Generalized Anxiety Research Articles

The combined effects of depression or anxiety with high-sensitivity C-reactive protein in predicting the prognosis of coronary heart disease patients

BackgroundDepression, anxiety and high-sensitivity C-reactive protein (hs-CRP) are individually associated with poor prognosis in patients with coronary heart disease (CHD). However, the combined effects of depression with inflammation or anxiety with inflammation on the prognosis have been rarely explored.MethodsThis prospective cohort study included 414 patients diagnosed with CHD. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. A score ≥ 5 points was defined as elevated depression or anxiety. High hs-CRP was defined as ≥ 3 mg/L. Follow-up was performed 2 years after the patients were discharged. The clinical results included noncardiac readmission, cardiac readmission, major cardiovascular events (MACEs), and composite events. The composite events included noncardiac readmission and MACEs. The Cox proportional hazard regression model was used to analyze the prognostic risk.ResultsAfter full adjustment, patients with elevated depression and high hs-CRP had a higher risk in predicting noncardiac readmission (hazard ratio (HR) = 3.87, 95% confidence interval (CI) = 1.10–9.02, p = 0.002) and composite events (HR = 1.93, 95% CI = 1.13–3.30, p = 0.016) than those with high hs-CRP alone. For the anxiety and hs-CRP group, high hs-CRP alone predicted a higher risk of noncardiac readmission (HR = 3.32, 95% CI = 1.57–7.03, p = 0.002) and composite events (HR = 1.75, 95% CI = 1.12–2.76, p = 0.015) than references. Elevated anxiety had no significant effects on all the endpoints. Furthermore, we didn’t find interactions between depression and hs-CRP or anxiety and hs-CRP.ConclusionIn patients with CHD, elevated depression with high hs-CRP was found to be significant in predicting the risk of noncardiac readmission and composite events. Early diagnosis and treatment of depression with inflammation are necessary in CHD patients.

Network analysis of resilience, anxiety and depression in clinical nurses

BackgroundResilience is a protective feature against anxiety and depression disorders. However, the precise relationship and structure of resilience and anxiety and depression remain poorly understood. This study sought to investigate the link among resilience’ components and anxiety as well as depression.Methods1,279 clinical nurses were recruited. 10-item Connor-Davidson Resilience Scale, Generalized Anxiety Disorder 7, and Patient Health Questionnaire 9 were employed to evaluate resilience, anxiety, and depression, respectively. The regularized partial-correlation network was generated utilizing data from cross-sectional survey and the bridge expected influence index was utilized to quantify bridge components.ResultsThe rates of anxiety and depression within clinical nurses were 67.3% and 67.2%, accordingly. Four strongest bridge edges appeared in the resilience-anxiety network, like “Adapt to change”- “Fear that something might happen”, and “Stay focused under pressure”- “Uncontrollable worry”. Two strongest bridge edges appeared in the resilience-depression network, like “Adapt to change”- “Concentration difficulties” and “Stay focused under pressure”- “Fatigue”. “Adapt to change” was recognized as bridging nodes in both the resilience-anxiety network and the resilience-depression network.ConclusionsInterventions targeting the bridge component “Adapt to change” within resilience, may mitigate the intensity of anxiety and depression symptoms among clinical nurses.

Improving Workplace Well-being in Modern Organizations: A Review of Large Language Model-based Mental Health Chatbots

The global rise in mental disorders, particularly in workplaces, necessitated innovative and scalable solutions for delivering therapy. Large Language Model (LLM)-based mental health chatbots have rapidly emerged as a promising tool for overcoming the time, cost, and accessibility constraints often associated with traditional mental health therapy. However, LLM-based mental health chatbots are in their nascency, with significant opportunities to enhance their capabilities to operate within organizational contexts. To this end, this research seeks to examine the role and development of LLMs in mental health chatbots over the past half-decade. Through our review, we identified over 50 mental health-related chatbots, including 22 LLM-based models targeting general mental health, depression, anxiety, stress, and suicide ideation. These chatbots are primarily used for emotional support and guidance but often lack capabilities specifically designed for workplace mental health, where such issues are increasingly prevalent. The review covers their development, applications, evaluation, ethical concerns, integration with traditional services, LLM-as-a-service, and various other business implications in organizational settings. We provide a research illustration of how LLM-based approaches could overcome the identified limitations and also offer a system that could help facilitate systematic evaluation of LLM-based mental health chatbots. We offer suggestions for future research tailored to workplace mental health needs.

Validation of a brief image elicitation task as an indicator of subjective wellbeing in the general population

BackgroundA novel image-based method (AgileBrain) demonstrates construct validity as a measure of wellbeing in the general working adult population.MethodAnalysis of data from four large nationally representative samples of American full-time workers employed by mid-to-large size companies conducted in November 2021 (n = 812), May 2022 (n = 810), June 2023 (n = 986), and January 2024 (n = 1,179).ResultsAcross all four studies, AgileBrain demonstrates convergent validity across multiple established indicators of subjective wellbeing including the Patient Health Questionnaire (PHQ-9), Center for Epidemiological Studies Depression Scale (CESD-10), Generalized Anxiety Disorder Scale (GAD-7), Neuroticism (BFI-S), UCLA Loneliness Scale, Perceived Stress Scale (PSS-10), Coping Styles (Brief COPE-28), self-reported diagnosed neurodiversity conditions and symptoms, and trauma history.ConclusionResults across these studies suggest that AgileBrain is useful as a screening tool for detecting compromised wellbeing in terms of construct validity. Given strong preferences for brief, gamified assessments, the validity advantages stemming from less consciously controllable responses, and the statistical advantages of measures associated with high response rates and normal distributions, AgileBrain emerges as strong tool for assessing subjective wellbeing at the population level and offers a promising approach to monitoring treatment effectiveness.

Psychological morbidity among coal miners compared to other occupations in Appalachia

ObjectivesDepressive symptoms, anxiety, and post-traumatic stress disorder (PTSD) are common morbidities among coal miners, but the risk of these morbidities has not been analyzed relative to other occupations taking into account relevant covariates.MethodsUsing random digit dialing, we surveyed men aged 50 or over with a history of employment who resided in counties in Appalachia with high coal workers’ pneumoconiosis (CWP) mortality rates. We used the Primary Care Post-Traumatic Stress (PTSD) Screen and the Brief Trauma Questionnaire to query specific traumatic experiences. We used the Patient Health Questionnaire scale to assess depression symptoms and the Generalized Anxiety Disorder questionnaire to measure anxiety. Multivariable logistic regression analyzed associations between coal mining and depression, anxiety, and PTSD, adjusting for trauma, smoking and demographics.ResultsOf 1,428 participants, 233 (16.3%) reported coal mining employment. Coal mining was associated with increased odds of depression (OR 1.6; 95% CI 1.1 to 2.4) and anxiety (OR 1.7; 95% CI 1.1 to 2.7). Among those with any trauma (n = 711), coal mining was not associated with increased risk of PTSD (OR 0.80; 95% CI 0.5 to 1.3]. Non-coal trauma was associated with three-fold increased odds of anxiety (OR 3.2; 95% CI 2.0 to 5.1); for coal trauma, anxiety was associated with six-fold increased odds (OR 6.0; 95% CI 2.9 to 12.4).ConclusionsAppalachian region coal miners carry an increased burden of depression and anxiety. This should be recognized by clinicians and at a population level, as worthy of individual and public health intervention.

The impact of immersive virtual reality meditation for depression and anxiety among inpatients with major depressive and generalized anxiety disorders

BackgroundMindfulness-Based Cognitive Therapy (MBCT) is a non-pharmacological approach to alleviating depression and anxiety. While technology based MBCT is a standardized cost-effective approach, there have been concerns about its feasibility and effectiveness in clinical settings.AimsThe purpose of this study was to investigate the longitudinal relationship between improved emotional regulation resulting from participation in Immersive Virtual Reality Meditation (IVRM) and Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) as monitored by electrocardiogram.MethodsThis study was a longitudinal single-arm clinical trial in which the intervention was conducted three times a week for 10 weeks at a behavioral health unit in a community hospital (n = 26). We measured Coherence Achievement Score (CAS), depression, and anxiety. The relationships between CAS, anxiety, depression, and covariates were analyzed using a Generalized Estimated Equation (GEE).ResultsThe findings of our study provide evidence that the CAS scores indicative of emotional regulation function after IVRM participation were associated with a reduction in depression and anxiety.ConclusionAmong the many technology-based complementary health care interventions that are available to reduce depression and anxiety, IVRM program use increases emotional regulatory function and decrease depression and anxiety.

Childhood trauma impacts internalizing problems in early adulthood: the affective implications of olfactory dysfunctions

Early detection and prevention of internalizing problems demand a thorough exploration of latent vulnerabilities before clinical symptoms emerge. Limited research attention has been paid to the influence of olfactory perception, a flexible factor intricately linked to emotional processing and external environmental factors. This study sought to examine the mediating role of olfactory function in the relationship between childhood trauma, encompassing both dimensions of child abuse and neglect, and internalizing problems. A total of 1661 individuals (801 males, Meanage = 21.67 years) participated in wave 1, with 327 participants (152 males, Meanage = 21.8 1 years) included in the follow-up wave 2 three months later. Online questionnaires, including the Childhood Trauma Questionnaire, Self-reported Olfactory Disorder Questionnaire, Beck Depression Inventory, and General Anxiety Disorder-7, were administered. Mediation tests were conducted using Mplus 8. Our findings revealed a significant mediating effect of olfactory dysfunction between childhood trauma and adult internalizing problems in wave 1 (B = 0.224, 95% CI [0.167, 0.294]). Childhood trauma heightened vulnerability to olfactory dysfunction (B = 0.721, 95% CI [0.671, 0.724]), subsequently exacerbating internalizing problems (B = 0.311, 95% CI [0.226, 0.408]). This effect persisted in longitudinal data (abuse: B = 0.686, p < 0.001; neglect: B = 0.200, p < 0.001). Regarding internalizing problems influenced by olfactory function, childhood abuse had a greater impact compared to childhood neglect (wave 1: χ2 = 56.012, p < 0.001; wave 2: χ2 = 5.156, p = 0.023). This study found that olfactory dysfunction mediated the relationship between childhood trauma and internalizing problems, contributing valuable insights into psychopathology and the early identification of symptoms related to internalizing problems.

Psychiatric Health, Life Skills, and Opportunities for Wellness Program: Addressing psychiatric need through integrated consultation, collaboration, and brief episodes of care.

Integrated behavioral health programs bring strong benefits to patients and health organizations including reductions in overall costs. However, obstacles to funding prevent the implementation and maintenance of these programs across the country. The Psychiatric Health, Life Skills and Opportunities for Wellness (PHLOW) Program is based on the collaborative care model and seeks to provide psychiatric care through an integrated model that is financially sustainable for the organization. This pilot observational study included patients who received psychiatric care indirectly via consultations with primary care providers and directly through brief episodes of care. Patient outcomes were demonstrated by score changes on the nine-item Patient Health Questionnaire and Generalized Anxiety Disorder 7 before and after participation in brief episodes of care. Overall cost of care savings was demonstrated through change over time in risk-adjusted per-member-per-month. Patients participating in the PHLOW program showed potential drops in anxiety and depression ratings, coinciding with a reduction in mental health claims. In addition, participation in the program involved a small number of patient visits and prevented referrals to long-term psychiatry, preserving access for higher acuity presentations. This demonstration of the value of the PHLOW program has led to additional financial support of the program through the primary regional Medicaid payor, enhancing sustainability, and potentially modeling a collaboration that may be feasible for other organizations implementing integrated behavioral health programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploding Head Syndrome among Patients Seeking Help for Tinnitus and/or Hyperacusis at an Audiology Department in the UK: A Preliminary Study.

Exploding head syndrome (EHS) is characterized by hearing a sudden loud noise or experiencing a sense of explosion in head during the transition of sleep-wake or wake-sleep. The experience of EHS shares similarities with tinnitus, where an individual perceives a sound without any external sound source. To the authors' knowledge, the possible relationship between EHS and tinnitus has not been explored. Preliminary assessment of prevalence of EHS and its related factors among patients seeking help for tinnitus and/or hyperacusis. Retrospective cross-sectional study. A total of 148 consecutive patients who sought help for tinnitus and/or hyperacusis at an audiology clinic in the United Kingdom. The data regarding demographics, medical history, audiological measures, and self-report questionnaires were collected retrospectively from the patients' records. Audiological measures comprised of pure-tone audiometry and uncomfortable loudness levels. The self-report questionnaires which were administered as a part of standard care comprised of the Tinnitus Handicap Inventory, numeric rating scale of tinnitus loudness, annoyance, and effect on life, hyperacusis questionnaire, Insomnia Severity Index, Generalized Anxiety Disorder scale 7, and Patient Health Questionnaire (PHQ-9). To establish presence of EHS, participants were asked "Do you ever hear a sudden, loud noise, or feel a sense of explosion in your head at night?" EHS was reported by 8.1% of patients with tinnitus and/or hyperacusis (12 out of 148). The patients with and without EHS were compared, but no significant relationships were found, between the presence of EHS and age, gender, tinnitus/hyperacusis distress, symptoms of anxiety or depression, sleep difficulties, or audiological measures. The prevalence of EHS in a tinnitus and hyperacusis population is similar to that in the general population. While there does not seem to be any association with sleep or mental factors, this might be due to the limited variability in our clinical sample (i.e., most patients exhibited high level of distress regardless of EHS). Replication of the results in a larger sample with more variety of symptom severity is warranted.

The role of anxiety in the association between nutrition literacy and health-related quality of life among college students.

The health-related quality of life (HRQOL) of college students is not promising and needs to be improved through effective interventions. This study aimed to investigate the associations of nutrition literacy (NL) with HRQOL and anxiety among college students, and to identify the role of anxiety in the relationship between NL and HRQOL. The cross-sectional survey was conducted via the "Wenjuanxing" platform from September to November 2023. The Food and Nutrition Literacy Questionnaire (FNLQ), the Generalized Anxiety Disorder (GAD-7) diagnostic tool and the SF-12 scale were used to assess NL, anxiety, and HRQOL, respectively. Logistic regression models, mediation analysis, additive and multiplicative interaction analyses were used. 2066 college students participated in the analysis. After adjusting for potential confounders, we found that college students with higher NL had higher HRQOL (OR = 2.52, 95% CI: 2.09-3.03, p < 0.001) and a lower risk of anxiety (OR = 0.53, 95% CI: 0.39-0.73, p < 0.001). Additionally, anxious college students had lower HRQOL (OR = 0.16, 95% CI: 0.11-0.24, p < 0.001). Furthermore, mediation analysis confirmed that anxiety was a partial mediator of the relationship between NL and HRQOL (β = 0.600, 95% CI: 0.406-0.779/0.430-0.818). Significant additive interactions were found between NL and Anxiety (RERI = 6.96, 95% CI: 2.74-11.17; AP = 0.51, 95% CI: 0.37-0.64; SI = 2.21, 95% CI: 1.58-3.07). Higher levels of NL are associated with better HRQOL and lower anxiety among college students. Additionally, anxiety partially mediated the relationship between NL and HRQOL. Furthermore, there is a synergy between NL and anxiety.

Linking early emotional abuse/neglect with young adolescents’ social (versus general) anxiety symptoms: A developmental cascade through emotion regulation

Despite the widely documented implications of childhood emotional abuse/neglect for subsequent anxiety symptoms, the implicated mechanisms remain under-revealed, especially the various transdiagnostic and specific pathways related to early experiences of emotional abuse versus emotional neglect and different types of subsequent anxiety symptoms (social versus general). Using three-wave data from 844 Chinese adolescents (Meanage = 13.21 at Wave 1, SD = 0.39; 53 % Boys), we tested emotion regulation strategies (cognitive reappraisal and expressive suppression) as explanatory mechanisms underlying the links between childhood emotional abuse/neglect and subsequent social anxiety symptoms (SAS), while simultaneously considering general anxiety symptoms (GAS) for the identification of possible specificity. Results indicated that expressive suppression played a mediating role in the links between emotional neglect and both forms of anxiety symptoms, whereas cognitive reappraisal served as a linking mechanism only for the link between emotional neglect and GAS. No effects were identified for emotional abuse. All associations were identified after controlling for the baseline levels of anxiety symptoms, the baseline uses of emotion regulation strategies, and covariates (age, gender, and family socioeconomic status). Our findings re-confirm that emotion regulation is an important intermediate process accounting for anxiety-related sequelae of early emotional deprivation, suggesting that expressive suppression appears to be a more developmentally transdiagnostic process shaped particularly by early emotional neglect to contribute to different types of subsequent anxiety symptoms. Accordingly, educational and clinical practices on emotion regulation likely benefit the affective well-being of young adolescents whose childhood has been clouded with emotional neglect.

Depression, Anxiety, and Stress Symptoms Among Students in Croatia During the COVID-19 Pandemic: A Systematic Review.

Background: The COVID-19 pandemic has led to an increased fear of infection, social isolation, financial concerns, and feelings of loneliness and uncertainty. Studies reveal that the pandemic has had a significant negative impact on mental health. This systematic review aimed to investigate the prevalence of depression, anxiety, and stress symptoms among students in Croatia during the COVID-19 pandemic. Methods: A systematic review was conducted following PRISMA guidelines. A literature search was performed on August 5, 2024, using the electronic databases Scopus, PubMed, Web of Science, and PsycINFO. The search utilized the Boolean logical operator expression ('depression' AND 'anxiety' AND 'stress' AND 'COVID-19' AND 'Croatia' AND 'student'). Results: Out of one hundred and fifty-four identified studies, five met the inclusion criteria and were included in the review. The studies used the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Depression, Anxiety, and Stress Scale-21 (DASS-21) to assess mental health. The results indicate a high prevalence of symptoms of depression, anxiety, and stress among students in Croatia during the pandemic. Conclusion: A high prevalence of negative affective emotions was observed among students in Croatia during the pandemic. This finding underscores the importance of developing effective strategies for the early identification and management of mental disorders among students, irrespective of the pandemic's conclusion.

Restless sleep is associated with increased anxiety in physical therapy students: a cross sectional survey study

BackgroundSleep and mental health are intimately related and shown to impact graduate students enrolled in health sciences programs, including physical therapy education. Doctorate of Physical Therapy (DPT) students’ attitudes and behaviors surrounding sleep and whether these factors are associated with mental health are unknown. This study aimed to describe sleep behaviors and attitudes of entry-level DPT students and to explore the relationship between subjectively reported sleep quality and self-reported symptoms of anxiety in these students.MethodsA cross-sectional online survey consisting of the Sleep Practices and Attitudes Questionnaire (SPAQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and demographic questions were used. Analyses investigated sleep behaviors and attitudes, along with the relationship (unadjusted odds ratio) between restless sleep and anxiety in DPT students in hybrid and traditional DPT programs across the United States (US).ResultsA total of 271 DPT students completed the survey. A majority of students reported feeling tired during most days (80.8%, n = 219), a quarter of participants (24.7%) reported having a history of trouble sleeping and four (1.5%) reported being diagnosed with a sleep disorder. Of those who reported their sleep duration, participants slept an average of 6.86 h. The mean GAD-7 score was 7.68 (SD = 4.90), suggestive of mild anxiety. Sixty-seven (24.7%) reported having a diagnosed anxiety disorder, with generalized anxiety being the most common diagnosis. Those who reported having restless sleep were 4.09 times more likely to have moderate to severe anxiety [unadjusted odds ratio = 4.09 (95% CI 2.27,7.35; p < 0.001)] compared to those who reported restful sleep.ConclusionsDPT students who rated sleep as restless exhibit signs of poor subjective sleep quality associated with an increased risk of experiencing moderate to severe anxiety compared to students who had restful sleep. Students reported behaviors surrounding sleep that may contribute to anxiety. These findings have implications for including sleep and mental health education and practices within DPT programs.

A Review of Survey Instruments and Pharmacy Student Outcomes for Stress, Burnout, Depression and Anxiety.

While the need to measure burnout, stress and mental health among pharmacy students has been emphasized in the literature, there is limited information on which validated scales should be used. The objective of this scoping review was to identify published studies that used validated scales for burnout, stress and mental health among pharmacy students to provide recommendations for implementation at schools/colleges of pharmacy. Thirty-two out of 153 articles published in the United States from 1 January 2000 to 30 September 2022 were included and categorized into studies measuring stress (20), burnout (4) and depression/anxiety (8). The most common validated scales used to assess stress and burnout among pharmacy students were the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory and the Oldenburg Burnout Inventory, respectively. For mental health, anxiety was most commonly investigated using a variety of scales such as the Generalized Anxiety Disorder-7; the Patient Health Questionnaire, 9-item was used to measure depression in two studies. Validity, ease of use, cost and generalizability are important considerations for selecting a scale. The PSS has been studied extensively in pharmacy students and has been correlated with other well-being domains. Studies that measured burnout and mental health (specifically, depression and anxiety) have less published evidence among pharmacy students.

Addressing Mental Health in Rural Settings: A Narrative Review of Blueberry Supplementation as a Natural Intervention.

Depression and anxiety are major public health issues; however, there is an unmet need for novel, effective, and accessible treatments, particularly in rural communities. Blueberries are an unexplored nutraceutical for these conditions due to their excellent nutritional profile, with particularly high levels of polyphenols and anthocyanins and benefits on mood, cognition, and health. Here, we present a narrative review of the literature concerning the etiology and treatments of major depressive disorder (MDD) and generalized anxiety disorder (GAD). In both animal and human studies, blueberry supplementation can ameliorate behavioral symptoms of both anxiety and depression. The mechanistic underpinnings of these behavioral improvements are not fully defined, but likely involve biochemical alterations in the gut-brain axis, including to inflammatory cytokines, reactive oxygen species, and growth factors. We also review the limitations of traditional therapies in rural settings. Finally, we assess the potential benefit of nutraceutical interventions, particularly blueberries, as novel therapeutics for these distinct, yet related mental health issues.

Effectiveness of Combined Pulmonary Rehabilitation and Progressive Muscle Relaxation in Treating Long-Term COVID-19 Symptoms: A Randomized Controlled Trial

Background: The aim of this study was to investigate the effects of pulmonary rehabilitation (PR) and additional progressive muscle relaxation (PMR) techniques in patients with long-term COVID-19 symptoms. Methods: We included 61 patients with long COVID-19 symptoms and randomly assigned them to two groups: PR only (group 1 with 30 subjects) and PR with PMR (group 2 with 31 subjects). The PR program consisted of gradual aerobic conditioning, strength training, and breathing exercises. Group 2 received additional 20 min daily sessions of progressive muscle relaxation techniques. Results: Following a 21-day intervention, it was observed that both groups had noteworthy improvements in lung function, exercise capacity, and sleep quality with statistical significance (p &lt; 0.0001). Group 2 showed significant improvements in overall health (as measured by the General Health Questionnaire-12), patient health (as assessed by the Patient Health Questionnaire-9), general anxiety levels (as indicated by the Generalized Anxiety Disorders Scale-7), and sleep quality (as measured by the Pittsburgh Sleep Quality Index), with statistical significance (p &lt; 0.0001), compared to group 1. Moreover, the statistical analysis demonstrated no significant difference in exercise capacity improvement between group 1 and group 2, as indicated by a p-value of 0.1711. Conclusions: The addition of progressive muscle relaxation to pulmonary rehabilitation significantly enhances mental health outcomes, particularly in reducing anxiety and improving sleep quality, for patients with long-term COVID-19 symptoms. These findings suggest that incorporating PMR into PR programs offers a valuable non-pharmacological approach to improving overall patient well-being during long-term COVID-19 recovery.

Insomnia as a predictor of treatment outcomes in adolescents receiving concentrated exposure treatment for OCD

BackgroundResearch suggests that individuals with obsessive-compulsive disorder (OCD) frequently experience insomnia. Some previous studies have suggested that insomnia may predict treatment outcomes, but the evidence is limited, especially for adolescents. This study examined the prevalence of insomnia in an adolescent OCD patient sample, explored the correlation between OCD and insomnia, and tested whether levels of insomnia at baseline predict outcomes for adolescent patients receiving the Bergen 4-Day Treatment (B4DT) for OCD.MethodsForty-three adolescent OCD patients who received B4DT were selected for this study. Treatment outcome was quantified as change in Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores across time from pre- to posttreatment and 3-month follow-up. Insomnia symptoms were measured by the Bergen Insomnia Scale (BIS). Linear mixed models were used to examine the relationship between the BIS and changes in CY-BOCS scores. We controlled for symptoms of general anxiety disorder measured by the GAD-7 and depression symptoms measured by the PHQ-9.ResultsIn this sample, 68.4% of the patients scored above the cutoff for insomnia on the BIS. There was a moderate correlation between baseline CY-BOCS and BIS that did not reach statistical significance (r = .32, p = .051). High BIS scores before treatment were significantly associated with poorer treatment outcomes, as measured by changes in CY-BOCS over time (p = .002). The association between baseline insomnia and change in OCD symptoms remained significant (p = .033) while controlling for GAD-7 and PHQ-9.ConclusionInsomnia is common among adolescents with OCD, and these data suggest that these patients may be at increased risk for poor treatment outcomes. Future research to explore mechanisms and adjunctive treatments is warranted.Trial registrationThe study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord: 2023/606482).

Clinical Effects of Asynchronous Provider-Guided Practice Sessions During Blended Care Therapy for Anxiety and Depression: Pragmatic Retrospective Cohort Study.

Blended care therapy models are intended to increase the efficiency and effectiveness of evidence-based psychotherapy by combining synchronous and asynchronous components of care. This retrospective cohort study evaluated the clinical effects of synchronous video therapy sessions and asynchronous guided practice session elements on anxiety and depression in a blended care therapy program, with a novel focus on asynchronous provider feedback messages. Participants were adults (N=33,492) with clinical symptoms of anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7] score of ≥8) and depression (Patient Health Questionnaire 9-item scale [PHQ-9] score of ≥10) at intake. Symptom trajectories were evaluated via individual growth curve models. Time-varying covariates evaluated effects of synchronous video session attendance and the presence or absence of each asynchronous guided practice session element occurring within 7 days and 8-14 days prior to each clinical outcome assessment. Guided practice session elements included client digital lesson completion, client digital exercise completion, and feedback messages sent by providers. Approximately 86.6% (29,012/33,492) of clients met criteria for clinical improvement by end of care (median 6, IQR 4-8 synchronous sessions). Synchronous video session attendance and client digital lesson completion in the past 7 days and in the past 8-14 days were each uniquely and significantly associated with lower GAD-7 scores (video session effects: bsession7=-0.82, bsession8-14=-0.58, P values<.001; digital lesson effects: blesson7=-0.18, blesson8-14=-0.26, P values <.001) and PHQ-9 scores (video session effects: bsession7=-0.89, bsession8-14=-0.67, P values <.001; digital lesson effects: blesson7=-0.12, blesson8-14=-0.30, P values <.001). Client digital exercise completion in the past 8-14 days was significantly associated with lower GAD-7 scores (bexercise8-14=-0.10; P<.001) but exercise completion in the 7 days prior to clinical outcome assessment was not (bexercise7=0.00; P=.89). Exercise completion in the past 7 days was significantly associated with lower PHQ-9 scores (bexercise7=-0.16; P<.001) but exercise completion in the past 8-14 days was not (bexercise8-14=-0.05; P=.09). Provider feedback messaging in the past 7 days and in the past 8-14 days was significantly associated with lower GAD-7 and PHQ-9 scores, respectively (GAD-7: bfeedback7=-0.12, P<.001; bfeedback8-14=-0.07, P=.004; PHQ-9: bfeedback7=-0.15, P<.001; bfeedback8-14=-0.08, P=.01). Provider feedback between synchronous therapy sessions provided significant benefit for symptom reduction, beyond the effects of client digital engagement and synchronous video sessions. When guided practice sessions are well integrated into care, blended care therapy provides meaningful improvements upon the traditional, synchronous session-only therapy model. Provider guidance and feedback for clients between synchronous sessions support more efficient and effective mental health care overall.

Dopaminergic- and Serotonergic-Dependent Behaviors Are Altered by Lanthanide Series Metals in Caenorhabditis elegans.

The lanthanide series elements are transition metals used as critical components of electronics, as well as rechargeable batteries, fertilizers, antimicrobials, contrast agents for medical imaging, and diesel fuel additives. With the surge in their utilization, lanthanide metals are being found more in our environment. However, little is known about the health effects associated with lanthanide exposure. Epidemiological studies as well as studies performed in rodents exposed to lanthanum (La) suggest neurological damage, learning and memory impairment, and disruption of neurotransmitter signaling, particularly in serotonin and dopamine pathways. Unfortunately, little is known about the neurological effects of heavier lanthanides. As dysfunctions of serotonergic and dopaminergic signaling are implicated in multiple neurological conditions, including Parkinson's disease, depression, generalized anxiety disorder, and post-traumatic stress disorder, it is of utmost importance to determine the effects of La and other lanthanides on these neurotransmitter systems. We therefore hypothesized that early-life exposure of light [La (III) or cerium (Ce (III))] or heavy [erbium (Er (III)) or ytterbium (Yb (III))] lanthanides in Caenorhabditis elegans could cause dysregulation of serotonergic and dopaminergic signaling upon adulthood. Serotonergic signaling was assessed by measuring pharyngeal pump rate, crawl-to-swim transition, as well as egg-laying behaviors. Dopaminergic signaling was assessed by measuring locomotor rate and egg-laying and swim-to-crawl transition behaviors. Treatment with La (III), Ce (III), Er (III), or Yb (III) caused deficits in serotonergic or dopaminergic signaling in all assays, suggesting both the heavy and light lanthanides disrupt these neurotransmitter systems. Concomitant with dysregulation of neurotransmission, all four lanthanides increased reactive oxygen species (ROS) generation and decreased glutathione and ATP levels. This suggests increased oxidative stress, which is a known modifier of neurotransmission. Altogether, our data suggest that both heavy and light lanthanide series elements disrupt serotonergic and dopaminergic signaling and may affect the development or pharmacological management of related neurological conditions.

Correlation Between Anxiety, Depression and Hemodynamic Changes in Office-Based Laryngeal Surgery.

To investigate the correlation between anxiety, depression, and hemodynamic changes during office-based laryngeal surgery (OBLS). All patients undergoing OBLS between February 2024 until July 2024 were invited to participate in the study. Participants had their vital signs recorded throughout the procedure at a 5-min interval. They also had to fill the Generalized Anxiety Disorder scale-7 (GAD-7) to assess anxiety severity and the Patient Health Questionnaire-9 (PHQ-9) to assess depression severity. Demographic data included age, gender, history of smoking, history of reflux disease, history of cardiovascular diseases, type and duration of procedure. A total of 45 patients were recruited in the study. During OBLS, 35.5% of patients developed hypertension and 28.9% developed tachycardia. There was a significant increase in mean systolic blood pressure (SBP) by 30.16 mmHg (p < 0.001), in mean diastolic blood pressure (DBP) by 31.44 mmHg (p < 0.001), and in mean heart rate (HR) by 14.2 beats per minute (p < 0.001). There was also a significant decrease in the mean O2 saturation by 0.4% (p = 0.001). There was no correlation between anxiety and SBP, DBP, HR, and O2 (r < 0.1). There was also no correlation between depression levels and SBP, DBP, HR, O2 (r < 0.1). There was a significant increase in the mean SBP, DP, and HR and a significant decrease in the O2 saturation in patients undergoing OBLS. However, there was no correlation between anxiety, depression and the changes in these vital signs. Future investigations are needed to understand the causes of hemodynamic instability in OBLS. 2 Laryngoscope, 2024.