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1.  Comorbidity of Infectious Diseases and Anxiety Disorders in Adults and Its Association with Quality of Life: A Community Study 
Objective: Infectious diseases and anxiety disorders are common and both are associated with substantial burden to individual, families, and society. A better understanding of their association may be helpful in explicating possible etiological mechanisms related to both. The goal of the current study was to investigate the relationship between specific infectious diseases and anxiety disorders among adults in the community, and to examine whether the co-occurrence of the two is associated with poorer quality of life compared to subjects with one or neither condition.
Methods: We used data from the 1998 German Mental Health survey with 4181 subjects aged 18–65. Various infectious diseases (lifetime) and health-related quality of life were assessed via self-report questionnaires and anxiety disorders (past 12-months) were diagnosed using M-CIDI interviews. Logistic regression analyses were used to evaluate the association between infectious diseases and anxiety disorders; a linear model adjusted for sex was used to examine whether comorbidity of infectious diseases and anxiety disorders was associated with quality of life.
Results: Whooping cough [odds ratio (OR) = 1.69, 95% confidence intervals (CI) = 1.36–2.09], scarlet fever (OR = 1.31, 95% CI = 1.02–1.68), and diphtheria (OR = 1.79, 95% CI = 1.21–2.64) were associated with increased prevalence of any anxiety disorder. Subjects with both infectious diseases and anxiety disorders reported lower levels of both mental and physical quality of life, compared with subjects with only one or neither condition.
Conclusion: Extending prior research, this study suggests a relationship between specific infectious diseases and anxiety disorders in an adult community sample. Research targeting etiological mechanisms related to the interplay between infectious diseases and anxiety disorders is warranted.
PMCID: PMC4095564  PMID: 25072049
representative survey; anxiety disorder; comorbidity; infectious diseases; quality of life
2.  Physical diseases among persons with obsessive compulsive symptoms and disorder: a general population study 
This study aimed at evaluating the comorbidity between DSM-IV obsessive compulsive disorder (OCD) and subthreshold forms and physical diseases in the general population as well as disability associated with comorbidity.
We used data from the 1998 German Mental Health Survey, a representative survey of the German population. Mental disorders and physical diseases of 4181 subjects (aged 18–65) were cross-sectionally assessed. Mental disorders were diagnosed using the M-CIDI/DIA-X interview. Physical diseases were assessed through a self-report questionnaire and a standardized medical interview. We created three groups of obsessive–compulsive symptoms: (1) no obsessive compulsive symptoms (n = 3,571); (2) obsessive compulsive symptoms (OCS, n = 371; endorsement of OCS (either obsession or compulsion) without fulfilling any core DSM-IV criteria); (3) subthreshold OCD/OCD (n = 239; fulfilling either some or all of the core DSM-IV criteria).
In comparison to subjects without OCS, subjects with subthreshold OCD/OCD showed higher prevalence rates of migraine headaches (OR 1.7; 95 % CI 1.1–2.5) and respiratory diseases (OR 1.7; 95 % CI 1.03–2.7); subjects with OCS showed higher prevalence rates of allergies (OR 1.6; 95 % CI 1.1–2.8), migraine headaches (OR 1.9; 95 % CI 1.4–2.7) and thyroid disorders (OR 1.4; 95 % CI 1.01–2.0). Subjects with both OCS and physical disease reported the highest number of days of disability due to physical or psychological problems during the past 30 days compared to subjects with only OCS, only physical disease or neither of them.
OCD and subthreshold forms are associated with higher comorbidity rates with specific physical diseases and higher disability than subjects without OCS. Possible etiological pathways should be evaluated in future studies and clinicians in primary care should be aware of these associations.
PMCID: PMC4228109  PMID: 24907897
OCD; Subthreshold types; Physical disease; Epidemiology; Obsessive compulsive symptoms; Disability
3.  Is worry different from rumination? Yes, it is more predictive of psychopathology! 
Objective: Although worry and rumination are everyday phenomena as well as common symptoms across numerous psychopathological disorders, the theoretical and clinical delineations of both concepts need more clarification. This study explored the degree of overlap between worry and rumination on the levels of standardized questionnaires and a priori lay concepts.
Method: The subjective conceptualization of worry and of rumination of 221 undergraduate and graduate students was assessed with the semantic differential technique, together with the frequency and intensity with which they experienced worry and rumination (based on their lay concepts). Standardized self-report measures for worry, rumination, depression, and anxiety were also administered.
Results: Worry was viewed as more negative than rumination and was more predictive of anxiety as well as of depression than rumination, especially when the assessment was based on the subjective lay concepts. The different measures of worry and rumination were only moderately correlated with each other.
Conclusion: It is concluded that the lay concepts worry and rumination and the hypothetical constructs worry and rumination should not be confused in personality and clinical research.
PMCID: PMC2778826  PMID: 19949448
worry; rumination; anxiety; depression; semantic differential technique; assessment
4.  Psychometric Properties of the Depression Anxiety and Stress Scale-21 in Older Primary Care Patients 
Journal of affective disorders  2008;110(3):248-259.
The Depression Anxiety Stress Scale (DASS) was designed to efficiently measure the core symptoms of anxiety and depression and has demonstrated positive psychometric properties in adult samples of anxiety and depression patients and student samples. Despite these findings, the psychometric properties of the DASS remain untested in older adults, for whom the identification of efficient measures of these constructs is especially important.
To determine the psychometric properties of the DASS 21-item version in older adults, we analyzed data from 222 medical patients seeking treatment to manage worry. Consistent with younger samples, a three-factor structure best fit the data. Results also indicated good internal consistency, excellent convergent validity, and good discriminative validity, especially for the depression scale. Receiver operating curve analyses indicated that the DASS-21 predicted the diagnostic presence of generalized anxiety disorder and depression as well as other commonly used measures.
These data suggest that the DASS may be used with older adults in lieu of multiple scales designed to measure similar constructs, thereby reducing participant burden and facilitating assessment in settings with limited assessment resources.
PMCID: PMC2709995  PMID: 18304648
Depression Anxiety Stress Scale; Older Adults; GAD; Anxiety; Assessment

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