Sex differences in the relationship between hepatic steatosis, mood and anxiety disorders.

OBJECTIVE: To investigate the association between non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), mental symptoms (mood, anxiety disorders and distress) by sex. METHODS: This a cross-sectional study performed in working-age adults from a Health Promotion Center (primary care) in São Paulo, Brazil. Self-reported mental symptoms from rating scales (21-item Beck Anxiety Inventory, Patient Health Questionnaire-9, and K6 distress scale) were evaluated by hepatic steatosis (NAFLD and ALD). Logistic regression models estimated the association between hepatic steatosis subtypes and mental symptoms by Odds ratios (OR) adjusted by confounders in the total sample and sex stratified. RESULTS: Among 7241 participants (70.5% men, median age: 45 years), the frequency of steatosis was of 30.7% (25.1% NAFLD), being higher in men than women (70.5% vs. 29.5%, p < 0.0001), regardless of the steatosis subtype. Metabolic risk factors were similar in both subtypes of steatosis, but not mental symptoms. Overall, NAFLD was inversely associated with anxiety (OR = 0.75, 95%CI 0.63-0.90) and positively associated with depression (OR = 1.17, 95%CI 1.00-1.38). On the other hand, ALD was positively associated with anxiety (OR = 1.51; 95%CI 1.15-2.00). In sex-stratified analyses, only men presented an association of anxiety symptoms with NAFLD (OR = 0.73; 95%CI 0.60-0.89) and ALD (OR = 1.60; 95%CI 1.18-2.16). CONCLUSIONS: The complex association between different types of steatosis (NAFLD and ALD), mood and anxiety disorders indicates the need for a deeper understanding of their common causal pathways.

Anxiety, Depression, and Anger in Bruxism: A Cross-sectional Study among Adult Attendees of a Preventive Center.

The relationship between emotional symptom and bruxism is not well-established. We aimed to investigate sleeping bruxism and psychological factors. A cross-sectional study was performed in working-age adults attended in general outpatient service. The main outcome was the sleep bruxism diagnosed by dentist. Sociodemographic, clinical and psychological characteristics were evaluated according to sleep bruxism (yes/no). Scores of self-report scales of psychological symptoms (Beck Anxiety Inventory, Patient Health Questionnaire, and Dimensions of Anger Reactions) were individually subjected to factor analysis, through the extraction method of principal axis factoring. The associations between probable cases of sleep bruxism with dimensions of anxiety (somatic and cognitive), depression, and anger were estimated by linear regression models. Linear regression models (with ß coefficients and 95% CI) were adjusted for sociodemographic covariates. Among 351 respondents, 37.3% presented sleep bruxism. Of them, high frequencies of symptoms of anger (68.1%), moderate-severe anxiety (23.6%), and depression (17.9%) were observed. After adjustment, somatic-anxiety (ß: 0,136; CI95%: 0,028 to 0.276) was associated with sleep bruxism, but not cognitive-anxiety, depression or anger. The presence of sleeping bruxism should be routinely explored among adults, regarding its relationship with emotional symptoms.

Dimensions of Anger Reactions (DAR-5): a useful screening tool for anger in the general population.

BACKGROUND: Dimensions of Anger Reactions (DAR-5) is a brief 5-item instrument to assess experience of anger. We aimed to verify the DAR-5 as a screening instrument in the community. METHODS: A sample of 368 apparently healthy adults who attended an outpatient ambulatory facility self-reported on the DAR-5 scale, the Spielberger's State-Trait Anger Expression Inventory (STAXI), the Beck Anxiety Inventory (BAI), and the Patient Health Questionnaire (PHQ-9). Indicators of reliability and validity were calculated to demonstrate the performance of the DAR-5. RESULTS: According to the DAR-5, around half the respondents found themselves becoming angry with people or situations and reported persistent duration of anger. Antagonism towards others was the least frequently experienced anger (8.4%). The DAR-5 was found to be reliable and stable, showing a significant correlation with the BAI and PHQ-9 for both sexes. In confirmatory factor analysis, a one-dimensional structure of anger experience was demonstrated through salient fit statistics. A cut-off > 8 was the best threshold against STAXI for discriminating cases of anger, irrespective of sex. CONCLUSIONS: The shortness of the DAR-5, along with its cost-effective applicability, qualifies this measuring tool as a useful instrument for inclusion in the routine assessment of anger reactions in the general population.Key pointsThis is the first time the validity of DAR-5 has been demonstrated in a developing country.The Portuguese version of DAR-5 has appropriate sensitivity and high specificity.The DAR-5 demonstrated to be a reliable and stable instrument, irrespective of sex.