Dietary intake of fish and PUFA, and clinical depressive and anxiety disorders in women

Fish and PUFA consumption are thought to play a role in mental health; however, many studies do not take into account multiple sources of PUFA. The present study analysed data from a sample of 935 randomly selected, population-based women aged 20–93 years. A validated and comprehensive dietary questionnaire ascertained the consumption of n-3 and n-6 PUFA. Another assessed fish and energy intake and provided data for a dietary quality score. The General Health Questionnaire-12 (GHQ-12) measured psychological symptoms and a clinical interview (Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition) assessed depressive and anxiety disorders. Median dietary intakes of long-chain n-3 fatty acids (310 mg/d) were below suggested dietary target levels. The only PUFA related to categorical depressive and anxiety disorders was DHA. There was a non-linear relationship between DHA intake and depression; those in the second tertile of DHA intake were nearly 70 % less likely to report a current depressive disorder compared to those in the first tertile. The relationship of DHA to anxiety disorders was linear; for those in the highest tertile of DHA intake, the odds for anxiety disorders were reduced by nearly 50 % after adjustments, including adjustment for diet quality scores, compared to the lowest tertile. Those who ate fish less than once per week had higher GHQ-12 scores, and this relationship was particularly obvious in smokers. These are the first observational data to indicate a role for DHA in anxiety disorders, but suggest that the relationship between DHA and depressive disorders may be non-linear.

Anxiety is more common in children with asthma

Objective There are a variety of reasons why there may be an association between asthma and anxiety in children. Research into the relation between asthma and anxiety has been limited by the sole use of parent-reported or self-reported asthma symptoms to define asthma status. The objective of this study was to determine if children with physician-defined asthma are more likely to suffer anxiety than children without asthma.

Design A population-based, cross-sectional assessment, of self-reported anxiety symptoms.

Setting and participants Children aged 5–13 years from Barwon region of Victoria, Australia. Asthma status was determined by review with a paediatrician. Controls were a sample of children without asthma symptoms (matched for age, gender and school).

Outcome measure The Spence Children's Anxiety Scale (SCAS) written questionnaire. The authors compared the mean SCAS score, and the proportion of children with an SCAS score in the clinical range, between the groups.

Results Questionnaires were issued to 205 children with asthma (158 returned, response rate 77%), and 410 controls (319 returned, response rate 78%). The SCAS scores were higher in asthmatics than controls (p<0.001); and were more likely to be in the clinical range (OR=2.5, 95% CI 1.1 to 5.8, p=0.036). There was no evidence that these associations could be explained by known confounding factors.

Conclusions Children with asthma are substantially more likely to suffer anxiety than children without asthma. Future studies are required to determine the sequence of events that leads to this comorbidity, and to test strategies to prevent and treat anxiety among children with asthma.

Gender-common and -specific neuroanatomical basis of human anxiety-related personality traits

Exploration of the relationships between regional brain volume and anxiety-related personality traits is important for understanding preexisting vulnerability to depressive and anxiety disorders. However, previous studies on this topic have employed relatively limited sample sizes and/or image processing methodology, and they have not clarified possible gender differences. In the present study, 183 (male/female: 117/66) right-handed healthy individuals in the third and fourth decades of life underwent structural magnetic resonance imaging scans and Temperament and Character Inventory. Neuroanatomical correlates of individual differences in the score of harm avoidance (HA) were examined throughout the entire brain using voxel-based morphometry. We found that higher scores on HA were associated with smaller regional gray matter volume in the right hippocampus, which was common to both genders. In contrast, female-specific correlation was found between higher anxiety-related personality traits and smaller regional brain volume in the left anterior prefrontal cortex. The present findings suggest that smaller right hippocampal volume underlies the basis for higher anxiety-related traits common to both genders, whereas anterior prefrontal volume contributes only in females. The results may have implications for why susceptibility to stress-related disorders such as anxiety disorders and depression shows gender and/or individual differences.

Trait motivation and emotion regulation as predictors of anxiety

This thesis demonstrates that high avoidance motivation, low approach motivation, and maladaptive emotion regulation contribute to the prediction of anxiety, within groups at low risk for an anxiety disorder. High avoidance motivation is largely the sole predictor of anxiety for those at high risk for an anxiety disorder.

Cigarette smoking, nicotine dependence and anxiety disorders : a systematic review of population-based, epidemiological studies

Background Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective), the population assessed (random sample versus clinical population) and diagnostic instrument utilized.

Methods We undertook a systematic review of population-based observational studies that utilized recognized structured clinical diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD)) for anxiety disorder diagnosis to investigate the relationship between cigarette smoking, nicotine dependence and anxiety disorders.

Results In total, 47 studies met the predefined inclusion criteria, with 12 studies providing prospective information and 5 studies providing quasiprospective information. The available evidence suggests that some baseline anxiety disorders are a risk factor for initiation of smoking and nicotine dependence, although the evidence is heterogeneous and many studies did not control for the effect of comorbid substance use disorders. The identified evidence however appeared to more consistently support cigarette smoking and nicotine dependence as being a risk factor for development of some anxiety disorders (for example, panic disorder, generalized anxiety disorder), although these findings were not replicated in all studies. A number of inconsistencies in the literature were identified.

Conclusions Although many studies have demonstrated increased rates of smoking and nicotine dependence in individuals with anxiety disorders, there is a limited and heterogeneous literature that has prospectively examined this relationship in population studies using validated diagnostic criteria. The most consistent evidence supports smoking and nicotine dependence as increasing the risk of panic disorder and generalized anxiety disorder. The literature assessing anxiety disorders increasing smoking and nicotine dependence is inconsistent. Potential issues with the current literature are discussed and directions for future research are suggested.

Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders : a review of current evidence

Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity and exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our review found that in respect to treatment of generalized anxiety or specific anxiety disorders, CAM evidence revealed support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the management of anxiety disorders.

Telephone delivered health coaching improves anxiety outcomes after myocardial infarction : the 'ProActive Heart' trial

Background: Recently, we found a telephone-delivered secondary prevention programme using health coaching (‘ProActive Heart’) to be effective in improving a range of key behavioural outcomes for myocardial infarction (MI) patients. What remains unclear, however, is the extent to which these treatment effects translate to important psychological outcomes such as depression and anxiety outcomes, an issue of clinical significance due to the substantial proportion of MI patients who experience depression and anxiety. The objective of the study was to investigate, as a secondary hypothesis of a larger trial, the effects of a telephone-delivered health coaching programme on depression and anxiety outcomes of MI patients.

Design: Two-arm, parallel-group, randomized, controlled design with six-months outcomes.

Methods: Patients admitted to one of two tertiary hospitals in Brisbane, Australia following MI were assessed for eligibility. Four hundred and thirty patients were recruited and randomly assigned to usual care or an intervention group comprising up to 10 telephone-delivered ‘health coaching’ sessions (ProActive Heart). Regression analysis compared Hospital Anxiety and Depression Scale scores of completing participants at six months (intervention: n = 141 versus usual care: n = 156).

Results: The intervention yielded reductions in anxiety at follow-up (mean difference = -0.7, 95% confidence interval=-1.4,-0.02) compared with usual care. A similar pattern was observed in mean depression scores but was not statistically significant.

Conclusions: The ProActive Heart programme effectively improves anxiety outcomes of patients following myocardial infarction. If combined with psychological-specific treatment, this programme could impact anxiety of greater intensity in a clinically meaningful way.

Reducing parental anxiety using a family based intervention for youth mental health : a randomized controlled trial

This paper presents findings on parent anxiety and attachment relationship style from the Deakin Family Options (DFO) pilot study, a randomized controlled pilot study comparing a family-based treatment (BEST Plus), versus a youth only treatment (CBT) versus a group who received both of these treatments (COMBINED). Eligible participants were families with a young person (aged 12 - 25 years) with a high prevalence mental health problem. Youth from participating families scored in the clinical or subclinical range for depression, anxiety and/or substance misuse symptoms on standardized measures during the initial assessment. The collected sample was drawn from regional and urban centers in Victoria, Australia and allocated to treatment condition using a simple randomization procedure (parallel design). It was hypothesized that families receiving the BEST Plus would experience greater reductions in youth and parent mental health symptoms, and improved parent-child relationships, compared with those in the CBT condition. This paper describes and discusses changes in parent anxiety and parent attachment, according to whether the parent participated in a treatment (BEST Plus) or did not (NONBEST Plus). Participants were blind to the study hypotheses. In total 71 parent participants returned pre data and were allocated to a treatment group. In this paper, data from parent participants who completed pre and post measures (n = 48) and pre, post, and 6-month follow-up measures (n = 28) on anxiety and attachment were analyzed by group (BEST Plus versus NONBEST Plus). The results of this study suggest that parent anxiety decreased significantly more following parent involvement in a group treatment, than for parents that did not receive treatment. Unexpectedly, avoidant attachment increased in the no treatment group, but remained relatively stable following the BEST Plus group. There were no significant findings in relation to compulsive traits and anxious attachment. These findings are discussed in light of the study limitations.

Precursors and correlates of anxiety trajectories from late childhood to late adolescence

The present research employed a prospective, multi-informant design to examine precursors and correlates of differing anxiety profiles from late childhood to late adolescence. The sample consisted of 626 boys and 667 girls who are participants in the Australian Temperament Project, a large, longitudinal, community-based study that has followed young people's psychosocial adjustment from infancy to adulthood. The present research analyzes data collected from the first 12 waves of data, from 4–8 months to 17 years. Parents, primary school teachers, maternal and child health nurses, and from the age of 11 onward, the young people themselves have provided survey data. Trajectory analyses revealed three distinct patterns of self-reported anxiety from late childhood to late adolescence, comprising low, moderate, and high (increasing) trajectories, which differed somewhat between boys and girls. A range of parent- and teacher-reported factors was found to be associated with these trajectories, including temperament style, behavior problems, social skills, parenting, negative family events, and peer relationships. Compared with male trajectories, female trajectories were associated with a greater variety of psychosocial variables (including parenting and externalizing problems), which may partially account for the higher prevalence of anxiety in adolescent girls compared with boys. Findings shed light on gender-specific pathways to anxiety and the need for comprehensive, integrative approaches to intervention and prevention programs.

The relationship between attachment style, anxiety sensitivity and interpretive bias among adolescent nonclinical panickers

Elevated anxiety sensitivity and the tendency to catastrophically misinterpret ambiguous bodily sensations has been demonstrated in people who experience nonclinical levels of panic (Richards, Austin, & Alvarenga, 2001), and anxiety sensitivity has been shown to be associated with insecure attachment in adolescents and young adults (Weems, Berman, Silverman, and Saavedra, 2001). This study investigated the relationship between attachment style, anxiety sensitivity and catastrophic misinterpretation among 11 nonclinical panickers and 58 nonanxious controls aged 18 to 19 years. Participants completed the Brief Bodily Sensations Interpretation Questionnaire (BBSIQ), Anxiety Sensitivity Index (ASI) and an attachment questionnaire. The hypothesis that insecurely attached individuals would demonstrate greater catastrophic misinterpretation and higher anxiety sensitivity than securely attached individuals was not supported; however, nonclinical panickers gave more anxiety-related interpretations of ambiguous internal stimuli than nonanxious controls. Results do not support the notion that attachment style is related to anxiety sensitivity or catastrophic misinterpretation (regardless of panic experience). Results do, however, support the notion that anxiety-related misinterpretation of ambiguous somatic sensations precedes the onset of panic disorder.

Anxiety online - a virtual clinic : preliminary outcomes following completion of five fully automated treatment programs for anxiety disorders and symptoms

Background : The development of e-mental health interventions to treat or prevent mental illness and to enhance wellbeing has risen rapidly over the past decade. This development assists the public in sidestepping some of the obstacles that are often encountered when trying to access traditional face-to-face mental health care services. Objective : The objective of our study was to investigate the posttreatment effectiveness of five fully automated self-help cognitive behavior e-therapy programs for generalized anxiety disorder (GAD), panic disorder with or without agoraphobia (PD/A), obsessive–compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD) offered to the international public via Anxiety Online, an open-access full-service virtual psychology clinic for anxiety disorders. Methods : We used a naturalistic participant choice, quasi-experimental design to evaluate each of the five Anxiety Online fully automated self-help e-therapy programs. Participants were required to have at least subclinical levels of one of the anxiety disorders to be offered the associated disorder-specific fully automated self-help e-therapy program. These programs are offered free of charge via Anxiety Online. Results : A total of 225 people self-selected one of the five e-therapy programs (GAD, n = 88; SAD, n = 50; PD/A, n = 40; PTSD, n = 30; OCD, n = 17) and completed their 12-week posttreatment assessment. Significant improvements were found on 21/25 measures across the five fully automated self-help programs. At postassessment we observed significant reductions on all five anxiety disorder clinical disorder severity ratings (Cohen d range 0.72–1.22), increased confidence in managing one’s own mental health care (Cohen d range 0.70–1.17), and decreases in the total number of clinical diagnoses (except for the PD/A program, where a positive trend was found) (Cohen d range 0.45–1.08). In addition, we found significant improvements in quality of life for the GAD, OCD, PTSD, and SAD e-therapy programs (Cohen d range 0.11–0.96) and significant reductions relating to general psychological distress levels for the GAD, PD/A, and PTSD e-therapy programs (Cohen d range 0.23–1.16). Overall, treatment satisfaction was good across all five e-therapy programs, and posttreatment assessment completers reported using their e-therapy program an average of 395.60 (SD 272.2) minutes over the 12-week treatment period. Conclusions : Overall, all five fully automated self-help e-therapy programs appear to be delivering promising high-quality outcomes; however, the results require replication.