Detection of anxiety symptoms and disorders in older adults: a diagnostic accuracy systematic review.

BACKGROUND: Anxiety symptoms and disorders are common in older adults and often go undetected. A systematic review was completed to identify tools that can be used to detect anxiety symptoms and disorders in community-dwelling older adults. METHODS: MEDLINE, Embase and PsycINFO were searched using the search concepts anxiety, older adults and diagnostic accuracy in March 2023. Included articles assessed anxiety in community-dwelling older adults using an index anxiety tool and a gold standard form of anxiety assessment and reported resulting diagnostic accuracy outcomes. Estimates of pooled diagnostic accuracy outcomes were completed. RESULTS: Twenty-three anxiety tools were identified from the 32 included articles. Pooled diagnostic accuracy outcomes were estimated for the Geriatric Anxiety Inventory (GAI)-20 [n = 3, sensitivity = 0.89, 95% confidence interval (CI) = 0.70-0.97, specificity = 0.80, 95% CI = 0.67-0.89] to detect generalized anxiety disorder (GAD) and for the GAI-20 (n = 3, cut off ≥ 9, sensitivity = 0.74, 95% CI = 0.62-0.83, specificity = 0.96, 95% CI = 0.74-1.00), Beck Anxiety Inventory (n = 3, sensitivity = 0.70, 95% CI = 0.58-0.79, specificity = 0.60, 95% CI = 0.51-0.68) and Hospital Anxiety and Depression Scale (HADS-A) (n = 3, sensitivity = 0.78, 95% CI = 0.60-0.89, specificity = 0.76, 95% CI = 0.60-0.87) to detect anxiety disorders in clinical samples. CONCLUSION: The GAI-20 was the most studied tool and had adequate sensitivity while maintaining acceptable specificity when identifying GAD and anxiety disorders. The GAI-20, GAI-Short Form and HADS-A tools are supported for use in detecting anxiety in community-dwelling older adults. Brief, self-rated and easy-to-use tools may be the best options for anxiety detection in community-dwelling older adults given resource limitations. Clinicians may consider factors including patient comorbidities and anxiety prevalence when selecting a tool and cut off.

A preliminary investigation of dissociation between subjective cognitive complaints and objective cognitive impairments in female patients with fibromyalgia: a role of information processing speed.

OBJECTIVES: Fibromyalgia (FM) is a chronic condition characterised by widespread pain, and cognitive difficulties represent one of the most common symptoms of FM. However, subjective cognitive complaints (SCC) may not necessarily indicate significant abnormalities in objective cognitive performances, and there is limited research investigating the relationship between these two aspects. This study thus aims to analyse the differences between SCC and objective cognitive performance in FM patients and to explore their associations. METHODS: A total of 32 FM female patients (age: 50.91±7.06; years since diagnosis: 4.34±4.53) recruited in this study underwent a comprehensive assessment covering four domains: pain, depression, trait anxiety, SCC, and objective cognitive functions (memory, executive function, and information processing speed). RESULTS: Eighty-seven percent of patients experienced significant negative impacts from pain; meanwhile, 91% and 62% showed marked tendencies towards trait anxiety and depression, respectively. Additionally, 56% of patients reported significantly higher levels of SCC. However, less than one-third of patients demonstrated impairments in various cognitive functions. SCC significantly correlated with pain intensity, depression, information processing speed, and trait anxiety, with pain intensity being a significant predictor (R2=.30). Furthermore, patients with significant SCC exhibited more abnormalities in pain, information processing speed, and trait anxiety compared to those without significant SCC. CONCLUSIONS: SCC may not necessarily correlate with objective cognitive impairments and might be specifically linked to defective information processing speed. It thus merits that clinical assessments for FM patients should incorporate measurements of information processing speed to gain a comprehensive understanding of SCC in FM patients.

[Association between emotional disorders and ophthalmopathology in residents of the Arkhangelsk region at the age of 60-74 years.]

A study was conducted to investigate the associations of the diseases of the organ of vision and its accessory apparatus with anxiety and depression in the elderly people. The study included 678 participants of the ESSE-RF3 population study in the Arkhangelsk region in the age of 60-74 years. We used a questionnaire, including the hospital scale of anxiety and depression score (HADS), and the assessment of the ophthalmological status. It was found that all the study participants had diseases of the visual organ. Elevated depression scores were associated with sex, age, marital status (being single), and disability, elevated anxiety scores - with sex. The scores on the anxiety scale were on average 25% higher in participants whose visual acuity decreased to 0,5 units, and showed no independent associations with diagnosed ophthalmological diseases. The scores on the depression scale were on average 33% higher in participants with visual acuity 0,5 units, and 22% higher in the presence of retinopathy. In conclusion, anxiety and depression in the elderly people were more associated with visual deficits rather than with the presence of ophthalmological diseases underlying a decrease in functional status.

Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial.

BACKGROUND: Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. OBJECTIVE: This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. METHODS: A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use-related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test-10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. RESULTS: In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). CONCLUSIONS: The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. TRIAL REGISTRATION: International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795.

The effect of simulation on auscultation skills, self-confidence and anxiety levels in nursing students: A randomized controlled trial.

AIM: This study evaluated the effect of simulation on auscultation skills, self-confidence and anxiety levels. BACKGROUND: Auscultation is an essential topic in nursing education and patient care. Simulation is efficacious in improving auscultation skills and self-confidence and reducing anxiety levels. It is a valuable educational approach whose effects should be evaluated and disseminated in the context of auscultation. DESIGN: This study had a randomised controlled trial design. METHODS: The study was conducted with second-year nursing students enrolled at a university in Turkey. One group of students studied auscultation of heart, lung and bowel sounds with a simulated patient (n = 28), the second group with a high fidelity simulator (n = 30) and the third group with traditional education (n = 28). Data were collected using a demographic information form, auscultation control list and Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale. The students' psychomotor auscultation skills, self-confidence and anxiety levels were evaluated. Data on auscultation skills were assessed after the intervention, while data on self-confidence and anxiety levels were collected at baseline, after the intervention and after clinical practices throughout the academic year. RESULTS: Anxiety and self-confidence levels showed statistically significant differences in intragroup evaluation. The self-confidence levels of the groups working with simulation did not change much in the follow-up test conducted after the end of clinical practices. The mean skill scores in the auscultation control list showed a statistically significant difference between the groups. CONCLUSIONS: Simulation and traditional approaches are effective in learning auscultation skills. However, the positive effects of simulation, particularly in enhancing students' self-confidence and reducing anxiety levels, appear to be more permanent and impactful than traditional education. Therefore, it is recommended that simulation be prioritized for teaching auscultation skills.

Measurement invariance of the Pandemic Anxiety Inventory in different demographic groups.

BACKGROUND: The Pandemic Anxiety Inventory (PAI) was developed in the context of the COVID-19 pandemic. Its content allows it to assess anxiety in connection to any pandemic. Previous research has demonstrated the instrument's reliability and validity. An important question for clinicians and researchers, however, remains open: Does the PAI have similar meaning for members of different demographic groups? The finding of measurement invariance would allow clinicians and researchers to comparatively assess pandemic-related anxiety across demographic groups, including favored and disfavored groups. METHODS: We conducted a multi-group confirmatory factor analysis to assess the measurement invariance of the PAI using data obtained from a sample of 379 residents of the United Kingdom. RESULTS: The PAI demonstrated invariance across genders, age groups, individuals who are married or in a relationship and those who are not, as well as individuals with higher and lower incomes. In an ancillary analysis, we found invariance across subsamples of Whites and Nonwhites, although we note that the Nonwhite group was small (n = 60) and heterogeneous. The findings of a supplemental MIMIC analysis were consistent with the above. CONCLUSIONS: The PAI shows measurement invariance across a variety of demographic groups. Our findings suggest that the instrument can be meaningfully employed to compare pandemic-related anxiety across these groups.

Validation of the German version of the 25-item hikikomori questionnaire 25.

OBJECTIVES: The 25-item Hikikomori Questionnaire (HQ-25) is an instrument developed to measure a condition characterized by extreme social withdrawal that was first described in Japan. This study aimed to translate the HQ-25 into German and validate the German version (HQ-25-G). METHODS: Translation was conducted according to established guidelines. Validation was based on data from a quota sample of individuals living in Germany, ranging from 18 to 74 years old (representing the distribution of age, sex and federal state, n = 5000). Data collection occurred during August and September 2023. We tested reliability, construct validity and concurrent validity. Moreover, HQ-25 scores for key sociodemographic group were reported. RESULTS: Internal reliability for the HQ-25-G was excellent (Cronbach's alpha = 0.93). We confirmed the original three-factor model. Moreover, higher hikikomori levels were significantly associated with more depressive symptoms (r = 0.50), more anxiety symptoms (r = 0.45), higher loneliness levels (r = 0.56), higher levels of objective social isolation (r = -0.47), higher levels of perceived social isolation (r = 0.59) and a higher preference for solitude (r = 0.45). CONCLUSIONS: In a large population-based sample (including younger adults, middle-aged adults and older adults), the HQ-25-G version proves to be a psychometrically robust instrument, which is useful for further exploring the phenomenon of hikikomori within the German-speaking population.

Factor structure and measurement invariance of the Depression anxiety stress scale (DASS-21) in Chinese left-behind and non-left-behind children: an exploratory structural equation modeling approach.

BACKGROUND: Comprehensive data has shown that adolescents often suffer from depression, anxiety, and low self-esteem, and are in a particularly fragile stage of psychological, physiological, and social development. Left-behind children in particular tend to have significantly higher, state anxiety and depression compared to non-left-behind children. The Depression, Anxiety, and Stress Scale (DASS-21) is an effective tool for evaluating depression, anxiety, and stress, and is used to measure levels of depression, anxiety, and stress in groups from a variety of backgrounds. The purpose of this study was to determine the effectiveness, reliability, and measurement invariance of the DASS-21 in Chinese left-behind children. METHOD: The test and re-test method was used (N = 676), and the exploratory structural equation model (Mplus v.8.3) used to verify basic measurement models. For measurement invariance, the configural, weak, strong, and strict models were tested. The reliability of the DASS-21 was also tested using the collected data. RESULTS: Analysis results showed that the DASS-21 had a stable three-factor structure in the sample of left-behind children in China. The measurement invariance test showed that gender and time not only had strong invariance, but also strict invariance. The results of cross left and non-left invariance indicated a lack of strict invariance. Finally, the McDonald's omega coefficient of the DASS-21 total scale was 0.864, and the internal consistency of each subscale was also good. CONCLUSIONS: The DASS-21 is shown to be an effective and reliable tool for measuring depression, anxiety and stress in Chinese left-behind children.

[Eco-anxiety: an emerging disorder linked to climate change]. / Éco-anxiété : un trouble émergent lié au dérèglement climatique.

ECO-ANXIETY: AN EMERGING DISORDER LINKED TO CLIMATE CHANGE. Eco-anxiety is the chronic fear of an environmental disaster, particularly in relation to global warming. Emerging in the 1990s, this concern is increasingly developing in all countries, especially among younger generations. It is not currently recognized as a diagnosis in psychiatric classifications, but some people (about 3% of the population) experience significant suffering and symptoms that can impair their quality of life. The role of the physician is then to look for an underlying anxiety or depressive disorder, or to assess the intensity of a possible specific Eco-anxiety Disorder. Treatment is based primarily on psychotherapeutic listening, stress and anxiety management methods, and cognitive behavioral therapy aimed at giving the patient better control over their emotions and means of action.

ÉCO-ANXIÉTÉ : UN TROUBLE ÉMERGENT LIÉ AU DÉRÈGLEMENT CLIMATIQUE. L'éco-anxiété est la crainte chronique d'une catastrophe environnementale, notamment en rapport avec le réchauffement climatique. Apparue dans les années 1990, cette inquiétude se développe de plus en plus dans tous les pays, surtout parmi les jeunes générations. Il ne s'agit pas d'un diagnostic reconnu à ce jour dans les classifications psychiatriques, mais certaines personnes (environ 3 % de la population) présentent une souffrance importante ainsi que des symptômes pouvant altérer leur qualité de vie. Le rôle du médecin est alors de rechercher un trouble anxieux ou dépressif sous-jacent, ou d'évaluer l'intensité d'un possible trouble éco-anxiété spécifique. Le traitement repose essentiellement sur une écoute psychothérapeutique, des méthodes de gestion du stress et de l'anxiété, et la thérapie comportementale et cognitive, visant à redonner au patient un meilleur contrôle de ses émotions et des moyens d'agir.

A Delphi study and development of a social and emotional wellbeing screening tool for Australian First Nations Peoples living in the Torres Strait and Northern Peninsula Area of Australia.

Tools screening depression and anxiety developed using the Western biomedical paradigm are still used with First Nations Peoples globally, despite calls for cross-cultural adaption. Recent work by this research team found that tools used to screen for depression and anxiety were inappropriate for use with Australian First Nations Peoples living in the Torres Strait and Northern Peninsula Area of Australia. The objective of this Delphi study, the second phase of a broader four-phase project, was to gain consensus from an expert mental health and/or social and emotional wellbeing (SEWB) panel to inform the development of an appropriate screening tool. This Delphi study took place between March and May 2023. Three sequential rounds of anonymous online surveys delivered using QualtricsTM were planned, although only two were needed to reach 75% consensus. The first round sought consensus on whether a new screening tool needed to be developed or whether existing tools could be used. The second round achieved consensus. Twenty-eight experts (47% response rate) participated across the two Delphi rounds. In the second round, 83% of these experts agreed or strongly agreed that a new screening tool, using the holistic First Nations concept of social and emotional wellbeing, be developed. Ninety-four percent of them agreed that it should take a Yarning approach. These findings enabled the development of a new SEWB screening tool that adopted a Yarning (narrative) approach designed for use in primary care and geriatric settings in the region. The new tool has four different Yarning areas: Community engagement and behaviour; Stress worries; Risk; and Feeling strong. Guidelines for tool use are integrated as well as Summary and Recommendation sections. At a macro-level this project responds to the need for new screening tools that are underpinned by First Nations worldviews.

Social Motivation Differentiates Social Anxiety and Depression: A Daily Diary Study.

Because social anxiety and depression commonly co-occur, it can be challenging to disentangle the emotional and motivational features of these conditions in everyday life contexts. In this daily diary study, we sought to understand the interplay between daily social anxiety and depression symptoms and emotion and motivation, determining whether daily symptoms are independently linked with positive affect, negative affect, and social motivation (desire to approach or to withdraw from others). Community-dwelling adults (N = 269) with a wide range of social anxiety and depression symptoms completed daily assessments for 14 consecutive days (a total of 2,986 daily surveys). Within-person analyses found that increases in social anxiety and depression symptoms were uniquely associated with elevated negative affect; only increases in depression symptoms were associated with diminished positive affect. Increases in social anxiety symptoms were associated with an elevated desire to approach others but not a desire to withdraw from others. By contrast, increases in depression symptoms were associated with a diminished desire to approach others and an elevated desire to withdraw from others. Desire for social connection may distinguish social anxiety from depression. Examining patterns of daily social motivation may enhance clinicians' ability to differentiate the difficulties that arise from social anxiety from those that arise from depression.

Patient Perspectives on Portal-Based Anxiety and Depression Screening in HIV Care: A Qualitative Study Using the Consolidated Framework for Implementation Research.

Electronic patient portals represent a promising means of integrating mental health assessments into HIV care where anxiety and depression are highly prevalent. Patient attitudes toward portal-based mental health screening within HIV clinics have not been well described. The aim of this formative qualitative study is to characterize the patient-perceived facilitators and barriers to portal-based anxiety and depression screening within HIV care in order to inform implementation strategies for mental health screening. Twelve adult HIV clinic patients participated in semi-structured interviews that were audio recorded and transcribed. The transcripts were coded using constructs from the Consolidated Framework for Implementation Research and analyzed thematically to identify the barriers to and facilitators of portal-based anxiety and depression screening. Facilitators included an absence of alternative screening methods, an approachable design, perceived adaptability, high compatibility with HIV care, the potential for linkage to treatment, an increased self-awareness of mental health conditions, the ability to bundle screening with clinic visits, and communicating an action plan for results. The barriers included difficulty navigating the patient portal system, a lack of technical support, stigmatization from the healthcare system, care team response times, and the novelty of using patient portals for communication. The patients in the HIV clinic viewed the use of a portal-based anxiety and depression screening tool as highly compatible with routine HIV care. Technical difficulties, follow-up concerns, and a fear of stigmatization were commonly perceived as barriers to portal use. The results of this study can be used to inform implementation strategies when designing or incorporating portal-based mental health screening into other HIV care settings.

Parenting styles and psychological effects on children with alopecia areata: exploring family dynamics, anxiety, and depression.

Alopecia areata (AA) is an autoimmune disease that develops due to inflammation and causes sudden hair loss. Ithas been observed that family circumstances may contribute to the development of AA. This study aims to assessthe relationship between the development of alopecia areata in children, family functions, and depression andanxiety levels in their parents.Thirty-nine participants diagnosed with AA and 41 healthy controls (HC), agedbetween 8 and 18 years, and their parents participated in the study. The assessment of the children included thecompletion of a socio-demographic data form, the Parenting Style Scale (PSS), and the Revised Children's Anxietyand Depression Scale (RCADS). The parents provided information on a sociodemographic form, the BeckDepression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The children in the control group scoredsignificantly higher on the PSS acceptance/ involvement subscale than those with AA. In the AA group, the numberof authoritative and indulgent (PSS) families was statistically significantly lower than that of the families in the HC,and the number of neglectful families was statistically significantly higher than those of the control group. Totalanxiety and depression t scores (RCADS) were statistically significantly higher in the AA children than in theHC. Our study demonstrates the importance of considering familial factors and parental mental health tounderstand and address alopecia areata in children. Our findings support the psychosomatic component of AA.Implementing comprehensive treatment strategies that target psychological well-being and family dynamics couldprove crucial.

Childhood maltreatment exposure is differentially associated with transdiagnostic perinatal depression symptoms.

History of childhood maltreatment (CM) is common and robustly associated with prenatal and postpartum (perinatal) depression. Given perinatal depression symptom heterogeneity, a transdiagnostic approach to measurement could enhance understanding of patterns between CM and perinatal depression. METHODS: In two independently collected samples of women receiving care at perinatal psychiatry clinics (n = 523 and n = 134), we categorized longitudinal symptoms of perinatal depression, anxiety, stress, and sleep into transdiagnostic factors derived from the Research Domain Criteria and depression literatures. We split the perinatal period into four time points. We conducted a latent profile analysis of transdiagnostic factors in each period. We then used self-reported history of CM (total exposure and subtypes of abuse and neglect) to predict class membership. RESULTS: A three-class solution best fit our data. In relation to positive adaptive functioning, one class had relatively more positive symptoms (high adaptive), one class had average values (middle adaptive), and one class had fewer adaptive symptoms (low adaptive). More total CM and specific subtypes associated with threat/abuse increased an individual's likelihood of being in the Low Adaptive class in both samples (ORs: 0.90-0.97, p < .05). LIMITATIONS: Generalizability of our results was curtailed by 1) limited racial/ethnic diversity and 2) missing data. CONCLUSIONS: Our results support taking a person-centered approach to characterize the relationship between perinatal depression and childhood maltreatment. Given evidence that increased exposure to childhood maltreatment is associated with worse overall symptoms, providers should consider incorporating preventative, transdiagnostic interventions for perinatal distress in individuals with a history of childhood maltreatment.

Inflammatory biomarkers and psychological variables to assess quality of life in patients with inflammatory bowel disease: a cross-sectional study.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic gastrointestinal condition. While inflammatory biomarkers are valuable for diagnosing and monitoring the disease, their correlation with patients' quality of life (QoL) is not well-established. PURPOSE: This study aims to investigate the correlations between inflammatory biomarkers and the quality of life (QoL) variables of individuals diagnosed with IBD in clinical remission. METHODS: The sample of this cross-sectional study included 74 patients (80% women; 45 ± 11 years old) diagnosed with IBD. Outcome variables included faecal calprotectin (FC), C-reactive protein (CRP), cortisol levels from hair samples, and anxiety and depression assessed using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), alongside QoL evaluated with the Inflammatory Bowel Disease Questionnaire 32 (IBDQ-32). Bivariate correlations were calculated using the Pearson correlation coefficient, and stepwise linear regression analyses were conducted to identify independent factors contributing to IBDQ-32 scores. RESULTS: The IBDQ-32 did not significantly correlate with any biomarkers. However, it exhibited a large and statistically significant negative correlation with HADS-A (r = -0.651) and HADS-D (r = -0.611) scores (p < 0.001). Stepwise linear regression analyses indicated that HADS-A was a significant and independent predictor for IBDQ-32 scores (Adjusted R2 = 0.41, ß = -0.65, p < 0.001). CONCLUSIONS: Inflammatory markers such as CRP, FC, or cortisol in hair do not play a decisive role in assessing the QoL of IBD patients. These findings emphasize the significance of considering psychological factors in evaluating and managing QoL in IBD patients in order to identify severity, suggesting that instruments like HADS should be integral to comprehensive patient assessments.

Identifying internalizing transdiagnostic profiles through motivational and cognitive control systems: Relations with symptoms, functionality, and quality of life.

BACKGROUND: The diversity of patients' symptomatology among people seeking treatment on community-based mental health services poses significant challenges to traditional models of care. Recent approaches favor identifying transdiagnostic factors that allow a better understanding of patient heterogeneity and designing more effective and quality interventions. This study examines the heterogeneity of patients with internalizing symptoms based on profiles identified with cognitive and motivational control variables. Differences between these profiles on dimensional measures of psychopathology and quality of life are examined. METHODS: 263 patients were selected by non-probabilistic sampling procedures on mental health services in the province of Huelva (Spain). A latent class analysis on the standardized scale scores of The Behavioral Inhibition/Behavioral Activation System Scales and the Effortful Control Scale of the Adult Temperament Questionnaire Short-Form was conducted. Profiles were compared on the scores of the Inventory of Depression and Anxiety Symptoms-II, the WHO Disability Assessment Schedule II, and the Health Assessment Questionnaire SF-36. RESULTS: The four latent profile solution is the one that showed the best fit indicators and substantive interpretability, with a kappa of 0.94 in the cross-validation procedure with 75% of the sample. No sex differences were found between the profiles (χ32 5.17, p = .160). Profiles #1 and #3, both characterized by an imbalance between low activation and high inhibition, had lower well-being, lower functionality, and quality of life. When comparing profile #2 (featuring the highest inhibitory control) lower scores on most internalizing scales are observed, specially claustrophobia, social anxiety, panic mania. Profile #4 (low control, high activation, and high inhibition) showed greater scores on both mania and euphoria and lower scores on emotional role. CONCLUSIONS: We identified four distinctive profiles that had overly increased behavioral inhibition (as expected in internalizing disorders) and differed in the degree of imbalance between inhibition and activation systems, and between motivational systems and top-down cognitive control. The profile characterized by high activation and reduced cognitive (inhibitory) control was the one showing greater mood-related symptoms and lower levels of quality of life. These profiles could be generated by treatment providers to guide clinical management in an evidence-based manner.

Digital Phenotyping for Stress, Anxiety, and Mild Depression: Systematic Literature Review.

BACKGROUND: Unaddressed early-stage mental health issues, including stress, anxiety, and mild depression, can become a burden for individuals in the long term. Digital phenotyping involves capturing continuous behavioral data via digital smartphone devices to monitor human behavior and can potentially identify milder symptoms before they become serious. OBJECTIVE: This systematic literature review aimed to answer the following questions: (1) what is the evidence of the effectiveness of digital phenotyping using smartphones in identifying behavioral patterns related to stress, anxiety, and mild depression? and (2) in particular, which smartphone sensors are found to be effective, and what are the associated challenges? METHODS: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) process to identify 36 papers (reporting on 40 studies) to assess the key smartphone sensors related to stress, anxiety, and mild depression. We excluded studies conducted with nonadult participants (eg, teenagers and children) and clinical populations, as well as personality measurement and phobia studies. As we focused on the effectiveness of digital phenotyping using smartphones, results related to wearable devices were excluded. RESULTS: We categorized the studies into 3 major groups based on the recruited participants: studies with students enrolled in universities, studies with adults who were unaffiliated to any particular organization, and studies with employees employed in an organization. The study length varied from 10 days to 3 years. A range of passive sensors were used in the studies, including GPS, Bluetooth, accelerometer, microphone, illuminance, gyroscope, and Wi-Fi. These were used to assess locations visited; mobility; speech patterns; phone use, such as screen checking; time spent in bed; physical activity; sleep; and aspects of social interactions, such as the number of interactions and response time. Of the 40 included studies, 31 (78%) used machine learning models for prediction; most others (n=8, 20%) used descriptive statistics. Students and adults who experienced stress, anxiety, or depression visited fewer locations, were more sedentary, had irregular sleep, and accrued increased phone use. In contrast to students and adults, less mobility was seen as positive for employees because less mobility in workplaces was associated with higher performance. Overall, travel, physical activity, sleep, social interaction, and phone use were related to stress, anxiety, and mild depression. CONCLUSIONS: This study focused on understanding whether smartphone sensors can be effectively used to detect behavioral patterns associated with stress, anxiety, and mild depression in nonclinical participants. The reviewed studies provided evidence that smartphone sensors are effective in identifying behavioral patterns associated with stress, anxiety, and mild depression.

High-definition transcranial direct current stimulation (HD-tDCS) in major depressive disorder with anxious distress-a study protocol for a double-blinded randomized sham-controlled trial.

BACKGROUND: Comorbid anxiety disorders and anxious distress are highly prevalent among individuals with major depressive disorder (MDD). The presence of the DSM-5 anxious distress specifier (ADS) has been associated with worse treatment outcomes and chronic disease course. Few studies have evaluated the therapeutic effects of High-definition transcranial direct current stimulation (HD-tDCS) on depressive and anxiety symptoms among MDD patients with ADS. The current randomized controlled trial aims to assess the efficacy of HD-tDCS as an augmentation therapy with antidepressants compared to sham-control in subjects of MDD with ADS. METHODS: MDD patients with ADS will be recruited and randomly assigned to the active HD-tDCS or sham HD-tDCS group. In both groups, patients will receive the active or sham intervention in addition to their pre-existing antidepressant therapy, for 2 weeks with 5 sessions per week, each lasting 30 min. The primary outcome measures will be the change of depressive symptoms, clinical response, and the remission rate as measured with the 17-item Hamilton Depression Rating Scale (HDRS-17) before and after the intervention and at the 2nd and 6th week after the completed intervention. Secondary outcome measures include anxiety symptoms, cognitive symptoms, disability assessment, and adverse effects. DISCUSSION: The HD-tDCS applied in this trial may have treatment effects on MDD with ADS and have minimal side effects. TRIAL REGISTRATION: The trial protocol is registered with www.chictr.org.cn under protocol registration number ChiCTR2300071726. Registered 23 May 2023.

Screening and treatment of anxiety symptoms within an interdisciplinary comprehensive epilepsy center.

Youth with epilepsy (YWE) are at elevated risk for anxiety, yet anxiety is often undetected and understudied in this population. Most research on anxiety in YWE is based on parent proxy-report and broad-band measures with limited sensitivity. The aim of the current study was to: 1) examine rates of anxiety symptoms in YWE using a diagnosis-specific, self-report measure of anxiety symptoms, 2) assess differences in anxiety symptoms by sociodemographic and medical variables, and 3) evaluate changes in anxiety symptoms following a brief behavioral health intervention delivered within an interdisciplinary epilepsy clinic visit. As part of routine clinical care, 317 YWE [Mage=13.4+2.5 years (range 7-19 years); 54% female; 84% White: Non-Hispanic] completed the Multidimensional Anxiety Scale for Children, self-report (MASC-10), with a subset completing the MASC-10 at a second timepoint (n=139). A retrospective chart review was completed and sociodemographic, medical variables and behavioral health interventions were collected. Thirty percent of YWE endorsed elevated anxiety symptoms, with higher rates in those who were younger. YWE who received a behavioral health intervention for anxiety (n=21) demonstrated greater decreases in anxiety symptoms from Time 1 to Time 2 compared to those who did not receive a behavioral intervention (n=108). The integration of psychologists into pediatric epilepsy clinics may have allowed for early identification of anxiety symptoms, as well behavioral interventions to address these symptoms, which has the potential to decrease the need for more intensive services.