Changes In Anxiety Symptoms Research Articles

IMPACT OF COVID-19 PANDEMIC ON MENTAL HEALTH IN OLDER ADULTS: COMPARISON BETWEEN 2020 AND 2022

Abstract The COVID-19 pandemic had a major impact on older adults’ mental health, but less is known about its longer-term effect. We examined changes in depressive and anxiety symptoms among older adults between the onset and two years into the pandemic. Data were drawn from two cross-sectional telephone surveys conducted with older adults aged ≥ 60 years in Hong Kong in 2020 and 2022. Respondents were screened for depression and anxiety using Patient Health Questionnaire-2 (PHQ-2) and General Anxiety Disorders-2 (GAD-2) and, if screened positive (i.e. scoring ≥ 3 in PHQ-2 or GAD-2), evaluated with PHQ-9 and GAD-7 for symptom severity. After case-control matching baseline age, gender, living districts, and pre-existing mental health conditions based on the respondent ratio between the two surveys (i.e. 2:1 ratio), 4095 and 2099 respondents from the 2020 and 2022 surveys were included in the analysis. Respondents’ average baseline age was 75 years old, 77% were female, and 13% had a pre-existing mental health condition. There were significant increases in the proportion of older adults screened positive for depression (8.3% to 13.5%) and anxiety (6.9% to 11.4%) and a significant increase in depressive symptom severity (4.63 to 7.72) between 2020 and 2022 (p < .001). Logistic regression suggested that, over two years, older adults with pre-existing mental health conditions were 1.59 times more likely to screen positive for depression than those without such conditions. Linear regression suggested that males were associated with increased depressive (B=-2.42, p=.004) and anxiety (B=-2.49, p=.021) symptom severity than females over the years.

Comparison of in-person vs. telebehavioral health outcomes from rural populations across America.

This study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementation program, the aims of this study were to evaluate outcomes in patient symptoms of depression and anxiety across the programs' 17 grantees and 95 associated sites, with each grantee having data from telehealth patients and from an in-person comparison group. The research design is a prospective multi-site observational study. Each grantee provided data on a nonrandomized convenience sample of telehealth patients and an in-person comparison group from sites with similar rural characteristics and during the same time period. Patient characteristics were collected at treatment initiation, and clinical outcome measures were collected at baseline and monthly. The validated clinical outcome measure instruments included the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety-related symptoms. Linear mixed models, with grantee as the random effect, were used to determine the association of behavioral health delivery (telehealth versus in-person) on the one-month change in PHQ-9 and GAD-7 while adjusting for covariates. Across a total of 1,514 patients, one-month change scores were improved indicating that PHQ-9 and GAD-7 scores decreased from baseline to the one-month follow-up at similar rates in both the in-person and telehealth groups. Reduction in scores averaged 2.8 for the telehealth treatment group and 2.9 for the in-person treatment group in the PHQ-9 subsample and 2.0 for the telehealth treatment group and 2.4 for the in-person treatment group in the GAD-7 subsample. There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 or GAD-7. Individuals with higher baseline scores demonstrated the greatest decrease in scores for both measures. Upon adjusting for baseline scores and grantee program, patient demographics were not found to be significantly associated with change in anxiety or depression symptoms. In our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.

Blended Care Therapy for Depression and Anxiety: Outcomes across Diverse Racial and Ethnic Groups

BackgroundStudies have reported positive outcomes of blended care therapy (BCT), which combines face-to-face care with internet modules. However, there is insufficient evidence of its effectiveness across racial and ethnic groups. This study evaluated outcomes of a BCT program, which combined video psychotherapy with internet cognitive-behavioral modules, across race and ethnicity.MethodsParticipants were 6492 adults, with elevated anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) symptoms, enrolled in employer-offered BCT. Changes in anxiety (GAD-7) and depression (PHQ-9) symptoms during treatment were evaluated using individual growth curve models. Interaction terms of time with race and ethnicity tested for between-group differences. Treatment satisfaction was assessed using a Net Promoter measure (range = 1 (lowest satisfaction) to 5 (greatest satisfaction)).ResultsParticipants’ self-reported race and ethnicity included Asian or Pacific Islander (27.5%), Black or African American (5.4%), Hispanic or Latino (9.3%), and White (47.2%). Anxiety symptoms decreased during treatment (p < 0.01), with greater reductions among Hispanic or Latino participants compared to White participants (p < 0.05). Depressive symptoms decreased across treatment (p < 0.01), with significantly greater decreases among some racial and ethnic groups compared to White participants. Declines in anxiety and depressive symptoms slowed across treatment (p’s < 0.01), with statistically significant differences in slowing rates of depressive symptoms across some racial and ethnic groups. Among participants with responses (28.45%), average treatment satisfaction ranged from 4.46 (SD = 0.73) to 4.67 (SD = 0.68) across race and ethnicity (p = 0.001). Racial and ethnic differences in outcomes were small in magnitude.ConclusionsBCT for anxiety and depression can be effective across diverse racial and ethnic groups.

Changes in depressive and anxiety symptoms during COVID-19 in children from the PROGRESS cohort.

We assessed associations between maternal stress, social support, and child resiliency during the COVID-19 pandemic in relation to changes in anxiety and depression symptoms in children in Mexico City. Participants included 464 mother-child pairs from a longitudinal birth cohort in Mexico City. At ages 8-11 (pre-COVID, 2018-2019) and 9-12 (during COVID, May-Nov 2020) years, depressive symptoms were assessed using the child and parent-reported Children's Depressive Inventory. Anxiety symptoms were assessed using the child-reported Revised Manifest Anxiety Scale. Linear regression models were used to estimate associations between maternal stress, social support, and resiliency in relation to changes in depressive and anxiety symptoms. We additionally assessed outcomes using clinically relevant cut-points. Models were adjusted for child age and sex and maternal socioeconomic status and age. Higher continuous maternal stress levels during the COVID-19 pandemic were associated with increases in depressive symptoms (β: 0.72; 95% CI: 0.12, 1.31), and higher odds of clinically relevant depressive and anxiety symptoms in the children. Maternal stress during the pandemic may increase mental health symptoms in pre-adolescent children. Additional studies are needed that examine the long-term pandemic-related impacts on mental health throughout the adolescent years. In this longitudinal cohort study of children in Mexico City, we observed that depressive symptoms were higher from before to during the pandemic. Maternal stress surrounding the pandemic may increase mental health symptoms in pre-adolescent children. Child resiliency may help to protect against pandemic-related stressors.

Changes in Mood, Anxiety, and Cognition with Polycystic Ovary Syndrome Treatment: A Longitudinal, Naturalistic Study.

Individuals with polycystic ovary syndrome (PCOS) are at increased risk of depression and anxiety symptoms and impairment in aspects of cognitive function. However, there is little evidence regarding effects of standard treatment for PCOS on these features of the syndrome. The aim of this study was to examine the effect of 12 weeks of naturalistic treatment of PCOS, with usual medications, on depression symptoms, anxiety symptoms and cognitive function. Thirty-three participants with PCOS received 12 weeks of individualised treatment based on clinical presentation. Changes in depression and anxiety symptoms were assessed with the self-report Hospital Anxiety and Depression Scale at baseline and 12 weeks, and cognitive function was assessed at the same time-points with a battery of tests spanning cognitive domains of verbal learning and memory, visuospatial learning and memory, psychomotor speed, attention and executive function. Outcomes were compared with a control group of 40 healthy participants. Participants with PCOS (mean age = 29.2 years; mean Body Mass Index = 27.4) were treated with a variety of medications, predominantly spironolactone (n = 22) and oral contraceptives (n = 16). Depression and anxiety symptoms improved significantly over the course of treatment, with moderate effect sizes (Cohen's d 0.43-0.55, p < 0.05). Effect sizes of the difference in change from that of the control group were moderate but did not reach statistical significance. Women undergoing PCOS treatment demonstrated significant improvements in aspects of cognitive function, but improvement did not differ significantly from controls and effect size changes were similar, suggesting practise effects in both groups. Our study provides preliminary evidence that treatment of PCOS may be associated with improvement in psychiatric aspects of the syndrome, particularly depressive symptoms.

Can Internet-Delivered Pain Management Programs Reduce Psychological Distress in Chronic Pain? Exploring Relationships Between Anxiety and Depression, Pain Intensity, and Disability.

Adults with chronic pain who also report high pain intensity and disability are more likely to experience depression and anxiety symptoms. The present study examined changes in anxiety and depression symptoms after an Internet-delivered pain management program based on baseline pain intensity and disability severity categories. We conducted a secondary analysis of data from four randomized controlled trials (N = 1,333). Greater pain intensity and disability were associated with increased odds of elevated anxiety or depression symptoms at baseline. Treatment led to greater reductions in anxiety and depression symptoms compared with a waitlist control, and these improvements occurred irrespective of baseline pain intensity or disability severity. Those individuals who reported ≥30% improvements in pain intensity or disability after treatment were more likely to also report ≥30% improvements in psychological symptoms. Importantly, most participants who achieved ≥30% improvements in depression and anxiety had not experienced such improvements in pain intensity or disability. These findings suggest that emerging Internet-delivered pain management programs can lead to reductions in psychological distress even when pain intensity and disability are severe or do not improve with treatment. This indicates the value of such treatments in treating distress and improving mental health in people with chronic pain.

Long-term impact of a behavioral weight management programon depression and anxiety symptoms: 5-year follow-up of the WRAP trial.

Behavioral weight management programs may support short-term mental health; however, limited evidence reports the long-term impacts. This study investigated the impact of behavioral weight management programs on depression and anxiety symptoms at 5 years from baseline. The Weight loss Referrals for Adults in Primary care (WRAP) trial randomized 1267 adults with BMI ≥ 28 kg/m2 to a brief intervention (BI) or commercial behavioral weight management program(WW; formerly Weight Watchers) for 12 or 52 weeks (CP12 and CP52, respectively). Linear regression was used to separately compare 5-year changes in depression and anxiety symptoms (by Hospital Anxiety and Depression Scale) between randomized groups, adjusting for baseline depression/anxiety symptoms, gender, and research center. A total of 643 (51%) participants attended the 5-year study follow-up visit. There was no evidence of a difference between the randomized groups for 5-year changes in depression (BI: -0.08 ± 3.29; CP12: 0.02 ± 3.01; CP52: -0.09 ± 3.41) or anxiety (BI: 0.16 ± 3.50; CP12: -0.05 ± 3.55; CP52: -0.66 ± 3.59) symptoms. This study found no evidence that commercial weight management programs differed in 5-year changes in depression and anxiety symptoms, compared with BI. These are average effects; some individuals experienced increases or decreases in symptoms. Future research should investigate who is at most risk of mental health declines and investigate how to support them. Future trials should transparently report long-term mental health outcomes to strengthen understanding.

Striatal Activity to Reward Anticipation as a Moderator of the Association Between Early Behavioral Inhibition and Changes in Anxiety and Depressive Symptoms From Adolescence to Adulthood

The early childhood temperament of behavioral inhibition (BI), characterized by inhibited and fearful behaviors, has been associated with heightened risk for anxiety and depression across the lifespan. Although several neurocognitive correlates underlying vulnerability to the development of anxiety among inhibited children have been identified, little is known about the neurocognitive correlates underlying vulnerability to the development of depression. To examine whether blunted striatal activation to reward anticipation, a well-documented neurocognitive vulnerability marker of depression, moderates the association between early BI and the developmental changes in depression and anxiety from adolescence to adulthood. Participants in this prospective longitudinal study were recruited at age 4 months between 1989 and 1993 in the US. Follow-up assessments extended into 2018 (age 26 years). Data were analyzed between September 2021 to March 2022. BI was measured through an observation paradigm in infancy (ages 14 and 24 months). Neural activity to anticipated rewards during a monetary incentive delay task was measured using functional magnetic resonance imaging in adolescence (between ages 15-18 years; 83 individuals had usable data). Anxiety and depressive symptoms were self-reported across adolescence to young adulthood (ages 15 and 26 years; n = 108). A latent change score model, accounting for the interdependence between anxiety and depression, tested the moderating role of striatal activity to reward anticipation in the association between early BI and changes in anxiety and depressive symptoms. A region of interest approach limited statistical tests to regions within the striatum (ie, nucleus accumbens, caudate head, caudate body, putamen). Of 165 participants, 84 (50.1%) were female and 162 (98%) were White. Preliminary analyses revealed significant increases in anxiety and depressive symptoms across ages 15 to 26 years, as well as individual variation in the magnitude of changes. Main analyses showed that reduced activity in the nucleus accumbens to reward anticipation moderated the association between early BI and increases in depressive (β = -0.32; b = -4.23; 95% CI, -7.70 to -0.76; P = .02), and more depressive symptoms at age 26 years (β = -0.47; b = -5.09; 95% CI, -7.74 to -2.43; P < .001). However, there were no significant interactions associated with latent changes in anxiety across age nor anxiety at age 26 years. Activity in the caudate and putamen did not moderate these associations. Blunted reward sensitivity in the ventral striatum may be a developmental risk factor connecting an inhibited childhood temperament and depression over the transition to adulthood. Future studies should examine the efficacy of prevention programs, which target maladaptive reward processing and motivational deficits among anxious youths, in reducing risks for later depression.

Anxiety and depression symptoms during the COVID-19 pandemic in European countries and Australia

Abstract Background Studies on mental health changes during the COVID-19 pandemic report no change or increasing prevalence of mental health problems in general, but less is known on changes in potentially disadvantaged groups over time. We investigated changes in anxiety and depression symptoms during the first year of the pandemic in France, Germany, Italy, the Netherlands, Spain, Sweden, and Australia by prior mental disorders and migration status. Methods Overall, 4,674 adults answered a web-based survey in May-June 2020 and were followed by three repeated surveys up to February 2021 in these countries. Information on socio-demographic, living conditions, psychosocial factors, diagnosis of mental disorders before, depression and anxiety symptoms during the pandemic and migration status (being a resident or not) was collected. Weighted general estimation equations modelling was used to investigate the association between prior mental disorders, migration status, and symptoms over time. Results Most participants were &amp;lt;40 years old (48%), women (78%), and highly educated (62%) with some variations across countries. The baseline prevalence of depressive and anxiety symptoms ranged between 19%-45% and 13%-35% respectively. In most countries, prevalence remained unchanged throughout the pandemic and was higher among people with prior mental disorder than without even after adjustment for socioeconomic, psychosocial, living and health factors. We observed interactions between previous mental disorders and symptoms of anxiety or depression over time in Germany (p = 0.01) and in Spain (p = 0.04). No prevalence difference was noted by migration status. Conclusions Depression and anxiety symptoms were worse among individuals with prior mental disorders than without, but there was no clear trend of mental health worsening in the observed groups during the first year of the pandemic. Still, monitoring mental health should be continued in the long-term, with special focus on vulnerable groups. Key messages • Depression and anxiety symptoms were higher in individuals with prior mental disorders during the first year of the pandemic in an international sample of six European countries and Australia. • There were no clear trends of mental health worsening in any of the observed groups in neither of the countries between May-June 2020 and February 2021.

Effectiveness of primary care psychological therapy services for the treatment of depression and anxiety in people living with dementia: Evidence from national healthcare records in England.

SummaryBackgroundDepression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia.MethodsNational data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration).FindingsSymptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia.InterpretationPsychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes.FundingThis work was supported by the Alzheimer's Society.

Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) Treatment in Comorbid Nicotine Addiction with Major Depressive Disorder and Obsessive-Compulsive Disorder

Objective: Nicotine addiction is a common health problem in psychiatric disorders. The aim of this study was to analyze the effects of rTMS on comorbid nicotine addiction in patients receiving recurrent Transcranial Magnetic Stimulation (rTMS) therapy for major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Method: Data of 32 patients (23 MDD, 9 OCD) were evaluated retrospectively. We compared the Hamilton Depression Rating Scale (HAM-D), Beck Anxiety Inventory (BAS), Yale-Brown Obsession Compulsion Scale (Y-BOCS), and Fagerström Test for Nicotine Dependence (FTND) scores at three time points (before treatment "0th week", at the end of treatment “6th week”, and 12 weeks after this assessment “18th week”). Results: The patients’ mean age was 40.47±10.20, 13(40.6%) were women. A significant reduction was found in HAM-D, BAS, FTND at weeks 6 (p&amp;lt;0.001 for all) and 18 (p&amp;lt;0.001 for all) compared to baseline scores. A binary logistic regression showed that changes in depression and anxiety symptoms were not associated with the changes in FTND ratings at weeks 6 and 18 (p=0.158, p=0.251, respectively). Conclusion: In this study, it can be said that rTMS treatment reduces the severity of nicotine addiction accompanying MDD and OCD, independent of the recovery of the psychiatric disease. This study suggests that rTMS can be an effective treatment for nicotine addiction comorbid with psychiatric disorders. We recommend placebo-controlled randomized double-blind studies.

Patient characteristics and changes in anxiety symptoms in patients with panic disorder: Post-hoc analysis of the PARADIES cluster randomised trial.

Anxiety disorders are among the most common mental health problems in primary care. The PARADIES (Patient Activation foR Anxiety DIsordErS) intervention combined elements of cognitive behavioural therapy with case management and has demonstrated efficacy. Our aim was to explore patient characteristics, which may influence the course of anxiety symptoms over a 12 months period. Multiple linear regression was used to quantify associations of baseline characteristics (demographics, clinical parameters, medication use) with changes in anxiety symptoms as measured by the Beck anxiety inventory. Treatment modalities (e.g. adherence to appointment schedules) were considered as confounders. We examined univariate associations between dependent and independent variables before considering all independent variables in a multivariate final model. To find the best model to explain BAI score changes, we performed step-wise selection of independent variables based on Akaike information criteria. We tested for interaction terms between treatment allocation (intervention vs control) and independent variables using the multivariate model. We repeated these analyses in control vs intervention groups separately. From the original trial (N = 419), 236 patients (56.3%) were included. In the multivariate model, receiving the intervention (p<0.001), higher anxiety symptom severity (p<0.001) and longer illness duration at baseline (p = 0.033) were significantly associated with changes in anxiety symptom severity to the better while depression severity at baseline (p<0.001) was significantly associated with changes in anxiety symptoms to the worse. In stratified analyses, the control group showed significant associations between depression symptom severity and illness duration with anxiety symptom changes while baseline severity of anxiety symptoms remained significantly associated with anxiety symptom changes in both groups. A brief primary-care-based exposure training combined with case management is effective in a broad range of patients with panic disorder with/without agoraphobia, including those with longer illness duration and co-existing symptoms of depression at baseline.

Symptoms of depression and anxiety increased marginally from before to during the COVID-19 pandemic among young adults in Canada.

We documented changes in depressive and anxiety symptoms from before to during the COVID-19 pandemic among young adults and investigated whether changes differed across participant characteristics. Data were available in an investigation of 1294 grade 7 students recruited in 1999–2000. For this analysis, we used data collected pre-pandemically in 2017–20 (mean (SD) age = 30.6 (1.0)) and during the pandemic in 2020–21 (mean (SD) age = 33.6 (0.6)). 673 participants with data in both cycles were retained for analysis. Symptoms were measured using the Major Depression Inventory (MDI) and the Generalized Anxiety Disorder-7 (GAD-7) scale. Standardized mean differences (SMD) of changes in MDI and GAD-7 values between cycles were calculated across participant characteristics. On average, MDI scores increased by 2.1 (95%CI 1.4, 2.8) points during the pandemic from mean 10.5; GAD-7 scores increased by 1.2 (0.8, 1.5) points from mean 4.7. The SMD was 0.24 (0.14, 0.33) for MDI, and 0.24 (0.13, 0.34) for GAD-7. No differences in MDI change scores were observed across participant characteristics. Differences in GAD-7 change scores were observed by mood/anxiety disorder (SMD − 0.31 (− 0.58, − 0.05)), household income (0.24 (0.02, 48)), living with young children (− 0.56 (− 1.23,− 0.05)), and adherence to public health recommendations 0.58 (0.19, 1.03)). Increases in depressive and anxiety symptoms were observed 10–16 months into the COVID-19 pandemic among adults age 32–36.

Reducing Anxiety and Stress among Youth in a CBT-Based Equine-Assisted Adaptive Riding Program.

Simple SummaryReining in Anxiety (RiA) is a therapeutic program for youth with mild-to-moderate anxiety delivered in a therapeutic riding setting by Certified Therapeutic Riding Instructors. RiA is based on five foundational components of Cognitive Behavioral Therapy (CBT): in vivo exposure, cognitive restructuring, youth psychoeducation, relaxation, and caregiver psychoeducation about anxiety. The intervention sought to support youth between the ages of 6–17 with self-identified anxiety. Due to global pandemic trauma, in the second iteration of the protocol, researchers also included two evidence-based trauma components: maintenance and personal safety skills. All instructors were trained in the RiA curriculum and delivered the same lessons. In addition to assessing the youth’s perception and changes over time, the researchers also assessed changes in the horses, both through saliva sampling. The authors learned that RiA may be a promising approach for reducing anxiety and stress among youth and that the intervention can be delivered by adaptive/therapeutic horseback riding instructors in a non-clinic setting.Reining in Anxiety (RiA) is a therapeutic program for youth with mild to moderate anxiety delivered in a therapeutic riding setting by Certified Therapeutic Riding Instructors. RiA was developed after a review of the evidence base for youth anxiety, is manualized, and includes five core CBT components: in vivo exposure, cognitive restructuring, youth psychoeducation, relaxation, and caregiver psychoeducation about anxiety. This study extended findings from a prior RCT that examined (1) the feasibility of collecting saliva samples from horses and children to measure stress (cortisol) and relaxation (oxytocin); (2) whether changes in stress and relaxation occurred both during each lesson and over the course of the 10-week intervention for horses and youth; (3) whether changes in anxiety symptoms, emotional regulation, and self-efficacy found in the first trial were comparable; and (4) if fidelity to the program was reliable. Youth participants (n = 39) ages 6–17 with caregiver-identified mild-to-moderate anxiety participated in a ten-week therapeutic intervention (RiA), which combined adaptive riding and components of CBT. Physiological data and self-report measures were taken at weeks one, four, seven, and ten for the youth and horses. Saliva assays assessed cortisol as a physiological marker of stress and anxiety, and oxytocin as a measure of relaxation. Fidelity data were recorded per session. Anxiety, as measured by caregiver self-reporting, significantly decreased from pre- to post-test, while emotional regulation scores increased. No significant changes in self-efficacy from pre- to post-test were observed. Saliva samples obtained from participants before and after riding sessions showed a consistent decrease in cortisol and a significant increase in oxytocin at two of the four timepoints (Week 1 and Week 7), but no overall pre- to post-test changes. Horse saliva data were collected using a modified bit; there were no significant changes in oxytocin or cortisol, suggesting that the horses did not have an increase in stress from the intervention. RiA may be a promising approach for reducing anxiety and stress among youth, as measured both by self-reported and by physiological measures. Collection of salivary assays for both youth and horses is feasible, and the intervention does not increase stress in the horses. Importantly, RiA can be delivered by adaptive/therapeutic horseback riding instructors in naturalistic (e.g., non-clinic-based) settings. As youth anxiety is a growing public health problem, novel interventions, such as RiA, that can be delivered naturalistically may have the potential to reach more youth and thus improve their quality of life. Further research is needed to examine the comparative value of RiA with other animal-assisted interventions and to assess its cost-effectiveness.

Short-term air pollution exposure and anxiety symptoms in children from Mexico City

BACKGROUND AND AIM: Short-term air pollution exposure has been linked to mental health conditions in adults; however, there is limited research in the younger populations in which symptoms often first arise. In this study, we examined the association between recent fine particulate matter (PM2.5) exposure and symptoms of anxiety in a cohort of 8–9-year-olds in Mexico City. METHODS: Participants included 455 mother-child pairs from a longitudinal birth cohort study in Mexico City. Anxiety symptoms were assessed at the 8–9-year study visit by trained psychologists using the Spanish version of the Revised Children’s Manifest Anxiety Scale. Daily PM2.5 predictions were estimated using a 1km satellite-based exposure model and averaged over several recent exposure windows including 1-12 months and 1-4 weeks prior to anxiety assessment. We additionally used recent weekly exposure averages in distributed lag models. Linear regression models were used to estimate the change in continuous anxiety symptoms with each 5-µg/m3 increase in PM2.5. Models were adjusted for maternal education, maternal age, child’s age at study visit, child sex, and season of study visit. We additionally assessed sex-specific effects by including an interaction term between PM2.5 and sex. RESULTS: A 5-unit increase in PM2.5 exposure averaged over the 1 month prior to study visit was associated with higher anxiety symptoms in the child (β= 0.65, 95% CI: 0.01, 1.30). These associations were primarily seen in females (β= 1.05, 95% CI: 0.10, 1.95, p-int: 0.10). Using DLM approaches, we identified a critical window for exposures 0-2 weeks prior to anxiety assessment. CONCLUSIONS: Fine particulate matter exposure was associated with elevated levels of child anxiety symptoms, particularly for more recent exposures. KEYWORDS: air pollution, mental health, LMIC, child health

Using clustering algorithms to examine the association between working memory training trajectories and therapeutic outcomes among psychiatric and healthy populations

Working memory (WM) training has gained interest due to its potential to enhance cognitive functioning and reduce symptoms of mental disorders. Nevertheless, inconsistent results suggest that individual differences may have an impact on training efficacy. This study examined whether individual differences in training performance can predict therapeutic outcomes of WM training, measured as changes in anxiety and depression symptoms in sub-clinical and healthy populations. The study also investigated the association between cognitive abilities at baseline and different training improvement trajectories. Ninety-six participants (50 females, mean age = 27.67, SD = 8.84) were trained using the same WM training task (duration ranged between 7 to 15 sessions). An algorithm was then used to cluster them based on their learning trajectories. We found three main WM training trajectories, which in turn were related to changes in anxiety symptoms following the training. Additionally, executive function abilities at baseline predicted training trajectories. These findings highlight the potential for using clustering algorithms to reveal the benefits of cognitive training to alleviate maladaptive psychological symptoms.

The potential moderating role of living in a conflict area on the link between classroom psychosocial stressors, perceived stress and change in anxiety symptoms in Israeli school children.

Perceived stress associated with relational victimization from peers and conflictual relations with the teacher have been linked with the development of anxiety symptoms in children. Living in conditions of ongoing stress from the broader environment has also been related to anxiety symptoms in children. In this study, we examined (a) the indirect effect between classroom psychosocial stressors (i.e., relational victimization and conflictual relationships with teachers), perceived stress and anxiety symptom development, and (b) whether this indirect effect was stronger for children living in a high threat region than for children living in a lower threat region. Children participating in the study attended elementary school either in a high threat of armed conflict region (15s to hide in bomb shelter when alarm sounds, n=220) or in a lower threat of armed conflict region (60s to hide in a bomb shelter when alarm sounds, n=188) in Israel. Children were first assessed on conflictual relationships with teachers and peers, subjectively perceived stress and anxiety in 2017 (T 0; M age=10.61years, SD=0.78; 45% boys) and re-assessed (T 1) 1year later, in 2018. Perceived stress mediated the association between classroom psychosocial stressors and anxiety development. No moderation by threat-region was found in this indirect effect. However, the association between perceived stress and anxiety development was only significant for children in the high threat region. Our study suggests that threat of war conflict amplifies the association between perceived stress and the development of anxiety symptoms.

Clinical feasibility of cognitive behavioural therapy for insomnia in a real-world mixed sample at a specialized psychiatric outpatient clinic

BackgroundA majority of psychiatric patients suffer from insomnia or insomnia-like problems. In addition to impairing quality of life, sleep problems can worsen psychiatric conditions, such as depression and anxiety, and can make treatment of various psychiatric conditions less successful. Several international guidelines recommend cognitive behavioural therapy for insomnia (CBT-I) as first line treatment. However, patients in psychiatric care are rarely offered this treatment, and there is a lack of studies evaluating the treatment in regular psychiatric settings. In this pilot study, we aimed to determine the clinical feasibility of a group-based CBT-I intervention in an outpatient clinical setting for patients with depression, bipolar disorder, anxiety disorders and PTSD. We also aimed to investigate if symptoms of insomnia, depression and anxiety changed after CBT-I.MethodsSeventeen patients at an out-patient psychiatric clinic for mixed psychiatric problems of anxiety, affective disorders and PTSD, were enrolled in a six-week long group-based CBT-I intervention. Primary outcomes were pre-defined aspects of treatment feasibility. Secondary outcomes were changes in self-reported symptoms of insomnia severity, depression, and anxiety between pre – and post intervention. Assessment of insomnia severity was also performed 3 months after treatment. Feasibility data is reported descriptively, changes in continuous data from pre- to post-treatment were analysed with dependent t-tests.ResultsAll feasibility criteria were met; there were enough patients to sustain at least one group per semester (e.g., minimum 8), 88% of included patients attended the first session, mean of attended sessions was 4.9 of 6, and drop-out rate was 5.9%. Therapists, recruited from clinical staff, found the treatment manual credible, and possible to use at the clinic. Symptoms of insomnia decreased after treatment, as well as symptoms of depression and anxiety.ConclusionCBT-I could prove as a clinically feasible treatment option for insomnia in a psychiatric outpatient setting.Trial registrationClinicaltrials.gov identifier: NCT05379244. Retrospectively registered 18/05/2022.

Moderators of treatment effect of Prompt Mental Health Care compared to treatment as usual: Results from a randomized controlled trial

BackgroundIn this exploratory study, we investigated a comprehensive set of potential moderators of response to the primary care service Prompt Mental Health Care (PMHC). MethodsData from an RCT of PMHC (n = 463) versus treatment as usual (TAU, n = 215) were used. At baseline mean age was 34.8, 66.7% were women, and 91% scored above caseness for depression (PHQ-9) and 87% for anxiety (GAD-7). Outcomes: change in symptoms of depression and anxiety and change in remission status from baseline to six- and 12- months follow-up. Potential moderators: sociodemographic, lifestyle, social, and cognitive variables, variables related to (mental) health problem and care. Each moderator was examined in generalized linear mixed models with robust maximum likelihood estimation. ResultsEffect modification was only identified for anxiolytic medication for change in symptoms of depression and anxiety; clients using anxiolytic medication showed less effect of PMHC relative to TAU (all p < 0.001), although this result should be interpreted with caution due to the low number of anxiolytic users in the sample. For remission status, none of the included variables moderated the effect of treatment. ConclusionAs a treatment for depression and/or anxiety, PMHC mostly seems to work equally well as compared to TAU across a comprehensive set of potential moderators.

The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data.

BackgroundDigital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ≥65 years remain substantially lower than in the general population and that approximately 20% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed.ObjectiveThis study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms.MethodsIn this retrospective analysis, we analyzed data from 375 real-world Happify users aged ≥65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level.ResultsIn all, 30% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities.ConclusionsThese data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population’s particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches.