The training times of athletes could play a role in clinical sleep problems due to their associations with sleep difficulty scores.

OBJECTIVES: Sleep is a key component of athletic recovery, yet training times could influence the sleep of athletes. The aim of the current study was to compare sleep difficulties in athletes across different training time groups (early morning, daytime, late evening, early morning plus late evening) and to investigate whether training time can predict sleep difficulties. METHODS: Athletes from various sports who performed at a national-level (n = 273) answered the Athlete Sleep Screening Questionnaire (ASSQ) along with several other questionnaires related to demographics, exercise training, and mental health. From the ASSQ, a Sleep Difficulty Score (SDS) was calculated. Transformed SDS (tSDS) was compared across different training time categories using multiple one-way ANOVAs. A stepwise regression was then used to predict tSDS from various sleep-related factors. RESULTS: SDSs ranged from none (31%), mild (38%), moderate (22%), and severe (9%). However, the one-way ANOVAs revealed training earlier or later vs. training daytime shifted the tSDS in a negative direction, a trend toward increased sleep difficulty. In particular, athletes training in the late evening (>20:00 or >21:00) had a significantly higher tSDS when compared to daytime training (p = .03 and p < .01, respectively). The regression model (p < .001) explained 27% of variance in the tSDS using depression score, age, training time, and chronotype score. CONCLUSION: Among a heterogeneous sample of national-level athletes, 31% displayed moderate to severe SDSs regardless of their training time. However, when athletes trained outside daytime hours there was a tendency for the prevalence of sleep difficulties to increase.

Pituitary dysfunction following mild traumatic brain injury in female athletes.

Objective: Pituitary dysfunction following mild traumatic brain injury can have serious physical and psychological consequences, making correct diagnosis and treatment essential. To the best of our knowledge, this study is the first to study the prevalence of pituitary dysfunction following mild traumatic brain injury in an all-female population following detailed endocrinological work-up after screening for pituitary dysfunction in female athletes. Design: This is a retrospective cohort study. Methods: Hormone screening blood tests, including serum blood values for thyroid-stimulating hormone, free thyroxin, insulin-like growth factor 1, prolactin, cortisol, follicle-stimulating hormone, luteinizing hormone, estrogen and progesterone, were taken in 133 female athletes. Results were repeatedly outside the reference value in 88 women necessitating further endocrinological evaluation. Two of those were lost to follow-up, and further endocrinological evaluation was performed in 86 participants. Results: Six women (4.6%, n = 131) were diagnosed with hypopituitarism, four (3.1%) with central hypothyroidism and two with growth hormone deficiency (1.5%). Ten women (7.6%) had hyperprolactinemia, and four (3.1%) of them had prolactinoma. Medical treatment was initiated in 13 (9.9%) women. Significant prognostic factors were not found. Conclusions: As 12.2% of female athletes with a history of mild traumatic brain injury had pituitary dysfunction (hypopituitarism 4.6%, hyperprolactinemia 7.6%), we conclude that pituitary dysfunction is an important consideration in post-concussion care. Hyperprolactinemia in the absence of prolactinoma may represent pituitary or hypothalamic injury following mild traumatic brain injury. Significance statement: Mild traumatic brain injury (mTBI) has become a growing public health concern as 50 million people worldwide sustain a traumatic brain injury annually, with mTBI being the most common (70-90%). As studies on mTBI have focused on mostly male populations this study aims to explore pituitary dysfunction (PD) in female athletes following mTBI. To the best of our knowledge, it is the first all-female study on PD following mTBI. The study found that 12.2% of the participating women had PD after mTBI. Six (4.6%) had hypopituitarism and ten (7.6%) had hyperprolactinemia. These findings suggest that PD following mTBI is an important consideration that endocrinologists and other medical staff working with athletes need to be aware of.

Investigating the PHQ-9 With Mokken Scale Analysis and Cognitive Interviews.

Scores on the Patient Health Questionnaire-9 (PHQ-9) are frequently used to assess depression both in research and in clinical practice. The aim was to examine the validity of the PHQ-9 sum score by using Mokken scale analysis (Study I) and cognitive interviews (Study II) on the Icelandic version of PHQ-9. A primary care sample of 618 individuals was used in Study I. The results indicate that the PHQ-9 items are not close enough to perfectly unidimensional for their sum score to accurately order people on the depression severity dimension. In Study II, the sample consisted of 53 individuals, with 28 having a history of depression and 25 not. The findings reveal a number of issues concerning respondents' use of the PHQ-9. No systematic differences were found in the results of the two groups. The PHQ-9 sum score should thus be interpreted and used with great care. We provide scale revision recommendations to improve the quality of PHQ-9.

Screening for possible hypopituitarism following mild traumatic brain injury: The first all-female study. Who do we need to evaluate further?

BACKGROUND: Studies on hypopituitarism (HP) following mild traumatic brain injury (mTBI) have focused on male populations although women may be more susceptible to the sequelae of mTBI. This is, to the best of our knowledge, the first all-female study screening for HP following mTBI. OBJECTIVE: Screening for possible HP in female athletes reporting a history of one or more mTBI. METHODS: Pituitary hormone screening blood tests (SBT) were performed in 133 of the 151 female athletes included. Repeated results outside the reference value (O-RV) were considered abnormal necessitating further endocrinological evaluation. RESULTS: Repeated SBT were O-RV in 88 women (66.2%). Decreased levels of serum insulin growth factor 1 (S-IGF1) were found in 55.6% of participants and elevated levels of serum prolactin (S-prolactin) in 22.6%. Serum cortisol levels were below the RV in 6.0% and thyroid hormonal levels in 11.3%. Lower age and increased number of mTBI symptoms correlated significantly with the risk of hormonal results O-RV. CONCLUSION: The majority of the study population had SBT O-RV, warranting further workup of possible HP. Decreased levels of S-IGF1 were most commonly observed followed by elevated S-prolactin possibly indicating hypothalamic-pituitary impairment. Lower age and increased number of symptoms of mTBI may indicate the need to screen for HP.

Towards defining biomarkers to evaluate concussions using virtual reality and a moving platform (BioVRSea).

Current diagnosis of concussion relies on self-reported symptoms and medical records rather than objective biomarkers. This work uses a novel measurement setup called BioVRSea to quantify concussion status. The paradigm is based on brain and muscle signals (EEG, EMG), heart rate and center of pressure (CoP) measurements during a postural control task triggered by a moving platform and a virtual reality environment. Measurements were performed on 54 professional athletes who self-reported their history of concussion or non-concussion. Both groups completed a concussion symptom scale (SCAT5) before the measurement. We analyzed biosignals and CoP parameters before and after the platform movements, to compare the net response of individual postural control. The results showed that BioVRSea discriminated between the concussion and non-concussion groups. Particularly, EEG power spectral density in delta and theta bands showed significant changes in the concussion group and right soleus median frequency from the EMG signal differentiated concussed individuals with balance problems from the other groups. Anterior-posterior CoP frequency-based parameters discriminated concussed individuals with balance problems. Finally, we used machine learning to classify concussion and non-concussion, demonstrating that combining SCAT5 and BioVRSea parameters gives an accuracy up to 95.5%. This study is a step towards quantitative assessment of concussion.

Staying Active under Restrictions: Changes in Type of Physical Exercise during the Initial COVID-19 Lockdown.

The COVID-19 pandemic and the associated governmental restrictions suddenly changed everyday life and potentially affected exercise behavior. The aim of this study was to explore whether individuals changed their preference for certain types of physical exercise during the pandemic and to identify risk factors for inactivity. An international online survey with 13,881 adult participants from 18 countries/regions was conducted during the initial COVID-19 related lockdown (between April and May 2020). Data on types of exercise performed during and before the initial COVID-19 lockdown were collected, translated, and categorized (free-text input). Sankey charts were used to investigate these changes, and a mixed-effects logistic regression model was used to analyze risks for inactivity. Many participants managed to continue exercising but switched from playing games (e.g., football, tennis) to running, for example. In our sample, the most popular exercise types during the initial COVID-19 lockdown included endurance, muscular strength, and multimodal exercise. Regarding risk factors, higher education, living in rural areas, and physical activity before the COVID-19 lockdown reduced the risk for inactivity during the lockdown. In this relatively active multinational sample of adults, most participants were able to continue their preferred type of exercise despite restrictions, or changed to endurance type activities. Very few became physically inactive. It seems people can adapt quickly and that the constraints imposed by social distancing may even turn into an opportunity to start exercising for some. These findings may be helpful to identify individuals at risk and optimize interventions following a major context change that can disrupt the exercise routine.

Prevalence, mental health and substance use of anabolic steroid users: a population-based study on young individuals.

Aims: The use of anabolic androgen steroids to enhance performance is not a modern phenomenon. However, the majority of today's anabolic androgen steroid users are not competitive athletes, but individuals who want to look leaner and muscular. This study aimed to examine the prevalence of anabolic androgen steroid use among young individuals and assess whether their mental health, lifestyle and substance use differ from non-anabolic androgen steroid users. Methods: A population-based study conducted in secondary schools, mean age was 17.3 years. A total of 10,259 participants (50% young women, 1% reported gender as 'other', 49% young men) answered questions on mental health, anabolic androgen steroid use, substance use and sports participation. Statistical analysis included descriptive statistics, t-test, χ2 and logistic regression. Results: The prevalence of anabolic androgen steroid use was 1.6%, and 78% of users were young men. Anabolic androgen steroid users had more anger issues, anxiety, depression, and their self-esteem was lower than among non-anabolic androgen steroid users (P<0.05). A larger proportion of anabolic androgen steroid users, 30%, had attempted suicide compared to 10% of non-users (χ2 (1, 9580) = 57.5, P<0.001). Proportionally, anabolic androgen steroid users were more likely to take medicine for mental health problems and misuse substances than non-users. Participation in non-organised sports, increased anger and body image were associated with increased odds of using anabolic androgen steroids. Conclusions: Anabolic androgen steroid use is a public health threat. It had an alarming effect on the life of individuals who report having used anabolic androgen steroids. Authorities, healthcare workers, parents and others working with young people need to be informed of the signs and risks of anabolic androgen steroid use to reduce future negative implications.

Effects of 2 physical exercise programs (circuit training and brisk walk) carried out during working hours on multidimensional components of workers' health: a pilot study.

OBJECTIVES: The objective of this study was to determine the effects of 2 physical exercise programs carried out during working hours in an office work environment on health-related parameters of employees. MATERIAL AND METHODS: The participants included 47 healthy office worker volunteers (aged 45±11.95 years, 27% males) who formed 3 groups: circuit training (CT), brisk walk (BW), and control (C) groups. The interventions lasted 12 weeks with a weekly frequency of three 30-minute sessions in the middle of the workday. All employees were evaluated with a multicomponent battery test which included: anthropometric and body composition measurements, a cardiorespiratory fitness test, lipid profile, blood pressure, and mental health (depression, anxiety, and stress). Basic descriptive statistics were calculated. A repeated measures ANOVA was performed to summarize changes in the variables studied after the application of the physical exercise programs. RESULTS: Generally, both exercise programs (CT and BW) maintained the body weight and body mass index while reducing body fat mass (a group × time interaction; 4.864 ≤ F ≤ 6.524, 0.001 ≤ p ≤ 0.015), although the CT intervention also showed relevant (inter-group) reductions in the waist-hip ratio (F = 11.311, p = 0.007) and increased skeletal muscle mass (F = 15.062, p = 0.003). Both exercise programs (CT and BW) improved the cardiorespiratory fitness test scores (a group × time interaction; F = 18.054, p < 0.001). There were no changes in the lipid profile or blood pressure after the interventions, but there was an improvement in mental health (4.760 ≤ F ≤ 8.087, 0.008 ≤ p ≤ 0.037). CONCLUSIONS: The findings suggest that both types of programs could be implemented in the employees' daily routine in order to improve their overall health. Nevertheless, studies with larger samples are necessary before the conclusions can be generalized. Int J Occup Med Environ Health. 2021;34(1):39-51.

Self-reported concussion history among Icelandic female athletes with and without a definition of concussion.

OBJECTIVE: This study examined whether Icelandic female athletes in contact sports, based their self-reported concussion history on adequate medical definitions, by assessing self-reported concussion history with and without a definition of concussion. Another aim was to examine whether currently active athletes were more knowledgeable of concussions than retired athletes. METHODS: Participants (age = 26.9, SD = 7.1) were 508 former (34.5%) and current (65.5%) elite female athletes in soccer (41%), handball (30.6%), basketball (19.1%), ice hockey (4.5%) and combat sports (4.7%). An online questionnaire (QuestionPro) was distributed to females in contact sports (snowball sampling). Participants later came for an in-person interview where the authenticity of previous responses was confirmed. In the questionnaire, participants answered background questions and questions about concussion history. First, they reported the total number of sustained concussions without a prompt. They reported the number of sustained concussions again after reading a definition of concussion. Participants could not correct their previous answers. Pearson's Chi-square was used for group comparisons. RESULTS: The prevalence of reported concussions increased from 40.2% to 64.8% following a definition. There was no significant difference in how many participants changed their answer when asked about sustaining SRCs before and after reading the definition based on whether the participants were still competitive or retired X2(1) = 0.69, p = 0.41. CONCLUSIONS: Our data suggest that understanding of concussions is inadequate among female athletes. Self-report will continue to be an essential source of clinical information and prompting with a definition can increase the reliability of self-reported concussions.

Psychological characteristics in women football players: Skills, mental toughness, and anxiety.

Women's football has been far less studied than men's. This work's objectives were to: (1) analyze the differences in psychological skills, mental toughness (MT), and anxiety in women football players according to their level (national team, first division, and second division); and (2) predict those three levels (using a multivariate model) according to the players' psychological skills, mental toughness, and anxiety. One hundred and forty-two Icelandic women football players (23.5 ± 3.5 years) participated in the study. They were classified into three groups according to their level: national team, and first and second divisions. Three questionnaires were used: the Test of Performance Strategies Questionnaire, the Sport Mental Toughness Questionnaire, and the Sport Anxiety Scale-2 questionnaire. A one-way ANOVA with Bonferroni post hoc correction was used to examine differences between teams. Applying a classification tree analysis, the participants were classified into three groups according to their level. There were few differences between the three groups in psychological skills, but in mental toughness and anxiety the national team had the highest and lowest values respectively, and the first and second division players differed in relaxation in competition (TOPS), total score and confidence (SMTQ), and worry (SAS-2). The classification tree correctly classified 54.9% of the sample with the variables total score (SMTQ) and activation in practice (TOPS). Therefore, given the relevance that psychological attributes appear to have for women football players' performance, it would seem indispensable to incorporate the figure of the sports psychologist into national and club teams.

Body Image Concern and Eating Disorder Symptoms Among Elite Icelandic Athletes.

The aim of this study was to analyse body image concerns and symptoms of eating disorders in elite Icelandic athletes according to their sex, and sport practiced. The participants were 755 athletes (24.8 ± 3.5 years in age) who compete at the highest possible level in Iceland. Representing 20 different sports, they were divided into five sports groups. Three questionnaires were used: the Body Shape Questionnaire to assess body image concerns; the Bulimia Test-Revised to assess the main symptoms of bulimia; and the Eating Disorder Examination Questionnaire to identify disordered eating attitudes and behaviours. A chi-squared test was used to analyse differences in prevalence of body image concern and eating disorders, a t-test for the differences between men and women, and a one-way ANOVA to compare the different sports. The main findings were that 17.9% of the athletes presented severe or moderate body image dissatisfaction, and 18.2% (25.3% of the women) were above the clinical cutoff for body image concern. Women's scores were higher than men's (whole sample and ball games) in all variables except restraint. These results seem to point to the existence of a real problem that athlete, coaches, doctors, and institutions need to take into account.

Effects of a Brief Transdiagnostic Cognitive Behavioural Group Therapy on Disorder Specific Symptoms.

BACKGROUND: In recent years, cognitive behavioural group therapies (CBGT) have been increasingly deployed as a strategy to increase the efficiency and cost-effectiveness in treatment of common mental health problems. The vast majority of these therapies are disorder specific, but in the last few years there has been growing interest in transdiagnostic CBGT. AIMS: The aim of this study was twofold: to evaluate the treatment effects of transdiagnostic CBGT on disorder specific symptoms and what (if any) differences would be observed in the treatment effects with regard to general as opposed to disorder specific symptoms measured pre- and post-treatment. METHOD: The participants were 233 adult patients diagnosed with depression and/or anxiety disorders. They underwent a 6-week transdiagnostic CBGT. To compare treatment effects on general and disorder specific symptoms, raw scores on all measures were converted to standardized scores. RESULTS: Pre-post differences were significant and there was no evidence that treatment was differentially effective for general and disorder specific symptoms. Effect sizes ranged from medium to large. CONCLUSION: The 6-week transdiagnostic CBGT is feasible for a wide range of mood and anxiety disorders. The results indicate that low-intensity transdiagnostic group therapies may have similar effects on both general and disorder specific symptoms.

Educational and sport factors as predictors of harmful alcohol drinking in adolescence: a prospective study in Bosnia and Herzegovina.

OBJECTIVES: The cause-effect relationship between educational and sport factors, and alcohol drinking in adolescents is rarely prospectively investigated. This study aimed to establish the possible influence of sport, scholastic and socio-demographic factors on harmful alcohol drinking (HD) and the initiation of HD in adolescents from Bosnia-Herzegovina. METHODS: Study included 881 adolescents (49% females) and consisted of (1) baseline tests (16 years of age) and (2) follow-up testing (18 years of age). The independent variables were scholastic and sport-related factors. Alcohol Use Disorders Identification Test was used, with the following dependent variables: (1) HD at baseline, (2) HD at follow-up, and (3) HD initiation. Logistic regressions were applied to define the relationships. RESULTS: Higher likelihood of HD was evidenced in children who performed poorly in school. Sport factors were positively correlated with HD at study baseline. Higher odds for HD initiation were found for adolescents who reported a lower GPA, a lower behavioral grade, more frequent school absences, and more unexcused school absences. CONCLUSIONS: The results showed scholastic failure as the predictor of HD initiation. The potential influence of sport factors on HD initiation should be studied at an earlier age.

Anthropometric Characteristics, Physical Fitness, and Throwing Velocity in Elite women's Handball Teams.

Saavedra, JM, Kristjánsdóttir, H, Einarsson, IÞ, Guðmundsdóttir, ML, Þorgeirsson, S, and Stefansson, A. Anthropometric characteristics, physical fitness, and throwing velocity in elite women's handball teams. J Strength Cond Res 32(8): 2294-2301, 2018-The aims of this study were (a) to analyze anthropometric, physical fitness, and throwing speed in women elite handball players of different ages and (b) to develop a multivariate model explaining handball performance from a multidimensional perspective. Eighty women handball players (18.2 ± 4.0 years in age) from national team selections participated in the study. The players belonged to A Team, under-19, under-17, and under-15 national teams. All were evaluated by basic anthropometry, physical fitness tests, and handball throwing speed. A 1-way analysis of variance was used to establish the differences between teams with a Bonferroni post hoc test. For each team, a discriminant analysis was performed to determine the predictor variables of performance. Pearson's simple correlation coefficients were calculated between each of the variables. The results of this particular study showed that (a) between the A Team and the U19 team, there were only differences in mass, countermovement jump (CMJ), medicine ball throw, and yo-yo test, (b) the A Team and U19 predictive models correctly classified 76 and 90% of the samples, respectively, with the variables involved being mass and body mass index (A Team) and 30-m sprint and 7-m throwing speed (U19 team), and (c) the 7- and 9-m throwing speeds were correlated with each other and with stature, mass, CMJ, and medicine ball throw (0.367 ≤ r ≤ 0.533; 0.001 ≤ p ≤ 0.05). These results could help improve coaches' knowledge of elite female teams, in particular, in the country where the study was conducted and in others of similar characteristics.

Discriminatory Power of Women's Handball Game-Related Statistics at the Olympic Games (2004-2016).

Sports performance analysis has been a growing field of study in the last decade. However, the number of studies in handball is small. The aims of this present study were (i) to compare handball game-related statistics by the match outcome (winning and losing teams) and (ii) to identify characteristics that discriminated performance in elite women's handball. The game-related statistics of the 236 matches played in the last four Olympic Games (Athens, Greece, 2004; Beijing, China, 2008; London, United Kingdom, 2012; and Rio de Janeiro, Brazil, 2016) were analysed. Differences between match outcomes (winning or losing teams) were determined using the chi-squared statistic, also calculating the effect sizes of the differences. A discriminant analysis was then performed applying the sample-splitting method according to match outcomes. The results showed the differences between winning and losing teams were red cards and assists. Also, the discriminant analysis selected five variables (shots, goalkeeper-blocked shots, technical fouls, steals, and goalkeeper-blocked fast-break shots) that classified correctly 83% of matches. The selected variables included offensive and defensive predictors. Coaches and players can use these results as a reference against which to assess their performance and plan training.

Effects of Exercise on Depression and Anxiety. A Comparison to Transdiagnostic Cognitive Behavioral Therapy.

The aims of this study were (i) to know the effects of an exercise program on a group of people with depression and anxiety and (ii) to compare theses effects with a transdiagnostic cognitive behavioral group therapy (TCBGT). The participants were 15 people with depression and/or anxiety symptoms. The participants followed an exercise program. Depression and anxiety symptoms were assessed with validated questionnaires. An exercise program can be used as a treatment option for people with depression and/or anxiety with good results in comparison with TCBGT.

Transdiagnostic cognitive behavioural treatment and the impact of co-morbidity: An open trial in a cohort of primary care patients.

BACKGROUND: The development of initiatives to improve access to psychological therapies has been driven by the realization that untreated anxiety and depression are both very common and costly to individuals as well as society. Effective and efficient treatments, mostly in the form of cognitive behavioural therapies (CBT), can be used in ways which enhance their acceptability and accessibility. To date, numbers of group therapies have been developed to improve cost efficiency, but in spite of growing interest in transdiagnostic approaches, group therapies have so far mostly been diagnosis specific. AIMS: This study is aimed at evaluating a brief transdiagnostic cognitive behavioural group therapy (TCBGT) designed to treat both anxiety and depression among patients in primary care. METHOD: The participants were 287 adult patients in primary care with diagnoses of depression and/or anxiety disorders. They underwent a 5-week TCBGT. A mixed design ANOVA was used to evaluate differential effects of treatment according to diagnostic groups (anxiety versus depression) and number of diagnoses (co-morbidity). RESULTS: Pre-post differences were significant and the treatment was equally effective for both anxiety disorders and depression. Number of diagnoses did not affect the outcome. CONCLUSIONS: The study indicates feasibility of the brief transdiagnostic group therapy for a wide range of mood and anxiety disorders in primary care. The results indicate that low intensity, brief transdiagnostic group therapies may be a feasible way to improve access to psychological therapies for a large number of patients.

Evaluation of the psychometric properties of the Icelandic version of the Clinical Outcomes in Routine Evaluation-Outcome Measure, its transdiagnostic utility and cross-cultural validation.

BACKGROUND: The development of transdiagnostic standardized measures of psychological distress have contributed to the development of practice-based evidence networks. The translation and validation of such measures cross culturally is important if such research is to be generalized across health care systems in different countries. METHOD: Translation of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) from English into Icelandic was undertaken according to recommended protocols. The resulting instrument was evaluated for reliability and validity in three groups: patients undergoing psychological treatment in general practice (n = 289), psychiatric outpatients (n = 98) and student controls (n = 207). The Mini-International Neuropsychiatric Interview was administered to the clinical participants. They also completed the CORE-OM and the Beck depression and anxiety inventories before and after treatment. The transdiagnostic relationship between CORE-OM scores and scores on those diagnostic measures was assessed. RESULTS: Good levels of validity, reliability and internal consistency were found for the CORE-OM and its domains and sensitivity to change over treatment shown. As anticipated, the risk domain had different characteristics than other domains. CORE-OM scores correlated strongly with both Beck Depression Inventory-Second edition and Beck Anxiety Inventory, particularly the problem domain. CONCLUSION: The Icelandic translation of the CORE-OM is psychometrically sound and can be applied in Icelandic mental health studies as it has been in English speaking settings. Nevertheless, the validity of the Icelandic version of the CORE-OM needs to be further investigated in larger and more diverse samples. KEY PRACTITIONER MESSAGE: The psychometric properties of the Icelandic version of the CORE-OM are comparable with the original English version. The results indicate transdiagnostic utility of the CORE-OM. The CORE-OM is a valuable instrument in outcome research on psychological treatment, specifically transdiagnostic treatment.

[The effect of antidepressants and sedatives on the efficacy of transdiagnostic cognitive behavioral therapy in groups in primary care]. / Ahrif thunglyndislyfja og roandi lyfja a arangur af osertaekri hugraenni atferlismedferd hopa i heilsugaeslu.

BACKGROUND: Cognitive behavioral therapy (CBT) and SSRI/SNRI antidepressants have proven to be effective treatments for anxiety and depression. The gain from combined CBT and antidepressant therapy has in some studies been greater than from monotherapy. Benzodiazepines may interfere with the efficacy of individual CBT-treatment. We examined the effects of SSRI/SNRI antidepressants and the effects of benzodiazepines/z-drugs on the efficacy of group CBT (gCBT) in primary care. MATERIAL AND METHODS: Primary outcome measures were the Beck's Depression Inventory II (BDI-II) and the Beck's Anxiety Inventory (BAI) scores before treatment and after the last session. The last observed score was carried forward and compared to the initial score for each individual, irrespective of the timing of the last score (LOCF). Mean change of scores was compared between groups of individuals on or not on SSRI/SNRI antidepressants and/or benzodiazepines/z-drugs. RESULTS: Over three years 557 subjects participated in a 5 week-long gCBT. Of these 355 returned BDI-II and 350 returned BAI at least twice. The mean score on SSRI/SNRI or benzo/z-drugs fell significantly both for those on combined treatment (medication and gCBT) and those who only received gCBT. Combined treatment with SSRI/SNRI and gCBT led to a greater fall in depressive symptoms compared to gCBT monotherapy. The efficacy of such combined treatment was less for those who also were prescribed benzodiazepines and/or z-drugs. CONCLUSIONS: Group CBT significantly improved symptoms of anxiety and depression in primary care. The improvement was not reduced by concomitant use of SSRI/SNRI antidepressants nor of benzodiazepines/z-hypnotics. The use of such medication is therefore not contraindicated for gCBT participants, at least not short term. Adding SSRIs or SNRIs to gCBT led to greater efficacy in reducing depressive symptom though the efficacy of such combined treatment was less for those who were also prescribed benzodiazepines and/or z-hypnotics.