Course Of Anxiety Symptoms Research Articles

The trajectory of anxiety symptoms during the transition from childhood to young adulthood is predicted by IQ and sex, but not polygenic risk scores

AbstractBackgroundUnderstanding the factors that determine distinct courses of anxiety symptoms throughout development will better guide interventions. There are scarce data‐driven longitudinal studies, using multi‐modal predictors, investigating the chronicity of anxiety symptoms from childhood to young adulthood, particularly in a middle‐income country.Methods2033 youths (ages 6–14 years [Mean age = 10.4 ± 1.94) at Baseline] were enrolled in the Brazilian High‐Risk Cohort for Mental Conditions longitudinal study, and assessed at three timepoints, between 2010 and 2019, using the Screen for Child Anxiety Related Disorders. Confirmatory Factor Analysis provided input to Growth Mixture Models to identify the best fitting trajectory model. Multinomial logistic regression analyses tested the effects of intelligence quotient (IQ), environmental factors and polygenic risk scores on internalizing symptomatology within trajectory class membership.ResultsThe best model solution identified three classes: high‐decreasing, moderate/low‐stable and low‐increasing symptoms over time. The high‐decreasing class showed a higher incidence of anxiety symptoms at the second time point (Mean age = 13.8 ± 1.93); while anxiety symptoms were highest in the low‐increasing class at the third timepoint (Mean age = 18.35 ± 2.03). Further, lower IQ predicted membership in the high‐decreasing trajectory class (OR = 0.68, 95% CI [0.55, 0.85]), while higher IQ predicted membership in the low‐increasing trajectory class (OR = 1.95, 95% CI [1.42, 2.67]). Finally, females were more likely than males to be in the low‐increasing trajectory class. Polygenic risk scores were not associated with anxiety trajectory class membership.ConclusionRecognizing that anxiety symptoms follow diverse paths over time will allow for more effective intervention strategies. Specifically, interventions could accommodate children for greater anxiety risk in early childhood (i.e., lower IQ) versus late adolescence (i.e., higher IQ). That said, the emotional needs of girls in late adolescence should be monitored, regardless of their cognitive abilities or high achievements.

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.

Basal and LPS-stimulated inflammatory markers and the course of anxiety symptoms

A cross-sectional relationship between low-grade inflammation –characterized by increased blood levels of C-reactive protein (CRP) and pro-inflammatory cytokines– and anxiety has been reported, but the potential longitudinal relationship has been less well studied. We aimed to examine whether basal and lipopolysaccharide (LPS-)induced levels of inflammatory markers are associated with anxiety symptom severity over the course of nine years.We tested the association between basal and LPS-induced inflammatory markers with anxiety symptoms (measured with the Beck’s Anxiety Inventory; BAI, Fear Questionnaire; FQ and Penn’s State Worry Questionnaire; PSWQ) at 5 assessment waves over a period up nine years. We used multivariate-adjusted mixed models in up to 2867 participants of the Netherlands Study of Depression and Anxiety (NESDA).At baseline, 43.6% of the participants had a current anxiety disorder, of which social phobia (18.5%) was most prevalent. Our results demonstrated that baseline inflammatory markers were significantly associated with several outcomes of anxiety at baseline over nine subsequent years. BAI subscale of somatic (arousal) symptoms of anxiety, and FQ subscale of agoraphobia demonstrated the strongest effects with standardized beta-coefficients of up to 0.14. The associations were attenuated by 25%-30% after adjusting for the presence of (comorbid) major depressive disorder (MDD), but remained statistically significant.In conclusion, we found that participants with high levels of inflammatory markers have on average high levels of anxiety consisting of physical arousal and agoraphobia, which tended to persist over a period of nine years, albeit with small effect sizes. These associations were partly driven by co-morbid depression.

Anxiety in Late-Life Depression: Determinants of the Course of Anxiety and Complete Remission

ObjectiveStudies on the course of depression often ignore comorbid anxiety disorders or anxiety symptoms. We explored predictors of complete remission (no depression nor anxiety diagnoses at follow-up) and of the course of comorbid anxiety symptoms. We additionally tested the hypothesis that the course of anxiety disorders and symptoms in depressed patients is explained by negative life-events in the presence of high neuroticism or a low sense of mastery. MethodsAn observational study of 270 patients (≥60 years) diagnosed with major depressive disorder and 2-year follow-up data, who participated in the Netherlands Study of Depression in Older persons (NESDO). Sociodemographic, somatic, psychiatric, and treatment variables were first explored as possible predictors. A multiple logistic regression analysis was used to examine their predictive value concerning complete remission. Subsequently, negative life-events, personality and their interaction were tested as potential predictors. Linear Mixed Models were used to assess whether the personality traits modified the effect of early and recent life-events, and time and their interactions on the course of the anxiety symptoms. ResultsA total of 135 of 270 patients achieved complete remission. Depressed patients with a comorbid anxiety disorder at baseline less often achieved complete remission: 38 of 103 (37.0%) versus 97 of 167 (58.1%). The severity of depressive and anxiety symptomatology, the presence of a comorbid anxiety disorder, and a poorer physical health at baseline predicted nonremission. In line with our hypothesis, a less favorable course of self-reported anxiety symptoms was associated with more recent negative life-events, but only among patients with a high level of neuroticism or a low level of mastery. ConclusionComorbid anxiety in depression as a negative impact on complete remission at 2-year follow-up. The course of anxiety severity seems dependent on the interaction of personality traits and life-events.

Longitudinal Course of Depressive, Anxiety, and Posttraumatic Stress Disorder Symptoms After Heart Surgery: A Meta-Analysis of 94 Studies.

This study aimed to analyze the longitudinal course of depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in patients with cardiac disease after heart surgery (HS). We conducted a systematic review and random-effects meta-analysis of cohort studies in patients undergoing HS, measuring anxiety, depressive, and PTSD symptoms before and at least 30 days thereafter. Subgroup and meta-regression analyses, investigation of publication bias, and quality assessment were undertaken. We included 94 studies relating to 15,561 patients. HS included coronary artery bypass graft surgery, valve replacement, implantable cardioverter-defibrillator placement, left ventricular assist device placement, heart transplantation, and other types of HS. Across studies, symptoms of depression (g = 0.32; 95% confidence interval [CI] = 0.25 to 0.39; p < .001) and anxiety improved after HS (g = 0.52; 95% CI = 0.43 to 0.62; p < .001), whereas PTSD symptoms worsened (g = -0.42; 95% CI = -0.80 to -0.04; p = .032). The reduction of depression and anxiety levels was more pronounced for patients with underlying coronary artery disease and heart failure and persisted for 1 year after HS, whereas the increase in PTSD symptoms returned to baseline after 6 months. Depression improvement was inversely associated with older age, diabetes, hypertension, and dyslipidemia and positively with baseline heart failure. No additional clinical or demographic variables were associated with the course of anxiety symptoms. Quality of included studies was low overall. Publication bias was nonsignificant. Depressive and anxiety symptoms improve for 1 year after HS, whereas PTSD symptoms might worsen. Older patients and those with metabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.

Effects of a transdiagnostic cognitive behaviour therapy-based programme on the natural course of anxiety symptoms in adolescence

BackgroundAnxiety disorders frequently have an onset during adolescence, which when left untreated could lead to a chronic course and outcome. This study aimed to examine the way in which a cognitive behaviour therapy-based programme (Super Skills for Life – adolescent version; SSL-A) could change the course of anxiety symptoms through adolescent's behavioural performance and cardiac function. MethodSixty-one adolescents at risk of developing an anxiety disorder (45.30% boys; M = 13.76 years, SD = 0.32) were randomly assigned to either an intervention (IG), placebo (PG), or a waitlist group (WG). Adolescents in the IG participated in SSL-A over an 8-week period. Adolescents in the PG participated in an 8-session school-work programme. Adolescents in the WG did not receive any intervention. Anxiety symptoms were assessed every six months, twice before the intervention, as well as at the post-intervention and six months after the intervention. Participants in the IG additionally underwent a stressful task to assess behavioural performance and cardiac adjustment. ResultsAdolescents in the IG significantly reported lower levels of social phobia and generalised anxiety symptoms at the follow-up assessment compared to the adolescents in the PG and the WG. They also showed a significant improvement in vocal quality and lower discomfort during a stressful task at post-intervention, and showed attenuated cardiac recovery indexes, in terms of sample entropy. LimitationsThe study has a small sample size. ConclusionSSL-A changed the natural course of anxiety symptoms, as shown by a significant reduction in social phobia and generalised anxiety symptoms, and a significant improvement in behaviour and physiological (cardiac) function during a stressful situation.

Trajectories of anxiety symptoms and associations with incident cardiovascular disease in adults with type 2 diabetes

BackgroundTrajectories of anxiety symptoms in people with type 2 diabetes (T2D) and their associations with diabetes health outcomes have not been investigated. This study examined latent longitudinal trajectories of anxiety symptoms in adults with T2D and their associations with incident cardiovascular disease (CVD). MethodsData were from the Evaluation of Diabetes Treatment Study, a community-based cohort study of adults aged 40–76years with T2D. Anxiety and CVD were assessed by self-report at baseline and at four annual follow-up assessments. N=832 participants without cardiovascular disease at baseline and 12-month follow-up were included in the present study. Group-based trajectories of anxiety at baseline, 12-month follow-up, and 24-month follow-up were modelled using latent class growth modeling. Associations between anxiety trajectories and CVD reported at 24-, 36-, or 48-month follow-ups were examined with logistic regression analysis adjusted for sociodemographic and lifestyle characteristics. ResultsFour distinct anxiety trajectories were identified, reflecting chronically low (39.4%), chronically moderate-low (47.4%), chronically moderate-high (11.1%), and chronically high (2.2%) anxiety. The likelihood of CVD was greater for the chronically moderate-low (OR=2.23, 95% CI=1.36–3.66), chronically moderate-high (OR=3.05, 95% CI=1.54–6.02), and chronically high (OR=3.61, 95% CI=1.09–12.00) anxiety trajectory groups compared to the chronically low anxiety group. ConclusionThe identified latent trajectories reflected three groups with chronic courses of anxiety symptoms at different levels of severity and one group with chronically low levels of anxiety. Chronic anxiety, even at subthreshold levels, was associated with an increased risk of CVD among people with T2D.

The natural course of anxiety symptoms in early adolescence: factors related to persistence

ABSTRACTBackground and objectives: Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases.Design: Prospective cohort study.Methods: Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n = 562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases.Results: Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence.Conclusions: The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.

Worry and cognitive control predict course trajectories of anxiety in older adults with late-life depression

BackgroundMany older adults with depressive disorder manifest anxious distress. This longitudinal study examines the predictive value of worry as a maladaptive cognitive emotion regulation strategy, and resources necessary for successful emotion regulation (i.e., cognitive control and resting heart rate variability [HRV]) for the course of anxiety symptoms in depressed older adults. Moreover, it examines whether these emotion regulation variables moderate the impact of negative life events on severity of anxiety symptoms. MethodsData of 378 depressed older adults (CIDI) between 60 and 93 years (of whom 144 [41%] had a comorbid anxiety disorder) from the Netherlands Study of Depression in Older Adults (NESDO) were used. Latent Growth Mixture Modeling was used to identify different course trajectories of six-months BAI scores. Univariable and multivariable longitudinal associations of worry, cognitive control and HRV with symptom course trajectories were assessed. ResultsWe identified a course trajectory with low and improving symptoms (57.9%), a course trajectory with moderate and persistent symptoms (33.5%), and a course trajectory with severe and persistent anxiety symptoms (8.6%). Higher levels of worry and lower levels of cognitive control predicted persistent and severe levels of anxiety symptoms independent of presence of anxiety disorder. However, worry, cognitive control and HRV did not moderate the impact of negative life events on anxiety severity. ConclusionsWorry may be an important and malleable risk factor for persistence of anxiety symptoms in depressed older adults. Given the high prevalence of anxious depression in older adults, modifying worry may constitute a viable venue for alleviating anxiety levels.

Anxiety trajectories in the second half of life: Genetic and environmental contributions over age.

Clinically significant anxiety symptoms are prevalent among the elderly, yet knowledge about the longitudinal course of anxiety symptoms in later life remains scarce. The goals of this study were to (a) characterize age trajectories of state anxiety symptoms in the second half of life, and (b) estimate genetic and environmental contributions to individual differences in the age trajectory of state anxiety. This study was based on data from 1,482 participants in the Swedish Adoption/Twin Study of Aging who were aged 50 and older at their first occasion (512 complete twin pairs, 458 singletons) and had up to 6 measurement occasions spanning 11 years. Consistent with life span developmental theories of age-related emotional change, anxiety symptom levels declined during the transition from midlife to the mid-60s, followed by a mild increase that gradually plateaued in the 80s. There were substantial individual differences in the age trajectory of anxiety. After accounting for effects of sex, cohort, mode of testing, and proximity to death, this longitudinal variation was partitioned into biometric sources. Nonshared environmental variance was highest in the late 60s and declined thereafter, whereas genetic variance increased at an accelerated pace from approximately age 60 onward. There was no evidence for effects of rearing or other shared environment on anxiety symptoms in later life. These findings highlight how the etiology of anxiety symptoms changes from midlife to old age.

Persistent and fluctuating anxiety levels in the 18 months following acute myocardial infarction: the role of personality

ObjectiveTo identify the varying courses of anxiety symptoms in the first 18 months after a myocardial infarction (MI) and to examine the importance of personality in determining elevated anxiety. MethodsFour hundred eighty-six MI patients completed the State-Trait Anxiety Inventory during hospitalization and at 2-, 12- and 18-months post-MI. At baseline, patients also completed the DS14 Type D personality scale, Anxiety Sensitivity Index and Beck Depression Inventory, and clinical and sociodemographic information was collected. ResultsGrowth mixture modeling analysis identified four anxiety trajectories. The majority of patients reported stable anxiety scores over time, indicative of either persistent high (17%) or low (71%) anxiety. Patients in the other two smaller groups initially reported moderate levels of anxiety that fluctuated during follow-up. Type D personality [odds ratio (OR)=5.34; 95% confidence interval (CI): 2.26–12.63], negative affectivity (OR=3.24; 95% CI: 1.29–8.14) and anxiety sensitivity (OR=3.35; 95% CI: 1.69–6.62) were the most prominent determinants of persistent high anxiety, independent of depression, sociodemographic and clinical factors. ConclusionsThe course of anxiety in the first 18 months after MI is relatively stable for the majority of patients. Patients with Type D personality, negative affectivity and anxiety sensitivity are at an increased risk for persisting elevated anxiety and should be identified and offered appropriate treatment.

The developmental course of anxiety symptoms during adolescence: the TRAILS study

Little is known about the development of anxiety symptoms from late childhood to late adolescence. The present study determined developmental trajectories of symptoms of separation anxiety disorder (SAD), social phobia (SoPh), generalized anxiety disorder (GAD), panic disorder (PD), and obsessive-compulsive disorder (OCD) in a large prospective community cohort. Anxiety symptoms were assessed in a community sample of 2220 boys and girls at three time-points across a 5-year interval. The Revised Child Anxiety and Depression Scale (RCADS) was used to assess anxiety symptoms, and multilevel growth-curve analyses were performed. All subtypes of anxiety first showed a decrease in symptoms (beta for age ranged from -.05 to -.13, p < .0001), followed by a leveling off of the decrease, and a subsequent slight increase in symptoms (beta for age-squared ranged from .006 to .01, p < .0001) from middle adolescence (GAD, SoPh, SAD) or late adolescence (PD and OCD) onwards. This increase in anxiety symptoms could not be explained by a co-occurring increase in depression symptoms. Girls had more anxiety symptoms than boys, and this difference remained stable during adolescence (p < .0001). Gender differences were strongly attenuated by adjustment for symptoms of depression. The current study shows that, in the general population, anxiety symptoms first decrease during early adolescence, and subsequently increase from middle to late adolescence. These findings extend our knowledge on the developmental course of anxiety symptoms during adolescence. This is the first study to separate the development of anxiety symptoms from that of symptoms of depression.

Course of Anxiety Symptoms Over an 18-Month Period in Exhausted Patients Post Percutaneous Coronary Intervention

Anxiety is a neglected risk factor in coronary artery disease. We examined the different courses of anxiety over an 18-month period in patients post percutaneous coronary prevention (PCI) and the predictors of group membership of these courses. Consecutive exhausted PCI patients (n = 638), participating in the EXhaustion Intervention Trial (EXIT), were assessed for depression at baseline using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and for symptoms of anxiety at baseline, 6, and 18 months using the State Trait Anxiety Inventory (state only). SAS procedure TRAJ was used to examine courses of anxiety symptoms over an 18-month period. Five trajectories were identified: nonanxious (13.2%), mildly anxious (39.7%), decreasingly anxious (11.6%), moderately anxious (29.3%), and severely anxious (6.3%), with four of them being stable over 18 months. Multinomial logistic regression analyses showed that angina pectoris, major depression, the use of anxiolytics, and low educational level distinguished moderate-to-severe anxious patients from nonanxious. The absence of angina and major depression and not using diuretics explained the decreasing trend in anxiety in one of the trajectories. Anxiety trajectories varied across patients, with four of five being stable over 18 months. In clinical practice, knowledge of these trajectories and their determinants may help identify distinct groups of patients with potentially differential risks of adverse health outcomes.

The development and maintenance of anxiety symptoms from infancy through adolescence in a longitudinal sample

This study examined the etiology and course of anxiety symptoms from infancy through adolescence in a longitudinal high-risk community sample. One hundred fifty-five subjects were assessed using a variety of observational, projective, and objective measures. Results of path analyses revealed the following: (a) anxiety symptoms showed moderate stability during childhood and adolescence; (b) heightened neonatal biobehavioral reactivity and poor regulation predicted emotion regulation difficulties in preschool, which predicted anxiety symptoms in childhood; (c) developmental incompetence in childhood predicted anxiety symptoms in preadolescence, and anxiety symptoms in preadolescence predicted incompetence in adolescence; (d) insecure attachment relationships in infancy predicted negative peer relationship representations in preadolescence, and these representations predicted anxiety symptoms in adolescence; (e) compared to males, females showed similar rates of anxiety symptoms in childhood but greater and more stable rates in adolescence; however, males and females showed similar patterns of association between risk factors and anxiety symptoms across childhood and adolescence; and (f) the model tested was specific in predicting anxiety symptoms and not psychopathology in general. The results support a developmental model of the etiology and maintenance of anxiety symptoms in childhood and highlight factors to consider in efforts to prevent and treat childhood anxiety.