Persistence Of Anxiety Research Articles

Symptom Persistence Relates to Volume and Asymmetry of the Limbic System after Mild Traumatic Brain Injury.

Background: Persistent symptoms have been reported in up to 50% of the 27 million people with mild traumatic brain injuries (mTBI) every year. MRI findings are currently limited by low diagnostic and prognostic sensitivities, constraining the value of imaging in the stratification of patients following mTBI. Limbic system structures are promising brain regions in offering prognostic factors for symptom persistence following mTBI. The objective of this study was to associate volume and symmetry of limbic system structures with the presence and persistence of common symptoms in patients with mTBI. Methods: This study focused on 524 adults (aged 18-82), 58% female, with 82% injured in motor vehicle accidents and 28% reporting loss of consciousness (LOC). Magnetic resonance imaging (MRI) data included a sagittal 3D T1-weighted sequence with 1.2 mm slice thickness, with voxel sizes of 0.93 mm × 0.93 mm × 1.2 mm, obtained a median of 156 days after injury. Symptom diagnosis and persistence were collected retrospectively from patient medical records. Intracranial volume-adjusted regional volumes per side utilizing automated volumetric analysis (NeuroQuant®) were used to calculate total volume, laterality index, and side-independent asymmetry. Covariates included age, sex, LOC, and days from injury. Limbic volumetrics did not relate to symptom presentation, except the (-) association between headache presence and thalamus volume (adjusted odds ratio = 0.51, 95% confidence interval = 0.32, 0.85). Headache, balance problems, anxiety, and depression persistence was (-) associated with thalamus volume (hazard ratio (HR) 1.25 to 1.94). Longer persistence of balance problems was associated with (-) lateral orbitofrontal cortex volume (HR = 1.33) and (+) asymmetry of the hippocampus (HR = 0.27). Persistence of cognitive deficits was associated with (+) asymmetry in the caudal anterior cingulate (HR = 0.67). Depression persistence was associated with (+) asymmetry in the isthmus of the cingulate gyrus (HR = 5.39). Persistence of anxiety was associated with (-) volume of the parahippocampal gyrus (HR = 1.67), orbitofrontal cortex (HR > 1.97), and right-biased laterality of the entorhinal cortex (HR = 0.52). Conclusions: Relative volume and asymmetry of the limbic system structures in patients with mTBI are associated with the persistence of symptoms, particularly anxiety. The conclusions of this study are limited by the absence of a reference group with no mTBI.

Persistence of anxiety among Asian Americans: racial and ethnic heterogeneity in the longitudinal trends in mental well-being during the COVID-19 pandemic.

To examine within-individual time trends in mental well-being and factors influencing heterogeneity of these trends. Longitudinal telephone survey of adults over 3 waves from the New York City (NYC) Metropolitan area during the COVID-19 Pandemic. Participants reported depression using the Patient Health Questionnaire (PHQ)-8, anxiety using the Generalized Anxiety Disorder (GAD)-7, and past 30-day increases in tobacco or alcohol use at each wave. Adjusted mixed effects logistic regression models assessed time trends in mental well-being. There were 1227 respondents. Over 3 study waves, there were statistically significant decreasing time trends in the odds of each outcome (adjusted OR (95% CI) 0.47 (0.37, 0.60); p < 0.001 for depression; aOR (95% CI) 0.55 (0.45, 0.66); p < 0.001 for anxiety; aOR (95% CI) 0.50 (0.35, 0.71); p < 0.001 for past 30-day increased tobacco use; aOR (95% CI) 0.31 (0.24, 0.40); p < 0.001 for past 30-day increased alcohol use). Time trends for anxiety varied by race and ethnicity (p value for interaction = 0.05, 4 df); anxiety declined over time among white, Black, Hispanic, and Other race and ethnicity but not among Asian participants. In a demographically varied population from the NYC Metropolitan area, depression, anxiety and increased substance use were common during the first months of the pandemic, but decreased over the following year. While this was consistently the case across most demographic groups, the odds of anxiety among Asian participants did not decrease over time.

Patterns of response to anti-CGRP monoclonal antibodies during first 6-months of treatment in resistant migraine patients: impact on outcome.

The response pattern to monoclonal antibodies against calcitonin gene-related peptide (anti-CGRP MAbs) shown in migraine prevention clinical trials is not always reproducible at an individual-level. To describe patterns of start and consistency of the response to anti-CGRP MAbs during first six months of treatment and the association to baseline clinical characteristics METHODS: This is a prospective clinical cohort observational study. We included migraine patients treated with erenumab or galcanezumab evaluated at baseline and after three and six months (M3-M6) of treatment. The response was categorized according to reduction in monthly headache days (MHD): Sustained-response (SustainedR, ≥50% at M3 and M6); Short-Response (ShortR, M3≥50% and M6<50%), Later-Response (LaterR, M3<50% and M6≥50%); Limited-Response (LimitedR, 25-50% at M3 and M6) and No-Response (NoR, <25% at M3 and M6). Response patterns were compared at baseline and with outcome variables at M3 and M6. We included 357 patients with a headache frequency of 21.0(16.0, 28.0) MHD and 84.0% (300/357) were chronic migraine. The distribution according to response pattern was: 37.0% (110/297) Sustained-Response, 16.8% (50/297) Later-Response, 10.4% (31/297) Short-Response, 22.6% (67/297) Limited-Response and 13.1% showed No-Response (39/297). Sustained-R and Later-R groups showed statistically significant anxiety and depression score reduction at M3 and M6 compared to other groups. Initial response to anti-CGRP MAbs is not consistent in all patients. Persistence of anxiety and depression might be associated with lower response rates at month 6.

Childhood abuse/neglect and temporal patterns in late-life anxiety

Objectives Anxiety has been associated with childhood abuse/neglect, but this relationship and its mechanisms are poorly documented in older adults. This study examined the association between childhood abuse/neglect and late-life anxiety temporal patterns (i.e. absence, remission, incidence, persistence), testing for mediators. Methods Data were derived for 724 French-speaking community-living older adults participating in the Étude sur la santé des ainés – Services study with available information at baseline and 4-year follow-up. Past-month anxiety was based on a cutoff score ≥5 on a French translation of the 7-item Generalized Anxiety Disorder at interviews. Questions on childhood abuse/neglect (e.g. psycho-emotional, physical, sexual) were administered. Adjusted multinomial regression analyses and mediation bootstrapping models were used. Tested mediators included traumatic events (excluding childhood abuse/neglect), daily hassles, psychological resilience, and cortisol activity. Results The absence, remission, incidence and persistence of anxiety was found in 45.3%, 25.3%, 8.7% and 20.7% of the sample, respectively. Participants with incident and persistent late-life anxiety experienced more childhood abuse/neglect. Participants with persistent anxiety also reported lower psychological resilience. The association between childhood abuse/neglect with anxiety incidence was mediated by daily hassles, while its association with anxiety persistence was mediated by daily hassles and psychological resilience. Conclusion Past childhood abuse/neglect was associated with late-life anxiety incidence and persistence, with psychological resilience and daily hassles potentially explaining this relationship. Further research should focus on ascertaining the clinical applications of psychosocial and biological profiles in informing the prevention and personalized treatment of anxiety in older adults.

Physical multimorbidity predicts the onset and persistence of anxiety: A prospective analysis of the Irish Longitudinal Study on Ageing

BackgroundThe aims of the present study were to examine prospective associations of multimorbidity (i.e., ≥2 chronic conditions) at baseline with incident and persistent anxiety over a two-year follow-up period among Irish older adults, and to quantify the extent to which sleep, pain, and disability mediate the multimorbidity-anxiety relationship. MethodsData from The Irish Longitudinal Study on Aging (TILDA) conducted between 2009 and 2011 with a follow-up after two years were analyzed. Anxiety referred to score ≥ 8 on the anxiety section of the Hospital Anxiety and Depression Scale. Lifetime diagnosis of 14 chronic conditions was obtained. Outcomes were incident and persistent anxiety at two-year follow-up. ResultsData on 5871 adults aged ≥50 years at baseline were analyzed [Mean (SD) age 63.3 (9.0) years; 51.2% women]. After adjustment for potential confounders, compared to no chronic physical conditions at baseline, ≥3 chronic conditions were associated with a significant 1.89 (95% CI = 1.16–3.08) times higher risk for new onset anxiety at follow-up. Furthermore, having 1, 2, and ≥3 conditions at baseline were associated with significant 1.48 (95% CI 1.02, 2.14), 1.74 (95% CI 1.19, 2.53), and 1.84 (95% CI 1.27, 2.68) times higher risk for persistent anxiety at follow-up. Sleep problems, pain, and disability were identified as significant mediators, explaining 22.9%–37.8% of the associations. ConclusionMultimorbidity was associated with both new onset and persistent anxiety among Irish older adults. Future interventional studies should examine whether addressing the identified mediators may lead to lower risk for incident or persistent anxiety among those with physical multimorbidity.

Prevalence and Persistence of Anxiety and Depression over Five Years since Breast Cancer Diagnosis-The NEON-BC Prospective Study.

Anxiety and depression are frequent among patients with breast cancer (BCa). Evidence of the persistence and recovery from these conditions and their determinants is scarce. We describe the occurrence of clinically significant anxiety and depression symptoms and their associated factors among BCa patients. A total of 506 women admitted in 2012 at the Portuguese Institute of Oncology of Porto were evaluated before treatment and after one, three, and five years (7.9% attrition rate). The five-year prevalence of anxiety and/or depression (Hospital Anxiety and Depression Scale, subscores ≥ 11) was 55.4%. The peak prevalence for anxiety was before treatment (38.0%), and after one year for depression (13.1%). One in five patients with anxiety/depression at baseline had persistent anxiety/depression over time, while only 11% and 22% recovered permanently from anxiety and depression, respectively, during the first year. Higher education, higher income, practicing physical activity, and adequate fruit and vegetable intake were protective factors against anxiety and/or depression. Loss of job and income, anxiolytics and antidepressants, cancer-related neuropathic pain, and mastectomy were associated with higher odds of anxiety and/or depression. These results highlight the importance of monitoring anxiety/depression during the first five years after cancer diagnosis and identify factors associated with these conditions.

Potential use of albumin and neutrophil-to-lymphocyte ratio to guide the evaluation and treatment of cancer-related depression and anxiety.

Depression and anxiety are common and associated with inflammation in patients with cancer. Inflammatory indices such as albumin and neutrophil-to-lymphocyte ratio (NLR) obtained from metabolic panels and complete blood counts should be available for mental health professionals treating anxiety and depression at cancer centers. We hypothesized that albumin and NLR extrapolated from non-mental health oncology appointments would be associated with anxiety and depression and drawn close enough to psychiatry visits to be useful for the psycho-oncologist. MATERIALS& METHODS: Depression and anxiety were evaluated in patients (n=97) referred to a cancer center psychiatric service for depression using the Patient Health Questionnaire-9 and General Anxiety Disorder-7. Albumin concentration and NLR were assessed for timing and correlation strength with anxiety and depression by setting (localized/metastatic cancer). Most patients (96%) had albumin or NLR available at any time point of which 45% were drawn within one week of the psychiatric appointment. No significant correlations were noted when evaluating localized cancer or NLR exclusively. For patients with metastatic cancer, anxiety and depression were correlated with albumin at any time point (r=-0.28, p<0.05; r=-0.40, p<0.01, respectively) and within a week of psychiatry appointment (r=-0.40, p<0.05; r=-0.68, p<0.001, respectively). Albumin evaluated within a week predicted 32% of depression score variance (β=-0.63, p=0.002). Hypoalbuminemia (<3.8g/ul) was associated with anxiety (χ2=4.43, p=0.04) and depression (χ2=11.06, p=0.001). Hypoalbuminemia in patients with metastatic cancer may help establish the presence or persistence of anxiety, depression, treatment refractoriness, and the use of inflammation in cancer-related psychological symptom management.

Changes in insomnia as a risk factor for the incidence and persistence of anxiety and depression: a longitudinal community study

BackgroundThe aim of this investigation was to examine the longitudinal association between change in insomnia status and the development of anxiety and depression in the general population.MethodsA survey was mailed to 5000 randomly selected individuals (aged 18–70 years) in two Swedish counties. After 6 months, a follow-up survey was sent to those (n = 2333) who answered the first questionnaire. The follow-up survey was completed by 1887 individuals (80.9%). The survey consisted of questions indexing insomnia symptomatology, socio-demographic parameters, and the Hospital Anxiety and Depression Scale. Change in insomnia status was assessed by determining insomnia at the two time-points and then calculating a change index reflecting incidence (from non-insomnia to insomnia), remission (from insomnia to non-insomnia), or status quo (no change). Multivariate binary logistic regression analyses were used to examine the aim.ResultsIncident insomnia was significantly associated with an increased risk for the development of new cases of both anxiety (OR = 0.32, p < .05) and depression (OR = 0.43, p < .05) 6 months later. Incident insomnia emerged also as significantly associated with an elevated risk for the persistence of depression (OR = 0.30, p < .05), but not for anxiety.ConclusionsThis study extends previous research in that incidence in insomnia was shown to independently increase the risk for the development of anxiety and depression as well as for the maintenance of depression. The findings imply that insomnia may be viewed as a dynamic risk factor for anxiety and depression, which might have implications for preventative work.

Environmental enrichment prevents the late effect of acute stress-induced fear extinction deficit: the role of hippocampal AMPA-GluA1 phosphorylation

The persistence of anxiety and the deficit of fear memory extinction are both phenomena related to the symptoms of a trauma-related disorder, such as post-traumatic stress disorder (PTSD). Recently we have shown that single acute restraint stress (2 h) in rats induces a late anxiety-related behavior (observed ten days after stress), whereas, in the present work, we found that the same stress impaired fear extinction in animals conditioned ten days after stress. Fourteen days of environmental enrichment (EE) prevented the deleterious effect of stress on fear memory extinction. Additionally, we observed that EE prevented the stress-induced increase in AMPA receptor GluA1 subunit phosphorylation in the hippocampus, but not in the basolateral amygdala complex and the frontal cortex, indicating a potential mechanism by which it exerts its protective effect against the stress-induced behavioral outcome.

Anxiety and Depression Correlates at Age 10 in Children Born Extremely Preterm.

Objective Anxiety and depression rates are known to be elevated in prematurely-born children and adolescents. This prospective study examines demographic, academic, and physical health correlates of anxiety and depression symptoms in a sample of 10-year-old children who were born extremely preterm. Methods Participants were 889 (51.2% male; 62.3% White) children who were born <28 weeks gestation. Child and family demographic data were collected at birth. When the children were 10, parents (n = 871) and teachers (n = 640) rated the level of anxiety and depression in children through the Child Symptom Inventory-4. Child academic functioning was assessed via the Wechsler Individual Achievement Test-III. Parents completed questionnaires about child academic functioning and physical health issues. Data analyses were conducted with multivariate linear modeling. Results Level of prematurity was significantly related to both parent and teacher reports of anxiety. Public health insurance and individualized education program (IEP) status were associated with both parent and teacher reports of depression. Hispanic ethnicity, public insurance, IEP status, and asthma were significantly associated with both parent-reported anxiety and depression. Gross motor impairment was associated with parent-reported anxiety and teacher-reported depression. Child obesity was associated with teacher reports of anxiety, while male sex was significantly related to teacher reports of depression. Conclusion This pattern of findings may suggest hypotheses for future research on models of the development and persistence of anxiety and depression within this particularly vulnerable group of children.

To Approach or to Avoid: The Role of Ambivalent Motivation in Attentional Biases to Threat and Spider Fear

People with anxiety difficulties show different patterns in their deployment of attention to threat compared to people without anxiety difficulties. These attentional biases are assumed to play a critical role in the development and persistence of anxiety. However, little is known about factors that influence attentional biases to threat. An emerging body of evidence suggests that visual attention to threat varies across the time course according to one’s motivation to approach vs. avoid threat. In order to better understand the relationship between motivation, attentional biases to threat, and anxiety, we had participants high in spider fear complete a sustained-attention task in full view of a live tarantula while their eye movements were tracked. Participants who were ambivalent about whether to look at the spider or to avoid looking exhibited a unique pattern of visual attention to the spider, and reported higher spider fear and more negative affect than did other participants at the end of the study. Our findings suggest that anxiety persistence may have more to do with goal prioritization than innate attentional biases. Future studies of attentional biases to threat should take motivation into account and study attention across the time course. Ambivalent motivation to threat should also be targeted in exposure therapy.

Impact of Rumination on Severity and Persistence of Anxiety and Depression in Cardiac Patients

Background: Anxiety and depression are common after an acute cardiac event. While many studies have investigated the predictors of anxiety and depression, few have focused on the role of rumination. The aim of this study was to identify the ruminative styles that predict anxiety and depression in the 2 years' postcardiac event. Methods: A total of 426 cardiac patients, 210 admitted for acute coronary syndrome (ACS), and 216 to undergo coronary artery bypass graft surgery were recruited from three metropolitan hospitals in Melbourne, Australia. Participants completed self-report questionnaires at the time of their event and at 12- and 24-months postevent. Anxiety and depression were assessed at all three time points, whereas ruminative styles were assessed at 24 months. Clinical information was retrieved from the participants' medical records. Bivariate and multivariate analyses were undertaken to identify the factors associated with and predictive of anxiety and depression at 24-months postevent. Results: A diagnosis of ACS, history of depression, smoking, and brooding and intrusive rumination were associated with both anxiety and depression, while female gender was associated with anxiety only. Brooding and intrusive rumination were the unique predictors of anxiety and depression, after controlling for other factors. Limitations: Generalizability of the findings is limited by the preponderance of men in the sample and by participant attrition over the study period. Conclusion: The findings indicate the importance of screening for rumination styles after a cardiac event to enhance targeting of psychological treatments for cardiac patients at risk of persistent anxiety or depression.

Anxiety symptom levels are persistent in older adults with a mental disorder: A 33-month follow-up study.

Anxiety symptoms are common in old age and have been suggested as risk factors for development of cognitive impairment and mortality. The objective of the present study was to investigate whether anxiety symptoms among older adults with a mental health diagnosis are persistent, and severity of anxiety predicts cognitive decline and mortality. We collected data from 201 patients referred to specialist mental health service in a department of geriatric psychiatry. Of these, 150 were reexamined after 33months, while 51 patients died before follow-up. Mean age (SD) at baseline among the patients that were reexamined was 73.4 (7.3) years, and 67% were women. The Geriatric Anxiety Inventory (GAI) was used to measure anxiety symptoms at baseline and follow-up. We investigated whether higher GAI scores at baseline were associated with persistence of anxiety. Associations with cognitive decline or mortality were also explored. The associations were estimated by use of trajectory analysis and regression models. Seventy-four percentages had the same level of anxiety symptoms, and 29% had a high level of anxiety at baseline and follow-up. GAI score at baseline was not associated with cognitive decline or mortality at 33-month follow-up. In a longitudinal study of anxiety symptoms among older adults in specialist mental health services, we demonstrate persistent high or low levels of anxiety symptoms. Anxiety trajectories over time were not predicted by patient characteristics. Also the level of anxiety cannot be used as predictor for future cognitive decline or mortality in a clinical population.

Effects of lipopolysaccharide administration and maternal deprivation on anxiety and depressive symptoms in male and female Wistar rats: Neurobehavioral and biochemical assessments

IntroductionPreclinical studies of early-life adversity (ELA11Early-life adversity: ELA. Lipopolysaccharide: LPS. Maternal deprivation: MD. Intraperitoneal: IP. Postnatal day: PND. Phosphate buffered saline: PBS. Nitric oxide: NO. Prefrontal cortex: PFC. Hippocampus: HP. Thiobarbituric-acid-reacting substances: TBARS. Superoxide dismutase: SOD. Nitroblue tetrazolium: NBT.) have highlighted the role of postnatal stress in the emergence and persistence of anxiety and depressive disorders. In this study, we compared anxious and depressive behaviors and oxidation levels in male and female Wistar rats subjected to three ELAs (lipopolysaccharide (LPS) induced, maternal deprivation (MD), or combination of the two stressors). MethodsRats were split into four groups: control group which received an intraperitoneal (IP) injection of saline on postnatal day (PND) 1, LPS-treated group which received an IP injection of LPS on PND1, MD group which was exposed to a 24-hour period of isolation on PND9, and LPS-treated/MD group which received an IP injection of LPS on PND1 then was exposed to a 24-hour period of isolation on PND9. Each group consisted of 12 rats and had an equal gender distribution. At three months, rats were subjected to neurobehavioral assessments and biochemical oxidative assays. ResultsCompared to controls, rats in the LPS and MD groups scored significantly higher on anxiety and depression-related measures. Gender differences in response were mainly observed in the MD group. Exposure to the combination of stressors led to a characteristic decrease in anxiety and an increase in depressive measures in both genders. All groups exposed to ELA showed a statistically significant increase in their oxidative stress levels. ConclusionResponse to ELA is gender-dependent and modulated by the nature, type, and number of stressors. Further investigations are critical to understand the mechanisms underlying combination of stressors and gender’s effect.

Effect of Nitric Oxide on Basolateral Amygdala on Persistence of Anxiety and Depression in Stressed Male Rats.

Introduction:The current study aimed at investigating the role of Nitric Oxide (NO) in the maintenance of anxiety and depression induced by stress in male Wistar rats using intra-Basolateral Amygdala (BLA) injection of NO precursor, L-arginine, Nitric Oxide Synthase (NOS) inhibitor, and L-NAME.Methods:Two 23-gauge stainless steel cannulas were placed in the BLA, stereotaxically. Seven days later, animals experienced electro foot shock stress based on the following protocol: animals experienced four sessions of stress for 60 minutes in four consecutive days. Five minutes before each stress session, the animals received different doses of L-arginine or L-NAME (1, 5 and, 10 μg/rat) or saline (0.5 μL/rat) intra-BLA. Six days after the stress termination, animals were tested for maintenance of anxiety-like behavior (elevated plus maze; EPM) and eight days after the stress they were examined for depression (forced swimming test; FST).Results:Stress reduced the time and number of open arms and decreased motor activity on EPM. Stress-induced anxiety was inhibited by L-arginine and L-NAME (1, 5, and 10 μg/rat). L-Arginine and L-NAME induced anxiety in non-stressed rats. Stress also increased the immobility time in animals in FST paradigm. Interestingly, both L-arginine and L-NAME, in all doses reduced the stress effect.Conclusion:BLA nitric oxide may play a pivotal role in anxiety and depression induced by stress in rats. Since the effects of both L-arginine and L-NAME were similar, NO might have a modulatory role in the BLA.

Anxiety sensitivity and fear of exercise in patients attending cardiac rehabilitation

BackgroundHabitual engagement in aerobic exercise is critically important for the secondary prevention of cardiovascular disease. Anxiety sensitivity, the fear of anxiety and arousal sensations, is a cognitive factor associated with risk and persistence of anxiety and stress disorders. Anxiety sensitivity has also been linked to various problematic health behaviors, including low levels of physical activity. Thus, anxiety sensitivity may undermine aerobic exercise participation in patients enrolled in cardiac rehabilitation (CR). PurposeThis is the first study to evaluate anxiety sensitivity in patients enrolled in CR, and examine the association between anxiety sensitivity and fears about the negative consequences of exercise. MethodsPatients (n = 69, 68.1% male) were enrolled in an outpatient, medically-supervised, multi-component 12-week CR program. Anxiety sensitivity was assessed with the Anxiety Sensitivity Index-3 (ASI-3). ResultsOn average, patients had completed 5.3 (SD = 3.5) weeks of CR. Scores on the ASI-3 indicated moderate levels of anxiety sensitivity (M = 17.2, SD = 12.3). Moderate and high levels of anxiety sensitivity were present in 43.5% and 31.9% of patients. Anxiety sensitivity was significantly moderately correlated with fear of negative consequences from exercise. After adjusting for relevant covariates, anxiety sensitivity accounted for significant incremental variance in fears of negative consequences from exercise, which was a medium-sized effect. ConclusionsElevated anxiety sensitivity is common in patients enrolled in CR and is associated with greater fears of negative consequences from exercise. Anxiety sensitivity may be an important clinical target in CR to decrease patients’ fears about bodily sensations to promote exercise engagement, and in turn, enhance CR outcomes.

Maternal depression and anxiety associated with dental fear in children: a cohort of adolescent mothers in Southern Brazil.

Exposure to maternal symptoms of depression/anxiety has long-term negative consequences for child development, regardless of the contextual risk. The objective of this study was to investigate the relationship of the symptomatology of persistent maternal depression and anxiety with child dental fear. This study was nested in a cohort of adolescent mothers in southern Brazil. Symptomatology of maternal depression and anxiety was assessed during pregnancy and postpartum, when the mothers' children were 24-36 months old, using Beck Depression Inventory and Beck Anxiety Inventory. The mothers answered a questionnaire to assess dental fear in their children, and to obtain socioeconomic and demographic data. Both mothers and their children were submitted to clinical oral examination (n= 540 dyads) to obtain oral health data. Multivariate hierarchical Poisson regression analysis was used to determine associations (p < 0.05). At data collection, the prevalence of maternal depressive symptoms was 39.1%, and anxiety was observed in 27.8% of the mothers, whereas 21.6% of the children presented dental fear. In the adjusted analysis, children's dental fear was positively associated with mothers' presenting depressive symptomatology and caries experience. The depression symptomatology trajectory was not associated with dental fear, whereas mothers with persistent symptoms of anxiety reported higher prevalence of dental fear toward their offspring. The findings of symptomatology of maternal depression observed at data collection and persistence of anxiety may negatively impact the child's perception of dental fear. Mothers are the main caregivers and primary models responsible for transmitting health-related behaviors; consequently, mental disorders affecting mothers may negatively impact their children.

Lack of Diagnostic Pluripotentiality in Patients at Clinical High Risk for Psychosis: Specificity of Comorbidity Persistence and Search for Pluripotential Subgroups.

More than 20 years after the clinical high risk syndrome for psychosis (CHR) was first articulated, it remains controversial whether the CHR syndrome predicts onset of psychosis with diagnostic specificity or predicts pluripotential diagnostic outcomes. Recently, analyses of observational studies, however, have suggested that the CHR syndrome is not pluripotential for emergent diagnostic outcomes. The present report conducted additional analyses in previously reported samples to determine (1) whether comorbid disorders were more likely to persist in CHR patients compared to a comparison group of patients who responded to CHR recruitment efforts but did not meet criteria, termed help-seeking comparison subjects (HSC); and (2) whether clinically defined pluripotential CHR subgroups could be identified. All data were derived from 2 multisite studies in which DSM-IV structured diagnostic interviews were conducted at baseline and at 6-month intervals. Across samples we observed persistence of any nonpsychotic disorder in 80/147 CHR cases (54.4%) and in 48/84 HSC cases (57.1%, n.s.). Findings with persistence of anxiety, depressive, and bipolar disorders considered separately were similar. Efforts to discover pluripotential CHR subgroups were unsuccessful. These findings add additional support to the view that the CHR syndrome is not pluripotential for predicting various diagnostic outcomes but rather is specific for predicting emergent psychosis.

Reducing Fear During Childhood to Prevent Anxiety Disorders Later: Insights From Developmental Psychobiology

Anxiety disorders are neurodevelopmental with the median age of onset 10 to 11 years, but developmental processes underlying fear and anxiety are rarely investigated. In the last decade, however, developmental rodent studies have increased our understanding of how to treat and prevent the persistence of anxiety. Behavioral findings from rodent studies match the observations in anxious children, and the neural and molecular findings help explain why anxiety disorders are indeed neurodevelopmental. Extinction processes that are involved in cognitive-behavioral therapy appear particularly effective in children compared with older populations. Policy should mandate school psychologists and government subsidies for therapy sessions to increase children’s mental-health-service utilization. Funding bodies also should challenge anxiety studies exclusively targeting adults to include younger people to investigate why anxiety disorders are developmental disorders and focus more on preventing their persistence later in life.

Presence and Predictive Value of Obsessive-Compulsive Symptoms in Anxiety and Depressive Disorders.

Obsessive-compulsive symptoms (OCS) co-occur frequently with anxiety and depressive disorders, but the nature of their relationship and their impact on severity of anxiety and depressive disorders is poorly understood. In a large sample of patients with anxiety and depressive disorders, we assessed the frequency of OCS, defined as a Young Adult Self-Report Scale-obsessive-compulsive symptoms score >7. The associations between OCS and severity of anxiety and/or depressive disorders were examined, and it was investigated whether OCS predict onset, relapse, and persistence of anxiety and depressive disorders. Data were obtained from the third (at 2-year follow-up) and fourth wave (at 4-year follow-up) of data collection in the Netherlands Study of Anxiety and Depression cohort, including 469 healthy controls, 909 participants with a remitted disorder, and 747 participants with a current anxiety and/or depressive disorder. OCS were present in 23.6% of the total sample, most notably in those with current combined anxiety and depressive disorders. In patients with a current disorder, OCS were associated with severity of this disorder. Moreover, OCS predicted (1) first onset of anxiety and/or depressive disorders in healthy controls (odds ratio [OR], 5.79; 95% confidence interval [CI], 1.15 to 29.14), (2) relapse in those with remitted anxiety and/or depressive disorders (OR, 2.31; 95% CI, 1.55 to 3.46), and (3) persistence in patients with the combination of current anxiety and depressive disorders (OR, 4.42; 95% CI, 2.54 to 7.70) within the 2-year follow-up period Conclusions: OCS are closely related to both the presence and severity of anxiety and depressive disorders and affect their course trajectories. Hence, OCS might be regarded as a course specifier signaling unfavorable outcomes. This specifier may be useful in clinical care to adapt and intensify treatment in individual patients.