Associations among anxiety, self-efficacy, and self-care in rural adolescents with poorly controlled asthma.

BACKGROUND: Rural adolescents are vulnerable to asthma; good self-care can reduce morbidity. The subtypes of anxiety (eg, asthma-related, generalized) may have differential associations with asthma self-care. Low self-efficacy, a determinant of behavior, is associated with increased anxiety. Little is known regarding these relationships in rural adolescents. OBJECTIVE: To evaluate whether anxiety symptoms are associated with asthma symptom prevention and management among rural adolescents and whether self-efficacy mediates these relationships. METHODS: We used baseline data from 197 rural adolescents (mean age = 16 years; 69% girls; 62% Black) who were part of a trial that tested the effectiveness of a school-based asthma intervention. Adolescents completed the Youth Asthma-Related Anxiety Scale, Screen for Child Anxiety and Emotional Disorders, Asthma Management Self-efficacy Index, and Asthma Prevention and Management Indices. Linear regression was performed to test whether: (1) asthma-related and generalized anxiety had curvilinear relationships with self-care; (2) social and separation anxiety had linear relationships with self-care; and (3) self-efficacy mediated relationships. RESULTS: Asthma-related anxiety had a significant curvilinear relationship with prevention (P = 0.001) and a linear association with management (P = .01). Generalized anxiety had a significant curvilinear association with management (P = .03), whereas social anxiety had a significant linear relationship with prevention (P = .04). Self-efficacy partially or fully mediated these relationships. CONCLUSION: Anxiety symptoms were associated with asthma self-care among this sample of rural adolescents, with differing roles for prevention and management. Self-efficacy may be a mechanism to improve asthma self-care among rural adolescents with anxiety. With a lack of self-efficacy, asthma-related, generalized, or social anxiety may motivate adolescents to take steps to care for their asthma.

Omega-3 fatty acids and anxiety: A systematic review of the possible mechanisms at play.

Introduction: Anxiety is prevalent, costly, and associated with significant adverse outcomes. The importance of nutrition is underestimated in the management of mental health disorders. In particular, omega-3 fatty acids (ω-3 FAs) are a critical component for healthy development and have been shown to reduce anxiety symptoms. Objective: This paper reviews the current state of the research to identify potential mechanisms underlying the relationship between ω-3 FAs and anxiety reduction. Method: Studies were identified using PubMed, PsycINFO, and CINAHL databases. Results: Of the 197 full-text studies screened, six met criteria for inclusion. Four mechanisms were identified based on primary outcomes reported by each study, Inflammatory Response, Brain-Derived Neurotrophic Factor (BDNF), Cortisol, and Cardiovascular Activity. Conclusion: Five key recommendations are provided to guide future research examining ω-3 FAs and anxiety. They include: (1) standardization of dosage and duration of ω-3 supplementation, (2) more rigorous measurement of variables, (3) effective blinding of participants, (4) designing experiments that test mediation, and (5) increasing sample diversity.

Psychometric Evaluation of the IBD-Specific Anxiety Scale: A Novel Measure of Disease-Related Anxiety for Adolescents With IBD.

Anxiety related to pediatric inflammatory bowel disease (IBD) is a common comorbidity; yet, this construct is understudied because of lack of available valid measurement. Objective: The present study will report the preliminary validation of the 20-item IBD-Specific Anxiety Scale (IBD-SAS) in a large, geographically diverse sample of adolescents aged 12-18 years with IBD. Method: A total of 281 adolescents, ages 12-18 (M = 14.8, SD = 1.78; 51% male), completed the IBD-SAS along with measures of IBD-related quality of life, anxiety, depressive symptoms, and disease activity. Factor structure was assessed using exploratory and confirmatory factor analyses (EFA and CFA). Results: EFA (Sample 1; n = 141) yielded one-, two-, three- and four-factor models. The CFA (Sample 2; n = 140) demonstrated that a four-factor model was superior to three- and two-factor model for the amended scale. In total, the IBD-SAS showed excellent internal consistency (Cronbach's α = .95) and was most strongly associated with health-related quality of life. Moderate to strong associations were observed between IBD-SAS and general measures of anxiety and depressive symptoms, and IBD disease activity providing additional support that health-specific anxiety is a valid and distinct construct. Conclusions: Based on the results of this study, the IBD-SAS displayed adequate psychometric properties and can meaningfully contribute to the assessment of IBD-specific anxiety in adolescents diagnosed with IBD, thus filling an empirical and clinical need in this population.

Anxiety symptoms and disease severity in children and adolescents with Crohn disease.

OBJECTIVES: Children and adolescents diagnosed as having Crohn disease (CD), a type of inflammatory bowel disease (IBD), have increased vulnerability for anxiety symptoms that may be related to disease-related processes. The aims of this article are 3-fold: to report the proportion of pediatric patients with CD whose self-reported anxiety symptoms are indicative of distress, to describe the constellation of anxiety symptoms, and to examine the relation between anxiety and disease symptoms. METHODS: Retrospective medical chart review was performed for 93 youths with CD (ages 9-18 years) who had completed the Screen for Child Anxiety Related Disorders during their gastroenterology visit. Medical records were reviewed for demographic and disease characteristics. the Harvey-Bradshaw Index (HBI) was used as a measure of CD activity. RESULTS: Thirty percent of the youths reported experiencing elevated anxiety symptoms (Screen for Child Anxiety Related Disorder score >20), and 50% had scored above the cutoff in 1 or more anxiety domains, with school anxiety, general anxiety, and separation anxiety symptoms reported most frequently. Youth rated with moderate/severe disease activity on the HBI (n = 4) self-reported more anxiety symptoms compared with youth with inactive disease (n = 78, P = 0.03). Greater school anxiety was significantly associated with decreased well-being (P = 0.003), more abdominal pain (P < 0.001), and the number of loose stools (P = 0.01). Having extraintestinal symptoms was significantly associated with higher somatic/panic anxiety (P = 0.01). CONCLUSIONS: Implementing a brief anxiety screen in tertiary pediatric settings may be one approach to identify young patients with CD in distress. Health care providers should consider periodic assessment of school anxiety among youth with CD.

An intersectional examination of the impact of COVID-stress and discrimination on college students' resilience and mental health.

Objective: To investigate the impact of COVID-stress and discrimination on mental health among a group of diverse college students using an intersectional framework. Participants: One thousand six hundred seventy-one undergraduate students (Mage = 20.42, SD = 2.74) were recruited from nine college campuses. Methods: Participants completed an online questionnaire assessing mental health symptoms, COVID-stress, and in-school discrimination. Hierarchical regressions and multi-group SEM path analysis were conducted to examine differences across intersectional identities. Results: Female-identifying students reported higher COVID-stress, anxiety and depressive symptoms, and lower resilience compared to males. COVID-stress and discrimination were highest among certain minoritized student groups. Using an intersectional framework, more COVID-stress and discrimination were associated with increased anxiety for almost all women of color. Unexpectedly, COVID-stress predicted anxiety symptoms for almost all male intersectional groups. Conclusions: Findings reaffirm the intersectional framework and highlight significant disparities in how students experience COVID-stress, discrimination, and mental health outcomes along dimensions of gender and race/ethnicity.

Inflammatory Cytokines, but Not Dietary Patterns, Are Related to Somatic Symptoms of Depression in a Sample of Women.

Background: Depression is a heterogenous disorder with both cognitive and somatic symptom dimensions that may differentially relate to systemic inflammation. Diet, which has the potential to modulate both inflammation levels and mood, is yet to be studied within the context of individual depression dimensions. This study examined the associations between inflammatory cytokines and dietary patterns with depressive symptom dimension profiles among a sample of women recruited in a non-clinical setting. Methods: Inflammatory cytokines (IL-6 and TNF-α), inflammatory diet (Diet Inflammatory Index; DII), and depressive symptoms (Beck Depression Inventory-II; BDI-II) were measured in 136 females (M age = 22.01 ± 4.02, range 18-59 years). Multiple linear regressions were used to investigate the relationships between inflammatory cytokines and diet with self-reported cognitive, somatic, and total depressive symptoms, adjusting for demographic factors. Results: Findings showed that increased somatic dimension scores were positively associated with IL-6 (ß = 0.273, p = 0.002) and TNF-α (ß = 0.215, p = 0.017), but not inflammatory diet (p = 0.300). Total BDI-II scores were only positively associated with IL-6 (ß = 0.221, p = 0.012), and cognitive dimension scores were not associated with any inflammation measures. Conclusions: These findings contribute to existing evidence that inflammatory cytokines are associated with the somatic symptoms of depression. Inflammatory diet index was not associated with depression measures.

The Psychological, Academic, and Economic Impact of COVID-19 on College Students in the Epicenter of the Pandemic.

Initial research has indicated that college students have experienced numerous stressors as a result of the pandemic. The current investigation enrolled the largest and most diverse sample of college students to date (N = 4714) from universities in New York (NY) and New Jersey (NJ), the epicenter of the North American pandemic in Spring 2020. We described the impact on the psychological, academic, and financial health of college students who were initially most affected and examined racial/ethnic group differences. Results indicated that students' mental health was severely affected and that students of color were disproportionately affected by academic, financial, and COVID-related stressors. Worry about COVID-19 infection, stressful living conditions, lower grades, and loneliness emerged as correlates of deteriorating mental health. COVID-19's mental health impact on college students is alarming and highlights the need for public health interventions at the university level.

Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial.

BACKGROUND: Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. METHODS: Children and adolescents (aged 8-16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were randomly assigned to a cognitive-behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting list control. RESULTS: TAPS was found to be an acceptable treatment for this population and was superior to the waiting list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self- and parent ratings indicated reductions in children's somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains 3 months following treatment. CONCLUSIONS: The study supports the feasibility and preliminary efficacy of a cognitive-behavioral intervention targeting co-occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children's dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments.

Systematic review: Psychosocial factors of resilience in young people with inflammatory bowel disease.

OBJECTIVE: Inflammatory bowel disease (IBD) affects a growing number of young people. While factors associated with poor disease experience in pediatric IBD have garnered much attention in the literature, less attention has focused on the factors associated with the resilient outcomes seen in the majority of young people with IBD. This review seeks to contribute to the literature by synthesizing research on the psychosocial factors that promote resilience in pediatric IBD and by offering future directions for the field. METHODS: Systematic searches of the MEDLINE, Embase, PsychInfo, and CINAHL databases were performed for quantitative English-language studies with keywords for IBD, resilience or factors of resilience, and pediatric populations, with no date restrictions. Reference lists of all included articles were searched. Quality assessments were performed using an NIH tool. RESULTS: Of 3315 articles identified, 17 were included. Studies were heterogeneous, with 19 psychosocial factors identified and analyzed for associations with over two dozen indicators of resilience. A narrative synthesis of included studies was performed. Study details were organized into three domains-individual, social, and family. Preliminary data indicate that resilience in pediatric IBD may be associated with positive body image, increased mindfulness, and improved social functioning, among other potential factors. CONCLUSIONS: Resilience in pediatric IBD is largely unstudied. Only one study pursued an understanding of resilience as an aim, and no studies incorporated validated measures of resilience. Future prospective, theory-driven research is needed to elucidate the network of factors and mechanisms that can foster resilience in children and adolescents with IBD.

CBT for anxiety and associated somatic complaints in pediatric medical settings: an open pilot study.

OBJECTIVE: To examine the initial feasibility and potential efficacy of a cognitive-behavioral intervention for youth with anxiety disorders and non-medical somatic symptoms. BACKGROUND: Based on a strong relationship between somatic complaints and anxiety disorders, screening youngsters seeking medical care due to physical symptoms with no organic basis may enhance the recognition of anxiety disorders and facilitate access to appropriate services. METHOD: Seven boys and girls, ages 8 through 15, with medically unexplained gastrointestinal complaints and anxiety disorders received a 12-session cognitive-behavioral intervention targeting anxiety and physical symptoms. Assessments were conducted at baseline and following treatment. RESULTS: All participants were classified as treatment responders. Three of the seven participants no longer met diagnostic criteria for their principal anxiety disorder. Children's physical discomfort decreased from a moderate to minimal level based on self- and parent-reports. CONCLUSIONS: Our modified cognitive-behavioral approach has promise for reducing anxiety and somatic symptoms in children seeking medical care.

An Innovative Treatment Approach for Children With Anxiety Disorders and Medically Unexplained Somatic Complaints.

Anxiety disorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxiety disorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric settings (i.e., pediatric medical settings, schools) is necessary. Pediatric medical offices represent ideal settings for detection and intervention for several reasons: (1) access to large numbers of children, (2) high prevalence of unrecognized anxiety disorders in medical settings, and (3) an association between anxiety disorders and medically unexplained somatic symptoms. This paper describes a cognitive-behavioral intervention for youth who present to pediatric medical settings with nonmedical somatic symptoms and undiagnosed anxiety disorders. We explain the rationale for and focus of our treatment approach, present two case studies illustrating the treatment process, and conclude with a discussion of implementation considerations.

Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents.

OBJECTIVE: To examine the association of adolescent asthma-related anxiety, social anxiety, separation anxiety, and caregiver asthma-related anxiety with asthma care by urban adolescents. METHODS: Participants were 386 ethnic minority adolescents (mean age 12.8 years) with persistent asthma and their caregivers. Adolescents reported what they do to prevent asthma symptoms and to manage acute symptoms, and if they or their caregiver is responsible for their asthma care. Adolescents completed the Youth Asthma-Related Anxiety Scale, and the social and separation anxiety subscales of the Screen for Child Anxiety and Emotional Disorders (SCARED); caregivers completed the Parent Asthma-Related Anxiety Scale. Linearity of the associations was assessed by generalized additive models. When there was no evidence for nonlinearity, linear mixed effects models were used to evaluate the effects of the predictors. RESULTS: Adolescent asthma-related anxiety had a strong curvilinear relationship with symptom prevention (P < .001). Adolescents took more prevention steps as their anxiety increased, with a plateau at moderate anxiety. There was a linear relationship of adolescent asthma-related anxiety to symptom management (ß = 0.03, P = .021) and to asthma responsibility (ß = 0.11, P = .015), and of caregiver asthma-related anxiety to adolescent symptom prevention (ß = 0.04, P = .001). Adolescent social and separation anxiety had weak to no relationship with asthma care. Results remained consistent when controlling for each of the other anxieties. CONCLUSIONS: Asthma-related anxiety plays an important, independent role in asthma care. When low, adolescents may benefit from increased support from caregivers and awareness of the consequences of uncontrolled asthma. When elevated, health providers should ensure the adolescents are not assuming responsibility for asthma care prematurely.

Patient-reported Anxiety: A Possible Predictor of Pediatric Inflammatory Bowel Disease Health Care Use.

BACKGROUND: Anxiety is linked with adverse health-related outcomes and increased health-seeking behaviors among patients with chronic illness. Yet, this relationship has received little attention in pediatric inflammatory bowel disease. The aim of this study was to examine whether anxiety symptoms predicted youth at increased risk for repeated disease relapse and greater gastrointestinal health care use over the subsequent 12 months. METHODS: Eighty-six pediatric patients aged 11 to 18 years (M = 14.7, SD = 2.0), and their caregivers completed a validated anxiety questionnaire during a gastrointestinal specialty appointment (baseline). Medical records were reviewed for the subsequent year to record the number of disease relapses and gastrointestinal health care services and generate disease activity scores at baseline and 12 months. Analysis of variance was used to examine anxiety levels between those who experienced ≤1 versus ≥2 disease relapses. Poisson regressions were used to model the relationship between child- and caregiver-reported anxiety and health care use, controlling for disease activity. RESULTS: The sample was predominantly white (81%) and male (56%). Patients with higher anxiety at baseline (M = 19.6; SD = 13.7) had more frequent (≥2) disease relapses compared with those with lower anxiety at baseline (M = 12.6; SD = 10.3). Higher anxiety, irrespective of reporter, also predicted greater total gastrointestinal health care use (P < 0.01). This included hospital-based interventions (P < 0.01), but not office encounters or outpatient endoscopic procedures. Findings remained significant after controlling for disease severity (P < 0.05). CONCLUSIONS: Assessment of anxiety may be one mechanism by which to identify those youth who are most vulnerable for disease exacerbation and costly interventions in the near future.

Integrating illness concerns into cognitive behavioral therapy for children and adolescents with inflammatory bowel disease and co-occurring anxiety.

PURPOSE: To examine the feasibility and preliminary benefits of an integrative cognitive behavioral therapy (CBT) with adolescents with inflammatory bowel disease and anxiety. DESIGN AND METHODS: Nine adolescents participated in a CBT program at their gastroenterologist's office. Structured diagnostic interviews, self-report measures of anxiety and pain, and physician-rated disease severity were collected pretreatment and post-treatment. RESULTS: Postintervention, 88% of adolescents were treatment responders, and 50% no longer met criteria for their principal anxiety disorder. Decreases were demonstrated in anxiety, pain, and disease severity. PRACTICE IMPLICATIONS: Anxiety screening and a mental health referral to professionals familiar with medical management issues is important.

Illness-specific anxiety: implications for functioning and utilization of medical services in adolescents with inflammatory bowel disease.

PURPOSE. Adolescents with inflammatory bowel disease (IBD) may be at heightened risk for developing anxiety and depression. This cross-sectional pilot study examined the relationship between anxiety and depression and health-related behaviors. METHODS. Thirty-six adolescents with diagnosed IBD, ages 12-17, and their parents were recruited from two pediatric gastroenterology medical centers. RESULTS. Clinical levels of anxiety (22%) and depressive symptoms (30%) were reported by patients. Regression analyses revealed that IBD-specific anxiety was significantly associated with greater utilization of medical services and worsened psychosocial functioning. PRACTICE IMPLICATIONS. Results provide preliminary support that IBD-specific anxiety may play an important role in disease management, yet concerns are rarely systematically assessed by health professionals.