Trajectories Of Anxiety Research Articles

The Asia Pacific Disaster Mental Health Network: Collaborative Research to Advance Mental Health and Community Resilience

Introduction:The mental health consequences of health emergencies and disasters have the potential to be sustained and severe. In recognition, the 2018 Kobe Expert Meeting on Health Emergency and Disaster Risk Management (Health EDRM), prioritized mental health as one of the key research areas of Health EDRM, to be addressed in a multi-country research project supported by WHO (Kayano et.al., 2019). As climate change, growing urbanization, population density and viral transmission generate increasingly severe hazards, attention to mental health will be critical.Method:The Asia Pacific Disaster Mental Health Network was established in 2020 to foster advancements in mental health research and policy in the region. Building connections between researchers, practitioners and policy makers, the Network includes broad representation from interdisciplinary scholars and organizations across eight Asian and Pacific nations. A research agenda was designed in early meetings, and collaborative research projects were established.Results:The Network has supported the development of innovative disaster mental health research investigating community engagement in recovery, psychosocial interventions, and evaluation frameworks. A recent multilingual systematic review of more than 200 longitudinal studies identified the long-term trajectories of post-traumatic stress symptoms, depression and anxiety following disasters and pandemics (Newnham et al., 2022). Synthesized evidence of risks related to age, gender and disaster type were determined to inform intervention targets.Conclusion:The Asia Pacific Disaster Mental Health Network established a platform for scholarly connection, intervention planning and knowledge dissemination. This presentation will provide an overview of the Network’s activities, and research highlights that have identified targeted points for policy and practice.

Longitudinal trajectories of anxiety, depression, and bipolar disorder in inflammatory bowel disease: a population-based cohort study.

Inflammatory bowel disease (IBD) is associated with psychiatric diseases, but it is unclear to what degree patients with IBD are affected over their lifetime. We aimed to longitudinally investigate the risk of anxiety, depression, and bipolar disorder before and after IBD diagnosis to understand the full burden of these diseases in patients with IBD. In this population based cohort study, we identified 22,103 patients diagnosed with IBD between January 1, 2003 and December 31, 2013 in the Danish National registers and 110,515 matched reference individuals from the general population. We calculated yearly prevalence of hospital contacts for anxiety, depression, and bipolar disorder and dispensed prescriptions for antidepressants from five years before to ten years after IBD diagnosis. We used logistic regression to calculate prevalence odds ratios (OR) for each outcome prior to IBD diagnosis, and Cox regression to calculate hazard ratios (HR) of new outcomes after IBD diagnosis. During >150,000 person years follow-up, patients with IBD had higher risk of anxiety (OR 1.4; 95% confidence interval (CI) 1.2-1.7) and depression (OR 1.4; 95% CI 1.3-1.6) starting at least five years before and continuing until at least ten years after IBD diagnosis (HR 1.3; 95% CI 1.1-1.5 for anxiety and HR 1.5; 95% CI 1.4-1.7 for depression). The risk was particularly high around IBD diagnosis and in patients diagnosed with IBD after the age of 40 years. We found no association between IBD and bipolar disorder. This population-based study suggests that anxiety and depression are clinically significant comorbidities of IBD both before and after IBD diagnosis, which warrant thorough evaluation and management, particularly around the time of IBD diagnosis. The Danish National Research Foundation [DNRF148], the Lundbeck Foundation [R313-2019-857], and Aage og Johanne Louis-Hansens Fond [9688-3374 TJS].

Pre- and early postpartum psychosocial stress trajectories in mothers and child body mass index at 3 years: a birth cohort study

BackgroundChild overweight remains a prevalent public health concern, but the impact of maternal psychosocial stress and related constructs, the timing, and possible trajectories on child body mass index (BMI) is controversial. We aimed to investigate the association of maternal stress, depression and anxiety symptoms, and maternal hair cortisol concentrations (HCC) at delivery, 6, and 12 months postpartum with child BMI and age- and sex-standardized BMI (BMI-SDS) at age 3 years.MethodsData were derived from the Ulm SPATZ Health Study with a baseline examination between 04/2012 and 05/2013 at the University Medical Centre Ulm, Germany, the only maternity clinic in Ulm, with a good representation of the source population. Adjusted regression analyses based on BMI/BMI-SDS (dependent) and trajectories of stress, depression, and anxiety (independent variables) were investigated in 596 mothers and children. Multiple imputation of missing covariates was performed.ResultsVarious trajectories in independent variables were identified, trajectories of maternal anxiety symptom differed between child sexes. We did not find an association between trajectories of maternal chronic stress, depression symptoms, or HCC and child BMI/BMI-SDS. However, trajectories of low-increasing maternal anxiety symptoms were linked to higher child BMI compared to a low-stable trajectory group (b = 0.58 kg/m2, 95% Confidence Interval: 0.11; 1.04) in girls.ConclusionsTrajectories of maternal anxiety symptoms were associated with the child’s BMI/BMI-SDS in girls at age 3 years. However, further large scale studies should include variables to determine the causal pathway and enlighten sex-specific differences.

Seven-year distress trajectories in uveal melanoma survivors.

Severe or persistent distress is associated with poorer quality of life in cancer survivors. Distress follows distinct trajectories within different population subgroups. Identifying characteristics and causes of trajectories can assist intervention development and targeting. In a 7-year study of uveal melanoma survivors, we aimed to characterize anxiety, depression, and fear of cancer recurrence (FCR) trajectories, and identify whether concerns about symptoms and functional problems over the first 3 years of survivorship predict memberships of high distress trajectories. In a closed cohort study, we used growth mixture modeling (GMM) to identify statistically optimal trajectories over 6-, 12-, 24-, 36-, 48-, 60-, 72-, and 84-month time point posttreatment in 475 patients. We then regressed trajectory memberships onto a 3-year series of measures of concerns about symptoms and functional problems, controlling demographic, clinical, and 6-month anxiety, depression, or FCR indicators. Anxiety, depression, and FCR were represented by two-class linear GMMs. The majority scored consistently low, but 17.5% showed consistently elevated anxiety, 10.9% consistently elevated depression, and 19.4% consistently elevated FCR. Higher anxiety trajectory membership was predicted by greater concerns about symptoms at 6 and 24 months, higher depression trajectory membership by symptoms at 24 months, and higher FCR trajectory membership by symptoms at 6 and 24 months and functional problems at 12 months. Much of the burden of persistent distress in cancer patients falls on a small proportion of survivors. Concerns about symptoms and functional problems are potential risk factors for distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relationship between anxiety and depressive trajectories of women who conceived through assisted reproductive technology and their children's emotional and behavioral problems: A prospective cohort study

ObjectiveThis study aimed to examine the relationship between the anxiety and depressive trajectory of women conceived through assisted reproductive technology (ART) and their children's emotional and behavioral problems. MethodsThis prospective cohort study including 18,711 women, was conducted between July 2014 and December 2017. Self-rating scales for anxiety and depression were used before treatment, during the first trimester, and two to three years postpartum. A latent class growth analysis identified their maternal anxiety and depressive symptom trajectories. Multiple comparison and linear regression models were performed to assess the relationships between maternal trajectories and their offspring's emotional and behavioral problems. ResultsThree longitudinal heterogeneous trajectories of maternal anxiety and depressive symptoms were identified: resilient, recurrent, and emergent. After adjusting for covariates, children with mothers in the recurrent and emergent trajectory groups had higher Child Behavior Checklist/2–3 scores. Additionally, the participants with a recurrent trajectory had lower education and employment levels and younger maternal age at delivery. They also had a history of ovarian surgery, primipara, secondary infertility, polycystic ovary syndrome, and more embryo transferred cycles, including intracytoplasmic sperm injections. Those with resilient trajectories had higher antral follicle counts and GnRH antagonist protocol. Finally, the participants with emergent trajectories had a lower monthly income, primipara, ectopic pregnancy, and fresh embryo transfers. ConclusionsInfertile women's psychological stress was not alleviated by the ART—sociodemographic, infertility-related and treatment-related characteristics determined three mental health trajectories. Children with mothers in recurrent and emergent trajectories showed higher odds of experiencing emotional and behavioral problems.

A prospective study of psychological distress among patients with advanced cancer and their caregivers.

Cancer can impact the psychological well-being of both patients and their informal caregivers. We investigated the joint trajectories of psychological distress among Singaporean advanced cancer patients-caregiver dyads. We also examined predictors of trajectory group membership. This study utilised data from 299 patients with advanced solid cancer and their caregivers over 33 months (12 times points). Group-based trajectory modelling was used to examine the joint trajectories of patient anxiety, patient depression, caregiver anxiety and caregiver depression scores using the Hospital Anxiety and Depression Scale. Four joint trajectory groups were found: (1) Patient-caregiver low distress (27%), (2) patient-caregiver increasing distress (28.5%), (3) patient low- caregiver borderline distress (25%), (4) patient-caregiver high distress (19.5%). Dyads where the patient is below 50 years of age were more likely to be in Group 4. Dyads where caregiver-patient emotional closeness was low were more likely to be in Groups 2 or 4 where dyads reported increasing/high distress. Dyads that reported financial inadequacy were more likely to be in Groups 2, 3 and 4, while dyads with caregivers who were employed were more likely to be in group 3. A substantial proportion of patients and caregivers reported anxiety and/or depression that lasted or increased throughout the study duration. We found significant heterogeneity in how dyads experienced psychological distress, suggesting that efforts should consider dyadic differences when providing psychological support. Particular focus should be placed on identifying dyads that are at risk and who require additional support.

Depression, anxiety, and stress in pregnancy and postpartum: A longitudinal study during the COVID-19 pandemic

IntroductionSymptoms of depression, anxiety, and stress in pregnant women are generally highest in the first trimester and then decrease throughout pregnancy, reaching their lowest point in the postpartum period. Pregnant women are a high-risk population for mortality and mental health symptoms due to COVID-19. However, the extent to which the chronic stress of the COVID-19 pandemic alters the trajectory of depression, anxiety and stress symptoms in pregnant/postpartum women is unknown. MethodsWomen (N=127) who were pregnant or who had given birth less than one month prior were recruited via online advertising during the COVID-19 pandemic. Participants were assessed up to three times during the pregnancy and at 1-month postpartum for depression (Edinburgh Postnatal Depression Scale), anxiety, and stress (Depression, Anxiety, and Stress Scale-21). Random intercepts models examined symptom change over time as well as predictors of elevated postpartum psychopathology. ResultsOn average, women completed their surveys at 8.5 weeks (first trimester), 21 weeks (second trimester), 32 weeks (third trimester) and 7-weeks postpartum. Women reported mild-moderate levels of depression, anxiety, and stress throughout pregnancy. There was a significant change in symptoms of depression and anxiety over time which was best represented by a quadratic rather than linear trajectory: symptoms increased until week 23–25 and then decreased. Stress levels remained consistently elevated over time. Higher symptom levels at 1-month postpartum were predicted by younger age, lower social support, and worry about going to a healthcare facility. Change in routine due to COVID-19 was not predictive of symptom trajectory from pregnancy to postpartum. ConclusionsDuring COVID-19, symptoms of depression and anxiety increased from early to mid-pregnancy but then declined slightly while stress levels remained elevated. Observed reductions in symptoms were small. Given the substantial persistent impact of perinatal distress and poor mental health on maternal and fetal health, providers should be aware of heightened levels of these symptoms in pregnant women during large-scale external health stressors such as COVID-19, and should implement screening procedures to identify and appropriately intervene with at-risk women.

Trajectories of change in subclinical anxiety and alcohol use during alcohol treatment: A parallel process growth model

BackgroundAnxiety is implicated in the course and prognosis of alcohol use disorder (AUD); however, it is unclear how current AUD treatments affect the joint trajectories of anxiety and alcohol use. We used data from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study to examine the longitudinal relationship between subclinical anxiety symptoms and alcohol use during and following AUD treatment in adults with AUD and no comorbid anxiety disorders. MethodsUnivariate and parallel process growth models using five waves of COMBINE study data were analyzed from 865 adults randomized to medication (n = 429) or medication plus psychotherapy (n = 436). Weekly drinking quantity and average weekly anxiety symptoms were measured at baseline, mid-treatment, end-of-treatment, and three follow-up periods. ResultsSignificant positive associations of anxiety symptoms and drinking were found at mid-treatment and over time. Temporal associations revealed that higher mid-treatment anxiety predicted decreases in drinking over time. Baseline anxiety and drinking predicted mid-treatment anxiety and drinking. Only baseline anxiety predicted increases in drinking over time. Group differences revealed mid-treatment drinking predicted decreases in anxiety over time in the medication group. ConclusionsFindings demonstrate the influence of subclinical anxiety on alcohol use during and up to one year after AUD treatment. Baseline anxiety symptoms may influence drinking behavior over the course of treatment. Findings suggest that greater attention to negative affect in AUD treatment is warranted even for those individuals who do have a comorbid anxiety disorder.

Impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study.

Little is still known about the long-term impact of childhood and adolescent persistent depression and anxiety in adulthood. To investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence on the development of multiple adverse outcomes in young adulthood. This study used data from 8122 participants in the Avon Longitudinal Study of Parents and Children cohort. The Development and Well-Being Assessment (DAWBA) examined child anxiety and depression symptomatology. The DAWBA generalised anxiety and mood subscales at 8, 10 and 13 years were selected, and a measure of comorbid anxiety and depression symptoms was created at each time point. Further, several mental and physical health, substance misuse and education/employment problems were assessed at 24 years. Latent class growth analyses were used to detect trajectories of anxiety, depression and comorbid anxiety and depression; and logistic regression to examine how persistent anxiety, depression or both were associated with adverse outcomes at 24 years. All three classes with persistent anxiety, depression or both were significantly associated with presenting with any mental health problems and any education/employment problem. Persistent high levels of depression and high levels of comorbid anxiety and depression, but not persistent high anxiety, were significantly associated with any physical health problem. High levels of comorbid anxiety and depression was the only DAWBA domain significantly associated with substance misuse; and overall, this was the domain that exerted the greatest negative impact, as it presented the highest odd ratio values. Children and adolescents with comorbid anxiety and depression are at the highest risk for having more adverse outcomes at 24 years.

An Unusual College Experience: 16-Month Trajectories of Depressive Symptoms and Anxiety among Chinese New Undergraduate Students of 2019 during the COVID-19 Pandemic

This study examines the trajectories of the mental health conditions of 13,494 new undergraduate students who enrolled in 2019 in China from the beginning of the pandemic to the local recurrence of the pandemic, and found factors which may be associated with diverse trajectories. The trajectories of depression-anxiety outcomes were modeled using the growth mixture model. The multinomial logistic regression model was used to identify variables associated with different trajectory groups. Both depression and anxiety in the new college students slightly increased during the 16-month period. The slopes of depression and anxiety were lower after the local outbreak. From the trajectories of depression and anxiety, five heterogeneous groups were identified: low-stable (64.3%), moderate-increased (18.2%), high-stable (11.1%), recovery (4.5%), and rapid-increased (1.8%). Environmental, somatic, and social factors were used to differentiate the low-stable group from the other groups. We found that college students with female gender, more conflict with parents, and feelings of loneliness during the pandemic were more likely to enter a high stability trajectory compared to a recovery trajectory. Most participants showed a stable mental health status, while others experienced deteriorating or chronic mental health problems, especially those who had sleep disturbances, less social support before the pandemic, or conflicts with parents during the pandemic. These students may need additional support and monitoring from college mental health providers to improve their wellbeing.

Emotion dysregulation and symptoms of anxiety and depression in early adolescence: Bidirectional longitudinal associations and the antecedent role of parent-child attachment.

Difficulties in emotion regulation have been consistently associated with various psychological difficulties, including anxiety and depression; however, less is known about the directionality of this relationship, particularly in adolescents. In addition, early parent-child attachment quality has been closely linked to the development of emotion regulation. Previous studies have proposed an overarching model in attempt to describe the developmental trajectory of anxiety and depression from early attachment, albeit with several limitations that are discussed in this paper. This study adds to this field of research by investigating the longitudinal associations between emotion dysregulation (ED) and symptoms of anxiety and depression among 534 early adolescents in Singapore over three timepoints in a school year, and the antecedent role of attachment quality on individual differences on these variables. Bidirectional influences were found between ED and anxiety and depression symptoms, respectively, between T1 and T2, but not T2 and T3, at the between- and within-individual levels of analysis. Additionally, attachment anxiety and avoidance were both significantly predictive of individual differences in ED and for both psychological symptoms. The current findings provide preliminary evidence of a mutually reinforcing relationship between ED and symptoms of anxiety and depression in early adolescence, where attachment quality serves as a developmental antecedent that sets these longitudinal associations in motion.

Trajectory of Anxiety, Depression and Quality of Life in Ankylosing Spondylitis: A Descriptive Study.

To investigate anxiety, depression, and health-related quality of life (HRQoL) over 15 years and associations between demographic, disease-related variables, anxiety and depression, and HRQoL in patients with AS. Descriptive study. Place and Duration of the Study: Istanbul Medeniyet University Goztepe Prof. Dr. Suleymsan Yalcin City Hospital, from June to December 2021. Seventy-five patients with AS, who were followed up in Physical Medicine and Rehabilitation outpatient clinic for 15 years, were included in this study, after their diagnosis was confirmed by the hospital system. The demographic information (gender, age, accommodation status, educational status, employment status, and time unemployed), diagnosis time, remission time, drugs used, usage of TNF-inhibitor drugs and duration of usage were recorded. Bath ankylosing spondylitis disease activity index (BASDAI) was used to the measure the disease activity, the hospital anxiety depression scale (HADS) was used for anxiety and depression screening and Short Form-36 (SF-36) was used for HRQoL. SF-36 physical component summary score, general health, social functioning, and role limitations due to physical health subscale scores improved significantly (p=0.004; p<0.000; p=0.024; p=0.002, respectively). It was observed that the effects of BASDAI, HADS anxiety and depression scores were significant on SF-36 (p=0.044; p=0.050; p=0.023), and time has a substantial impact on SF-36 (p=0.003). The effects of gender, education level, and occupation were not found statistically significant (p>0.05 for each). Within 15 years, quality of life increased, anxiety and depression decreased in AS patients. Along with disease activity, anxiety and depression were found to be the most important factors affecting the change in quality of life over time. Ankylosing spondylitis, Anxiety, Depression, Disease activity, Quality of life.

The impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study

IntroductionLittle is still known about the long-term impact of childhood and adolescent persistent depression and anxiety on adulthood.ObjectivesTo investigate the impact of persistent anxiety, depression, and comorbid anxiety and depression across childhood and adolescence on the development of multiple adverse outcomes in young adulthood.Methods This study used data from 8,122 participants in the ALSPAC cohort, in the UK. The Development and Wellbeing Assessment (DAWBA) was administered to capture child anxiety and depression symptomatology. We focused on the DAWBA generalized anxiety and mood subscales at 8, 10 and 13 years, and created a measure of comorbid anxiety and depression symptoms (i.e., anxiety + depression) at each time point. Further, a range of mental and physical health, and functional problems were assessed at 24 years. Latent Class Growth Analyses was used to detect trajectories of anxiety, depression and comorbid anxiety and depression, separately; and logistic regression to examine how persistent anxiety, depression or both associated with adverse outcomes at 24 years.ResultsAll three classes with persistent anxiety, depression or both associated with presenting any mental health and functional problem at 24 years. However, persistent high anxiety was not associated with any physical health problem at 24 years. Finally, high levels of comorbid anxiety and depression was the domain that exerted the greatest negative impact at 24 years.ConclusionsChildren and adolescents with comorbid anxiety and depressions are at highest risk for suffering from more adverse outcomes at 24 years, compared to those presenting anxiety and depression alone.Disclosure of InterestNone Declared

Contribution of risk and resilience factors to anxiety trajectories during the early stages of the COVID-19 pandemic: A longitudinal study.

The COVID-19 pandemic, and the response of governments to mitigate the pandemic's spread, resulted in exceptional circumstances that comprised a major global stressor, with broad implications for mental health. We aimed to delineate anxiety trajectories over three time-points in the first 6months of the pandemic and identify baseline risk and resilience factors that predicted anxiety trajectories. Within weeks of the pandemic onset, we established a website (covid19resilience.org), and enrolled 1362 participants (n=1064 from US; n=222 from Israel) who provided longitudinal data between April-September 2020. We used latent growth mixture modelling to identify anxiety trajectories and ran multivariate regression models to compare characteristics between trajectory classes. A four-class model best fit the data, including a resilient trajectory (stable low anxiety) the most common (n=961, 75.08%), and chronic anxiety (n=149, 11.64%), recovery (n=96, 7.50%) and delayed anxiety (n=74, 5.78%) trajectories. Resilient participants were older, not living alone, with higher income, more education, and reported fewer COVID-19 worries and better sleep quality. Higher resilience factors' scores, specifically greater emotion regulation and lower conflict relationships, also uniquely distinguished the resilient trajectory. Results are consistent with the pre-pandemic resilience literature suggesting that most individuals show stable mental health in the face of stressful events. Findings can inform preventative interventions for improved mental health.

Latent Trajectories and Risk Factors of Prenatal Stress, Anxiety, and Depression in Southwestern China—A Longitudinal Study

(1) Background: Few studies have explored the heterogeneity of trajectories of stress, anxiety, and depressive symptoms during pregnancy. This study aimed to explore the trajectory groups of stress, anxiety, and depressive symptoms in women during pregnancy and the risk factors associated with those groups. (2) Methods: Data came from pregnant women recruited from January to September 2018 in four hospitals in Chongqing Province, China. A structured questionnaire was given to pregnant women, which collected basic information, including personal, family, and social information. The growth mixture model was applied to identify potential trajectory groups, and multinomial logistic regression was applied to analyze factors of trajectory groups. (3) Results: We identified three stress trajectory groups, three anxiety trajectory groups, and four depression trajectory groups. Less developed regions, inadequate family care, and inadequate social support were associated with a high risk of stress; residence, use of potentially teratogenic drugs, owning pets, family care, and social support were strongly associated with the anxiety trajectory group; family care and social support were the most critical factors for the depression trajectory group. (4) Conclusions: The trajectories of prenatal stress, anxiety, and depressive symptoms are dynamic and heterogeneous. This study may provide some critical insights into the characteristics of women in the high-risk trajectory groups for early intervention to mitigate worsening symptoms.

Trajectories of Psychopathic Traits, Anxiety, and Violence Exposure Differentially Predict Antisociality in Legal System-Involved Youth.

Psychopathic traits are associated with several forms of antisociality, including criminal offending, legal system involvement, and substance use. Some research suggests that primary (high psychopathic traits, low negative emotions) versus secondary (high psychopathic traits, high negative emotions and/or negative experiences and environments) variants confer different levels of risk for antisociality. However, research has not examined trajectories of co-occurring fluctuations in psychopathic traits, negative emotions, and negative experiences and environments or how trajectory membership relates to antisociality. We implemented group-based multi-trajectory modeling in a sample of 809 justice-involved male (n = 681) and female (n = 128) youth from the Pathways to Desistance Study to address these gaps. We identified four trajectories of co-occurring change in psychopathic traits, anxiety, and violence exposure spanning three years: Low (low levels of each factor); Moderate Psychopathic Traits, High Negative Emotions and Experiences (moderate-decreasing psychopathic traits and high-decreasing anxiety/violence exposure); Potential Primary Psychopathic Traits (elevated-decreasing psychopathic traits, moderate-decreasing anxiety, moderate-stable violence exposure); and High/Secondary Psychopathic Traits (high-stable psychopathic traits, elevated-stable anxiety, high-decreasing violence exposure). Compared to the Low trajectory, all trajectories predicted greater violent crime and substance use three and four years later. Additionally, compared to the Low trajectory, the Potential Primary Psychopathic Traits trajectory predicted more nonviolent offending three years later. Finally, the High/Secondary Psychopathic Traits trajectory showed the most persistent antisociality, predicting more nonviolent crime, higher substance dependence symptoms, and higher likelihood of arrest three and four years later. Youth with co-occurring high psychopathic traits, anxiety, and violence exposure appear most at risk for severe antisociality.

U.S. vs. Foreign Nativity and 10-Year Trajectories of Mental Health after Traumatic Brain Injury: A Model Systems Study.

Previous research has found racial and ethnic disparities in life satisfaction, depression, and anxiety after traumatic brain injury (TBI). However, limited studies have examined differences in these variables between U.S.- and foreign-born individuals with TBI. The purpose of this study was to examine whether differences exist in mental health outcomes between U.S.- and foreign-born individuals with TBI at 1, 2, 5, and 10 years after injury, as well as examine whether demographic and injury-related characteristics account for these differences. Participants were 8289 individuals with TBI who identified as U.S.-born and 944 who identified as born outside the U.S. in the TBI Model Systems study. Participants completed measures of mental health outcomes at 1, 2, 5, and 10 years after injury. Foreign-born individuals with TBI had comparable levels of depression and anxiety trajectories to U.S.-born individuals, yet higher life satisfaction trajectories, even after controlling for demographic and injury-related variables. Rehabilitation professionals should consider in their clinical work the mechanisms that likely influence mental health outcomes among foreign-born individuals, including family-based values that increase resilience, as well as the possible under-reporting of mental health symptoms along the lines of cultural norms.

Psychosocial Functioning in Transgender Youth after 2 Years of Hormones

BackgroundLimited prospective outcome data exist regarding transgender and nonbinary youth receiving gender-affirming hormones (GAH; testosterone or estradiol).MethodsWe characterized the longitudinal course of psychosocial functioning during the 2 years after GAH initiation in a prospective cohort of transgender and nonbinary youth in the United States. Participants were enrolled in a four-site prospective, observational study of physical and psychosocial outcomes. Participants completed the Transgender Congruence Scale, the Beck Depression Inventory–II, the Revised Children’s Manifest Anxiety Scale (Second Edition), and the Positive Affect and Life Satisfaction measures from the NIH (National Institutes of Health) Toolbox Emotion Battery at baseline and at 6, 12, 18, and 24 months after GAH initiation. We used latent growth curve modeling to examine individual trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a period of 2 years. We also examined how initial levels of and rates of change in appearance congruence correlated with those of each psychosocial outcome.ResultsA total of 315 transgender and nonbinary participants 12 to 20 years of age (mean [±SD], 16±1.9) were enrolled in the study. A total of 190 participants (60.3%) were transmasculine (i.e., persons designated female at birth who identify along the masculine spectrum), 185 (58.7%) were non-Latinx or non-Latine White, and 25 (7.9%) had received previous pubertal suppression treatment. During the study period, appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased. Increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and decreases in depression and anxiety symptoms. The most common adverse event was suicidal ideation (in 11 participants [3.5%]); death by suicide occurred in 2 participants.ConclusionsIn this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.)

Changes in mental health outcomes in the general population 14 months into the COVID-19 pandemic in Italy

BackgroundThe COVID-19 pandemic exerted an immediate detrimental impact on the population's psychological wellbeing worldwide. This longitudinal cohort study investigated the trajectories of depression, anxiety, and stress-related symptoms 14 months into the COVID-19 pandemic in Italy, along with the impact of sociodemographic, contextual and psychological predictor variables. MethodsA web-based survey spread throughout the internet between March and April 2020 (baseline) and between April and May 2021 (follow-up). Selected outcomes were post-traumatic stress symptoms, depression and anxiety. A general distress condition was considered as meeting the threshold score in any of the three outcomes. ResultsA total of 5501 (25.09 %) subjects responded to the follow-up assessment. Based on the presence or absence of symptoms at the two timepoints, 2691 subjects (52.03 %) were resilient to any outcome, 350 (6.77 %) subjects had an incident general distress; 1061 (20.49 %) subjects displayed remittent general distress, while 1071 (20.71 %) subjects showed persistent general distress. Persistent distress was associated with female gender, lower age, a history of mental disorder, low resilience and the lack of social meetings. LimitationsDue to the web-based design, potential biases such as self-selection bias and systematic bias in estimating mental health outcomes could not be excluded. ConclusionWe showed overall decrease of distress in the general population 14 months after the first pandemic peak in Italy. However, a significant proportion of the sample continues to experience clinically relevant symptoms over time. Factors associated with change in mental health outcomes could help in the design of strategies to mitigate the long-term impact of the pandemic.

Trajectory of chronic and neuropathic pain, anxiety and depressive symptoms and pain catastrophizing after total knee replacement. Results of a prospective, single-center study at a mean follow-up of 7.5 years

IntroductionA considerable number of patients are not satisfied after total knee replacement (TKR) because of persistent pain. This pain can also be neuropathic in origin. Both types of pain have a large impact on function and quality of life. Furthermore, the trajectory of anxiety and depressive symptoms and pain catastrophizing has rarely been studied after TKR surgery. The primary objective of this study was to define the trajectory of knee pain after primary TKR. The secondary objectives were to evaluate how neuropathic pain, anxiety and depressive symptoms and pain catastrophizing change over time. MethodsThis prospective, single-center study included patients who underwent primary TKR for primary osteoarthritis between July 2011 and December 2012. Personal data (age, sex, body mass index, knee history, operated side, surgical approach, type of implant, operative time, and rehabilitation course) and the responses to seven questionnaires (Numerical pain rating scale, DN4-interview for neuropathic pain, Oxford Knee Scale, Hospital and Anxiety Depression Scale, Beck Depression Inventory, Patient Catastrophizing Scale and Brief Pain Inventory) were determined preoperatively, at 6 months postoperative and at a mean follow-up of 7.5 years. ResultsPreoperatively, 129 patients (35 men, 94 women) filled out all the questionnaires. Subsequently, 32 patients were excluded because of incomplete responses at 6 months postoperative, 6 were excluded because they had undergone revision surgery, 11 patients were lost to follow-up and 5 patients had died. In the end, 65 patients were available for analysis (50% of the initial cohort) who were 74 years old on average at inclusion. Between the preoperative period and 6 months postoperative, pain (p<0.001), function (p<0.001), anxiety symptoms (p<0.001) and catastrophizing (p<0.001) had improved. Depressive symptoms did not change (p=0.63). Between 6 months postoperative and the latest follow-up, none of the parameters changed further (p>0.05). Of the 65 patients analyzed, 21% had chronic pain of undefined origin at 6 months postoperative and 26% had chronic pain at the end of follow-up, with 50% also having neuropathic pain. Preoperatively, 40% of the 65 patients had neuropathic pain, 30% at 6 months (p=0.27) and 18% at 7.5 years after TKR (p=0.01). ConclusionThe number of patients who have chronic pain after TKR is considerable, especially since knee pain stabilized at 6 months postoperative. Early detection is vital to prevent the pain from becoming chronic, which makes it more difficult to treat. Half the patients with persistent pain also had neuropathic pain, which should be detected before surgery so the patients can be referred to a specialized pain management center. The presence of anxiety and depressive symptoms and pain catastrophizing is not a contraindication to TKR, but these patients should be referred to specialists for treatment before surgery. Level of evidenceIV, prospective cohort study.