Improvement In Anxiety Symptoms Research Articles

Effects of Two Alcohol Reduction Interventions on Depression and Anxiety Symptoms of ART Clients in Vietnam.

Little is known about the potential mental health impacts of cognitive behavioral therapy and motivational interviewing interventions that focus on alcohol reduction among people with HIV (PWH). Our study aimed to assess the impact of two evidence-based alcohol reduction interventions on depression and anxiety symptoms of antiretroviral therapy (ART) clients with hazardous alcohol use. We conducted a secondary data analysis of data from a three-arm randomized controlled trial among ART clients in Thai Nguyen, Vietnam that evaluated the impacts of two alcohol reduction interventions in Vietnam. ART clients 18years old or more with hazardous alcohol use (based on the Alcohol Use Disorders Identification Test-Consumption) were enrolled and randomized into one of three arms: Combined intervention, Brief intervention, and Standard of care (SOC). Symptoms of depression, measured with the Patient Health Questionnaire-9, and anxiety, measured with the Generalized Anxiety Disorder-7 scale, were assessed at baseline and 3, 6, and 12months post-intervention. Generalized estimating equations were used to evaluate the effects of the interventions on depression and anxiety symptoms. The prevalence of depression and anxiety symptoms at baseline was 25.1% and 16.1%, respectively. Decreases in depression and anxiety symptoms were observed in all three armsfrom baseline to 12-month follow-up. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. Interventions with a dual focus on alcohol and mental health are needed to achieve more pronounced and sustainable improvements in depression and anxiety symptoms for PWH with hazardous alcohol use.

Peer-Delivered Cognitive-Behavioral Therapy for Postpartum Depression: A Randomized Controlled Trial.

Objective: To determine if a 9-week group cognitive-behavioral therapy (CBT) intervention delivered by women who have recovered from postpartum depression (peers) can effectively reduce symptoms of postpartum depression (PPD) and anxiety and improve social support and the mother-infant relationship.Methods: A sample of 73 mothers living in Ontario, Canada, were randomized into experimental and waitlist control groups between March 2018 and February 2020. Participants were ≥ 18 years of age, had an infant < 12 months old, were fluent in English, and scored ≥ 10 on the Edinburgh Postnatal Depression Scale. The experimental group completed the 9-week group CBT intervention immediately after study enrollment, while the control group did so after a 9-week waiting period. All outcomes were assessed at enrollment (n = 54) and 9 weeks later (n = 38). Outcomes were assessed in the experimental group at 6 months to assess treatment stability.Results: Peer-delivered group CBT for PPD led to clinically and statistically significant improvements in symptoms of depression (F1,47 = 22.52, P < .01) and anxiety (F1,45 = 20.56, P < .05) in the experimental group, and these improvements were stable at the 6-month follow-up. Perceptions of impaired mother-infant bonding (t15 = 3.72, P < .01) and rejection and pathological anger (t15 = 3.01, P < .01) also decreased at the 6-month follow-up in the experimental group.Conclusions: Peer-delivered group CBT for PPD effectively treats symptoms of PPD and anxiety and may lead to improvements in the mother-infant relationship. This intervention is an effective and potentially scalable means by which access to a treatment that meets the needs and wants of mothers with PPD can be increased.Trial Registration: ClinicalTrials.gov Identifier: NCT03285139.

Escitalopram more effective than exercise for anxiety in heart patients

Patients with heart disease who received the antidepressant escitalopram experienced greater improvement in anxiety symptoms compared with placebo, a 12‐week randomized trial has found. Patients in the same trial who were randomized to an aerobic exercise program experienced less consistent benefits than the escitalopram group. Study results were published online Aug. 18, 2021, in JAMA Psychiatry.

Discussion Guide for the Petrinec Article

Discussion Guide for the Petrinec Article

Repetitive transcranial magnetic stimulation therapy markedly reduces anxiety in adults with major depressive disorder: A retrospective analysis of 664 patients

Abstract Background: Patients with MDD commonly have comorbid anxiety that can severely affect quality of life and, in some cases, predicts inferior response to antidepressant treatment. Nonetheless, for some antidepressant treatments, it is also established that clinical improvement in depressive symptoms is accompanied by improvement in comorbid anxiety symptoms. However, there is limited information on the impact of treatment with TMS on the severity of comorbid anxiety symptoms in MDD patients. Methods: Patient data was extracted from a clinical registry of patients treated with left-sided high frequency TMS. Six hundred and sixty-four (664) patients were identified who demonstrated at least moderate depression and anxiety symptom severity prior to commencing treatment for MDD. These patients had total scores greater than 10 on both the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Patients were aged 22 to 70 years and had received a minimum course of 20 left-sided treatments. Results: GAD-7 response was defined as a postTMS decrease from baseline in GAD-7 scores ≥ 6 (minimally clinically important difference) and remission was defined as a final GAD-7 score < 5; 65.5% of patients (95% CI: 61.9%. 69.1%) were GAD-7 responders and 34% met the remission criterion. Mean change in the GAD-7 score was -8.0 ± 5.7 (p<0.0001). Mean change in total score on the PHQ-9 was -10.5±6.7 (p<0.0001), and 58.9% of patients demonstrated a 50% or greater improvement in PHQ-9 score. The correlation between change scores on the GAD-7 and PHQ-9 was 0.75 (p<00001), indicating substantial covariation. Conclusions: High frequency TMS may reduce symptoms of both anxiety and depression in adults with MDD. We will also contrast this group with significant co-morbid anxiety to MDD patients with low baseline levels of anxiety in likelihood of antidepressant response to TMS. Keywords: TMS, anxiety, depression, high frequency

Common and differential connectivity profiles of deep brain stimulation and capsulotomy in refractory obsessive-compulsive disorder.

Neurosurgical interventions including deep brain stimulation (DBS) and capsulotomy have been demonstrated effective for refractory obsessive-compulsive disorder (OCD), although treatment-shared/-specific network mechanisms remain largely unclear. We retrospectively analyzed resting-state fMRI data from three cohorts: a cross-sectional dataset of 186 subjects (104 OCD and 82 healthy controls), and two longitudinal datasets of refractory patients receiving ventral capsule/ventral striatum DBS (14 OCD) and anterior capsulotomy (27 OCD). We developed a machine learning model predictive of OCD symptoms (indexed by the Yale-Brown Obsessive Compulsive Scale, Y-BOCS) based on functional connectivity profiles and used graphic measures of network communication to characterize treatment-induced profile changes. We applied a linear model on 2 levels treatments (DBS or capsulotomy) and outcome to identify whether pre-surgical network communication was associated with differential treatment outcomes. We identified 54 functional connectivities within fronto-subcortical networks significantly predictive of Y-BOCS score in patients across 3 independent cohorts, and observed a coexisting pattern of downregulated cortico-subcortical and upregulated cortico-cortical network communication commonly shared by DBS and capsulotomy. Furthermore, increased cortico-cortical communication at ventrolateral and centrolateral prefrontal cortices induced by DBS and capsulotomy contributed to improvement of mood and anxiety symptoms, respectively (p < 0.05). Importantly, pretreatment communication of ventrolateral and centrolateral prefrontal cortices were differentially predictive of mood and anxiety improvements by DBS and capsulotomy (effect sizes = 0.45 and 0.41, respectively). These findings unravel treatment-shared and treatment-specific network characteristics induced by DBS and capsulotomy, which may facilitate the search of potential evidence-based markers for optimally selecting among treatment options for a patient.

Ketamine-assisted psychotherapy for trauma-exposed patients in an outpatient setting: A clinical chart review study

Abstract Trauma exposure across the lifespan produces risks for posttraumatic stress disorder (PTSD), depression, anxiety, as well as global disability in functioning. This retrospective clinical chart review is the first of its kind to assess the utility of sublingual ketamine-assisted body-centered psychotherapy in trauma-exposed patients in a real world clinic setting. De-identified clinical records data on self-reported symptom measures were retrospectively analyzed for patients (N = 18; M age = 45.22, SD = 12.90) entering ketamine-assisted psychotherapy treatment in an outpatient clinic between 2018 and 2020. Patients who completed six sessions of ketamine therapy reported meaningful (e.g., medium effect size) improvements in PTSD symptoms (P = 0.058; d = −0.48) and global disability in functioning (P = 0.050; d = −0.52) and statistically significant and meaningful improvements in depression (P = 0.019; d = −0.53). There were no improvements in anxiety symptoms. Sublingual ketamine-assisted psychotherapy was associated with heterogenous clinical utility among patients with trauma-exposure in an outpatient setting. This study was underpowered and unrepresentative of the population of ketamine patients in the United States. Replication of these findings is needed with larger and more diverse patient samples.

Switching from efavirenz to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide reduces central nervous system symptoms in people living with HIV.

Background:Central nervous system (CNS) symptoms after efavirenz (EFV) treatment in people living with human immunodeficiency virus (HIV) could persist and impact their quality of life. We assessed the impact of EFV-based regimen replacement with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF), which is considered an alternative option for subjects who do not tolerate EFV. Most specifically, we assessed the safety and the efficacy of E/C/F/TAF and its effects on the participants’ neuropsychiatric toxicity symptoms in a real-life setting.Methods:A prospective cohort study was conducted among virologic suppressed HIV-positive participants receiving EFV-based regimens with ongoing CNS toxicity ≥ grade 2. The participants were switched to single-pill combination regimens E/C/F/TAF and followed up for 48 weeks. The neuropsychiatric toxicity symptoms were measured using a CNS side effects questionnaire, as well as the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. The primary outcome measure was the proportion of participants experiencing grade 2 or higher CNS toxicity after EFV switch off at weeks 12, 24, and 48. Secondary endpoints included virologic and immunological responses and the effect on fasting lipids at week 48 after switch.Results:One hundred ninety-six participants (96.9% men, median age: 37.5 years, median: 3.7 years on prior EFV-containing regimens) were included in the study. Significant improvements in anxiety and sleep disturbance symptoms were observed at 12, 24, and 48 weeks after switching to E/C/F/TAF (P < 0.05). No significant change in depression symptom scores was observed. At 48 weeks after switch, HIV viral load <50 copies/mL was maintained in all of the participants, median fasting lipid levels were moderately increased (total cholesterol [TC]: 8.2 mg/dL, low-density lipoprotein cholesterol [LDL-C]: 8.5 mg/dL, high-density lipoprotein cholesterol [HDL-C]: 2.9 mg/dL, and triglyceride (TG): 1.6 mg/dL, and the TC:HDL-C ratio remained stable.Conclusions:The single-pill combination regimens E/C/F/TAF is safe and well tolerated. This study reveals that switching from EFV to E/C/F/TAF significantly reduces neuropsychiatric toxicity symptoms in people living with HIV with grade 2 or higher CNS complaints.

Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trial

BackgroundThere is a need for high-quality research regarding exercise interventions for persons with anxiety disorders. We investigate whether a 12-week exercise intervention, with different intensities, could reduce anxiety symptoms in patients with anxiety disorders. Methods286 patients were recruited from primary care in Sweden. Severity of symptoms was self-assessed using the Beck Anxiety Inventory (BAI) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Participants were randomly assigned to one of two group exercise programs with cardiorespiratory and resistance training and one control/standard treatment non-exercise group, with 1:1:1 allocation. ResultsPatients in both exercise groups showed larger improvements in both anxiety and depressive symptoms compared to the control group. No differences in effect sizes were found between the two groups. To study a clinically relevant improvement, BAI and MADRS-S were dichotomized with the mean change in the control group as reference. In adjusted models the odds ratio for improved symptoms of anxiety after low-intensity training was 3.62 (CI 1.34–9.76) and after moderate/high intensity 4.88 (CI 1.66–14.39), for depressive symptoms 4.96 (CI 1.81–13.6) and 4.36 (CI 1.57–12.08) respectively. There was a significant intensity trend for improvement in anxiety symptoms. LimitationsThe use of self-rating measures which bears the risk of an under- or overestimation of symptoms. ConclusionsA 12-week group exercise program proved effective for patients with anxiety syndromes in primary care. These findings strengthen the view of physical exercise as an effective treatment and could be more frequently made available in clinical practice for persons with anxiety issues.

Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial.

Given the growing evidence that a range of lifestyle factors are involved in the etiology of depression, a ‘lifestyle medicine’ approach can be potentially safe and cost-effective to prevent or treat depression. To examine the effects and acceptability of a group-based, integrative lifestyle medicine intervention as a standalone treatment for managing depressive symptoms, a pilot randomized controlled trial (RCT) was conducted in a Chinese adult population in 2018. Participants (n = 31) with PHQ-9 score above the cut-off of ≥ 10, which was indicative of moderate to severe depression, were recruited from the general community in Hong Kong and randomly assigned to lifestyle medicine group (LM group) or care-as-usual group (CAU group) in a ratio of 1:1. Participants in the LM group received 2-hour group sessions once per week for six consecutive weeks, which covered diet, exercise, mindfulness, psychoeducation, and sleep management. Linear mixed-effects model analyses showed that the LM group had a significant reduction in PHQ-9 scores compared to the CAU group at immediate posttreatment and 12-week posttreatment follow-up (d = 0.69 and 0.73, respectively). Moreover, there were significantly greater improvements in anxiety, stress, and insomnia symptoms (measured by DASS-21 and ISI) at all time points in the LM group (d = 0.42–1.16). The results suggests that our 6-week group-based, integrative lifestyle intervention program is effective in lowering depressive, anxiety, stress, and insomnia symptoms in the Chinese population. Further studies in clinical populations with a larger sample size and longer follow-up are warranted.

33.2 HARNESSING THE POWER OF BAYESIAN HIERARCHICAL MODELING: IMPLICATIONS FOR CLINICIANS

This presentation aims to provide an overview of Bayesian hierarchical modeling (BHM) for clinicians and to demonstrate the application of this multilevel modeling approach to understanding variation in antidepressant response across large trials in children and adolescents. After a brief introduction to BHMs in clinically relevant terms, this presentation will examine how BHMs capture heterogeneity across groups of patients. The BHM will be compared to the standard mixed model with repeated measures (MMRM) approach. The presenter will then examine how BHMs can explicitly model the correlation in symptoms over time in an individual patient enrolled in a clinical trial. Finally, an application to TORDIA will be reviewed, in which the individual trajectory of treatment response was modeled using an individual logarithmic trend “random effects” coefficients BHM. From the model estimates, Bayesian 2-tailed p values were computed to evaluate the null hypothesis: no difference was found in efficacy between SSRIs and venlafaxine. Using BHMs in the TORDIA study (n = 334), we demonstrate that for patients who did not receive CBT (n = 168), SSRIs produced greater and faster improvement in depressive symptoms compared to venlafaxine (p = 0.015). For patients with anxiety symptoms in addition to MDD, no differences in response or trajectory of response were detected between SSRIs and venlafaxine (p = 0.168). For patients receiving CBT (n = 162), SSRIs and venlafaxine produced similar improvements in symptoms of anxiety (p = 0.491) and depression (p =0.077). The traditional MMRM is static, relies on large sample assumptions, and is more restrictive in modeling individual patient variation. The BHM addresses these shortcomings and can be applied to existing and new randomized controlled trials in child and adolescent psychiatry. Applying BHMs in TORDIA revealed that SSRIs produce greater and faster improvement in depressive symptoms compared to venlafaxine (p = 0.015). With this approach, clinicians can move beyond “average response” and consider trajectory of response based on individual patient characteristics. This can inform recommendations for treatment trial duration and help understand which patients benefit from what treatments.

33.3 INTRODUCTION TO PROBABILITY-BASED STATISTICAL APPROACHES IN CHILD AND ADOLESCENT PSYCHIATRY

This session aims to provide child and adolescent psychiatrists with an overview and application of probability-based tools, especially Bayesian hierarchical models (BHMs) in child and adolescent mental health. This presentation will introduce probability-based approaches and demystify modern computational methods such as Monte Carlo methods. First, the presentation will review contemporary Bayesian understanding of probability and its application to risk prediction and measuring outcomes in randomized controlled trials. Second, the presentation will describe the differences between modern approaches to analyzing clinical trials (vs standard mixed models for repeated measures [MMRMs]) and how clinicians can leverage this to understand variation in outcomes in clinical trials. Third, the presentation will describe how these approaches can be leveraged to understand how individual patient characteristics influence response. These concepts will be applied to analyses of data from the Child/Adolescent Anxiety Multimodal Study (CAMS). Probabilistic models more precisely estimate treatment effects and decrease the restrictive assumptions inherent to standard approaches. The “Bayesian machinery” of Markov chain Monte Carlo (MCMC) methods—when applied to CAMS—reveals that sertraline monotherapy (n = 134) increases the probability of responses week over week (weeks 0 to 4, p < 0.0001; weeks 4 to 8, p < 0.0004), but additional improvement in anxiety symptoms is unlikely from week 8 to week 12 (p = 0.39). For clinicians, these analyses suggest that if a patient has not responded by week 8, additional benefit is unlikely during the next 4 weeks (p = 0.39). These contemporary probability-based approaches underscore the problems associated with large sample assumptions, unobserved heterogeneity, and hypothesis testing for complex models across individuals in child and adolescent psychiatry. Moreover, the application to CAMS reveals that this inference framework can also be enhanced by explicitly modeling the time dependencies in the data. With these approaches, clinicians can move beyond “average response” and these models can inform recommendations for treatment trial duration and help to understand which patients benefit from what treatments.

Acute neurofunctional effects of escitalopram during emotional processing in pediatric anxiety: a double-blind, placebo-controlled trial.

Anxiety disorders are the most common mental disorders in adolescents. However, only 50% of pediatric patients with anxiety disorders respond to the first-line pharmacologic treatments-selective serotonin reuptake inhibitors (SSRIs). Thus, identifying the neurofunctional targets of SSRIs and finding pretreatment or early-treatment neurofunctional markers of SSRI treatment response in this population is clinically important. We acquired pretreatment and early-treatment (2 weeks into treatment) functional magnetic resonance imaging during a continuous processing task with emotional and neutral distractors in adolescents with generalized anxiety disorder (GAD, N = 36) randomized to 8 weeks of double-blind escitalopram or placebo. Generalized psychophysiological interaction analysis was conducted to examine the functional connectivity of the amygdala while patients viewed emotional pictures. Full-factorial analysis was used to investigate the treatment effect of escitalopram on amygdala connectivity. Correlation analyses were performed to explore whether pretreatment and early (week 2) treatment-related connectivity were associated with treatment response (improvement in anxiety) at week 8. Compared to placebo, escitalopram enhanced emotional processing speed and enhanced negative right amygdala-bilateral ventromedial prefrontal cortex (vmPFC) and positive left amygdala-right angular gyrus connectivity during emotion processing. Baseline amygdala-vmPFC connectivity and escitalopram-induced increased amygdala-angular gyrus connectivity at week 2 predicted the magnitude of subsequent improvement in anxiety symptoms. These findings suggest that amygdala connectivity to hubs of the default mode network represents a target of acute SSRI treatment. Furthermore, pretreatment and early-treatment amygdala connectivity could serve as biomarkers of SSRI treatment response in adolescents with GAD. The trial registration for the study is ClinicalTrials.gov Identifier: NCT02818751.

Online Psychosocial Intervention for Persons with Spinal Cord Injury: A Meta-Analysis

<h3>Objective(s)</h3> To investigate the efficacy of internet-based psychosocial interventions on symptoms of anxiety and depression amongst those with spinal cord injury (SCI). <h3>Data Sources</h3> Medline, PsycInfo and EMBASE databases. Only English studies with sufficient data were included. <h3>Study Selection</h3> Study selection articles reviewed by 2 independent reviewers (R.S. and S.M.) and were included if they met the following inclusion criteria: study involved application of an online psychosocial intervention; study sample was adults with SCI; and study reported the effects of the intervention on depression and/or anxiety. 5 met inclusion criteria. <h3>Data Extraction</h3> Two independent reviewers extracted the following data from selected articles: author, study design, sample size, age, sex, time since injury, level of SCI, severity of SCI, inclusion criteria, exclusion criteria, intervention type, comparator, contact with therapist, intervention duration, time points of measures, outcomes, dropout rates, concomitant treatments, and adverse effects. <h3>Data Synthesis</h3> Low heterogeneity was evident for the primary outcomes of anxiety(I2=13.1%, p=0.33) and depression(I2=29.3, p=0.23). Fixed-effects model was used. Pooled analysis demonstrated small improvements for anxiety(SDM=0.42±0.09, p < 0.001) and depression(SDM=0.41±0.09, p < 0.001) at post-treatment, and moderate improvements at 3-month follow-up for anxiety(SDM=0.50±0.1, p < 0.001) and depression(SDM=0.64±0.10, p < 0.001) outcomes. Low heterogeneity for the secondary outcome of pain was reported(I2=33.8%, p=0.22). Fixed effects model was used. Pooled analysis demonstrated small improvements for pain(SDM=0.41±0.10, p < 0.001) at post-treatment and 3-month follow-up(SDM=0.34±0.10, p=0.001) as well. Dropout rates ranged from 10-28%, including incomplete post-treatment measures and not only those who did not complete the programs. <h3>Conclusions</h3> Pooled analysis of the 5 studies included revealed that online psychosocial interventions resulted in significant improvements in overall anxiety and depressive symptoms, small improvements in pain outcomes, and similar effect sizes to those reported in previous systematic reviews on psychosocial outcomes among similar populations. <h3>Author(s) Disclosures</h3> N/A.

Mission Reconnect: Exploring the Mobile and Web Based Complementary and Integrative Health Program Experience for Veterans with Chronic Pain and PTSD and Their Partners

<h3>Research Objectives</h3> There is a global trend in healthcare towards non-pharmacological and complementary and integrative approaches to health (CIH). The primary objective of this poster is to present the experience of veterans with chronic pain and PTSD and their partners with a remotely delivered CIH education program. <h3>Design</h3> A parent four year, mixed methods randomized control trial proposed to conduct telephone interviews with a subsample of veteran and partner intervention dyads. Transcripts were analyzed using a content analysis. Data in this poster represent preliminary findings from 13 dyads that have been interviewed to date. <h3>Setting</h3> Three Veterans Administration Medical Centers recruited participants from surrounding areas, resulting in recruitment from 12 states. <h3>Participants</h3> Veterans with chronic pain and PTSD, and their selected partners (e.g., spouse, child). <h3>Interventions</h3> The Mission Reconnect program is a partnered, self-directed intervention which teaches CIH skills (e.g., meditation, partnered massage) remotely using mobile and web-based mediums. <h3>Main Outcome Measure(s)</h3> Main outcomes are physical and mental, overall quality of life for veterans; and social relationship with partners. <h3>Results</h3> Participants reported improvements in physical, mental, overall quality of life for veterans; and social relationship with partners. Veterans reported improvements in sleep quality, pain management, and anxiety and PTSD symptoms. For veterans and partners, respondents reported improvements in quality of life, including feeling energized, refreshed, centered, and relaxed; and enhanced relationships, including increase in quality time spent together, and expression of affection. <h3>Conclusions</h3> Veterans and their partners reported Mission Reconnect is an effective approach to "reconnecting with life." Online and mobile CIH approaches should be considered for other diverse patient populations and partners, who will benefit from ongoing self-care management. Future research should examine cost-effectiveness of such approaches and broadscale implementation. <h3>Author Disclosures</h3> None disclosed.

Mental health of new undergraduate students before and after COVID-19 in China

The purpose of this study was to examine the changes in severity of anxiety and depression symptoms, stress and sleeping quality after three months of mass quarantine for COVID-19 among undergraduate fresh students compared to their pre-COVID-19 measures. We used participants from the Chinese Undergraduate Cohort (CUC), a national prospective longitudinal study to examine the changes in anxiety and depression symptoms severity, stress and sleep quality after being under mass quarantine for three months. Wilcoxon matched pair signed-rank test was used to compare the lifestyle indicators. Severity of anxiety, depression symptoms, stress and sleep quality were compared with Wilcoxon signed-rank test. We used generalized estimating equation (GEE) to further quantify the change in mental health indicators and sleep quality after the COVID-19 mass quarantine compared to baseline. This study found that there was no deterioration in mental health status among Chinese new undergraduate students in 2020 after COVID-19 mass quarantine compared with the baseline measures in 2019. There was an improvement in sleep quality and anxiety symptoms. After adjusting for age, sex, exercise habit, time spent on mobile gadgets, and time spent outdoors, year 2020 was significantly associated with severity of depression symptoms in males (OR:1.52. 95%CI:1.05–2.20, p-value = 0.027). Year 2020 was significantly associated with the improvement of sleeping quality in total (OR:0.45, 95%CI:0.38–0.52, p < 0.001) and in all the subgroups. This longitudinal study found no deterioration in mental health status among Chinese new undergraduate students after three months of mass quarantine for COVID-19.

Effectiveness and tolerability of eight-week treatment with dosulepin hydrochloride in patients with major depressive disorder not responding to four consecutive weeks of treatment with single selective serotonin reuptake inhibitor

Background: Though manageable, major depressive disorder remains an underdiagnosed and undertreated condition. The objective of this study was to assess the effectiveness and safety of 8 weeks of treatment with the tricyclic antidepressant dosulepin hydrochloride in patients with depressive episodes not responsive to 4 consecutive weeks of treatment with a single selective serotonin reuptake inhibitor (SSRI).Methods: Patients diagnosed with depressive episode without psychotic symptoms (by ICD-10 diagnostic criteria for research), mini-mental state examination score of ≥24, and not responsive to four weeks of treatment with SSRIs (&lt;50% reduction in depressive symptoms) were enrolled. The main outcome measures were mean change in the Hamilton depression, Hamilton anxiety, and insomnia severity index scores at Week 8 compared to baseline. Adverse events were recorded for safety assessment.Results: A total of 94 patients were enrolled, of which, 90 (95.7%) patients completed the study. Compared to baseline, 8 weeks of treatment significantly changed the HAM-D score by -12.7 (p&lt;0.0001), HAM-A score by -8.3 (p&lt;0.0001), and ISI score by -10.5 (p&lt;0.0001). One patient reported anemia and was withdrawn from the study. Dry mouth and insomnia followed by headache, blurred vision, and drowsiness were the most commonly reported side effects as measured with the antidepressant side-effects checklist. Most side effects were of mild intensity and were related to study medication.Conclusions: Eight weeks of treatment with dosulepin hydrochloride resulted in significant and clinically relevant improvements in depression, anxiety, and insomnia symptoms in Indian patients with MDD.

A mindfulness meditation mobile app improves depression and anxiety in adults with sleep disturbance: Analysis from a randomized controlled trial

ObjectiveThe objective of this study was to 1) determine the effects of a meditation app on depression and anxiety in adults with sleep disturbance, and 2) explore the potential mediating effects of fatigue, daytime sleepiness, and pre-sleep arousal on the relationship between use of the meditation app and changes in depression and anxiety. MethodsParticipants were 239 adults with elevated insomnia symptoms (i.e., scores ≥ 10 on the Insomnia Severity Index) and limited or no previous experience with meditation. Depression, anxiety, fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, four weeks, and eight weeks. Repeated-measures ANCOVAs assessed intervention effects on depression and anxiety. Mediation models were estimated using the PROCESS macro. ResultsParticipants in the meditation group had more improvement in depression and anxiety symptoms during the intervention period than did those in the control group. Changes in somatic and cognitive pre-sleep arousal at mid-intervention fully mediated effects on depression and partially mediated effects on anxiety. There were no significant indirect effects of fatigue and daytime-sleepiness on changes in mental health. ConclusionsA meditation app may improve depression and anxiety in adults with sleep disturbance, with effects being driven by improvements in pre-sleep arousal. Future studies should consider targeting pre-sleep arousal to improve mental health in this population.

Comparative efficacy of non-pharmacological interventions on behavioural and psychological symptoms in elders with dementia: A network meta-analysis.

AimTo explore the best non‐pharmaceutical interventions for improving the behavioural and psychological symptoms in elders with dementia.DesignBayesian network meta‐analysis.MethodsA comprehensive electronic literature search was performed in five English databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) that were published up to 31 October 2019.ResultsA total of 41 RCTs were included in this network meta‐analysis involving 5 different non‐pharmacological interventions: therapeutic recreation (TC), reminiscence therapy (RT), behaviour therapy (BT), massage therapy (MT) and individualized nursing (IN).The results of network meta‐analysis showed that individualized nursing was the best in improving depression, cognitive function, and activities of daily living of behavioural and psychological symptoms of dementia. Behaviour therapy was the best in improving anxiety symptoms. Reminiscence therapy was the best in improving neuropsychiatric symptoms.

Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: the FACTOID feasibility study.

Generalised anxiety disorder, characterised by excessive anxiety and worry, is the most common anxiety disorder among older people. It is a condition that may persist for decades and is associated with numerous negative outcomes. Front-line treatments include pharmacological and psychological therapy, but many older people do not find these treatments effective. Guidance on managing treatment-resistant generalised anxiety disorder in older people is lacking. To assess whether or not a study to examine the clinical effectiveness and cost-effectiveness of acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder is feasible, we developed an intervention based on acceptance and commitment therapy for this population, assessed its acceptability and feasibility in an uncontrolled feasibility study and clarified key study design parameters. Phase 1 involved qualitative interviews to develop and optimise an intervention as well as a survey of service users and clinicians to clarify usual care. Phase 2 involved an uncontrolled feasibility study and qualitative interviews to refine the intervention. Participants were recruited from general practices, Improving Access to Psychological Therapies services, Community Mental Health Teams and the community. Participants were people aged ≥ 65 years with treatment-resistant generalised anxiety disorder. Participants received up to 16 one-to-one sessions of acceptance and commitment therapy, adapted for older people with treatment-resistant generalised anxiety disorder, in addition to usual care. Sessions were delivered by therapists based in primary and secondary care services, either in the clinic or at participants' homes. Sessions were weekly for the first 14 sessions and fortnightly thereafter. The co-primary outcome measures for phase 2 were acceptability (session attendance and satisfaction with therapy) and feasibility (recruitment and retention). Secondary outcome measures included additional measures of acceptability and feasibility and self-reported measures of anxiety, worry, depression and psychological flexibility. Self-reported outcomes were assessed at 0 weeks (baseline) and 20 weeks (follow-up). Health economic outcomes included intervention and resource use costs and health-related quality of life. Fifteen older people with treatment-resistant generalised anxiety disorder participated in phase 1 and 37 participated in phase 2. A high level of feasibility was demonstrated by a recruitment rate of 93% and a retention rate of 81%. A high level of acceptability was found with respect to session attendance (70% of participants attended ≥ 10 sessions) and satisfaction with therapy was adequate (60% of participants scored ≥ 21 out of 30 points on the Satisfaction with Therapy subscale of the Satisfaction with Therapy and Therapist Scale-Revised, although 80% of participants had not finished receiving therapy at the time of rating). Secondary outcome measures and qualitative data further supported the feasibility and acceptability of the intervention. Health economic data supported the feasibility of examining cost-effectiveness in a future randomised controlled trial. Although the study was not powered to examine clinical effectiveness, there was indicative evidence of improvements in scores for anxiety, depression and psychological flexibility. Non-specific therapeutic factors were not controlled for, and recruitment in phase 2 was limited to London. There was evidence of high levels of feasibility and acceptability and indicative evidence of improvements in symptoms of anxiety, depression and psychological flexibility. The results of this study suggest that a larger-scale randomised controlled trial would be feasible to conduct and is warranted. Current Controlled Trials ISRCTN12268776. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 54. See the NIHR Journals Library website for further project information.