Death Anxiety in Huntington Disease: Longitudinal Heath-Related Quality-of-Life Outcomes

A meta-analysis of the association of death anxiety with psychological distress and psychopathology

Death anxiety (DA), apprehension when thinking about death, has long been associated with distress. Studies have suggested that DA may transdiagnostically contribute to mental disorders. We conducted a systematic review and meta-analysis, aiming to estimate the relationship between DA and distress or symptoms of mental disorders. The included studies reported the correlation between DA and distress or symptoms of mental disorders, across general population and clinical samples, using previously validated measures for all outcomes. PsychInfo and the Psychology and Behavioral Sciences Collection (via EBSCO), Embase, and Medline (via PubMed) were systematically searched up to 30 October 2023. Study quality was evaluated with the Study Quality Assessment Tools (National Heart, Lung, and Blood Institute). A total of 129 studies were included, reporting on 158 independent samples, for a total of 34,147 participants. Most studies were rated as poor quality. The findings indicated consistently positive associations between DA and distress outcomes (general anxiety: r = 0.42, P < 0.001; depression: r = 0.41, P < 0.001; distress: r = 0.36, P < 0.001). Heterogeneity was substantial, and prediction intervals crossed zero for all outcomes, except for anxiety and distress. We found no moderation by DA measure, sample type or the proportion of women in the sample. However, the association was stronger (t(35.37) = -2.055, P = 0.047) when medical conditions were present (r = 0.48, P < 0.001) than when they were absent (r = 0.37, P < 0.001). There was evidence of small-study effects, indicating possible publication bias. DA should be investigated in longitudinal studies across diverse samples of patients to clarify its contribution to psychopathology.

[Psychiatric symptoms of Huntington's disease]

Huntington's disease (HD) is an autosomal dominant inherited disease, which leads to motor, cognitive and psychiatric symptoms. The diagnosis can be confirmed by genetic testing for extended CAG repeats in the Huntingtin gene. Mental and behavioral symptoms are common in HD and can appear several years before the onset of motor symptoms. The psychiatric symptoms include apathy, depression, anxiety, obsessive-compulsive symptoms and, in some cases, psychoses and aggression. These are currently restricted to symptomatic treatment as disease-modifying treatment approaches are still under investigation. The current clinical practice is based on expert opinions as well as experience with the treatment of similar symptoms in other neurological and mental health diseases. This article provides an overview of the complex psychiatric manifestations of HD, the diagnostic options and the established pharmacological and nonpharmacological treatment approaches.

Pathomechanisms of behavioral abnormalities in Huntington disease: an update

Huntington disease (HD), a devastating autosomal-dominant neurodegenerative disease caused by an expanded CAG trinucleotide repeat, is clinically characterized by a triad of symptoms including involuntary motions, behavior problems and cognitive deficits. Behavioral symptoms with anxiety, irritability, obsessive-compulsive behaviors, apathy and other neuropsychiatric symptoms, occurring in over 50% of HD patients are important features of this disease and contribute to impairment of quality of life, but their pathophysiology is poorly understood. Behavior problems, more frequent than depression, can be manifest before obvious motor symptoms and occur across all HD stages, usually correlated with duration of illness. While specific neuropathological data are missing, the relations between gene expression and behavior have been elucidated in transgenic models of HD. Disruption of interneuronal communications, with involvement of prefronto-striato-thalamic networks and hippocampal dysfunctions produce deficits in multiple behavioral domains. These changes that have been confirmed by multistructural neuroimaging studies are due to a causal cascade linking molecular pathologies (glutamate-mediated excitotoxicity, mitochondrial dysfunctions inducing multiple biochemical and structural alterations) and deficits in multiple behavioral domains. The disruption of large-scale connectivities may explain the variability of behavior profiles and is useful in understanding the biological backgrounds of functional decline in HD. Such findings offer new avenues for targeted treatments in terms of minimizing neurobehavioral impairment in HD.

Relationship Between Posttraumatic Stress Disorder, Death Anxiety, and Insomnia in Adults After the Earthquake

This study aimed to determine the relationship between posttraumatic stress disorder, death anxiety, and insomnia in adults after the earthquake. This study, designed in a relational-cross-sectional-descriptive model, was conducted with 624 adult individuals living in a province affected by the earthquake that occurred in Turkey on February 6, 2023. The study data were collected using a personal information form, Posttraumatic Stress Disorder Checklist, Turkish Death Anxiety Scale, and Bergen Insomnia Scale. The analysis of the study data was performed by using SPSS 25.0, AMOS 24.0, and G*Power 3.1 Statistical package software. A significant positive correlation was found between posttraumatic stress disorder and Insomnia and Death Anxiety (p < .05). There was a significant positive correlation between Death Anxiety and Insomnia (p < .05). It was determined that Death Anxiety has a mediating role in the impact of posttraumatic stress disorder on insomnia (95% Confidence Interval: 0.572/1.407) (p < .05). It was determined that the model created in line with the hypotheses was compatible and the model fit indices were within the desired limits, with x2/df = 1.795, RMSEA = 0.03, CFI = 0.95, GFI = 0.946, AGFI = 0.93, IFI = 0.95. It was determined that posttraumatic stress disorder increased death anxiety and insomnia after the earthquake. Conducting longitudinal studies on the post-earthquake period is recommended.

Relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases: mediating effects of death anxiety

BACKGROUND

Many studies have explored the relationship between self-esteem and quality of life. However, few studies have elucidated the mechanisms underlying the relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases. The present study aimed to explore the mediating role of death anxiety in this relationship.

METHODS

Middle-old-aged patients with chronic diseases were selected as the respondents by using a multi-stage sampling method, random number table method from October 2021 to February 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine. The Cumulative Disease Rating Scale, the Self-Esteem Scale (SES), the Chinese version of the Death Anxiety Scale (CT-DAS), and the Simplified version of the Quality of Life Scale (SF-12) were used as the researching tools to conduct the survey. SPSS26.0 was used to analysis data. AMOS 23.0 software was used to construct structural equation modeling.

RESULTS

294 valid questionnaires were collected. There were significant differences in quality of life among middle-aged and elderly patients with chronic diseases who have different physical activities, socialization, and chronic pain (P < 0.01); Self-esteem was positively associated with quality of life (r = 0.330, P < 0.01), self-esteem was negatively associated with death anxiety (r = -0.222, P < 0.01), and death anxiety was negatively associated with quality of life (r = -0.263, P < 0.01); Death anxiety partially mediated the relationship between self-esteem and quality of life, with the mediating effect accounting for 18.40% of the total effect.

CONCLUSION

Death anxiety partially mediates the relationship between self-esteem and quality of life. Interventions to improve self-esteem and reduce death anxiety should be used to improve the quality of life of middle-aged and senior patients with chronic diseases.