Increased summer temperature is associated with reduced calf mass of a circumpolar large mammal through direct thermoregulatory and indirect, food quality, pathways.

Climate change represents a growing ecological challenge. The (sub) arctic and boreal regions of the world experience the most rapid warming, presenting an excellent model system for studying how climate change affects mammals. Moose (Alces alces) are a particularly relevant model species with their circumpolar range. Population declines across the southern edge of this range are linked to rising temperatures. Using a long-term dataset (1988-1997, 2017-2019), we examine the relative strength of direct (thermoregulatory costs) and indirect (food quality) pathways linking temperature, precipitation, and the quality of two important food items (birch and fireweed) to variation in moose calf mass in northern Sweden. The direct effects of temperature consistently showed stronger relationships to moose calf mass than did the indirect effects. The proportion of growing season days where the temperature exceeded a 20 °C threshold showed stronger direct negative relationships to moose calf mass than did mean temperature values. Finally, while annual forb (fireweed) quality was more strongly influenced by temperature and precipitation than were perennial (birch) leaves, this did not translate into a stronger relationship to moose calf weight. The only indirect path with supporting evidence suggested that mean growing season temperatures were positively associated with neutral detergent fiber, which was, in turn, negatively associated with calf mass. While indirect impacts of climate change deserve further investigation, it is important to recognize the large direct impacts of temperature on cold-adapted species.

Camera collars reveal macronutrient balancing in free-ranging male moose during summer.

Understanding how the nutritional properties of food resources drive foraging choices is important for the management and conservation of wildlife populations. For moose (Alces alces), recent experimental and observational studies during the winter have shown macronutrient balancing between available protein (AP) and highly metabolizable macronutrients (total non-structural carbohydrates [TNC] and lipids). Here, we combined the use of continuous-recording camera collars with plant nutrient analyses and forage availability measurements to obtain a detailed insight into the food and nutritional choices of three wild moose in Norway over a 5-day period in summer. We found that moose derived their macronutrient energy primarily from carbohydrates (74.2%), followed by protein (13.1%), and lipids (12.7%). Diets were dominated by deciduous tree browse (71%). Willows (Salix spp.) were selected for and constituted 51% of the average diet. Moose consumed 25 different food items during the study period of which 9 comprised 95% of the diet. Moose tightly regulated their intake of protein to highly metabolizable macronutrients (AP:TNC + lipids) to a ratio of 1:2.7 (0.37 ± 0.002SD). They did this by feeding on foods that most closely matched the target macronutrient ratio such as Salix spp., or by combining nutritionally imbalanced foods (complementary feeding) in a non-random manner that minimized deviations from the intake target. The observed patterns of macronutrient balancing aligned well with the findings of winter studies. Differential feeding on nutritionally balanced downy birch (Betula pubescens) leaves versus imbalanced twigs+leaves across moose individuals indicated that macronutrient balancing may occur on as fine a scale as foraging bites on a single plant species. Utilized forages generally met the suggested requirement thresholds for the minerals calcium, phosphorus, copper, molybdenum, and magnesium but tended to be low in sodium. Our findings offer new insights into the foraging behavior of a model species in ungulate nutritional ecology and contribute to informed decision-making in wildlife and forest management.

Increased intake of tree forage by moose is associated with intake of crops rich in nonstructural carbohydrates.

Animals representing a wide range of taxonomic groups are known to select specific food combinations to achieve a nutritionally balanced diet. The nutrient balancing hypothesis suggests that, when given the opportunity, animals select foods to achieve a particular target nutrient balance, and that balancing occurs between meals and between days. For wild ruminants who inhabit landscapes dominated by human land use, nutritionally imbalanced diets can result from ingesting agricultural crops rich in starch and sugar (nonstructural carbohydrates [NCs]), which can be provided to them by people as supplementary feeds. Here, we test the nutrient balancing hypothesis by assessing potential effects that the ingestion of such crops by Alces alces (moose) may have on forage intake. We predicted that moose compensate for an imbalanced intake of excess NC by selecting tree forage with macro-nutritional content better suited for their rumen microbiome during wintertime. We applied DNA metabarcoding to identify plants in fecal and rumen content from the same moose during winter in Sweden. We found that the concentration of NC-rich crops in feces predicted the presence of Picea abies (Norway spruce) in rumen samples. The finding is consistent with the prediction that moose use tree forage as a nutritionally complementary resource to balance their intake of NC-rich foods, and that they ingested P. abies in particular (normally a forage rarely eaten by moose) because it was the most readily available tree. Our finding sheds new light on the foraging behavior of a model species in herbivore ecology, and on how habitat alterations by humans may change the behavior of wildlife.

Coprophagy in moose: A first observation.

Coprophagy, the eating of feces, has been documented in a wide range of species but appears to be rare or difficult to detect in deer (Cervidae). Here, we report the first observation of coprophagy in moose Alces alces, which was recorded using camera collars on free-ranging moose in Norway. The footage shows an instance of allocoprophagy by an adult female moose in spring (May). We summarize the current knowledge about coprophagy in deer and briefly discuss potential drivers and possible implications for disease transmission. Further research is needed to determine whether coprophagy occurs frequently in moose and whether this behavior is positive (e.g., increased intake of nutrients) or negative (increased infection by parasites or pathogens).

Integrating omics to characterize eco-physiological adaptations: How moose diet and metabolism differ across biogeographic zones.

With accelerated land conversion and global heating at northern latitudes, it becomes crucial to understand, how life histories of animals in extreme environments adapt to these changes. Animals may either adapt by adjusting foraging behavior or through physiological responses, including adjusting their energy metabolism or both. Until now, it has been difficult to study such adaptations in free-ranging animals due to methodological constraints that prevent extensive spatiotemporal coverage of ecological and physiological data.Through a novel approach of combining DNA-metabarcoding and nuclear magnetic resonance (NMR)-based metabolomics, we aim to elucidate the links between diets and metabolism in Scandinavian moose Alces alces over three biogeographic zones using a unique dataset of 265 marked individuals.Based on 17 diet items, we identified four different classes of diet types that match browse species availability in respective ecoregions in northern Sweden. Individuals in the boreal zone consumed predominantly pine and had the least diverse diets, while individuals with highest diet diversity occurred in the coastal areas. Males exhibited lower average diet diversity than females.We identified several molecular markers indicating metabolic constraints linked to diet constraints in terms of food availability during winter. While animals consuming pine had higher lipid, phospocholine, and glycerophosphocholine concentrations in their serum than other diet types, birch- and willow/aspen-rich diets exhibit elevated concentrations of several amino acids. The individuals with highest diet diversity had increased levels of ketone bodies, indicating extensive periods of starvation for these individuals.Our results show how the adaptive capacity of moose at the eco-physiological level varies over a large eco-geographic scale and how it responds to land use pressures. In light of extensive ongoing climate and land use changes, these findings pave the way for future scenario building for animal adaptive capacity.

Reflections on PTSD's future in DSM-V.

Research findings have fuelled debate on the construct validity of post-traumatic stress disorder (PTSD). Accompanying these issues are competing suggestions to redefine PTSD's criteria, including a recent proposal by DSM-V committee members. We review various approaches to revising the PTSD diagnosis and conclude that proposed changes should be placed in the appendix that the DSM has used for experimental criteria sets.

An ultra-brief screening scale for anxiety and depression: the PHQ-4.

BACKGROUND: The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. OBJECTIVE: When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. METHOD: Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. RESULTS: Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. CONCLUSION: The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.

Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment.

OBJECTIVE: To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to functional impairment. METHOD: Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and functional impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with functional impairment. RESULTS: In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to functional impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of functional impairment. CONCLUSIONS: Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.

Gastrointestinal symptoms in primary care: prevalence and association with depression and anxiety.

OBJECTIVE: Results from general population studies suggest a relationship between gastrointestinal (GI) symptoms, depression, and anxiety. However, no primary care study has investigated this issue. This study investigates the prevalence of GI symptoms in primary care and their association with depression and anxiety. METHOD: Within a cross-sectional survey, 2091 consecutive patients from 15 primary care clinics in the United States completed self-report questionnaires regarding GI symptoms [15-item Patient Health Questionnaire (PHQ-15)], anxiety [seven-item Generalized Anxiety Disorder Scale (GAD-7)], and depression (PHQ-8). Of those, 965 randomly selected patients additionally underwent a criterion standard diagnostic telephone interview (Structured Clinical Interview for DSM-IV) for the most common anxiety disorders. RESULTS: A total of 380 [18% (95% CI, 16.3% to 19.3%)] patients reported to be substantially bothered by at least one GI symptom in the previous 4 weeks. The prevalence of severe levels of depression (PHQ-8 score > or =15) was nearly fivefold in patients with GI symptoms compared to patients without GI symptoms (19.1% vs. 3.9%; P<.001), and the prevalence of severe levels of anxiety (GAD-7 score > or =15) was nearly fourfold in patients with GI symptoms compared to patients without GI symptoms (19.4% vs. 5.6%; P<.001). Similarly, with each additional GI symptom, the odds for an interview-based diagnosis of specific anxiety disorders increased significantly: For example, compared to patients with no GI symptom, the odds ratio (OR) (95% CI) for generalized anxiety disorder in patients with one GI symptom was 3.7 (2.0 to 6.9); in patients with two GI symptoms, OR=6.5 (3.1 to 13.6); and in patients with three GI symptoms, OR=7.2 (2.7 to 18.8). CONCLUSION: GI symptoms are associated significantly with depression and anxiety in primary care. It is suggested to screen as a routine for anxiety and depression in patients with GI symptoms and, if indicated, to initiate specific treatment.

Clinical utility of five dimensional systems for personality diagnosis: a "consumer preference" study.

This study compares the clinical relevance and utility of five dimensional diagnostic systems for personality disorders that have been proposed for the forthcoming edition of DSM (DSM-V): (1) a criteria counting model based on current DSM-IV diagnostic criteria; (2) a prototype matching model based on current DSM-IV diagnostic criteria; (3) a prototype matching model based on the Shedler-Westen Assessment Procedure (SWAP); (4) the Five Factor Model; and (5) Cloninger's Psychobiological Model. A random national sample of psychiatrists and psychologists applied all 5 diagnostic systems to a patient in their care and rated the clinical utility of each system. The SWAP Prototype Matching and DSM-IV Prototype Matching models were judged most clinically useful and relevant. The Five Factor Model and Cloninger's Psychobiological Model were judged least useful. The prototype matching systems most faithfully capture the personality syndromes seen in clinical practice, and permit rich descriptions of diagnostic constructs without a proportionate increase in user effort. A prototype matching approach to personality diagnosis deserves consideration for DSM-V.

Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection.

BACKGROUND: Anxiety, although as common as depression, has received less attention and is often undetected and undertreated. OBJECTIVE: To determine the current prevalence, impairment, and comorbidity of anxiety disorders in primary care and to evaluate a brief measure for detecting these disorders. DESIGN: Criterion-standard study performed between November 2004 and June 2005. SETTING: 15 U.S. primary care clinics. PARTICIPANTS: 965 randomly sampled patients from consecutive clinic patients who completed a self-report questionnaire and agreed to a follow-up telephone interview. MEASUREMENTS: 7-item anxiety measure (Generalized Anxiety Disorder [GAD]-7 scale) in the clinic, followed by a telephone-administered, structured psychiatric interview by a mental health professional who was blinded to the GAD-7 results. Functional status (Medical Outcomes Study Short Form-20), depressive and somatic symptoms, and self-reported disability days and physician visits were also assessed. RESULTS: Of the 965 patients, 19.5% (95% CI, 17.0% to 22.1%) had at least 1 anxiety disorder, 8.6% (CI, 6.9% to 10.6%) had posttraumatic stress disorder, 7.6% (CI, 5.9% to 9.4%) had a generalized anxiety disorder, 6.8% (CI, 5.3% to 8.6%) had a panic disorder, and 6.2% (CI, 4.7% to 7.9%) had a social anxiety disorder. Each disorder was associated with substantial impairment that increased significantly (P < 0.001) as the number of anxiety disorders increased. Many patients (41%) with an anxiety disorder reported no current treatment. Receiver-operating characteristic curve analysis showed that both the GAD-7 scale and its 2 core items (GAD-2) performed well (area under the curve, 0.80 to 0.91) as screening tools for all 4 anxiety disorders. LIMITATION: The study included a nonrandom sample of selected primary care practices. CONCLUSIONS: Anxiety disorders are prevalent, disabling, and often untreated in primary care. A 2-item screening test may enhance detection.

Saving PTSD from itself in DSM-V.

Papers in this special issue of the Journal of Anxiety Disorders concern critical issues and core assumptions that underlie the diagnostic construct of posttraumatic stress disorder. Rather than addressing specific points raised in these papers, we consider the issues and their implications for redefining PTSD and associated disorders in the DSM-V. Specific proposals are advanced to tighten definitional criteria for traumatic events and posttraumatic symptoms. We believe the more stringent criteria express the intent of the PTSD category and will promote more effective research on whether that intent was legitimate or based on misconceptions.

A brief measure for assessing generalized anxiety disorder: the GAD-7.

BACKGROUND: Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. METHODS: A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. RESULTS: A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. CONCLUSION: The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients.

OBJECTIVE: The Patient Health Questionnaire depression scale (PHQ-9) is a well-validated, Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition (DSM-IV) criterion-based measure for diagnosing depression, assessing severity and monitoring treatment response. The performance of most depression scales including the PHQ-9, however, has not been rigorously evaluated in different racial/ethnic populations. Therefore, we compared the factor structure of the PHQ-9 between different racial/ethnic groups as well as the rates of endorsement and differential item functioning (DIF) of the 9 items of the PHQ-9. The presence of DIF would indicate that responses to an individual item differ significantly between groups, controlling for the level of depression. MEASUREMENTS: A combined dataset from 2 separate studies of 5,053 primary care patients including non-Hispanic white (n=2,520), African American (n=598), Chinese American (n=941), and Latino (n=974) patients was used for our analysis. Exploratory principal components factor analysis was used to derive the factor structure of the PHQ-9 in each of the 4 racial/ethnic groups. A generalized Mantel-Haenszel statistic was used to test for DIF. RESULTS: One main factor that included all PHQ-9 items was found in each racial/ethnic group with alpha coefficients ranging from 0.79 to 0.89. Although endorsement rates of individual items were generally similar among the 4 groups, evidence of DIF was found for some items. CONCLUSIONS: Our analyses indicate that in African American, Chinese American, Latino, and non-Hispanic white patient groups the PHQ-9 measures a common concept of depression and can be effective for the detection and monitoring of depression in these diverse populations.

Racial and ethnic differences in the relationship between depression severity and functional status.

OBJECTIVE: Major depression has a negative impact on functional status and quality of life, but little is known about racial or ethnic differences in the relationship between depression and functional disability. This study compared the association between depression severity and functional status among three different racial or ethnic groups. METHODS: Data were from participants in the original Patient Health Questionnaire (PHQ) Primary Care Study and PHQ Obstetrics-Gynecology Study (N=5,427). Among the study participants, 62.0 percent were non-Hispanic white, 14.8 percent were African American, and 23.1 percent were Latino. Depression severity was assessed with the PHQ-9, the self-administered DSM-IV criteria-based depression module of the PHQ diagnostic instrument for mental disorders. Functional status was measured with the scales of the Medical Outcomes Study 20-item Short Form Health Survey (SF-20), self-reported disability days, clinic visits, and symptom-related difficulty. Groups were compared in terms of mean PHQ-9 scores and functional status at varying levels of depression severity. Linear regression was used to control for age, gender, education level, and language. RESULTS: Mean PHQ-9 scores were not significantly different between the three different racial or ethnic groups. Similar linear associations were found in all three racial or ethnic groups between increasing PHQ-9 scores (more severe depression) and worsening function on the SF-20 scales and an increased number of disability days and clinic visits. Latinos reported significantly less functional impairment on all measures of functionality compared with non-Hispanic whites. CONCLUSIONS: Functional impairment increased with increasing levels of depression severity in all three racial or ethnic groups, although Latinos consistently reported fewer functional disturbances compared with non-Hispanic whites.

Estimating population size using single-nucleotide polymorphism-based pedigree data.

Reliable population estimates are an important aspect of sustainable wildlife management and conservation but can be difficult to obtain for rare and elusive species. Here, we test a new census method based on pedigree reconstruction recently developed by Creel and Rosenblatt (2013). Using a panel of 96 single-nucleotide polymorphisms (SNPs), we genotyped fecal samples from two Swedish brown bear populations for pedigree reconstruction. Based on 433 genotypes from central Sweden (CS) and 265 from northern Sweden (NS), the population estimates (N = 630 for CS, N = 408 for NS) fell within the 95% CI of the official estimates. The precision and accuracy improved with increasing sampling intensity. Like genetic capture-mark-recapture methods, this method can be applied to data from a single sampling session. Pedigree reconstruction combined with noninvasive genetic sampling may thus augment population estimates, particularly for rare and elusive species for which sampling may be challenging.

Major depression, physical illness, and suicidal ideation in primary care.

OBJECTIVE: To determine the association between major depression and suicidal ideation and the role of physical illness in this link among primary care patients. METHOD: More than 3,000 randomly selected primary care patients at eight sites across the United States completed the PRIME-MD PHQ, a screen for mental disorders for use in primary care. Physicians independently diagnosed physical illnesses. Multiple logistic regression analyses were used to determine the relationship between PRIME-MD depression, physical illness, and suicidal ideation. RESULTS: Pulmonary disease was associated with an increased likelihood of suicidal ideation, even among patients without major depression [odds ratio = 1.9 (1.04, 3.4)]. There was evidence of statistical interaction between pulmonary disease and depression in increasing the odds of suicidal ideation. Specifically, patients with pulmonary disease without depression, those with depression without pulmonary disease, and patients with both pulmonary disease and depression had significantly increased odds of suicidal ideation with odd ratios of 1.9 (1.04, 3.4), 7.4 (5.6, 9.7), and 9.6 (5.1, 18.0), respectively. CONCLUSIONS: These data suggest that some physical disorders may be associated with increased suicidal ideation in primary care and may also play a role in the relationship between depression and suicidal ideation among primary care patients. Primary care physicians may wish to engage in an in-depth evaluation of psychiatric problems, especially current suicidal ideation, among patients with specific ongoing physical illnesses.

Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses.

BACKGROUND: The aim of this study was to compare the validity of the Hospital Anxiety and Depression Scale (HADS), the WHO (five) Well Being Index (WBI-5), the Patient Health Questionnaire (PHQ), and physicians' recognition of depressive disorders, and to recommend specific cut-off points for clinical decision making. METHODS: A total of 501 outpatients completed each of the three depression screening questionnaires and received the Structured Clinical Interview for DSM-IV (SCID) as the criterion standard. In addition, treating physicians were asked to give their psychiatric diagnoses. Criterion validity and Receiver Operating Characteristics (ROC) were determined. Areas under the curves (AUCs) were compared statistically. RESULTS: All depression scales showed excellent internal consistencies (Cronbach's alpha: 0.85-0.90). For 'major depressive disorder', the operating characteristics of the PHQ were significantly superior to both the HADS and the WBI-5. For 'any depressive disorder', the PHQ showed again the best operating characteristics but the overall difference did not reach statistical significance at the 5% level. Cut-off points that can be recommended for the screening of 'major depressive disorder' had sensitivities of 98% (PHQ), 94% (WBI-5), and 85% (HADS). Corresponding specificities were 80% (PHQ), 78% (WBI-5), and 76% (HADS). In contrast, physicians' recognition of 'major depressive disorder' was poor (sensitivity, 40%; specificity, 87%). LIMITATIONS: Our sample may not be representative of medical outpatients, but sensitivity and specificity are independent of disorder prevalence. CONCLUSIONS: All three questionnaires performed well in depression screening, but significant differences in criterion validity existed. These results may be helpful in the selection of questionnaires and cut-off points.

Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians' diagnosis.

OBJECTIVES: To compare the validity of detecting panic disorder using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire (PHQ), a screening question, and physicians' diagnosis, and to test whether modified evaluation algorithms improve the operating characteristics of these questionnaires. Additionally, patient and physician acceptability of the screening questionnaires was investigated. METHODS: The total sample of 499 patients comprised 348 medical outpatients and 151 psychosomatic outpatients. The Structured Clinical Interview for DSM-IV (SCID) was the criterion standard for the presence of a panic disorder. Sensitivity, specificity, predictive values, and overall accuracy were compared for the different measures. The conditional test characteristics were calculated based on the observed prevalence of panic disorder in the medical and psychosomatic subsample, respectively. RESULTS: Panic disorder was diagnosed in 4.3% of the medical outpatients and in 19.2% of the psychosomatic outpatients. The HADS, PHQ, and screening question achieved good operating characteristics. In contrast, physicians detected only 15% of cases with panic disorder. Modified evaluation algorithms of the questionnaires lead to an improvement of test characteristics. Of all measures, the PHQ had the best operating characteristics. The use of screening questionnaires was accepted by 96% of the patients and 97% of the physicians. CONCLUSIONS: The questionnaires as well as the screening question performed well in detecting panic disorder. Thus, the integration of these highly accepted measures into clinical evaluation is suggested. Recommendations for the selection of specific evaluation algorithms are given.