and mental health. The study revealed that more than half of the participants had moderate to concerning symptoms of anxiety. The analysis indicated that poor perceived health, ineffective coping strategies, high perceived stress, and hampered daily activities due to health issues, are significant predictors of increased anxiety. Conversely, positive or stable social relations with relatives, neighbors, and locals, and the absence of discrimination, were shown to be crucial in reducing anxiety levels.

Prevalence and Correlators of Anxiety and Depression in Premature Coronary Artery Disease

Purpose

The present study assessed the correlation between anxiety and depression in young and middle-aged Chinese patients with coronary artery disease (CAD).

Patients and Methods

This study included 313 patients diagnosed with premature CAD at the Department of Cardiology between January and July 2023. The Zung Self-Rating Anxiety/Depression Scale (SAS/SDS) was used as a standardized scale to assess mental health symptoms. A binary logistic regression model (backward) was used to analyze the correlation between anxiety and depression in premature CAD.

Results

Anxiety was observed in 154 persons with a prevalence of 49.20%, with a median SAS score of 53.0 (52.00-54.00). Depression was observed in 91 patients, with a prevalence of 29.07%, with a median SDS score was 55.00 (54.00-57.00). A total of 63 (20.13%) patients had comorbid anxiety and depression. Multivariate logistic regression analysis revealed that anxiety was positively associated with severe coronary artery stenosis, systolic blood pressure (SBP), body mass index, and snoring. However, it is negatively associated with high-income levels. Depression was positively associated with age, severe coronary artery stenosis, and snoring. However, it was negatively associated with SBP. Comorbid anxiety and depression were positively associated with age, severe coronary artery stenosis, and snoring.

Conclusion

For the first time, we investigated the prevalence and correlators of anxiety and depression in premature CAD. Therefore, the correlators of emotional status should be routinely evaluated in both primary and specialized care services.

Tapestry of postnatal emotional disorders: exploring the interplay of anxiety and depressive disorders and their associated risk factors in Sudanese women

Background

This research aims to unravel the prevalence of postnatal emotional disorders with a focus on how postnatal anxiety remained under-estimated and often embroiled in postnatal depression.

Methods

Out of 600 postnatal women invited to take part in this study from two prominent primary care clinics in Khartoum, 468 women agreed to participate in this study. Three questionnaires were utilized in this study, a Personal Information Questionnaire (PIQ), Hospital Anxiety and Depression Scale (HADS), and Beck depression Inventory (BDI). Multiple linear regression analysis applied to gauge risk factors with postnatal anxiety and depression.

Results

More than half (52.50%) of women showed evidence of both anxiety and depression using HADS, while only (20.9%) of cases were detected by BDI, showing evidence of moderate depressive disorder. A substantial proportion (28.4%) showed high levels of comorbidity of anxiety and depression in the category of moderate to severe symptoms. Main risks factors for postnatal disorders were past psychiatric illness (β = 0.25, p = 0.001), a family history of psychiatric illness (β = 0.15, p = 0.002), and stress due to the number of children (β = 0.32, p = 0.001).

Conclusion

This study advances our understanding of postnatal emotional disorders, particularly highlighting the prevalence as well as correlates of postpartum anxiety. More importantly, this study highlights the importance of routine screen for emotional distress in postnatal women.

Impact of negative emotions and insomnia on sepsis: A mediation Mendelian randomization study

BACKGROUND

Negative emotions and insomnia (NEI) can lead to inflammation, which is a characteristic of sepsis. However, the interaction among NEI and sepsis has not yet been proven. Therefore, Mendelian mediation was used to explore this relationship in this study.

METHODS

The genetic correlation NEI and sepsis was assessed by via linkage disequilibrium scores (LDSC). A two-sample Mendelian randomization (MR) study design was performed to examine the causal association between NEI and sepsis using the inverse variance weighted (IVW) method. The reliability of the results was estimated by weighted median and MR-Egger methods, but heterogeneity was evaluated via Radial and Cochran's Q tests. Biases in gene polymorphisms were checked by MR-Egger regression and MR-PRESSO. Mendelian mediation analyses were applied to quantify the intermediary effect and proportional contribution.

RESULTS

A genetic link between sepsis and depression was determined via LDSC analysis. The relationship between depression and sepsis was revealed through MR analysis [odds ratio (OR) = 1.21, 95 % confidence interval (CI) = 1.08-1.36, p = 1.07 × 10-3)]. The results were not influenced by heterogeneity or pleiotropy biases. Chitinase 3 Like 1 (CHI3L1) was a mediator with a mediation effect size of 0.12. The ratio of the intermediated effect to total effect was 10.31 %.

CONCLUSION

CHI3L1 is a key factor which mediates the interaction between NEI and sepsis.

Estimation of the Global Disease Burden of Depression and Anxiety between 1990 and 2044: An Analysis of the Global Burden of Disease Study 2019

(1) Background: Depression and anxiety are the most common and severe mental disorders. This research estimated the prevalence and disease burden of depression and anxiety from 1990 to 2044. (2) Methods: Data on disease burden, population, and risk factors were identified and gathered from the Global Health Data Exchange database. The time trends, sex and age differences, key factors, and regional variations in and predictions of depression and anxiety were analyzed based on the age-standardized incidence rate, prevalence rate, and DALY rate. (3) Results: Our findings revealed that the burden of depression and anxiety was heavy. Specifically, the age-standardized DALY rate of depression started to decrease compared with trends related to anxiety disorders. Meanwhile, females bear a heavier burden for both depression and anxiety. Seniors and the middle-aged population carry the highest burden regarding mental disorders. Both high- and low-socio-demographic-index countries were found to be high-risk regions for depressive disorders. The disease burden attributed to childhood sexual abuse, bullying victimization, and intimate partner violence has increased since 1990. Finally, projections regarding depression and anxiety revealed geographic and age variations. (4) Conclusions: Public health researchers, officers, and organizations should take effective age-, sex-, and location-oriented measures.

Long-term remission and relapse of anxiety and depression in older adults after Cognitive Behavioural Therapy (CBT): A 10-year follow-up of a randomised controlled trial

BACKGROUND

This study examined the long-term durability of cognitive behaviour therapy (CBT) for older adults with comorbid anxiety and depression 10 years after treatment, in comparison to an active control group.

METHOD

Participants from a randomised controlled trial for older adults with comorbid anxiety and depression (Wuthrich et al., 2016) were re-contacted. Participants had received either group CBT or an active control treatment (Discussion Group). The final sample (N = 54; Aged 70-84, Mage = 76.07, SD = 3.83; 59 % of the eligible original sample) completed a diagnostic interview, cognitive assessment and self-report measures of symptoms and quality of life.

RESULTS

CBT was associated with significantly improved long-term (10-year) efficacy for reducing anxiety and depression in older adults compared to the Discussion group. Effects included higher rates of remission (58 % remission of all diagnoses vs 27 %, 88 % of all depressive diagnoses vs 54 %, 63 % of all anxiety diagnoses vs 35 %, 67 % of primary diagnosis vs 42 %), lower rates of relapse (25-31 % vs 50-78 %) and lower rates of chronic treatment-resistance (8 % primary disorder vs 39 %, 21 % any disorder vs 58 %). Participants who showed an acute treatment response at post-treatment were 7-9 times more likely to be in remission after 10 years than those with residual symptoms.

LIMITATIONS

Results may not generalise to those who do not complete CBT, and the time trajectory of symptom change is unclear.

CONCLUSIONS

Long-term improvements in symptoms are specific to CBT. Results provide compelling evidence for CBT as an effective and durable treatment for late-life anxiety and depression.

Feasibility and preliminary efficacy of a theory-informed resistance exercise training single-arm intervention for major depression

Many adults with major depressive disorder (MDD) do not receive effective treatment. The potential benefits of resistance exercise training (RET) are understudied and may be mechanistically related to cerebral blood flow changes.

PURPOSE

To assess feasibility, acceptability, and preliminary efficacy of a 16-week, theory-informed RET trial for the treatment of MDD and explore changes in cerebral blood flow.

METHODS

Ten adults with DSM-5-diagnosed MDD were enrolled in a single-arm, 16-week, twice-weekly, whole-body RET intervention, consistent with US and WHO Physical Activity resistance exercise guidelines. To build intrinsic motivation and develop exercise-preparatory habits, motivators and commitment were discussed weekly. Screening, enrollment, and intervention attendance and compliance rates documented feasibility. At baseline and weeks 8, 16, and 26, current MDD diagnosis, clinician-rated, and self-reported symptom severity were evaluated along with cerebral blood flow which was assessed as middle cerebral artery (MCA) mean blood velocity, conductance, and pulsatility.

RESULTS

Nine participants completed the intervention. Strong feasibility and acceptability (98 % adherence, 93 % compliance, and 90 % retention) were found. MDD remission was reached by 8/9 participants at week 16 and persisted through week 26. There were large decreases in clinician-rated and self-reported symptoms at each assessment (Hedges' g = 0.84-2.13). There were small-to-moderate increases in MCA velocity (g = 0.32-0.57) and conductance (g = 0.20-0.76) across time, with minimal changes in pulsatility (all g < 0.21).

CONCLUSIONS

Preliminary results suggest RET for MDD treatment is feasible and plausibly efficacious, finding large antidepressant effects. A sufficiently powered randomized controlled trial to assess RET's efficacy for treating MDD via potential cerebrovascular mechanisms is warranted.

Sleep, anxiety, depression, and stress in critically ill patients: a descriptive study in a Portuguese intensive care unit

BACKGROUND

Sleep disorders are common among patients admitted to intensive care units (ICUs). This study aimed to assess the perceptions of sleep quality, anxiety, depression, and stress reported by ICU patients and the relationships between these perceptions and patient variables.

METHODS

This cross-sectional study used consecutive non-probabilistic sampling to select participants. All patients admitted for more than 72 hours of ICU hospitalization at a Portuguese hospital between March and June 2020 were asked to complete the "Richard Campbell Sleep Questionnaire" and "Anxiety, depression, and Stress Assessment Questionnaire." The resulting data were analyzed using descriptive statistics, Pearson's correlation coefficient, Student t-tests for independent samples, and analysis of variance. The significance level for rejecting the null hypothesis was set to α ≤0.05.

RESULTS

A total of 52 patients admitted to the ICU for at least 72 hours was recruited. The mean age of the participants was 64 years (standard deviation, 14.6); 32 (61.5%) of the participants were male. Approximately 19% had psychiatric disorders. The prevalence of self-reported poor sleep was higher in women (t[50]=2,147, P=0.037) and in participants with psychiatric problems, although this difference was not statistically significant (t[50]=-0.777, P=0.441). Those who reported having sleep disorders before hospitalization had a worse perception of their sleep.

CONCLUSIONS

Sleep quality perception was worse in female ICU patients, those with psychiatric disorders, and those with sleep alterations before hospitalization. Implementing early interventions and designing nonpharmacological techniques to improve sleep quality of ICU patients is essential.

Sex differences in symptom network structure of depression, anxiety, and self-efficacy among people with diabetes: a network analysis

Aims

The present study aims to explore the relations between symptoms of depression and anxiety and self-efficacy among people with diabetes. At the same time, we also examined the sex difference between network structures.

Methods

This study recruited 413 participants with diabetes, and they completed Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and the Self-efficacy for Diabetes (SED). Symptom network analysis and network comparison test were used to construct and compare the depression-anxiety symptom network models of the female and male groups. Finally, we conducted flow diagrams to explore the symptoms directly or indirectly related to self-efficacy.

Results

The strongest edges in the depression-anxiety symptom networks are the edge between "GAD3" (Excessive worry) and "GAD4" (Trouble relaxing) and the edge between "PHQ1" (Anhedonia) and "PHQ4" (Energy) in the female and male groups, respectively. Most of the symptoms with the highest EI and bridge EI are related to worry and nervousness. Additionally, in the flow diagram of the female group, "PHQ6" (Guilt) has a high negative association with self-efficacy.

Conclusion

Females with diabetes are more vulnerable to depression and anxiety. Interventions targeting key symptoms in the network may be helpful in relieving the psychological problems among people with diabetes.

Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis

BACKGROUND

Depression is the most common psychiatric disorder among older adults. Despite the effectiveness of pharmacological and psychological therapies, many patients with late-life depression (LLD) are unable to access timely treatment. Telecare has been shown to be effective in addressing patients' psychosocial issues, while its effectiveness in serving patients with LLD remains unclear.

OBJECTIVE

This study aimed to evaluate the effectiveness of telecare in reducing depression and anxiety symptoms and improving quality of life (QoL) in patients with LLD.

METHODS

Databases including the Cochrane Library, Web of Science, PubMed, Embase, and EBSCO were searched for randomized controlled trials (RCTs) evaluating the effectiveness of telecare for LLD from database establishment to December 28, 2022.

RESULTS

A total of 12 RCTs involving 1663 participants were identified in this study. The meta-analysis showed that (1) telecare significantly reduced depressive symptoms in patients with LLD compared to those in usual care (UC; standardized mean difference [SMD]=-0.46, 95% CI -0.53 to -0.38; P<.001), with the best improvement observed within 3 months of intervention (SMD=-0.72, 95% CI -1.16 to -0.28; P<.001); (2) other scales appeared more effective than the Patient Health Questionnaire-9 for LLD in telecare interventions (SMD=-0.65, 95% CI -0.96 to -0.35; P<.001); (3) telecare was more effective than telephone-based interventions for remote monitoring of LLD (SMD=-1.13, 95% CI -1.51 to -0.76; P<.001); (4) the reduction of depressive symptoms was more pronounced in patients with LLD with chronic conditions (SMD=-0.67, 95% CI -0.89 to -0.44; P<.001); (5) telecare was more effective for LLD in Europe and the Americas than in other regions (SMD=-0.73, 95% CI -0.99 to -0.47; P<.001); (6) telecare significantly reduced anxiety symptoms in patients with LLD (SMD=-0.53, 95% CI -0.73 to -0.33; P=.02); and (7) there was no significant improvement in the psychological components of QoL in patients with LLD compared to those receiving UC (SMD=0.30, 95% CI 0.18-0.43; P=.80).

CONCLUSIONS

Telecare is a promising modality of care for treatment, which can alleviate depression and anxiety symptoms in patients with LLD. Continued in-depth research into the effectiveness of telecare in treating depression could better identify where older patients would benefit from this intervention.

Webcam-Based Eye-Tracking of Attentional Biases in Alzheimer's Disease: A Proof-Of-Concept Study

OBJECTIVES

To measure home-based older adults' attentional biases (AB) using webcam-based eye-tracking (WBET) and examine internal consistency.

METHODS

Twelve participants with and without cognitive impairment completed online self-report anxiety and depression screens, and a 96-trial dot-probe task with eye-gaze tracking. For each trial, participants fixated on a cross, free-viewed sad-neutral, sad-angry, sad-happy, angry-neutral, angry-happy, and happy-neutral facial expression pairings, and then fixated on a dot. In emotional-neutral pairings, the time spent looking (dwell-time) at neutral was averaged and subtracted from the emotional average to indicate biases "away from" (negative score) and "toward" (positive score) each emotional face. Internal consistency was estimated for dwell-times and bias scores using Cronbach's alpha and Spearman - Brown corrected split-half coefficients.

RESULTS

The full-cohort and a comorbid anxious and depressed sub-group (n = 6) displayed AB away from sad faces, and toward angry and happy faces, with happy-face AB being more pronounced. AB indices demonstrated low reliability except sub-group happy-face indices. Happy-face AB demonstrated the highest reliability.

CONCLUSIONS

AB measures were in-line with lab-based eye-tracking literature, providing some support for WBET-based measurement.

CLINICAL IMPLICATIONS

Establishing the feasibility of WBET-based measures is a step toward an objective home-based clinical tool. Literature-based suggestions are provided to improve reliability.

Role of sensory processing sensitivity and high sensation seeking in migraine with typical aura

The psychological differences between migraine with aura (MwA) patients and healthy controls (HCs) have not been sufficiently investigated in the current scientific literature. Taking this into account, the present study aimed to examine differences between MwA patients and HCs in sensory processing sensitivity factors, high sensation seeking factors, depression, and anxiety. Mentioned variables were also used to determine their predictive role in predicting the group membership (MwA patients vs HCs). The Highly Sensitive Person Scale, the revised High Sensation Seeking Test, and the Hospital Anxiety and Depression Scale were administered to a sample of seventy-one respondents (39 MwA patients and 32 HCs). MwA patients had a significantly higher score for the low sensory threshold (sensory processing sensitivity factor) in comparison with HCs (4.36 ± 1.4 vs 3.45 ± 1.1, p = 0.003). There was no significant difference in other subscales of sensory processing sensitivity, as well as regarding the high sensation seeking, anxiety, and depression scores, between those two groups. The logistic regression model correctly classified 79.5% MwA patients and 66.7% HCs. The low sensory threshold was a statistically significant predictor for MwA patients (p = 0.001). Our results indicate a certain similarity in the brain sensitivities of MwA patients and people with sensory processing sensitivity trait. Moreover, this shows that the constructs of sensitivity in migraine patients and highly sensitive people overlap to an extent, suggesting the similarity between the conceptualization of sensitivity in the psychological literature and the conceptualization of sensitivity in the medical literature.

Depression in Older Adults: Do Current DSM Diagnostic Criteria Really Fit?

OBJECTIVES

The great heterogeneity in symptoms and clinical signs of depression in older adults makes the current diagnostic criteria difficult to apply. This scoping review aims to provide an update on the relevance of each of the diagnostic criteria as defined in the DSM-5.

METHODS

In order to limit the risk of bias inherent in the study selection process, a priori inclusion and exclusion criteria were defined. Articles meeting these criteria were identified using a combination of search terms entered into PubMed, PsycINFO, PsycARTICLES and SocINDEX.

RESULTS

Of the 894 articles identified, 33 articles were selected. This review highlights a different presentation of depression in older adults. Beyond the first two DSM core criteria, some symptoms are more common in older adults: appetite change, sleep disturbance, psychomotor slowing, difficulty concentrating, indecisiveness, and fatigue.

CONCLUSIONS

This review provides an updated description of the clinical expression of depressive symptoms in the older population while highlighting current pending issues.

CLINICAL IMPLICATIONS

Somatic symptoms should be systematically considered in order to improve the diagnosis of depression in older adults, even if, in some cases, they may reflect symptoms of age-related illnesses.

Efficacy of manual acupuncture vs. placebo acupuncture for generalized anxiety disorder (GAD) in perimenopausal women: a randomized, single-blinded controlled trial

Background

Generalized anxiety disorder (GAD) is common among perimenopausal women. Acupuncture may be an effective treatment for GAD, but evidence is limited. The pathogenesis of GAD is not yet clear, but it is related to the hypothalamic-pituitary-adrenal axis and its excretion, cortisol (CORT), and the adrenocorticotropic hormone (ACTH). The objective of this study is to evaluate the efficacy of manual acupuncture (MA) vs. placebo acupuncture (PA) for perimenopausal women with GAD.

Methods

This study is a single-center, randomized, single-blind clinical trial conducted in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 112 eligible patients with GAD were randomly assigned (1:1) to receive MA (n = 56) or PA (n = 56) three times per week for 4 weeks. The primary outcome measure was the HAMA score. The secondary outcome measures were the GAD-7 and PSQI scores and the levels of CORT and ACTH. The evaluation will be executed at the baseline, 2 weeks, the end of the treatment, and a follow-up 3-month period.

Results

Significant improvements in HAMA (p < 0.001, η2p = 0.465), GAD-7 (p < 0.001, η2p = 0.359) and ACTH (p = 0.050) values were found between T0 and T2 in the MA group compared to the PA group. No difference in PSQI (p = 0.613, η2p = 0.011) and CORT (p = 0.903) was found between T0 and T2 in the MA group compared to the PA group. Long-term improvements in HAMA (p < 0.001, p < 0.001) were found in the MA group and PA group.

Conclusion

This study was the first completed study to evaluate the efficacy of acupuncture and placebo acupuncture for GAD in perimenopausal patients. Results suggested that placebo acupuncture has a therapeutic effect, however, acupuncture had a greater therapeutic effect than placebo acupuncture. This study supports the effectiveness of acupuncture and thereby contributes to extended treatment options for GAD.Clinical trial registration:http://www.chictr.org.cn, Chinese Clinical Trial Registry, ID: ChiCTR2100046604. Registered on 22 May 2021.

Enabling QALY estimation in mental health trials and care settings: mapping from the PHQ-9 and GAD-7 to the ReQoL-UI or EQ-5D-5L using mixture models

PURPOSE

Patient-reported outcome measures (PROMs) are commonly collected in trials and some care settings, but preference-based PROMs required for economic evaluation are often missing. For these situations, mapping models are needed to predict preference-based (aka utility) scores. Our objective is to develop a series of mapping models to predict preference-based scores from two mental health PROMs: Patient Health Questionnaire-9 (PHQ-9; depression) and Generalised Anxiety Questionnaire-7 (GAD-7; anxiety). We focus on preference-based scores for the more physical-health-focussed EQ-5D (five-level England and US value set, and three-level UK cross-walk) and more mental-health-focussed Recovering Quality-of-Life Utility Index (ReQoL-UI).

METHODS

We used trial data from the Improving Access to Psychological Therapies (IAPT) mental health services (now called NHS Talking Therapies), England, with a focus on people with depression and/or anxiety caseness. We estimated adjusted limited dependent variable or beta mixture models (ALDVMMs or Betamix, respectively) using GAD-7, PHQ-9, age, and sex as covariates. We followed ISPOR mapping guidance, including assessing model fit using statistical and graphical techniques.

RESULTS

Over six data collection time-points between baseline and 12-months, 1340 observed values (N ≤ 353) were available for analysis. The best fitting ALDVMMs had 4-components with covariates of PHQ-9, GAD-7, sex, and age; age was not a probability variable for the final ReQoL-UI mapping model. Betamix had practical benefits over ALDVMMs only when mapping to the US value set.

CONCLUSION

Our mapping functions can predict EQ-5D-5L or ReQoL-UI related utility scores for QALY estimation as a function of variables routinely collected within mental health services or trials, such as the PHQ-9 and/or GAD-7.

Comorbid Depressive and Anxiety Symptomatology in Older Adults: The Role of Aging Self-Stereotypes, Loneliness, and Feelings of Guilt Associated with Self-Perception as a Burden

The main objective of this study was to analyze the differences between older adults' symptom profiles (subclinical, anxiety, depressive, and comorbid) in negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden. Participants were 310 community-dwelling people aged 60 years and over. The sample was grouped into four symptom profiles of older adults: anxiety, depressive, comorbid anxiety-depression, and subclinical symptoms. We carried out multinomial logistic regression analyses to analyze the role of assessed variables in the explanation of the four symptom profiles. Older adults who reported a comorbid symptomatology presented higher negative aging self-stereotypes and feelings of loneliness than the other three profiles. Compared with the subclinical profile, older adults who reported clinical symptomatology (anxiety, depressive, and comorbid profile) presented higher feelings of guilt associated with self-perception as a burden. The findings of this study suggest potential associations that may contribute to understanding and treating comorbid anxiety and depressive symptoms in older adults.

From improved sleep regularity to reduced sleep complaints and mental health conditions: a population-based interventional study using a smartphone-based virtual agent

STUDY OBJECTIVES

To explore the effect of sleep regularity on sleep complaints and mental health conditions (i.e. insomnia, fatigue, anxiety, and depressive symptoms) in a population-based interventional study using a smartphone-based virtual agent.

METHODS

A populational cohort based on the Kanopée application, which provided interactions with a virtual companion to collect data on sleep and make personalized recommendations to improve sleep over 17 days. A pre-intervention sleep diary and interview were used for cross-sectional analysis (n = 2142), and a post-intervention sleep diary and interview were used for longitudinal analysis (n = 732). The intra-individual mean (IIM) and standard deviation (ISD) of total sleep time (TST) were calculated to measure sleep quantity and sleep regularity.

RESULTS

The mean age at baseline was 49 years, 65% were female, 72% reported insomnia, 58% fatigue, 36% anxiety, and 17% depressive symptoms. Before the intervention, irregular and short sleep was associated with a higher likelihood of insomnia (Relative risk [RR] = 1.26 [1.21-1.30] for irregular TST and RR = 1.19 [1.15-1.23] for short TST), fatigue, anxiety, and depressive symptoms. After the intervention, the IIM of the TST increased while the ISD of the TST and sleep complaints and mental health conditions decreased. More regular TST was associated with reduced insomnia and depressive symptoms (RR = 1.33 [1.10-1.52] and RR = 1.55 [1.13-1.98], respectively).

CONCLUSIONS

Our results reveal a longitudinal association between sleep regularity and sleep complaints and mental health conditions. Policymakers, health professionals, and the general population should be aware that, beyond its positive effect on sleep health, regular sleep could promote mental health.

Anxiety and Depression in Patients With Inflammatory Bowel Disease at King Fahad Specialist Hospital, Qassim Region

Background Inflammatory bowel disease (IBD) includes Crohn's disease (CD) and ulcerative colitis (UC). It carries a risk of annual relapses and multiple intense flares, which require lifelong treatment and, sometimes, surgical interventions. This affects patients negatively in various aspects of their functioning, and they are left with an increased risk of disturbed quality of life and mental illnesses. Aim This study is carried out to describe the prevalence and risk factors of anxiety and depression symptoms among adult patients with IBD at King Fahad Specialist Hospital, Qassim, Saudi Arabia, and to examine the relationship between mental illness and disease activity. Patient and methods This cross-sectional descriptive study targets adult patients with IBD attending a gastroenterology clinic and medical day care unit. A self-administered questionnaire was given to patients with the help of an IBD nurse. The questionnaire includes the patient's demographic data (i.e., age, gender, etc.), symptoms and treatment patterns, the General Anxiety Disorder (GAD) questionnaire to measure anxiety, and the Patient Health Questionnaire (PHQ-9) to measure depression. Results Among the 179 IBD patients, 60.9% were males, and 40.8% were in the age group of 25-35 years. CD was the most prevalent IBD (73.2%). Perineal CD was detected in 45%. The prevalence of patients who were positive for anxiety symptoms was 17.3%, while the prevalence of depressive symptoms was 19.6%. The independent risk factor for anxiety was female gender, while the independent risk factor for depression was extraintestinal manifestation. The preventive factor for depression was treatment with IV medication. Conclusion Almost one-fifth of IBD patients were considered to have either anxiety or depression. Female gender was a risk factor for anxiety while extraintestinal manifestation of IBD was a risk factor for depression. Interestingly, treatment with IV medication was found to be the protective factor for depression. More investigations are warranted to give more insights regarding the prevalence and risk factors of psychological disorders among patients with IBD in our region.

Probiotics as functional foods: How probiotics can alleviate the symptoms of neurological disabilities

Neurological disorders are diseases of the central nervous system with progressive loss of nervous tissue. One of the most difficult problems associated with neurological disorders is that there is no clear treatment for these diseases. In this review, the physiopathology of some neurodegenerative diseases, etiological causes, drugs used and their side effects, and finally the role of probiotics in controlling the symptoms of these neurodegenerative diseases are presented. Recently, researchers have focused more on the microbiome and the gut-brain axis, which may play a critical role in maintaining brain health. Probiotics are among the most important bacteria that have positive effects on the balance of homeostasis via influencing the microbiome. Other important functions of probiotics in alleviating symptoms of neurological disorders include anti-inflammatory properties, short-chain fatty acid production, and the production of various neurotransmitters. The effects of probiotics on the control of abnormalities seen in neurological disorders led to probiotics being referred to as "psychobiotic. Given the important role of the gut-brain axis and the imbalance of the gut microbiome in the etiology and symptoms of neurological disorders, probiotics could be considered safe agents that positively affect the balance of the microbiome as complementary treatment options for neurological disorders.

Time-Varying Effect Models for Examining Age-Dynamic Associations in Gerontological Research

OBJECTIVES

Dynamic processes unfolding over later adulthood are of prime interest to gerontological researchers. Time-varying effect modeling (TVEM) accommodates dynamic change trajectories, but its use in gerontological research is limited. We introduce and demonstrate TVEM with an empirical example based on the National Health and Aging Trends Study (NHATS).

METHODS

We examined (a) age-varying prevalence of past month elevated symptoms of depression and anxiety and (b) age-varying associations between older adults' elevated symptoms of depression and anxiety and needing help with basic activities of daily living and educational attainment.

RESULTS

The proportion of participants reporting elevated symptoms of depression and anxiety in the past month increased gradually from 23-29% across the ages 70-92. Individuals needing help with ADLs had higher odds of reporting elevated symptoms of depression and anxiety, however the association was strongest for those in their 60s versus 80s. Across all ages, adults with lower education levels had higher odds of reporting elevated symptoms of depression and anxiety, an association that also varied by age.

CONCLUSION

We demonstrated TVEM's value for studying dynamic associations that vary across chronological age. With the recent availability of free, user-friendly software for implementing TVEM, gerontological researchers have a new tool for exploring complex change processes that characterize older adults' development.

Evaluating the interactive effects of dietary habits and human gut microbiome on the risks of depression and anxiety

BACKGROUND

Gut microbiome and dietary patterns have been suggested to be associated with depression/anxiety. However, limited effort has been made to explore the effects of possible interactions between diet and microbiome on the risks of depression and anxiety.

METHODS

Using the latest genome-wide association studies findings in gut microbiome and dietary habits, polygenic risk scores (PRSs) analysis of gut microbiome and dietary habits was conducted in the UK Biobank cohort. Logistic/linear regression models were applied for evaluating the associations for gut microbiome-PRS, dietary habits-PRS, and their interactions with depression/anxiety status and Patient Health Questionnaire (PHQ-9)/Generalized Anxiety Disorder-7 (GAD-7) score by R software.

RESULTS

We observed 51 common diet-gut microbiome interactions shared by both PHQ score and depression status, such as overall beef intake × genus Sporobacter [hurdle binary (HB)] (PPHQ = 7.88 × 10-4, Pdepression status = 5.86 × 10-4); carbohydrate × genus Lactococcus (HB) (PPHQ = 0.0295, Pdepression status = 0.0150). We detected 41 common diet-gut microbiome interactions shared by GAD score and anxiety status, such as sugar × genus Parasutterella (rank normal transformed) (PGAD = 5.15 × 10-3, Panxiety status = 0.0347); tablespoons of raw vegetables per day × family Coriobacteriaceae (HB) (PGAD = 6.02 × 10-4, Panxiety status = 0.0345). Some common significant interactions shared by depression and anxiety were identified, such as overall beef intake × genus Sporobacter (HB).

CONCLUSIONS

Our study results expanded our understanding of how to comprehensively consider the relationships for dietary habits-gut microbiome interactions with depression and anxiety.

Association between secondhand smoke exposure and negative emotions among 12-15-year-old non-smoking adolescents from 63 low- and middle-income countries

BACKGROUND

Secondhand smoke (SHS) exposure is associated with negative emotions in adolescents, but the association between SHS exposure and negative emotions has been understudied, especially in low- and middle-income countries. Hence, we studied the association between SHS exposure and negative emotions among 12-15-year-old non-smoking adolescents from 63 low- and middle-income countries (LMICs).

METHODS

We calculated the pooled prevalence of SHS exposure, loneliness, and anxiety in 12-15-year-old non-smoking adolescents. Multivariable logistic regression was used to evaluate country-specific associations between SHS exposure and negative emotions, after adjusting for important confounders. Meta-analyses were performed to evaluate the overall, regional, and country-income level pooled associations.

RESULTS

Of the adolescents included in the analysis, 34.88 % had less than daily SHS exposure and 13.41 % were exposed to SHS daily. The overall prevalence of loneliness and anxiety in the adolescents was 10.51 % and 8.95 %, respectively. Exposure to SHS in the past 7 days was associated with loneliness and anxiety, with odds ratios (95 % confidence intervals) of 1.15 (1.09-1.21) and 1.24 (1.17-1.31), respectively. These positive associations were observed in girls, but not in boys. In addition, there was a positive dose-response relationship between the day of exposure to SHS and loneliness and anxiety.

LIMITATIONS

The GSHS data were obtained from a self-report questionnaire and the participants were only adolescents in school.

CONCLUSIONS

Our study revealed a positive association between SHS exposure and negative emotions among non-smoking adolescents from LMICs.

Conceptualizing anxiety and depression in children and adolescents: a latent factor and network analysis

The objective of this study is to gain insight into the inherent structure of anxiety and depressive symptoms by combining the strengths of latent factor analysis and network analysis. The sample comprised 743 children and adolescents aged 4–18 years (M = 11.64, SD = 3.66, 61% males) who sought routine care outpatient psychotherapy. Parents or primary caregivers rated anxiety and depressive symptoms of their children on a DSM-5-/ICD-10-based symptom checklist. First, we analyzed the factor structure of the internalizing symptoms using exploratory factor analysis (EFA). Next, we conducted a network analysis and identified central and bridge symptoms that may explain comorbidity between anxiety disorders and depression. We then employed exploratory graph analysis (EGA) as an alternative tool within the framework of network psychometrics to estimate the number of dimensions (i.e., communities within a network). Finally, we tested a model based on these results using confirmatory factor analysis. The results demonstrate a complex interplay between anxiety and depressive symptom domains. Four factors/communities were identified by EFA and EGA, but the item-community allocation differed, and the interpretation of factors/communities was unclear. A clear distinction between these domains could not be supported. However, associations within a domain were stronger than associations between the two domains. We identified pain, suicidal, irritable, and afraid of adults as bridge items between the symptom domains. In conclusion, our findings further advance the general understanding of the frequently reported co-occurrence of anxiety and depressive symptoms and diagnoses in clinical practice. Identifying bridge symptoms may inform intervention practices by targeting specific symptoms that contribute to the maintenance of anxious and depressive behaviors.

Assessing the joint effects of mitochondrial function and human behavior on the risks of anxiety and depression

BACKGROUND

Psychiatric disorders have great health hazards and the exact pathogeny remains elusive now. We aim to explore the potential interaction effects of mitochondrial function and human behavior on the risks of anxiety and depression.

METHODS

The genome-wide association study (GWAS) data of mitochondrial function (N = 383,476-982,072) were obtained from published studies. Individual level genotype and phenotype data of anxiety, depression and behavioral factors (including drinking, smoking and physical activity) were all from the UK Biobank (N = 84,805-85,164). We first calculated the polygenic risk scores (PRS) of mitochondrial function as the instrumental variables, and then constructed linear regression analyses to systematically explore the potential interaction effects of mitochondrial function and human behavior on anxiety and depression.

RESULTS

In total samples, we observed mitochondrial heteroplasmy (MtHz) vs. Drinking (P_GAD-7 = 6.49 × 10^-3; P_PHQ-9 = 1.89 × 10^-3) was positively associated with both anxiety and depression. In males, MtHz vs. Drinking (P_Male = 3.46 × 10^-5) was positively correlated with depression. In females, blood mitochondrial DNA copy number (mtDNA-CN) vs. Drinking (P_Female = 8.63 × 10^-3) was negatively related to anxiety. Furthermore, we identified additional 6 suggestive interaction effects (P < 0.05) for anxiety and depression.

LIMITATIONS

Considering all subjects were from UK Biobank, it should be careful to extrapolate our findings to other populations with different genetic background.

CONCLUSIONS

Our results suggest the significant impacts of mitochondrial function and human behavior interactions on the development of anxiety and depression, providing new clues for clarifying the pathogenesis of anxiety and depression.

The relationship between anxiety and depression under the pandemic: The role of life meaning

Introduction

COVID-19 is a stressor creating much anxiety for the general public, such as anxiety related to possible infection, social distancing, financial strain and uncertainty. As the scientific literature shows that there is an intimate relationship between anxiety and depression, it is important to ask whether anxiety is related to depression under the pandemic and whether spirituality indexed by life meaning can moderate the relationship between anxiety and depression. According to theories highlighting the importance of life meaning, relative to people with a higher level of life meaning, the relationship between anxiety and depression would be stronger in people with a lower level of life meaning.

Methods

Empirically, we collected data in two waves (i.e., before and after the first wave of COVID-19, respectively) from 4,981 adolescents recruited in Sichuan, China. Then, the 41-item "Screen for Child Anxiety Related Emotional Disorders" was employed to measure anxiety symptoms, 20-item "Center for Epidemiological Studies-Depression Scale" was utilized to examine depression symptoms, and the "Spirituality Subscale of the Chinese Positive Youth Development Scale" for assessing life meaning.

Results

We found that anxiety significantly predicted depression at each wave and across time. Second, controlling for Wave 1 depression scores, results showed that a drop in Wave 1 anxiety predicted a drop in depressive symptoms over time. Regarding the relationship between meaning in life and depression, spirituality indexed by meaning in life negatively predicted depression at each wave and over time, and predicted change in depression across time. Finally, multiple regression analyses showed that life meaning moderated the predictive effect of anxiety on depression.

Discussion

The findings support the thesis that spirituality serves as a protective factor for psychological morbidity in Chinese adolescents. The study also suggests the importance of helping adolescents to develop life meaning under COVID-19.

Incident and Recurrent Depression among Adults Aged 50 Years and Older during the COVID-19 Pandemic: A Longitudinal Analysis of the Canadian Longitudinal Study on Aging

The COVID-19 pandemic and accompanying public health measures have exacerbated many risk factors for depression in older adulthood. The objectives of the current study are: (1) to determine the risk of incident and recurrent depression during the COVID-19 pandemic among those with, or without, a history of depression; and (2) to identify factors that were predictive of depression in these two groups. The study population included 22,622 participants of the Canadian Longitudinal Study on Aging who provided data at baseline (2011-2015), follow-up (2015-2018), and twice during the pandemic (April-May 2020, September-December 2020). The Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to classify individuals with depression. Logistic regression was used to estimate the odds of depression during COVID across a series of risk factors. Individuals with a history of depression had four times the risk of depression during the pandemic when compared to those without a history of depression, even after controlling for relevant covariates. Other factors associated with depression during the pandemic include being female, having fewer savings, and experiencing COVID-19 related stressors, such as health stressors, difficulties accessing resources, and family conflict. Clinicians working with older adults should consider interventions to support high-risk groups, such as those with recurrent depression.

Assessment of clinical outcomes of medicinal cannabis therapy for depression: analysis from the UK Medical Cannabis Registry

BACKGROUND

Although pre-clinical experiments associate cannabinoids with reduced depressive symptoms, there is a paucity of clinical evidence. This study aims to analyze the health-related quality of life changes and safety outcomes in patients prescribed cannabis-based medicinal products (CBMPs) for depression.

METHODS

A series of uncontrolled cases from the UK Medical Cannabis Registry were analyzed. The primary outcomes were changes from baseline in the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Sleep Quality Scale (SQS), and EQ-5D-5 L at 1, 3, and 6 months. Secondary outcomes included adverse events incidence.

RESULTS

129 patients were identified for inclusion. Median PHQ-9 at baseline was 16.0 (IQR: 9.0-21.0). There were reductions in PHQ-9 at 1-month (median: 8.0; IQR: 4.0-14.0; p < 0.001), 3-months (7.0; 2.3-12.8; p < 0.001), and 6-months (7.0; 2.0-9.5; p < 0.001). Improvements were also observed in GAD-7, SQS, and EQ-5D-5L Index Value at 1, 3, and 6 months (p < 0.050). 153 (118.6%) adverse events were recorded by 14.0% (n = 18) of participants, 87% (n = 133) of which were mild or moderate.

CONCLUSION

CBMP treatment was associated with reductions in depression severity at 1, 3, and 6 months. Limitations of the study design mean that a causal relationship cannot be proven. This analysis provides insights for further study within clinical trial settings.

Primary Outcomes for Adults Receiving the Unified Protocol after Hurricane Harvey in an Integrated Healthcare Setting

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy for treating anxiety and depression. However, there are limited effectiveness data when conducted in real-world settings with diverse populations, including those with trauma. We evaluated treatment outcomes in a naturalistic, community setting among 279 adults who received UP following Hurricane Harvey. We examined change in overall clinical severity, depression and anxiety symptoms, functional impairment, and baseline outcome predictors (i.e., demographic characteristics, impact from Hurricane Harvey, co-occurrence of depression and anxiety symptoms). Global clinical severity, depression and anxiety symptoms, and functional impairment decreased by end-of-treatment. Participants experienced global symptom improvement to a lesser degree than demonstrated in efficacy trials. Participants who experienced greater storm impact reported larger reductions in anxiety symptoms than those less impacted by Harvey. Further studies evaluating the effectiveness of the UP post-disaster and with diverse samples are needed.

Mental health conditions and unsafe driving behaviors: A naturalistic driving study on ADHD and depression

INTRODUCTION

Road injuries remain a persistent public health concern across the world. The task of driving is complicated by mental health conditions, which may affect drivers' executive functioning and cognitive resource allocation. This study examines whether attention-deficit/hyperactivity disorder (ADHD) and depression are associated with unsafe driving behaviors.

METHOD

Generalized linear mixed models were employed to estimate the association of self-reported ADHD and depression with 18 unsafe driving behavior types found prior to at-fault crashes and near-crashes using a large-scale naturalistic driving dataset. Driver demographics, cognitive traits, environmental factors, and driver random effects were included to reduce confounding and biases.

RESULTS

Controlling for other covariates, people with self-reported ADHD were more likely to have performed improper braking or stopping (OR = 4.89, 95% CI 1.82-13.17) prior to an at-fault crash or near-crash, while those with self-reported depression did not have a significant association with any unsafe driving behavior.

CONCLUSIONS

After accounting for demographic, cognitive, and environmental covariates, individuals with ADHD and depression were not prone to purposefully aggressive or reckless driving. Instead, drivers with self-reported ADHD may unintentionally execute unsafe driving behaviors in particular driving scenarios that require a high level of cognitive judgment.

PRACTICAL APPLICATIONS

These findings can inform the curriculum design of driver's education programs that help learners with mental health conditions gain practice in certain road scenarios, for example, more practice on preemptively reducing speed instead of making sudden brakes and smooth turning on curved roads for students with ADHD. Furthermore, specific advanced driver assistance systems may prove particularly helpful for drivers with ADHD, such as detection of leading objects and curve speed warning.

Self-reported mental health during the COVID-19 pandemic and its association with alcohol and cannabis use: a latent class analysis

BACKGROUND

Mental health problems and substance use co-morbidities during and after the COVID-19 pandemic are a public health priority. Identifying individuals at high-risk of developing mental health problems and potential sequela can inform mitigating strategies. We aimed to identify distinct groups of individuals (i.e., latent classes) based on patterns of self-reported mental health symptoms and investigate their associations with alcohol and cannabis use.

METHODS

We used data from six successive waves of a web-based cross-sectional survey of adults aged 18 years and older living in Canada (6,021 participants). We applied latent class analysis to three domains of self-reported mental health most likely linked to effects of the pandemic: anxiety, depression, and loneliness. Logistic regression was used to characterize latent class membership, estimate the association of class membership with alcohol and cannabis use, and perform sex-based analyses.

RESULTS

We identified two distinct classes: (1) individuals with low scores on all three mental health indicators (no/low-symptoms) and (2) those reporting high scores across the three measures (high-symptoms). Between 73.9 and 77.1% of participants were in the no/low-symptoms class and 22.9-26.1% of participants were in the high-symptom class. We consistently found across all six waves that individuals at greater risk of being in the high-symptom class were more likely to report worrying about getting COVID-19 with adjusted odds ratios (aORs) between 1.72 (95%CI:1.17-2.51) and 3.51 (95%CI:2.20-5.60). Those aged 60 + were less likely to be in this group with aORs (95%CI) between 0.26 (0.15-0.44) and 0.48 (0.29-0.77) across waves. We also found some factors associated with class membership varied at different time points. Individuals in the high-symptom class were more likely to use cannabis at least once a week (aOR = 2.28, 95%CI:1.92-2.70), drink alcohol heavily (aOR = 1.71, 95%CI:1.49-1.96); and increase the use of cannabis (aOR = 3.50, 95%CI:2.80-4.37) and alcohol (aOR = 2.37, 95%CI:2.06-2.74) during the pandemic. Women in the high-symptom class had lower odds of drinking more alcohol during the pandemic than men.

CONCLUSIONS

We identified the determinants of experiencing high anxiety, depression, and loneliness symptoms and found a significant association with alcohol and cannabis consumption. This suggests that initiatives and supports are needed to address mental health and substance use multi-morbidities.

Age differences in trajectories of depressive, anxiety, and burnout symptoms in a population with a high likelihood of persistent occupational distress

OBJECTIVES

Work in occupations with higher levels of occupational stress can bring mental health costs. Many older adults worldwide are continuing to work past traditional retirement age, raising the question whether older adults experience depression, anxiety, or burnout at the same or greater levels as younger workers, and whether there are differences by age in these levels over time.

DESIGN/SETTING/PARTICIPANTS

Longitudinal survey of 1161 currently employed US clergy followed every 6-12 months for up to 66 months.

MEASUREMENTS

Depression was measured with the 8-item Patient Health Questionnaire (PHQ-8). Anxiety was measured using the anxiety component of the Hospital Anxiety and Depression Scale (HADS). Burnout symptoms were assessed using the three components of the Maslach Burnout Inventory: emotional exhaustion (EE), depersonalization (DP), and sense of personal accomplishment (PA).

RESULTS

Older participants had lower scores of depression, anxiety, EE, and DP and higher levels of PA over time compared to younger adults. Levels of EE decreased for older working adults, while not significantly changing over time for those younger. DP symptoms decreased over time among those 55 years or older but increased among those 25-54 years.

CONCLUSIONS

Older working adults may have higher levels of resilience and be able to balance personal life with their occupation as well as may engage in certain behaviors that increase social support and, for clergy, spiritual well-being that may decrease stress in a way that allows these older adults to appear to tolerate working longer without poorer mental health outcomes.

The Effects of Depression and Anxiety on 90-day Readmission Rates After Total Hip and Knee Arthroplasty

Background

Patients undergoing total joint arthroplasty have higher rates of anxiety, depression or anxiety and depression than the general population and higher costs of care, which lead to higher levels of postoperative dissatisfaction and readmission rates. We evaluated the readmission rates of patients undergoing total hip or knee arthroplasty with diagnoses of anxiety, depression, or both.

Methods

Our hospital's prospectively collected data from Michigan's statewide total joint database were reviewed from 2013 to 2018. Rates of anxiety, depression or anxiety and depression were determined based on preoperative anxiolytic or antidepressant medications using National Drug Codes.

Results

A total of 4107 cases were included. Of which 4.28% had a readmission within the 90-day global period, and 12% had a history of depression or anxiety or both. For the entire cohort, those on anxiolytic medication were 153% more likely to be readmitted than those not on medication (P = .017). When comparing total hip arthroplasty (THA) or total knee arthroplasty (TKA), patients taking anxiolytic medication and undergoing TKA were 120% more likely to undergo readmission within 90 days (P = .021). Patients on depression medication alone were not at increased risk of readmission in the TKA cohort (P = .991). For THA, neither diagnosis appeared a risk factor for readmission (P = .852).

Conclusions

Patients with depression, anxiety, or both undergoing TKA were at a statistically significant risk of readmission within 90 days compared with patients without these diagnoses. Anxiety and depression were both risk factors for readmission, but anxiety appeared to have a more significant impact. Patients undergoing THA on the other hand did not appear to share this risk profile.

Psychiatric and cognitive characteristics of older adults admitted to a Video-EEG monitoring (VEM) unit

OBJECTIVE

To compare the clinical, psychiatric, and cognitive characteristics of older with younger patients presenting to a video-EEG monitoring (VEM) unit.

METHOD

This was a retrospective case-control study involving patients admitted for VEM over a two-year period (from April 2018 to April 2020) at two comprehensive epilepsy units. Patients were categorized into an older (≥60 years) and a younger (<60 years) group. Younger patients were individually matched to older adults to form a matched younger group. Diagnosis was determined by a consensus opinion of epileptologists, neurologists, and neuropsychiatrists. The main diagnostic categories were epilepsy, psychogenic nonepileptic seizures (PNES), and 'other' diagnosis (non-diagnostic and other nonepileptic diagnoses). Clinical psychiatric diagnoses were obtained from neuropsychiatric reports. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). Subjective cognitive function was assessed using the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) cognitive subscales.

RESULTS

Five-hundred and thirty three patients (71 older, 462 younger) aged 16-91 years were admitted to the VEM unit during the study period. There was a diagnosis of focal epilepsy in 55% of the older group and 48% of the younger group, generalized epilepsy in 3% of the older group and 10% of the younger group, and 'other' in 32% of the older group and 19% of the younger group. Ten percent (2 males and 5 females) of the older group were diagnosed with PNES compared to 22% of the younger group (p = 0.016). A depressive disorder was diagnosed in 34% of the older group and 24% of the younger group (p = 0.20). An anxiety disorder was diagnosed in 15% of the older group and 25% of the younger group (p = 0.15). Mild neurocognitive disorder was more common in the older group (34%) compared to the matched younger group (34% vs 3%, p < 0.001). The older group had lower mean NUCOG scores compared to the matched younger group (79.49 vs 87.73, p = <0.001). There was no evidence for a relationship between mean NUCOG score and overall subjective cognitive difficulties for the older group (r = 0.03, p = 0.83). Among older adults, those diagnosed with PNES had more experiences of childhood trauma. Measures of dissociation, depression, or general anxiety did not differ between PNES and non-PNES diagnoses in the older group.

CONCLUSION

Psychiatric comorbidities are common among older adults admitted for VEM. The psychological impact of epilepsy and risk factors for PNES seen in younger patients are also applicable in the older group. The older group demonstrated more cognitive impairments than the younger group, although these were usually unrecognized by individuals. Older adults admitted to VEM will benefit from psychiatric and neuropsychological input to ensure a comprehensive care approach to evaluation and management.

Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis

OBJECTIVES

Co-occurring mood and anxiety disorders are common in older adult populations and are associated with worse long-term outcomes and poorer treatment response than either disorder alone. This systematic review and meta-analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co-occurring mood and anxiety disorders in older adults.

METHOD

The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines.

INCLUSION

Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post-treatment. ResultsFour studies were included (total n = 255, mean age range 67-71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co-occurring anxiety (Hedges' g = -0.44), and treating anxiety in the presence of depression (Hedges' g = -0.55). However, conclusions are limited; the meta-analysis was non-significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow-up were not established.

CONCLUSION

Co-occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high-quality clinical trials are needed that target the treatment of co-occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.

Intersectional analysis of chronic mild stress-induced lncRNA-mRNA interaction networks in rat hippocampus reveals potential anti-depression/anxiety drug targets

Despite studies providing insight into the neurobiology of chronic stress, depression and anxiety, long noncoding RNA (lncRNA)-mediated mechanisms underlying the common and distinct pathophysiology of these stress-induced disorders remain nonconclusive. In a previous study, we used the chronic mild stress paradigm to separate depression-susceptible, anxiety-susceptible and insusceptible rat subpopulations. In the current study, lncRNA and messenger RNA (mRNA) expression was comparatively profiled in the hippocampus of the three stress groups using microarray technology. Groupwise comparisons identified distinct sets of lncRNAs and mRNAs associated with the three different behavioral phenotypes of the stressed rats. To investigate the regulatory roles of the dysregulated lncRNAs upon mRNA expression, correlations between the differential lncRNAs and mRNAs were first analyzed by combined use of weighted gene coexpression network analysis and ceRNA theory-based methods. Subsequent functional analysis of strongly correlated mRNAs indicated that the dysregulated lncRNAs were involved in various biological pathways and processes to specifically induce rat susceptibility or resiliency to depression or anxiety. Further intersectional analysis of phenotype-associated and drug-associated lncRNA-mRNA networks and subnetworks assisted in identifying 16 hub lncRNAs as potential targets of anti-depression/anxiety drugs. Collectively, our study established the molecular basis for understanding the similarities and differences in pathophysiological mechanisms underlying stress-induced depression or anxiety and stress resiliency, revealing several important lncRNAs that represent potentially new therapeutic drug targets for depression and anxiety disorders.

Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial

Background

Only a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults.

Methods

We will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes.

Discussion

This project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce.

Trial registration

The trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.

Predictors of persistence of anxiety disorders across the lifespan: a systematic review

Despite the substantial disease burden of anxiety disorders, physicians have a poor understanding of factors that predict their typical persistent course. This systematic review of predictors of persistent anxiety disorders covered 48 studies with 29 690 patients diagnosed with an anxiety disorder that were published in PubMed, PsycINFO, and Web of Science between Jan 1, 1980 (introduction of DSM-III), and Dec 1, 2019. We also compared predictors between children, adolescents, adults, and older adults (ie, ≥55 years). A persistent course was primarily predicted by clinical and psychological characteristics, including having panic attacks, co-occurring personality disorders, treatment seeking, poor clinical status after treatment, higher severity and longer duration of avoidance behaviour, low extraversion, higher anxiety sensitivity, and higher behavioural inhibition. Unlike disorder onset, sociodemographic characteristics did not predict persistence. Our results outline a profile of patients with specific clinical and psychological characteristics who are particularly vulnerable to anxiety disorder persistence. Clinically, these patients probably deserve additional or more intensive treatment to prevent development of chronicity.

Analysis of Chronic Mild Stress-Induced Hypothalamic Proteome: Identification of Protein Dysregulations Associated With Vulnerability and Resiliency to Depression or Anxiety

Chronic stress as a known risk factor leads to hyperactivity of the hypothalamus-pituitary-adrenal (HPA) axis in both depression and anxiety. However, the stress-induced dysfunction of the HPA axis in these disorders especially the common and unique molecular dysregulations have not been well-explored. Previously, we utilized a chronic mild stress (CMS) paradigm to segregate and gain depression-susceptible, anxiety-susceptible, and insusceptible groups. In this study, we continue to examine the possible protein expression alterations of the hypothalamus as the center of the HPA axis in these three groups by using a proteomic approach. Though isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative analysis, a total of 593 dysregulated proteins were identified. These were potentially associated with vulnerability and adaptability of CMS-caused depression or anxiety and therefore might become novel investigative protein targets. Further independent analysis using parallel reaction monitoring (PRM) indicated that 5, 7, and 21 dysregulated proteins were specifically associated with depression-susceptible, anxiety-susceptible, and insusceptible groups, respectively, suggesting that the same CMS differently affected the regulation system of the rat hypothalamic proteome. In summary, the current proteomic research on the hypothalamus provided insights into the specific and common molecular basis for the HPA dysfunction mechanisms that underlie resiliency and vulnerability to stress-induced depression or anxiety.

Chronic mild stress-induced protein dysregulations correlated with susceptibility and resiliency to depression or anxiety revealed by quantitative proteomics of the rat prefrontal cortex

Chronic stress is a significant risk factor for depression as well as anxiety disorders. Yet, the stress-induced specific and common molecular dysregulations of these disorders have not been fully understood. Previously, we constructed a chronic mild stress (CMS) rat model to separate and obtain depression-susceptible, anxiety-susceptible, and insusceptible groups. In this study, the prefrontal cortical proteomes of the three stressed groups were comparatively profiled utilizing isobaric tags for relative and absolute quantitation (iTRAQ)-coupled tandem mass spectrometry approach. A total of 212 protein dysregulations were identified, potentially correlating to susceptibility or resilience to CMS-induced depression or anxiety, and thus might serve as potential protein targets for further investigation. In addition, independent analysis by parallel reaction monitoring identified changes in Gfap, Rhog, Gnai2, Ppp1r1b, and Uqcrh; Tubb6, Urod, Cul1, Spred1, and Gpcpd1; Acadl, Ppp1r1a, Grm2, Mtor, Lsm8, Cplx2, and Tsta3 that were distinctly correlated to depression-susceptible, anxiety-susceptible, or insusceptible groups, respectively. This suggested that identical CMS had different effects on the protein regulation system of the rat prefrontal cortex. Collectively, the present proteomics study of the prefrontal cortex established a significant molecular basis and offered new insights into the specificity and commonality of pathophysiologic mechanisms underlying susceptibility and resiliency to stress-induced depression or anxiety.

Mediation model of comorbid anxiety disorders in late-life depression

BACKGROUND

A number of studies have been conducted on risk factors of comorbid anxiety disorders regarding late-life depression (LLD). This study investigated the associated factors and their relationship to comorbid anxiety disorders in LLD.

METHODS

Participants included 190 elderly Thais (73.2% female, with a mean age of 68.39 ± 6.74 years) with depressive disorders, diagnosed according to DSM-IV Diagnosis Axis I disorders assessed by Mini-International Neuropsychiatric Interview. Demographic data, medical and psychiatric history, family psychiatric history, past depression, family history of depression, Neuroticism Inventory and 7-Item Hamilton Depression Rating Scale (HAMD-7) were analyzed for path analysis using Structural Equation Model framework. The bootstrapping method was used for testing indirect effects.

RESULTS

Being female was associated with comorbid anxiety disorders with an indirect effect (β = - 0.032, P = 0.018) through neuroticism, depression severity, history and family history of depression. Family history of depression had no effect on comorbidity (P = 0.090). Neuroticism had an indirect effect on comorbid anxiety disorders (β = 0.075, P = 0.019) via depression severity as reflected by HAMD-7 score (β = 0.412, P =  < 0.001). Total variance explained from this model was 11%. This model had good-fit index with Chi-square > 0.05, CFI and TLI > 0.95 and RMSEA < 0.06.

CONCLUSION

Neuroticism mediates the effect of relationship between sex, family history and history of depressive disorders and comorbid anxiety disorders in LLD. Moreover, depression severity is a mediator for neuroticism and comorbid anxiety disorders. Longitudinal studies are warranted to indicate the importance of effective treatment of depression to lower the risk of developing comorbid anxiety disorders among depressed elderly.

Comparative efficacy of add-on rTMS in treating the somatic and psychic anxiety symptoms of depression comorbid with anxiety in adolescents, adults, and elderly patients-A real-world clinical application

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant treatment for depression. Many patients with depression have comorbid anxiety symptoms. However, previous rTMS studies have focused on patients with depression, and often excluded comorbid anxiety. This real-world study aimed to investigate the comparative efficacy of add-on rTMS in treating the somatic and psychic anxiety symptoms of depression comorbid with anxiety in adolescents, adults and elderly patients.

METHODS

This study included 147 depression patients with anxiety symptoms who were treated with at least 10 sessions of rTMS. The symptoms of anxiety and depression were assessed with the Hamilton Rating Scale for Anxiety (HAMA) and the Hamilton Rating Scale for Depression (HAMD) at baseline and after 2 and 4 weeks of treatment. This was done to compare the improvement degree of add-on rTMS on somatic and psychic anxiety symptoms in adolescents, adults and elderly patients respectively.

RESULTS

Both somatic and psychic anxiety symptoms were significantly improved after the add-on rTMS in adolescents, adults and elderly patients. The improvement of somatic anxiety was better than that of psychic anxiety after rTMS treatment in elderly patients (t_2w=3.895, P<0.001; t_4w=2.823, P = 0.008).

LIMITATION

The overall sample was mostly composed of elderly patients, while adolescents and adult patients were fewer.

CONCLUSIONS

The add-on rTMS treatment can improve somatic anxiety better than psychic anxiety in depression with anxiety symptoms, especially in elderly patients.

Anxiety of Older Persons Living Alone in the Community

Anxiety is a common mental health problem among older persons, and the prevalence is higher in those who live alone than those who live with others. This study aimed to explore the experiences of anxiety in older persons living alone. A descriptive phenomenological approach was used to collect and analyze the interview data from 15 older persons (5 males, 10 females) living alone in Seoul, South Korea. Four main themes emerged from the data analysis: fear of being alone, concern about having an aged body, apprehension mixed with depression and loneliness, and fear of economic difficulties. These findings indicate that older persons living alone should receive continuous attention to prevent them from being neglected and their anxiety from worsening. Above all, it is vital to ensure comprehensive support for older persons living alone to alleviate their anxiety.

Anxiety and depression in Multiple Sclerosis (MS): Antecedents, consequences, and differential impact on well-being and quality of life

BACKGROUND

Individuals with multiple sclerosis (MS) are often plagued by the unpredictability of their disease and have to contend with uncertainty in their life and significant life changes. This can lead to high levels of stress, perceived lack of control, helplessness, and anxiety. Despite these circumstances, anxiety disorders are often overshadowed by depression, which can result in its presence being overlooked and undertreated by many medical professionals.

METHODS

One hundred and eighty three individuals with MS completed a comprehensive online survey assessing depression and anxiety and the demographic and disease risk factors of such, including social support and substance use. Participants also completed measures of MS symptomatology, disease management, psychological well-being, and quality of life to determine the impact of depression and anxiety on outcomes associated with MS.

RESULTS

Findings suggest that both depression and anxiety are prevalent in MS and related to many outcomes. However, based on comparisons of the associations and group comparisons, with a few exceptions, anxiety proved to more impactful than depression when examining these outcomes. When evaluating the risk factors/contributors of anxiety and depression, social support was a consistent predictor. Younger age and shorter disease duration were also associated with anxiety, while lower education and substance use were predictors of depression.

CONCLUSION

Findings suggest that attention to anxiety be given as much as depression as it plays a large role in individuals' perceived health and well-being, which subsequently impacts the severity of symptoms and overall quality of life. Early identification of anxiety and potential substance use and increased social support also appear to be crucial for mitigating the impact of depression and anxiety.

Effects of Probiotics on Depressive or Anxiety Variables in Healthy Participants Under Stress Conditions or With a Depressive or Anxiety Diagnosis: A Meta-Analysis of Randomized Controlled Trials

Background: Probiotics have been associated with the treatment of depression and anxiety. However, the results reported in the literature have been inconsistent, and no meta-analysis specifically reported probiotics used on participants with varying levels of emotional state. Methods: This meta-analysis aimed to study the effectiveness of probiotics on anxious or depressive symptomatology for participants under stress conditions or with a depressive or anxiety disorder diagnosis. Medline, PubMed, EMBASE, and the Cochrane Library were searched through December 2019 for randomized controlled trials (RCTs). The primary outcomes were depression and anxiety scores. Main inclusion criteria: RCTs of probiotics for participants with a mood or emotional disorder diagnosis or under stress situations; and all participants were adults (age ≥16 years); Assessed by the modified Jadad assessment scale found seven high-quality studies and three low-quality studies. Results: Ten clinical trials (n = 685 total participants) were included based on the inclusion and exclusion criteria. All studies were assessed as low or moderate risk of bias. The meta-analysis showed that probiotics could significantly reduce the depression scale for patients with anxiety and depression, and healthy participants under stress. However, there was no significant difference between the probiotics and placebo groups in the reduction of patient anxiety scores, even if they are depressive or anxious patients or healthy participants under stress. Subgroup analysis revealed that probiotics had significant effect on depressive symptoms just in patients with depression, and no significant change in anxiety in patients, and no improvement in participant performance under stress. Conclusions: Probiotics could alleviate depressive symptoms in patients with a depression diagnosis or depression scores also in anxiety disorder diagnosis, and suggesting that probiotics may be adjunct therapies for mood or emotional disorders. Therefore, it is essential that probiotics could be more involved in the treatment of patients with depression in the future. The evidence of probiotics successfully treating depression is still insufficient, and more high-quality studies on patients with depression are still needed.

Gender-specific prevalence and associated factors of major depressive disorder and generalized anxiety disorder in a Chinese rural population: the Henan rural cohort study

Background

This study aims to investigate the prevalence and associated factors of major depressive disorder (MDD) and generalized anxiety disorder (GAD) by gender in Chinese rural adults.

Methods

A total of 29,993 participants aged from 18 to 79 years from the Henan Rural Cohort Study were included in this study. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were used to assess MDD and GAD through a face-to-face interview. Multivariate logistic regression model was conducted to analyze the associated factors for MDD and GAD.

Results

The age-standardized prevalence of MDD and GAD (and 95%CI) in the total sample were 5.41% (5.17–5.66%) and 4.94% (4.71–5.18%), respectively. Besides, the crude prevalence in women were significantly higher than men for both MDD (6.81% vs. 4.77%) and GAD (6.63% vs. 3.93%) (both P < 0.001). Tetrachoric correlation test showed high comorbidity between MDD and GAD (r = 0.88, P = 0.01). Further analysis revealed that age, sex, marital status, educational level, per capita monthly income, drinking, physical activity, and body mass index were associated with MDD and GAD in the overall sample. Gender difference was found among age groups for MDD (P_interaction < 0.001).

Conclusions

These findings showed that Chinese rural adults were at low risk for prevalence of MDD and GAD. Women had higher prevalence and risks for MDD and GAD compared with men, indicating that women deserved more attention. Gender-specific interventions on the modifiable associated factors are urgently needed to improve the mental conditions for Chinese rural population.

Clinical trial registration

The Henan Rural Cohort Study has been registered in the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06.

Hippocampal proteomic changes of susceptibility and resilience to depression or anxiety in a rat model of chronic mild stress

Chronic stressful occurrences are documented as a vital cause of both depression and anxiety disorders. However, the stress-induced molecular mechanisms underlying the common and distinct pathophysiology of these disorders remains largely unclear. We utilized a chronic mild stress (CMS) rat model to differentiate and subgroup depression-susceptible, anxiety-susceptible, and insusceptible rats. The hippocampus was analyzed for differential proteomes by combining mass spectrometry and the isobaric tags for relative and absolute quantitation (iTRAQ) labeling technique. Out of 2593 quantified proteins, 367 were aberrantly expressed. These hippocampal protein candidates might be associated with susceptibility to stress-induced depression or anxiety and stress resilience. They provide the potential protein systems involved in various metabolic pathways as novel investigative protein targets. Further, independent immunoblot analysis identified changes in Por, Idh2 and Esd; Glo1, G6pdx, Aldh2, and Dld; Dlat, Ogdhl, Anxal, Tpp2, and Sdha that were specifically associated to depression-susceptible, anxiety-susceptible, or insusceptible groups respectively, suggesting that identical CMS differently impacted the mitochondrial and metabolic processes in the hippocampus. Collectively, the observed alterations to protein abundance profiles of the hippocampus provided significant and novel insights into the stress regulation mechanism in a CMS rat model. This might serve as the molecular basis for further studies that would contributed to a better understanding of the similarities and differences in pathophysiologic mechanisms underlying stress-induced depression or anxiety, and stress resiliency.

Reducing risk factors for cognitive decline through psychological interventions: a pilot randomized controlled trial

OBJECTIVES

Modifiable factors associated with increased risk of cognitive decline include emotional (anxiety, depression), cognitive (low social and mental stimulation), and health factors (smoking, alcohol use, sedentary lifestyle, obesity). Older adults with anxiety and depression may be at heightened risk due to direct and indirect impacts of emotional distress on cognitive decline.

DESIGN

Randomized controlled trial.

SETTING

Community sample attending a university clinic. Participants: 27 participants (female = 20) aged over 65 years (M = 72.56, SD = 6.74) with an anxiety and/or mood disorder. Interventions: two cognitive behavioral therapy (CBT) interventions (face-to-face or low intensity) that targeted emotional, health, and cognitive risks for cognitive decline.

MEASUREMENTS

Participants completed diagnostic interviews; self-report measures of anxiety, depression, quality of life, and lifestyle factors at baseline; post-treatment; and 3-month follow-up.

RESULTS

Both interventions resulted in significant and sustained improvements in depression, anxiety, quality of life, and physical and social activity. At post-treatment, face-to-face CBT demonstrated significantly greater improvements in emotional symptoms, alcohol use, and memory (exercise approached significance). At 3-month follow-up, gains were maintained and there were significantly greater increases in mental activity for face-to-face CBT, with social activity approaching significance. Conclusions: This study demonstrates the feasibility of CBT interventions to reduce emotional as well as lifestyle risk factors associated with cognitive decline in at-risk older participants. Large studies are needed to evaluate the long-term impact on cognitive decline. The trial was registered with the Australian and New Zealand Clinical Trials Registry (Trial Registration No. ACTRN12618000939291).