Anxiety disorders and falls among older adults

BACKGROUND: Falls are common among older adults and can lead to serious injuries, including fractures. We aimed to determine associations between anxiety disorders and falls in older adults. METHODS: Participants were 487 men and 376 women aged ≥60 years enrolled in the Geelong Osteoporosis Study, Australia. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient edition (SCID-I/NP), lifetime history of anxiety disorders was determined. Falls were determined by self-report. In men, a falls-risk score (Elderly Falls Screening Test (EFST)) was also calculated. RESULTS: Among fallers, 24 of 299 (8.0%) had a lifetime history of anxiety disorder compared to 36 of 634 (5.7%) non-fallers (p=0.014). Examination of the association between anxiety and falls suggested differential relationships for men and women. In men, following adjustment for psychotropic medications, mobility and blood pressure, lifetime anxiety disorder was associated with falling (OR 2.96; 95%CI 1.07-8.21) and with EFST score (OR 3.46; 95%CI 1.13-10.6). In women, an association between lifetime anxiety disorder and falls was explained by psychotropic medication use, poor mobility and socioeconomic status. LIMITATIONS: Sub-group analyses involving types of anxiety and anxiety disorders over the past 12-months were not performed due to power limitations. CONCLUSION: Although anxiety disorders were independently associated with a 3-fold increase in likelihood of reported falls and high falls risk among men, an independent association was not detected among women. These results may aid in prevention of falls through specific interventions aimed at reducing anxiety, particularly in men.

Maternal depression, anxiety, body dissatisfaction and self-esteem: do they increase the risk of pre-schooler obesity?

An examination of the relationship between maternal depression, anxiety, body dissatisfaction and self-esteem, child feeding practices, and obesity risk in pre-schoolers. A systematic review revealed moderate associations between maternal depression and pre-schooler obesity risk, and a possible link between both maternal anxiety and body dissatisfaction and pre-schooler obesity risk. The empirical studies however, did not support a link between any of the measures of psychosocial health and pre-schooler obesity risk.

Maternal anxiety and children's laboratory pain: the mediating role of solicitousness

There has been limited empirical examination of how parent variables such as anxiety and solicitousness collectively impact child pain response. We sought to examine the relationships among maternal anxiety, solicitous parenting, and children's laboratory anxiety and pain intensity in children with chronic pain. Participants included 80 children and adolescents (ages 8-18) with chronic pain and their mothers. Children completed questionnaires and lab pain tasks measuring their parents' solicitous parenting, pressure, cold and heat pain anticipatory anxiety and pain intensity. Using bootstrapping analysis, maternal anxiety predicted child anticipatory anxiety and pain intensity in girls with chronic pain, which was mediated by the child's report of parental solicitousness. For boys with chronic pain, maternal anxiety predicted boys' anticipatory anxiety and pain intensity, with no support for mediation. This study adds to the growing literature demonstrating the impact of maternal anxiety on children's pain. The study highlights the importance of considering parents in treatment designed to reduce children's pain.

Motivation, responsibility and anxiety : parenting dispositions of Chinese mothers

One of the key principles in the ideology which underpins education is the value of children’s family experience. Central to this idea is the view of parents as important. Parenting has become a vital dimension in contemporary education. Parenting discourses traditionally focus on such concepts as parenting style, approach, attitude or practice. The main consideration behind these concepts is what parents appear to be doing at a single point of time, referring to parenting per se. This paper takes on the notion of disposition in order to understand urban Chinese mothers’ habitual and characteristic ways of child rearing. It presents evidence to show that a group of Chinese mothers had parenting dispositions of motivation, responsibility and anxiety. Data came from a series of conversations between 50 Chinese mothers of preschool children and five early childhood teachers through a synchronous online text chat. In the process of consulting the early childhood teachers, the parents expressed many concerns, questions and views of childrearing and early childhood education, thereby providing evidence about their thinking and behaviour. Drawing on the concept of ‘disposition’, the study provides insights into the common thinking threads that characterized Chinese parenting and the ways those threads were woven into their disposed approaches to child rearing and early education.

Controversies revisited: a systematic review of the comorbidity of depression and anxiety with inflammatory bowel diseases

BACKGROUND: Although mental health concerns are known to occur commonly for those with inflammatory bowel diseases (IBD), the nature of this comorbid relationship has not been systematically reviewed to date. A review in 2007 identified 5 controversies regarding anxiety/depression rates and various comparators between and within IBD. We aimed to systematically analyze and critique the current evidence regarding this comorbidity, providing an update to the 5 controversies.

METHODS: Ebscohost Medline, CINAHL, Embase, and PsychINFO were searched between 2005 and 2014 using systematic review methodology. Controlled quantitative studies examining either symptoms or diagnoses of anxiety and depression in IBD were included in the review, with study quality assessed using a scale developed a priori to evaluate observational research.

RESULTS: (1) IBD versus healthy controls (pooled mean proportions) (n = 13 studies): anxiety 19.1% versus 9.6%, depression 21.2% versus 13.4%; (2) IBD inactive versus IBD active disease (n = 26): anxiety 28.2% versus 66.4%, depression 19.9% versus 34.7%; (3) ulcerative colitis versus Crohn's disease (n = 28): anxiety 31% versus 37%, depression 22% versus 24.4%; (4) IBD versus other chronic medical conditions (n = 17): anxiety 41.9% versus 48.2%, depression 14.5% versus 28.4%; (5) onset of anxiety/depression before or after IBD onset (n = 2): adults more likely to develop anxiety/depression before IBD onset, but a substantial proportion develops depression after onset; an increased risk for children of developing anxiety/depression after IBD onset.

CONCLUSIONS: The high rates of anxiety and depression for those with IBD, particularly when disease is active, warrant a systemic approach to screening and treatment.

A cognitive behavioural therapy booklet for anxiety in functional gastrointestinal disorders: patient and health practitioner perspectives

OBJECTIVE: Psychotherapy is commonly used to treat functional gastrointestinal disorders (FGiDs), yet face-to-face psychotherapy is 15 labour intensive, less convenient for patients as it involves travel to the practice, costly and not always easily available. Self-administered psychotherapies have not been extensively investigated in this population. This study aimed to examine the feasibility and acceptability of a self-administered cognitive behavioural therapy booklet to reduce anxiety in patients with FGiD.

METHOD: A mixed-methods study underpinned by the Health Belief Model was conducted.

RESULTS: The booklet has been well received by patients (n = 26) and doctors (n = 8) and its acceptability and feasibility confirmed.

CONCLUSIONS: The results of the study suggest that this self-help tool is acceptable by patients and doctors as part of treatment for anxiety in FGiDs and its effectiveness should be further tested in adequately powered studies.

An aggravated trajectory of depression and anxiety co-morbid with Hepatitis C: a within-groups study of 61 Australian outpatients.

BACKGROUND: This study aimed to explore the course of depression and anxiety in chronic hepatitis C patients. METHODS:   Data were combined from two studies: (1) Hospital Anxiety and Depression Scale (HADS) scores in 395 consecutive Australian outpatients from 2006 to 2010 formed the baseline measurement; and (2) Depression Anxiety Stress Scales (DASS) scores in a survey of a sub-sample of these patients in 2011 formed the follow-up measurement. After converting DASS to HADS scores, changes in symptom scores and rates of case-ness (≥8), and predictors of follow-up symptoms were assessed. RESULTS:   Follow-up data were available for 61 patients (70.5% male) whose age ranged from 24.5 to 74.6 years (M=45.6). The time to follow-up ranged from 20.7 to 61.9 months (M=43.8). Baseline rates of depression (32.8%) and anxiety (44.3%) increased to 62.3% and 67.2%, respectively. These findings were confirmed, independent of the conversion, by comparing baseline HADS and follow-up DASS scores with British community norms. Baseline anxiety and younger age predicted depression, while baseline anxiety, high school non-completion, and single relationship status predicted anxiety. CONCLUSION:  This study demonstrated a worsening trajectory of depression and anxiety. Further controlled and prospective research in a larger sample is required to confirm these findings.

Pilot CBT trial for anxiety in alcohol use disorders treatment

Purpose – The purpose of this paper is to test the effectiveness of a self-directed cognitive behavioural therapy (CBT) booklet allowing immediate access to treatment for anxiety during alcohol use disorder (AUD) interventions. Design/methodology/approach – Parallel pilot randomised controlled trial: 69 individuals in AUD treatment, continued to receive treatment alone (control: n=29) or in addition, a self-directed, four week CBT booklet to manage anxiety (intervention: n=40). Primary outcome measures were changes in state (SAnx) and trait anxiety (TAnx) at four weeks. Secondary outcome measures were changes in adaptive (ACop), maladaptive (MCop) coping and quality of life (QoL, physical (PHQoL), psychological (PSQoL), social (SQoL), environment (EQoL)) at four weeks. Findings – Participants had significantly higher SAnx (p<0.01) and TAnx (p<0.01) baseline scores compared to the general population. There were no statistically significant group changes in SAnx or TAnx (p>0.05). Control group allocation predicted improvement in ACop (p<0.01), MCop (p<0.05), PHQoL (p<0.01), PSQoL (p<0.05) and SQoL (p<0.01); CBT group allocation predicted improvement in EQoL (p=0.05). All effect sizes were small to moderate (Cohen’s d<0.50). Percentage of book completion did not determine changes in anxiety, coping or quality of life. Originality/value – A four week self-directed CBT booklet did not significantly reduce anxiety during AUD treatment. Larger sample sizes will determine the most suitable treatment delivery mode for this type of CBT.

The effects of a designer music intervention on patients' anxiety, pain, and experience of colonoscopy: a short report on a pilot study.

There is a controversy on whether listening to music before or during colonoscopy reduces anxiety and pain and improves satisfaction and compliance with the procedure. This study aimed to establish whether specifically designed music significantly affects anxiety, pain, and experience associated with colonoscopy. In this semirandomized controlled study, 34 patients undergoing a colonoscopy were provided with either muted headphones (n = 17) or headphones playing the investigator-selected music (n = 17) for 10 minutes before and during colonoscopy. Anxiety, pain, sedation dose, and overall experience were measured using quantitative measures and scales. Participants' state anxiety decreased over time (P < .001). However, music did not significantly reduce anxiety (P = .441), pain scores (P = .313), or midazolam (P = .327) or fentanyl doses (P = .295). Despite these findings, 100% of the music group indicated that they would want music if they were to repeat the procedure, as compared with only 50% of those in the nonmusic group wanting to wear muted headphones. Although no significant effects of music on pain, anxiety, and sedation were found, a clear preference for music was expressed, therefore warranting further research on this subject.

The experience of anxiety in colonoscopy outpatients: a mixed-method study.

Colonoscopy is commonly used to investigate gastrointestinal symptoms such as pain or changes in bowel habits and may either induce patient anxiety or assist in patient reassurance. Currently, 2 studies investigating negative colonoscopy, reassurance, and anxiety came to conflicting conclusions on this issue. Furthermore, it is possible that differences in coping styles may influence patient anxiety. A mixed-methods study was conducted with 26 precolonoscopy and 24 postcolonoscopy patients to address the conflicting, limited literature regarding colonoscopy, coping, and anxiety. Participants completed postal surveys and interviews were conducted with 16 participants. There was no significant difference between pre- and postcolonoscopy groups on any anxiety measures; however, this was possibly because of individual differences. Significant positive correlations were found between maladaptive coping and state anxiety indicating that healthcare professionals should consider screening for maladaptive coping in patients needing invasive procedures. Neither problem- nor emotion-focused coping showed any significant relationship with state anxiety. Interviews revealed that clinicians and endoscopy nurses should be aware that some patients are not absorbing correct information about colonoscopy, specifically that they may be conscious or experience pain during the procedure. Because of this, clinicians should ensure that patients understand standard practice at their hospital. In addition, interview data suggested that more attention should be given to pain management as it currently may not be adequate during conscious sedation.

Symptoms of depression and anxiety are independently associated with clinical recurrence of inflammatory bowel disease

BACKGROUND & AIMS: We examined the relationship between symptoms of depression and anxiety and clinical recurrence of inflammatory bowel disease (IBD) in a large patient cohort. We considered the progression of depression and anxiety over time. METHODS: We collected clinical and treatment data on 2007 adult participants of the Swiss IBD study (56% with Crohn's disease [CD], 48% male) performed in Switzerland from 2006 through 2015. Depression and anxiety symptoms were quantified by using the Hospital Anxiety and Depression Scale. The relationship between depression and anxiety scores and clinical recurrence was analyzed by using survival-time techniques. RESULTS: We found a significant association between symptoms of depression and clinical recurrence over time (for all patients with IBD, P = .000001; for subjects with CD, P = .0007; for subjects with ulcerative colitis, P = .005). There was also a significant relationship between symptoms of anxiety and clinical recurrence over time in all subjects with IBD (P = .0014) and in subjects with CD (P = .031) but not ulcerative colitis (P = .066). CONCLUSIONS: In an analysis of a large cohort of subjects with IBD, we found a significant association between symptoms of depression or anxiety and clinical recurrence. Patients with IBD should therefore be screened for clinically relevant levels of depression and anxiety and referred to psychologists or psychiatrists for further evaluation and treatment.

"It's a tube up your bottom; it makes people nervous": the experience of anxiety in initial colonoscopy patients.

This study aimed to prospectively consider the effect of colonoscopy on patients' experiences of anxiety at 4 time points related to an initial colonoscopy, using a qualitative approach. The study involved a sample of 13 patients undergoing an initial colonoscopy at a public hospital and followed for 12 months. Four exploratory interviews were conducted with each participant: before the procedure, 1 week, 2 weeks, and 12 months after the procedure. Thematic analysis was conducted to summarize patients' responses. In these participants, colonoscopy was associated with stigma. The discussion of the procedure was perceived as stressful and embarrassing and led to anxiety. Irrational expectations regarding the procedure were also contributing to anxiety, as was a doctor-patient relationship based on unequal powers and lack of control. Before the procedure, fear of a serious diagnosis contributed to anxiety; however, postprocedure, an unclear or functional diagnosis also appeared to increase anxiety. Anticipating the preparation for the procedure was also reported as an important factor in preprocedure anxiety. A shift toward a biopsychosocial approach to healthcare, such as providing patients with a greater sense of control by participating in decision making, should be recommended as it may reduce anxiety.