A Proposed Algorithm for the Pharmacological Treatment of Generalized Anxiety Disorder in the Older Patient.

BACKGROUND: This is a new algorithm from the Psychopharmacology Algorithm Project at the Harvard South Shore Program, focused on generalized anxiety disorder (GAD) in older adults. Pertinent articles were identified and reviewed. RESULTS: Selective serotonin reuptake inhibitors (SSRIs) are considered to be first-line medications, with a preference for sertraline or escitalopram. If avoiding sexual side effects is a priority, buspirone is an option for the relatively healthy older adult. If response is inadequate, the second recommended trial is with a different SSRI or one of the serotonin-norepinephrine update inhibitors (SNRIs), venlafaxine or duloxetine. For a third medication trial, additional alternatives added to the previous options now include pregabalin/gabapentin, lavender oil, and agomelatine. If there is an unsatisfactory response to the third option chosen, quetiapine may be considered. We recommend caution with the following for acute treatment in this population: benzodiazepines and hydroxyzine. Other agents given low priority but having some supportive evidence were vilazodone, vortioxetine, mirtazapine, and cannabidiol. Acknowledging that the median age of onset of GAD is in early adulthood, many patients with GAD will have been started on benzodiazepines (or other medications that require caution in the elderly) for GAD at a younger age. These medications may be continued with regular observation to see if the potential harms are starting to exceed the benefits and a switch to other recommended agents may be justified.

Enhanced diagnostics for generalized anxiety disorder: leveraging differential channel and functional connectivity features based on frontal EEG signals.

Generalized Anxiety Disorder (GAD) is a chronic anxiety condition characterized by persistent excessive worry, anxiety, and fear. Current diagnostic practices primarily rely on clinicians' subjective assessments and experience, highlighting a need for more objective and reliable methods. This study collected 10-minute resting-state electroencephalogram (EEG) from 45 GAD patients and 36 healthy controls (HC), focusing on six frontal EEG channels for preprocessing, data segmentation, and frequency band division. Innovatively, this study introduced the "Differential Channel" method, which enhances classification performance by enhancing the information related to anxiety from the data, thereby highlighting signal differences. Utilizing the preprocessed EEG signals, undirected functional connectivity features (Phase Lag Index, Pearson Correlation Coefficient, and Mutual Information) and directed functional connectivity features (Partial Directed Coherence) were extracted. Multiple machine learning models were applied to distinguish between GAD patients and HC. The results show that the Deep Forest classifier achieves excellent performance with a 12-second time window of DiffFeature. In particular, the classification of GAD and HC was successfully obtained by combining OriFeature and DiffFeature on Mutual Information with a maximum accuracy of 98.08%. Furthermore, it was observed that undirected functional connectivity features significantly outperformed directed functional connectivity when fewer frontal channels were used. Overall, the methodologies developed in this study offer accurate and practical identification strategies for the early screening and clinical diagnosis of GAD, offering the necessary theoretical and technical support for further enhancing the portability of EEG devices.

The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation.

BACKGROUND: Around the world, people living in objectively difficult circumstances who experience symptoms of generalized anxiety disorder (GAD) do not qualify for a diagnosis because their worry is not 'excessive' relative to the context. We carried out the first large-scale, cross-national study to explore the implications of removing this excessiveness requirement. METHODS: Data come from the World Health Organization World Mental Health Survey Initiative. A total of 133 614 adults from 12 surveys in Low- or Middle-Income Countries (LMICs) and 16 surveys in High-Income Countries (HICs) were assessed with the Composite International Diagnostic Interview. Non-excessive worriers meeting all other DSM-5 criteria for GAD were compared to respondents meeting all criteria for GAD, and to respondents without GAD, on clinically-relevant correlates. RESULTS: Removing the excessiveness requirement increases the global lifetime prevalence of GAD from 2.6% to 4.0%, with larger increases in LMICs than HICs. Non-excessive and excessive GAD cases worry about many of the same things, although non-excessive cases worry more about health/welfare of loved ones, and less about personal or non-specific concerns, than excessive cases. Non-excessive cases closely resemble excessive cases in socio-demographic characteristics, family history of GAD, and risk of temporally secondary comorbidity and suicidality. Although non-excessive cases are less severe on average, they report impairment comparable to excessive cases and often seek treatment for GAD symptoms. CONCLUSIONS: Individuals with non-excessive worry who meet all other DSM-5 criteria for GAD are clinically significant cases. Eliminating the excessiveness requirement would lead to a more defensible GAD diagnosis.

Antioxidant intake and its relationship with generalized anxiety disorder among adults.

Antioxidant intake may contribute to the prevention of numerous diseases, particularly those related to stress-induced psychiatric and stress disorders. The current study aimed to assess the relationship between daily antioxidant intake (DAI) and Generalized Anxiety Disorder (GAD) in adults. It also sought to investigate the correlation between the type of diet in conjunction with DAI and the scores on GAD 7-Item Scale in adults. A cross-sectional design was used to examine if DAI was lower in individuals with GAD; followed by an interventional study of 40 adults with severe GAD, who were exposed to higher DAI for a period of 6 weeks. The results indicated that participants with severe GAD had significantly lower levels of DAI compared to healthy controls (p < 0.001). After 6 weeks of antioxidant supplementation, a significant decrease in GAD-7 scores of participants was observed (p < 0.001). The study found a significant negative relationship between DAI and GAD.

Psychometric properties of the generalized anxiety disorder questionnaire (GAD-7) in a polish postpartum women sample.

OBJECTIVE: Generalized Anxiety Disorder is an international mental health problem. Prevalence for anxiety disorders reported in perinatal period is high and related with adverse parental and child outcomes. Thus, the objective of this study was to investigate the psychometric properties and factorial validity of General Anxiety Disorder-7 questionnaire (GAD-7) in the context of postpartum mothers. METHODS: In this cross-sectional study, 278 mothers (mean age 31.09; SD = 4.42) were recruited at the Neonatology, Gynecology, and Obstetrics Ward. Generalized Anxiety Disorder was assessed with GAD-7, stress with Parental Stress Scale (PSS), while risk of depression with Edinburgh Postpartum Depression Scale (EPDS). Confirmatory factor analysis (CFA) was used to verify factor structure of GAD-7 and the internal consistency was evaluated using reliability coefficients: Cronbach's Alpha and McDonald's Omega. RESULTS: The internal consistency of the GAD-7 was high (Cronbach's Alpha = 0.90 and MacDonald's Omega = 0.91). GAD-7 had significant correlations with the variables examined for construct validity, stress (PSS; r = 0.35, p < 0.01) and risk of depression (EPDS; r = 0.76, p < 0.01). The Confirmatory Factor Analysis results supported a good fit of the data to the model: χ²(df) = 14.19 (14), p = 0.44; Comparative Fit Index (CFI) = 0.99; Tucker-Lewis Index (TLI) = 0.99; Root Mean Square Error of Approximation (RMSEA) = 0.007 (90% C.I. 0.000; 0.059). CONCLUSION: GAD-7 has satisfactory psychometric properties. GAD-7 had significant correlations with the variables examined for construct validity with PSS and EPDS. GAD-7 is a reliable instrument for screening anxiety symptoms in perinatal period in research and clinical setting.

Reliability and validity of facial expression recognition in the screening of generalized anxiety disorder.

INTRODUCTION: Anxiety disorder is one of the most prevalent mental disorders in China. However, there are obvious subjective factors in the current assessment of anxiety disorders, which may lead to certain diagnostic errors. The identification and diagnosis of anxiety disorders can be further improved if objective biological indicators are added in the assessment process. The current research validates facial expression recognition as a screening tool to assist in detecting generalized anxiety disorder. METHODS: Based on the International Affective Picture System, we constructed an aided diagnostic experimental paradigm and recorded their facial expression. The split-half reliability was displayed by the Pearson correlation heatmap. The paradigm, GAD-7 and HAMA scales were administered to 60 generalized anxiety disorder patients and 60 matched healthy controls to evaluate the criterion-related validity. Additionally, we conducted a diagnostic study by using MINI as a gold standard and calculated ROC analysis to examine the screening performance of the facial expressions. RESULTS: The heatmap showed very high correlations (r > 0.60, PS < 0.05) along the diagonal of the square heatmap (from the bottom left corner to the top right). The Pearson correlation coefficients between the GAD-7, HAMA and seven facial expressions ranged from -0.35(neutral, P < 0.01) to 0.34(angry, P < 0.01). The intergroup effects of neutral, anger and fear emotions were statistically significant (F = 18.893, P < 0.001; F = 20.535, P < 0.001; F = 9.091, P = 0.003). ROC analysis showed AUC for neutral, angry and scared facial expressions were 0.723, 0.792 and 0.727 respectively. CONCLUSION: This study constructed a tool for auxiliary screening of GAD patients and provided an objective automatic facial expression recognition method to assist psychological diagnosis.

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.

The Prevalence of Anxiety and Depression in Children With Postural Orthostatic Tachycardia Syndrome (POTS): A Retrospective Study.

INTRODUCTION: Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance characterized by various symptoms such as dizziness, lightheadedness, and increased heart rate. Conflicting reports exist regarding the prevalence of anxiety and depression in adults with POTS, while data on pediatric POTS remains scarce. METHOD: A retrospective analysis of pediatric patients aged 11-17 years with POTS, who underwent autonomic testing at Nemours Children's Hospital in Orlando, Florida, was conducted. The patients were screened for anxiety, using the Severity Measure for Generalized Anxiety Disorder-Child Age 11-17 years (GAD-7) questionnaire, and depression, using PHQ-9 Modified for Adolescence (PHQ-A) for depression. The prevalence rates of anxiety and depression in the study cohort were compared to historical data from similar age groups in the existing literature. The study was approved by the Nemours Children's Hospital Institutional Review Board. RESULTS: The cohort comprised 27 children with POTS (26 females, age 15.8±1.6 years). Overall, 74% exhibited moderate-to-severe anxiety, depression, or both, with 44% having comorbid anxiety and depression. In total, 4/27 (14%) had pure depression and 4/27 (14%) had pure anxiety. Six patients had no depression or anxiety. On average, POTS symptoms began 1.9±1.3 years before diagnosis. Eleven patients took stable doses of psychotropic medications. After a follow-up period of 5.1±1.7 months of POTS therapy, seven patients had follow-up questionnaires. In 4/7 patients, the depression severity improved, and in 3/7 patients, the anxiety severity improved. Patients were not actively treated for depression and anxiety during this time. CONCLUSION: Anxiety and depression are prevalent among pediatric patients with POTS. While preliminary data suggests POTS therapy may alleviate these psychological symptoms, further longitudinal studies are warranted to explore the therapeutic impact in greater detail.

Augmented Reality as an Aid to Behavior Therapy for Anxiety Disorders: A Narrative Review.

Anxiety disorders are among the most common mental disorders worldwide. These conditions are characterized by excessive anxiety that is difficult to control. In most anxiety disorders, symptoms are triggered by exposure to specific objects or situations. This leads sufferers to avoid such exposures, leading to impaired social and occupational functioning and reduced quality of life. Therapies based on behavioral principles, either alone or in combination with cognitive techniques, are the most effective psychological interventions for anxiety disorders. However, the effectiveness of these therapies may be limited due to a lack of generalization from clinic to real-world settings. Augmented reality (AR) is a technology that provides an interactive experience by superimposing computer-generated content, often in multiple sensory modalities, on the real world. Emerging evidence suggests that AR may be useful in treating a broad range of mental disorders, including anxiety disorders. This review examines the evidence for the use of AR-based techniques as an aid to behavioral or cognitive-behavioral therapies for anxiety disorders. The available evidence suggests that this method may offer significant advantages over conventional therapies, particularly in the case of specific phobias, but also in social anxiety disorder. AR can also be combined with other novel technologies to monitor psychophysiological markers of anxiety and its reduction over the course of treatment. The advantages of AR could be related to its combination of real and simulated content, allowing for better generalization of the benefits of conventional exposure-based therapy. Though the safety, efficacy, and cost-effectiveness of this method need to be confirmed in larger samples, it could lead to a paradigm shift in the way behavioral therapies for anxiety disorders are conceptualized and delivered.

Shoden promotes Relief from stress and anxiety: A randomized, double-blind, placebo-controlled study on healthy subjects with high stress levels.

Background: This randomized placebo-controlled study examined the effect of ashwagandha root and leaf extract 60 mg (AE60) and 120 mg (AE120) (35 % withanolide glycosides, Shoden) in physically healthy subjects with higher stress and anxiety. It is hypothesized that a low dose extract with higher withanolide glycosides would decrease cortisol and increase testosterone thereby reducing stress and anxiety. Methods: This parallel arm study recruited 60 subjects with an allocation ratio of 1:1:1 (AE60:AE120: placebo) for 60 days. Subjects who fulfilled the DSM -IV Criteria for generalized anxiety disorder (GAD) with a Hamilton Anxiety Rating Scale, HAMA score >20, and morning serum cortisol >25 mcg/dl were included in the study. The participants did not have depression symptoms and were screened using Montgomery-Asberg Depression Rating Scale. The primary outcome measure was HAMA and the secondary measures were morning serum cortisol, testosterone, perceived stress scale (PSS), clinical global impressions scale (CGI), and patient's global impression of change scale (PGIC). Results: After 60 days, significant differences were observed between the treatment groups and placebo. HAMA scores decreased by 59 % in both AE60 and AE120 groups compared to a negligible increase of 0.83 % in the placebo group (p < 0.0001). Morning serum cortisol levels decreased by 66 % in AE60 and 67 % in AE120, compared to a 2.22 % change in the placebo group (p < 0.0001). Testosterone levels increased by 22 % in AE60 and 33 % in AE120, compared to a 4 % increase in males in the placebo group (p < 0.0001). PSS scores decreased by 53 % in AE60 and 62 % in AE120, CGI-severity scores decreased by 72 % in AE60 and 68 % in AE120, and PGIC scores improved by 60 % in both AE60 and AE120 groups, all showing significant differences compared to the placebo group. Conclusion: Ashwagandha extract with 35 % withanolide glycosides (Shoden) at 60 mg and 120 mg was significantly effective in reduced morning serum cortisol and increasing total testosterone. Therefore, it can be recommended for reducing high stress and anxiety. Clinical trial registration: The study was prospectively registered in Clinical Trial Registry, India with registration number CTRI/2022/04/042133 [Registered on: April 25, 2022].

Anxiety and sleep mediate the effect of food insecurity on depression in single parents in Ghana.

BACKGROUND: Data on the association between food insecurity and depression in single parents in low- and middle-income countries (LMICs) are limited, and no study has reported the serial mediation effects of psychosocial factors in this association. This study examines the extent to which anxiety and sleep serially explain the food insecurity and depression link among single parents in Ghana. METHODS: Data on 627 single parents were obtained through a multi-stage stratified sampling technique. Food insecurity was assessed using the Food and Agriculture Organization Food Insecurity Experience Scale (FIES), and depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D-10). Multivariable OLS models and bootstrapping serial mediation analyses were performed to evaluate the hypothesized associations. RESULTS: The mean age (SD) was 45.0 (14.7) years; 67.3% females. After full adjustment, food insecurity was significantly associated with increases in anxiety symptoms (ß = 0.61, 95%CI = 0.476 - 0.737), sleep problems (ß = 0.04, 95%CI = 0.02 - 0.07), and depression (ß = 0.24, 95%CI = 0.12 - 0.36). Food insecurity indirectly related to depression via anxiety (ß = 0.35, 95%CI = 0.26-0.44) representing 55.8%, sleep (ß = 0.03, 95%CI = 0.0032-0.0575) suggesting 4.0%, and anxiety→sleep (ß = 0.013, 95%CI = 0.0024-0.0265) yielding 2.0% of the total effect. CONCLUSIONS: Food insecurity was positively associated with depression. This association was partially and serially explained by generalized anxiety and sleep problems. Efforts to address depression among single parents should consider interventions for food insecurity and psychosocial problems, particularly in LMICs.

Examining the psychometric properties of the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 among young urban South African women.

BACKGROUND: Valid, reliable, and easy-to-administer scales are crucial for identifying mental health conditions, especially in LMICs where such scales tend not to be validated. This study aims to address this gap by investigating the psychometric properties and factorial structure of the PHQ-9 and GAD-7 in a sample of young women in Soweto, South Africa. METHODS: The PHQ-9 and GAD-7 were administered to 6028 women aged 18-28 years old. Cronbach's alpha, Mokken scale analysis, and Confirmatory Factor Analysis were used to provide support for the internal consistency and construct validity of these scales. RESULTS: Both scales demonstrated good internal consistency (α = 0.81 for PHQ-9 and α = 0.84 for GAD-7). Internal consistency reliability was further supported by positive inter-item correlations and item-by-scale correlations for all items on both measures. CFA of the PHQ-9 and GAD-7 showed a reasonable fit for the 1-factor model and 2-factor models (depression and anxiety with somatic and cognitive subtypes). LIMITATIONS: This study was limited to young African women in urban Soweto who were proficient in English, which may affect generalizability. Differences in language or cultural context may impact the accuracy and applicability of these scales to other African populations. CONCLUSION: The PHQ-9 and GAD-7 are valid and reliable for identifying psychological distress in the studied population. Despite showing good psychometric properties, further diagnostic assessment is needed to confirm clinical diagnoses. The scales are useful for identifying those at risk but not a substitute for comprehensive diagnostic evaluations.

Predictive effect of lipopolysaccharide-stimulated inflammatory cytokines on symptoms of generalized anxiety disorder.

BACKGROUND: Generalized anxiety disorder (GAD) is a relatively common mental disorder. Recently, inflammation, an important factor for the development of depression, has attracted increasing attention. Several studies have shown that inflammatory cytokines can affect the pathophysiological processes of several nervous system diseases. We hypothesized that there is a correlation between the levels of lipopolysaccharide (LPS)-stimulated inflammatory cytokines and the clinical symptoms of GAD. AIM: To investigate the predictive effect of LPS-stimulated inflammatory cytokines on symptoms of GAD. METHODS: This was a cross-sectional study in which 89 patients with GAD diagnosed at The First Hospital of Hebei Medical University from January 2022 to December 2022 and 70 individuals without anxiety and depression (controls) during the same period were included. Fasting venous blood was collected from all the subjects in heparin tubes, and another 3 ml of blood was supplemented with LPS (10 ng/ml). The plasma levels of 12 cytokines [Interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, IL-17A, IL-12p70, and IFN-α] were detected. RESULTS: Post-LPS stimulation, the levels of IL-1ß, IL-6, IL-8, IL-10, and TNF-α in both the control and GAD groups were significantly elevated above those in the nonstimulated groups, with IL-6 and IL-8 showing marked increases. Increases in IL-8 and TNF-α were statistically significant in the GAD group (P < 0.05). IL-1ß, IL-6, IL-8, IL-10, and TNF-α were found to be significantly correlated with Hamilton Anxiety Rating Scale (HAMA) scores (P < 0.05). A negative correlation was observed between IL-10 levels and HAMA scores. Further analysis revealed that TNF-α was associated with mental anxiety, whereas IL-1ß, IL-8, and IL-10 were associated with physical anxiety symptoms, with IL-10 showing a negative correlation with physical anxiety. IL-6 was associated with both mental and physical aspects of anxiety. CONCLUSION: The physical symptoms of GAD are related to inflammatory factors. IL-1ß, IL-8, IL-10, and TNF-a can be used as predictors of physical or mental anxiety in patients with GAD.

Non-invasive brain stimulation in the treatment of generalized anxiety disorder: A systematic review and meta-analysis.

BACKGROUND: Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS), continuous theta-burst stimulation (cTBS), and transcranial direct current stimulation (tDCS), is an emerging intervention that has been used to treat various mental illnesses. However, previous studies have not comprehensively compared the efficacies of various NIBS modalities in alleviating anxiety symptoms among patients with generalized anxiety disorder (GAD). Therefore, this study conducted a systematic review and meta-analysis to assess the efficacy of NIBS for patients with GAD. METHODS: A systematic search of four major bibliographic databases (Embase, PubMed, Web of Science and The Cochrane Library) was conducted from inception dates to November 26, 2023 to identify eligible studies. The data were analyzed using a random-effects model. RESULTS: Seven randomized controlled trials (RCTs) were included in the meta-analysis. Significant differences were found in changes in Hamilton anxiety rating scale (HARS) scores, study-defined response, and remission between the intervention and control groups. Moreover, the intervention groups experienced a significantly higher frequency of headaches. CONCLUSION: The results revealed that interventions improved GAD compared to control groups. cTBS and rTMS exhibited better treatment efficacy than tDCS, which did not appear to have a significant therapeutic effect. Longer follow-up periods and larger sample sizes are required in future RCTs. TRIAL REGISTRATION: This meta-analysis was conducted in accordance with PRISMA guidelines and registered at PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, CRD42023466285).

Comparison of Resting-State Functional Connectivity Between Generalized Anxiety Disorder and Social Anxiety Disorder: Differences in the Nucleus Accumbens and Thalamus Network.

Background: Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are distinguished by whether anxiety is limited to social situations. However, reports on the differences in brain functional networks between GAD and SAD are few. Our objective is to understand the pathogenesis of GAD and SAD by examining the differences in resting brain function between patients with GAD and SAD and healthy controls (HCs). Methods: This study included 21 patients with SAD, 17 patients with GAD, and 30 HCs. Participants underwent psychological assessments and resting-state functional magnetic resonance imaging. Whole-brain analyses were performed to compare resting-state functional connectivity (rsFC) among the groups. In addition, logistic regression analysis was conducted on the rsFC to identify significant differences between GAD and SAD. Results: Patients with SAD and GAD had significantly higher rsFC between the bilateral postcentral gyri and bilateral amygdalae/thalami than HCs. Compared with patients with SAD, those with GAD had significantly higher rsFC between the right nucleus accumbens and bilateral thalami and between the left nucleus accumbens and right thalamus. rsFC between the left nucleus accumbens and right thalamus positively correlated with state anxiety in patients with SAD and GAD, respectively. In addition, logistic regression analysis revealed that the right nucleus accumbens and the right thalamus connectivity could distinguish SAD from GAD. Conclusions: GAD and SAD were distinguished by the right nucleus accumbens and the right thalamus connectivity. Our findings offer insights into the disease-specific neural basis of SAD and GAD. Clinical Trial Registration Number: M10545. Impact Statement This study is the first to identify a resting state functional connectivity that distinguishes social anxiety disorder (SAD) from generalized anxiety disorder (GAD) and to clarify a common connectivity in both disorders. We found that the connectivity between the right nucleus accumbens and the right thalamus differentiated SAD from GAD. Furthermore, these rsFC differences suggest an underlying basis for fear overgeneralization. Our findings shed light on the pathophysiology of these conditions and could be used as a basis for further studies to improve outcomes for such patients.

Impact of an Online Discussion Forum on Self-Guided Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Randomized Trial.

BACKGROUND: Internet-delivered cognitive behavioral therapy (ICBT) is an effective and accessible treatment for various mental health concerns. ICBT has shown promising treatment outcomes among public safety personnel (PSP), who experience high rates of mental health problems and face barriers to accessing other mental health services. Client engagement and clinical outcomes are better in ICBT with therapist guidance, but ICBT is easier to implement on a large scale when it is self-guided. Therefore, it is important to identify strategies to improve outcomes and engagement in self-guided ICBT and other self-guided digital mental health interventions. One such strategy is the use of online discussion forums to provide ICBT clients with opportunities for mutual social support. Self-guided interventions accompanied by online discussion forums have shown excellent treatment outcomes, but there is a need for research experimentally testing the impact of online discussion forums in ICBT. OBJECTIVE: We aimed to evaluate a transdiagnostic, self-guided ICBT intervention tailored specifically for PSP (which had not previously been assessed), assess the impact of adding a therapist-moderated online discussion forum on outcomes, and analyze participants' feedback to inform future research and implementation efforts. METHODS: In this randomized trial, we randomly assigned participating PSP (N=107) to access an 8-week transdiagnostic, self-guided ICBT course with or without a built-in online discussion forum. Enrollment and participation were entirely web-based. We assessed changes in depression, anxiety, and posttraumatic stress as well as several secondary outcome measures (eg, treatment engagement and satisfaction) using questionnaires at the pre-enrollment, 8-week postenrollment, and 20-week postenrollment time points. Mixed methods analyses included multilevel modeling and qualitative content analysis. RESULTS: Participants engaged minimally with the forum, creating 9 posts. There were no differences in treatment outcomes between participants who were randomly assigned to access the forum (56/107, 52.3%) and those who were not (51/107, 47.7%). Across conditions, participants who reported clinically significant symptoms during enrollment showed large and statistically significant reductions in symptoms (P<.05 and d>0.97 in all cases). Participants also showed good treatment engagement and satisfaction, with 43% (46/107) of participants fully completing the intervention during the course of the study and 96% (79/82) indicating that the intervention was worth their time. CONCLUSIONS: Previous research has shown excellent clinical outcomes for self-guided ICBT accompanied by discussion forums and good engagement with those forums. Although clinical outcomes in our study were excellent across conditions, engagement with the forum was poor, in contrast to previous research. We discuss several possible interpretations of this finding (eg, related to the population under study or the design of the forum). Our findings highlight a need for more research evaluating the impact of online discussion forums and other strategies for improving outcomes and engagement in self-guided ICBT and other digital mental health interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT05145582; https://clinicaltrials.gov/study/NCT05145582.

Assessing the prevalence of generalized anxiety disorder in a multicultural medical education setting in Saudi Arabia during the COVID-19 pandemic.

Introduction: Mental health among medical students is an area that has been increasingly garnering world-wide attention. Yet, despite this increased attention, research related to anxiety disorders in Saudi Arabia remain limited. This study aims to address this gap by assessing the prevalence of generalized anxiety disorder (GAD) as well as explore its association with students' sociodemographic factors and academic performance among medical students in a Saudi Arabian institute that has a diverse, multicultural student body. Methods: The study takes place in a unique educational environment: a privately funded institute in Riyadh, the capital of Saudi Arabia, with 32% of its student body comprising international students from over 40 countries, during the COVID-19 pandemic. The study deploys the use of a survey that was sent to the students at this institute via their institutional emails. A survey containing 33 items assessing demographics, GAD using GAD-7 questionnaire, stress-relief measures, online learning experience during the pandemic, mental disorders, anxiety associated with the pandemic, two open-ended questions, and one item assessing sleep difficulty. Results: The results of the survey showed that a significant majority of the responders' scores in the GAD-7 assessment were in the range of moderate to severe anxiety. The results also suggest that low cGPA and the first academic years are significantly associated with higher GAD-7 scores. Students found severe time constraints, difficult educational content, and lack of psychological support to be major sources of stress. Furthermore, students suggested providing an in-house psychologist, personalized feedback, and guidance on study tactics as methods to reduce anxiety. Conclusion: These findings, among others, suggest a need for further studies and research in this field to uncover broader patterns and inform targeted mental health support strategies.

Association between secondhand smoke exposure and anxiety among adolescents: A nationwide cross-sectional study.

INTRODUCTION: Adolescents are especially susceptible to the harmful effects of secondhand smoke exposure. Mental health issues may be one of these negative consequences. This study aimed to explore the association between secondhand smoke exposure and anxiety among Korean adolescents. METHODS: This study used the nationwide representative cross-sectional data obtained from the 4-year (2020-2023) Korea Youth Risk Behavior Survey. In total, 214514 individuals aged 12-18 years were included in this study (109910 males and 104604 females). Secondhand smoke exposure was assessed based on responses to questions concerning the days they were exposed (at home and in public places), while anxiety levels were measured using the Generalized Anxiety Disorder 7 scale. Multivariable logistic regression analysis divided by sex was performed to explore the association (p=0.0173 for interaction by secondhand smoke exposure and sex), and adjusted odds ratios (ORs) with 95% confidence intervals (CI) were calculated. RESULTS: Among the study population, 8.8% of the male and 15.6% of the female participants had anxiety. After adjusting for covariates, adolescents with secondhand smoke exposure had a higher likelihood of reporting anxiety than those without the exposure (male, OR=1.23; 95% CI: 1.16-1.29; female, OR=1.27; 95% CI: 1.21-1.33). In additional stratified analyses, this association was more prominent among those who were never smokers, were exposed for more days, and had severe levels of anxiety. CONCLUSIONS: This study found that secondhand smoke exposure was associated with anxiety in adolescents; hence, proper political interventions to reduce secondhand smoke exposure may be required.

Worry Postponement From the Metacognitive Perspective: A Randomized Waitlist-Controlled Trial.

Background: Pathological worry is associated with appraisals of worrying as uncontrollable. Worry postponement (WP) with a stimulus control rationale appears to be effective in non-clinical samples. However, preliminary research in participants with generalized anxiety disorder (GAD) does not support its efficacy in reducing negative metacognitions or worry. The aim of this study was to investigate the efficacy of WP with a metacognitive rationale. Method: Participants with GAD (n = 47) or hypochondriasis (HYP; n = 35) were randomly assigned to either an intervention group (IG) or waitlist (WL). The IG received a two-session long WP intervention aiming at mainly reducing negative metacognitions concerning uncontrollability of worrying. Participants were instructed to postpone their worry process to a predetermined later time during the six days between the two sessions. Participants completed questionnaires of negative metacognitions and worry at pre-assessment, post-assessment, and follow-up. Results: We observed a significant Time*Group interaction for negative metacognitions and worry. Post-hoc analyses on the total sample and separately for GAD and HYP revealed significantly lower worry scores in the treated GAD sample compared to the WL, representing the only significant effect. In the GAD group, pre-post-effect sizes were small for negative metacognitions and large for worry. Effects persisted to a four-week follow-up. Conclusion: WP with a metacognitive rationale seems to be effective in reducing worry in participants with GAD. The effectiveness for HYP seems limited, possibly due to the small sample size.

The Importance of Psychological Assessment in the Management of Bladder Pain Syndrome/Interstitial Cystitis and Vulvodynia: A Case Report.

This case report emphasizes the crucial role of psychological assessment in the management of patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and vulvodynia. A 48-year-old woman with a five-year history of refractory BPS/IC and vulvodynia presented with frequent urination, pelvic pain, and severe dyspareunia, which led to sexual aversion and divorce from her partner. Previous treatments, including lifestyle modifications, analgesics, anticholinergics, hydrodistension, intravesical dimethyl sulfoxide, and psychiatric interventions, had been ineffective. Psychological assessments using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Toronto Alexithymia Scale-20 revealed severe symptoms of depression, anxiety, and alexithymia. Due to the patient's sexual aversion and the absence of a partner, a complete Female Sexual Function Index (FSFI) could not be administered. Instead, a partial FSFI and artificial intelligence-translated reference value of the Female Sexual Distress Scale-Revised were used to assess aspects relevant to the patient's condition. The patient underwent three monthly sessions of Fotona laser therapy, erbium, and neodymium laser at one-month intervals. Treatment outcomes were evaluated using the Numeric Rating Scale-11, Vulvodynia Total, Interstitial Cystitis Symptom Index, and psychological assessment tools. At the six-month follow-up, all physical and psychological symptoms showed significant improvement and complete remission was achieved at 12 months. Despite the overall positive treatment outcomes, the patient's sexual aversion persisted, and accurate measurement was not possible, highlighting the complexity of addressing sexual function in patients with BPS/IC and vulvodynia. This case report underscores the need for a holistic approach to managing these conditions, addressing both the physical and psychological aspects of the disease.