Mapping the Relationship between Health-related Beliefs, Fear, Avoidance, and Depression: Lessons from the Pandemic and Beyond.

The COVID-19 pandemic brought a mental health crisis, with depression symptoms increasing nearly three-fold compared to pre-pandemic levels. To explain this surge and to outline related novel treatment targets for post-pandemic psychiatric interventions, the current study examined cognitive, emotional, and behavioral predictors of depression (in the context of the recent pandemic). Participants completed measures assessing perceived danger, perceived infectiousness, and fear of the coronavirus (COVID-19). Participants also reported symptoms of depression and behavioral tendencies: pandemic-related compulsive checking, cleaning, and avoidance (of activities, situations, places, and people). A multiple mediation model revealed that the relationship between perceived infectiousness of the virus and depression was atemporally mediated by fear of the virus and pandemic-related avoidance of activities, situations, places, and people. Furthermore, avoidance played a uniquely important role in the mediation model. First, it directly mediated the relationship between perceived infectiousness and depression, even when omitting fear from the model. Second, avoidance was a discriminant predictor of depression, as neither pandemic-related checking and reassurance-seeking nor cleaning behavior mediated the relationship between cognition and depressive symptoms. Clinical implications are discussed, including how addressing the relationship between anxiety about viral infections and depression can prospectively increase treatment success as we move beyond the pandemic.

Examining Differences in Behavioural Avoidance Between Younger and Older Adults.

OBJECTIVES: Studies have found older adults report fewer anxiety symptoms than younger adults. As behavioral avoidance is theoretically associated with maintaining anxiety, this study sought to examine age-related differences in avoidance and anxiety in a cross-cultural sample of older (n = 60, 60-92 years) and younger adults (n = 70; 17-24 years). METHODS: Community dwelling participants from Australia and the United States of America completed self-report measures of anxiety, worry, and depression. Participants also self-rated levels of avoidance to 133 common fearful situations using a card sort task. RESULTS: Older adults reported significantly less avoidance of age-adjusted social and medical scenarios, more avoidance of aggressive scenarios, with no significant difference for animal or agoraphobic scenarios when compared to younger adults. Age-related effects were no longer significant in full models, in which the main effect of anxiety explained variance in avoidance for social, medical, animal, agoraphobic, but not aggression scenarios. CONCLUSIONS: Age differences in avoidance behavior were accounted for by differences in anxiety symptoms, except for avoidance of aggressive scenarios, which was not associated with anxiety. CLINICAL IMPLICATIONS: Age differences in levels of avoidance of common fearful situations were found, and may be associated with differences in anxiety symptom severity.

Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire - Abbreviated (PSWQ-A).

OBJECTIVE: The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A). DESIGN: Longitudinal assessment of GAD symptoms pre- and posttreatment. PARTICIPANTS: Participants were 259 older adults aged 60-86 years with a diagnosis of GAD who were assessed before and after treatment. INTERVENTION: Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. MEASUREMENTS: Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A. RESULTS: Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status. CONCLUSIONS: Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

A Review of You Tube Content to Assess US Mental Health During the Covid-19 Pandemic.

Mental health concerns have increased in prevalence since the beginning of the COVID-19 pandemic. Many turn to online resources for relevant information. The purpose of this study is to describe the availability of mental health information on YouTube, and to assess the relevance of the videos' content in relation to the actual need of the population. The 100 most-watched YouTube videos in English resulting from a YouTube search of "COVID-19" and "mental health" were evaluated. Of mental health conditions, anxiety and depression were mentioned in over 50% of the videos. A positive correlation was found between videos that mentioned anxiety and those that mentioned depression (p < 0.001). The numbers of videos focused on anxiety and depression were correlated with themes such as life stressors and social distancing (p < 0.05). Videos that did not make recommendations for dealing with stressors had more positive ratings than videos that did make such recommendations (p = 0.002). The content of YouTube videos addressing mental health issues during COVID-19 reflects the actual prevalence of specific mental health conditions during this same time period. Viewer ratings may be indicative of the public need for information about mental health conditions and validation for difficult experiences on social media sites. YouTube must be better utilized to disseminate information about mental illness.

Which Variant of Anxiety Is Associated with Smartphone Expertise in Community Dwelling Older Adults?

OBJECTIVES: Older adults vary greatly in their mastery of state-of-the-art smartphones. Anxiety may function as a barrier to technological expertise. This study characterizes an older community-dwelling sample (n = 71) in terms of their levels of demonstrated smartphone expertise relative to variants of anxiety (e.g., trait, social, tech-related). METHODS: A 20-step behavioral smartphone challenge task, the Smartphone Task for Older Adults (STOA), was used to evaluate older adults' knowledge of a range of smartphone functions. Self-report measures of anxiety symptoms and perceived digital proficiency were also administered. RESULTS: STOA scores were relatively low (x = 8.26, s.d. = 5.65) and showed negative relations with tech-anxiety and in-vivo frustration, but not social or trait anxiety. A hierarchical regression model indicated that tech-related anxiety and in-vivo frustration contributed significantly to STOA scores, above and beyond established predictors such as education. CONCLUSIONS: Tech-anxiety and frustration while learning new smartphone functions may characterize the next cohort of older adults who have not effectively mastered the use of smartphones. CLINICAL IMPLICATIONS: Anxiety management skills derived from cognitive behavior therapy and other self-regulation tools could help those who experience tech-anxiety or frustration during smartphone training, facilitating the development of expertise.

Assessing the Readability of Covid-19 Testing Messages on the Internet.

The COVID-19 pandemic first became evident at the end of 2019, and because of the many unknown aspects of this emerging infectious disease, the internet quickly became a source of information for consumers. It is important for any vital information to be written unambiguously, and at a level that can be understood by all people regardless of education levels. The purpose of this study was to assess the readability of 50 sources of COVID19 testing information online. Only 6 websites out of 50 received an appropriate readability score on more than one assessment. One-sample, one-tailed t-tests (α = 0.05, df = 49) were used to see if the websites with information on COVID-19 testing are being written at appropriate reading levels. The resulting p-values indicate that each p-value recorded is substantially below 0.05, it is very unlikely that websites on this topic are being written at the recommended levels. Even the optimal messages on COVID-19 reflect a confusing and rapidly changing public health crisis, however if messages are kept simple and clear, individuals will have the best possible chance of optimizing behavioral mitigation strategies. These are compelling reasons for informational hosts to take necessary steps to ensure that messages are written in as simple terms as possible. To this end, it is suggested that internet sites dispersing COVID-19 testing information build in text analysis methods for all published messages, particularly those meant to inform best health practices in the time of a pandemic.

Communicating Mental Health Support to College Students During COVID-19: An Exploration of Website Messaging.

College counseling centers are assumed to play a vital role in addressing students' mental health needs during the COVID-19 pandemic. The aim of this study was to characterize the extent to which NYC metropolitan area school websites communicated to students their updated mental health service offerings, psychoeducational information related to COVID-19, and community-based resources after the abrupt end to on-campus services during the Spring semester. A total of 138 websites were analyzed. Overall, only half of the surveyed web pages provided information about remote counseling, and just under two thirds of schools (57.97%) had directions for students experiencing a mental health emergency. As predicted, enrollment size was associated with whether psychoeducation about mental health and COVID-19 and information about remote counseling were available on a school's website. In both cases, medium-sized schools were the most likely to have these resources available on their websites as compared to small and large-sized schools. College counseling center web pages should include robust and current information that targets schools' diverse student bodies.

Subscales of the Fear Survey Schedule-III in Community Dwelling Older Adults - Relations to Clinical and Cognitive Measures.

Objectives: One major obstacle to the diagnosis and treatment of specific phobias in later life is the lack of assessment tools that are relevant to the fears of older adults. This study investigated the utility of five reliable subscales (Blood/Injury, Agoraphobia, Aggression, Animal/Insect, Social Fears) derived from the Fear Survey Schedule-III, a popular measure of phobic fear, in discriminating older from younger participants.Method: The sample was comprised of 81 younger and 61 older adults who completed self-report measures of anxiety and depression and neuropsychological tests.Results: Older adults scored significantly higher than their younger counterparts only on the Aggression subscale of the FSS-III; whereas younger adults scored significantly higher than the older group only on the Social Fears subscale. These subscales showed slightly different associations with other measures of anxiety, depression, and intelligence across age groups. Within the older sample, scores on the Aggression subscale were significantly higher than all other subscales except for Social Fears.Conclusions: It is recommended that clinicians and researchers use subscale scores derived from the FSS-III, rather than total scores, when treating and studying fears of later life.Clinical Implications: Use of FSS-III subscales in assessment could result in improved detection and treatment of phobias in later life, and thus raise quality of life among the elderly. Older adults' fears of victimization should be prioritized as a possible treatment target in clinical settings.

Prefrontal-limbic connectivity during worry in older adults with generalized anxiety disorder.

OBJECTIVES: Although generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders in older adults, very little is known about the neurobiology of worry, the hallmark symptom of GAD in adults over the age of 60. This study investigated the neurobiology and neural circuitry of worry in older GAD patients and controls. METHOD: Twenty older GAD patients and 16 age-matched controls (mean age = 67.88) were compared on clinical measures and neural activity during worry using functional magnetic resonance imaging. RESULTS: As expected, worry elicited activation in frontal regions, amygdala, and insula within the GAD group, with a similar but less prominent frontal pattern was observed in controls. Effective connectivity analyses revealed a positive directional circuit in the GAD group extending from ventromedial through dorsolateral prefrontal cortices, converging on the amygdala. A less complex circuit was observed in controls with only dorsolateral prefrontal regions converging on the amygdala; however, a separate circuit passing through the orbitofrontal cortex converged on the insula. CONCLUSION: Results elucidate a different neurobiology of pathological versus normal worry in later life. A limited resource model is implicated wherein worry in GAD competes for the same neural resources (e.g. prefrontal cortical areas) that are involved in the adaptive regulation of emotion through cognitive and behavioral strategies.

Emotional stroop performance in older adults: effects of habitual worry.

OBJECTIVE: In clinically anxious individuals, selective attention to negative cues in the environment may perpetuate a vicious cycle of emotional dysfunction. However, very little is known regarding the role of negative attentional bias in anxious older adults. There is evidence that in older adults without clinical anxiety, the opposite bias (toward positive, and away from negative, emotional material) is present. We explored how these age-related changes in emotional processing interact with anxiety. METHOD: Sixty older adults (age 60+) completed the emotional Stroop (eStroop) task, a widely used measure of attentional bias, which requires rapid identification of the color in which neutral and emotional words are printed. Participants were stratified into high-, mid-, and low-worry groups on the basis of a self-report measure, the Penn State Worry Questionnaire. RESULTS: The high-worry group exhibited a bias toward threat-related words whereas the low- and mid-worry groups showed a bias away from threat-related words. By contrast, the low- and mid-worry groups showed a bias toward positive words, potentially consistent with an established positivity effect in older adults whereas the high-worry group showed a bias away from positive items. CONCLUSION: Older adults who worry frequently exhibit a pattern of eStroop performance that is broadly consistent with the younger adult literature, suggesting that selective attention toward threat-related information may be seen as a relevant factor in older, as in younger, anxiety.

Improving recognition of late life anxiety disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: observations and recommendations of the Advisory Committee to the Lifespan Disorders Work Group.

BACKGROUND: Recognition of the significance of anxiety disorders in older adults is growing. The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a timely opportunity to consider potential improvements to diagnostic criteria for psychiatric disorders for use with older people. The authors of this paper comprise the Advisory Committee to the DSM5 Lifespan Disorders Work Group, the purpose of which was to generate informative responses from individuals with clinical and research expertise in the field of late-life anxiety disorders. METHODS: This paper reviews the unique features of anxiety in later life and synthesizes the work of the Advisory Committee. RESULTS: Suggestions are offered for refining our understanding of the effects of aging on anxiety and other disorders (e.g., mood disorders) and changes to the DSM5 criteria and text that could facilitate more accurate recognition and diagnosis of anxiety disorders in older adults. Several of the recommendations are not limited to the study of anxiety but rather are applicable across the broader field of geriatric mental health. CONCLUSIONS: DSM5 should provide guidelines for the thorough assessment of avoidance, excessiveness, and comorbid conditions (e.g., depression, medical illness, cognitive impairment) in anxious older adults.

Predictors of unsuccessful magnetic resonance imaging scanning in older generalized anxiety disorder patients and controls.

A thorough understanding of the neurobiology of late life anxiety is likely to depend on the use of brain imaging techniques such as magnetic resonance imaging (MRI). Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders in older adults, and is thus a focus for neurobiological studies using MRI. This study tested 1-3 weeks predictors of unsuccessful scan outcomes (i.e., scan trials in which the participant moved excessively or prematurely terminated the scan) in older adults with GAD (n = 39) and age- and sex-matched nonanxious controls (n = 21). It was hypothesized that successful completion of a prior MRI scan, clinical status (GAD versus control), and scores on the Anxiety Sensitivity Index (ASI; Peterson et al. 1986), a measure tapping psychological aspects of medical interventions, would predict scan outcome when current diagnoses of claustrophobia were controlled. In logistic regression analyses, unsuccessful scan outcome was predicted by prior MRI completion and ASI Mental Concerns subscale scores, but not clinical status. This model correctly classified 91% of successful and 71% of unsuccessful scans. An alternative model that included a single ASI item rather than Mental Concerns subscale scores showed similar performance, and a model including categorical anxiety sensitivity groups was also effective but slightly less accurate. Implications for improving the success rates of MRI with older adults are discussed.

Attention mechanisms in children with anxiety disorders and in children with attention deficit hyperactivity disorder: implications for research and practice.

Inattention is among the most commonly referred problems for school-aged youth. Research suggests distinct mechanisms may contribute to attention problems in youth with anxiety disorders versus youth with attention deficit hyperactivity disorder (ADHD). This study compared children (8-17 years) with anxiety disorders (n = 24) and children (8-16 years) with ADHD (n = 23) on neurocognitive tests of both general and emotion-based attention processes. As hypothesized, children with ADHD demonstrated poorer selective and sustained attention, whereas youth with anxiety disorders demonstrated greater attentional bias toward threatening faces on a visual probe task. Findings suggest the neuropsychological differentiation of attention problems in anxious and ADHD children, despite potentially similar phenotypes.

The language of university communications during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic of 2020 raised concern for those spending time in college classrooms and dormitories. Students faced sudden changes to their lives and relied upon written messages for directives. This study investigated the language of university-based communications, based on models of crisis communication and epidemic management. METHODS: The Linguistic Inquiry and Word Count was used to investigate the language in the most salient written messages from universities to students regarding the migration to online classes. RESULTS: As predicted, certain word types were used more frequently than others. The larger the student body, the more frequently universities used positive emotion/resilience and power/organizational words. and the more likely a COVID update would be posted on the homepage within three months' time. CONCLUSION: Messages should be guided by models of crisis management and carefully crafted, given the role of universities in managing large numbers of students during ongoing pandemic illness.

Is a diverse sample of college students motivated by compassionate, neutral, or fear-inducing language in COVID-19 crisis messages?

Objective: During public health emergencies such as the ongoing COVID-19 illness pandemic, it is essential to rapidly disseminate crisis messages which often contain embedded health directives. This study investigated which of three variants of the same messages (neutral tone, positive/compassionate tone, negative/fear-inducing tone) were most likely to motivate readers to engage in the health behavior proscribed in the message. Participants: Participants were 87 female and 41 male undergraduates at an urban university in the northeast U.S. Methods: A survey with three versions of eight different COVID messages containing health directives was administered. Results: Those who indicated stronger influence of positive/compassionate crisis messages (i.e., had higher Crisis Messages Survey scores) had higher adaptive health engagement scores, lower worry scores, and were likely to have had a past diagnosis of COVID-19. Moreover, a regression model including COVID-19 status and worry scores accounted for a significant proportion of variance in Crisis Messages Survey scores. Conclusions: Findings indicate that the use of neutral and compassionate language is optimal in motivating health behaviors embedded in university crisis messages.

Feasibility and acceptance of a nonpharmacological cognitive remediation intervention for patients with Parkinson disease.

Many patients with idiopathic Parkinson disease (PD) experience deficits in executive skills (ES; eg, attentional control, self-monitoring), which are associated with a range of impairing symptoms such as visual hallucinations, decreased motor control, and increased apathy. Pharmacological methods for improving ES in PD have shown to be somewhat unreliable. The goal of this study was to evaluate the feasibility and patient acceptance of a nonpharmacological cognitive remediation program that aimed to improve sustained, selective, alternating, and divided attentional abilities in a sample of 16 nondemented PD patients. Based on ratings of 4 feasibility dimensions (fatigue, effort, progress, enjoyment), patients with PD demonstrated a high degree of acceptance and successfully engaged in the program. As predicted, ratings of progress differed significantly across tasks according to difficulty level and were positively related to posttraining improvement in ES. Fatigue ratings showed negative associations with other indices across task types, suggesting that monitoring fatigue during cognitive remediation is essential. Patients' ratings of enjoyment did not correspond to task difficulty, indicating that tasks could be simultaneously challenging and rewarding. Males reported exerting greater effort during the training than females. It was concluded that the intervention is appropriate for testing in a randomized controlled trial.

Health-Related Correlates of Demonstrated Smartphone Expertise in Community-Dwelling Older Adults.

Smartphone use in the older population is understudied, despite a growing use of technology in this age group. This study characterized the relation of demonstrated smartphone expertise to self-reported health attitudes and behaviors in 85 community-dwelling adults, mean age 77.24 (7.64) years. Self-report instruments included a demographic survey, a health attitudes measure, and a mobility checklist. Participants completed a behavioral challenge, the Smartphone Task for Older Adults (STOA). Demonstrated expertise in smartphone use (STOA-DESU), familiarity with apps, and ability to replicate functions after demonstration showed differential relations with health outcomes. DESU was positively associated with education, income, Altarum Consumer Engagement Measure (ACE), and Life Space Questionnaire (LSQ) scores and was negatively associated with age and daily medications. Additional findings replicated aspects of the well-known digital divide, and showed that those older adults with restricted mobility or diabetes had less knowledge of and more difficulties in using smartphones. Despite these problems, health-related functions must be optimized for older populations.

The COVID-19 Inventory: Measuring anxiety related to illness pandemic across college males and females.

BACKGROUND: Due to close proximity in dormitories, classes, and social activities, college students have been identified as a vulnerable population throughout the COVID-19 pandemic of 2020. OBJECTIVES: This study tested properties of a new COVID-19 Inventory (C-19-I). It was expected that the measure would show acceptable validity and reliability, females would report greater COVID-19 anxiety than males, and the addition of gender would improve a regression model of COVID-19 anxiety. METHOD: Participants were 201 college undergraduates who completed multiple self-report measures and two snack selection tasks. RESULTS: The C-19-I showed a multifactor solution and acceptable psychometric properties. Females scored higher than males and were more likely than males to select a healthy snack after responding to questions about illness and contamination. CONCLUSIONS: This study validates a new measure of COVID-19 anxiety and contributes to a deeper understanding of how college adults respond to pandemic illness.

The language of states' COVID-19 messages: Correlates of positive and negative emotion and health outcomes.

Crisis communication is most effective when it takes into consideration the emotional reactions of those involved. Messages pertaining to pandemic illness such as COVID-19 should thus include the most effective types of words, given the goal of crisis management. This study investigated hypothesized word categories (e.g., reward/risk, focus on present versus past) related to superordinate categories of positive and negative emotional tone in COVID-19 fact sheets from each of the fifty states in the U.S. The relation of six word types to the superordinate categories and a health outcome variable (the rate of deaths per positive virus cases) was also tested. Results indicated that each of the six word types mapped on to either the positive or negative emotion word category. Furthermore, messages that included more reward and uncertainty words were associated with lower deaths per positive virus cases. Implications for future pandemic crisis messages are discussed.

Use of the Instagram Hashtags #winemom and #momjuice Among Mothers During the COVID-19 Pandemic: Descriptive, Cross-sectional Study.

BACKGROUND: The tendency of parents to consume alcohol during the COVID-19 pandemic is likely to be moderated by pandemic-related stress combined with the ongoing demands of childcare and home-based education, which are reported to be more burdensome for females than males. OBJECTIVE: The purpose of this study was to describe alcohol-related content posted by mothers on Instagram during the COVID-19 pandemic. METHODS: Using two popular hashtags, #momjuice and #winemom, 50 Instagram posts on each were collected from the "top posts" tab. The coding categories were created inductively and were as follows: displays alcohol (drinking/holding alcohol or alcohol itself), person is making alcoholic beverages, type of alcohol featured or discussed, highlights anxiety and/or depression/mental state, highlights struggling (in general), highlights parenting challenges, encourages alcohol consumption, discourages alcohol consumption, features a person wearing clothing or shows products promoting alcohol, promotes alcohol rehabilitation, highlights caffeine to alcohol daily transition throughout the day, and highlights other drugs besides caffeine and alcohol. RESULTS: Overall, the 100 selected posts had a total of 5108 comments and 94,671 likes. The respective averages were 51.08 (SD 77.94) and 946.71 (SD 1731.72). A majority (>50%) of the posts reviewed encouraged alcohol consumption (n=66) and/or displayed alcohol (n=56). Of the 66 that encouraged and/or displayed alcohol, the common type of alcohol discussed or featured was wine (n=55). Only 6 posts discouraged alcohol use and only 4 provided the audience with a disclaimer. None of the videos promoted or endorsed alcohol rehabilitation in any way. Only 37 posts highlighted struggle. However, these posts garnered more than a majority of the likes (n=50,034, 52.3%). Posts that showed struggle received an average of 1359.57 (SD 2108.02) likes. Those that did not show struggle had an average of 704.24 (SD 1447.46) likes. An independent one-tailed t test demonstrated this difference to be statistically significant (P=.0499). CONCLUSIONS: The findings of this investigation suggest that though these hashtags ostensibly exist to valorize excess alcohol consumption, they may be serving as a support system for mothers who are experiencing increased burdens and role stress during the pandemic. Given the strains placed on mothers overall and especially during the COVID-19 pandemic, efforts must be taken to increase access to and affordability of telehealth-based mental health care.