Mood And Anxiety Symptom Questionnaire Research Articles

Relationships between depression, anxiety, and motivation in the real-world: Effects of physical activity and screentime.

Mood and anxiety disorders are highly prevalent and comorbid worldwide, with variability in symptom severity that fluctuates over time. Digital phenotyping, a growing field that aims to characterize clinical, cognitive and behavioral features via personal digital devices, enables continuous quantification of symptom severity in the real world, and in real-time. In this study, N=114 individuals with a mood or anxiety disorder (MA) or healthy controls (HC) were enrolled and completed 30-days of ecological momentary assessments (EMA) of symptom severity. Novel real-world measures of anxiety, distress and depression were developed based on the established Mood and Anxiety Symptom Questionnaire (MASQ). The full MASQ was also completed in the laboratory (in-lab). Additional EMA measures related to extrinsic and intrinsic motivation, and passive activity data were also collected over the same 30-days. Mixed-effects models adjusting for time and individual tested the association between real-world symptom severity EMA and the corresponding full MASQ sub-scores. A graph theory neural network model (DEPNA) was applied to all data to estimate symptom interactions. There was overall good adherence over 30-days (MA=69.5%, HC=71.2% completion), with no group difference (t(58)=0.874, p=0.386). Real-world measures of anxiety/distress/depression were associated with their corresponding MASQ measure within the MA group (t's > 2.33, p's < 0.024). Physical activity (steps) was negatively associated with real-world distress and depression (IRRs > 0.93, p's ≤ 0.05). Both intrinsic and extrinsic motivation were negatively associated with real-world distress/depression (IRR's > 0.82, p's < 0.001). DEPNA revealed that both extrinsic and intrinsic motivation significantly influenced other symptom severity measures to a greater extent in the MA group compared to the HC group (extrinsic/intrinsic motivation: t(46) = 2.62, p < 0.02, q FDR < 0.05, Cohen's d = 0.76; t(46) = 2.69, p < 0.01, q FDR < 0.05, Cohen's d = 0.78 respectively), and that intrinsic motivation significantly influenced steps (t(46) = 3.24, p < 0.003, q FDR < 0.05, Cohen's d = 0.94). Novel real-world measures of anxiety, distress and depression significantly related to their corresponding established in-lab measures of these symptom domains in individuals with mood and anxiety disorders. Novel, exploratory measures of extrinsic and intrinsic motivation also significantly related to real-world mood and anxiety symptoms and had the greatest influencing degree on patients' overall symptom profile. This suggests that measures of cognitive constructs related to drive and activity may be useful in characterizing phenotypes in the real-world.

Depressive and anxiety symptoms, and neural correlates of reward and punishment anticipation in female athletes with amenorrhea.

Studies in estrogen deficiency states such as primary ovarian insufficiency and Turner syndrome suggest that estrogen status may be an important modulator of mood and emotions. In this study we compared depressive and anxiety symptoms between adolescent and young adult female oligo-amenorrheic athletes (AA) and eumenorrheic females (EM), and explored structural, and functional changes in related brain areas during reward processing, a behavioral construct that is altered in depression and anxiety. We included (i) 24 AA participating in ≥4 hours/week of aerobic exercise or running ≥20 miles/week for ≥6 months in the preceding year, with lack of menstrual cycles for ≥3 months within at least 6 preceding months of oligo-amenorrhea, OR in premenarchal girls, absence of menses at >15 years), and (ii) 27 EM aged 14-25 years. Participants completed the Beck Depression Inventory-II (BDI-II), State and Trait Anxiety Inventory (STAI), and Mood and Anxiety Symptoms Questionnaire (MASQ). Structural MRI and brain activation during a functional MRI (fMRI) task that probes reward and punishment processing was examined in a subset of 10 AA and 23 EM. Median (IQR) age and BMI of AA and EM groups were 20.6 (19.0-22.6) vs. 20.6 (19.2-23.7) years, p=0.6 and v 20.3 (18.8-21.5) vs. 21.9 (19.6-23.5) kg/m2, p=0.005, respectively. While groups did not differ for BDI-II scores, AA had higher anhedonic depression MASQ scores (p=0.04), and STAI (p=0.03) scores vs. EM. In the fMRI subset, AA had higher caudate volumes vs. EM [F(1, 29)=9.930, p=0.004]. Lower activation observed in the right caudate during reward anticipation in AA compared with EM (p=0.036) suggests blunted reward processing in the striatum in estrogen deficient states. Athletes with amenorrhea had higher depressive and anxiety symptomatology compared to eumenorrheic young women. Exploratory analyses demonstrated increased caudate volumes and decreased caudate activation during reward processing in athletes with amenorrhea suggesting that estrogen may play a role in reward processing.

Presenting a model of pain outcomes in patients with chronic low back pain based on mood and anxiety symptoms and emotional schemas: The mediating role of experiential avoidance and self-compassion

Introduction: Various psychological factors, such as mood and anxiety symptoms, can affect pain outcomes. Aim: The present research was conducted to identify these factors aiming at providing a conceptual model of pain outcomes based on emotional schemas and symptoms mediated by experiential avoidance, pain acceptance, and self-compassion of patients with chronic pain. Method: In this descriptive correlational research, the statistical population consisted of men and women (aged 30-50) with chronic low back pain referring to pain clinics in Akhtar, Labafinejad, and Imam Hossein hospitals, Tehran, Iran, in 2019-2020. We selected 400 people using a convenience sampling method considering the inclusion criteria. The tools included the Mood and Anxiety Symptoms Questionnaire (MASQ), Emotional Schemas-Short Form, Acceptance and Action Questionnaire (AAQ), Chronic Pain Acceptance Questionnaire (CPAQ) and the Self-Compassion Scale (SCS). Data were analyzed with SPSS-21 and LISREL-8.8 using Structural Equation Modeling (SEM). Results: The fitted model showed that the direct effect of mood and anxiety symptoms on increasing emotional schemas (p&lt;0.05) was equal to 5, and the direct effect of emotional schemas was significant on increasing experiential avoidance, reducing pain acceptance and self-compassion (p&lt;0.05). Also, the indirect effect of mood and anxiety symptoms through increasing emotional schemas, increasing experiential avoidance, decreasing pain acceptance, and self-compassion on increasing pain outcomes was significant (p&lt;0.05). Conclusion: Experiential avoidance, pain acceptance, and self-compassion could mediate the relationship between emotional symptoms and emotional schemas to pain outcomes. Therefore, developing therapeutic interventions based on emotional schemas to reduce emotional schemas and experiential avoidance and increase pain acceptance and self-compassion could help reduce pain outcomes in patients with chronic pain.

The genetics of ME: A commentary on Hajdarevic et al.

Depression is characterized by altered neurobiological responses to threat and inflammation may be involved in the development and maintenance of symptoms. However, the mechanistic pathways underlying the relationship between the neural underpinnings of threat, inflammation and depressive symptoms remain unknown.Twenty participants with major depressive disorder (MDD) and 17 healthy controls (HCs) completed this study. Peripheral blood mononuclear cells (PBMCs) were collected and stimulated ex vivo with lipopolysaccharide (LPS). We then measured a broad array of secreted proteins and performed principal component analysis to compute an aggregated immune reactivity score. Subjects completed a well-validated emotional face processing task during functional magnetic resonance imaging (fMRI). Amygdala activation was measured during perception of threat for the main contrast of interest: fear > happy face. Participants completed the Mood and Anxiety Symptom Questionnaire (MASQ) and the Perceived Stress Scale (PSS). Correlation analyses between amygdala activation, the aggregate immune score, and symptom were computed across groups. A mediation analysis was also performed across groups to further explore the relationship between these three variables.In line with our hypotheses and with prior work, the MDD group showed greater amygdala activation in response to threat compared to the HC group [t35 = -2.038, p = 0.049]. Internal consistency of amygdala activation to threat was found to be moderate. Response to an ex vivo immune challenge was greater in MDD than HC based on the computed immune reactivity score (PC1; t35 = 2.674, p = 0.011). Amygdala activation was positively correlated with the immune score (r = 0.331, p = 0.045). Moreover, higher amygdala activation was associated with greater anxious arousal measured by the MASQ (r = 0.390, p = 0.017). Exploring the role of stress, we found that higher perceived stress was positively associated with both inflammatory response (r = 0.367, p = 0.026) and amygdala response to threat (r = 0.325, p = 0.050). Mediation analyses showed that perceived stress predicted anxious arousal, but neither inflammation nor amygdala activation fully accounted for the effect of perceived stress on anxious arousal.These data highlight the potential importance of threat circuitry hyperactivation in MDD, consistent with prior reports. We found that higher levels of inflammatory biomarkers were associated with higher amygdala activation, which in turn was associated with anxious arousal. Future research utilizing larger sample sizes are needed to replicate these preliminary results.

Exaggerated amygdala response to threat and association with immune hyperactivity in depression

BackgroundDepression is characterized by altered neurobiological responses to threat and inflammation may be involved in the development and maintenance of symptoms. However, the mechanistic pathways underlying the relationship between the neural underpinnings of threat, inflammation and depressive symptoms remain unknown. MethodsTwenty participants with major depressive disorder (MDD) and 17 healthy controls (HCs) completed this study. Peripheral blood mononuclear cells (PBMCs) were collected and stimulated ex vivo with lipopolysaccharide (LPS). We then measured a broad array of secreted proteins and performed principal component analysis to compute an aggregated immune reactivity score. Subjects completed a well-validated emotional face processing task during functional magnetic resonance imaging (fMRI). Amygdala activation was measured during perception of threat for the main contrast of interest: fear > happy face. Participants completed the Mood and Anxiety Symptom Questionnaire (MASQ) and the Perceived Stress Scale (PSS). Correlation analyses between amygdala activation, the aggregate immune score, and symptom were computed across groups. A mediation analysis was also performed across groups to further explore the relationship between these three variables. ResultsIn line with our hypotheses and with prior work, the MDD group showed greater amygdala activation in response to threat compared to the HC group [t35 = -2.038, p = 0.049]. Internal consistency of amygdala activation to threat was found to be moderate. Response to an ex vivo immune challenge was greater in MDD than HC based on the computed immune reactivity score (PC1; t35 = 2.674, p = 0.011). Amygdala activation was positively correlated with the immune score (r = 0.331, p = 0.045). Moreover, higher amygdala activation was associated with greater anxious arousal measured by the MASQ (r = 0.390, p = 0.017). Exploring the role of stress, we found that higher perceived stress was positively associated with both inflammatory response (r = 0.367, p = 0.026) and amygdala response to threat (r = 0.325, p = 0.050). Mediation analyses showed that perceived stress predicted anxious arousal, but neither inflammation nor amygdala activation fully accounted for the effect of perceived stress on anxious arousal. ConclusionThese data highlight the potential importance of threat circuitry hyperactivation in MDD, consistent with prior reports. We found that higher levels of inflammatory biomarkers were associated with higher amygdala activation, which in turn was associated with anxious arousal. Future research utilizing larger sample sizes are needed to replicate these preliminary results.

The Role of the Endocannabinoids 2-AG and Anandamide in Clinical Symptoms and Treatment Outcome in Veterans with PTSD

Background Although current treatments for Post-Traumatic Stress Disorder (PTSD) in war veterans are effective, unfortunately 30–50% still do not benefit from these treatments. Trauma-focused therapies, eg exposure therapy, are primarily based on extinction processes in which the endocannabinoid system (ECS) plays a significant role. Therefore, it can be hypothesized that poor treatment response on trauma-focused therapy due to extinction deficits may be associated with a poorly functioning ECS. The present study examined whether the endocannabinoids anandamide (AEA) and 2-arachidonylglycerol (2-AG) are associated with post-treatment symptom reduction. Methods Blood plasma levels of AEA and 2-AG were determined in war veterans with a PTSD diagnosis (n = 54) and combat controls (n = 26) before and after a 6–8 month interval. During this period veterans with PTSD received trauma-focused therapy (eg cognitive behavioral therapy with exposure or eye-movement desensitization and reprocessing). Clinical symptoms were assessed before and after therapy with the Clinician Administered PTSD Scale (CAPS), State-Trait Anxiety Inventory (STAI) and Mood and Anxiety Symptom Questionnaire (MASQ). Results Regression analysis demonstrated that pretreatment endocannabinoid levels were not predictive of PTSD symptom reduction. Additionally, baseline endocannabinoid levels did not differ between either PTSD and combat controls or between combat controls, treatment responders, and non-responders. Only cortisol levels significantly decreased over time from pre- to posttreatment (p = .041). Endocannabinoid levels were significantly lower in individuals who reported cannabis use during their lifetime, independent of PTSD diagnosis. Furthermore, correlation analysis revealed that pretreatment 2-AG levels in PTSD were positively correlated with anxious arousal (r = .354, p = .015) and negatively with avoidance symptoms (r = -.271, p = .048). Both posttreatment AEA and 2-AG were positively correlated with trait anxiety (AEA r = .459, p = .003; 2-AG r = .423, p = .006), anxious arousal (AEA r = .351, p = .024; 2-AG r = .311, p = .048) and general distress depression symptoms (AEA r = .414, p = .007; 2-AG r = .374, p = .016). Conclusion Since endocannabinoids are mainly generated ‘on demand’, future work could benefit by investigating endocannabinoid circulation under both baseline and stressful conditions. In line with previous research cannabis use was associated with lower endocannabinoid levels. The correlation analysis between pre- and posttreatment endocannabinoid levels and pre- and posttreatment clinical symptomatology were exploratory analysis and should be replicated in future research.

Depression-, Anxiety-, and Anger and Cognitive Functions: Findings From a Longitudinal Prospective Study.

Background: Determinants of changes in cognitive function during aging are not well-understood. We aimed to estimate the effects of depression-, anxiety- and anger symptoms on cognition and on cognition changes, especially on changes in episodic memory (EM) and executive functioning (EF).Methods: We analyze data from the Mid-Life in the Midlife in the United States Biomarker study at two time points including n = 710 women, and n = 542 men (1996/1997) at the first assessment and n = 669 women, and n = 514 men at the second assessment (2013/2014). To assess cognition we used the Brief Test of Adult Cognition (BTACT). To measure depression-, anxiety- and anger symptoms we used the Mood and Anxiety Symptom Questionnaire (MASQ), the Center for Epidemiologic Studies Depression Scale (CES-D) and the State-Trait Anger Expression Inventory (STAXI). We used repeated models analyses to explore changes in cognition, and repeated measures linear mixed-effects models to investigate depression, anxiety and anger effects on cognition. All analyses were adjusted for potential confounders (cognition at baseline, age, education, income).Results: At the first assessment, women had significantly better episodic memory functioning than men; men in the oldest age group had significant better executive functioning. At the second assessment, more education, and white ethnicity were associated with less negative changes on episodic memory and executive functioning. Depression- and anger symptoms were associated with declines in episodic memory among women; anxiety symptoms were associated with declines in episodic memory and executive functioning in both gender in men (EF: β: −0.02, (95% CI: −0.03, −0.01; EM: β −0.02 (−0.02, 95% CI: −0.03, −0.01) and in women (EF: β −0.01, 95% CI: −0.02, −0.0004; EM: β −0.013, 95% CI: −0.03, −0.001).Conclusions: Depression-, anxiety- and anger symptoms were associated with changes in episodic memory and executive functioning. Further longitudinal studies are critical in populations in more countries to better understand the impact of depression, anxiety and anger symptoms on cognition changes.

Assessing Changes in Symptoms of Depression and Anxiety During Four Weeks of Cannabis Abstinence Among Adolescents.

Background: Cannabis use is prevalent among adolescents, and many report using in attempts to alleviate negative mood and anxiety. Abstinence from substances such as alcohol and tobacco has been reported to improve symptoms of anxiety and depression. Few studies have examined the effect of cannabis abstinence on symptoms of anxiety and depression.Objective: To test the effect of 4 weeks of continuous cannabis abstinence on depressive and anxious symptoms.Methods: Healthy, non-treatment seeking adolescents who used cannabis at least weekly (n = 179) were randomized to either 4 weeks of cannabis abstinence achieved through a contingency management paradigm (CB-Abst) or cannabis use monitoring without an abstinence requirement (CB-Mon). Abstinence was assessed by self-report verified with quantitative assay of urine for cannabinoids. Anxiety and depressive symptoms were assessed weekly with the Mood and Anxiety Symptom Questionnaire (MASQ).Results: Symptoms of depression and anxiety decreased throughout the study for all participants (MASQ-AA: stnd beta = −0.08, p = 0.01, MASQ-GDA: stnd beta = −0.11, p = 0.003, MASQ-GDD: stnd beta = −0.08, p = 0.02) and did not differ significantly between randomization groups (p's > 0.46). Exploratory analyses revealed a trend that abstinence may be associated with greater improvement in symptoms of anxiety and depression among those using cannabis to cope with negative affect and those with potentially hazardous levels of cannabis use.Conclusions: Among adolescents who use cannabis at least weekly, 4 weeks of cannabis abstinence was not associated with a significant change in anxiety or depressive symptoms compared to continued use. For recreational cannabis users who may be concerned about reducing their use for fear of increased symptoms of anxiety and depression, findings suggest that significant symptom worsening may not occur within the first 4 weeks of abstinence. Further studies are needed in clinical populations where anxiety and depression symptoms are measured more frequently and for a longer period of abstinence. Future studies are also needed to determine whether there are subgroups of adolescents who are uniquely impacted by sustained cannabis abstinence.

Efficacy of attention bias modification training for depressed adults: a randomized clinical trial.

This study examined the efficacy of attention bias modification training (ABMT) for the treatment of depression. In this randomized clinical trial, 145 adults (77% female, 62% white) with at least moderate depression severity [i.e. self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) ⩾13] and a negative attention bias were randomized to active ABMT, sham ABMT, or assessments only. The training consisted of two in-clinic and three (brief) at-home ABMT sessions per week for 4 weeks (2224 training trials total). The pre-registered primary outcome was change in QIDS-SR. Secondary outcomes were the 17-item Hamilton Depression Rating Scale (HRSD) and anhedonic depression and anxious arousal from the Mood and Anxiety Symptom Questionnaire (MASQ). Primary and secondary outcomes were administered at baseline and four weekly assessments during ABMT. Intent-to-treat analyses indicated that, relative to assessment-only, active ABMT significantly reduced QIDS-SR and HRSD scores by an additional 0.62 ± 0.23 (p = 0.008, d = -0.57) and 0.74 ± 0.31 (p = 0.021, d = -0.49) points per week. Similar results were observed for active v. sham ABMT: a greater symptom reduction of 0.44 ± 0.24 QIDS-SR (p = 0.067, d = -0.41) and 0.69 ± 0.32 HRSD (p = 0.033, d = -0.42) points per week. Sham ABMT did not significantly differ from the assessment-only condition. No significant differences were observed for the MASQ scales. Depressed individuals with at least modest negative attentional bias benefitted from active ABMT.

Measuring treatment outcome in patients with anxiety disorders: A comparison of the responsiveness of generic and disorder-specific instruments

BackgroundFor routine outcome monitoring, generic (i.e., broad-based) and disorder-specific instruments are used to monitor patient progress. While disorder-specific instruments may be more sensitive to therapeutic change, generic measures can be applied more broadly and allow for an assessment of therapeutic change, irrespective of a specific anxiety disorder. Our goal was to investigate whether disorder-specific instruments for anxiety disorders are a valuable (or even necessary) addition to generic instruments for an appropriate assessment of treatment outcome in groups of patients. MethodsData were collected from 2002 to 2013 from psychiatric outpatients in treatment for Social Phobia (SP; n = 834), Generalized Anxiety Disorder (GAD; n = 661), Panic Disorder (PD; n = 944), Obsessive-Compulsive Disorder (OCD; n = 460), and Posttraumatic Stress Disorder (PTSD; n = 691). Instruments used were the generic Brief Symptom Inventory (BSI), The Mood and Anxiety Symptoms Questionnaire (MASQ), and several disorder-specific instruments (e.g., Social Interaction Anxiety Scale, Social Phobia Scale, Panic Appraisal Inventory, etc.). Responsiveness (i.e., sensitivity to therapeutic change) was examined through correlational analyses, effect sizes (ES), and analysis of variance for repeated measures. ResultsThe MASQ appeared generally more responsive than the BSI, except for the BSI Anxiety subscale for PD. Disorder-specific measures equaled the MASQ and BSI in responsiveness. When statistically significant differences occurred, the ES was small. Discussion/conclusionsFor most anxiety disorder groups (i.e., SP, PD and OCD), the MASQ or BSI was equally suited as disorder-specific instruments to detect change at group level. Exceptions are GAD and PTSD. These findings suggest limited incremental information value of disorder-specific instruments over the MASQ and BSI for measuring change.

Depressive symptom profiles, cardio-metabolic risk and inflammation: Results from the MIDUS study

BackgroundThis study aimed to (1) provide a comprehensive characterization of depressive symptoms profiles, and (2) examine the cross-sectional association between depressive symptom profiles and cardio-metabolic outcomes, including metabolic syndrome and obesity, while controlling for sociodemographic variables, health behaviors and inflammation. MethodsOur sample was comprised of 1085 participants (55.80% female) enrolled in the MIDUS-II biomarker study. Latent profile analysis (LPA) was used to derive depressive symptom profiles using subscales of the Mood and Anxiety Symptom Questionnaire (MASQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) subscales as well as Pittsburgh Sleep Quality Index (PSQI) global score. Metabolic syndrome was defined according to the Interim Joint Statement definition. CRP was used as a marker of inflammation. ResultsFour depressive symptom profiles were identified. The “No Symptoms” subgroup (60.65% of the sample) had the lowest overall scores across subscales. The “Mild Symptoms” subgroup (26.73%) was characterized by lower scores across indicators, with subscales measuring somatic symptoms being the highest within group. The “Moderate Symptoms” subgroup (10.32%) had higher scores across subscales (1 SD above the mean), with subscales measuring negative affect/loss of interest being the highest within group. Finally, the “Acute symptoms” subgroup (2.30%) was characterized by the highest overall scores (1.5–3 SD above the mean) on all indicators. After controlling for sociodemographic characteristics and health behaviors, the “Moderate Symptoms” subgroup was significantly associated with metabolic syndrome (OR=1.595, p=0.035) and obesity (OR=1.555, p=0.046). Further, there was a trend between the “Mild Symptoms” subgroup and the presence of obesity (OR=1.345, p=0.050). Inflammation attenuated these associations. ConclusionsFour depressive symptom profiles were identified among healthy mid-life individuals in the US. These profiles are differentially associated with cardio-metabolic outcomes. Future work should examine whether distinct symptom profiles may reflect differential pathways to increased risk, and whether tailored management of symptoms is needed.

Simulating computer adaptive testing with the Mood and Anxiety Symptom Questionnaire.

In a post hoc simulation study (N = 3,597 psychiatric outpatients), we investigated whether the efficiency of the 90-item Mood and Anxiety Symptom Questionnaire (MASQ) could be improved for assessing clinical subjects with computerized adaptive testing (CAT). A CAT simulation was performed on each of the 3 MASQ subscales (Positive Affect, Negative Affect, and Somatic Anxiety). With the CAT simulation's stopping rule set at a high level of measurement precision, the results showed that patients' test administration can be shortened substantially; the mean decrease in items used for the subscales ranged from 56% up to 74%. Furthermore, the predictive utility of the CAT simulations was sufficient for all MASQ scales. The findings reveal that developing a MASQ CAT for clinical subjects is useful as it leads to more efficient measurement without compromising the reliability of the test outcomes. (PsycINFO Database Record

Identifying Individuals With Generalised Anxiety Disorder: A Receiver Operator Characteristic Analysis of Theoretically Relevant Measures

This article appraises the ability of several measures, assessing symptomatology theoretically relevant to generalised anxiety disorder (GAD), to accomplish successful classification of individuals with DSM-IV GAD and individuals with mood or other anxiety disorders. Participants were 197 individuals (average age = 36.43; 67.5% female) receiving treatment at a clinic, who completed pretreatment self-report measures. Receiver operator characteristic analyses and logistic regression analyses were employed to determine the classificatory abilities, including sensitivity and specificity, of several GAD relevant measures. The Penn State Worry Questionnaire (PSWQ) accomplished significant classification in both comparison group dyads: GAD-Anxiety and GAD-Mood. Whereas the general distress of depression subscale of the Mood and Anxiety Symptoms Questionnaire (MASQ) accomplished significant classification in the GAD-Anxiety group dyad, both the general distress of anxiety and anxious arousal subscales of the MASQ did so in the GAD-Mood group dyad. Only the PSWQ significantly predicted the presence of GAD, while controlling for other symptom variables. Though evidence supports the uniqueness of some symptoms of GAD, including worry, often considered pathognomonic to GAD, the modest areas under the curve, sensitivity, and specificity of the measures afford tenuous support for the utility of these measures. The lack of highly sensitive and specific symptomatology comport with critiques of GAD as a diagnostically delimited category.

Gender differences in outpatients with anxiety disorders: the Leiden Routine Outcome Monitoring Study.

Data from the general population show higher prevalence of different anxiety disorders in women as compared with men. We analysed gender differences in a naturalistic sample of outpatients with anxiety disorders in a mental healthcare setting. Routine outcome monitoring data were collected from 1333 patients (age: 18-65; 63.3% women) fulfilling Diagnostic and Statistical Manual of Mental Disorders IV criteria of current anxiety disorder according to the Mini-International Neuropsychiatric Interview between 2004 through 2006. Data included Comprehensive Psychopathological Rating Scale, Brief Symptom Inventory (BSI), Short Form Health Survey (SF-36), Mood and Anxiety Symptom Questionnaire (MASQ). Chi-squared test and t-test were used to compare women with men for variables with parametric distributions, and Mann-Whitney test for non-parametric distribution. Adjustments for potential confounders (age, level of education, ethnicity and comorbidites) were made by logistic regression models (for discrete variables) or analysis of covariance. The female-to-male ratio (i.e., 844 women, 489 men) for any anxiety disorder was 1.73 : 1 (95% confidence interval [CI]: 1.63-1.83), with the strongest skewness for post-traumatic stress disorder (2.80 : 1) and the smallest one for social phobia (1.18 : 1). Compared with men, women reported more severe self-rating scores on the BSI (on average, the scores were 12.3% higher on 3 of 9 subscales: somatisation, interpersonal sensitivity and anxiety), SF-36 (self-reported generic health status was lower on 5 of 8 subscales: physical functioning, social functioning, physical problems, vitality and bodily pain) and MASQ (on average, the scores were 6.6% higher on 4 of 5 subscales: anxious arousal, general distress, general distress depression, general distress anxiety). On the contrary, no gender difference was found in the severity of anxiety symptoms measured by the Brief Anxiety Scale. Women were more likely to suffer from comorbid depression and bulimia nervosa, and less likely from substance abuse. In a treatment-seeking population the prevalence rate of anxiety disorders was 1.7 times higher in female compared with men. Female outpatients were more severely affected on self-rated but not on observer-rated scales.

Validation of the mood and anxiety symptom questionnaire in korean adolescents.

ObjectiveThe tripartite model categorizes symptoms of depression and anxiety into three groups: 1) non-specific general distress that is shared between depression and anxiety, 2) depression-specific symptoms that include low positive affect and loss of interest, and 3) anxiety-specific symptoms that include somatic arousal. The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure these three factors of depression and anxiety. The purpose of the present study was to test the psychometric properties of the Korean version of the MASQ (K-MASQ) in adolescents.MethodsCommunity-dwelling adolescents (n=933) were randomly assigned to two groups. Exploratory factor analysis and confirmatory factor analysis were conducted in each group to identify the factor structure of the K-MASQ. The reliability and validity of the K-MASQ were also evaluated.ResultsOur results support the three-factor structure of the K-MASQ in adolescents. However, we found that the specific items of each factor differed from those of the original MASQ. That is, the depression-specific factor was only related to low positive affect and not loss of interest, and the anxiety-specific factor included more items related to general somatic symptoms of anxiety. The reliability and validity of the K-MASQ were found to be satisfactory.ConclusionThe K-MASQ supports the tripartite model of depression and anxiety and has satisfactory reliability and validity among Korean adolescents. The K-MASQ can be used to distinguish unique symptoms of depression and anxiety in Korean adolescents.

The psychometric properties of the Cognitive-Somatic Anxiety Questionnaire in Chinese undergraduate students and clinical patients

BackgroundThe present study was conducted to develop a Chinese version of the 14-item Cognitive-Somatic Anxiety Questionnaire (CSAQ) and examine its psychometric properties. MethodsThe original English version of the CSAQ was first translated into Chinese and then backtranslated and modified until cross-language equivalence was established. This version was then completed by 2168 undergraduate students and 289 clinical patients with mental disorder in China. The Mood and Anxiety Symptoms Questionnaire (MASQ) was also administered to students. Confirmatory factor analysis was performed to examine the two-factor construct, and the CSAQ's internal consistency, test–retest reliability, and concurrent and discriminant validity were also evaluated. ResultsThe two-factor model (cognitive and somatic) of the CSAQ was confirmed, and the scale showed an adequate model fit in the student and clinical samples. The CSAQ showed adequate internal consistency (student sample: Cronbach's α=0.82, mean inter-item correlation coefficient=0.25; clinical sample: Cronbach's α=0.81, mean inter-item correlation coefficient=0.23) and good stability (2-week test–retest reliability in student sample, 0.84). The coefficient of correlation between CSAQ and overall anxious symptoms MASQ scores among students was 0.64. ConclusionsThe Chinese version of the CSAQ is a promising instrument for reliable and valid measurement of anxiety in Chinese populations.

Validation of a short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ) in adolescents and young adults

The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure the symptom-dimensions of the tripartite model of anxiety and depression. A 30-item short adaptation of the MASQ (MASQ-D30) was previously developed and validated in adult psychiatric outpatients. The aim of the present study was to evaluate the validity and reliability of the MASQ-D30 in a sample of adolescents and young adults. Help-seeking adolescents from Australia (N=147; mean age: 17.7 years; 58.8% female) completed the original, 90-item MASQ. Confirmatory Factor Analysis (CFA) was used to evaluate the construct validity (a 3-factor structure) of the original MASQ and the MASQ-D30. Internal consistencies and correlations with other instruments were calculated and compared between versions. CFA showed that the intended 3-factor structure fit adequately to the MASQ-D30 data (CFI=0.95; RMSEA=0.08). Internal consistencies ranged from 0.85 to 0.92 across the scales and patterns of correlations with the Center for Epidemiological Studies-Depression (CES-D) indicated adequate convergent/divergent properties. Importantly, the observed psychometric characteristics were comparable with the original MASQ and alternative short-forms. Results indicated that the MASQ-D30 is a valid and reliable instrument in young people, allowing for quick assessment of the tripartite dimensions of depression and anxiety.

Combining Decision Trees and Stochastic Curtailment for Assessment Length Reduction of Test Batteries Used for Classification

For classification problems in psychology (e.g., clinical diagnosis), batteries of tests are often administered. However, not every test or item may be necessary for accurate classification. In the current article, a combination of classification and regression trees (CART) and stochastic curtailment (SC) is introduced to reduce assessment length of questionnaire batteries. First, the CART algorithm provides relevant subscales and cutoffs needed for accurate classification, in the form of a decision tree. Second, for every subscale and cutoff appearing in the decision tree, SC reduces the number of items needed for accurate classification. This procedure is illustrated by post hoc simulation on a data set of 3,579 patients, to whom the Mood and Anxiety Symptoms Questionnaire (MASQ) was administered. Subscales of the MASQ are used for predicting diagnoses of depression. Results show that CART-SC provided an assessment length reduction of 56%, without loss of accuracy, compared with the more traditional prediction method of performing linear discriminant analysis on subscale scores. CART-SC appears to be an efficient and accurate algorithm for shortening test batteries.

Assessment of self-reported negative affect in the NIH Toolbox

We report on the selection of self-report measures for inclusion in the NIH Toolbox that are suitable for assessing the full range of negative affect including sadness, fear, and anger. The Toolbox is intended to serve as a “core battery” of assessment tools for cognition, sensation, motor function, and emotional health that will help to overcome the lack of consistency in measures used across epidemiological, observational, and intervention studies. A secondary goal of the NIH Toolbox is the identification of measures that are flexible, efficient, and precise, an agenda best fulfilled by the use of item banks calibrated with models from item response theory (IRT) and suitable for adaptive testing. Results from a sample of 1763 respondents supported use of the adult and pediatric item banks for emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®) as a starting point for capturing the full range of negative affect in healthy individuals. Content coverage for the adult Toolbox was also enhanced by the development of a scale for somatic arousal using items from the Mood and Anxiety Symptom Questionnaire (MASQ) and scales for hostility and physical aggression using items from the Buss–Perry Aggression Questionnaire (BPAQ).

Development of a Brief Measure of Postpartum Distress

Previous measures of postpartum distress have focused on depressed mood despite evidence that postpartum anxiety is just as prevalent. The purpose of this study was to develop a new, brief screening measure to identify postpartum distress, defined as symptoms of depression and anxiety. In Study 1, potential items were assembled focusing on depressed mood and a variety of anxiety domains to develop a new postpartum distress scale. Women up to 12 months postpartum (n=289) completed the new scale items, the Edinburgh Postpartum Depression Scale (EPDS), and the Mood and Anxiety Symptom Questionnaire (MASQ) on the Internet. In Study 2, women up to 12 months postpartum (n=139) completed the new Postpartum Distress Measure (PDM), the EPDS, the Obsessive-Compulsive Inventory-Revised (OCI-R), and the Relationship Assessment Scale (RAS) to validate the new measure. Data from Study 1 yielded a two-factor solution, and 10 items were selected for the new PDM. Six items were chosen for the PDM general distress scale, and four items for the PDM obsessive-compulsive scale. Data from Study 2 again yielded a two-factor solution, supporting both the general distress and obsessive-compulsive components. Psychometric data suggested that the measure had adequate internal consistency and construct validity. The 10-item PDM comprises general distress and obsessive-compulsive factors that were obtained from a wider pool of depressive and anxiety items. These data suggest that the PDM may be a helpful tool in identifying a broader range of postpartum distress, including obsessive-compulsive symptoms that were formerly neglected in clinical screening measures. More studies are needed to confirm its clinical utility.