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Xu H, Luo X, Shen Y, Jin X. Emotional abuse and depressive symptoms among the adolescents: the mediation effect of social anxiety and the moderation effect of physical activity. Front Public Health 2023; 11:1138813. [PMID: 37441642 PMCID: PMC10333479 DOI: 10.3389/fpubh.2023.1138813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/01/2023] [Indexed: 07/15/2023] Open
Abstract
Background Childhood maltreatment has been identified as a risk factor for depressive symptoms. Social anxiety is closely associated with depression. Physical activity has been regarded as an underlying protective factor. Little is known about the complex relations among these factors in Chinese middle school students. This study aimed to explore whether social anxiety mediated the association between childhood maltreatment and depressive symptoms and investigate whether physical activity moderated the indirect or direct effect of the mediation model. Methods A total of 1,570 middle school students were recruited and measured for childhood maltreatment (measured by Childhood Trauma Questionnaire-Short Form Chinese version), social anxiety (as the mediator, measured by the Chinese simplified version of Social Anxiety Scale for Adolescents), depressive symptoms (measured by the Chinese version of Depression Anxiety Stress Scales-21), physical activity (as the moderator), and covariates such as age, sex, and nationality. The proposed relationships were tested using mediation and moderated mediation models. Results Emotional abuse was directly associated with depression, and the association between emotional abuse and depression was partially mediated by social anxiety. The associations between emotional abuse with depression and with social anxiety were moderated by physical activity. Conclusion This study revealed the mediating role of social anxiety and the moderating role of physical activity between emotional abuse and depression, which emphasizes the potential benefits of sufficient physical activity to reduce social anxiety and depressive symptoms, and more intervention studies should be conducted to explore the direct influence of sufficient physical activity in the future.
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Affiliation(s)
- Huiming Xu
- School of Physical Education, Changsha University of Science and Technology, Changsha, Hunan, China
| | - Xuerong Luo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanmei Shen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xingyue Jin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Lofthouse MK, Waite P, Černis E. Developing an understanding of the relationship between anxiety and dissociation in adolescence. Psychiatry Res 2023; 324:115219. [PMID: 37119790 DOI: 10.1016/j.psychres.2023.115219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 04/06/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
Anxiety is a common problem in adolescence which is hypothesised to be associated with dissociation, a range of distressing symptoms linked to reduced psychosocial functioning. Yet, to date, research into the mechanisms of dissociation in adolescents has been limited. The present study investigated the link between trait anxiety and dissociative experiences (depersonalisation and 'felt sense of anomaly') using an online survey. Cognitive appraisals of dissociation, perseverative thinking, and body vigilance were assessed as potential mediating factors of this relationship. 1211 adolescents aged 13-18 years were recruited via social media advertisements and local schools. Linear regression showed a moderate positive relationship between trait anxiety and both dissociation constructs. Hierarchical regression indicated that cognitive appraisals of dissociation and perseverative thinking mediated the relationship between trait anxiety and both dissociation constructs, but trait anxiety was a significant predictor for felt sense of anomaly but not depersonalisation after including the mediators. The final models accounted for 58.7% of variance in depersonalisation and 68.4% of variance in felt sense of anomaly. These results support the hypothesis that dissociation is associated with anxiety in adolescence. They also demonstrate that cognitive-behavioural conceptualisations may be valid for understanding dissociation in adolescence.
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Affiliation(s)
- Miss Katie Lofthouse
- University of Oxford, Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; University of East Anglia, Norwich Medical School, Chancellors Drive, Norwich NR4 7TJ, United Kingdom
| | - Polly Waite
- University of Oxford, Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Emma Černis
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Oxford OX3 7JX, United Kingdom; University of Birmingham School of Psychology, Edgbaston, Birmingham B15 2TT, United Kingdom
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Yang J, Millman LSM, David AS, Hunter ECM. The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review. J Trauma Dissociation 2023; 24:8-41. [PMID: 35699456 DOI: 10.1080/15299732.2022.2079796] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Depersonalization-Derealization disorder (DDD) is a psychiatric condition characterized by persistent feelings of detachment from one's self and of unreality about the outside world. This review aims to examine the prevalence of DDD amongst different populations. A systematic review protocol was developed before literature searching. Original articles were drawn from three electronic databases and included only studies where prevalence rates of DDD were assessed by standardized diagnostic tools. A narrative synthesis was conducted. Twenty-three papers were identified and categorized into three groups of participants: general population, mixed in/outpatient samples, and patients with specific disorders. The prevalence rates ranged from 0% to 1.9% amongst the general population, 5-20% in outpatients and 17.5-41.9% in inpatients. In studies of patients with specific disorders, prevalence rates varied: 1.8-5.9% (substance abuse), 3.3-20.2% (anxiety), 3.7-20.4% (other dissociative disorders), 16.3% (schizophrenia), 17% (borderline personality disorder), ~50% (depression). The highest rates were found in people who experienced interpersonal abuse (25-53.8%). The prevalence rate of DDD is around 1% in the general population, consistent with previous findings. DDD is more prevalent amongst adolescents and young adults as well as in patients with mental disorders. There is also a possible relationship between interpersonal abuse and DDD, which merits further research.
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Affiliation(s)
- Jinyan Yang
- Division of Psychiatry, University College London, London, UK
| | | | - Anthony S David
- Division of Psychiatry, University College London, London, UK
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Longo P, Marzola E, Martini M, Amodeo L, Abbate-Daga G. Anorexia Nervosa and Somatoform Dissociation: A Neglected Body-Centered Perspective. J Trauma Dissociation 2023; 24:141-156. [PMID: 36052411 DOI: 10.1080/15299732.2022.2119631] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Dissociation in anorexia nervosa (AN) is common (literature reported 29% of dissociative disorders in eating disorders) and higher in patients with binge-purging AN (BP-AN) than in those with restricter AN (R-AN). However, the distinction between somatoform (SomD) and psychoform dissociation (PsyD) is understudied. We aimed to assess the differences in PsyD and SomD, eating-related, general, and body-related psychopathology, and childhood trauma between subtypes of AN. Then, we attempted to describe a subgroup of patients with AN with marked SomD comparing them to patients without SomD, also controlling the results for PsyD and AN subtypes. Inpatients with AN (n = 111; 109 women and 2 men) completed self-reported questionnaires evaluating dissociation, eating-related, body-related, and general psychopathology, and childhood abuses. Patients with BP-AN reported higher SomD and PsyD and a more severe clinical picture than those with R-AN. The SomD-group (n = 41) showed higher eating concerns, trait-anxiety, body-related variables, and sexual/physical abuse compared to the no-SomD group (n = 70), independently of AN subtype and PsyD symptoms. Results described particular features of patients with AN and SomD. Data, clinically, suggest a careful assessment, for both SomD and PsyD, especially when a history of bodily-impacting trauma is present, potentially fostering dissociation-informed interventions.
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Affiliation(s)
- Paola Longo
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Martini
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Laura Amodeo
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
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Wu YQ, Liu F, Chan KQ, Wang NX, Zhao S, Sun X, Shen W, Wang ZJ. Childhood psychological maltreatment and internet gaming addiction in Chinese adolescents: Mediation roles of maladaptive emotion regulation strategies and psychosocial problems. CHILD ABUSE & NEGLECT 2022; 129:105669. [PMID: 35598385 DOI: 10.1016/j.chiabu.2022.105669] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/18/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Internet gaming addiction (IGA) is a global concern, especially among young children. There have been some suggestions that childhood psychological maltreatment influences the development of IGA, but evidence for this has thus far been lacking. OBJECTIVE The goal of this study was to investigate the association between childhood psychological maltreatment and IGA in adolescents and the mediation roles of maladaptive emotion regulation strategies and psychosocial problems (depression and social anxiety). METHODS This study recruited 1280 (girls = 690) middle school students with a mean age of 16.09 ± 0.98 years old. All participants undertook a standardized assessment of childhood psychological maltreatment, maladaptive emotion regulation strategies, psychosocial problems (depression and social anxiety), and IGA. RESULTS We examined whether the effect of childhood psychological maltreatment on IGA was mediated by maladaptive emotion regulation strategies and psychosocial problems (depression and social anxiety). Both parallel and sequential mediation analysis showed that maladaptive emotion regulation strategies and depression mediated the relationship between childhood psychological maltreatment and IGA. CONCLUSIONS Childhood psychological maltreatment is positively associated with IGA in adolescents. Maladaptive emotion regulation strategies and depression both significantly mediated the relationship between childhood psychological maltreatment and IGA.
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Affiliation(s)
- Yu-Qing Wu
- Department of Psychology, Ningbo University, China
| | - Fang Liu
- Department of Psychology, Ningbo University, China
| | - Kai Qin Chan
- Department of Psychology, James Cook University, Singapore
| | | | - Shu Zhao
- Department of Psychology, Ningbo University, China
| | - Xin Sun
- Department of Psychology, Ningbo University, China
| | - Wangbing Shen
- School of Public Administration, Hohai University, China
| | - Zuo-Jun Wang
- Department of Psychology, Ningbo University, China; School of Public Administration, Hohai University, China.
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Wiegand A, Munk MHJ, Drohm S, Fallgatter AJ, MacIsaac JL, Kobor MS, Nieratschker V, Kreifelts B. Neural correlates of attentional control in social anxiety disorder: the impact of early-life adversity and DNA methylation. J Psychiatry Neurosci 2021; 46:E663-E674. [PMID: 34916236 PMCID: PMC8687622 DOI: 10.1503/jpn.210064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/10/2021] [Accepted: 10/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social anxiety disorder is characterized by intense fear and avoidance of social interactions and scrutiny by others. Although alterations in attentional control seem to play a central role in the psychopathology of social anxiety disorder, the neural underpinnings in prefrontal brain regions have not yet been fully clarified. METHODS The present study used functional MRI in participants (age 18-50 yr) with social anxiety disorder (n = 42, 31 female) and without (n = 58, 33 female). It investigated the interrelation of the effects of social anxiety disorder and early-life adversity (a main environmental risk factor of social anxiety disorder) on brain activity during an attentional control task. We applied DNA methylation analysis to determine whether epigenetic modulation in the gene encoding the glucocorticoid receptor, NR3C1, might play a mediating role in this process. RESULTS We identified 2 brain regions in the left and medial prefrontal cortex that exhibited an interaction effect of social anxiety disorder and early-life adversity. In participants with low levels of early-life adversity, neural activity in response to disorder-related stimuli was increased in association with social anxiety disorder. In participants with high levels of early-life adversity, neural activity was increased only in participants without social anxiety disorder. NR3C1 DNA methylation partly mediated the effect of social anxiety disorder on brain activity as a function of early-life adversity. LIMITATIONS The absence of behavioural correlates associated with social anxiety disorder limited functional interpretation of the results. CONCLUSION These findings demonstrate that the neurobiological processes that underlie social anxiety disorder might be fundamentally different depending on experiences of early-life adversity. Long-lasting effects of early-life adversity might be encoded in NR3C1 DNA methylation and entail alterations in social anxiety disorder-related activity patterns in the neural network of attentional control.
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Affiliation(s)
- Ariane Wiegand
- From the Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, Eberhard Karls University of Tübingen, Tübingen, Germany (Wiegand, Munk, Drohm, Fallgatter, Nieratschker, Kreifelts); the International Max Planck Research School for Cognitive and Systems Neuroscience, University of Tübingen, Tübingen, Germany (Wiegand); the Department of Biology, Technische Universität Darmstadt, Darmstadt, Germany (Munk); the Department of Medical Genetics, University of British Columbia-BC Children's Hospital Research Institute, Vancouver, BC (MacIsaac, Kobor); and the Werner Reichardt Centre for Integrative Neuroscience, Tübingen, Germany (Nieratschker)
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Jones LL, Rickards H. History of abuse and psychogenic nonepileptic seizures: A systematic review. Seizure 2021; 92:200-204. [PMID: 34555802 DOI: 10.1016/j.seizure.2021.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/02/2023] Open
Abstract
Psychogenic nonepileptic seizures resemble epileptic seizures but lack the physiological basis of epileptic seizures. We conducted a systematic review to explore whether childhood abuse is a risk factor for subsequent development of PNES. We reviewed only papers with an epilepsy control group, which employed strict criteria for diagnosis of epilepsy and well-validated tools for assessing abuse history. Odds ratios (ORs) for the different categories of childhood abuse and for childhood abuse as a whole were calculated where not previously available, and pooled ORs were calculated where suitable. In papers where OR could not be calculated data are presented as p values. Most Odds Ratios fell between 1.8 and 5.2 with relatively narrow confidence intervals. In 14 out of 18 calculations, 95% confidence intervals did not cross 1. This suggests that the chance of reporting abuse is higher in people with PNES than those with epilepsy and may be a causative factor in developing PNES. Several limitations of the data and directions for future study are discussed.
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Affiliation(s)
- Laura Lloyd Jones
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Hugh Rickards
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Vogel M, Meyer F, Frommer J, Walter M, Lohmann CH, Croner R. Unwillingly traumatizing: is there a psycho-traumatologic pathway from general surgery to postoperative maladaptation? Scand J Pain 2020; 21:238-246. [PMID: 34387954 DOI: 10.1515/sjpain-2020-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgery may possibly be undermined by psychologic, psychiatric and psychosomatic problems, as long as these problems interfere with a patient's capacity to cope with surgery adaptively. Recent studies have shown that interpersonal trauma, e.g. abuse or neglect, and its correlates are involved in the adaptation to surgery. This observation is heuristically coherent, given the respective traumatization is an interpersonal event occurring in a relationship. Notably, surgery inevitably leads to the violation of physical boundaries within a doctor-patient relationship. Based on the principles of psycho-traumatologic thinking, such a constellation is deemed qualified to activate posttraumatic symptoms in the traumatized. METHOD The present topical review summarizes the respective findings which point to a subgroup of patients undergoing surgery, in whom difficulty bearing tension and confiding in others may cause adaptive problems relevant to surgery. Although this theorizing is empirically substantiated primarily with respect to total knee arthroplasty (TKA), a pubmed-research reveals psychopathologic distress to occur prior to surgery beyond TKA. Likewise, posttraumatic distress occurs in large numbers in the context of several operations, including cardiac, cancer and hernia surgery. CONCLUSION Aspects of psychological trauma may be linked to the outcomes of general surgery, as well, e.g. biliary, hernia or appendix surgery. The mechanisms possibly involved in this process are outlined in terms of a hierarchical organization of specific anxiety and negative affect as well as in terms of psychodynamics which imply the unconscious action of psychologic defenses at their core. IMPLICATIONS Not least, we encourage the screening for trauma and its correlates including defenses prior to general surgery in order to identify surgical candidates at risk of, e.g. chronic postoperative pain, before the operation.
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Affiliation(s)
- Matthias Vogel
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Meyer
- Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Jörg Frommer
- Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena Friedrich Schiller University, Jena, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Roland Croner
- Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
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