Functional dissection of neural connectivity in generalized anxiety disorder

Differences in the correlated activity of networked brain regions have been reported in individuals with generalized anxiety disorder (GAD) but an overreliance on the null-hypothesis significance testing (NHST) framework limits the identification and characterization of disorder-relevant relationships. In this preregistered study, we applied a Bayesian statistical framework as well as NHST to the analysis of resting-state fMRI scans from females with GAD and demographically matched healthy comparison females. Eleven a-priori hypotheses about functional correlativity (FC) were evaluated using Bayesian (multilevel model) and frequentist (t-test) inference. Reduced FC between the ventromedial prefrontal cortex (vmPFC) and the posterior-mid insula (PMI) was confirmed by both statistical approaches. FC between the vmPFC-anterior insula, the amygdala-PMI, and the amygdala-dorsolateral prefrontal cortex (dlPFC) region pairs did not survive multiple comparison correction using the frequentist approach. However, the Bayesian model provided evidence for these region pairs having decreased FC in the GAD group. Leveraging Bayesian modeling, we demonstrate decreased FC of the vmPFC, insula, amygdala, and dlPFC in females with GAD. Exploiting the Bayesian framework revealed FC abnormalities between region pairs excluded by the frequentist analysis, as well as other previously undescribed regions, demonstrating the benefits of applying this statistical approach to resting state FC data.

Mental health of people living with HIV during the COVID-19 epidemic in Tokyo

Background The COVID-19 pandemic significantly impacts physical health and mental health. People living with HIV (PLWH) have a higher prevalence of psychiatric disorders than the general population. We examined the mental health of PLWH during the COVID-19 pandemic in Japan. Methods We retrospectively examined the medical records of PLWHs who underwent the Kessler Psychological Distress Scale-10, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 at an HIV referral hospital in Tokyo. Stringency Index (SI) values were used to measure the intensity of social infection control measures. Results Between February 2020-May 2021, 30 PLWH were examined at least once. The median age was 49 years, 29 PLWH were on antiretroviral therapy, and the median CD4 count was 580.5/µL. A total of 30% of the patients experienced distress, 45% depression, and 21.4% generalized anxiety disorder. Fourteen PLWH were taken for a median of four tests (IQR:2.0-7.3) and classified into three types: 1) Moderate distress or mild depression or anxiety at the beginning that decreased gradually (six patients, 43%), 2) persistent severe distress, but moderate depression or anxiety gradually decreased (six patients, 43%), and 3) extremely severe distress and depression or anxiety continued to syncope with the SI values (two patients, 14%). Having no partners, unemployment, and a history of psychiatric diseases were more commonly observed in the highly severe mental health groups. Conclusions PLWH are more vulnerable to the COVID-19 pandemic than the general population, especially those with substantial social isolation. Attention should be paid to the mental health of PLWH.

Psychological Effects of COVID-19 among Healthcare Workers and How They Are Coping: A Web-based, Cross-sectional Study during the First Wave of COVID-19 in Pakistan

Objective: To ascertain the psychological impacts of COVID-19 among the Pakistani healthcare workers (HCWs) and their coping strategies. Methods: This web-based, cross-sectional study was conducted among HCWs (N=398) from Punjab province of Pakistan. The generalized anxiety scale (GAD-7), patient health questionnaire (PHQ-9) and Brief-COPE were used to assess anxiety, depression and coping strategies, respectively. Results: The average age of respondents was 28.67 years (SD=4.15), with the majority of medical doctors (52%). The prevalence of anxiety and depression were 21.4% and 21.9%, respectively. There was no significant difference in anxiety and depression scores among doctors, nurses and pharmacists. Females had significantly higher anxiety (p=0.003) and depression (p=0.001) scores than males. Moreover, frontline HCWs had significantly higher depression scores (p=0.010) than others. The depression, not anxiety, score were significantly higher among those who did not receive the infection prevention training (p=0.004). Most frequently adopted coping strategy were religious coping (M=5.98, SD=1.73), acceptance (M=5.59, SD=1.55) and coping planning (M=4.91, SD=1.85). Conclusion: A considerable proportion of HCWs are having generalized anxiety and depression during the ongoing COVID-19 pandemic. Our findings call for interventions to mitigate mental health risks in HCWs.

A survey of depression and anxiety disorders in urban and rural Suriname

Background Suriname is a Low-middle income country consisting of diverse population groups. Epidemiological studies concerning mental disorders like depression and anxiety had not been conducted until 2015. The treatment gap for mental disorders in Low and middle-income countries (LMICs) may reach 76-80% as treatment is not always readily available. In this study, we estimate and compare the prevalence of potential cases of depression and anxiety, as well as the size of the treatment gap in a rural (Nickerie) and urban (Paramaribo) region of Suriname, a lower middle-income country. Methods Subjects were selected by a specific sampling method of the national census bureau. The Center for Epidemiological Studies-Depression (CES-D) was used to assess depression. Generalized anxiety disorder was assessed with the Generalized Anxiety Disorder 7 (GAD-7) and The Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ) were used to assess Panic disorder. The treatment gap was calculated by estimating the percentage of subjects with depression or anxiety that did not seek out professional help. Results About 18% of the respondents from Nickerie and 16% from Paramaribo were at risk of depression and the established cut-off values of the instruments used indicate that about 3-4% in both regions may suffer from Generalized Anxiety Disorder. Women in both samples were most at risk of high anxiety about body sensations and maladaptive thoughts about panic. The treatment gap varies between 78 and 100% for the two disorders. Conclusions A high depression rate has been found in both areas, especially among young females. In addition, a high treatment gap is noted which insinuates that more therapeutic strategies are required to tackle depression and anxiety in Suriname.

Validation of the Geriatric Anxiety Inventory in younger adults

This study investigated the psychometric properties of the Geriatric Anxiety Inventory (GAI) in younger adults. Participants were 212 younger adults age M = 22 (range = 17–53) years. They completed a demographic information questionnaire and self-report measures: the GAI, the Depression Anxiety Stress Scales (DASS), the Generalized Anxiety Disorder–7 (GAD-7), the Patient Health Questionnaire–9 (PHQ-9), the Penn State Worry Questionnaire (PSWQ), and the Worry Behaviors Inventory (WBI). Data from the GAI were collected at two time points, one week apart, and data from other self-report measures were collected once via Qualtrics, an online survey platform. The internal consistency and test–retest score reliability of the GAI were excellent. It had good congruent validity with other anxiety measures, limited divergent validity with depression measures, and sound convergent validity with worry measures. The GAI showed good discrimination between probable cases and noncases of generalized anxiety disorder (participants who scored ⩾8 on the GAD-7) and its optimal cutoff score for probable cases of GAD was ⩾12. A unidimensional component structure of the GAI best fit this study’s data. This study has provided preliminary evidence that the GAI is reliable and valid for use in an Australian sample of younger adults.

Effect of Coronavirus-19 on Mental Condition of International Students in China

Despite its importance, no study investigates the effects of COVID-19 on the mental condition of international students in China. By using data from international students in China, this study finds the positive and affirmative connection between fear of COVID-19 and generalized anxiety disorder among foreign students. Furthermore, this study reveals a negative association between fear of COVID-19 and the psychological well-being of foreign students in China. We also find that emotional intelligence has a positive and optimistic moderating influence on the relationship between fear of COVID-19 and generalized anxiety disorder but it has not moderating effect on the relationship between fear of COVID-19 and psychological well-being. Our study contributes to the body and knowledge and offers new insights concerning the effects of COVID-19 on the mental condition of international students.

Further development of the intolerance of uncertainty model of GAD: a case series

Intolerance of uncertainty (IoU) is important in the development and maintenance of worry and generalized anxiety disorder (GAD; Dugas et al., 1997). However, it remains unclear why some people respond so negatively to uncertainty and have poor clinical outcomes. We adapted the IoU model to include the influence of developmental and/or attachment factors, and their possible importance to intolerability of uncertainty and associated hypothetical worries. Seven consecutive GAD referrals for CBT were naturalistically treated with the novel approach. All participants completed the 7-item Generalized Anxiety Disorder Scale (GAD-7; Spitzer et al., 2006), the Penn State Worry Questionnaire (PSWQ; Meyer et al., 1990), as well as a novel 10-item Premonition Bias Questionnaire (PBQ; C. Chigwedere et al., unpublished). From pre- to post-treatment, results for both GAD (p=.001) and worry (p=.005) improved significantly. Clinically significant change or a post-treatment score within the normal population range were observed for both the GAD-7 and PSWQ. The change in believability of worry, measured on the PBQ was also significant from pre- to post-treatment (p=.008). Overall, the novel approach may be an alternative approach to treating GAD, with some potential, both as an adjunctive or standalone treatment. However, this is a small case series and the presented novel approach requires empirical support and evaluation in larger experimental studies.