Generalized Anxiety Disorder Symptoms Research Articles

Interpersonal contrast avoidance as a mechanism for the maintenance of worry

Despite consistent links between interpersonal problems and worry, mechanisms explaining this relationship remain unknown. The Contrast Avoidance Model (CAM; Newman & Llera, 2011) posits that individuals at risk for chronic worry and generalized anxiety disorder (GAD) fear sudden negative mood shifts, using worry to perpetuate negative moods and avoid these negative emotional contrasts. We propose interpersonal (IP) contrast avoidance (e.g., acting friendly to prevent others from causing mood shifts) as a novel explanation for interpersonal dysfunction in worriers. This study investigated IP contrast avoidance and worry in two samples. A nonclinical sample ranging in GAD symptoms (Study 1; N = 92) reported IP problems at baseline then IP contrast avoidance and worry over eight weeks (637 diaries). As expected, baseline IP problems prospectively predicted worry indirectly through chronic IP contrast avoidance. Affiliative, submissive, cold, and total IP contrast avoidance strategies predicted same-week and lagged next-week worry increases; affiliative, submissive, and total strategies also predicted maintenance of worry over eight weeks in growth models. Lastly, Study 2 showed the relevance of IP contrast avoidance strategies in a treatment-seeking clinical sample (N = 40), correlating with interpersonal problems and worry. Overall, results provide proof-of-concept for extending the CAM to the interpersonal domain.

Factors associated with burnout in Polish healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has placed the healthcare system under substantial strain that has caused elevated psychological distress among healthcare workers (HCWs). Previous studies have found a high prevalence of burnout among HCWs exacerbated by the COVID-19 pandemic and have delineated some associated factors, but further research is needed. Little is known, for example, whether the economic status of HCWs or experiencing negative and positive emotions contribute to burnout. The present study was meant to fill this gap. A total of 412 HCWs (i.e.: nurses - 47%, physicians-28%, psychologists-14%, and other healthcare professionals-11%), aged 21-69 years (M = 36.63; SD = 11.76) participated in a web-based cross-sectional study. Data was collected from June to November 2020. The participants filled out measures assessing two dimensions of burnout (Exhaustion and Disengagement), depression, generalized anxiety, positive and negative emotions, along with the survey evaluating organizational aspects of their work during the pandemic. Burnout thresholds were met by 54 and 66% of respondents for Disengagement and Exhaustion, respectively, which is high but comparable to levels found in other countries during the pandemic. Similarly to previous work, depression and anxiety were high in HCWs, with 24 % of them being in the risk group for clinical severity of depression and 34% in the risk group for a clinical generalized anxiety disorder (GAD). Regression analysis showed that the intensity of negative emotions was the strongest predictor of Exhaustion, whereas the intensity of positive emotions was the strongest predictor of Disengagement. Depression and GAD symptoms were positively related to Exhaustion, and economic status was inversely related to Disengagement. These results suggest that distress in HCWs during the pandemic was related to symptoms of burnout, whereas higher income and experiencing positive emotions were associated with reduced burnout levels. Our findings call for the development of burnout intervention programs that could build capacities for dealing with depression and other negative emotions and at the same time teach skills on how to increase positive emotions in HCWs.

Ayurvedic management of Generalised Anxiety Disorder (GAD) induced insomnia- A case report

This case report is the description of Ayurvedic management of Generalised Anxiety Disorder (GAD) induced insomnia of a 22 years old male. Apart from insomnia, the patient suffered from both physical and psychological symptoms of GAD for about 7 months. Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Without approaching conventional medicine, patient came directly to the Out Patient Department (OPD) of Regional Ayurveda Research Institute, Thiruvananthapuram, Kerala for management. In Ayurveda, insomnia can be considered as Nidranasha; for GAD exact neck to neck correlation cannot be made. Internal medications and external procedures with nidrajanak, rasayana, Ojaskara, medhya, unmadahar properties were applied. Assessments were conducted through Hamilton Anxiety Rating Scale (HARS), GAD 7 scale, Pittsburgh Sleep Quality Index (PSQI), WHO Quality of Life- BREF, and Clinical Global Improvement scale (CGI) on Day 1, Day 20 and Day 34 of intervention. The case is unique in the sense that complete relief from all symptoms was obtained after 20 days with cost effective measures and nil side effects. Ayurvedic intervention was found to be a good alternative therapy in the management of GAD induced insomnia.

Positive relations mediate the bidirectional connections between depression and anxiety symptoms

IntroductionMajor depressive disorder (MDD) and generalized anxiety disorder (GAD) co-occur at high rates, often preceding and predicting one another over long durations. Interpersonal theories propose that relationships with others may contribute to the longitudinal connections between MDD and GAD. Therefore, the current study examined the mediational effect of positive relations with others in these connections over 18 years. MethodsCommunity-dwelling adults (n = 3294) participated in data collection at three time-points (Time 1 [T1], Time 2 [T2], and Time 3 [T3]) spaced about nine years apart. MDD and GAD symptoms were assessed using the Composite International Diagnostic Interview–Short Form. Positive relations was measured with the Psychological Well-Being Scale–Positive Relations with Others subscale. Structural equation mediation modeling was used for data analysis. ResultsResults indicated that lower T2 positive relations significantly mediated the relationship between higher T1 MDD severity predicting more severe T3 GAD symptoms (d = 0.375) and explained 10.7% of the variance. T2 positive relations also had a significant mediational effect in the association between T1 GAD symptoms positively predicting T3 MDD severity (d = 0.360), accounting for 12.2% of the variance of this connection. These mediational effects were significant after adjusting for age, gender, education, and T1 symptoms (d = 0.277–0.677). ConclusionsSupporting interpersonal theories, lack of positive relations with others mediated the bidirectional connections between MDD and GAD symptoms across 18 years. Future research should continue to explore the influence of positive relations on mental health and whether treatments that enhance interpersonal functioning could improve treatment for depression and anxiety.

Do Proximal Risk Factors Mediate the Impact of Affect on Symptoms of Generalized Anxiety Disorder and Major Depressive Disorder? An Extension of the Hierarchical Model of Cognitive Vulnerability

Background: Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are among the most prevalent forms of psychopathology. The hierarchical model of cognitive vulnerability proposes that higher order risk factors explain co-occurrence among internalizing disorders, whereas lower order risk factors explain discordance. Methods: Participants (N = 646; mean age = 38.50, SD = 10.00; 49.2% female) were recruited from Amazon MTurk to complete self-report questionnaires related to psychopathology in the summer of 2020. Structural equation modeling was used to examine the relations that negative affect (NA) and positive affect (PA) share with MDD and GAD, through rumination and intolerance of uncertainty (IU), cross-sectionally. Results: When modeling both IU and depressive rumination together as explaining the indirect effects from affect to psychopathology, the association between NA and symptoms of MDD was explained by depressive rumination. There were no indirect effects from PA to MDD or GAD symptoms. When modeled separately, both risk factors explained the associations NA shared with MDD and GAD symptoms. Conclusions: The present study extends the hierarchical model of cognitive vulnerability by finding that depressive rumination explains the association between NA and symptoms of MDD, even when controlling for IU.

The relationship between problematic internet use and anxiety disorder symptoms in youth: Specificity of the type of application and gender

During adolescence, some youth develop anxiety disorders such as social anxiety disorder (SAD) or generalized anxiety disorder (GAD). However, few studies have been conducted to understand the specific contribution of SAD and GAD to Problematic Internet Use (PIU). In order to adapt intervention strategies, a specific understanding of the contribution of each of these disorders to PIU is necessary. The goal of this study is to evaluate the unique contributions of GAD, SAD, self-esteem, gender, preferred Internet application (video game or social media) and stressful events among PIU adolescents. The sample was constituted of 2883 adolescents (44.3% boys; age 14.61 years) recruited in high schools. Two groups of problematic Internet users were formed based on their time spent on video games (PIU-VG) or social media (PIU-SM). A multinomial logistic regression model showed that self-identifying as girl, living with GAD symptoms, reporting many stressful events and low self-esteem increase the risk of PIU-SM. Likewise, self-identifying as boy, having SAD symptoms, reporting stressful events and low self-esteem increase the risk of PIU-VG. GAD appears to be specifically associated with problematic social media use and SAD with problematic video games use. Results suggest the importance of considering specific anxiety disorders in adolescent PIU evaluation and intervention.

Reducing anxiety and attentional bias with reward association learning and attentional bias modification.

The current study examined the effects of a reward associative learning procedure and the traditional threat-avoidance ABM paradigm on anxiety and attentional bias. In reward training, participants were given high rewards for correct responses to neutral target and low rewards for correct responses to negative target. In reward control training, participants received no cues of rewards after their responses. High trait anxious individuals (N = 76) first completed a session of reward training or reward control training, followed by four sessions of ABM training or ABM control training. Generalized anxiety disorder symptom (GAD-7) and attentional bias in a dot-probe task were assessed during pre-and post-training. Results indicated that the effect of ABM training on reducing anxiety was only obtained in the reward training condition. Participants who received reward training showed significantly less attentional bias compared with those receiving reward control training. There was no significant training effect of ABM on atttentiona bias. Results suggested that reward training reduced general anxiety and attentional bias. Traditional ABM training reduced anxiety only when combined with reward training. Attentional bias in anxiety are modifiable through reward training.

Longitudinal analyses of depression, anxiety, and suicidal ideation highlight greater prevalence in the northern Dutch population during the COVID-19 lockdowns

BackgroundThe pandemic of the coronavirus disease 2019 (COVID-19) has led to an increased burden on mental health. AimsTo investigate the development of major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicidal ideation in the Netherlands during the first fifteen months of the pandemic and three nation-wide lockdowns. MethodParticipants of the Lifelines Cohort Study –a Dutch population-based sample-reported current symptoms of MDD and GAD, including suicidal ideation, according to DSM-IV criteria. Between March 2020 and June 2021, 36,106 participants (aged 18–96) filled out a total of 629,811 questionnaires across 23 time points. Trajectories over time were estimated using generalized additive models and analyzed in relation to age, sex, and lifetime history of MDD/GAD. ResultsWe found non-linear trajectories for MDD and GAD with a higher number of symptoms and prevalence rates during periods of lockdown. The point prevalence of MDD and GAD peaked during the third hard lockdown at 2.88 % (95 % CI: 2.71 %–3.06 %) and 2.92 % (95 % CI: 2.76 %–3.08 %), respectively, in March 2021. Women, younger adults, and participants with a history of MDD/GAD reported significantly more symptoms. For suicidal ideation, we found a significant linear increase over time in younger participants. For example, 20-year-old participants reported 4.14× more suicidal ideation at the end of June 2021 compared to the start of the pandemic (4.64 % (CI: 3.09 %–6.96 %) versus 1.12 % (CI: 0.76 %–1.66 %)). LimitationsOur findings should be interpreted in relation to the societal context of the Netherlands and the public health response of the Dutch government during the pandemic, which may be different in other regions in the world. ConclusionsOur study showed greater prevalence of MDD and GAD during COVID-19 lockdowns and a continuing increase in suicidal thoughts among young adults suggesting that the pandemic and government enacted restrictions impacted mental health in the population. Our findings provide actionable insights on mental health in the population during the pandemic, which can guide policy makers and clinical care during future lockdowns and epi/pandemics.

Initial assessment of the feasibility and efficacy of a scalable digital CBT for generalized anxiety and associated health behaviors in a cardiovascular disease population

Generalized anxiety disorder (GAD) is a significant yet modifiable risk factor for worse cardiovascular disease (CVD) outcomes. The treatment of GAD in an accessible manner represents an unmet need in CVD, given that patients with CVD experience numerous barriers to in-person treatment engagement. This paper presents the rationale and design for an investigation of a strategy to enhance care for patients with CVD by introducing a scalable, affordable, and system-friendly digital intervention that targets a prominent modifiable risk factor (generalized anxiety and associated worry) for negative health behaviors in CVD. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the degree to which a digital cognitive behavior therapy (dCBT), relative to a waitlist control group, engages anxiety and worry outcomes in a sample of 90 adults who have experienced an acute CVD event and who have comorbid GAD symptoms. We also investigate the degree to which dCBT leads to greater changes in GAD symptoms compared to the control condition and whether reductions in these symptoms are associated with corresponding reductions in cardiac anxiety and cardiac health behaviors (including smoking, physical activity, heart-healthy diet, and medication adherence). We propose that by targeting GAD symptoms in CVD in a way that does not tax ongoing medical care provision, we have the potential to improve the uptake of effective care and address both GAD and associated health behaviors.

The importance of recognizing worthlessness for suicide prevention in adolescents with Attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric diagnoses among children and adolescents. Depression and general anxiety disorder (GAD) are often co-occurring with ADHD among children and adolescents. Previous studies have found that ADHD, depression and GAD are all strongly correlated with suicidal thoughts and planning. The current study aimed to further explore the association between ADHD, GAD and depressive symptoms as well as their association with suicidal thoughts and planning among adolescents. Adolescents with ADHD diagnosis were involved from child psychiatry outpatient clinics and adolescents without a psychiatric treatment or diagnosis were enrolled from high schools in Hungary. The Mini International Neuropsychiatric Interview for Children and Adolescents was used to evaluate psychiatric symptoms and disorders as well as suicidal thoughts and planning. Regularized psychological networks were used to investigate the associations. Altogether 185 adolescents (58 females and 127 males; mean age 14.79 years, SD = 1.48), 89 with ADHD and 96 without ADHD were enrolled. Depression symptom worthlessness was directly related to suicidal thoughts and planning, CI95 of the logit B between worthlessness and suicidal thought (0.72, 1.66). Both ADHD and anxiety were indirectly related to suicidal thoughts and planning through depression: CI95 of the logit B between being disorganized and feeling worthless is (0.38, 3.02), and CI95 of the logit B between being distressed and feeling worthless is (0.57, 2.52). This study draws the attention of clinicians to the importance of recognizing "worthlessness" for suicide prevention in adolescents with ADHD. Furthermore, the results support previous studies, whereby symptoms of depression and anxiety mediate the relationship between ADHD and suicidal thoughts and planning. These results highlight the importance of ADHD comorbidities with depression and GAD and their effect on suicidal thoughts and planning.

Effect of Internet-mediated music therapy intervention on reduction in generalized anxiety disorder symptoms among displaced Nigerians of the Russia–Ukraine war

This study aimed to ascertain the usefulness of music therapy as an intervention for reducing the symptoms of generalized anxiety disorder (GAD) among Nigerian students who were evacuated from Ukraine as a result of the Russia–Ukraine war. The researchers sampled 401 students who were enrolled in different degree programs in Ukraine but displaced due to the war. The researchers assigned 201 students to no music therapy group and 200 to a music therapy group. The evacuees from the music therapy group took part in 12 music therapy sessions delivered to them through an Internet-mediated platform (Zoom). The result of the study showed that before the music therapy treatment, participants in both groups reported severe anxiety. After the intervention, participants in the control group still reported severe anxiety (even though their score dropped slightly from 16.8 to 16.1). However, their counterparts in the music therapy group dropped significantly from severe to mild anxiety. During the follow-up evaluation, participants in the music therapy further dropped significantly from mild to minimal anxiety. In contrast, those in the no music therapy slightly dropped to moderate anxiety disorder. The implications of these results on the field of music as a public health tool have been explored.

Long-Term Management of Generalised Anxiety Disorder with Low-Dose Continuous Infusions of Flumazenil: A Case Series

Generalised anxiety disorder (GAD) is a common anxiety disorder associated with social and occupational impairment. Recently, a theory was postulated that dysfunctional gamma aminobutyric acid type A receptors (GABAA) are implicated in anxiety symptomology, which could be corrected by flumazenil, an antagonist at the benzodiazepine binding site on the GABAA receptor. Participants had a primary diagnosis of GAD and were treated initially with an eight-day continuous low-dose flumazenil infusion (total 32 mg at a rate of 4 mg/24 h). Some participants were re-treated with a further four- or eight-day infusion. Treatment response was measured as a 50% reduction in anxiety or stress scores on the Depression Anxiety Stress Scale-21 (DASS-21). Remission was measured as scores ≤3 or ≤7 on the anxiety and stress subscales of the DASS-21, respectively. Eight cases are reported. All cases met the criteria for treatment response on the anxiety and stress subscale of the DASS-21. Remission was achieved in seven participants on the anxiety subscale and in five on the stress subscale. No changes in hepatic, renal, or haematological function were likely attributed to flumazenil. Data suggest that low-dose continuous flumazenil infusion manages GAD symptoms and is safe. Although these results are promising, future randomised control trials are required to confirm these results.

Community Violence Exposure and Generalized Anxiety Symptoms: Do Callous-Unemotional Behaviors Moderate this Relation Among Urban Youth?

Community violence exposure (CVE; i.e., direct victimization and witnessed violence) is a major public health concern among youth who reside in low income, urban neighborhoods, who tend to experience CVE chronically and disproportionately. Frequent CVE is associated with generalized anxiety disorder (GAD) symptoms, such as persistent or excessive worry and difficulty concentrating. However, not all youth experiencing CVE exhibit such symptoms. One understudied factor that may moderate this relation is callous-unemotional (CU) behaviors (e.g., behaviors consistent with lack of guilt, low levels of empathy). CU behaviors are associated with lower levels of responsiveness to contextual processes; as such, CU behaviors may be associated with lower levels of GAD symptoms in the context of CVE. However, little research considers CU behaviors and GAD symptoms concurrently. To address this gap, the present study examined associations among witnessed and direct CVE, CU behaviors, and GAD symptoms among low-income, urban youth (N = 104, 50% male, Mage = 9.93 ± 1.22 years old, 95% African-American/Black). Multiple regression analyses indicated teacher-reported CU behaviors moderated the relations between CVE and caregiver-reported GAD symptoms. Post-hoc probing revealed that among youth with higher levels of CVE, higher levels of CU behaviors were associated with elevated GAD symptoms compared to their peers with lower levels of CU behaviors. Youth with lower levels of CU behaviors evidenced moderate levels of GAD symptoms regardless of their levels of CVE. Thus, low-income, urban youth who experience elevated levels of CVE may be at increased risk for co-occurring GAD and CU symptoms.

Generalized Anxiety Disorder: Does the Emotion Dysregulation Model Predict Symptoms Beyond the Metacognitive Model?

While the Metacognitive Model (MCM) of generalized anxiety disorder (GAD) is well-established, the Emotion Dysregulation Model (EDM) of GAD has received less attention. This study examined whether the EDM helps explain GAD above and beyond the MCM. The influence of gender was also explored. A non-clinical university sample (N = 626) completed measures of GAD symptoms, worry severity, the MCM, and the EDM. In support of the EDM, it was found that fear of depression predicted GAD symptoms for men, while fear of anxiety predicted GAD symptoms for women. However, across genders, the strongest predictor of GAD symptoms and worry severity was negative beliefs about worry. While these findings support the MCM view that holding the beliefs that worry is harmful and dangerous is the strongest predictor of GAD overall, incorporating aspects of the EDM into our understanding and treatment of GAD may be beneficial.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10942-022-00479-7.

Do You See What I See? Longitudinal Associations Between Mothers’ and Adolescents’ Perceptions of Their Relationship and Adolescent Internalizing Symptoms

This 6-year community study examined how discrepancies in mothers’ and adolescents’ perceptions of their relationship were longitudinally associated with adolescent internalizing symptoms, and vice versa. 497 adolescents (57% boys, Mage T1 = 13.03, SDage = 0.46) and their mothers reported in 6 annual waves on conflict and warmth in the mother-adolescent relationship and adolescents reported on their depressive and Generalized Anxiety Disorder (GAD) symptoms. Latent Congruence Models suggested that both adolescent depressive and GAD symptoms significantly predicted higher levels of conflict as well as stronger discrepancies in perceptions of conflict 1-year later. In turn, higher levels of conflict significantly predicted both adolescent depressive and GAD symptoms 1-year later. For warmth, lower levels significantly predicted adolescent depressive symptoms 1-year later. Concluding, these findings suggest (1) more systematic evidence for longitudinal associations between conflict than warmth in the mother-adolescent relationship and adolescent internalizing symptoms; (2) support for a transactional model, including support for both interpersonal scar or symptom-driven effects (concerning both levels of and mother-adolescent discrepancies in conflict) and interpersonal risk or relationship-driven effects (concerning levels of both conflict and warmth); (3) longitudinal effects from adolescent internalizing symptoms to mother-adolescent discrepancies, but not vice versa; and (4) strong consistency in patterns of findings across both adolescent depressive and GAD symptoms, with few differential longitudinal associations with aspects of mother-adolescent relationship quality. Thereby, this study provides a more nuanced understanding of the direction of effects between adolescent internalizing symptoms and both levels of and discrepancies in mothers’ and adolescents’ perceptions of their relationship.

Correlates of Dampening and Savoring in Generalized Anxiety Disorder.

Chronic worry and generalized anxiety disorder (GAD) symptoms are associated with infrequent savoring, and high dampening, of positive emotions. The goal of the present study was to investigate the indirect role of GAD-relevant processes, including intolerance of uncertainty (IU), fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation, in the relationship between GAD symptom severity and the tendency to engage in dampening and not savor positive emotions. Community participants (N = 233) completed questionnaires online.In separate models, IU, fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation fully mediated the relationships between GAD symptom severity and greater dampening and lower savoring. However, controlling for depression, only IU remained a significant mediator. A post hoc latent analysis of the mediators provided support for an underlying construct that may reflect intolerance of uncomfortable states. Intolerance of uncomfortable states was found to significantly mediate the relationship between GAD symptoms and greater dampening and lower savoring. Difficulty withstanding uncertainty may be particularly relevant in understanding why people with elevated GAD symptoms engage in efforts to avoid experiencing positive emotions. Further, the findings suggest that there may be a common factor underlying a variety of GAD-associated constructs reflecting a broad intolerance of uncomfortable inner states. Theoretical and clinical implications are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41811-022-00145-x.

Childhood behavioral inhibition and attachment: Links to generalized anxiety disorder in young adulthood.

Generalized anxiety disorder (GAD) is under-treated yet prevalent among young adults. Identifying early risk factors for GAD would contribute to its etiological model and identify potential targets for intervention. Insecure attachment patterns, specifically ambivalent and disorganized, have long been proposed as childhood risk factors for GAD. Similarly, childhood behavioral inhibition has been consistently associated with anxiety disorders in adulthood, including GAD. Intolerance of uncertainty (IU), the tendency to react negatively to uncertain situations, has also been shown to be a crucial component of GAD. Furthermore, maternal anxiety is an important feature of developmental models of anxiety including GAD. Yet, to date, no study has examined, within a comprehensive model, how attachment and behavioral inhibition in childhood, maternal anxiety in adolescence, and IU in emerging adulthood contribute to GAD in adulthood. The present study thus examines these links using a longitudinal design with 62 Canadian participants and their mothers. At age 6, participants' attachment and behavioral inhibition were assessed observationally. Maternal anxiety was measured when participants were 14 years of age. IU and GAD were assessed when participants were 21 and 23 years of age, respectively. Structural equation modeling showed that IU mediates the relationships between behavioral inhibition and GAD, while controlling for maternal anxiety. Ambivalent and disorganized-controlling attachment patterns are also indirectly associated with increased GAD symptoms via greater IU scores. Furthermore, a direct and positive effect of behaviorally disorganized attachment was found on GAD symptoms. This longitudinal study supports integrating attachment, behavioral inhibition, and IU in a model of GAD.

Mental health of the Slovak population during COVID-19 pandemic: A cross-sectional survey.

BACKGROUNDPopulation’s mental health surveillance is essential for knowing the distribution of mental well-being and mental disorders in the society. This allows for the establishment, evaluation, and revision of preventive measures and curative services. The results of such monitoring should serve as a database for evidence-based mental health policy. Mental disorders are among the top ten causes of burden globally and crisis situations such as the pandemic increase the risk of mental health problems, as they cause constant fear of contagion and the implementation of restrictive measures. The impact of the coronavirus disease 2019 (COVID-19) pandemic on the general population of the Slovak Republic has not yet been studied. The hypothesis was that more than one fifth of the population (women to a greater extent) will have symptoms of anxiety and depression.AIMTo assess the mental health of the general Slovak population aged 15 years and older in the summer of 2021 by determining the prevalence of depressive and anxiety symptoms.METHODSAn anonymous cross-sectional survey was implemented in a sample of 1501 respondents in the summer of 2021 during the COVID-19 pandemic. The inclusion criteria were age of 15 years and older and ability to complete the survey questionnaire online or in a face-to-face interview. The survey assessed anxiety symptoms by the seven-item general anxiety disorder and depressive symptoms by the nine-item patient health questionnaire instruments. Recognized cut-off scores of 10 or greater were used for both. RESULTSAnxiety symptoms were present in 19.32% and depression in 24.65% of the sample. Symptoms of both disorders were more common in females: 15.00% of males and 24.00% of females experienced anxiety symptoms, and 19.00% of males and 30.00% of females experienced symptoms of depression. Symptoms of both disorders were the most common in the youngest age group (15-25 years old): One fifth of males (20.29%) and one third of females (35.32%) had symptoms of anxiety, and 26.09% males and 43.79% females had symptoms of depression. Mean score for anxiety was 5.44 [standard deviations (SD) = 4.96] for the overall sample, 6.15 (SD = 5.14) for females, and 4.67 (SD = 4.63) for males. The youngest females of the 15-25 years age group had the highest score (7.55, SD = 5.27) among all age groups, for both sexes. Mean score for depression was 6.74 for the overall sample (SD = 5.75), 7.43 for females (SD = 5.87), and 5.99 (SD = 5.52) for males. The highest depression score was observed in the youngest females of the 15-25 years age group (9.34, SD = 6.07). We found a significant association between anxiety or depressive symptoms and younger age [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.16-2.45 and OR: 1.65, 95%CI: 1.17-2.34, respectively], being female (OR: 1.86, 95%CI: 1.42-2.42 and OR: 1.76, 95%CI: 0.20-0.29, respectively), and having primary education (OR: 1.66, 95%CI: 1.08-2.54 and OR: 1.65, 95%CI: 1.16-2.63, respectively).CONCLUSIONResults of our study indicate that anxiety and depression are frequent in the Slovak Republic during the COVID-19 pandemic. This important observation should serve as an information basis for the development of effective mental health policies, consisting of preventive programs, and early detection and effective treatment services. The study results provide strong argument for the necessity of mental health reform that is currently being shaped in the Slovak Republic.

Anxiety Screening among the General Population of Latvia and Associated Factors.

Background and Objectives: The aim of this study was to determine the point prevalence of at least mild anxiety symptoms and symptoms of generalized anxiety disorder in the Latvian general population, and to analyze the associated factors. Materials and Methods: A computer-assisted face-to-face survey was conducted in 2019–2020 with a multistage stratified probability sample of the Latvian general adult population (n = 2687). Anxiety was assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale; a score of ≥5 was defined as indicating the presence of mild symptoms of anxiety, and a score of ≥10 as the cutoff for identifying cases of generalized anxiety disorder. The Patient Health Questionnaire 9 (PHQ-9) and MINI International Neuropsychiatric Interview (M.I.N.I.) modules were used for assessing comorbid conditions. Multinomial logistic regression was conducted. Results: The point prevalence of mild anxiety symptoms was 10.9%. The point prevalence of generalized anxiety disorder symptoms was 3.9%. Higher odds of mild anxiety symptoms were detected in respondents of a young age (vs. 65 y.o. and older, aOR 3.1, p < 0.001), unmarried respondents (vs. married/cohabiting, aOR 1.5, p = 0.02), those living in the capital city (aOR 1.6, p = 0.008) or rural areas (aOR 1.5, p = 0.03) (vs. other towns), respondents with poor self-rated health (vs. good, aOR 2.6, p < 0.001), and diagnosed alcohol use disorder (aOR 1.9, p < 0.001), suicidal behavior (aOR 2.4, p < 0.001), and symptoms of depression (aOR 6.4, p < 0.001) (vs. no such conditions). As for symptoms of generalized anxiety disorder, female sex (vs. males, aOR 2.5, p = 0.003), age below 44 years (vs. 65+, aOR 6.2, p = 0.002), average self-rated health (vs. good, aOR 2.6, p = 0.005), and poor self-rated health (vs. good, aOR 5.3, p < 0.001), together with comorbid suicidal behavior (aOR 6.1, p < 0.001) and symptoms of depression (aOR 43.4, p < 0.001) (vs. no such conditions), increased the odds. Conclusions: Young age, poor self-rated health, and comorbid symptoms of depression and suicidal behavior were significant factors associated with symptoms of both mild anxiety and generalized anxiety disorder. Being unmarried, living in the capital city or rural areas, and alcohol use disorder were associated with mild anxiety symptoms alone. Female sex was associated with generalized anxiety disorder symptoms alone.

Integrating Mindfulness and Acceptance Into Traditional Cognitive Behavioral Therapy During the COVID-19 Pandemic: A Case Study of an Adult Man With Generalized Anxiety Disorder.

Generalized Anxiety Disorder (GAD) can be chronic and impairing, highlighting the need for effective treatments. Although Cognitive Behavior Therapy (CBT) is an effective treatment for GAD, a number of patients continue to report GAD symptoms treatment. Integrating evidenced-based treatment components into CBT treatments, such as mindfulness- and acceptance-based treatment components found in Acceptance and Commitment Therapy (ACT), may help improve the efficacy of treatment. Emerging interventions and research suggest that the cognitive restructuring aspect of CBT and acceptance stance of ACT (e.g., cognitive defusion) can be implemented into treatment concurrently from a stance of increasing a patient’s coping skills repertoire and psychological flexibility. This systemic case analysis examined the efficacy and clinical utility of integrating ACT into a manualized CBT treatment for GAD. Furthermore, this study examined treatment efficacy and therapeutic alliance as the treatment rapidly and unexpectedly transitioned from in-person to telehealth due to the COVID-19 pandemic. Pre- to post-treatment and time-series analyses showed significant decreases in anxiety symptoms, worry, depressive symptoms, and emotion dysregulation. Although there was an initial increase in depressive and anxiety symptoms, worry, and emotion dysregulation following the switch from in-person to telehealth services, these quickly subsided and resumed a downward trend. The therapeutic relationship did not deteriorate during the transition to telehealth. This case study provides evidence of feasibility and efficacy of an integrated CBT/ACT approach in treating GAD. It also suggests that despite some temporary increase in symptoms, therapeutic alliance and treatment efficacy were not impacted by the switch to telehealth.