Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019

Microbiome modulation as a novel therapeutic modality for anxiety disorders: A review of clinical trials

Anxiety disorders are one of the major conditions in psychiatry characterized by symptoms such as worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors. Recent developments have drawn attention to the putative involvement of peripheral systems in the control of anxiety, and the gut microbiota has come to light as an emerging peripheral target for anxiety. The relationship between the gut-brain axis, a bidirectional communication network between the central nervous system (CNS) and enteric nervous system (ENS), and anxiety has been the subject of some recent studies. Therefore, this systematic review analyzed clinical trials evaluating the potential of microbiome modulation methods in mitigating and ameliorating anxiety disorders. Clinical studies on probiotic, prebiotic, synbiotic supplements, dietary interventions, and fecal microbiota transplantation in anxiety disorders were screened. All of the studies examined the effects of probiotic intervention. One of these studies compared a prebiotic-rich diet with probiotic supplementation. Longitudinal analyses showed that the probiotic intervention alleviated anxiety. However, most of the controlled studies reported that the probiotic intervention did not make a difference compared to placebo. Thus, the current findings suggest that it is too early to consider the promising role of microbiome modulation in the treatment of anxiety disorders. However, it is obvious that more clinical research is needed to clarify issues such as probiotic strains, prebiotic types, and their doses that may be effective on anxiety disorders.

Medication use is associated with distinct microbial features in anxiety and depression

This study investigated the relationship between gut microbiota and neuropsychiatric disorders (NPDs), specifically anxiety disorder (ANXD) and/or major depressive disorder (MDD), as defined by Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV or V criteria. The study also examined the influence of medication use, particularly antidepressants and/or anxiolytics, classified through the Anatomical Therapeutic Chemical (ATC) Classification System, on the gut microbiota. Both 16S rRNA gene amplicon sequencing (16S) and shallow shotgun sequencing (WGS) were performed on DNA extracted from 666 fecal samples from the Tulsa-1000 and Neurocomputational Mechanisms of Affiliation and Personality Study Center for Biomedical Research Excellence (NeuroMAP CoBRE) cohorts. The results highlight the significant influence of medication use; antidepressant use is associated with significant differences in gut microbiota beta diversity and has a larger effect size than NPD diagnosis. Next, specific microbes were associated with ANXD and MDD, highlighting their potential for non-pharmacological intervention. Finally, the study demonstrated the capability of Random Forest classifiers to predict diagnoses of NPD and medication use from microbial profiles, suggesting a promising direction for the use of gut microbiota as biomarkers for NPD. Though the effect sizes were larger in females than males, similar trends emerged for both sexes. These findings encourage future research on the gut microbiota's role in NPD and its interactions with pharmacological treatments.

Evaluating the efficacy and acceptability of non-invasive brain stimulation for generalized anxiety disorder: a systematic review and network meta-analysis

Non-invasive brain stimulation (NIBS) has the potential to treat generalized anxiety disorder (GAD). To assess the efficacy (response/remission/post-treatment continuous anxiety severity scores) and acceptability (failure to complete treatment for any reason) of NIBS, we searched PubMed, Web of Science, and the Cochrane Library (as of April 2024) for articles on NIBS for GAD and conducted a network meta-analysis of eight randomized trials (20 treatment arms, 405 participants). Data were pooled using standardized mean difference (SMD) and odds ratio (OR) with 95 % confidence interval (CI). Repetitive transcranial magnetic stimulation (rTMS) was the most widely studied treatment for GAD. The right dorsolateral prefrontal cortex (DLPFC) was the most common treatment target for GAD. High-frequency rTMS showed higher response rates (OR 291.40, 95 % CI 13.08 to 6490.21) and remission rates (OR 182.14, 95 % CI 8.72 to 3805.76) compared with other active therapies. Continuous theta burst stimulation (cTBS) greatly improved continuous post-treatment anxiety severity scores (SMD -2.56, 95 % CI -3.16 to -1.96). No significant differences in acceptability were found between the treatment strategies and the sham stimulation group. These findings provide evidence to consider NIBS techniques as alternative or adjunctive treatments for GAD.

Can an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? Results from a randomized controlled prevention trial

BACKGROUND AND OBJECTIVES

Rates of mental health disorders are rising among adolescents and young adults. Therefore, scalable methods for preventing psychopathology in these age groups are needed. As repetitive negative thinking (RNT) is a risk factor for depression and anxiety disorders, targeting RNT via smartphone app promises to be an effective, scalable strategy. The current three-arm, parallel group, randomized controlled trial tested whether a self-help app designed to reduce RNT decreased psychopathological symptoms and RNT in adolescents and young adults at risk for mental disorders.

METHOD

A sample of 16-22-year-olds with elevated levels of RNT (N = 365) were randomly allocated to either use a one of two self-help apps designed to reduce RNT for 6 weeks or to a waitlist. The full RNT-focused intervention app encompassed a variety of RNT-reducing strategies, whereas the concreteness training app focused on one of these strategies, namely, concrete thinking.

RESULTS

The apps did not decrease depressive symptoms, anxiety symptoms and RNT relative to the waitlist. However, exploratory analyses using a minimum dose criterion showed that participants who used the full-RNT-focused intervention app more often, reported greater baseline to follow-up decreases in depressive symptoms compared to waitlist.

LIMITATIONS

Include decreased power due to slightly more dropout than expected and limited generalizability due to the mostly female and highly educated sample.

CONCLUSIONS

RNT-focused prevention via a self-help app did not decrease depression and anxiety, presumably due to too little engagement with the app content provided.

Global burden of mental disorders in 204 countries and territories, 1990-2021: results from the global burden of disease study 2021

BACKGROUND

Mental disorders, one of the leading causes of the global health-related burden, which has been exacerbated by the emergence of the COVID-19 pandemic (2019-2021). In this study, we aim to provide global, regional, and national estimates of the mental disorders burden from 1990 to 2021, including during the COVID-19.

METHODS

We collected data from the Global Burden of Disease Study 2021 (GBD 2021) on the incidence, disability-adjusted life years (DALYs), age-standardized incidence rate (ASIR), and age-standardized DALY rate (ASR) of 12 mental disorders from 204 countries and regions. The socio-demographic index (SDI) was used to evaluate the correlation between mental disorders burden and different regions. We utilized joinpoint regression analysis to estimate the average annual percentage change (AAPC).

RESULTS

In 2021, there were 444,397,716 incident cases and 155,418,119 DALYs globally from mental disorders. From 1990 to 2021, there was an upward trend in both ASIR [15.23% (12.97-17.60%)] and ASR [17.28% (15.06-19.44%)]. In 2021, the highest ASIR was observed in Central Sub-Saharan Africa (8706.11), while the lowest was in East Asia (3340.99). Australia (2787.87) had the highest ASR. Nationally, Greenland, Greece, the United States, and Australia had the highest ASRs. During the COVID-19 pandemic, aside from East Asia, both the ASIR showed an upward trend in the five SDI and other GBD regions. In 2021, the ASR for females was higher than that for males. Among the 12 subtypes, major depressive disorder (557.87) and anxiety disorders (524.33) had the highest ASR. Major depressive disorder ranked first in ASR in 13 of the 21 regions worldwide. Despite the overall upward trend in DALYs for mental disorders [AAPC: 5.96; 95%CI: (4.99, 6.92)], the ASR exhibited varying trends among different subtypes, with anxiety disorders experiencing the most significant increase.

CONCLUSIONS

GBD 2021 showed that the burden of mental disorders has increased over the past three decades, with notable regional disparities. High SDI regions and females should be paid more attention. To alleviate future burdens, providing comprehensive mental health support, establishing effective mental health knowledge dissemination and tailored interventions are in great need.

CLINICAL TRIAL NUMBER

Not applicable.

Association between healthy eating Index-2020 and anxiety: Insights from NHANES highlighting fruit and vegetable intake

BACKGROUND

Anxiety is a prevalent mental health issue globally, and diet has been increasingly recognized as a potential influencing factor. This study investigates the association between the Healthy Eating Index-2020 (HEI-2020) and anxiety in a nationally representative U.S.

POPULATION

METHODS

Cross-sectional data from 10,870 adults in the National Health and Nutrition Examination Survey (NHANES) (2007-2012) were analyzed. Weighted multivariable logistic regression, restricted cubic splines (RCS), subgroup analyses, and K-means clustering were employed. Sensitivity analyses included propensity score matching and linear regression.

RESULTS

Higher HEI-2020 scores were inversely associated with anxiety risk after adjusting for all variables (OR for highest vs. lowest quartile: 0.75, 95 % CI: 0.61-0.94). RCS revealed a nonlinear relationship in the fully adjusted model (P-nonlinear = 0.0398). Subgroup analyses identified stronger associations in females and adults aged 40-65. Cluster analysis demonstrated reduced anxiety risk with higher fruit and vegetable intake (P for trend<0.05), independent of overall diet quality. Components including total fruits, whole fruits, vegetables, and reduced added sugars showed consistent inverse associations (P-FDR < 0.05).

CONCLUSIONS

High-quality diets with higher HEI-2020 scores, particularly those rich in fruits and vegetables and low in added sugars, may be associated with reduced anxiety risk, with heightened benefits for middle-aged females. These findings highlight the potential association between diet and anxiety.

A Comparison of Symptom Structure between Panic Disorder with and without Comorbid Agoraphobia Using Network Analysis

PURPOSE

Panic disorder (PD) and PD with comorbid agoraphobia (PDA) share similar clinical characteristics but possess distinct symptom structures. However, studies specifically investigating the differences between PD and PDA are rare. Thus, the present study conducted a network analysis to examine the clinical networks of PD and PDA, focusing on panic symptom severity, anxiety sensitivity, anticipatory fear, and avoidance responses. By comparing the differences in network structures between PD and PDA, with the goal of identifying the central and bridge, we suggest clinical implications for the development of targeted interventions.

MATERIALS AND METHODS

A total sample (n=147; 55 male, 92 female) was collected from the psychiatric outpatient clinic of the university hospital. We conducted network analysis to examine crucial nodes in the PD and PDA networks and compared the two networks to investigate disparities and similarities in symptom structure.

RESULTS

The most influential node within the PD network was Anxiety Sensitivity Index-Revised (ASI-R1; fear of respiratory symptom), whereas Panic Disorder Severity Scale (PDSS5; phobic avoidance of physical sensations) had the highest influence in the PDA network. Additionally, bridge centrality estimates indicated that each of the two nodes met the criteria for "bridge nodes" within their respective networks: ASI-R1 (fear of respiratory symptom) and Albany Panic and Phobic Questionnaire (APPQ3; interoceptive fear) for the PD group, and PDSS5 (phobic avoidance of physical sensation) and APPQ1 (panic frequency) for the PDA group.

CONCLUSION

Although the network comparison test did not reveal statistical differences between the two networks, disparities in community structure, as well as central and bridging symptoms, were observed, suggesting the possibility of distinct etiologies and treatment targets for each group. The clinical implications derived from the similarities and differences between PD and PDA networks are discussed.

Prevalence of anxiety disorders in Latin America: a systematic review and meta-analysis

Background

The prevalence of anxiety disorders among the adult population in Latin America (LATAM) and its association with development indicators is insufficiently characterised. We estimated pooled regional, country, and sex-specific prevalence rates of anxiety disorders in LATAM based on International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. Additionally, we examined the association between its prevalence and four country-level development indicators: Human Development Index (HDI), income inequality (Gini coefficient), Gender Inequality Index (GII), and Intentional Homicide Rate (IHR).

Methods

We conducted a systematic review and meta-analysis of population-based studies on the prevalence of ICD/DSM anxiety disorders in LATAM from 1990 to 2024, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO, LILACS, and grey literature. Study quality was assessed using JBI's critical appraisal tools. Pooled estimates were generated using random-effects meta-analysis, and heterogeneity was evaluated using the I-squared (I 2) statistic. Meta-regression analyses were performed to examine the ecological association between anxiety disorders prevalence and four development indicators. The study was registered with PROSPERO (CRD42020190238).

Findings

Using data from 36 studies in LATAM, we calculated the lifetime, 12-month, and current prevalence of ICD/DSM anxiety disorders at 14.55% (95% Confidence Interval 12.32%-17.11%; I 2 = 97.9%); 6.61% (5.20-8.37; I 2 = 98.1%), and 3.27% (2.34-4.56; I 2 = 97.5%), respectively. Heterogeneity was high across prevalence periods, sexes, and countries (all I 2 ≥ 91.4%), warranting caution in interpreting pooled estimates. Elevated 12-month and current prevalence rates of anxiety disorders were associated with higher Gini coefficients (p ≤ 0.0013). Additionally, higher current prevalence was associated with lower HDI (p = 0.0103) and higher GII (p = 0.0023), while elevated 12-month prevalence was associated with higher IHR (p = 0.011).

Interpretation

This study shows that approximately one in seven people in LATAM experience anxiety disorders at some point in their lives. These findings highlight the need to strengthen mental health systems in the region, and evidence the association between prevalence of anxiety disorders and development indicators. Our results can serve as a baseline for tracking anxiety disorders and for informed decision-making at the national and regional levels. The substantial heterogeneity between studies and the underrepresentation of some countries underscore the imperative for enhancing regional mental health capacities.

Funding

Pfizer Independent Medical Education Grant (69879319).

Proteomic signatures and predictive modeling of cadmium-associated anxiety in middle-aged and elderly populations: an environmental exposure association study

BACKGROUND

Emerging evidence implicates environmental contaminants such as cadmium (Cd) as modifiable risk factors for anxiety. Despite growing recognition of heavy metal toxicity in neuropsychiatric disorders, the molecular mechanisms linking environmental exposure to anxiety pathogenesis remain poorly understood.

METHODS

Based on the established cohort of individuals with cognitive impairment in cadmium-contaminated areas, this cross-sectional association study enrolled 50 middle-aged and elderly hospitalized patients from these regions, adhering to the STROBE guidelines. Blood concentrations of cadmium (Cd), lead (Pb), and mercury (Hg) were analyzed in relation to anxiety severity assessed via the Hamilton Anxiety Rating Scale (HAMA). Plasma proteomic profiling was performed using data-independent acquisition (DIA) quantitative technology with an LC-MS/MS platform (timsTOF Pro, Bruker Daltonics), systematically characterizing 2,531 proteins across all samples. Machine learning techniques, specifically XGBoost and LASSO, were employed to identify biomarkers that were subsequently validated through mediation analysis and animal experiments, allowing for the screening of key protein signatures. Finally, clinical variables were integrated to construct a comprehensive model, which was then thoroughly evaluated.

RESULTS

Anxious individuals exhibited significantly higher blood Cd levels than controls (β = 0.50, 95% CI: 0.07-0.93, p < 0.01), with anxiety positively correlating with depression (r = 0.62, p = 0.003) and inversely with ApoE3 genotype prevalence. Proteomics identified 120 differentially expressed proteins in anxious patients, enriched in oxidative phosphorylation and neurodegenerative pathways. CCDC126 emerged as a cadmium-associated biomarker, validated in rat models exposed to Cd. Combining CCDC126, blood Cd, Pb, and hypertension, a clinical prediction model achieved robust discrimination (AUC = 0.80, validation cohort).

CONCLUSIONS

This first integrative environmental-proteomic study highlights cadmium's synergistic role in anxiety pathophysiology and psychiatric comorbidity. The predictive model offers translatable potential for early risk stratification, while CCDC126 provides mechanistic insights for targeted interventions in populations exposed to environmental pollutants.

Does a growth mindset curb anxiety among Chinese medical students? Validation based on propensity score matching

BACKGROUND

Excessive anxiety is a common and hazardous mental disorder, especially in medical education. Positive psychology has proposed an effective path to reduce anxiety among medical students through mindset change. This study tests whether a growth mindset curbs anxiety in Chinese medical students.

METHODS

The online cross-sectional survey was conducted among medical students enrolled in medical schools in Northeast China, yielding 3,114 valid responses (valid response rate = 89.2%). Data were statistically analyzed using STATA 17.0. The questionnaire covered sociodemographic statistics, the Growth Mindset Scale, and the Generalized Anxiety Disorder scale. Propensity score matching was utilized to investigate the causal relationship between a growth mindset and anxiety, thereby controlling for potential confounding variables.

RESULTS

The detection rate of anxiety symptoms was 41.1%, and anxiety status significantly differed by scholarship, grades, parenting style, and academic stress. Propensity score matching showed a mean treatment effect of -0.096 in the one-to-one matching sample, and - 0.112 and - 0.126 for K-nearest-neighbor matching and kernel matching, respectively. All were significant at the 1% level.

CONCLUSION

Medical students have a high prevalence of anxiety symptoms influenced by scholarship, grades, parenting style, and academic pressure. Furthermore, their growth mindset may help alleviate their anxiety, and it continues to develop as educators emphasize their health status. Fostering a growth mindset among Chinese medical students may promote their mental health, alleviate anxiety, and improve overall well-being. Parents should support their children to overcome anxiety and encourage them to try new things, and Chinese medical students are encouraged to continually adjust their mindset to cope with challenges positively. Educators should foster the cultivation of growth mindset in medical students through multidimensional interventions involving cognitive scaffolding, behavioral reinforcement, and environmental structuring, which consequently enhances their psychological well-being.

CLINICAL TRIAL NUMBER

Not applicable.

Association between dietary flavonoid intake and anxiety: data from NHANES 2017-2018

BACKGROUND

Anxiety disorders are among the most prevalent mental health conditions, characterized by excessive fear, tension, avoidance behaviors, and heightened threat perception. Approximately 1 in 14 individuals meets the diagnostic criteria for an anxiety disorder. Flavonoids, bioactive compounds found in fruits, vegetables, and tea, possess antioxidant, anti-inflammatory, and neuroprotective properties. However, evidence on the relationship between flavonoid intake and anxiety risk remains limited. This study examines the association between flavonoid intake and anxiety risk and explores the effects of specific flavonoid subclasses.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES). Individual flavonoid intake was assessed using two-day 24-hour dietary recalls, and anxiety status was evaluated through a standardized anxiety questionnaire. To assess the relationship between flavonoid intake and anxiety risk, weighted logistic regression analysis was performed. Additionally, restricted cubic spline (RCS) analysis was employed to evaluate potential nonlinear associations. We conducted subgroup analyses for flavonoids that showed significant associations in the logistic regression, including theaflavin-3-gallate, total flavones, total flavanones, total isoflavones, and naringenin. These analyses aimed to explore the moderating effects of demographic characteristics such as sex, age, marital status, smoking status, and body mass index (BMI).

RESULTS

We analyzed data from 1,637 participants in the NHANES. Significant differences were observed between the anxious and non-anxious groups in age, poverty-income ratio (PIR), BMI, smoking status, marital status, education level, and flavonoid intake. The anxious group had higher age (47.12 vs. 42.81 years, P < 0.0001), PIR (P < 0.0001), and BMI (P = 0.01). They also had a higher proportion of females, unmarried individuals, and current smokers (P < 0.0001). Logistic regression analysis showed that genistein, petunidin, naringenin, apigenin, and total flavones were significantly associated with reduced anxiety risk (P < 0.05). Subgroup analysis confirmed protective effects in males, married individuals, participants with General Educational Development (GED)-level education, and specific ethnic groups. RCS analysis suggested nonlinear relationships, with total flavones, total flavanones, and naringenin showing protective effects at low intake levels (P < 0.05). All models demonstrated good fit (P < 0.001).

CONCLUSION

Flavonoid intake is inversely associated with anxiety risk, particularly Theaflavin-3-gallate, Total Flavones, Total Flavanones, Total Isoflavones, and Naringenin. Further studies are needed to confirm optimal intake levels and underlying mechanisms.

A higher burden of post-stroke depression and anxiety and their predictors among stroke survivors in the Amhara Regional State, Ethiopia, in 2024: a prospective multicenter study

Background

A substantial proportion of stroke survivors suffer from post-stroke depression and anxiety. These mental disorders are linked to several modifiable risk factors and lead to severe functional impairment or premature death. There is a lack of evaluation, prevention, and treatment of these prevalent mental illnesses. This study aimed to investigate the overall burden of post-stroke depression and anxiety and their predictors in the Amhara Regional State, Ethiopia, in 2024.

Methods

From 01 February to 01 April 2024, a multicenter cross-sectional study was conducted on 404 stroke survivors from five comprehensive specialized hospitals in the Amhara Regional State, Ethiopia. Five trained physiotherapists conducted interviews, reviewed medical records, and took physical measurements using a pretested, semi-structured questionnaire to obtain high-quality data for analysis. Descriptive statistics were taken into consideration to provide a broad overview of the data and distribution of conditions. Additionally, binary logistic regression was used to find predictors with a p-value of less than 0.2 that could be subjected to multivariate logistic regression analysis, which was used to find the significant associated factors. A p-value of less than 0.05 with a 95% confidence interval (CI) was deemed significant.

Results

The prevalence of post-stroke depression and anxiety among stroke survivors in the Amhara Regional State was 64.1% (95% CI: 59.3-68.6%) and 45.5% (95% CI: 40.7-50.4), respectively. Variables including male sex [adjusted odds ratio (AOR)=1.97, 95% CI: 1.06-3.67], stroke complication presence (AOR=2.83, 95% CI: 1.64-4.88), and comorbidity presence (AOR=6.23, 95% CI: 3.91-9.19) were significantly associated with post-stroke depression. Retirement (AOR=1.64, 95% CI: 1.91-4.72), less time for hospitalization (AOR=2.05, 95% CI: 1.09-3.84), and comorbidity presence (AOR=2.09, 95% CI: 1.32-3.29) were the significantly associated factors of post-stroke anxiety.

Conclusions

Relatively higher burdens of post-stroke depression and anxiety were observed among stroke survivors in the Amhara Regional State, Ethiopia. Variables such as sex, stroke complication, and comorbidity, and retirement, time for hospitalization, and comorbidity were predictors significantly associated with post-stroke depression and anxiety, respectively. Early mental health screening and diagnosis of old age, complicated case patients, and retired stroke survivors are required for early-stage interventions.

Social stress increases anxiety by GluA1-dependent synaptic strengthening of ventral tegmental area inputs to the basolateral amygdala

BACKGROUND

Brain defensive mechanisms evolved to maintain low levels of state anxiety. However, risk factors such as stress exposure shifts activity within defensive circuits, resulting in increased anxiety. The amygdala is a crucial node for maintaining adaptive anxiety levels, and amygdala hyperactivity can lead to pathological anxiety through mechanisms that are not well understood.

METHODS

We used chronic social defeat stress (CSD) in mice. We combined anatomical tracing methods, patch-clamp recordings and optogenetics to probe how synaptic inputs from the ventral tegmental area (VTA) to the basolateral amygdala (BLA) are affected by CSD. We performed in vivo fiber photometry recordings to track inputs onto basolateral amygdala. Array tomography and electron microscopy were used to unravel the structural composition of VTA-BLA synapses.

RESULTS

We identified the VTA as a source of glutamatergic inputs to the BLA potentiated by stress. In turn, inputs from mPFC were not potentiated. BLA-projecting VTA glutamatergic neurons are activated by social stress, increasing their excitability and synaptic strength. In vivo potentiation of VTA glutamatergic inputs in the BLA is sufficient to increase anxiety. We showed that stress-induced synaptic strengthening is mediated by insertion of GluA1-containing AMPA receptors. Impeding GluA1 subunit trafficking in BLA neurons with VTA upstream inputs prevents stress-induced increase in synaptic firing and anxiety.

CONCLUSIONS

Potentiation of VTA inputs increases synaptic integration, enhancing amygdala activity and promoting maladaptive anxiety. Understanding the impact of amygdala hyperactivity could lead to targeted therapies, restoring circuit balance and offering new precision medicine approaches for anxiety disorders.

The prospective association of adolescent loneliness and low resilience with anxiety and depression in young adulthood: The HUNT study

BACKGROUND

Loneliness is a recognized risk factor for anxiety and depression, yet research on its interaction with low resilience remains sparse, particularly across the adolescent-to-adult transition. This study investigates how adolescent loneliness, both independently and in interaction with low resilience, influences anxiety and depression in young adulthood.

METHODS

This study utilized longitudinal data from The Trøndelag Health Study (HUNT) to track adolescents (13-19 years) from Young-HUNT3 (2006-08) through to HUNT4 (2017-19). Loneliness was assessed via a single-item measure, while resilience was estimated using the Resilience Scale for Adolescents. Anxiety and depression outcomes at the 11-year follow-up were measured using the Hospital Anxiety and Depression Scale. Multivariable logistic regression analyses were done to analyze the associations. Moreover, interaction effects were evaluated using relative excess risk due to interaction (RERI).

RESULTS

Loneliness during adolescence independently predicted anxiety and depression in young adulthood. Adolescents experiencing both loneliness and low resilience showed notably higher risks compared to other groups (highly resilient adolescents without loneliness [reference], highly resilient adolescents with loneliness, and adolescents with low resilience and low loneliness). The combined effect of loneliness and low resilience exhibited a synergistic interaction on the additive scale, although it was not statistically significant (RERI 0.13, 95% CI -2.39-2.65).

CONCLUSION

Adolescent loneliness and low resilience independently predict anxiety and depression in young adulthood. The interaction between loneliness and low resilience further heightens these risks. This underscores the importance of early interventions that focus on resilience-building during adolescence and reducing the impacts of loneliness on mental health.

A review of kappa opioid receptor antagonists and their clinical trial landscape

Myriad signaling pathways are implicated in neuropsychiatric disorders, yet many mechanisms are unknown and current treatment options are limited. The intriguing dynorphin/kappa opioid receptor (KOR) system that is widely distributed throughout the brain appears to be essential in regulating many physiological and pathophysiological processes. This review explores up to date advances on the relationship between the dynorphin/KOR system with a particular focus on the KOR antagonist compounds tested as clinical candidates that could offer potential treatment options for CNS disorders.

Meta-analysis of prospective longitudinal cohort studies on the impact of childhood traumas on anxiety disorders

OBJECTS

Childhood trauma is an early pathogenic factor that increases individuals' vulnerability to mental illness. This systematic review aims to explore the evidence regarding the association between childhood trauma and the subsequent occurrence of anxiety disorders.

METHODS

Embase, Scopus, and PubMed databases were searched for peer-reviewed longitudinal cohort studies published in English between January 1, 1995, and November 15, 2022. These studies investigated the association between childhood traumas and later diagnose of anxiety disorders. Including studies in one previous meta-analysis and two umbrella reviews, a total of 27 manuscripts were retained in this meta-analysis.

RESULTS

The evidence strongly revealed that childhood trauma exposure has detrimental effects on anxiety disorders, consistent from youth to adulthood. Moreover, these effects remained consistent across various types of anxiety disorders, including generalized anxiety disorder and social anxiety disorder, agoraphobia, specific phobia, panic attack and panic disorder. Importantly, exposure to childhood trauma, including maternal dysfunction, paternal dysfunction, physical abuse, sexual abuse, emotional abuse and bullying, was associated with later development of anxiety disorders, with bullying and maternal dysfunction ranking highest.

CONCLUSIONS

This meta-analysis underscores that childhood trauma exposure significantly increases the risk of anxiety disorders across different age groups and types of anxiety disorders. Various forms of childhood trauma, including maternal dysfunction, paternal dysfunction, physical abuse, sexual abuse, emotional abuse and bullying, are consistently associated with later development of anxiety disorders, highlighting the importance of early intervention and support in preventing anxiety disorders.

Association between fluoride exposure and psychiatric disorders in adults

To explore the association between fluoride exposure and depression / anxiety in adults, the 1,169 participants were recruited. The demographic information of participants was obtained through questionnaire survey and physical measurements. Morning urine samples were collected, and urinary fluoride (UF) level was determined. Changes in depression and anxiety levels were evaluated using the Patient Health Questionnaire-2 and General Anxiety Disorder-2 scales. The association between psychiatric disorders and UF levels was analyzed. In the total population, the prevalence of depression and anxiety were 3.17% and 4.19%, respectively. These results showed no significant association between depression / anxiety scale scores and UF levels. Logistic regression suggested no significant association between depression / anxiety levels, and UF levels, but there was an interaction between UF and income on depression. Our findings highlighted the interaction between fluoride exposure and monthly income, which may affect depression in adults.

Anxiety and depression among a community-recruited cohort of people who use methamphetamine: A longitudinal analysis

AIMS

This study (1) estimated changes in anxiety and depression throughout 3 years in a community-recruited cohort who use methamphetamine and (2) modelled whether these changes were associated with patterns of methamphetamine use or other time-varying or fixed covariates.

DESIGN, SETTING AND PARTICIPANTS

We used a longitudinal analysis using data derived from surveys conducted between August 2016 and March 2020, set in metropolitan and rural locations in Victoria, Australia. Participants comprised a total of 849 adults with regular methamphetamine use history at baseline, recruited for the prospective VMAX study via snowball and respondent-driven sampling.

MEASUREMENTS

Anxiety and depression symptoms were measured using the Generalized Anxiety Disorder (GAD)-7 and the Patient Health Questionnaire (PHQ)-9 instruments. Frequency of methamphetamine use was measured by self-reported number of days per week participants used any form of methamphetamine in the past month.

FINDINGS

Changes in anxiety and depression symptom scores were associated with change in route of administration from non-injecting to injecting [adjusted coefficient (adj. coeff.) = 1.44, 95% confidence intervals (CI) = 0.39, 2.48, adj. coeff. = 1.49, 95% CI = 0.39, 2.58], change in severity of dependence for methamphetamine (adj. coeff. = 0.29, 95% CI = 0.21, 0.37, adj. coeff. = 0.34, 95% CI = 0.26, 0.42), starting treatment for drugs other than methamphetamine (adj. coeff. = -2.21, 95% CI = -3.70, -0.73, adj. coeff. = -2.09, 95% CI = -3.60, -0.58) and other covariates.

CONCLUSIONS

Among regular methamphetamine users in Australia, changes in anxiety or depression scores are associated with changes in route of administration, dependence severity and starting treatment for other drugs, but do not appear to be associated with frequency of methamphetamine use.

Association between the Hospital Anxiety and Depression Scale and Swallowing Function in Dysphagic Patients in Japan

OBJECTIVE

Dysphagia affects 2.3 %-16 % of the general population and increases with age. It can lead to malnutrition, weight loss, aspiration pneumonia, and emotional symptoms such as anxiety and depression. Mental health disorders impact appetite and muscle mass, further worsening dysphagia. Additionally, cultural and economic factors influence anxiety and depression, which can either result from or contribute to dysphagia. Studies on the relationship between anxiety, depression, and swallowing function using FEES are limited in Asian populations. The Hospital Anxiety and Depression Scale (HADS) is a useful tool for assessing mood disorders. Therefore, in this study, we aimed to investigate the associations among anxiety, depression, and swallowing function in Japanese patients with dysphagia using HADS.

METHODS

Data on age; sex; HADS; Eating Assessment Tool-10 (EAT-10); Functional Oral Intake Scale (FOIS); tongue pressure; Hyodo score, a scoring system for evaluating the swallowing function determined by flexible endoscopic evaluation of swallowing (FEES); and videofluoroscopic dysphagia scale (VDS), assessed by videofluoroscopic swallowing study, were collected and analyzed from medical records. Hyodo score consists of four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) glottal closure reflex or cough reflex induced by touching the epiglottis or arytenoid; (3) swallowing reflex induced by colored water; and (4) extent of pharyngeal clearance after colored water is swallowed. The Mann-Whitney U test, Fisher's exact test, and multiple logistic regression analyses were used to estimate associations between HADS and swallowing function.

RESULTS

No significant relationships were observed between the EAT-10, FOIS, and VDS with HADS scores. Patients with depression were associated with a significantly higher percentage of anorexia complaints (p = 0.047). Lower tongue pressure was observed in patients with depression than in patients without depression (p = 0.002). Patients with anxiety had better swallowing function, as assessed by the Hyodo score (p = 0.047). Fluid clearance, a component of the Hyodo score, was significantly better in patients with anxiety (p = 0.03) even after propensity score matching adjusted for the effects of age, sex, and fluid clearance.

CONCLUSION

In patients with anxiety, swallowing function assessed by FEES was favorable, whereas a higher proportion of patients with depression reported decreased appetite, and lower tongue pressure. This discrepancy between subjective dysphagia and FEES findings suggests that patients with anxiety may underestimate their swallowing function.

Astrocytes in Rodent Anxiety-Related Behavior: Role of Calcium and Beyond

Anxiety is a physiological, emotional response that anticipates distal threats. When kept under control, anxiety is a beneficial response, helping animals to maintain heightened attention in environments with potential dangers. However, an overestimation of potential threats can lead to an excessive expression of anxiety that, in humans, may evolve into anxiety disorders. Pharmacological treatments show variable efficacy among patients, highlighting the need for more efforts to better understand the pathogenesis of anxiety disorders. Mounting evidence suggests that astrocytes, a type of glial cells, are active partners of neurons in brain circuits and in the regulation of behaviors under both physiological and pathological conditions. In this review, I summarize the current literature on the role of astrocytes from different brain regions in modulating anxious states, with the goal of exploring novel cerebral mechanisms to identify potential innovative therapeutic targets for the treatment of anxiety disorders.

Trends in the epidemiology of anxiety disorders from 1990 to 2021: A global, regional, and national analysis with a focus on the sociodemographic index

BACKGROUND

Anxiety disorders are widespread across the world. Understanding the global burden of anxiety disorders in the past and future can provide important references for optimizing prevention and control strategies in healthcare systems.

METHODS

The estimation of anxiety disorders in the Global Burden of Disease Study 2021 using systematic review was conducted to describe incidence, prevalence and disability adjusted life years (DALYs) in 204 countries and regions from 1990 to 2021. Trends were examined using joinpoint regression analysis and correlation between Sociodemographic Index (SDI) and temporal trends was assessed.

RESULTS

In 2021, the global age-standardised prevalence rate (ASPR), age-standardised incidence rate (ASIR), and age-standardised DALYs rates for anxiety disorders were 4421.9 (95 % uncertainty intervals [UIs] 3768.3 to 5182.1), 678.3(565.2 to 832.4), and 524.3(363.1 to 716.3) per 100,000 population, which were 18 %, 20.6 %, and 18.2 % higher than in 1990, respectively. In 2021, Brazil (9007.4), Portugal (9712.4), and Paraguay (8390) had the highest ASPR of anxiety disorders. Brazil (53.2 %), Peru (38.4 %), and Bolivia (42.2 %) showed the largest increases in ASPR across the study period. In women, the global DALY rate of anxiety disorders increased up to age 20-44 years and then decreased with advancing age, whereas for men the rate the same as in women. Regionally, an overall undulating pattern association was found between SDI and the age standardised DALYs rate of anxiety disorders. The global female ASIR slightly increased from 1990 to 2019 (Annual percent change [APC]: 0.02 %). However, from 2019 to 2021, it saw a substantial rise (APC: 10.78 %).

CONCLUSIONS

With the development of society, the disease burden of anxiety disorder will become increasingly severe. It is very important to study the accurate epidemiological data on anxiety disorder for clinical diagnosis and treatment and health policy.

Mental Well-being in Menopause

The hormonal changes that accompany the transition to menopause are disruptive to most women, and for some, mental health maybe adversely affected. Depressive symptoms and major depression are the best-studied conditions in association with menopause, but anxiety, executive function, and comorbid pre-existing psychiatric conditions all influence the symptomatology that women will experience during this phase of their lives. The epidemiology, diagnosis, and evidence-based treatment guidelines for perimenopausal patients are discussed.

Three-Month Durability of Bilateral Two-Level Stellate Ganglion Blocks in Patients with Generalized Anxiety Disorder: A Retrospective Analysis

Purpose: Determine if performing ultrasound-guided, bilateral, two-level cervical sympathetic chain blocks (2LCSB) (performed on subsequent days) provides durable improvement in symptoms associated with anxiety. Methods: A retrospective chart review was conducted between January 2022 and November 2024. We identified 114 patients who received bilateral, 2LCSB for anxiety symptoms. Generalized Anxiety Disorder 7-Item Scale (GAD-7) outcome measure scores were collected at baseline and three-months post procedure in 71 males and 43 females. Results: Out of 114 patients, 99 patients (86.8%) showed a long-lasting improvement in their GAD-7 scores. Collected GAD-7 forms had a baseline average of 15.52 (14.99 for males and 16.40 for females), which decreased after three months to an average of 7.28 (6.96 for males and 7.81 for females). This represents a 52% average improvement in anxiety symptoms. Conclusions: In individuals treated with bilateral, 2LCSB, GAD-related symptoms were improved by 52% for at least 3 months regardless of initial anxiety severity.

Epoetin alfa has a potent anxiolytic effect on naive female rats

BACKGROUND

Epoetin alfa is a derivative of the erythropoietin hormone. This study aims to investigate the epoetin alfa effect on anxiety-like behaviors.

METHODS

Adult female Wistar Albino rats were divided into Control (n = 8), 1000 U Epoetien alfa, and 2000 U Epoetien alpha. Epoetin alfa was administered intraperitoneally once a week for 4 weeks. The animals were then subjected to open field test, elevated plus maze, light-dark box, and the behaviors were video recorded.

RESULTS

Epoetin alfa significantly reduced anxiety-like behaviors in both low- and high-dose groups in a dose-independent manner. This anxiolytic effect was seen in all three anxiety tests. Further, exploratory behaviors such as unsupported rearing and head-dipping behaviors increased with the application of Epoetin alfa. This protocol did not alter locomotor activity.

CONCLUSION

The present study found beneficial effects of epoetin alfa on behaviors. Further studies on the effect of derivatives of erythropoietin hormone on anxiety-like behaviors are needed.

The global, regional, and national disease burden of colorectal cancer attributable to low physical activity from 1990 to 2021: an analysis of the Global Burden of Disease Study 2021

OBJECTIVES

This study aims to estimate the spatiotemporal variation in the burden of colorectal cancer (CRC) attributable to low physical activity (LPA) at global, regional, and national levels from 1990 to 2021.

STUDY DESIGN

Cross-sectional study.

METHODS

Annual data on deaths of CRC related to LPA, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), and the age-standardized DALYs rate (ASDR) for 204 countries and territories from 1990 to 2021 was extracted from the Global Health Data Exchange website. They were retrieved by age (5-year age groups from 25 to 94 years, and 95+ years), gender (male and female), and Socio-demographic Index (SDI). The association between age-standardized rates and SDI values was assessed by Spearman's correlation.

RESULTS

Between 1990 and 2021, there was nearly a twofold increase in DALYs and mortality globally for CRC related to LPA, despite decreases in ASMR and ASDR (EAPC: -0.82% and -0.83%, respectively). However, on a national scale, ASMR and ASDR increased in more than half of the world's countries and territories. Moreover, a greater burden of CRC related to LPA was observed in older populations, females, and those residing in regions with an SDI near 0.77.

CONCLUSION

These findings indicate the critical need to raise awareness about the preventive role of physical activity in CRC. Policymakers should prioritize developing and implementing strategies that ensure equitable access to sports resources, enabling more people to meet the World Health Organization guidelines.

The global, regional, and national burden of type 2 diabetes mellitus attributable to low physical activity from 1990 to 2021: a systematic analysis of the global burden of disease study 2021

BACKGROUND

Low physical activity (LPA) is a leading risk factor for type 2 diabetes mellitus (T2DM). We examine the temporal and spatial trends in the burden of T2DM attributable to LPA at the global, regional, and country scales.

METHODS

Data were obtained from the Global Burden of Disease Study 2021. The numbers of deaths and disability-adjusted life years (DALYs) of LPA-related T2DM, and the corresponding age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were compared across regions and countries by age, sex, and sociodemographic index (SDI). The annual percentage changes (EAPCs) in the ASMR or ASDR were calculated to quantify temporal trends from 1990 to 2021. We also quantified the relationship between SDI and the ASMR and ASDR of T2DM attributable to LPA.

RESULTS

Globally, the number of T2DM deaths and DALYs attributable to LPA were approximately 0.15 million and 5.52 million respectively in 2021, which more than doubled compared to 1990. Over the past 32 years, the global EAPCs of ASMR and ASDR were 0.26 (95% CI: 0.20, 0.31) and 0.97 (95% CI: 0.93, 1.02), respectively. The ASMR or ASDR had a reverse U-shaped relationship with the SDI, with the most severe burden observed in the low-middle and middle SDI regions. The age group older than 60 years had the highest rate of DALYs for LPA-related T2DM in 2021, while the 25-44 age group showed the largest increase between 1990 and 2021.

CONCLUSIONS

Over the past 32 years, the global burden of LPA-related T2DM has continued to increase at an alarming rate in almost all countries, particularly in regions with low-middle and middle SDI. Substantial increases in national action are urgently needed to target elder populations especially in low-middle and middle SDI regions, and special efforts should be made to promote physical activity in young adults with LPA.

Global, regional and national burden of tracheal, bronchus, and lung cancer attributable to ambient particulate matter pollution from 1990 to 2021: an analysis of the global burden of disease study

BACKGROUND

The ambient particulate matter pollution may play a critical role in the initiation and development of tracheal, bronchus, and lung (TBL) cancer. Up to now, far too little attention has been paid to TBL cancer attributable to ambient particulate matter pollution. This study aims to assess the disease burden of TBL cancer attributable to ambient particulate matter pollution in global, regional and national from 1990 to 2021 to update the epidemiology data of this disease.

METHODS

Leveraging data from the Global Burden of Disease (GBD) 2021 study, we analyzed the worldwide burden of TBL cancer resulting from ambient particulate matter pollution using indices including disability-adjusted life years (DALYs), age-standardised rate of DALYs (ASDR). This burden was further segmented based on variables including geographical location, and socio-demographic index (SDI), age and sex.

RESULTS

The ASDR per 100,000 population of TBL cancer attributable to ambient particulate matter pollution increased by 0.2%[95% UI 0.1 to 0.3] to 79.6[95% UI 49.0 to 111.2] from 1990 to 2021 Globally. Middle-aged and elderly individuals accounted for the majority of the disease burden, with the highest value at the 65-69 years. Most of the disease burden was concentrated in countries with High-middle SDI. There was a positive correlation between ASDR of TBL cancer due to particulate matter pollution and the SDI(ρ = 0.66, p < 0.001). East Asia and Central Europe exhibited higher observed values than the fitted curves, while such as Austraiasia South Asia and Western Sub-Saharan Africa had a lower observed values than the fitted curves. Decomposition analysis showed that population aging and growth were the two major drivers of the increase in DALYs.

CONCLUSIONS

The disease burden of TBL cancer attributable to ambient particulate matter pollution has increased, especially in regions and countries with High-middle SDI.

Familial coaggregation of major psychiatric disorders and neurodevelopmental disorders among first-degree relatives of individuals with generalized anxiety disorder

BACKGROUND

Anxiety disorders, major psychiatric disorders (e.g., schizophrenia and major affective disorders), and neurodevelopmental disorders (e.g., autism and attention-deficit/hyperactivity disorder [ADHD]) may cluster together within families. However, whether the first-degree relatives (FDRs) of individuals with generalized anxiety disorder (GAD) are at an elevated risk of neurodevelopmental or major psychiatric disorders remains unknown.

METHODS

We identified 2,378,190 FDRs of patients with GAD and 9,512,760 birth year-matched and sex-matched controls from Taiwan's National Health Insurance Research Database. Neurodevelopmental disorders, including autism and ADHD, and major psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, and GAD, were identified.

RESULTS

The FDRs-parents, offspring, and siblings-of individuals with GAD were more likely to be diagnosed as having schizophrenia (relative risk: 1.22), bipolar disorder (1.36), major depressive disorder (1.29), autism (1.20), ADHD (1.52), obsessive-compulsive disorder (1.21), and GAD (1.61) than are the FDRs of individuals without GAD.

CONCLUSION

Our findings support the notion of a familial coaggregation between GAD, major psychiatric disorders, and neurodevelopmental disorders. Future studies should elucidate the definitive genetic etiology of this familial coaggregation.

Dynamic changes and future trend predictions of the global burden of anxiety disorders: analysis of 204 countries and regions from 1990 to 2021 and the impact of the COVID-19 pandemic

Background

Anxiety disorders is a significant contributor to the Global Burden of Diseases (GBD), particularly in the aftermath of the COVID-19 pandemic, which has exacerbated the issue. Previous studies have not examined the impact of the COVID-19 pandemic on anxiety disorders over the entire time series, nor have they offered predictions regarding future trends of global anxiety disorders in the aftermath of the pandemic. This study aims to present the Age-Standardized Prevalence Rates (ASPR), Age-Standardized Incidence Rates (ASIR), and disability-adjusted life years (DALYs) associated with anxiety disorders from 1990 to 2021 across 204 countries and regions, emphasizing the age structure and the disease burden following the pandemic. Additionally, it examines the relationship between the burden of anxiety disorders and the COVID-19 pandemic, as well as trend predictions for the incidence of anxiety disorders from 2022 to 2050.

Methods

We analysed data from the GBD 2021 study, employed the GBD method to integrate epidemiological data on ASPR, ASIR, and DALYs to accurately assess the global burden of anxiety disorders across various regions, genders, and age groups. Additionally, joint point regression analysis was applied to rigorously examine the time trends of anxiety disorders from 1990 to 2021, calculating the annual percentage change (APC), annual average percentage change (AAPC), and their corresponding 95% confidence intervals (CIs). Furthermore, path analysis was utilized to investigate the impact pathways between the COVID-19 pandemic and anxiety disorders. Finally, a Bayesian age-period-cohort (BAPC) model was employed to predict the prevalence trends of anxiety disorders from 2022 to 2050.

Findings

From 1990 to 2021, the ASPR, ASIR, and DALYs associated with anxiety disorders worldwide exhibited a significant upward trend, particularly evident from 2019 to 2021, during which all three metrics experienced a sharp increase. The most pronounced changes in the burden of anxiety disorders from 2019 to 2021 were observed in high socio-demographic index (SDI) regions, where the ASIR surpassed expected levels in tropical Latin America, high-income North America, and Australia in 2021. Bulgaria recorded the highest increase in anxiety disorders burden during this period, with a change rate of 0.32, while Bhutan experienced the smallest increase, with a total change rate of 0.02. Notably, the global anxiety disorders burden among women is greater than that among men. From 2019 to 2021, women aged 20-24 years were particularly impacted by the COVID-19 pandemic, with a change rate of 0.21. Additionally, the ASIR of COVID-19 pandemic in 2021 had a significant positive correlation with the prevalence of anxiety disorders, standardized path coefficient value of 0.224 (z = 2.708, P < 0.01). Projections indicate that by 2050, the number of individuals affected by anxiety disorders may reach 87.36 million (95% UI: 59.28-115.44). It is also anticipated that the prevalence of anxiety disorders among the 15-19 age group will exceed that of other age groups by 2050.

Interpretation

The COVID-19 pandemic has significantly impacted the future burden of anxiety disorders, necessitating greater attention towards young individuals, particularly women. There is an urgent need for the adoption of targeted prevention and treatment strategies on a global scale, especially in high SDI regions, to effectively address the escalating issue of anxiety disorder burden.

Funding

Jilin Province 2023 Health Science and Technology Capability Enhancement Plan Project (2023LC024) and Jilin Provincial Department of Science and Technology project (20230203054SF). Research Project on Teaching Reform of Graduate Education at Beihua University (JG [2024]009), Education and Teaching Reform Project of Beihua University (21xjyb-1241759), Jilin Province Education Science "14th Five Year Plan" Project (GH24295).

Changes in the prevalence of severe anxiety and depression symptoms and the associated factors in adults living in Manaus: a comparison of two cross-sectional studies conducted in 2015 and 2019

BACKGROUND

Emotional distress increases, also affected by the setting.

OBJECTIVE

To estimate changes in prevalence of severe anxiety and depressive symptoms and associated factors.

DESIGN AND SETTING

This cross-sectional study included adults living in Manaus selected through a three-stage probability sampling in 2015 and 2019.

METHODS

This is an analysis of two surveys conducted. The outcomes were assessed by Generalized Anxiety Disorder 7-item (≥ 15 points) and Patient Health Questionnaire 9-item (≥ 20), and changes were tested by chi-square goodness-of-fit. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated by Poisson regression.

RESULTS

Severe anxiety symptoms increased from 3.3% (95%CI = 2.7-3.9) in 2015 (n = 3,479) to 8.7% (95%CI = 7.5-9.8) in 2019 (n = 2,321); severe depressive symptoms changed from 2.5% (95%CI = 2.0-3.0) to 8.5% (95%CI = 7.3-9.6). Variations were more pronounced in social vulnerability (P < 0.05). Outcomes were higher in women (anxiety: PR = 1.27; 95%CI = 1.20-1.34, depression: PR = 1.35; 95%CI = 1.27-1.44), low-income individuals (anxiety: PR = 1.90; 95%CI = 1.20-3.00, depression: PR = 1.98; 95%CI = 1.22-3.19), less educated individuals (anxiety: PR = 2.20; 95%CI = 1.16-4.18, depression: PR = 2.37; 95%CI = 1.23-4.60), and individuals with poor health status (anxiety: PR = 9.06; 95%CI = 6.72-12.21, depression: PR = 8.99; 95%CI = 6.67-12.12).

CONCLUSION

Severe anxiety and depression tripled in Manaus, potentially reflecting Brazilian socioeconomic crises.

Effect of a Web-Based Heartfulness Program on the Mental Well-Being, Biomarkers, and Gene Expression Profile of Health Care Students: Randomized Controlled Trial

BACKGROUND

Health care students often experience high levels of stress, anxiety, and mental health issues, making it crucial to address these challenges. Variations in stress levels may be associated with changes in dehydroepiandrosterone sulfate (DHEA-S) and interleukin-6 (IL-6) levels and gene expression. Meditative practices have demonstrated effectiveness in reducing stress and improving mental well-being.

OBJECTIVE

This study aims to assess the effects of Heartfulness meditation on mental well-being, DHEA-S, IL-6, and gene expression profile.

METHODS

The 78 enrolled participants were randomly assigned to the Heartfulness meditation (n=42, 54%) and control (n=36, 46%) groups. The participants completed the Perceived Stress Scale (PSS) and Depression Anxiety Stress Scale (DASS-21) at baseline and after week 12. Gene expression with messenger RNA sequencing and DHEA-S and IL-6 levels were also measured at baseline and the completion of the 12 weeks. Statistical analysis included descriptive statistics, paired t test, and 1-way ANOVA with Bonferroni correction.

RESULTS

The Heartfulness group exhibited a significant 17.35% reduction in PSS score (from mean 19.71, SD 5.09 to mean 16.29, SD 4.83; P<.001) compared to a nonsignificant 6% reduction in the control group (P=.31). DASS-21 scores decreased significantly by 27.14% in the Heartfulness group (from mean 21.15, SD 9.56 to mean 15.41, SD 7.87; P<.001) while it increased nonsignificantly by 17% in the control group (P=.04). For the DASS-21 subcomponents-the Heartfulness group showed a statistically significant 28.53% reduction in anxiety (P=.006) and 27.38% reduction in stress (P=.002) versus an insignificant 22% increase in anxiety (P=.02) and 6% increase in stress (P=.47) in the control group. Further, DHEA-S levels showed a significant 20.27% increase in the Heartfulness group (from mean 251.71, SD 80.98 to mean 302.74, SD 123.56; P=.002) compared to an insignificant 9% increase in the control group (from mean 285.33, SD 112.14 to mean 309.90, SD 136.90; P=.10). IL-6 levels showed a statistically significant difference in both the groups (from mean 4.93, SD 1.35 to mean 3.67, SD 1.0; 28.6%; P<.001 [Heartfulness group] and from mean 4.52, SD 1.40 to mean 2.72, SD 1.74; 40%; P<.001 [control group]). Notably, group comparison at 12 weeks revealed a significant difference in perceived stress, DASS-21 and its subcomponents, and IL-6 (all P<.05/4). The gene expression profile with messenger RNA sequencing identified 875 upregulated genes and 1539 downregulated genes in the Heartfulness group compared to baseline, and there were 292 upregulated genes and 1180 downregulated genes in the Heartfulness group compared to the control group after the intervention.

CONCLUSIONS

Heartfulness practice was associated with decreased depression, anxiety, and stress scores and improved health measures in DHEA-S and IL-6 levels. The gene expression data point toward possible mechanisms of alleviation of symptoms of stress, anxiety and depression.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN82860715; https://doi.org/10.1186/ISRCTN82860715.

Student mental health outcomes of a clustered SMART for developing an adaptive implementation strategy to support school-based CBT delivery

PURPOSE

Most youth experiencing anxiety/depression lack access to evidence-based mental health practices (EBPs). School-delivered care improves access, and various support can help school professionals (SPs; school social workers, counselors) deliver EBPs, like Cognitive Behavioral Therapy (CBT). Understanding implementation strategies' impact on downstream mental health outcomes is crucial to scaling up EBPs to address the treatment gap, but it has rarely been assessed.

METHODS

This paper compares implementation strategies' impact on change in student outcomes, collected as exploratory outcomes from a type III hybrid implementation-effectiveness trial. A clustered, sequential, multiple-assignment randomized trial design was used, which embedded four implementation supports that differentially sequence three implementation strategies, Replicating Effective Programs (REP), Coaching, and Facilitation. Prior to the first randomization, N = 169 SPs from 94 Michigan high schools each identified up to 10 students whom they believed could benefit from CBT and facilitated student survey completion. Changes in students' depression (Patient Health Questionnaire-9, modified for teens) and anxiety symptoms (Generalized Anxiety Disorder-7) over 10 months were compared across the four sequences of implementation support using a generalization of a marginal, weighted least squares approach developed for a clustered SMARTs.

RESULTS

Small, non-clinically significant reductions in symptoms over the study period were found. Pairwise comparisons found no significant differences in symptom change across the four implementation strategies. The difference in the estimated mean PHQ-9T/GAD-7 scores between the least and the most intensive strategies (REP vs. REP+Coaching+Facilitation) was 1.04 (95%CI = -0.95, 3.04) for depression and 0.82 (95%CI = -0.89, 2.52) for anxiety.

DISCUSSION

No difference in symptom change was found across the four implementation strategies. Multiple forms of implementation support may be useful for improving student mental health outcomes.

TRIAL REGISTRATION

NCT03541317-Registered on 29 May 2018 on ClinicalTrials.gov PRS.

Regulation of hippocampal miRNA expression by intestinal flora in anxiety-like mice

This study investigated the possible interaction between gut flora and miRNAs and the effect of both on anxiety disorders. The model group was induced with chronic restraint stress (CRS) and each group was tested for anxiety-like behaviour by open field test and elevated plus maze test. Meanwhile, the gut flora was analysed by 16S rRNA high-throughput sequencing. The miRNAs in hippocampus were analysed by high-throughput sequencing, and the key miRNAs were obtained by using the method of bioinformatics analysis. PCR was used to verify the significantly related key miRNAs. Spearman correlation analysis was used to explore the correlation between behaviour, key miRNAs and differential gut microbiota. The 16S rRNA high-throughput sequencing result showed that the gut flora was dysregulated in the model group. In particular, Verrucomicrobia, Akkermansia, Anaerostipes, Ralstonia, Burkholderia and Anaeroplasma were correlated with behaviour. The results of miRNA high-throughput sequencing analysis and bioinformatics analysis showed that 7 key miRNAs influenced the pathogenesis of anxiety, and qRT-PCR results were consistent with the high-throughput sequencing results. Mmu-miR-543-3p and mmu-miR-26a-5p were positively correlated with Verrucomicrobia, Akkermansia and Anaerostipes. Therefore, we infer that chronic stress caused the decrease of Akkermansia abundance, which may aggravate the decrease of mmu-miR-543-3p and mmu-miR-26a-5p expression, leading to the increase of SLC1A2 expression. In conclusion, gut flora has played an important influence on anxiety with changes in miRNAs.

The relationship between dietary sugar consumption and anxiety disorders: A systematic review

High-sugar intake is a risk factor for chronic diseases such as cardiovascular disease and type 2 diabetes, but less is known about its role in anxiety disorders. This systematic review aimed to systematically synthesise and assess the existing evidence regarding the association between dietary sugars intake and anxiety disorders. Following PRISMA guidelines, a systematic search of PubMed, MEDLINE, Embase, APA PsycArticles and APA PsycINFO was conducted up to 19th August 2022. Study quality was assessed by the Newcastle-Ottawa scale (NOS) and the Cochrane risk of bias tool. Eleven studies (10 cross-sectional and 1 randomised controlled trial [RCT]) were included. Seven cross-sectional studies had very good quality or good quality, and the quality of the RCT was at low risk of bias. These studies examined sugar-sweetened beverages (n = 7), sugar-sweetened foods (n = 4) and/or added sugar (n = 5). The findings suggest a possible positive relationship of added sugar consumption with anxiety disorders, with age as a potential moderator in such association. No conclusions can be drawn on the associations between sugar-sweetened beverages, sugar-sweetened foods consumption and anxiety disorders. Due to the included studies being mostly cross-sectional, the conclusions drawn from the existing evidence should be interpreted with caution. The longitudinal design is warranted to investigate any causal relationship and the potential mechanisms underlying these heterogeneous results. The potential difference in effect at different ages observed in this review should be further examined.

Rising global burden of anxiety disorders among adolescents and young adults: trends, risk factors, and the impact of socioeconomic disparities and COVID-19 from 1990 to 2021

Background

Anxiety disorders are among the most prevalent mental health conditions globally, particularly affecting adolescents and young adults (10-24 years), and causing substantial psychological and social impairments. This study analyzed changes in the incidence, prevalence, and disability-adjusted life years (DALYs) of anxiety disorders in this age group from 1990 to 2021, emphasizing the impact of socioeconomic disparities and the COVID-19 pandemic, particularly post-2019.

Methods

Utilizing the Global Burden of Disease(GBD) 2021 data from 204 countries, this study evaluated global trends in anxiety disorders among adolescents and young adults. Conducted between May 16 and August 1, 2024, it assessed prevalence, incidence, DALYs, and estimated annual percentage changes (EAPCs) from 1990 to 2021. Joinpoint regression identified significant shifts in incidence rates, with key risk factors, especially bullying victimization,examined. The analysis was stratified by region, country, age group, sex, and Socio-Demographic Index (SDI).

Results

From 1990 to 2021, the global incidence of anxiety disorders among those aged 10-24 years increased by 52%, particularly in the 10-14 age group and post-2019. Females showed higher prevalence rates than males, and DALYs rose notably among the 20-24-year-olds. Regions with middle SDI reported the highest incidence and prevalence, whereas high SDI regions experienced the largest increases. India had the highest number of cases, while Mexico saw the greatest rise. A gradual decline in incidence was noted until 2001, followed by a slow increase, with a sharp rise from 2019 to 2021. Bullying victimization was a significant risk factor, especially in regions with a high anxiety disorder burden.

Conclusion

The rising incidence of anxiety disorders among adolescents and young adults over the past 30 years reflects the increasing global mental health burden. Socioeconomic factors, particularly in middle SDI regions, and the impact of the COVID-19 pandemic have exacerbated this trend. Effective, targeted interventions focusing on early prevention and community-based mental health management are urgently needed to mitigate the long-term impact on young populations globally.

Characterising the anxiogenic network from functional connectivity analysis of the CO2 challenge model

The CO2 challenge model (CCM) is a gas inhalation paradigm that provides precisely controlled anxiety induction in experimental settings. Despite its potential as an experimental model of anxiety, our understanding of the neural effects of the CCM is incomplete. This study employs resting-state functional magnetic resonance imaging (rs-fMRI) to explore functional connectivity (FC) changes underlying the CCM. Following a preliminary CO2 tolerance assessment, participants completed an MRI session that included three rs-fMRI scans: during inhalation of control air (pre and post), and during a 6% CCM exposure. Here, we confirm that 6% CCM is a tolerable anxiogenic model in the MRI setting. We demonstrate that a transient CCM-induced increase in subjective anxiety is associated with an increase in FC within limbic and anxiety-related regions, with the insula emerging as a central node in this altered connectivity pattern. Further analysis revealed a significant correlation between the levels of subjective anxiety and enhanced FC between the brainstem and medial frontal cortex, highlighting the dynamic role of the brainstem in response to CO2-induced anxiety. These findings underscore the value of combining CCM and rs-fMRI to characterise the neural mechanisms of anxiety, with important implications for evaluating potential therapeutic interventions.

The more self-control, the more anxious?- A network analysis study of the relationship between self-control and psychological anxiety among Chinese university students

INTRODUCTION

With the growing prevalence of anxiety symptoms among university students, self-control is an important potential influence. This study aims to understand the network structure of self-control and anxiety, and to identify the core symptoms within this network. It will provide a theoretical basis for the prevention and intervention of anxiety symptoms in university students.

METHOD

We used network analysis to study anxiety and self-control in 3,792 university students from six schools in Heilongjiang Province, China. We checked for linear connections in the networks using a restricted cubic spline. We conducted the analyses and made graphs using R software.

RESULTS

(i) The total sample network showed that higher levels of self-control in university students were associated with lower anxiety levels and were validated by the restrictive cubic spline. (ii) There was the strongest negative correlation (edge weight = -0.42) between Without thinking (SC7) and Panic (A5), and the edge weight coefficients of this self-control component and anxiety symptoms were greater than those of other self-control components. (iii) Physical exertion (A6) and Scared (A7) were identified as the core symptoms of the overall network, with expected influence of 1.08 and 1.08 (Z-score). (iv) A significant difference was observed between the anxiety positive network structure and the total sample network structure, with the strongest positive correlation between Iron self-control (SC3) and Breathing difficulty (A2) (edge weight = 0.22), with the strongest negative correlation between Certain things (SC2) and Situations (A4) (edge weight = -0.35). (v) The self-control component Iron self-control (SC3) had only one positive edge in the rural network, and only two positive edges in not one child network.

CONCLUSION

The present study offered a new perspective on the relationship between self-control and anxiety using network analysis for the first time. The control component Without thinking (SC7) was an important concept influencing the negative correlation of anxiety, and Physical exertion (A6) and Scared (A7) were core symptoms in the total network. Heterogeneity analyses showed a tendency for the more self-controlled to be more anxious in the anxiety positive sample. These results may be a potential target for preventing and intervening anxiety in university students.

Health sciences students' career commitment, mental health, and physical activity during the COVID-19 pandemic

Objective: To understand the biopsychosocial dimensions of university health sciences students' experiences during the COVID-19 pandemic. Participants: Health sciences students (n = 297) from two universities in July and August 2020. Methods: Participants completed a Web-based survey asking about depression, anxiety, physical activity, coronavirus threat, and career commitment. Results: Moderate or severe depression and anxiety were reported by 28.6% and 31.3% of respondents, respectively. Depression and anxiety were positively correlated with perceived coronavirus threat and negatively correlated with career commitment and strenuous physical activity. A change in career commitment interests during the COVID-19 pandemic was reported by 11% of respondents. Conclusions: Identified factors that could be targeted by universities to support their students and secure career commitment include online learning challenges, ability to secure clinical placements, mental health (anxiety and depression), financial challenges, family pressure, and promotion of physical activity.

Global, regional, and national burden of bullying related mental disorders of adolescent from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019

Few studies have assessed the burden of mental disorders in adolescents related to bullying victimization at the global, regional, and national levels. We analyzed adolescent mental disorder disability-adjusted life years (DALYs) attributed to bullying in 204 countries, following the Global Burden of Disease study 2019 framework. The DALYs rate of adolescent for bullying-related mental disorders global increased from 110.45 (95 % uncertainty intervals (UI): 40.76, 218.62) per 100,000 in 1990 to 138.92 (95 % UI: 54.37, 268.19) per 100,000 in 2019. The largest increase in DALYs rates were obvious in low-SDI and high-SDI regions. In 2019, the DALYs rate of adolescents with bullying-related anxiety disorders was 1.4 times higher than those depressive disorders; the DALYs rate of adolescents with bullying-related mental disorder in females was 1.3 times higher than that of male, and older adolescent (15-19 years old) was 1.4 times higher than younger adolescent (10-14 years old). High-income North America had the fastest increase in DALYs rates of mental disorders related to bullying. In general, a positive correlation was observed between bullying DALY rate of adolescent and SDIs at the regional and national levels. Our study highlights significant disparities in adolescent mental health burden from bullying. Governments must implement adaptive policies to address diverse needs effectively.

Cost-effectiveness analysis of mindfulness-based cognitive therapy in patients with anxiety disorders in secondary mental health care settings alongside a randomized controlled trial

Introduction

Anxiety disorder is one of the most prevalent mental disorders. Mindfulness-based cognitive therapy (MBCT) is effective for treating anxiety disorders. However, no studies have investigated the cost-effectiveness of MBCT for anxiety disorders. We aimed to conduct a cost-effectiveness analysis alongside a randomized controlled trial (RCT) to clarify the cost-effectiveness of MBCT for anxiety disorders.

Methods

A cost-effectiveness analysis alongside an RCT was conducted for 8 weeks in 40 patients with anxiety disorders at a university hospital. Patients (1) aged 20-75 years; (2) who were diagnosed with panic disorder/agoraphobia or social anxiety disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria; and (3) who provided written consent were analyzed. The participants were allocated randomly (1:1 ratio) to the augmented MBCT group (i.e., MBCT plus treatment as usual [TAU]) or TAU (waitlist control) group. The cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER), which is the ratio of the incremental costs divided by the incremental state-trait anxiety inventory- state (STAI-S), state-trait anxiety inventory- trait (STAI-T), and quality-adjusted life years (QALYs). The QALYs were estimated using The Japanese version of EuroQoL five-dimensional 3-level questionnaire. The unit cost data were derived from the government-regulated fees. This study was conducted from a public healthcare insurance perspective. No discount rates were considered.

Results

A total of 38 participants with complete data were included in the analysis. The MBCT was JPY 13,885 more than the cost of TAU and was associated with a STAI-S, STAI-T, and QALY increase of 10.13, 12.00, 0.009 respectively. The ICER were JPY 1,371 (USD13) per STAI-S, JPY 1,157 (USD 11) per STAI-T, and JPY 1,566,357 (USD 14,940) per QALY respectively. MBCT had an 77.5% probability of being cost-effective at a willingness to pay threshold in Japan (JPY 5,000,000 per QALY). The results of the four one-way sensitivity analyses supported the robustness of the base-case analysis findings.

Discussion

Augmented MBCT for anxiety disorders is cost-effective compared with TAU post-treatment from a public healthcare insurance perspective. Future studies should include long-term observations, and analysis from a societal perspective.

A review of exercise interventions for reducing anxiety symptoms: Insights and implications

Generalized anxiety disorder (GAD) is a prevalent mental health condition affecting a significant proportion of the adult population. Despite the availability of pharmacological treatments, their long-term efficacy and potential side effects necessitate exploring alternative interventions. Aerobic exercise has emerged as a promising non-pharmacological approach for managing anxiety symptoms in individuals with GAD. This narrative review examines the efficacy of aerobic exercise interventions in alleviating symptoms of anxiety disorders, drawing on a comprehensive analysis of relevant literature. The review synthesizes findings from studies investigating various forms of aerobic exercise, including high-intensity interval training, resistance training, Pilates, and walking. The results indicate that aerobic exercise interventions demonstrate efficacy in reducing anxiety symptoms and improving overall well-being across diverse populations, including primary care patients, individuals with coronary heart disease, and older adults with cancer undergoing chemotherapy. The review discusses the neurobiological and psychological mechanisms underlying the anxiolytic effects of aerobic exercise. It highlights the implications of these findings for clinical practice, public health initiatives, and future research directions. Despite the promising evidence, limitations in study methodologies and heterogeneity across interventions warrant a cautious interpretation of the results. Further research is needed to elucidate optimal exercise modalities, dosages, and long-term effects on anxiety outcomes.

Trends in Adolescent Health: Successes and Challenges From 2010 to the Present

PURPOSE

This review considers trends in some of the major adolescent health outcomes and contextual influences since 2010, and explores the relevance of recent cultural, societal, and public health developments on adolescent well-being.

METHODS

Based on a review of major reports published since 2010, we identified key topics of impact on adolescent health and development across several domains (education, economic opportunity, sexual and reproductive health, nutrition, and mental health) and ecological levels (from individual- to macro-level influences). Within these areas, we synthesized findings to describe recent trends, noting variation across countries/regions, gender/sex, and other social stratifications when possible.

RESULTS

Since 2010, progress in several areas of sexual and reproductive health has been most striking, with notable global declines in female genital mutilation/cutting, child marriage, HIV transmission, and adolescent childbearing. Participation and retention in school has increased, although the COVID-19 pandemic interrupted positive progress for many adolescents and contributed to social isolation and economic insecurity. The mental health and nutrition domains have clear challenges. Increased internalizing mental health issues have been observed cross-culturally, especially among girls. The prevalence of anemia has remained stagnant, while overweight and obesity rates are rising. Within domains, we highlight uneven progress across and within countries.

DISCUSSION

Based on recent successes and emerging challenges in adolescent well-being, we find that more and better research is needed that consistently takes an intersectional perspective, and critically, action must be taken to consolidate the gains in sexual and reproductive health and extend them to other areas of adolescent health.

Effect of whey protein-derived decapeptide on mood status and blood variables in healthy adults: a randomized, double-blind, placebo-controlled cross-over trial

PURPOSE

The importance of maintaining good mental health with overall well-being has recently drawn attention from various fields. Functional peptides found from various protein sources reportedly reduce mental health problems. We found a new decapeptide (AJI-801) from whey proteins, which can possibly improve mood status and increase blood acetyl-L-carnitine (ALC) and fibroblast growth factor 21 (FGF21) levels. In this study, we assessed the effects of a single intake of whey protein hydrolysate containing a high amount of AJI-801 (WPH) on blood variables and mood status.

METHODS

A randomized, double-blind, placebo-controlled cross-over trial of two doses of WPH (100 and 500 mg) was conducted. Participants, aged between 20 and 59 years with fatigue were allocated to two groups based on the WPH doses received, and set first test food in each study. The blood ALC and FGF21 levels at baseline and after 60, 120, and 180 min of test food intake were analyzed and the responses to the questionnaire items for mood status were obtained at baseline and after 60 and 180 min of test food intake.

RESULTS

There were no significant differences in the blood ALC and FGF21 levels between the two groups. As mood status, intake of 500-mg WPH (including 2.5-mg AJI-801) showed significant improvement in Depression/Dejection of the Profile of Mood States Questionnaire second edition and visual analog scale score for depression, as compared to the placebo.

CONCLUSIONS

Intake of AJI-801 500-mg WPH (including 2.5-mg AJI-801) contributes to the improvement of feeling down in healthy persons with fatigue.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trial Registry (UMIN 000046829).

Chronic pregabalin treatment reduced anxiety, and acute pregabalin treatment increased depression-like behaviors in rats

BACKGROUND

Pregabalin is an antiepileptic drug that binds to the alpha-2/delta unit at presynaptic voltage-dependent calcium channels. We aimed to investigate the effect of acute and chronic pregabalin administration on anxiety and depression-like behaviors.

METHODS

Fifty-six male Wistar albino rats were divided into seven groups: control, vehicle, and five different dose groups (5, 10, 30, 60, and 100 mg/kg). Pregabalin was administered for two weeks. Depression-like behaviors were evaluated by Forced swimming test. Anxiety-like behavior (ALB) was evaluated by Open field test (OFT), Elevated Plus Maze (EPM), and light-dark box. Subjects underwent the forced swimming test (FST) after the first dose, while the open field test (OFT), elevated plus maze (EPM), and light-dark box (LDB) were performed after two weeks of treatment. Further sucrose preference test was conducted to evaluate anhedonia until the end of the experiment.

RESULTS

In the forced swimming test, depression-like behaviors increased after acute single-dose administration of 10, 30, 60, 100 mg/kg pregabalin. According to OFT results, chronic 100 mg/kg pregabalin showed anxiolytic effects by decreasing grooming, and freezing behaviors. In addition, 100 mg/kg chronic pregabalin administration significantly increased the time spent in the central region, the number of entries to the center, and the unsupported rearing number without causing any change in locomotor activity. According to EPM results, both chronic 60 and 100 mg/kg pregabalin treatments showed anxiolytic effects by increasing open arm time and head dipping behavior. In addition, 60 and 100 mg/kg chronic pregabalin administration significantly decreased stretch attend posture. All pregabalin administrations between 5 and 100 mg/kg displayed anxiolytic effects in the LDB. Sucrose preference was above 65% for the duration of all experiments and subjects did not show anhedonia.

CONCLUSION

Acute pregabalin treatment triggered depression-like behaviors. Anhedonia, which may be associated with depression, was not observed during chronic treatment. Moreover, chronic treatment with pregabalin revealed potent anxiolytic effects in different behavior patterns and doses for all tests of unconditional anxiety. In particular, 100 mg/kg chronic pregabalin administration decreased anxiety-like behaviors in all experiment setups. Although the anxiolytic effect was demonstrated in chronic treatment, acute treatment of pregabalin induced depression-like behaviors, and thus in clinical practice should be done with caution, especially in patients with anxiety-depression comorbidity.

Association between socioeconomic position of the household head, food insecurity and psychological health: an application of propensity score matching

BACKGROUND

Mental health outcomes can be influenced by various factors, one of which has recently gained attention, namely food security. Food security is paramount to maintaining not only physical, but also mental health. There is an increasing need to understand the interplay between food insecurity (FI) and mental health outcomes, especially among vulnerable populations. The objective of this study was to investigate the effect of FI on psychological health (anxiety and depression) as well as to examine the modifying effect of socioeconomic position on this relationship.

METHODS

A cross-sectional study was conducted in Maputo City, Mozambique, in 1,842 participants. Data were collected through structured interviews using a modified version of the US Department of Agriculture Household Food Security Module to measure FI, and the Hospital Anxiety and Depression Scale to measure anxiety and depression. A composite variable for psychological health was created. Propensity score matching and interaction effect analyses were employed to examine the effects of FI on psychological health and the moderating role of socioeconomic position.

RESULTS

Of the 1,174 participants randomly assigned to propensity score matching, 787 were exposed to FI while 387 were unexposed. The analysis revealed stark disparities in psychological health outcomes associated with FI. The risk of poor psychological health among those exposed to FI was 25.79%, which was significantly higher than the 0.26% in unexposed individuals. The risk difference was 25.54% points (95% CI: 22.44-28.63), with a risk ratio of 99.82. Our assessment of population attributable fractions indicated that nearly all the risk for poor psychological health in the exposed group could be ascribed to FI. The interaction effects analysis revealed that socioeconomic status modifies this relationship. Specifically, heads of food-insecure households with a lower socioeconomic position tended to report poor mental health compared to their food-secure counterparts with a higher position.

CONCLUSIONS

The findings underscore the profound impact of FI on the mental health of household heads in Maputo City, socioeconomic position being a significant modifier. Addressing household FI along with the socioeconomic position of household heads could be pivotal to mental health promotion, especially among vulnerable populations.

Adrenergic C1 neurons enhance anxiety via projections to PAG

Anxiety is an emotional state precipitated by the anticipation of real or potential threats. Anxiety disorders are the most prevalent psychiatric illnesses globally and increase the risk of developing comorbid conditions that negatively impact the brain and body. The etiology of anxiety disorders remains unresolved, limiting improvement of therapeutic strategies to alleviate anxiety-related symptoms with increased specificity and efficacy. Here, we applied novel intersectional tools to identify a discrete population of brainstem adrenergic neurons, named C1 cells, that promote aversion and anxiety-related behaviors via projections to the periaqueductal gray matter (PAG). While C1 cells have traditionally been implicated in modulation of autonomic processes, rabies tracing revealed that they receive input from brain areas with diverse functions. Calcium-based in vivo imaging showed that activation of C1 cells enhances excitatory responses in vlPAG, activity that is exacerbated in times of heightened stress. Furthermore, inhibition of C1 cells impedes the development of anxiety-like behaviors in response to stressful situations. Overall, these findings suggest that C1 neurons are positioned to integrate complex information from the brain and periphery for the promotion of anxiety-like behaviors.

Multiple faces of anxiety: a frontal lobe perspective

Marked dysregulation of the human prefrontal cortex (PFC) and anterior cingulate cortex (ACC) characterises a variety of anxiety disorders, and its amelioration is a key feature of treatment success. Overall treatment response, however, is highly variable, and about a third of patients are resistant to treatment. In this review we hypothesise that a major contributor to this variation in treatment response are the multiple faces of anxiety induced by distinct forms of frontal cortex dysregulation. Comparison of findings from humans and non-human primates reveals marked similarity in the functional organisation of threat regulation across the frontal lobes. This organisation is discussed in relation to the 'predatory imminence continuum' model of threat and the differential engagement of executive functions at the core of both emotion generation and regulation strategies.

Professional, educational and psychosocial impacts of the COVID-19 pandemic on pediatricians

OBJECTIVES

COVID-19 infection is not limited to medical aspects, but may have significant negative impacts on education, tourism, the economy as well as sociocultural, ethical, and legal aspects. We aimed to assess the multidimensional impact of the COVID-19 pandemic on pediatricians by examining their COVID-19 infection, domestic life and quarantine, as well as work patterns, educational activities, and psychosocial impact.

METHODS

An online survey consisted of seven sections and 68 questions was prepared through 'Google Forms.' The survey was sent via e-mail to physicians who are members of the National Pediatric Association of Turkey.

RESULTS

The pandemic has affected pediatricians working in our country in a multifaceted aspect. They experienced significant anxiety/depression/stress, 8% of them felt it at a pathological level and were receiving treatment, and women and young pediatricians were more vulnerable to the pandemic. The more adequately informed about the disease, the more prepared for COVID-19 and lower levels of psychological distress, which emphasizes the importance of education and institutional continuing support. Our study showed that academic education was seriously disrupted and the satisfaction rate with virtual education was low.

CONCLUSION

Although COVID-19 has less impact today, it has taught us that it is necessary to be ready for new pandemics in the future. The required measures should be taken urgently and effectively healthcare professionals should follow a rational and applicable disaster plan.