Maternal depressive symptoms are a strong predictor of increases in depressive symptoms in offspring, yet knowledge of individual differences that may moderate the association between youth and maternal symptoms is still relatively scant. Youth genetic susceptibility to maternal depressive symptoms in particular is a nearly unexplored area of research.
This study used a multiwave prospective design and lagged hierarchical linear modeling analyses to examine whether youth 5-HTTLPR genotype moderated the longitudinal association between mother and youth depressive symptoms in a community sample (N = 241 youth). Maternal and youth symptoms were assessed every 3 months over 1 year (five waves of data).
Youth 5-HTTLPR interacted with idiographic elevations in maternal depressive symptoms (elevations relative to mothers’ average level of symptoms) to predict prospective increases in youth symptoms 3 months later. Youth with the SS genotype experienced greatest increases in depressive symptoms when exposed to elevations in maternal symptoms. Youth 5-HTTLPR did not interact with maternal nomothetic elevations in depressive symptoms (severity of symptoms compared to the sample as a whole).
These findings advance knowledge on genetic susceptibility for intergenerational transmission of depression between mothers and their children.
child/adolescent; depression; gene–environment; maternal child; mood disorders
Brain serotonin-1A receptors (5-HT1A) are implicated in anxiety. We compared regional brain 5-HT1A binding in medication-free participants with posttraumatic stress disorder (PTSD) and healthy volunteers using fully quantitative positron emission tomography (PET) methods.
Twenty patients with DSM-IV PTSD (13 with comorbid major depressive disorder, [MDD]) and 49 healthy volunteers underwent PET imaging with 5-HT1A antagonist radioligand [C-11]WAY100635. Arterial blood sampling provided a metabolite-corrected input function and the concentration of free ligand in plasma (fP) for estimation of regional binding potential, BPF ( = Bavailable /KD). Linear mixed modeling compared BPF between groups across regions of interest (ROIs).
The PTSD group had higher 5-HT1A BPF across brain ROIs (P = .0006). Post hoc comparisons showed higher 5-HT1A BPF in PTSD in all cortical ROIs (26–33%), amygdala (34%), and brainstem raphe nuclei (43%), but not hippocampus. The subgroup of seven PTSD patients without comorbid MDD had higher 5-HT1A BPF compared with healthy volunteers (P = .03).
This is the first report of higher brainstem and forebrain 5-HT1A binding in vivo in PTSD. The finding is independent of MDD. PTSD and MDD have in common an upregulation of 5-HT1A binding including midbrain autoreceptors that would favor less firing and serotonin release. This abnormality may represent a common biomarker of these stress-associated brain disorders.
posttraumatic stress disorder (PTSD); serotonin-1A (5-HT1A); positron emission tomography; WAY100635; major depressive disorder
Depressed breastfeeding women may have concerns about taking antidepressant medications due to fears regarding infant exposure. We examined the clinical records of 73 breastfeeding women who sought depression treatment, to identify characteristics of those who took antidepressants. Compared to women who were not treated with pharmacotherapy, breastfeeding patients who took antidepressants had more severe symptoms, greater functional impairment, more extensive psychiatric histories, and were less likely to be involved in a committed relationship. No differences were found in age, race, or education.
postpartum depression; breastfeeding; antidepressants; treatment acceptability; infant exposure
Increased reactivity of the insular cortex and decreased activity of the dorsal anterior cingulate (ACC) are seen in functional imaging studies of post-traumatic stress disorder (PTSD), and may partly explain the persistent fear- and anxiety-proneness that characterize the disorder. A possible neurochemical correlate is altered function of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). We report results from what we believe is the first study applying proton magnetic resonance spectroscopy (1H-MRS) to measure brain GABA in PTSD.
Thirteen adults with DSM-IV PTSD and 13 matched healthy control subjects underwent single voxel 1H-MRS at 4 Tesla. GABA was measured in the right anterior insula and dorsal anterior cingulate, using MEGAPRESS spectral editing. Subjects were interviewed with the Structured Clinical Interview for DSM-IV and the Clinician Administered PTSD Scale, and also completed the State and Trait Anxiety Inventory.
Insula GABA was significantly lower in PTSD subjects than in controls, and dorsal ACC GABA did not differ significantly between the groups. Insula GABA was not significantly associated with severity of PTSD symptoms. However, lower insula GABA was associated with significantly higher state and trait anxiety in the subject sample as a whole.
PTSD is associated with reduced GABA in the right anterior insula. This preliminary evidence of the 1H-MRS GABA metabolite as a possible biomarker of PTSD encourages replication in larger samples and examination of relations with symptom dimensions. Future studies also should examine whether insula GABA is a marker of anxiety proneness, cutting across clinical diagnostic categories.
post-traumatic stress disorder; magnetic resonance spectroscopy; anxiety; insular cortex; GABA
This study explores the relationships between therapist variables (CBT competence, and CBT adherence) and clinical outcomes of computer-assisted CBT for anxiety disorders delivered by novice therapists in a primary care setting.
Participants were recruited for a randomized controlled trial of evidence-based treatment, including computer-assisted CBT, versus treatment as usual. Therapists (Anxiety Clinical Specialists; ACSs) were non-expert clinicians, many of whom had no prior experience in delivering psychotherapy (and in particular, very little experience with CBT). Trained raters reviewed randomly selected treatment sessions from 176 participants and rated therapists on measures of CBT-competence and CBT-adherence. Patients were assessed at baseline and at 6, 12, and 18 month follow-ups on measures of anxiety, depression, and functioning, and an average reliable change index was calculated as a composite measure of outcome. CBT-competence and CBT-adherence were entered as predictors of outcome, after controlling for baseline covariates.
Higher CBT-competence was associated with better clinical outcomes whereas CBT-adherence was not. Also, CBT-competence was inversely correlated with years of clinical experience and trended (not significantly, though) down as the study progressed. CBT-adherence was inversely correlated with therapist tenure in the study.
Therapist competence was related to improved clinical outcomes when CBT for anxiety disorders was delivered by novice clinicians with technology assistance. The results highlight the value of the initial training for novice therapists as well as booster training to limit declines in therapist adherence.
Anxiety; cognitive behavioral therapy; treatment; primary care; dissemination/implementation
Biased attention patterns have been observed at early (16–500ms post-stimulus onset) and intermediate (1500–4000ms post-onset) timepoints in anxious youth, but it is unclear whether a more sustained form of neural-attentional bias, persisting well beyond the time frame of stimulus presentation and behavioral response, is also apparent. We investigated early, intermediate, and sustained forms of bias using behavioral measures and pupillary reactivity, an index of cognitive and affective load, to gain insight into potential neurocognitive targets for early intervention.
Twenty non-anxious youth and 74 youth with Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder and/or Social Phobia completed a dot-probe task, which requires participants to respond to a dot replacing either a neutral or fearful face. Emotional faces were presented for short/early (200 ms) or intermediate (2s) intervals and followed by a sustained post-stimulus interval. Pupil dilation, gaze direction, and reaction times were measured during task completion.
Early and intermediate vigilance patterns in reaction times and an avoidant pattern in gaze direction were observed in all participants irrespective of anxiety. Sustained pupil dilation in anxious youth was observed on trials in which the dot replaced fearful faces, along with an inflexible pattern of pupillary responding in comparison to controls.
Sustained cognitive-affective load following emotional face viewing is altered and inflexible in anxious youth. These prolonged alterations extend well beyond the timeframe of behavioral attentional bias and may indicate inflexible and insufficient sustained cognitive control. Early interventions targeting these alterations could improve long-term mental health trajectories.
pupil; anxiety; pediatric; attentional bias; dot-probe task
Previous studies demonstrate that anxiety is characterized by biased attention toward threats, typically measured by differences in motor reaction time to threat and neutral cues. Using eye-tracking methodology, the current study measured attention biases in anxious and nonanxious youth, using unrestricted free viewing of angry, happy, and neutral faces.
Eighteen anxious and 15 nonanxious youth (8–17 years old) passively viewed angry-neutral and happy-neutral face pairs for 10 s while their eye movements were recorded.
Anxious youth displayed a greater attention bias toward angry faces than nonanxious youth, and this bias occurred in the earliest phases of stimulus presentation. Specifically, anxious youth were more likely to direct their first fixation to angry faces, and they made faster fixations to angry than neutral faces.
Consistent with findings from earlier, reaction-time studies, the current study shows that anxious youth, like anxious adults, exhibit biased orienting to threat-related stimuli. This study adds to the existing literature by documenting that threat biases in eye-tracking patterns are manifest at initial attention orienting.
anxiety; threat-bias; orienting; eye tracking
To evaluate the prevalence of new onset or worsening of anxiety symptoms, as well as their clinical implications, during the first two weeks of Selective Serotonin Reuptake Inhibitor (SSRI) pharmacotherapy for depression.
Adult outpatients with non-psychotic major depressive disorder were enrolled in an 8-week acute phase SSRI treatment trial at 15 clinical sites across the US. Worsening anxiety was defined as a greater than 2 point increase on the Beck Anxiety Inventory (BAI) between baseline and Week 2. New onset of anxiety symptoms was ascribed when the BAI baseline rating was 0 and the Week 2 value was greater or equal to 2 points on the BAI.
Overall, after two weeks of treatment, 48.8% (98 of 201 participants) reported improvement in anxiety symptoms, 36.3% (73 of 201) reported minimal symptom change, and 14.9% (30 of 201) reported worsening of anxiety symptoms. No association was found between change in anxiety symptoms within the first two weeks and change in depressive symptoms or remission at the end of 8 weeks of treatment. For participants with clinically meaningful anxiety symptoms at baseline, however, worsening of anxiety during the first two weeks of treatment was associated with worsening depressive symptoms by 8 weeks (p = .054).
The trajectory of anxiety symptom change early in SSRI treatment is an important indicator of eventual outcome for outpatients with major depression and baseline anxiety symptoms.
anxiety; change; depression; SSRI; outcome
The study examined the comorbidity of obsessive-compulsive disorder (OCD) with major depressive disorder (MDD) in a family study of OCD with pediatric probands.
The study examined the lifetime prevalence of MDD in 133 first- and 459 second-degree relatives of pediatric probands with OCD and normal controls, and identified clinical variables associated with MDD in case first-degree relatives (FDR). All available FDR were directly interviewed blind to proband status; parents were also interviewed to assess the family psychiatric history of FDR and second-degree relatives (SDR). Best-estimate diagnoses were made using all sources of information. Data were analyzed with logistic regression and robust Cox regression models.
Lifetime MDD prevalence was higher in case than control FDR (30.4% vs. 15.4%). Lifetime MDD prevalence was higher in FDR of case probands with MDD than in either FDR of case probands without MDD (46.3% vs. 19.7%) or control FDR (46.3% vs. 15.4%). MDD in case FDR was associated with MDD in case probands and with age and OCD in those relatives. Lifetime MDD prevalence was similar in case and control SDR. However, lifetime MDD prevalence was higher in SDR of case probands with MDD than in either SDR of case probands without MDD (31.9% vs. 16.8%) or control SDR (31.9% vs. 15.4%).
The results provide further evidence of the heterogeneity of early-onset OCD and suggest that early-onset OCD comorbid with MDD is a complex familial syndrome.
anxiety; comorbidity; first-degree relatives; second-degree relatives; logistic regression; survival analysis
In clinical samples, comorbidity between depressive and anxiety disorders is associated with greater symptom severity and elevated suicide risk. Less is known, however, regarding the long-term psychosocial impact that a lifetime history of both MDD and one or more anxiety disorders has in community samples. This report evaluates clinical, psychological, social, and stress-related characteristics associated with a lifetime history of MDD and anxiety.
Data from 915 women aged 42–52 who were recruited as part of the the Study of Women's Health Across the Nation Mental Health Study were used to examine clinical and psychosocial features across groups of women with a SCID-diagnosed lifetime history of MDD alone, anxiety alone, both MDD and anxiety, or neither MDD nor anxiety.
As compared with women with a history of either MDD or anxiety alone, women with a comorbid history were more likely to report recurrent MDD, multiple and more severe lifetime anxiety disorders, greater depressive and anxiety symptoms, diminished social support, and more past-year distressing life events. Exploratory analyses indicated that women with a comorbid history also report more childhood abuse/neglect and diminished self-esteem, as compared with women with a history of either disorder alone.
Midlife women with a comorbid history that includes both MDD and anxiety disorders report diminished social support, more symptomatic distress, and a more severe and recurrent psychiatric history. Future research is needed to clarify the biological and psychosocial risk factors associated with this comorobid profile, and to develop targeted interventions for this at-risk group.
major depressive disorder; anxiety disorders; comorbidity; child abuse; social support; stress, psychological
This study was designed to examine the concordance of proposed DSM-5 posttraumatic stress disorder (PTSD) criteria with DSM-IV classification rules and examine the impact of the proposed DSM-5 PTSD criteria on prevalence.
The sample (N=185) included participants who were recruited for studies focused on trauma and health conducted at an academic medical center and VA medical center in the southeastern United States. The prevalence and concordance between DSM-IV and the proposed DSM-5 classifications were calculated based on results from structured clinical interviews. Prevalence rates and diagnostic efficiency indices including sensitivity, specificity, area under the curve (AUC), and Kappa were calculated for each of the possible ways to define DSM-5 PTSD.
Ninety-five percent of the sample reported an event that met both DSM-IV PTSD Criterion A1 and A2, but only 89% reported a trauma that met Criterion A on DSM-5. Results examining concordance between DSM-IV and DSM-5 algorithms indicated that several of the algorithms had AUCs above .90. The requirement of two symptoms from both Clusters D and E provided strong concordance to DSM-IV (AUC = .93; Kappa = .86) and a greater balance between sensitivity and specificity than requiring three symptoms in both Clusters D and E.
Despite several significant changes to the diagnostic criteria for PTSD for DSM-5, several possible classification rules provided good concordance with DSM-IV. The magnitude of the impact of DSM-5 decision rules on prevalence will be largely affected by the DSM-IV PTSD base rate in the population of interest.
posttraumatic stress disorder; PTSD; DSM-V; DSM-IV; diagnostic criteria; syndromes
Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are highly comorbid. A possible explanation is that they share four symptoms according to the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition – Text Revision (DSM-IV-TR). The present study addressed the symptom overlap of people meeting DSM-IV-TR diagnostic criteria for GAD, MDD, or both to investigate whether comorbidity might be explained by overlapping diagnostic criteria.
Participants (N = 1,218) were enrolled in the Coordinated Anxiety Learning and Management (CALM) study (a randomized effectiveness clinical trial in primary care). Hypotheses were: 1) the comorbid GAD/MDD group would endorse the overlapping symptoms more than the non-overlapping symptoms, and 2) the comorbid GAD/MDD group would endorse the overlapping symptoms more than GAD only or MDD only groups, whereas differences would not occur for non-overlapping symptoms.
The overlapping GAD/MDD symptoms were endorsed more by the comorbid group than the MDD group but not the GAD group when covarying for total symptom endorsement. Similarly, the comorbid group endorsed the overlapping symptoms more than the non-overlapping symptoms and did not endorse the non-overlapping symptoms more than the GAD or MDD groups when covarying for total symptom endorsement.
The results suggest that comorbidity of GAD and MDD is strongly influenced by diagnostic overlap. Results are discussed in terms of errors of diagnostic criteria, as well as models of shared psychopathology that account for diagnostic criteria overlap.
generalized anxiety disorder; major depressive disorder; comorbidity; primary care; diagnostic criteria
Social Phobia (SP) is a prevalent disorder in primary care settings. To date, few researchers have examined the natural course of SP in primary care. We examined the natural course and predictors of recovery in a large sample of primary care patients.
Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in primary care patients. The current report pertains to 182 patients with SP at intake. We examined intake demographic and clinical variables as predictors of recovery within the five years of follow-up.
The probability of recovery from SP during the 5 year follow-up period was .40. At intake, a longer duration of SP episode, co-morbid Panic Disorder with Agoraphobia, lower psychosocial functioning, and the presence of a medical condition predicted lower rates of recovery.
These findings highlight the chronicity of SP, as well as factors that may affect its naturalistic course. It is imperative that primary care physicians and mental health specialists assess for and treat SP in their practices. Future research is warranted to further examine the effect of medical and psychiatric comorbidity on SP course.
Social Phobia; Social Anxiety Disorder; Primary Care; Course; Prospective
Generalized Social Anxiety Disorder (GSAD) is characterized by excessive fear and avoidance of several types of social and performance situations. The pathophysiology is not well understood, but research in animals and humans has provided evidence that oxytocin helps regulate normal social affiliative behavior. Previous work in healthy male subjects demonstrated a rise in plasma oxytocin after receiving a high trust signal. To examine the oxytocin system in GSAD, we measured plasma oxytocin in GSAD patients and controls, before and after the social “Trust Game,” a neuroeconomic test examining trust behavior and reaction to trust using real monetary incentives.
Thirty-nine subjects with GSAD and 28 healthy controls provided three blood samples for oxytocin measurement before the Trust Game, and one sample after the game. Plasma estradiol was also measured at baseline. The Trust Game protocol version prioritized the sending of a signal of high cooperation and trust to all participants. All analyses controlled for gender and estradiol levels.
Mean oxytocin levels post-Trust Game (p=0.025), and overall (area under the curve, p=0.011) were lower in GSAD patients compared to controls, after controlling for sex and estradiol. There was no significant change in oxytocin levels after the Game in either group.
We report low plasma oxytocin levels in patients with generalized social anxiety disorder during a pro-social laboratory task paradigm. Additional research will be important to further examine the relationship between oxytocin and social behavior in GSAD.
social anxiety disorder; oxytocin; trust; neuropeptide; oxytocin/physiology; cooperative behavior; hormones/blood; trust/psychology; humans
Cognitive and affective processing has been the central focus of brain-related functions in psychology and psychiatry for many years. Much less attention has been paid to, what could be considered the primary function of the brain, to regulate the function of the body. Recent developments, which include the conceptualization of interoception as a process consisting of integrating the information coming from the inside of the body in the central nervous system (CNS) and the appreciation that complex emotional processes are fundamentally affected by the processing and regulation of somatic states, have profoundly changed the view of the function and dysfunction of the brain. This review focuses on the relationship between breathing and anxiety. Several anxiety disorders have been associated with altered breathing, perception of breathing and response to manipulations of breathing. Both clinical and experimental research studies are reviewed that relate breathing dysfunctions to anxiety. Altered breathing may be useful as a physiological marker of anxiety as well as a treatment target using interoceptive interventions.
Sleep disturbance (SD) has complex associations with depression, both preceding and following the onset and recurrence of depression. We hypothesized that students with depressive symptoms with SD would demonstrate a greater burden of comorbid psychiatric symptoms and functional impairment compared to students with depressive symptoms without SD.
During a mental health screening, 287 undergraduate students endorsed symptoms of depression (Beck Depression Inventory [BDI] ≥ 13) and filled out the following self-report measures: demographic questionnaire, BDI, Anxiety Symptom Questionnaire—intensity and frequency (ASQ), Beck Hopelessness Scale (BHS), Beck Anxiety Inventory (BAI), Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ), and the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ). SD was measured using the BDI sleep item #16 dichotomized (score 0: no SD; or score > 0: some SD).
Students with depressive symptoms and SD (n = 220), compared to those without SD (n = 67), endorsed significantly more intense and frequent anxiety and poorer cognitive and physical functioning. Students with depressive symptoms with and without SD did not significantly differ in depressive severity, hopelessness, or quality of life.
College students with depressive symptoms with SD may experience a greater burden of comorbid anxiety symptoms and hyperarousal, and may have impairments in functioning, compared to students with depressive symptoms without SD. These findings require replication. Depression and Anxiety 00:1–8, 2013.
sleep; depression; anxiety; hopelessness; functioning; quality of life; college students; mental health screening; hyperarousal
Transdiagnostic cognitive-behavioral treatments for anxiety disorders have been gaining increased attention and empirical study in recent years. Despite this, research on transdiagnostic anxiety treatments has, to date, relied on open trials, or comparisons to waitlist conditions, published benchmarks, or relaxation-based interventions.
The current study was a randomized clinical trial examining the efficacy of a 12-week transdiagnostic cognitive-behavioral group treatment in comparison to 12-week diagnosis-specific group CBT protocols for panic disorder, social anxiety disorder and generalized anxiety disorder.
Results from 46 treatment initiators suggested significant improvement during treatment, strong evidence for treatment equivalence across transdiagnostic and diagnosis-specific CBT conditions, and no differences in treatment credibility.
This study provides evidence supporting the efficacy of transdiagnostic CBT by comparison to current gold-standard diagnosis-specific CBT for social anxiety disorder, generalized anxiety disorder, and panic disorder. Transdiagnostic group CBT has the benefit of potentially easing dissemination and increasing access to evidence based treatments for anxiety without sacrificing efficacy.
Transdiagnostic; Cognitive-Behavioral Therapy; Non-Inferiority; Group Therapy
Findings regarding the relationship between patient treatment preference and treatment outcome are mixed. This is a secondary data analysis investigating the relationship between treatment preference, and symptom outcome and attrition in a large 2-phase depression treatment trial.
Patients met DSM-IV criteria for chronic forms of depression. Phase I was a 12-week, nonrandomized, open-label trial in which all participants (n=785) received antidepressant medication(s) (ADM). Phase I nonremitters were randomized to Phase II, in which they received 12 weeks of either Cognitive-Behavioral System of Psychotherapy (CBASP) + ADM (n=193), Brief Supportive Psychotherapy (BSP) + ADM (n=187), or ADM only (n=93). Participants indicated their treatment preference (medication only, combined treatment or no preference) at study entry. Symptoms were measured at 2-week intervals with the 24-item Hamilton Rating Scale for Depression (HAM-D).
A large majority of patients reported a preference for combined treatment. Patients who preferred medication only were more likely to endorse a chemical imbalance explanation for depression, whereas those desiring combined treatment were more likely to attribute their depression to stressful experiences. In Phase I, patients who expressed no treatment preference showed greater rates of HAM-D symptom reduction than those with any preference, and patients with a preference for medication showed higher attrition than those preferring combined treatment. In Phase II, baseline treatment preference was not associated with symptom reduction or attrition.
Treatment preferences may moderate treatment response and attrition in unexpected ways. Research identifying factors associated with differing preferences may enable improved treatment retention and response.
treatment outcome; treatment engagement
Previous work has shown that inhibition of fear is impaired in posttraumatic stress disorder (PTSD) resulting from both civilian and combat trauma. The purpose of the present study was to investigate the inhibition of learned fear in traumatized individuals diagnosed with either acute stress disorder (ASD) or PTSD. This is the first study to use a conditioned inhibition paradigm with traumatized individuals within a month of trauma exposure. We hypothesized that impaired fear inhibition would be evident in PTSD, but not ASD.
Using established translational, psychophysiological methods including fear-potentiated startle, and skin conductance, we examined fear acquisition, stimulus discrimination, and the transfer of learned safety in a Croatian population with ASD or PTSD. This cross-sectional study included three age-matched groups: healthy nontrauma controls (n = 27), a group with chronic PTSD (10 or more years since trauma exposure, n = 24), and a group with ASD (30 days or less since trauma exposure, n = 27).
The presence of trauma-related psychopathology, whether acute or chronic, was associated with an impaired ability to transfer learned safety based on fear-potentiated startle measures, while healthy control subjects showed significant fear inhibition in the presence of the safety cue compared to the danger cue, F(1,26) = 12.64, P = .001.
These data expand our previously observed findings of PTSD-associated fear inhibition deficits by demonstrating that trauma-related impairments in safety learning are evident within 30 days of trauma exposure.
anxiety disorders; biological markers; PTSD; startle; trauma
It has been suggested that clinician-rated scales and self-report questionnaires may be interchangeable in the measurement of depression severity, but it has not been tested whether clinically significant information is lost when assessment is restricted to either clinician-rated or self-report instruments. The aim of this study is to test whether self-report provides information relevant to short-term treatment outcomes that is not captured by clinician-rating and vice versa.
In genome-based drugs for depression (GENDEP), 811 patients with major depressive disorder treated with escitalopram or nortriptyline were assessed with the clinician-rated Montgomery–Åsberg Depression Rating Scale (MADRS), Hamilton Rating Scale for Depression (HRSD), and the self-report Beck Depression Inventory (BDI). In sequenced treatment alternatives to relieve depression (STAR*D), 4,041 patients treated with citalopram were assessed with the clinician-rated and self-report versions of the Quick Inventory of Depressive Symptomatology (QIDS-C and QIDS-SR) in addition to HRSD.
In GENDEP, baseline BDI significantly predicted outcome on MADRS/HRSD after adjusting for baseline MADRS/HRSD, explaining additional 3 to 4% of variation in the clinician-rated outcomes (both P < .001). Likewise, each clinician-rated scale significantly predicted outcome on BDI after adjusting for baseline BDI and explained additional 1% of variance in the self-reported outcome (both P < .001). The results were confirmed in STAR*D, where self-report and clinician-rated versions of the same instrument each uniquely contributed to the prediction of treatment outcome.
Complete assessment of depression should include both clinician-rated scales and self-reported measures.
depression; assessment/diagnosis; clinical trials; antidepressants; treatment; mood disorders
Although cognitive-behavioral therapy (CBT) is efficacious in the treatment of generalized anxiety disorder (GAD), many individuals remain symptomatic following treatment, indicating a need for further treatment development. As a result, many researchers have developed unique cognitive-behavioral therapies that highlight specific targets for intervention. The current study examined the effect of an acceptance-based behavioral therapy for GAD on the proposed targets for intervention highlighted in several of these theoretical models: emotion regulation difficulties, intolerance of uncertainty, and low perceptions of control. Clients were randomly assigned to immediate (n = 15) or delayed (n = 16) treatment. Individuals treated with the acceptance-based behavioral therapy reported significantly fewer difficulties in emotion regulation and fear of emotional responses, as well as greater tolerance of uncertainty and perceived control over anxiety than individuals in the waitlist control condition. In addition, these effects were maintained at 3- and 9-month follow-up assessments.
generalized anxiety disorder; mindfulness; worry; emotion regulation; perceived control
Anxiety disorders are among the most common psychiatric disorders; meditative therapies are frequently sought by patients with anxiety as a complementary therapy. Although multiple reviews exist on the general health benefits of meditation, no review has been focused on the efficacy of meditation for anxiety specifically.
Major medical databases were searched thoroughly with keywords related to various types of meditation AND anxiety. Over 1000 abstracts were screened, and 200+ full articles were reviewed. Only RCTs were included. The Boutron (2005) checklist to evaluate a report of a non-pharmaceutical trial (CLEAR-NPT) was used to assess study quality; 90% authors were contacted for additional information. Review Manager 5 was used for meta-analysis.
A total of 36 RCTs were included in the meta-analysis (2,466 observations). Most RCTs were conducted among patients with anxiety as a secondary concern. The study quality ranged from 0.3 to 1.0 on the 0.0–1.0 scale (mean = 0.72). Standardized mean difference (SMD) was −0.52 in comparison with waiting-list control (p < .001; 25 RCTs), −0.59 in comparison with attention control (p < .001; 7 RCTs), and −0.27 in comparison with alternative treatments (p < 0.01; 10 RCTs). 25 studies reported statistically superior outcomes in the meditation group compared to control. No adverse effects were reported.
This review demonstrates some efficacy of meditative therapies in reducing anxiety symptoms, which has important clinical implications for applying meditative techniques in treating anxiety. However, most studies measured only improvement in anxiety symptoms, but not anxiety disorders as clinically diagnosed.
meditation; meditative therapies; anxiety; systematic review; meta-analysis
Maternal depression is associated with a higher incidence of behavioral problems in infants, but the effects of maternal depression as early as 1 month are not well characterized. The objective of this study is to determine the neurobehavioral effects of maternal depression on infants exposed and not exposed to methamphetamine (MA) using the NICU Network Neurobehavioral Scale (NNNS).
Four hundred twelve mother–infant pairs were enrolled (MA = 204) and only biological mothers with custody of their child were included in the current analysis. At the 1-month visit (n = 126 MA-exposed; n = 193 MA-unexposed), the Beck Depression Inventory-II (BDI-II) was administered, and the NNNS was administered to the infant. Exposure was identified by self-report and/or gas chromatography/mass spectroscopy confirmation of amphetamine and metabolites in newborn meconium. Unexposed subjects were matched, denied amphetamine use, and had negative meconium screens. General Linear Models tested the effects of maternal depression and prenatal MA exposure on NNNS, with significance accepted at P < .05.
The MA group had an increased incidence of depression-positive diagnosis and increased depression scores on the BDI-II. After adjusting for covariates, MA exposure was associated with increased arousal and handling scores, and a decreased ability to self-regulate. Maternal depression was associated with higher autonomic stress and poorer quality of movement. No additional differences were observed in infants whose mothers were both depressed and used MA during pregnancy.
Maternal depression is associated with neurodevelopmental patterns of increased stress and decreased quality of movement, suggesting maternal depression influences neurodevelopment in infants as young as 1 month.
amphetamine; drug; antenatal
Attention bias for socially threatening information, an empirically supported phenomenon, figures prominently in models of social phobia. However, all published studies examining this topic to date have relied on group means to describe attention bias patterns; research has yet to examine potential subgroups of attention bias among individuals with social phobia (e.g., vigilant or avoidant). Furthermore, almost no research has examined how attention biases in either direction may predict change in symptoms as a result of treatment.
This study (N=24) compared responses to cognitive behavioral therapy (CBT) for social phobia between individuals with avoidant and vigilant biases for threatening faces at pretreatment.
Participants with avoidant biases reported significantly and clinically higher symptom levels at posttreatment than did those with vigilant biases.
These findings suggest that an avoidant attention bias may be associated with reduced response to CBT for social phobia.
attention biases; social phobia; treatment response