Generalized Anxiety Research Articles

Effects of A Brief Resonance Frequency Breathing Exercise on Heart Rate Variability and Inhibitory Control in the Context of Generalised Anxiety Disorder

Abstract Generalised anxiety disorder (GAD) is associated with cognitive and physiological symptoms including uncontrollable worry, inhibitory control deficits, and low heart rate variability (HRV). Literature linking HRV and inhibition in GAD is predominantly correlational. The present experiment investigated whether HRV has a causal role in maintaining inhibitory control. Participants (N = 135, 111 female) aged 18–37 reporting high levels of symptoms associated with GAD (GAD-7 scores ≥ 10; Penn State Worry Questionnaire scores ≥ 56) were assigned to an experimental or active control condition and completed baseline measures of HRV, respiration rate, and inhibitory control. The experimental condition completed resonance frequency breathing (RFB) training, and the control condition practiced breathing at their mean breathing rate before repeating the inhibitory control assessment. Participants also completed the breathing training before a behavioural worry task. The experimental condition was predicted to show increased HRV, alongside improved inhibitory control and better ability to stop worrying as compared to the control condition. HRV increased during the experimental condition, as compared to the control condition. However, there were no significant effects of RFB on inhibitory control or worry, or on HRV during the inhibitory control tasks. In conclusion, RFB can increase HRV in high GAD scorers, but further research is required to determine whether there is a relationship between increased HRV and symptoms of GAD in a single session experiment.

Correlates of self-rated resilience following traumatic brain injury.

Resilience reflects the capacity of persons to continue to function in a positive way in the context of adverse conditions. Prior research has suggested that resilience may affect emotional adjustment and quality of life after traumatic brain injury (TBI). The purpose of this investigation was to determine to what extent self-rated resilience influences cognitive test performance after TBI. We conducted a retrospective analysis of data collected during routine clinical care over a period of about 3 years at a regional rehabilitation facility. Participants included 100 adult persons with TBI (46% uncomplicated mild injury, 32% complicated mild injury and 22% severe injury). They had been clinically referred and seen for an outpatient neuropsychological evaluation within 1-36 months post injury. Main measures included the Connor-Davidson Resilience Scale-10 (CD - RISC-10), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Trail MakingTest (TMT). Self-rated resilience, as reflected in CD - RISC-10 ratings, had strong negative correlations with symptoms of depression (PHQ-9) and anxiety (GAD-7). As expected, worse injury severity, older age and lower education level were associated with worse performance on both parts of the TMT (all p's< .03). Importantly, beyond those influences, self-rated resilience was also positively associated with TMT performance. However, this was the case only in those who had threshold levels of normal resilience. Across the range of TBI severity, resilience as self-rated on the CD - RISC-10 is strongly related to subjective symptoms of anxiety and depression. It does not have a linear relationship with objective cognitive test performance. Instead, a minimum level of normal resilience is needed in order for it to support cognition after TBI. Findings of sub-threshold levels of resilience would support interventions to boost it and thereby potentially improve outcomes.

UK Medical Cannabis Registry: An Analysis of Clinical Outcomes of Medicinal Cannabis Therapy for Cancer Pain.

Cancer pain (CP) is a prevalent condition with limited pharmacotherapeutic options. Cannabis-based medicinal products (CBMPs) have shown analgesic effects, but their efficacy in CP remains contentious. This study aims to evaluate the change in patient-reported outcome measures (PROMs) and adverse events (AEs) in CP patients treated with CBMPs. A case series was conducted using prospectively collected clinical data from the UK Medical Cannabis Registry. Primary outcomes were the changes in the Brief Pain Inventory (BPI), pain visual analogue scale (Pain-VAS), EQ-5D-5L, Generalized Anxiety Disorder-7 (GAD-7), Patient Global Impression of Change (PGIC) and Single-Item Sleep Quality Scale (SQS) questionnaires from baseline to 1, 3, and 6 months. AEs were recorded and graded. p < 0.050 was considered statistically significant. One hundred and sixty-eight participants were included. CBMPs were associated with improvements in all pain-specific PROMs at all follow-up periods (p < 0.050). Improvements in GAD-7, SQS, and EQ-5D-5L index scores were also observed (p < 0.050). Twenty-nine AEs (17.26%) were reported by five patients (2.98%), mostly mild-to-moderate (72.41%). Although the observational design means causality cannot be established, the findings support the development of future randomized controlled trials into CP management with CBMPs.

EXPRESS: Depression and anxiety in Chinese patients hospitalized with primary headache: A cross-sectional multicenter study.

Primary headache and psychiatric diseases are bidirectional correlated. The real-world data of depression and anxiety in Chinese patients hospitalized for primary headache, considering all subtypes, remain unclear. This study enrolled patients attending eight Chinese headache centers from October 2022 to September 2023. A WeChat mini-program was designed to collect data. Headache was diagnosed and confirmed by two headache specialists. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were used to assess depression and anxiety. Overall, 1963 patients with primary headache were analyzed; the prevalence of depression and anxiety was 20.1% (396/1963) and 14.8% (290/1963), respectively. Of the 1963 patients, 217 (11.1%) had history of anxiety or depression and 184 (9.4%) had undergone assessments. Patients with both primary headache and depression were more likely to be women (77.8% vs. 71.9%), experience more severe headache (numerical rating scale; 6.2±1.9 vs. 5.7±1.9) and greater impacts on quality of life (Headache Impact Test-6; 65.3±8.5 vs. 58.1±11.5). Those with both primary headache and anxiety exhibited similar results and were less educated. Depression and anxiety were more prevalent in chronic migraineurs (CM) than in episodic migraineurs (36.8% vs. 16.9% and 28.9% vs. 12.3%, respectively) and in those with chronic (CTTH) than in those with episodic tension-type headache (30.6% vs. 15.1% and 20.1% vs. 12.8%, respectively). Depression and anxiety are inadequately diagnosed and strongly associated with sex, severe headache, chronification and disability in patients with primary headache in China. To improve the health of patients with primary headaches, early screening for depression and anxiety is important.

The bergen 4-day treatment for panic disorder: a longer-term follow-up

IntroductionBergen 4-Day treatment (B4DT) is a form of concentrated exposure-based cognitive behavioral therapy (CBT) in which patients receive treatment over four consecutive days. Previous studies have shown B4DT to be a promising treatment format for panic disorder (PD), although the long-term stability of treatment gains requires additional study.AimThe aim of the current study was to evaluate the longer-term effectiveness of B4DT for patients with panic disorder with or without agoraphobia. This study extends a previously published study by providing a long-term follow-up of the same cohort (n = 30), initially assessed at three months post-treatment.MethodThirty patients with panic disorder were consecutively included in a retrospect open trial. The primary outcome measure was the Panic Disorder Severity Scale. The secondary outcome measures were the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9. Outcomes were assessed at pretreatment, posttreatment, 3-month follow-up, and longer-term follow-up (with a mean time of 18 months).ResultsThere was a significant reduction in panic disorder symptoms from pretreatment to longer-term follow-up (d = 5.03, 95% CI [18.55, 21.12] to [1.33, 3.87]). The Panic Disorder Severity Scale (PDSS) mean decreased from 19.83 (SD = 0.64, 95% CI [18.55, 21.12]) before treatment, to 4.37 (SD = 0.64, 95% CI [2.98, 5.76]) post-treatment, followed by further decreases at the 3-month follow-up to a mean of 2.84 (SD = 0.64, 95% CI [1.45, 4.22]), and at the longer-term follow-up to 2.60 (SD = 0.64, 95% CI [1.33, 3.87]). There was no significant difference in symptom severity between the 3-month and 18-month assessments, indicating a sustained improvement (p <.001). At the 18-month follow-up, 90% of the patients were classified as being in remission. There were also significant reductions in symptoms of depression (d = 1.44) and generalized anxiety (d = 1.62) that were maintained at the longer-term follow-up assessment.ConclusionThe results from the current study indicated that the treatment effects of B4DT are stable over time and that the treatment format appears to be promising for PD. Confirming these preliminary results in rigorous study designs is needed.Trial registrationThe study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord-2021/209619).

The effect of progressive muscle relaxation therapy on diabetes distress &amp; anxiety among people with type 2 diabetes

Background &amp; objectives Diabetes distress (DD) is a mental condition that can develop in people with diabetes and shares characteristics with stress, anxiety, and depression. The aim was to determine the effect of Jacobson’s Progressive Muscle Relaxation (PMR) therapy on DD, anxiety, glycemic control, hemodynamic and lipid measures among people with type 2 diabetes (T2DM). Methods A total of 80 participants were recruited for this prospective randomised intervention study and divided into two groups equally; group 1 (Control) (n=40) received general counselling for stress reduction and group 2 (Intervention) (n=40) received PMR therapy and general counselling for stress reduction. A pre-, and post-test was done with diabetes distress Scale (DDS) and generalized anxiety disorder (GAD) Scales. Baseline data on anthropometric, hemodynamic, biochemical details were collected and repeated after three months. Thirty-six participants, with four dropouts in each group, reported for follow up. Diabetes medication regimens in both groups remained unchanged throughout the study period. Results There was a significant reduction in the total mean scores of DDS (Pre vs. Post) (3.8 vs. 1.6) and GAD Scale (17.9 vs. 6.3; P&lt;0.0001) in the intervention group. The PMR therapy group showed a significant reduction in HbA1c, fasting and post prandial (PP) glucose levels with HbA1c (baseline vs. follow up; 9.2% vs. 7.6%), fasting (194.5 mg/dl vs. 142.4 mg/dl) and PP glucose levels (266.5 mg/dl vs. 175.5 mg/dl) (P=0.001) whereas control group showed an increase in HbA1c, fasting and PP glucose levels. The impact of PMR therapy was also reflected in the lipid profile. Seventy per cent of the intervention group participants followed PMR therapy regularly. Interpretation &amp; conclusions Our study findings highlighted that PMR therapy had a positive effect on diabetes distress and anxiety among people with T2DM. It also improved glycemic control and can be used as an adjunctive to the medications for better management of T2DM.

Toys in the bedroom: use of sexual devices in partnered sexual activity is associated with higher female orgasmic intensity, arousal, and sexual satisfaction and is not related to psychopathologies.

Sex devices are tools that can improve the sexual health of users, but their effects on sexual outcomes in partnered intercourse have rarely been evaluated. The aim of this study was to assess the relationship between partnered and solitary use of sex devices and different sexual health outcomes among sexually active women aged 18-35 in a heterosexual relationship. The cross-sectional descriptive study was conducted with 361 participants between May and June 2023 recruited through a social media campaign. Female sexual function was measured with the Female Sexual Function Index and the Orgasmometer-F. The Generalized Anxiety Disorder scale, the Patient Health Questionnaire and the Dark Future Scale were used to investigate psychological health. Statistical analysis was performed with the statistical software R; the significance level for statistical analyses was set as P<0.05. The outcomes of the study include female sexual function and orgasmic intensity, as well as measures of symptoms of anxiety, depression, and uncertainty for the future. Compared to those who only used sex devices for solitary masturbation, women using sex devices in the context of partnered intercourse had higher arousal and satisfaction scores (P= 0.042 and P= 0.004, respectively), as well as higher subjective perception of orgasmic intensity over the last 6months (P= 0.005) and in partnered sexual intercourse in the last 4weeks (P= 0.002). Conversely, orgasmic intensity during masturbation in the last 4weeks was higher among solitary users (P< 0.001). No significant difference was found between the two study groups for all other outcome measures. The use of sex devices in the context of partnered intercourse is associated with increased sexual function and more intense orgasmic experience. The study investigates a novel topic, on a large sample size, by using several validated instruments to measure sexual functioning of participants. However, a definite cause-effect relationship cannot be established due to the study design. Self-report bias and lack of clinical data on study participants are further limitations. Additionally, being a study limited to heterosexual, sexually active women involved in a relationship, results cannot be generalized to all women. The study found an association between better sexual functioning and use of sex devices in partnered intercourse.

Depression, anxiety, and stress among USMLE aspirants: a cross-sectional survey

Background: The United States Medical Licensure Examination (USMLE) represents a critical step for medical licensure in the United States, requiring extensive preparation that can lead to significant mental health challenges among aspirants. This study aims to explore the prevalence and contributing factors of depression, anxiety, and stress among USMLE aspirants. Methods: This cross-sectional survey investigates the prevalence and contributing factors of depression, anxiety, and stress among USMLE aspirants. We deployed a detailed online and paper-based questionnaire targeting a diverse pool of 321 medical students and graduates globally. The survey incorporated validated scales such as the Perceived Stress Scale, Generalized Anxiety Disorder 7-item scale, and Patient Health Questionnaire-9 to evaluate mental health statuses. Data analysis was conducted using SPSS, focusing on demographic correlations and mental health outcomes. Results: A total of 321 participant’s data were collected, out of whom 51.1% (n = 164) were male and 48.9% (n = 157) were female. 91.3% (n = 293) were International Medical Graduates (IMG), while 8.7% (n = 28) were American Medical Graduates (AMG), educational status results show undergraduates 38.6% (n = 124) and graduates 61.4% (n = 197). Participants were interviewed through a validated questionnaire, and 75.1% (n = 241) had depression, 71.96 (n = 231) had anxiety, (n = 16) had low stress, (n = 231) had moderate, and (n = 66) had severe perceived stress. Conclusion: Our study reveals a high prevalence of depression, anxiety, and stress among USMLE aspirants, with significant variations across demographic subgroups and chosen medical specialities.

Shared prognostic information in amyotrophic lateral sclerosis – systematic assessment of the patients’ perception of neurofilament light chain and the ALS functional rating scale

BackgroundIn amyotrophic lateral sclerosis (ALS), neurofilament light chain (NfL) was introduced as a prognostic biomarker. More recently, NfL values can be shared on the patient’s ALS app. Also, the ALS functional rating scale (ALSFRS-R) is an established patient-reported assessment of disease progression. The scale can be obtained during clinic visits or remotely. However, few systematic data are available on the patients’ perception of prognostic information about NfL and ALSFRS-R and the remote sharing of these data.MethodsIn a multicenter study, 149 ALS patients were assessed for their perception of shared information about NfL and ALSFRS-R using an investigator-designed survey and established questionnaires. The recommendation of NfL and ALSFRS-R to fellow patients was assessed using the Net Promoter Score (NPS). Burden by shared information was investigated in two distinct settings: (1) clinic information when receiving results on NfL and/or ALSFRS-R during clinic visits and (2) remote information about NfL values and self-rating of the ALSFRS-R via the ALS app. General anxiety was measured by the Fear of Progression Questionnaire – Short Form (FoP-Q-SF).ResultsInformation about NfL and ALSFRS-R, respectively (n = 149), were regarded as relevant for patients themselves (75.2% and 77.2%) and for research (98% and 96%). The NPS showed a high recommendation rate for NfL (+ 21) and ALSFRS-R (+ 26). Only a minority of patients perceived shared information about NfL as burdensome, with a lower burden in the clinic setting (n = 1, 4.2%) than in the remote setting (n = 8, 12%; p = 0.015). Remote digital assessment of the ALSFRS-R was well received, with a reported burden in 9.8% (n = 9) of the participants. The FoP-Q-SF revealed fear of progression in 40% of the respondents (n = 60).ConclusionsThis study underscored the relevance of information about NfL and ALSFRS-R from the patient’s perspective. Furthermore, patients proved to appreciate the relevance of this data for ALS research. Sharing information about NfL or ALSFRS-R was rarely perceived as burdensome even in a remote setting using the ALS app. These findings pave the way for further development of the patient-centered approach to sharing prognostic information in ALS.

Stressor-evoked heart rate, perceived physiological arousal, and anxiety symptoms in young adults.

Acute psychological stress is associated with increases in heart rate (HR) and state anxiety. Stressor-evoked perceived HR changes relate more strongly to state anxiety than actual HR reactivity. However, research has yet to examine these associations in the context of general anxiety symptoms. Participants (N = 160) completed a resting baseline period followed by a standardized acute psychological stress task; HR was recorded throughout. After the stress task, participants rated their perceived stressor-evoked physiological arousal and anxiety intensity. Participants also completed a general anxiety symptoms measure ~17 days later. The a priori hypothesized model demonstrated a good fit to the data, χ2 (59) = 93.15, p = .003; CFI = 0.94; TLI = 0.91; SRMR = 0.05; RMSEA = 0.06 (90 % CI = 0.04-0.08). After controlling for covariates, perceived physiological arousal was positively related to both cognitive and somatic anxiety. In turn, only somatic anxiety was positively associated with general anxiety symptoms. Perceived physiological arousal was related to general anxiety symptoms through state somatic anxiety. HR reactivity was not statistically significantly associated with either cognitive or somatic anxiety. The study was correlational, which limits the ability to determine causation. Perceived HR, rather than actual HR, is more closely associated with anxiety intensity during acute psychological stress. Stressor-evoked perceived HR and general anxiety symptoms are related indirectly through stressor-evoked somatic anxiety intensity. The findings have implications for elucidating the mechanisms of the stress-anxiety relationship.

The relationship between trait- and state-math anxiety and math engagement: The role of math learning context and task difficulty.

Various findings regarding the relationship between math anxiety and engagement have been identified in the literature, with many focusing on general math anxiety and overall math engagement. Based on the control-value theory, this study examined the relationships between trait- and state-math anxiety and behavioural and cognitive engagement in math under daily practice and exam preparation conditions across math tasks of varying difficulty levels. A survey study with 449 high school students and an experimental study with 33 freshmen were conducted. Students' trait- and state-math anxiety, as well as behavioural and cognitive engagement in math, were measured under daily practice and exam preparation conditions across easy and difficult math tasks. A two-level latent variable model was built in the survey study, and two-way ANOVAs and regressions were used in the experimental study. Students exhibited greater state anxiety under exam preparation conditions in the survey study and showed differences in state-math anxiety and engagement across learning contexts and math tasks in the experimental study. Students with higher trait-math anxiety displayed less engagement in both studies, while those with higher state-math anxiety when facing difficult tasks tended to engage more cognitively in the experiment. These findings demonstrated discrepancies in the relationships between trait- and state-math anxiety and math engagement, while accounting for learning context and task difficulty.

Status and risk factors for depression, anxiety, and insomnia symptoms among adolescents in the post-pandemic era

BackgroundOwing to their vulnerability to public health crises, adolescents’ mental health status, and related risk factors in the post-pandemic era in China require examination. This study aimed to lay a foundation for subsequent interventions and mental disorder prevention among adolescents.MethodsAn anonymous online survey was conducted January 8–18, 2023. The survey comprised two parts. The first part collected personal information. The second part included the nine-item Patient Health Questionnaire, seven-item Generalized Anxiety Disorder Scale, and Pittsburgh Sleep Quality Index.ResultsOf 50,666 adolescent participants, 46.8% displayed depressive symptoms, 31.5% showed anxiety symptoms, and 47.9% experienced difficulties initiating sleep within 30 min, while 4.9% manifested depressive, anxiety, and insomnia symptoms simultaneously. Chi-square tests revealed significant variations in the prevalence of these conditions according to age, sex, coronavirus disease-2019 (COVID-19) infection status, family infection status, and increased screen time (P < 0.001). Logistic regression analysis indicated heightened rates of depression, anxiety, and insomnia symptoms among rural adolescents, females, those aged 16–18 years, individuals with a history of COVID-19, those with a long COVID-19 illness, and those with increased screen time (all P < 0.001).ConclusionThe mental health status of adolescents in the post-pandemic era should be taken seriously, particularly that of females, high school students, and adolescents with increased use of electronic screens. Among such efforts, school administrators should strengthen their connection with psychologists, as early identification and intervention in adolescents are important for preventing school crises.

The effect of self-compassion versus mindfulness interventions on autonomic responses to stress in generalized anxiety disorders

ObjectiveAlthough research on psychological interventions in generalized anxiety disorder (GAD) has provided evidence of their effectiveness regarding self-reported outcomes, few studies have examined their psychophysiological effects. Heart rate is emerging as a potential biomarker of efficacy in anxiety disorders. This study aimed to investigate the effects of a self-compassion intervention versus a mindfulness intervention on physiological arousal in response to induced stress.MethodsForty-seven patients with GAD had heart rate data collected during a stress task before and after a 2-week pharmacological treatment (known as treatment as usual, TAU), a self-compassion intervention + TAU or a mindfulness intervention + TAU. They also reported state anxiety, positive affect, and negative affect at pre- and post- intervention before the stress task. ANOVAs were conducted to analyze the effects on electrocardiogram data self-reported measurements.ResultsSelf-compassion intervention uniquely decreased heart rate response to a stressor whereas mindfulness intervention did not. Both treatments decreased state anxiety and negative affect to a stressor, while increased positive affect in this context. We also demonstrated a significant correlation between decreased heart rate response and less negative emotions.ConclusionThe Findings provides novel physiological evidence that self-compassion interventions buffer stress reactivity in individuals with GAD. Attention shall be paid to the limitations in small and unequal sample size and a non-randomized study design.

Co-occurrence of depression, anxiety and increased alcohol use during the late stage of the COVID-19 pandemic in Saskatchewan, Canada: a cross-sectional survey

BackgroundImpact of the COVID-19 pandemic on mental health and substance use is well recognised. COVID-19 impacted Saskatchewan particularly hard as it has a higher prevalence of alcohol consumption than the...

Network analysis of interactions of rumination and anxiety on smartphone dependence symptoms

ObjectiveRumination and anxiety have been posited as correlates of smartphone dependence (SPD). However, little is known regarding how the components of both affect SPD symptoms at subtle levels. Therefore, we used the network analysis approach to identify the connections at a micro level to provide possible interventions for reducing SPD symptoms.MethodsUsing symptom-level network analysis, we used the ruminative response scale-10, the generalized anxiety disorder scale-7, and the mobile phone addiction index scale-17 to investigate Chinese preservice teachers (Mage = 21.1, N = 1160). Subsequently, we estimated a graphical lasso correlation network for these teachers, which encompassed rumination components, anxiety components, and SPD symptoms. Specifically, the central and bridge centralities within the network structure were examined for the impacts of rumination and anxiety on SPD symptoms.ResultsThe three intracluster connections of rumination, anxiety, and SPD were tighter than the intercluster, with structural connections in rumination and anxiety networks closer than the triggered SPD symptoms cluster. Importantly, reflection reactions towards “write down what you are thinking and analyze it” (a component of rumination) were identified as a central and bridging node that might be a target for intervention for SPD symptoms.ConclusionWe identify potential edge-bridging rumination and anxiety on SPD and locate highly central components within each cluster via network analysis.

Neural processes linking joint hypermobility and anxiety: key roles for the amygdala and insular cortex.

Anxiety symptoms are elevated among people with joint hypermobility. The underlying neural mechanisms are attributed theoretically to effects of variant connective tissue on the precision of interoceptive representations contributing to emotions. To investigate the neural correlates of anxiety and hypermobility using functional neuroimaging. We used functional magnetic resonance neuroimaging to quantify regional brain responses to emotional stimuli (facial expressions) in people with generalised anxiety disorder (GAD) (N = 30) and a non-anxious comparison group (N = 33). All participants were assessed for joint laxity and were classified (using Brighton Criteria) for the presence and absence of hypermobility syndrome (HMS: now considered hypermobility spectrum disorder). Participants with HMS showed attenuated neural reactivity to emotional faces in specific frontal (inferior frontal gyrus, pre-supplementary motor area), midline (anterior mid and posterior cingulate cortices) and parietal (precuneus and supramarginal gyrus) regions. Notably, interaction between HMS and anxiety was expressed in reactivity of the left amygdala (a region implicated in threat processing) and mid insula (primary interoceptive cortex) where activity was amplified in people with HMS with GAD. Severity of hypermobility in anxious, compared with non-anxious, individuals correlated with activity within the anterior insula (implicated as the neural substrate linking anxious feelings to physiological state). Amygdala-precuneus functional connectivity was stronger in participants with HMS, compared with non-HMS participants. The predisposition to anxiety in people with variant connective tissue reflects dynamic interactions between neural centres processing threat (amygdala) and representing bodily state (insular and parietal cortices). Correspondingly, interventions to regulate amygdala reactivity while enhancing interoceptive precision may have therapeutic benefit for symptomatic hypermobile individuals.

Effectiveness of Cognitive Behavioral Therapy Provided Through a Web Application for Subthreshold Depression, Subthreshold Insomnia, and Subthreshold Panic: Open-Labeled 6-Arm Randomized Clinical Trial Pilot Study.

A common definition of "subthreshold" is that the diagnostic threshold is not met but the individuals are not asymptomatic. Some symptoms are present, causing significant difficulty in functioning and negatively impacting quality of life. Despite the attention given to subthreshold symptoms and the interventions for subthreshold symptoms being efficient in preventing the transition to psychiatric disease in primary care, reports on specific interventions are insufficient. This study aimed to verify the effectiveness of internet-delivered cognitive behavioral therapy (ICBT) for subthreshold depression (SD), subthreshold insomnia (SI), and subthreshold panic (SP). Additionally, this study aimed to explore the minimally important change (MIC) of each subthreshold group's effectiveness outcome. Participants aged 18-70 years from internet research monitors were categorized into SD, SI, and SP groups based on screening assessment. They were randomly assigned to intervention or control groups within each subthreshold symptom. The intervention groups worked on 4 weeks of nonguided ICBT ("Mentre"), while the control groups worked on a sham app. The primary outcome was the score change from screening (T1) to 4-week follow-up (T4) using the Center for Epidemiologic Studies Depression Scale (CESD) in the SD group, the Pittsburgh Sleep Quality Index (PSQI) in the SI group, and the Panic and Agoraphobia Scale (PAS) in the SP group. Secondary outcomes were score changes in the Generalized Anxiety Disorder-7 (GAD-7) scale, the Patient Health Questionnaire 9 (PHQ-9), the CESD, the PSQI, and the PAS, except the primary outcome in each group. Secondary outcomes were analyzed using complete-case analysis and repeated-measures ANOVA. Additionally, the MIC in the primary endpoint for each group was also calculated as an exploratory outcome. The SD, SP, and SI groups contained 846, 597, and 1106 participants, respectively. In the SD group, the difference in the CESD score change from baseline to follow-up between the intervention and control groups was significant (difference=0.52, 95% CI 1.29-4.66, P<.001). In the SI group, the difference in the PSQI score change was also significant (difference=0.53, 95% CI 0.11-0.94, P=.01). However, in the SP group, the difference in the PAS score change was not significant (difference=0.07, 95% CI -2.00 to 2.15, P=.94). Our ICBT program Mentre contributes to the improvement of SI and SD. This suggests that nonguided ICBT may be effective in preventing SI and SD from progressing to the full threshold. However, appropriate definitions of subthreshold symptoms are necessary. In particular, it is difficult to define SP, and further research that considers the specific factors of each subthreshold symptom is necessary to accumulate evidence. University Hospital Medical Information Network (UMIN) UMIN000051280; https://tinyurl.com/2wyahhe3.

The Role of Sports in Building Resilience: A Machine Learning Approach to the Psychological Effects of the COVID-19 Pandemic on Children and Adolescents

(1) Background: This study evaluated whether physical activity and sports serve as a protective factor in mitigating COVID-19 pandemic long-term consequences. (2) Methods: A survey of 1702 participants (8–18 years) used the Impact of Event Scale (IES), Generalized Anxiety Disorder Scale (GAD-7), and Center for Epidemiological Studies Depression Scale for Children (CES-DC). Participants were categorized based on their engagement in sports, cultural activities, or sedentary behaviors. Statistical analysis included non-parametric tests, CHAID models, and clustering. (3) Results: In total, 65.5% of participants experienced minimal to mild anxiety, and 34.5% reported moderate to severe anxiety. The main predictor of depression is the sample age, followed by the training experience. Depressive symptoms were identified in 71.3% of participants (75.7% adolescents; 64% children). Adolescents with longer training experience (67.6%) showed lower depression compared to those with shorter experience (77.2%). For post-traumatic stress, 38% of children and 46% of adolescents exceeded cut-off scores for significant symptoms, with age and training level identified as key predictors. Among children, sport experience with low weekly frequency was associated with the lowest depression rates (59.5%). (4) Conclusions: Four years after the pandemic, a high percentage of anxiety and depression disorders is observed in the youth population, particularly among adolescents. Sports appear to slightly alleviate this serious condition.

Preliminary effectiveness of the Bergen 4-day treatment for OCD in Iceland

ABSTRACT The Bergen 4-day treatment (B4DT) for obsessive-compulsive disorder (OCD) is a concentrated form of exposure and response prevention that has been evaluated and implemented nationwide in Norway. Its effectiveness has yet to be fully established in other countries. A total of 86 patients with OCD underwent the treatment at the Icelandic Anxiety Centre (KMS) from 2018 to 2023. Of these, 61.6% were classified as having severe symptoms, and 38.4% with moderate symptoms. Of the sample, 72.1% had previously received psychological treatment for OCD and 86.0% had at least one comorbid disorder, depression being the most common (50.0%). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered pre-treatment, posttreatment, and at 3-month follow-up, along with measures on general anxiety, depression, and occupational impairment. The mean score on Y-BOCS was 30.5 (SD = 3.6) pre-treatment, 10.6 (SD = 4.1) posttreatment and 10.9 (SD = 5.4) at 3-month follow-up. By the end of treatment, 94.9% of the patients had responded and 68.0% were in remission. At the 3-month follow-up, 92.5% were responders and 67.9% remitters. Participants were satisfied with the treatment and had improved in terms of occupational functioning, which was maintained at follow-up. These preliminary results suggest that the B4DT may be a swift and effective treatment format for OCD.

An Innovative Clinic-Based Intervention to Improve Adolescent Access to Sexual and Mental Health Services: The Total Teen Program.

Adolescents encounter numerous healthcare access barriers, leading to poor health outcomes. Researchers developed the Total Teen (TT) program to improve access to sexual and reproductive health (SRH) and mental health (MH) services in settings providing adolescents and young adults (12-25) health services. This pilot study assessed the TT's impact on care across three settings: school-based health clinics, a federally qualified health center, and an adolescent health clinic for 12 weeks. Sociodemographic data, including age, race/ethnicity, gender, and insurance status, were collected. MH was assessed using patient health questionnaire (PHQ)-9 and generalized anxiety disorder (GAD)-2 scales, and sexual health was evaluated based on CDC guidelines and additional evidence-based questions. One-on-one time, confidential consultations, SRH and MH micro visits, and referrals measured access. Descriptive statistics, Pearson Chi-square tests, and Kruskal-Wallis tests compared site outcomes, while logistic regression models adjusted for age, gender, race, and site. Four hundred and fifty-one participated in the TT program across the three sites. Concerning micro visits and referrals, being male was associated with lower depression rates (P = .0003) and generalized anxiety disorder (P = .0099). Being males also predicted micro visit receipt (P = .0199). Concerning SRH micro visits, higher sexual behavior scores (P < .0001) were significantly associated with a greater likelihood of utilizing SRH micro visits. Results indicate that TT improves access to SRH and MH services and referrals for at-risk adolescents. Findings underscore the importance of integrating SRH and MH services into routine adolescent care and involving health organizations and providers as key stakeholders in enhancing preventive healthcare access.