Parental Alienation and Generalized Anxiety Symptoms in Adolescents and Young People: The Moderating Role of Pet Attachment

To evaluate the cooccurrence, and predictors of remission, of general anxiety, depression, and posttraumatic stress disorder symptoms during 2-year follow-up in survivors of acute lung injury treated in an ICU. Prospective cohort study, with follow-up at 3, 6, 12, and 24 months post-acute lung injury. Thirteen medical and surgical ICUs in four hospitals. Survivors among 520 patients with acute lung injury. The outcomes of interest were measured using the Hospital Anxiety and Depression Scale anxiety and depression subscales (scores ≥ 8 indicating substantial symptoms) and the Impact of Event Scale-Revised (scores ≥ 1.6 indicating substantial posttraumatic stress disorder symptoms). Of the 520 enrolled patients, 274 died before 3-month follow-up; 186 of 196 consenting survivors (95%) completed at least one Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised assessment during 2-year follow-up, and most completed multiple assessments. Across follow-up time points, the prevalence of suprathreshold general anxiety, depression, and posttraumatic stress disorder symptoms ranged from 38% to 44%, 26% to 33%, and 22% to 24%, respectively; more than half of the patients had suprathreshold symptoms in at least one domain during 2-year follow-up. The majority of survivors (59%) with any suprathreshold symptoms were above threshold for two or more types of symptoms (i.e., general anxiety, depression, and/or posttraumatic stress disorder). In fact, the most common pattern involved simultaneous general anxiety, depression, and posttraumatic stress disorder symptoms. Most patients with general anxiety, depression, or posttraumatic stress disorder symptoms during 2-year follow-up had suprathreshold symptoms at 24-month (last) follow-up. Higher Short-Form-36 physical functioning domain scores at the prior visit were associated with a greater likelihood of remission from general anxiety and posttraumatic stress disorder symptoms during follow-up. The majority of acute lung injury survivors had clinically significant general anxiety, depression, or posttraumatic stress disorder symptoms, and these symptoms tended to co-occur across domains. Better physical functioning during recovery predicted subsequent remission of general anxiety and posttraumatic stress disorder symptoms.

Introduction Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly comorbid. These conditions commonly develop during early adulthood, and they negatively impact health and social, academic, and workplace functioning. Sleep hygiene, which includes behaviors and routines that support consolidated sleep, may be a factor in GAD/MDD comorbidity. Indeed, sleep disturbances are a symptom of both disorders. We tested the hypothesis that GAD and MDD symptoms would be more highly correlated at lower levels of sleep hygiene. Participants (N= 180) were undergraduate students recruited from the online Sona research pool from a large Southern university. Regression analyses supported the hypothesis, suggesting that the association of GAD with MDD symptoms was moderated by sleep hygiene, Specifically, the environment and behavior aspects of sleep hygiene were associated with a stronger association between GAD and MDD symptoms. The findings implicate sleep hygiene as a moderator in the comorbidity of GAD and MDD. Methods Participants (n= 180) were undergraduate students recruited from a large, urban university. Measures used were the Sleep Hygiene Index, Patient Health Questionnaire- 9, and Generalized Anxiety Disorder- 7. The hypothesis was tested using the Process macro. Results GAD symptoms were associated with depression symptoms, B =.610, 95% CI [.474,.747]. Sleep disturbing environment/behavior was associated with depression, B =.166, 95% CI [.005,.326], but irregular sleep-wake schedule was not, B = -.000, 95% CI [-.038,.037]. There was an interaction between GAD symptoms and sleep disturbing environment/behavior, B =.024, 95% CI [.001,.048], but not between GAD symptoms and irregular sleep-wake cycle, B = -.000, 95% CI [-.038,.037]. Evaluation of simple slopes indicated that the association between GAD symptoms and depression was stronger at higher levels of sleep disturbing environment/behavior. Conclusion In conclusion, we found that the association between GAD and MDD symptoms was stronger at higher levels of environmental and behavioral components of poor sleep hygiene. Our findings suggest that the relation between GAD and MDD symptoms was stronger in those with higher levels of sleep disturbing environment and behaviors. Comorbidity did not depend on sleep/wake cycle. Our findings have implications for GAD/MDD interventions. Support (if any)

Traumatic memories are directly associated with depression and generalized anxiety symptoms, independent of posttraumatic stress symptoms.

Community violence exposure (CVE; i.e., direct victimization and witnessed violence) is a major public health concern among youth who reside in low income, urban neighborhoods, who tend to experience CVE chronically and disproportionately. Frequent CVE is associated with generalized anxiety disorder (GAD) symptoms, such as persistent or excessive worry and difficulty concentrating. However, not all youth experiencing CVE exhibit such symptoms. One understudied factor that may moderate this relation is callous-unemotional (CU) behaviors (e.g., behaviors consistent with lack of guilt, low levels of empathy). CU behaviors are associated with lower levels of responsiveness to contextual processes; as such, CU behaviors may be associated with lower levels of GAD symptoms in the context of CVE. However, little research considers CU behaviors and GAD symptoms concurrently. To address this gap, the present study examined associations among witnessed and direct CVE, CU behaviors, and GAD symptoms among low-income, urban youth (N = 104, 50% male, Mage = 9.93 ± 1.22 years old, 95% African-American/Black). Multiple regression analyses indicated teacher-reported CU behaviors moderated the relations between CVE and caregiver-reported GAD symptoms. Post-hoc probing revealed that among youth with higher levels of CVE, higher levels of CU behaviors were associated with elevated GAD symptoms compared to their peers with lower levels of CU behaviors. Youth with lower levels of CU behaviors evidenced moderate levels of GAD symptoms regardless of their levels of CVE. Thus, low-income, urban youth who experience elevated levels of CVE may be at increased risk for co-occurring GAD and CU symptoms.

Approximately 20 % of adolescents around the world experience mental health problems, most commonly depression or anxiety. High levels of anxiety disorder symptoms can hinder adolescent development, persist into adulthood, and predict negative mental outcomes, such as suicidal ideation and attempts. We analyzed generalized anxiety disorder (GAD) symptoms in cross-cultural samples from the general population. We sought to examine cultural and gender differences, and correlates of GAD symptoms in samples of adolescents from six countries located in three different continents (Europe: Bulgaria, Italy, the Netherlands; Africa: Kenya; Asia: China and Philippines). Participants were 3,445 (51 % male) adolescents aged between 14 and 18 years old. They filled self-report measures of GAD symptoms and identity. First, it was found that the scores on GAD symptoms varied significantly across countries, with Dutch respondents reporting the lowest levels whereas Filipino participants exhibited the highest levels of GAD symptoms. Second, gender differences (i.e., girls reported more GAD symptoms than boys) were significant in each country (as well as in the total sample), with the only exception being that of Kenya. Third, GAD symptoms were significantly related to identity processes and similarities and differences across countries were examined. This study highlighted that prevalence, gender differences, and correlates of GAD vary across countries. Therefore, it is important when researching GAD symptoms to examine one’s research findings within a global perspective.

Although prior studies have documented the co-occurrence of generalized anxiety disorder (GAD) and alcohol use disorder (AUD) disorder, there is a paucity of research assessing the patterns of alcohol involvement among individuals with GAD symptoms. This study investigated subtypes, or classes, of comorbid AUD and GAD symptoms, and assessed the association of class membership with health-related quality of life. Using data from the Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, a latent class analysis was performed on the subset of individuals who were current drinkers and had reported ever experiencing a 6-month episode of feeling tense, nervous, or worried most of the time. We examined the association of these latent classes with physical and mental health-related quality of life measured by the Short Form-12, version 2. Latent class analysis identified a 5-class model of AUD and GAD symptoms. A significant graded relationship was observed between the ordered classes and severity of impairment on the mental health scale of the Short Form-12, version 2, but no significant relationship was found with the physical health scale. Mental, but not physical, health-related quality of life in this population is associated with both the number and pattern of comorbid GAD and AUD symptoms.

Although community violence exposure (CVE) confers risk for generalized anxiety symptoms, not all youth who are exposed to violence exhibit such symptoms, suggesting that other factors moderate this relation. One candidate for moderation is executive functioning (EF), which is linked to both CVE and generalized anxiety symptoms. Nevertheless, little research has examined whether EF moderates the CVE-anxiety relation. To address this gap, we examined associations among CVE (i.e., direct victimization and witnessed violence), EF abilities (i.e., emotional control and shifting), and parent- and child-reported generalized anxiety disorder (GAD) symptoms among low income, urban youth (N=104, 50% male, M=9.93±1.22years). In terms of main effects, lower levels of emotional control were associated with increased parent-reported GAD symptoms, whereas lower levels of shifting abilities were associated with increased parent- and child-reported GAD symptoms across both subtypes of CVE. EF abilities moderated the relation between direct victimization and both parent- and child-reported GAD symptoms, but did not moderate the relation between witnessed violence and GAD symptoms. Post-hoc probing indicated that when youth were exposed to higher levels of direct victimization, those with lower EF abilities exhibited elevated GAD symptoms. However, the level of direct victimization did not impact the level of GAD symptoms among youth with higher EF abilities. Findings have implications for prevention and intervention programs among at-risk youth who are exposed to community violence.

Anxiety and Depressive Symptoms in Adolescents with Type 1 Diabetes

Traitement du trouble d’anxiété généralisée chez des individus présentant un trouble bipolaire : un protocole à cas unique

This longitudinal study examined the direction of effects between adolescents’ generalized anxiety disorder (GAD) symptoms and perceived parent-adolescent attachment relationship quality, as well as the moderating role of gender and age. 1,313 Dutch adolescents (48.5% boys) from two age cohorts of early (n = 923, Mage = 12 at W1) and middle (n = 390, Mage = 16 at W1) adolescents completed questionnaires regarding their attachment relationship to parents and GAD symptoms in four waves. Cross-lagged path analyses demonstrated that adolescents’ GAD symptoms and perceived father-adolescent attachment relationship quality bidirectionally negatively affected each other over time. For mothers, adolescents’ GAD symptoms negatively predicted perceived mother-adolescent attachment relationship quality over time. The within-wave correlated residuals between perceived attachment relationship quality with fathers and GAD symptoms were stronger for boys than for girls and stronger for the cohort of middle adolescents than for the cohort of early adolescents. This study demonstrates that both the parents’ and the adolescents’ gender as well as the adolescents’ age affects the relation between adolescents’ GAD symptoms and perceived parent-adolescent attachment relationship quality.

ObjectiveStudies have only recently begun to explore the role of interpersonal factors in relation to anxiety sensitivity, a trait that has been hypothesised as a risk factor for the development of anxiety disorders. Therefore, the goal of this research was to further investigate the relations between anxiety sensitivity, worry, generalised anxiety disorder symptoms, and parent and peer attachment, more specifically—perceived parent and peer alienation on a clinical sample for the first time. The mediating role of anxiety sensitivity between perceptions of alienation and current worry and generalised anxiety disorder symptoms was also examined.MethodsAnalyses were conducted on a total sample of 72 psychiatric patients with diagnosed anxiety or depression disorder, who completed the Generalized Anxiety Disorder Questionnaire‐IV, Penn State Worry Questionnaire, Inventory of Parent and Peer Attachment, and Anxiety Sensitivity Index. All patients were Caucasian, and 48.6% of participants were men (Mage = 44.2 years) and 51.2% were women (Mage = 41.1 years).ResultsParticipants with higher intensity of worry and generalised anxiety disorder symptoms reported higher perceptions of being alienated only from their peers. Also, anxiety sensitivity mediated the relation between perceptions of alienation from peers and worry and generalised anxiety disorder symptoms.ConclusionPerceptions of peer rather than parent alienation appear to be a salient construct in relation to the present levels of anxiety sensitivity, uncontrollable worry, and generalised anxiety disorder symptoms in individuals with a diagnosis of mental illness. Implications for cognitive–behavioural therapy practitioners are also shortly discussed.

BACKGROUND:The COVID-19 pandemic has significantly impacted the psychological well-being of healthcare providers (HCPs) worldwide. Understanding the prevalence and associated factors of depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) among these providers is crucial. Assess the prevalence of major depression, GAD, and PTSD symptoms among HCPs in the United Arab Emirates (UAE) during the COVID-19 pandemic. Additionally, this study sought to identify demographic, work-related, and health-related factors associated with these psychological symptoms.MATERIALS AND METHODS:A cross-sectional survey involving 992 HCPs across various healthcare institutions in the UAE was conducted. Participants were administered standardized assessment tools, including the Patient Health Questionnaire-9 (PHQ-9) for depression, the GAD-7) for GAD, and the Impact of Event Scale-Revised (IES-R) for PTSD. Independent t-tests and one-way analysis of variance (ANOVA) were employed to assess the prevalence and associated factors.RESULTS:The findings revealed that approximately 19% of the participants exhibited significant symptoms of major depression (PHQ-9 ≥10), while 57.1% reported no significant anxiety symptoms, and 54.4% displayed minimal or no significant PTSD symptoms. Participants with COVID-19, family infections, and work overload showed higher depression, GAD, and PTSD symptoms. Married in-hospital workers significantly differed from single prehospital workers in psychological symptoms. Occupation, level of education, working department, and age significantly influenced the perceived severity of depression, GAD, and PTSD symptoms. Specifically, the ANOVA test revealed significant differences in depression (F = 3.01, P < 0.05), GAD (F = 11.4, P < 0.001), and PTSD symptoms (F = 3.6, P < 0.05) based on occupation. Nurses had higher depression (5.8 ± 7.4) and GAD (7.4 ± 6.6) scores, while physicians had elevated PTSD symptoms (22.4 ± 21.0). Participants with a bachelor’s degree had significantly higher depression (7.0 ± 8.4), GAD (7.2 ± 7.4), and PTSD symptoms (22.9 ± 24.6) than those with diplomas or postgraduate degrees. In the intensive care unit (ICU), higher levels of depression (9.3 ± 9.1), GAD (7.6 ± 7.5), and PTSD symptoms (24.7 ± 25.4) were reported. Participants at the screening center had higher depression (5.4 ± 4.7) and PTSD symptoms (15.2 ± 16.8) than those in other prehospital departments. However, participants in PHCs reported higher levels of GAD symptoms (5.8 ± 7.1) compared to those at screening centers, and EMTs. Concerning age groups, participants between 50 and 60 years old experienced more depressive symptoms (8.3 ± 6.7), while those aged 40-49 reported higher GAD (8.5 ± 7.3) and PTSD symptoms (27.0 ± 19.0).CONCLUSION:This study underscores the importance of proactive mental health support and tailored interventions for HCPs. It highlights the need for workload management and work-life balance, as well as personalized support for those directly affected by COVID-19. Moreover, it emphasizes the significance of pandemic preparedness and comprehensive training for HCPs. The study findings contribute to a deeper understanding of the diverse factors influencing the psychological well-being of HCPs during public health crises.

Is intolerance of uncertainty a necessary condition for anxiety symptoms in adolescents? A necessary condition analysis study.

Parental rearing behaviours, including modelling of anxiety, have been associated with corresponding anxiety symptoms in children and adolescents. However, there is a paucity of research investigating the relationship between worry-related learning experiences from parents and general worry or generalised anxiety disorder (GAD) symptoms in children and adolescents. The purpose of the present study was to examine this association. It was predicted that worry-related learning experiences from parents would be a significant predictor of adolescent GAD symptoms. To evaluate this hypothesis, 348 adolescents from public and private secondary schools in the Southeast were surveyed. Consistent with previous research, the results of this study indicated that observation of parent worry was significantly and positively associated with adolescent GAD symptoms. Overall, these results suggest that parental modelling of worry may be related to the development and maintenance of pathological worry in youth. The findings of this study serve to inform prevention and treatment programmes targeting general worry symptoms in youth.

The comorbidity of depression and generalized anxiety have raised questions about the existing classification system. Based on the perspective of network analysis, the developmental relationship between psychological symptoms can be explored more clearly. The current study aimed to explore the longitudinal network association of depressive symptoms and generalized anxiety symptoms in non-clinical adolescents. The sample contained 1,947 Chinese adolescents (Mage = 13.93, SD = 1.71; 48.5% girls). Their depression (PHQ-9) and generalized anxiety (GAD-7) symptoms were assessed at baseline (T1) and 6-month follow-up (T2). Data was analyzed using a cross-lagged network analysis. Depressive symptoms and generalized anxiety symptoms were closely related and did not appear to be distinct categories in adolescence. More generalized anxiety symptoms predicted depressive symptoms rather than vice versa. After controlling for gender, and age, "Difficulty relaxing" presented the highest out-expected influence (out-EI) in the network, while "trouble concentrating", and "suicidal ideation" showed the lowest in expected influence (in-EI). Findings suggested that interventions for generalized anxiety symptoms may help reduce depressive symptoms among Chinese adolescents. Specifically, alleviating "difficulty relaxing" may improve overall mental health.