Generalized Anxiety Disorder Screener Research Articles

Family functioning and mental wellbeing impairment during initial quarantining for the COVID-19 pandemic: A study of Canadian families.

Quarantine measures imposed due to COVID-19 have negatively impacted individual wellbeing. However, the research on the factors impacting mental health and functioning of families is limited. The current study explores socio-economic and demographic factors that mediate poor family functioning, anxiety, and depressive symptoms in response to quarantine measures in Canadian parents and children. 254 Canadian families completed an online questionnaire capturing demographic information and mental wellbeing of individuals and of the whole family. Family functioning was assessed using the Family Assessment Device General Functioning subscale (FAD-GF), and individual mental wellbeing was measured with the Generalized Anxiety Disorder screener (GAD-7) and Patient Health Questionnaire (PHQ-9). Generalized linear models and logistic regression were used to model socio-demographic impacts on outcome variables. Problematic family functioning was found in 78.5% of families with a high proportion of parents reporting above-threshold symptoms of anxiety (62.9%) and depression (73.4%). Many children also reported above-threshold symptoms of anxiety (54.6%) and depression (70.7%). Family functioning was impacted by parent and child age, parental employment status and pre-existing conditions for children. Anxiety and depression experienced by parents and children was increased in families with parents aged <45, household income<$100,000 pre-existing psychiatric conditions, or having a child aged >5 years. These findings show that most Canadian families observed in this study experienced above threshold symptoms of anxiety, depression and poor family functioning. Our study provides an initial step towards identifying characteristics of at-risk families and targeting interventions to mediate negative effects of quarantining.

Association between psychosocial distress, sexual disorders, self-esteem and quality of life with male androgenetic alopecia: a population-based study with men at age 46

ObjectivesTo study the association between androgenetic alopecia (AGA) and its severity with psychosocial well-being in male subjects aged 46 years at the population level.DesignCross-sectional study.SettingThe Northern Finland Birth Cohort 1966...

Validation of the Korean Version of Impact of Event Scale-Revised (IES-R) in Korean Nurses during the COVID-19 Pandemic.

Nurses working amid the COVID-19 pandemic are at increased risk of developing post-traumatic stress disorder (PTSD). This study was conducted to verify the reliability and validity of the Korean version of Impact of Event Scale—Revised (IES-R), one of the most used tools for assessing trauma. Secondary data of 249 nurses who performed face-to-face nursing tasks during the COVID-19 pandemic, collected through an online survey, were analyzed by conducting a factor analysis of the K-IES-R and testing the internal consistency and concurrent validity with the Perceived Stress Scale (PSS), Generalized Anxiety Disorder Screener (GAD-7), and Dimensions of Anger Reactions-5 (DAR-5). The result of an exploratory factor analysis of the K-IES-R supported a three-factor structure of intrusion, avoidance, and sleep disturbance, with CMIN/DF = 2.98, RMSEA = 0.09, SRMR = 0.03, CFI = 0.93, and TLI = 0.90. The Cronbach’s alpha of each subscale was 0.88–0.94. The total K-IES-R score and each factor’s value showed a significant correlation (moderate or higher) with the PSS, GAD-7, and DAR-5. The K-IES-R was verified as a useful tool for assessing post-traumatic stress symptoms in nurses who directly perform nursing tasks in crises such as COVID-19. This study suggests the tool be used for early assessment of post-traumatic stress symptoms in nurses and providing appropriate interventions.

The Association Between Internet Addiction and Anxiety in Nursing Students: A Network Analysis.

Background: Nursing students who suffer from co-occurring anxiety experience added difficulties when communicating and interacting with others in a healthy, positive, and meaningful way. Previous studies have found strong positive correlations between Internet addiction (IA) and anxiety, suggesting that nursing students who report severe IA are susceptible to debilitating anxiety as well. To date, however, network analysis (NA) studies exploring the nature of association between individual symptoms of IA and anxiety have not been published.Objective: This study examined associations between symptoms of IA and anxiety among nursing students using network analysis.Methods: IA and anxiety symptoms were assessed using the Internet Addiction Test (IAT) and the Generalized Anxiety Disorder Screener (GAD-7), respectively. The structure of IA and anxiety symptoms was characterized using “Strength” as a centrality index in the symptom network. Network stability was tested using a case-dropping bootstrap procedure and a Network Comparison Test (NCT) was conducted to examine whether network characteristics differed on the basis of gender and by region of residence.Results: A total of 1,070 nursing students participated in the study. Network analysis showed that IAT nodes, “Academic decline due to Internet use,” “Depressed/moody/nervous only while being off-line,” “School grades suffer due to Internet use,” and “Others complain about your time spent online” were the most influential symptoms in the IA-anxiety network model. Gender and urban/rural residence did not significantly influence the overall network structure.Conclusion: Several influential individual symptoms including Academic declines due to Internet use, Depressed/moody/nervous only while being off-line, School grades suffering due to Internet use and Others complain about one's time spent online emerged as potential targets for clinical interventions to reduce co-occurring IA and anxiety. Additionally, the overall network structure provides a data-based hypothesis for explaining potential mechanisms that account for comorbid IA and anxiety.

Validation of the Generalized Anxiety Disorder Screener (GAD-7) in Spanish Pregnant Women.

Anxiety during pregnancy is one of the most common mental health problems and a significant risk factor for postpartum depression. The Generalized Anxiety Disorder-7 (GAD-7) is one of the most widely used self-report measures of anxiety symptoms available in multiple languages. This study evaluates the psychometric properties and underlying factor structures of the Spanish GAD-7 among pregnant women in Spain. Spanish-speaking pregnant women (N = 385) were recruited from an urban obstetrics setting in Northern Spain. Women completed the GAD-7 and the anxiety subscale of the Symptom Checklist (SCL90-R) at three time points, once per trimester. The reliability, concurrent validity, and factor analyses were conducted to evaluate the psychometric properties and factor structure, respectively. In the first trimester, the GAD-7 demonstrated good internal consistency (a = 0.89). GAD-7 is positively correlated with SCL90-R (anxiety subscale; r=0.75; p < 0.001). The proposed one-factor structure is found using exploratory factor analysis -FACTOR program - with Unweighted Least Squares procedure and optimal implementation of parallel analysis (GFI = 0.99). Health providers should screen for anxiety using the GAD-7 during pregnancy among urban Spanish-speaking samples to provide appropriate follow-up care.

Quality of Life of Patients With Cancer During the COVID-19 Pandemic.

The COVID-19 pandemic has changed the organisation of medical care. This is the first prospective observational study on patient-reported outcomes, quality of life (HRQOL) and satisfaction in patients with cancer with their care management in a day hospital during the period of May-June 2020. The Generalised Anxiety Disorder Screener and 12-Item Short-Form Health Survey were used. The survey was completed by 189 of 267 patients. They were generally aged 61 to 70 years and women and presented with lung, breast, or colorectal cancer. Patients had low anxiety scores (mean: 3.2±4.5), with only 11.1% showing anxiety. Risk factors of anxiety included female gender (p=0.03) and lifestyle (residence, family environment) (p=0.01). The patient's physical health was stable, whereas mental health had deteriorated (p<0.0001). Risk factors of altered HRQOL included age and lifestyle. Patients greatly appreciated all the facilities of the day hospital and its organisation. This study shows a preserved HRQOL and low anxiety of patients with cancer during the COVID-19 pandemic.

Labour Market Attachment, Workplace Infection Control Procedures and Mental Health: A Cross-Sectional Survey of Canadian Non-healthcare Workers during the COVID-19 Pandemic.

BackgroundThe COVID-19 pandemic has led to large proportions of the labour market moving to remote work, while others have become unemployed. Those still at their physical workplace likely face increased risk of infection, compared to other workers. The objective of this paper is to understand the relationship between working arrangements, infection control programs (ICP), and symptoms of anxiety and depression among Canadian workers, not specifically working in healthcare. MethodsA convenience-based internet survey of Canadian non-healthcare workers was facilitated through various labour organizations between April 26 and June 6, 2020. A total of 5180 respondents started the survey, of which 3779 were assessed as employed in a full-time or part-time capacity on 2 March 2020 (prior to large-scale COVID-19 pandemic responses in Canada). Of this sample, 3305 (87.5%) had complete information on main exposures and outcomes. Anxiety symptoms were measured using the Generalised Anxiety Disorder screener (GAD-2), and depressive symptoms using the Patient Health Questionnaire screener (PHQ-2). For workers at their physical workplace (site-based workers) we asked questions about the adequacy and implementation of 11 different types of ICP, and the adequacy and supply of eight different types of personal protective equipment (PPE). Respondents were classified as either: working remotely; site-based workers with 100% of their ICP/PPE needs met; site-based workers with 50–99% of ICP/PPE needs met; site-based workers with 1–49% of ICP/PPE needs met; site-based workers with none of ICP/PPE needs met; or no longer employed. Regression analyses examined the association between working arrangements and ICP/PPE adequacy and having GAD-2 and PHQ-2 scores of three and higher (a common screening point in both scales). Models were adjusted for a range of demographic, occupation, workplace, and COVID-19-specific factors.ResultsA total of 42.3% (95% CI: 40.6–44.0%) of the sample had GAD-2 scores of 3 and higher, and 34.6% (95% CI: 32.–36.2%) had PHQ-2 scores of 3 and higher. In initial analyses, symptoms of anxiety and depression were lowest among those working remotely (35.4 and 27.5%), compared to site-based workers (43.5 and 34.7%) and those who had lost their jobs (44.1 and 35.9%). When adequacy of ICP and PPE was taken into account, the lowest prevalence of anxiety and depressive symptoms was observed among site-based workers with all of their ICP needs being met (29.8% prevalence for GAD-2 scores of 3 and higher, and 23.0% prevalence for PHQ-2 scores of 3 and higher), while the highest prevalence was observed among site-based workers with none of their ICP needs being met (52.3% for GAD-2 scores of 3 and higher, and 45.8% for PHQ-2 scores of 3 and higher).ConclusionOur results suggest that the adequate design and implementation of employer-based ICP have implications for the mental health of site-based workers. As economies re-open the ongoing assessment of ICP and associated mental health outcomes among the workforce is warranted.

The Psychometric Properties of the Patient Health Questionnaire-4 for Pregnant Women.

Background: Perinatal anxiety and depression are common complications during pregnancy. The purpose of this study was to examine the item characteristics, reliability, validity, and factorial structure of the four-item Patient Health Questionnaire-4 (PHQ-4) and to determine the associations between scale scores and sociodemographic factors in a sample of pregnant women from Spain. Method: A total of 845 pregnant women were recruited from two public hospitals in Spain between 2014 and 2016. Participants completed a self-report questionnaire that included Patient Health Questionnaire-4, including the two-item Patient Health Questionnaire and the two-item Generalized Anxiety Disorder Screener. Results: Exploratory and confirmatory factor analysis and scale inter-correlations between the PHQ-4 and PHQ-9 revealed that the PHQ-4 has a bivariate structure and adequately assesses the dimensions of antenatal anxiety and depression. Conclusion: The PHQ-4 is a reliable and valid instrument to screen for depression and anxiety during pregnancy. The PHQ-4 is an ultra-brief measure that can be used to screen for antenatal depression and anxiety to prevent the negative consequences associated with these mental health conditions among mothers and infants.

Reason to doubt the ICHD-3 7-day inclusion criterion for mild TBI-related posttraumatic headache: A nested cohort study.

Posttraumatic headache is difficult to define and there is debate about the specificity of the 7-day headache onset criterion in the current definition. There is limited evidence available to guide decision making about this criterion. A nested cohort study of 193 treatment-seeking veterans who met criteria for persistent headache attributed to mild traumatic injury to the head, including some veterans with delayed headache onset up to 90 days post-injury, was undertaken. Survival analysis examined the proportion of participants reporting headache over time and differences in these proportions based on sex, headache phenotype, and mechanism of injury. 127 participants (66%; 95% CI: 59-72%) reported headache onset within 7 days of head injury and 65 (34%) reported headache onset between 8 days and 3 months after head injury. Fourteen percent of participants reported pre-existing migraine before head injury, and there was no difference in the proportion of veterans with pre-existing migraine based on headache onset. Headache onset times were not associated with sex, headache phenotype, or mechanism of injury. There were no significant differences in proportion of veterans with headache onset within 7 days of head injury based on headache phenotype (70% migraine onset within 7 days, 70% tension-type headache within 7 days, 56% cluster headache within 7 days; p ≥ .364). Similar findings were observed for head injury (64% blast, 60% blunt; p = .973). There were no significant differences observed between headache onset groups for psychiatric symptoms (Posttraumatic Stress Disorder Checklist for DSM-5 = 1.3, 95% CI = -27.5, 30.1; Patient Health Questionnaire-9 Item = 3.5, 95% CI = -6.3, 3.7; Generalized Anxiety Disorder Screener = 6.5, 95% CI = -2.7, 15.6). Although most of the sample reported headache onset within 7 days of head injury, one-third experienced an onset outside of the diagnostic range. Additionally, veterans with headache onset within 7 days of head injury were not meaningfully different from those with later onset based on sex, headache phenotype, or mechanism of head injury. The ICHD-3 diagnostic criteria for 7-day headache onset should be expanded to 3 months. NCT02419131.

The Relationship Between Depression, Anxiety, and Burnout Among Physician Assistant Students: A Multi-Institutional Study

PurposeBurnout, depression and anxiety are common in medical students; however, there is limited research on these outcomes in Physician Assistant (PA) students. With a growing number of PA education programs, examining this issue in PA students can provide important information that can ultimately affect the quality of educational outcomes and future health care delivery. MethodsAll Virginia PA programs (n = 8) in 2018 participated in a cross-sectional study. Students received a recruitment email providing a link to an anonymous survey. Participants completed the Maslach Burnout Inventory (MBI-SS) student version, Generalized Anxiety Disorder Screener (GAD-7), and the Patient Health Questionnaire (PHQ-2) and provided demographic information. We used two hierarchical linear regression models to assess the ability of depression and anxiety to predict emotional exhaustion and cynicism, respectively, while controlling for sociodemographic variables. The first regression model utilized emotional exhaustion as the dependent variable while the second examines cynicism. ResultsThe sample consisted of 320 PA students (response rate = 32%). Twenty-three percent were at risk for depression; 43% met criteria for moderate to severe anxiety. Both anxiety (β = 0.53; p < .001), and depression (β = .91; p < .001), significantly predicted emotional exhaustion. There was a significant association between depression cynicism (β = 2.1.; p < .001). ConclusionTo our knowledge, this is the first examining the relationship between depression, anxiety and burnout in PA students. Our findings are similar to those from studies among medical students indicating these issues need to be addressed in PA students.

Mental Health Status of Survivors Following COVID-19 in Wuhan, China: A Descriptive Study

Background: Inpatients with coronavirus disease 2019 (COVID-19) have been well depicted in clinical characteristics. However, few studies reported post-discharge conditions, especially mental health status, for survivors following COVID-19. In this study, we aimed to first report mental health status in COVID-19 survivors and explore relevant influence factors. Methods: In this descriptive case series, we enrolled a population of 370 COVID-19 survivors in Wuhan Jinyintan Hospital, China. Survivors were discharged during Jan 4 and Feb 12, 2020. Telephone follow-up was conducted. Readmission status and post-discharge symptoms and signs were inquired. Mental health conditions of anxiety and depression were assessed using The Generalized Anxiety Disorder Screener (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), respectively. Results: The median post-discharge follow-up period was 22 days (interquartile range 20~30 days). Of the 370 COVID-19 survivors, no survivors were readmitted due to recurrence of SARS-CoV-2-positive pneumonia. Sixty (16.2%) survivors had post-discharge cough and 45 (12.2%) had breathlessness after activity. One hundred and seventy-three (46.8%) survivors worried about recurrence and 174 (47.0%) worried about infection to others such as their family. Two hundred and ninety-three (79.2%) survivors took a home quarantine lifestyle. Fifty (13.5%) survivors occurred anxiety and 40 (10.8%) survivors occurred depression. Survivors were most bothered by sleeping disorders (29.5%). Four survivors (1.1%) once had thoughts of suicide in several days. Three hundred and fifty-six (96.2%) survivors were willing to return to hospital for health examination. Anxiety was significantly associated with post-discharge respiratory symptoms, worry about recurrence and worry about infection to others (P<0.05). Depression was significantly associated with gender of female, post-discharge respiratory symptoms, worry about recurrence, worry about infection to others and home quarantine lifestyle (P<0.05). Interpretation: About 10 percent of COVID-19 survivors would develop anxiety or depression, because of post-discharge residual respiratory symptoms, worry about recurrence and infection to others. We clinicians and psychiatrists must pay attention to mental health care for these survivors. We need to explain to COVID-19 survivors that they should not be overly worried about residual respiratory symptoms and a rare event of recurrence. In addition, depression caused by home quarantine lifestyle should also be noted and relieved. Funding Statement: This study was supported by The National Natural Science Foundation of China (NSFC) (81972393, 81772705, 31570775), NSFC (81630001, 81770075), Shanghai Municipal Key Clinical Specialty (shslczdzk02201) and Shanghai Top-Priority Clinical Key Disciplines Construction Project (2017ZZ02013), Sub-specialist project of Qingpu Branch of Zhongshan Hospital, Fudan university (YZK 2019-04), 2019 Hospital-level National Natural Science Foundation Incubation Project (QYP 2019-03), Science and technology development fund of Qingpu district science and technology commission in 2018 (QKY 2018-01), Academic Leader of Shanghai Qingpu District Healthcare Commission (WD2019-36), Shanghai key discipline of medicine (ZK2019B07 SZ2019- 1), NSFC(81870035), Project of Shanghai municipal commission of health and family planning (201740210). Declaration of Interests: All authors declared that they have no Conflicts of Interest. Ethics Approval Statement: This study was approved by the Ethics Committee of Jinyintan Hospital in Wuhan, China.

Social media as an emerging tool for reducing prescription opioid misuse risk factors.

Interventions are urgently needed to reduce prescription opioid misuse risk factors, including anxiety and concomitant use of sedatives. However, only a limited number of randomized controlled opioid intervention trials have been conducted. We sought to determine whether an online behavior change/support community, compared to a control Facebook group, could reduce anxiety and opioid misuse among chronic pain patients. 51 high-risk non-cancer chronic pain patients were randomly assigned to either a Harnessing Online Peer Education (HOPE) peer-led online behavior change intervention or a control group (no peer leaders) on Facebook for 12 weeks. Inclusion criteria were: 18 years or older, a UCLA Health System patient, prescribed an opioid for non-cancer chronic pain between 3 and 12 months ago, and a score of ≥9 on the Current Opioid Misuse Measure (COMM) and/or concomitant use of benzodiazepines. Participation in the online community was voluntary. Patients completed baseline and follow-up assessments on Generalized Anxiety Disorder screener (GAD-7), COMM, and frequency of social media discussions about pain and opioid use. Compared to control group participants, intervention participants showed a baseline-to-follow-up decrease in anxiety, and more frequently used social media to discuss pain, prescription opioid use, coping strategies, places to seek help, and alternative therapies for pain. Both groups showed a baseline to follow-up decrease in COMM score. Preliminary results support the use an online community interventions as a low-cost tool to decrease risk for prescription opioid misuse and its complications.

Utility of Brief Psychological Measures for Prediction of Prolonged Symptom Clearance in Concussed Student Athletes.

Variability in recovery time following sport-related concussion (SRC) is poorly understood. We explored the utility of brief mood, anxiety, and sleep questionnaires as postinjury predictors of SRC symptom clearance in adolescents. At initial visit 0-2weeks postinjury, concussed athletes aged 12-18 years self-reported injury/medical factors (prior concussion, loss of consciousness, amnesia, and concussion symptom severity) and were administered psychological symptom measures. At 3months, medical record review determined return-to-play (RTP) date. Subjects were divided into two datasets, with the first utilized for developing cutoff scores and then validated with the second dataset. A total of 64% of the 141 participants had early RTP (within 21days postinjury), and 23% had late RTP (postinjury day 30 or later). The Generalized Anxiety Disorder Screener (GAD-7, M=2.1, SD=3.1) was the only significant predictor (p=.001), with a 1.4-fold [95% CI 1.2-1.8] increased risk for every point. No other factors in the full model discriminated recovery groups (ps>.05). Receiver operating characteristic curve analysis derived a GAD-7 cut score ≥3 (sensitivity=56.7%, specificity=74.2%, AUCs=0.63-0.79, ps<.001). Postconcussion anxiety symptoms may help identify individuals at increased risk for prolonged recovery.

Influence of Depression and Anxiety on Satisfaction and Expectation Fulfillment in Foot and Ankle Surgery

Category:Ankle, Ankle Arthritis, Arthroscopy, Bunion, Hindfoot, Midfoot/Forefoot, Sports, TraumaIntroduction/Purpose:Depression and anxiety are increasingly recognized to have a dramatic impact on patients with musculoskeletal pathologies. They complicate treatment due to complex relationships between pain, function, and affective symptoms. Depression/anxiety can cause social isolation, attention towards painful symptoms, and avoidance of physical exertion, all which may affect patient outcomes in orthopaedic surgery. Prior work has demonstrated that patients with depression/anxiety have greater preoperative expectations of foot/ankle surgery. However, no study to date has investigated the effect depression/anxiety on fulfillment of expectations and patient satisfaction postoperatively. We hypothesized that patients with preoperative depression or anxiety symptoms would have lower rates of expectation fulfillment than patients without affective disorders, particularly for expectations of pain relief and going back to normal.Methods:Patients undergoing elective foot/ankle surgery at a single center were prospectively enrolled. Demographics, diagnoses, and preoperative Foot and Ankle Outcomes Scores (FAOS) were collected. Preoperatively, patients completed an expectations survey, which asks about anticipated improvement in items including pain control, ambulation, function, and more generalized items like going back to normal and preventing foot/ankle pathology from worsening. Depression and anxiety were assessed using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder screener (GAD-7) respectively; for both surveys, scores of 10 or more were used to designate depression and anxiety. Patients repeated the expectations survey 2 years postoperatively, answering how much improvement was actually attained for each item. Patients also reported satisfaction with surgery, perception of overall improvement, extent to which expectations were fulfilled, and answered the Delighted- Terrible scale. Survey responses were compared between patients with depression and/or anxiety (D/A) and no D/A patients using t-tests and Chi-square analyses (p<0.05).Results:Of 271 total patients, 53 (20%) met criteria for D/A. D/A and no D/A patients were statistically similar in age (54.4 vs 55.7 yrs), gender (62% vs 66% female), comorbidities, education, ethnicity, and diagnoses. D/A patients had significantly worse preoperative FAOS scores and greater preoperative expectations. Postoperatively, both groups had similar proportions of expectations fulfilled (p=0.292) and improvements in FAOS scores (p>0.225). D/A patients had significantly less expectation fulfillment for ambulation tolerance (77% vs 90%, p=0.017), improving confidence in foot/ankle (77% vs 88%, p=0.049), and going back to normal (76% vs 87%, p=0.043). D/A patients were significantly more dissatisfied (21% vs 9%, p=0.013), had less perceived improvement, and were less likely to want to repeat surgery (p=0.019) or recommend surgery to someone else (p=0.017).Conclusion:D/A patients had significantly lower postoperative rates of overall perceived improvement and satisfaction with surgery compared to patients without affective symptoms. A majority of D/A patients did not meet their expectations for ambulation tolerance, confidence, and returning to normal. However, despite having worse baseline outcomes scores and more preoperative expectations, patients with depression/anxiety had similar improvements in FAOS and proportions of expectations fulfilled postoperatively. Therefore, despite perceived poor outcomes, D/A patients have similar improvements in outcomes and expectation fulfillment. These findings may improve surgeon/patient communication and management of expectations.

The development and psychometric evaluation of the Chinese Big Five Personality Inventory-15.

The Chinese Big Five Personality Inventory (CBF-PI), a 134-item self-report scale, and its 40-item brief version (CBF-PI-B) are sound psychometric instruments used to measure the Big Five personality domains in the Chinese population. However, their applicability is limited by their length, as well as restricted by assessment conditions. In this study, we developed and validated a new shortened version with 15 items (CBF-PI-15) through exploratory factor analysis and confirmatory factor analysis in a large sample (Sample 1) of 10,738 Chinese adults (mean = 33.90 years, SD = 9.39 years, range 17–57 years). Measurement invariance results suggested the CBF-PI-15 were invariant across gender and age groups. Convergent, discriminant and criterion validities were tested in Sample 2 (N = 256, mean = 21.62 years, SD = 3.06 years, range 18–35 years) and findings showed an expected correlational pattern with external variables. Results revealed positive correlations of Neuroticism with the Barratt Impulsiveness Scale Brief Version (BIS-Brief), the Patient Health Questionnaire, and the Generalized Anxiety Disorder Screener, as well as a strongly negative correlation between Conscientiousness and BIS-Brief. Additionally, Conscientiousness positively correlated with academic performance as expected. In conclusion, the CBF-PI-15 holds promise as an informative alternative for the original CBF-PI-B when administration time or conditions are limited, and our findings provide preliminary support for the utility of the CBF-PI-15.

Are ‘neurotypical controls’ really neurotypical? Individual differences in mental health traits in ‘control’ populations

Are ‘neurotypical controls’ really neurotypical? Individual differences in mental health traits in ‘control’ populations

Does Duration of Pain at Baseline Influence Clinical Outcomes of Low Back Pain Patients Managed on an Evidence-based Pathway?

Longitudinal observational study. To investigate the association between the duration of pain at baseline and the clinical outcomes of patients with low back pain (LBP) enrolled on the North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP). The NERBPP is a clinical pathway based upon National Institute for Health and Care Excellence (NICE) guidelines (2009) for LBP of <1-year duration. Recent changes to NICE guidelines (2016) advocate the same management for all LBP patients regardless of pain duration. Patients with LBP referred onto the NERBPP by their General Practitioner between May 2015 and January 2017 were included. Data from 667 patients, who provided pre- and post data for pain (Numerical rating scale), function (Oswestry Disability Index), quality-of-life (EuroQol five-dimension, five-level questionnaire), anxiety (the Generalized Anxiety Disorder Screener), and depression (the Patient Health Questionnaire), were analyzed using a series of covariate-adjusted models. Patients were categorized into four groups based upon baseline pain duration: <3 months, ≥3 to <6 months, ≥6 months to <12 months, ≥12 months. Each group showed improved outcomes greater than the minimal clinically important difference (MCID) for each measure as defined in NICE guidelines (2016). There was a trend toward better outcomes for those with shorter pain durations. The magnitude of the differences between the groups, in most instances, was below the MCID. For example, mean improvement in function for those with baseline pain duration <3 months was 20 points and 12 points for those of pain duration ≥12 months, both above the MCID of ≥10. Patients with different durations of LBP at baseline improved on the NERBPP, supporting the recent modification to NICE guidelines. However, those with shorter durations of pain may have superior outcomes in the short term, suggesting added benefit in getting patients onto the pathway in the early stages of LBP. 3.

The Generalized Anxiety Disorder Screener (GAD‐7) and the anxiety module of the Hospital and Depression Scale (HADS‐A) as screening tools for generalized anxiety disorder among cancer patients

Anxiety in cancer patients may represent a normal psychological reaction. To detect patients with pathological levels, appropriate screeners with established cut-offs are needed. Given that previous research is sparse, we investigated the diagnostic accuracy of 2 frequently used screening tools in detecting generalized anxiety disorder (GAD). We used data of a multicenter study including 2141 cancer patients. Diagnostic accuracy was investigated for the Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital Anxiety and Depression Scale (HADS-A). GAD, assessed with the Composite International Diagnostic Interview for Oncology, served as a reference standard. Overall accuracy was measured with the area under the receiver operating characteristics curve (AUC). The AUC of the 2 screeners were statistically compared. We also calculated accuracy measures for selected cut-offs. Diagnostic accuracy could be interpreted as adequate for both screeners, with an identical AUC of .81 (95% CI: .79-.82). Consequently, the 2 screeners did not differ in their performance (P=.86). The best balance between sensitivity and specificity was found for cut-offs ≥7 (GAD-7) and ≥8 (HADS-A). The officially recommended thresholds for the GAD-7 (≥ 10) and the HADS-A (≥11) showed low sensitivities of 55% and 48%, respectively. The GAD-7 and HADS-A showed AUC of adequate diagnostic accuracy and hence are applicable for GAD screening in cancer patients. Nevertheless, the choice of optimal cut-offs should be carefully evaluated.

Comorbidities confounding the outcomes of surgery for third window syndrome: Outlier analysis.

ObjectivePatients with third window syndrome and superior semicircular canal dehiscence (SSCD) symptoms whose surgical outcomes placed them as outliers were systematically studied to determine comorbidities that were responsible for their poor outcomes due to these confounding factors.Study DesignObservational analytic case‐control study in a tertiary referral center.MethodsTwelve adult patients with clinical SSCD syndrome underwent surgical management and had outcomes that did not resolve all of their subjective symptoms. In addition to one of the neurotologists, 2 neurologists (one specializing in migraine and the other a neuro‐ophthalmologist), and a psychologist clinician‐investigator completed comprehensive evaluations. Neuropsychology test batteries included: the Millon Behavioral Medicine Diagnostic; Patient Health Questionnaire (PHQ‐9) and Generalized Anxiety Disorder Screener (GAD‐7); Adverse Childhood Experiences Scale; the Wide Range Assessment of Memory and Learning, including the 3 domains of verbal memory, visual memory, and attention/concentration; Wechsler Adult Intelligence Scale; and the Delis‐Kaplan Executive Function System. The control cohort was comprised of 17 participants who previously underwent surgery for third window syndrome that resulted in the expected outcomes of resolution of their third window syndrome symptoms and cognitive dysfunction.ResultsThere was a high rate of psychological comorbidity (n = 6) in the outlier cohort; multiple traumatic brain injuries were also a confounding element (n = 10). One patient had elevated cerebrospinal fluid (CSF) pressure requiring ventriculoperitoneal shunting to control the recurrence of dehiscence and one patient with a drug‐induced Parkinson‐like syndrome and idiopathic progressive neurological degenerative process.ConclusionsComponents of the Millon Behavioral Medicine Diagnostic, PHQ‐9 and GAD‐7 results suggest that these instruments would be useful as screening tools preoperatively to identify psychological comorbidities that could confound outcomes. The identification of these comorbid psychological as well as other neurological degenerative disease processes led to alternate clinical management pathways for these patients.Level of Evidence2b.

Preventing intimate partner violence via the Internet: A randomized controlled trial of emotion-regulation and conflict-management training for individuals with aggression problems.

The aim of this randomized controlled trial was to investigate the effect of an Internet-delivered cognitive behaviour therapy (iCBT), which incorporated emotion-regulation and conflict-resolution techniques, on intimate partner violence (IPV). Another aim was to test the theoretical underpinnings of the treatment model using mediation analysis. Sixty-five participants with aggression problems in intimate adult relationships were recruited from the community and were randomly assigned to iCBT or to a monitored waitlist control. Participants were assessed with standardized self-report measures of IPV or aggression (Multidimensional Measure of Emotional Abuse, Revised Conflict Tactics Scale, and Aggression Questionnaire), relationship quality (Dyadic Adjustment Scale), anxiety or depression symptomatology (Patient Health Questionnaire; Generalized Anxiety Disorder Screener), at pretreatment, posttreatment (8weeks), and 1-year follow-up. Process variables (subscales of Dysfunctional and Emotional Regulation Scale and Anger Rumination Scale) were assessed weekly over the active treatment phase. Robust linear regression analysis of all randomized participants showed significant treatment effects on emotional abuse relative to control at postassessment. Mediation analysis using growth curve modeling revealed that the treatment effect was partially mediated by changes in emotion-regulation ability. Controlled effects on secondary outcomes were also observed. Analyses of uncontrolled effects indicted that gains on IPV were maintained at 1-year follow-up. iCBT focusing on enhancing conflict-resolution skills and emotion-regulation ability has the potential to reduce IPV among self-recruited individuals with mild forms of abusive behaviour in intimate relationships. Emotion-regulation ability is potentially a key therapeutic process of change. Internet-delivered clinician-guided cognitive behaviour therapy is a viable treatment option for reducing intimate partner violence among self-recruited individuals with mild forms of abusive behaviour. For persons who display patterns of frequent and severe violence, other treatments are most likely needed. Emotion-regulation training is potentially a key therapeutic component that ought to be incorporated in interventions targeting IPV.