Co-occurring Anxiety Symptoms Research Articles

Dysfunctional beliefs associated with hair pulling disorder: an examination in clinical versus non-clinical groups

ABSTRACT Objective Until recently, empirical studies had been limited with respect to investigating factors that influence the onset and maintenance of hair pulling disorder (HPD), particularly regarding the role of dysfunctional cognitions and beliefs. The primary aim of this study was to examine the relationships between symptom severity and belief domains in a sample with hair pulling disorder compared with non-clinical participants, using the Beliefs in Trichotillomania Scale (BiTS); a recently developed measure of relevant negative self-beliefs, coping efficacy beliefs, and perfectionist cognitions. Method Twenty adults with HPD and 43 age- and gender-matched control participants completed the BiTS and several measures of related constructs. Results HPD severity was significantly and positively correlated with negative self-beliefs and low coping efficacy, but not perfectionism, even after controlling for anxiety and depressive symptoms. Focussed hair pulling, but not automatic hair pulling, was correlated with each BiTS domain; however, once anxiety and depressive symptoms were controlled for, the significant relationship between focussed hair pulling and perfectionism was no longer apparent. The BiTS psychometric properties demonstrated good internal consistency and differentiated clinical from non-clinical participants, with clinical participants endorsing greater negative self-beliefs, lower coping efficacy, and greater perfectionism compared with control participants. Conclusions Negative self beliefs, low coping efficacy, and perfectionism have differential relationships with HPD severity and hair pulling styles, variable on the presence of co-occurring anxiety and depressive symptoms. While further support for the BiTS internal consistency was obtained, future examination of divergent validity with a more diverse range of constructs is required.

Exploring the co-occurrence of depression, anxiety and insomnia symptoms, diagnoses and treatments in primary care: observational study using UK primary care data.

Depression, anxiety and insomnia often co-occur. However, there is a lack of research regarding how they cluster and how this is related to medication used to treat them. To describe the frequencies and associations between depression, anxiety and insomnia, and treatment for these conditions in primary care. A retrospective cohort study using UK electronic primary care records. We included individuals aged between 18 and 99 years old with one or more records suggesting they had a diagnosis, symptom or drug treatment for anxiety, depression or insomnia between 2015 and 2017. We report the conditional probabilities of having different combinations of diagnoses, symptoms and treatments recorded. There were 1 325 960 records indicative of depression, anxiety or insomnia, for 739 834 individuals. Depression was the most common condition (n = 106 117 records), and SSRIs were the most commonly prescribed medication (n = 347 751 records). Overall, individuals with a record of anxiety were most likely to have co-occurring symptoms and diagnoses of other mental health conditions. For example, of the individuals with a record of generalised anxiety disorder (GAD), 24% also had a diagnosis of depression. In contrast, only 0.6% of those who had a diagnosis of depression had a diagnosis or symptom of GAD. Prescribing of more than one psychotropic medication within the same year was common. For example, of those who were prescribed an SNRI (serotonin-norepinephrine reuptake inhibitor), 40% were also prescribed an SSRI (selective serotonin reuptake inhibitor). The conditional probabilities of co-occurring anxiety, depression and insomnia symptoms, diagnoses and treatments are high.

39 Co-Occurring Depression and Anxiety is Associated with Greater Cognitive Variability in Persons with Multiple Sclerosis

Objective:Research examining co-occurring anxiety and depression in persons with multiple sclerosis (PwMS) is scarce, though an estimated 20% of PwMS experience clinically significant anxiety and depression (Gascoyne et al., 2019). Recent work by Hanna & Strober (2020) found that PwMS with comorbid anxiety and depression reported worse outcomes in all constructs of symptomatology, disease management, psychological well-being, and quality of life. However, it is unclear how co-occurring anxiety and depression symptoms may influence or exacerbate cognitive difficulties in PwMS. Further, considering there are high levels of comorbidity between depression, anxiety, and fatigue in PwMS, this study aims to examine the unique variances of depression, anxiety, co-occurring depression and anxiety, and fatigue on cognitive functioning.Participants and Methods:86 PwMS (F=65,M=21) completed a comprehensive neuropsychological battery that included self-report measures of anxiety, depression, and fatigue. An intraindividual variability (IIV) composite score was calculated by combining standardized intraindividual standard deviation and maximum discrepancy scores on measures of attention/processing speed and memory for each participant. Lower scores indicate worse performance (i.e., greater variability). A hierarchical regression was conducted with IIV as the outcome variable and with depression, anxiety, cognitive fatigue, physical fatigue, and the interaction between depression and anxiety as predictors. Expanded Disability Status Scale (EDSS) scores were included as a covariate.Results:The only model that included a statistically significant predictor of IIV was the final model, which included EDSS, depression, anxiety, cognitive fatigue, physical fatigue, and the interaction between depression and anxiety, F(6,77)=2.97, p=.01, AR2=.08. While the main effects of depression and anxiety were not significant, the interaction between depression and anxiety was significant, F(6,77)=7.20, p=.01, n2=.09. Simple effects tests revealed that the relationship between IIV and anxiety was marginally significant for those at the cutoff for clinical depression (square root BDI-FS=2; BDI-FS=4), F(6,77)=3.52, p=.07, n2=.04. However, the effect of anxiety on IIV increased as depression increased. For example, in those with high levels of depression (1.5 SD above the mean), there was a significant relationship between anxiety and IIV, F(6,77)=4.16, p=.04, n2=.05, though this was not the case for those with low levels of depression (1.5 SD below the mean), F(6,77)=0.01, p=.92, n2=.00.Conclusions:The interaction between depression and anxiety predicted variability in performance such that those with high levels of depression and anxiety demonstrated significantly greater IIV. Since dispersion is considered a marker for neurocognitive integrity, this may suggest that co-occurring psychological disturbances are associated with poorer cognitive integrity, an important consideration for interventions and outcomes. While interventions aimed at treating co-occurring depression and anxiety have been largely overlooked within the MS literature (Butler et al., 2016), transdiagnostic interventions have been beneficial for general adult populations with co-occurring anxiety and depression (McEvoy et al., 2009). Future work should examine the efficacy of interventions aimed at addressing co-occurring depression and anxiety in PwMS, as this may help to improve cognitive functioning, as well as perception of functioning, which will likely further improve quality of life and overall well-being.

The Role of Pediatric Sensory Over-responsivity and Anxiety Symptoms in the Development of Family Accommodations.

Sensory over-responsivity (SOR) is linked with elevated anxiety and reduced family wellbeing. Family accommodation of anxiety relates with greater symptom severity and reduced intervention outcome. This study examined the contribution of child SOR and co-occurring anxiety symptoms to family accommodation and its consequences. Ninety families of typically developing children (ages 4-13 years), completed an online survey including the Sensory Profile 2, Screen for Child Anxiety Related Emotional Disorders (SCARED), and Family Accommodation Sensory Scale (FASENS). FASENS scores include frequency of accommodation, child impact, and family impact.Children with elevated anxiety symptoms had significantly higher sensory and FASENS scores. Stepwise linear regression indicated that only SOR symptoms significantly predicted the frequency of sensory family accommodation, while both SOR and anxiety symptoms predicted the impact of family accommodation upon child and family well-being.Both SOR and anxiety symptoms in children predict the impact of sensory family accommodations on child and family well-being.

Postdischarge Nausea and Vomiting and Co-occurring Symptoms in Women Following Breast Cancer Surgery

PurposeThe purpose of this study was to investigate the influence of potential co-occurring symptoms, including fatigue, sleep disturbance, anxiety, depressive symptoms, and pain, on the incidence of postdischarge nausea (PDN) measured two days following discharge to home after surgery for breast cancer. DesignThis study used a prospective, cross-sectional, observational design. MethodsThe sample was 334 women aged 27 to 88 years of age. Demographic data were collected from the patient and the medical record before surgery. Symptom data were collected 48 hours following surgery using the Patient Reported Outcome Measurement System (PROMIS) and numerical nausea and pain scales. FindingsEighty-five (25.4%) of study participants reported some nausea two days after discharge. Study participants who experienced PDN frequently described that it occurred after they left the hospital to drive home following their surgery. Unadjusted odds ratios showed the presence of co-occurring symptoms of anxiety, fatigue, sleep disturbance, and pain were all significantly associated with the presence of nausea 48 hours following surgery. Other significant factors associated with (PDN) were history of motion sickness, history of pregnancy-induced nausea, use of opioids, and type of surgery. ConclusionsSame-day surgery nurses providing postoperative education for women following surgery for breast cancer should explain to patients that nausea may occur after they are discharged, especially those with known motion sickness. In addition, patients should be informed that other symptoms, especially fatigue, sleep disturbance, and anxiety, may co-occur.

Prevalence and Phenomenology of Anxiety in Preschool-Aged Children with Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) are at a higher risk for developing co-occurring anxiety symptoms and diagnosable anxiety disorders compared to children with neurotypical development (NTD). The objective of the current study was to characterize the prevalence and phenomenology of anxiety in preschool-aged children with ASD. Our sample consisted of preschoolers (M = 52.8months, SD = 10.8months) with ASD (n = 77, 66% with co-occurring intellectual disability, ID) and NTD (n = 55). We employed multi-method (questionnaire and semi-structured diagnostic interview) and multi-informant (parent- and teacher-report) assessments of anxiety. Children with ASD were significantly more likely to meet criteria for an anxiety disorder than children with NTD. Over 70% of our sample with ASD met DSM-5 criteria for an anxiety disorder, with Specific Phobia and Separation Anxiety Disorder being the most prevalent. A range of specific fears was endorsed in the group with ASD, many of which overlapped with ASD symptoms. Parents, but not teachers, also reported greater anxiety symptoms for children with ASD relative to the comparison sample. Prevalence and phenomenology of anxiety in our sample with ASD generally did not differ between those with and without co-occurring ID, with the exception of higher rates of generalized anxiety in those without ID. Results showed poor concordance between parent questionnaires and a semi-structured diagnostic interview in detecting clinically-elevated anxiety in children with ASD. Implications for clinical practice and research are discussed.

A protocol for unguided internet self-help cognitive behaviour therapy for perfectionism in adolescents at-risk of eating disorders

Perfectionism has a strong association with eating disorders, anxiety and depression. Unguided internet cognitive behaviour therapy for perfectionism has demonstrated efficacy in female adolescents without elevated eating disorder symptoms. No research to date has examined unguided internet cognitive behaviour therapy for perfectionism for adolescents with elevated eating disorder symptoms as an indicated prevention for eating disorders and co-occurring symptoms of anxiety and depression. The protocol outlines the plan for a randomised controlled trial of a co-designed, unguided internet cognitive behaviour therapy for perfectionism with female adolescents with elevated symptoms of eating disorders. The intervention will be a 4-week programme compared to a waitlist control. Outcomes on eating disorder symptoms, anxiety and depression will be measured pre and post intervention and follow-up. Trial registrationThis trial was registered on 23 September 2020 with the Australian New Zealand Clinical Trials Registry (ACTRN12620000951954P).

Alleviating Excessive Worries Improves Co-Occurring Depression and Pain in Adolescent and Young Adult Cancer Patients: A Network Approach.

ObjectiveAnxiety, depression, and pain are highly interactive with each other in adolescent and young adult (AYA) cancer patients. This study aims to map out the connectivity between anxiety, depression and pain symptoms amongst Chinese AYA cancer patients from the perspective of a network model.MethodsTwo hundred and eighteen AYA patients, aged between 15 and 39 years at diagnosis; completed the Patient Health Questionnaire (PHQ), Generalized Anxiety Disorder (GAD), and McGill Pain Questionnaire-Visual Analogue Scale (MPQ-VAS). Network analyses were performed.ResultsIn all, 38.07% (95% CI = 31.58–44.57%) of the participants reported depression, 30.73% (95% CI = 24.56–36.91%) reported anxiety, and 14.22% (95% CI = 9.55–18.89%) reported current pain. The generated network illustrated that anxiety, depression and pain community were well connected. In the network, “having trouble relaxing” (GAD4, node strength = 1.182), “uncontrollable worry” (GAD2, node strength = 1.165), and “sad mood” (PHQ2, node strength = 1.144) were identified as the most central symptoms, while “uncontrollable worry” (GAD2, bridge strength = 0.645), “guilty” (PHQ6, bridge strength = 0.545), and “restlessness” (GAD5, bridge strength = 0.414) were the key bridging symptoms that connected different communities.ConclusionAnxiety, depression and pain symptoms are highly interactive with each other. Alleviating AYA cancer patient’s excessive worries might be helpful in improving the patient’s co-occurring anxiety, depression and pain symptoms.

The Effect of Psychosocial Interventions for Reducing Co-occurring Symptoms of Depression and Anxiety in Individuals withProblematic Internet Use: A Systematic Review and Meta-analysis.

The objective of this study is to conduct a systematic review and meta-analysis to assess the effect of psychosocial interventions in reducing problematic Internet use (PIU), anxiety, and depression symptoms in a sample of people. This review was registered on the PROSPERO database (CRD42020181912) and a total of 15 studies were included. Analyses of the effect of the interventions were conducted based on the standardized mean difference of the studied outcomes (PIU, anxiety, and depression). Most studies reported a positive effect of psychosocial interventions on reducing symptoms of PIU, depression, and anxiety among people with PIU. However, only one detected a robust effect in reducing symptoms of anxiety. For depression, this effect was more modest, and there was no difference between the different modalities of psychosocial interventions. The results suggest that psychosocial interventions are effective in reducing both symptoms of PIU and co-occurring symptoms of depression and anxiety in individuals with PIU.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11469-022-00846-6.

Context-dependent amygdala–prefrontal connectivity during the dot-probe task varies by irritability and attention bias to angry faces

Irritability, defined as proneness to anger, is among the most common reasons youth are seen for psychiatric care. Youth with irritability demonstrate aberrant processing of anger-related stimuli; however, the neural mechanisms remain unknown. We applied a drift-diffusion model (DDM), a computational tool, to derive a latent behavioral metric of attentional bias to angry faces in youth with varying levels of irritability during functional magnetic resonance imaging (fMRI). We examined associations among irritability, task behavior using a DDM-based index for preferential allocation of attention to angry faces (i.e., extra-decisional time bias; Δt0), and amygdala context-dependent connectivity during the dot-probe task. Our transdiagnostic sample, enriched for irritability, included 351 youth (ages 8–18; M = 12.92 years, 51% male, with primary diagnoses of either attention deficit/hyperactivity disorder [ADHD], disruptive mood dysregulation disorder [DMDD], an anxiety disorder, or healthy controls). Models accounted for age, sex, in-scanner motion, and co-occurring symptoms of anxiety. Youth and parents rated youth’s irritability using the Affective Reactivity Index. An fMRI dot-probe task was used to assess attention orienting to angry faces. In the angry-incongruent vs. angry-congruent contrast, amygdala connectivity with the bilateral inferior frontal gyrus (IFG), insula, caudate, and thalamus/pulvinar was modulated by irritability level and attention bias to angry faces, Δt0, all ts350 > 4.46, ps < 0.001. In youth with high irritability, elevated Δt0 was associated with a weaker amygdala connectivity. In contrast, in youth with low irritability, elevated Δt0 was associated with stronger connectivity in those regions. No main effect emerged for irritability. As irritability is associated with reactive aggression, these results suggest a potential neural regulatory deficit in irritable youth who have elevated attention bias to angry cues.

Understanding Co-Occurring ADHD and Anxiety Symptoms within a Developmental Framework: Risk and Protective Factors of Early Temperament and Peer Relations.

Symptoms of ADHD and anxiety often co-occur, yet we are limited in our understanding of which children with ADHD symptoms are more likely to develop anxiety symptoms in adolescence. This longitudinal study examined the role of behavioral inhibition (BI) and peer relationships (i.e., peer support and peer victimization) in relation to childhood ADHD and adolescent anxiety symptoms in a community sample, which was oversampled for reactivity. Data were drawn from a larger longitudinal study (N = 291) examining trajectories of BI. For the current analyses, we used behavioral observations of BI at ages 2 and 3, parent report of their child's ADHD symptoms at age 7, child report of peer support and peer victimization at age 12, and adolescent report of anxiety symptoms at age 15. Using structural equation modeling, results indicated that BI and peer support moderated the relation between ADHD and anxiety symptoms, such that ADHD symptoms predicted later anxiety symptoms only for youth who displayed low BI in toddlerhood and reported experiencing lower levels of peer support in early adolescence. Findings highlight the role of early temperament and peer relationships on the relation between childhood ADHD and adolescent anxiety symptoms, and underscore the importance of evaluating multiple risk factors when examining the development of psychopathology.

Mapping the Presence of Anxiety Symptoms in Adults With Major Depressive Disorder.

Background: Patients with major depressive disorder (MDD) often present with co-occurring anxiety symptoms. The network method provides a novel view on understanding the co-occurrence of depressive and anxiety symptoms. Thus, the purpose of our study was to explore it by applying network analysis methods.Methods: We used electronic medical records from West China Hospital in China. In total, 3,424 patients who met the criteria for MDD were included. R-studio 3.6 was used to estimate the network structure. First, we estimated the network structure of depression and anxiety symptoms using the graphic LASSO algorithm. Then, we estimated the centrality indices of nodes to determine which symptoms are more central in the network. We then estimated the bridge centrality indices using the bridge function via the R package networktools.Results: Some strong connections were found like “easy to wake up,” “wake up early,” and “difficulty falling asleep,” “suicidal thoughts,” and “hopelessness.” “Depressed mood,” “somatic anxiety,” “hopelessness,” “anxiety mood,” and “tension” have the higher centrality indices. Results revealed eight bridge symptoms (e.g., concentration/memory difficulty, gastrointestinal symptoms) in the co-occurrence network structure.Conclusions: This research suggests that the described approach in mapping the presence of anxiety symptoms in individuals with major depression might potentially increase diagnostic precision and help choose more targeted interventions and potentially reduce the occurrence of treatment resistance.

Integrating Screening and Treatment of Unhealthy Alcohol Use and Depression with Screening and Treatment of Anxiety, Pain, and Other Substance Use Among People with HIV and Other High-Risk Persons

We review and synthesize results from a series of analyses estimating the benefit of screening for unhealthy alcohol use, depression, and tobacco to detect individuals at heightened risk for co-occurring anxiety, pain, depression, unhealthy alcohol use, and other substance use among people with HIV and HIV-uninfected individuals in the Veterans Aging Cohort Study. We also examine the potential impact of reducing unhealthy alcohol use and depressive symptoms on the incidence of co-occurring conditions. We found that screening for alcohol and depression may help identify co-occurring symptoms of anxiety, depression, and pain interference, treating unhealthy alcohol use may improve co-occurring pain interference and substance use, and improving depressive symptoms may improve co-occurring anxiety, pain interference, and smoking. We propose that an integrated approach to screening and treatment for unhealthy alcohol use, depression, anxiety, pain, and other substance use may facilitate diagnostic assessment and treatment of these conditions, improving morbidity and mortality.

Drinking patterns of college students with comorbid depression and anxiety symptoms: the moderating role of gender

ABSTRACT Background: Students with anxiety or mood issues tend to engage in more problematic drinking, but less is known about those students with co-occurring anxiety and mood symptoms. Methods: This study compares rates of weekly alcohol use, hazardous drinking, and alcohol-related negative consequences in a sample of 699 college students with symptoms of comorbid anxiety and depression (35% of the sample) compared to their non-symptomatic drinking peers, as well as the moderating role of gender. Results: We found main effects of gender and comorbidity status such that participants with comorbid symptoms of anxiety and depression or who were male reported higher rates of weekly alcohol use, more hazardous drinking and more alcohol-related negative consequences than their non-symptomatic and female peers. We also found an interaction effect on alcohol-related negative consequences such that male participants with comorbid anxiety and depression reported more alcohol-related negative consequences than all other groups. Conclusion: These findings imply that while any student drinker with both anxiety and depression may be considered at higher risk for problematic drinking behavior, the risk of negative consequences in particular may be highest in the men of that group.

Self-Reported Emotional Reactivity, Depression, and Anxiety: Gender Differences among a Psychiatric Outpatient Sample

Abstract The objective of this study was to identify the relationship of emotional reactivity with depression and anxiety symptoms among adults diagnosed with a serious mental illness (SMI) and to explore gender differences in these relationships. Cross-sectional data were collected from intensive case management services recipients (N = 150). Hierarchical multiple regression was used to identify the associations of self-reported positive emotions, fear, sadness, and anger to depression and anxiety, while testing the interaction of gender with emotional response. Compared with men, women reported significantly higher depressive and anxiety symptoms and greater reactivity to sadness and fear. Emotional response variables explained 35.5% of the variance in depression and 38.7% in anxiety. Gender did not moderate the relationship between emotional response and depression; however, gender did moderate the relationship between reactivity to positive emotions and anxiety. Self-reported emotional response may provide clinicians with insight into the severity and presentation of co-occurring anxiety and depressive symptoms among adults with SMI. Increasing the experience of positive emotions among women with SMI may contribute to reduced anxiety symptoms. Therapists and rehabilitation counselors may consider the interplay between mood and anxiety symptoms and emotional response styles to reduce the burden of psychiatric distress among people with SMI.

Co-Occurring Psychopathology Moderates Social Skills Improvement in a Randomized Controlled Trial of a Collaborative School-Home Intervention for Children with ADHD

ABSTRACT Objective Children with ADHD often exhibit marked impairment in their social skills, but evidence-based psychosocial interventions for ADHD have shown limited efficacy in remediating these deficits. Co-occurring psychopathology exacerbates social deficits in children with ADHD and is a plausible moderator of treatment response. To identify factors contributing to variable social skills treatment response, we examined co-occurring externalizing, depression, and anxiety symptoms as moderators of social skills outcomes in a randomized controlled trial of the Collaborative Life Skills (CLS) program, an evidence-based collaborative school-home ADHD intervention. Method Participants were 159 children with ADHD (M age = 8.35 years, 28.3% female) at 27 schools in an urban public school district. Twenty-three schools were randomly assigned to CLS or usual services, with an additional four schools assigned to Spanish-adapted CLS or usual services. Multi-informant measures of co-occurring psychopathology and social skills were collected at baseline and post-treatment. Results Parent-rated externalizing and depression symptoms moderated treatment effects on social skills, whereby higher symptomatology in each domain was unrelated to social skills improvement in the CLS group but predicted worsening social skills in response to usual services. In contrast, teacher-rated anxiety moderated treatment effects on social skills, whereby higher anxiety predicted greater social skills improvement in response to CLS but was unrelated to social skills outcomes following usual services. Conclusions Findings reflect novel evidence that child psychopathology domains exhibit unique moderating effects on social skills treatment response in children with ADHD. We discuss implications for optimizing evidence-based interventions to target social impairment in this population.

Emotionally valenced stimuli impact response inhibition in those with substance use disorder and co-occurring anxiety and depression symptoms

BackgroundSubstance use disorder (SUD) is associated with impaired response inhibition. Given the deficits in emotion regulation associated with SUD, it is unclear if this impairment is exacerbated by emotionally valenced stimuli. Co-occurring conditions may further exacerbate these impairments as many co-occurring conditions further impact emotion regulation. It was hypothesized that negative stimuli may further impact response inhibition for this population. MethodsThe current study used the stop-signal task to examine response inhibition to negative, neutral and positive stimuli in a sample of those with a history of SUD and co-occurring depression and anxiety symptoms. ResultsResponse inhibition was poorer for negative stimuli relative to neutral stimuli. There was no difference between negative and positive stimuli. Depression severity moderated the difference between response inhibition for negative and neutral stimuli. At elevated depression, response inhibition was worse and there was no difference across emotional stimuli. At low depression, there was a significant difference between negative and neutral stimuli. This effect was not found for anxiety symptoms. LimitationsStudy participants presented with polysubstance use of varying duration and amount. It is unclear whether findings are attributed to specific substances, or substance use broadly. Additionally, happy, angry, and calm facial emotions were used to represent positive, negative, and neutral valences respectively. It is unclear whether these findings are generalizable to other emotional expressions. ConclusionResults suggested that emotionally valenced stimuli affected response inhibition among those with low symptom severity. At elevated symptom severity, response inhibition to all stimuli were impaired.

School Inclusion in Children and Adolescents with Autism Spectrum Disorders in France: Report from the ELENA French Cohort Study.

Children and adolescents with ASD are increasingly included in regular school settings, however little is known about how placement decisions are made. In the present study, we examined the types and duration of school attendance among children and adolescents in the ELENA Cohort, a multi-center study of children and adolescents with ASD, ages 2-16years, in France. Results showed that 88% of subjects were attending school and that children and adolescents with more severe adaptive and cognitive deficits were less likely to attend school. The results provide a topography on school inclusion and ASD in France. Challenging behaviors and sensory processing difficulties were associated with partial-inclusion; and co-occurring anxiety symptoms were associated with inclusion on a full-time basis.

Association of the cumulative burden of late-life anxiety and depressive symptoms with functional impairment.

This study investigates the association of the cumulative burden of anxiety-only, depression-only, and comorbid anxiety and depression symptoms with (a) incident self-care or household activities impairment among those with no baseline self-care or household activities impairment, respectively, or (b) change in status of self-care or household activities impairment among those with baseline impairment. This study consists of participants (N = 4619) from the National Health and Aging Trends Study, a longitudinal study that examines a nationally representative sample of US adults aged 65 years and older. Outcomes included incident or change in self-care or household activity impairment. Primary independent variables were yearly counts of screening positive for clinically significant symptoms for anxiety-only, depression-only, or co-occurring anxiety and depression. Multivariable logistic regression models examined incident impairment and change in impairment status. Yearly counts of anxiety-only symptoms were associated with incident impairment in self-care and household activities and less improvement in self-care functioning. Yearly counts of depression-only symptoms were associated with incident impairment in self-care and household activities. Yearly counts of co-occurring symptoms of anxiety and depression were associated with incident impairment in self-care and household activities, less improvement in self-care activities, and worsening impairment in household activities. This study finds that the cumulative burden of co-occurring anxiety and depression symptoms is associated with incident impairment in functioning, persistent self-care impairment, and deterioration in household activity impairment. These findings emphasize the importance of managing late-life anxiety and depressive symptoms, which are treatable, frequently co-occur, and contribute to disability.

What is at the core of OCD? A network analysis of selected obsessive-compulsive symptoms and beliefs

BackgroundObsessive-compulsive disorder (OCD) is a heterogeneous condition that consists of distinct subtypes, and identification of its core symptoms may inform how to best conceptualize the heterogeneity. Accordingly, we used network analysis to evaluate which symptoms (and associations between symptoms) are most central to OCD symptoms and beliefs. MethodsParticipants consisted of a combined sample of adults with a primary diagnosis of OCD (N = 150), those with other primary diagnoses (N = 114), and an unselected nonclinical sample (N = 310). Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) assessed by the Obsessive-Compulsive Inventory-Revised and the Obsessional Beliefs Questionnaire-44. ResultsThe most central symptoms in the network were negative appraisals of intrusive thoughts (i.e., Having intrusive thoughts means I'm out of control). Some of the strongest associations between symptoms were also observed for those pertaining to intrusive thoughts and their negative appraisal. Furthermore, central symptoms in the network predicted depression and anxiety (over and above peripheral symptoms) among those with a primary diagnosis of OCD, but not the severity of OCD symptoms. LimitationsThe approach was exploratory rather than experimental and relied solely on self-report measures of OCD symptoms and beliefs. ConclusionsNegative appraisals of intrusive thoughts were the most central symptoms in the OCD network, and they uniquely predict co-occurring symptoms of anxiety and depression, suggesting that these symptoms should be prioritized in theoretical and treatment models of OCD.