Anxiety disorders and depression and risk for drug use disorders across the life course: Sex and ethnic contrasts

The present study examined the linkage between mental (i.e., anxiety disorders and depression) and drug use disorders in a multi-ethnic (i.e., 25% Euro-American, 38% Hispanic/Latino, 33% African American, 4% other) sample of adults (N = 1638, age 18–93 years old). Risk for drug use disorders was examined, while attending to methodological issues of prior research including (1) psychiatric comorbidity, (2) variations in risk associated with sex, ethnicity, and age, and (3) temporal order between mental and drug use disorders. ^ Participants were assessed using the Composite International Diagnostic Interview (CIDI; World Health Organization, 1990). A life history calendar (Freedman et al., 1988) was used to aid the ordering of onsets of all disorders assessed. ^ Preliminary analysis indicated anxiety disorders and depression were significant predictors of drug use disorders, but after controlling for comorbidity and temporal order, anxiety disorders and depression were no longer predictive of drug use disorders. Findings are discussed in terms of their usefulness for prevention and treatment of drug use disorders. ^

Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

ENVIRONMENTAL INFLUENCES AND EPIGENETIC MECHANISMS IN RISK FOR DEPRESSION

Genetic and environmental factors interact to influence vulnerability for internalizing psychopathology, including Major Depressive Disorder (MDD). The mechanisms that account for how environmental stress can alter biological systems are not yet well understood yet are critical to develop more accurate models of vulnerability and targeted interventions. Epigenetic influences, and more specifically, DNA methylation, may provide a mechanism by which stress could program gene expression, thereby altering key systems implicated in depression, such as frontal-limbic circuitry and its critical role in emotion regulation. This thesis investigated the role of environmental factors from infancy and throughout the lifespan affecting the serotonergic (5-HT) system in the vulnerability to and treatment of depression and anxiety and potential underlying DNA methylation processes. First, we investigated the contributions of additive genetic vs. environmental factors on an early trait phenotype for depression (negative emotionality) in infants and their stability over time in the first 2 years of life. We provided evidence of the substantial contributions of both genetic and shared environmental factors to this trait, as well as genetically- and environmentally- mediated stability and innovation. Second, we studied how childhood environmental stress is associated with peripheral DNA methylation of the serotonin transporter gene, SLC6A4, as well as long-term trajectories of internalizing behaviours. There was a relationship between childhood psychosocial adversity and SLC6A4 methylation in males, as well as between SLC6A4 methylation and internalizing trajectory in both sexes. Third, we investigated changes in emotion processing and epigenetic modification of the SLC6A4 gene in depressed adolescents before and after Mindfulness-Based Cognitive Therapy (MBCT). The alterations from pre- to post-treatment in connectivity between the ACC and other network regions and SLC6A4 methylation suggested that MBCT may work to optimize the connectivity of brain networks involved in cognitive control of emotion as well as also normalize the relationship between SLC6A4 methylation and activation patterns in frontal-limbic circuitry. Our results from these three studies strengthen the theory that environmental influences are critical in establishing early vulnerability factors for MDD, driving epigenetic processes, and altering brain processes as an individual undergoes treatment, or experiences relapse.

La música en el desarrollo de la espiritualidad y la religiosidad. Una aproximación al Cristianismo y al Budismo

La música puede afectar al individuo en todos sus niveles –físico, mental y espiritual–. El presente artículo se centra en el papel que ésta desempeña en el desarrollo de la vida espiritual y trascendental. Para ello, realizaremos un repaso histórico de su evolución estética y social, abordaremos dicho fenómeno a nivel fisiológico y presentaremos sus aplicaciones clínicas y sociales. Seguidamente y a modo de ejemplo de las concepciones de pensamiento occidental y oriental, trataremos la forma en que el cristianismo y el budismo conciben la música dentro de su doctrina. Finalizaremos con algunas reflexiones sobre el tema.

A Relação entre Mindfulness, Auto-Compaixão, Vergonha e Psicopatologia em Praticantes e Não Praticantes de Meditação/Yoga

O estudo do mindfulness tem sido alvo de um crescente interesse no domínio da Psicologia, pela sua importância no aumento de bem-estar e redução de sintomatologia psicopatológica. Os estudos realizados acerca da forma como o mindfulness assume um papel preponderante no bem-estar psicológico dos indivíduos, tendo por base um conjunto de competências ou aptidões que podem ser aprendidas e praticadas, favorece uma melhoria da saúde e do bem-estar dos indivíduos. Deste modo, com o objectivo de contribuir para o conhecimento da relação entre mindfulness, auto-compaixão, vergonha e psicopatologia em praticantes e não praticantes de meditação/yoga, realizou-se um conjunto de estudos numa amostra constituída por 121 sujeitos, em que 53 integram uma população praticante de meditação/yoga e 68 pertencem à população geral não praticante de meditação/yoga. Os resultados revelam que indivíduos praticantes de meditação/yoga registam valores significativamente mais elevados nas facetas observar e não reagir da escala de mindfulness. Por sua vez, sujeitos com maiores índices de traço de mindfulness apresentam níveis mais baixos de vergonha externa e interna. Para além disto, indivíduos com elevado traço de mindfulness distinguem-se significativamente dos indivíduos com baixo traço de mindfulness ao apresentarem níveis mais elevados de auto-compaixão e níveis mais baixos de depressão, ansiedade e stress. / The study of mindfulness has been the target of a growing interest in the field of psychology because of its importance in increasing welfare and lessening of psychopathological symptoms. Studies on how mindfulness plays a central role in psychological well-being of individuals, based on a set of competencies or skills that can be learned and practiced, promotes improved health and well-being of individuals. Thus, in order to contribute to the knowledge of the relationship between mindfulness, self-pity, shame and psychopathology in non-practitioners and practitioners of meditation / yoga, it was held a series of studies on a sample of 121 subjects, in which 53 were part of a population practicing meditation / yoga and 68 belong to the general population not practicing meditation / yoga. The results show that individuals who practice meditation / yoga recorded significantly higher values in the watch and not react aspects of mindfulness scale. In turn, subjects with higher trait mindfulness have lower levels of external and internal shame. In addition, individuals with higher trait mindfulness differ significantly from individuals with low trait mindfulness of the present higher levels of self-pity and lower levels of depression, anxiety and stress.

The impact of mindfulness on the wellbeing and performance of educators: A systematic review of the empirical literature

Given the potentially demanding nature of teaching, efforts are underway to develop practices that can improve the wellbeing of educators, including interventions based on mindfulness meditation. We performed systematic review of empirical studies featuring analyses of mindfulness in teaching contexts. Databases were reviewed from the start of records to January 2016. Eligibility criteria included empirical analyses of mindfulness and wellbeing outcomes acquired in relation to practice. A total of 19 papers met the eligibility criteria and were included in the systematic review, consisting of a total 1,981 participants. Studies were principally examined for outcomes such as burnout, anxiety, depression and stress, as well as more positive wellbeing measures (e.g., life satisfaction). The systematic review revealed that mindfulness was generally associated with positive outcomes in relation to most measures. However, the quality of the studies was inconsistent, and so further research is needed, particularly involving high-quality randomised control trials.

Association of depression and anxiety status with 10-year cardiovascular disease incidence among apparently healthy Greek adults:the ATTICA study

Background: Chronic stress frequently manifests with anxiety and/or depressive symptomatology and may have detrimental cardiometabolic effects over time. As such, recognising the potential links between stress-related psychological disorders and cardiovascular disease (CVD) is becoming increasingly important in cardiovascular epidemiology research. The primary aim of this study was to explore prospectively potential associations between clinically relevant depressive symptomatology and anxiety levels and the 10-year CVD incidence among apparently healthy Greek adults. Design: A population-based, health and nutrition prospective survey. Methods: In the context of the ATTICA Study (2002–2012), 853 adult participants without previous CVD history (453 men (45 ± 13 years) and 400 women (44 ± 18 years)) underwent psychological evaluations through validated, self-reporting depression and anxiety questionnaires. Results: After adjustment for multiple established CVD risk factors, both reported depression and anxiety levels were positively and independently associated with the 10-year CVD incidence, with depression markedly increasing the CVD risk by approximately fourfold (adjusted odds ratio (95% confidence interval) 3.6 (1.3, 11) for depression status; 1.03 (1.0, 1.1) for anxiety levels). Conclusions: Our findings indicate that standardised psychological assessments focusing on depression and anxiety should be considered as an additional and distinct aspect in the context of CVD preventive strategies that are designed and implemented by health authorities at the general population level.

ENVIRONMENTAL INFLUENCES AND EPIGENETIC MECHANISMS IN RISK FOR DEPRESSION

Thesis (Ph.D, Psychology) -- Queen's University, 2016-10-04 17:37:07.888

Anxiety, stress and depression in young adults with type 1 Diabetes

Introdução: A vida dos jovens adultos com diabetes tipo 1 (DM1) tem muitas exigências e as consequências psicológicas da adesão contínua aos aspetos do tratamento pode afetar a qualidade de vida. Objetivos: Conhecer o suporte social, satisfação com a vida, ansiedade, stresse e depressão nos jovens adultos com DM1. Material e Métodos: Estudo quantitativo realizado com 278 jovens adultos com DM1 (18 - 35 anos). Resultados: Os jovens consideram ter bom suporte social. A média de satisfação com a vida é 6,6 ±1,7 (escala 0-10). A maior parte dos jovens não apresenta estados persistentes de ansiedade e de excitação e tensão (stresse), pelo que têm resistência à frustração e desilusão. A maioria dos jovens não apresenta sintomas de depressão, revelando auto-estima, sentimentos positivos, motivação, entusiasmo e perceção da probabilidade de alcançar objetivos de vida que sejam significativos. A análise fatorial das escalas de ansiedade, stresse e depressão permitiu encontrar 3 fatores que explicam 50% da variância total: stresse (36%), ansiedade (8%), depressão (6%). Conclusões: Os jovens adultos com DM1 têm bom suporte social e satisfação com a vida. A maior parte dos jovens não revela sintomas de ansiedade, stresse e depressão. O suporte social e a satisfação com a vida poderão contribuir para uma boa saúde mental.

The relationship between personality characteristics and postconcussion symptoms in a non-clinical sample

Postconcussion symptoms are relatively common in the acute recovery period following mild traumatic brain injury (MTBI). However, for a small subset of patients, self reported postconcussion symptoms continue long after injury. Many factors have been proposed to account for the presence of persistent postconcussion symptoms. The influence of personality traits has been proposed as one explanation. The purpose of this study was to examine the relation between postconcussion-like symptom reporting and personality traits in a sample of 96 healthy participants. Participants completed the British Columbia Postconcussion Symptom Inventory (BC-PSI) and the Millon Clinical Multiaxial Inventory III (MCMI-III). There was a strong positive relation between the majority of MCMI-III scales and postconcussion-like symptom reporting. Approximately half of the sample met the International Classification of Diseases-10 Criterion C symptoms for Postconcussional Syndrome (PCS). Compared with those participants who did not meet this criterion, the PCS group had significant elevations on the negativistic, depression, major depression, dysthymia, anxiety, dependent, sadistic, somatic, and borderline scales of the MCMI-III. These findings support the hypothesis that personality traits can play a contributing role in self reported postconcussion-like symptoms.

Development of the benefit finding in multiple sclerosis (MS) caregiving scale: A longitudinal study of relations between benefit finding and adjustment

Benefit finding is a meaning making construct that has been shown to be related to adjustment in people with MS and their carers. This study investigated the dimensions, stability and potency of benefit finding in predicting adjustment over a 12 month interval using a newly developed Benefit Finding in Multiple Sclerosis Scale (BFiMSS). Usable data from 388 persons with MS and 232 carers was obtained from questionnaires completed at Time 1 and 12 months later (Time 2). Factor analysis of the BFiMSS revealed seven psychometrically sound factors: Compassion/Empathy, Spiritual Growth, Mindfulness, Family Relations Growth, Life Style Gains, Personal Growth, New Opportunities. BFiMSS total and factors showed satisfactory internal and retest reliability coefficients, and convergent, criterion and external validity. Results of regression analyses indicated that the Time 1 BFiMSS factors accounted for significant amounts of variance in each of the Time 2 adjustment outcomes (positive states of mind, positive affect, anxiety, depression) after controlling for Time 1 adjustment, and relevant demographic and illness variables. Findings delineate the dimensional structure of benefit finding in MS, the differential links between benefit finding dimensions and adjustment and the temporal unfolding of benefit finding in chronic illness.

Mechanisms of improvement in treatment for depression : test of a self-efficacy and performance model

Tested D. J. Kavanagh's (1983) depression model's explanation of response to cognitive-behavioral treatment among 19 20–60 yr old Ss who received treatment and 24 age-matched Ss who were assigned to a waiting list. Measures included the Beck Depression Inventory and self-efficacy (SE) and self-monitoring scales. Rises in SE and self-monitored performance of targeted skills were closely associated with the improved depression scores of treated Ss. Improvements in the depression of waiting list Ss occurred through random, uncontrolled events rather than via a systematic increase in specific skills targeted in treatment. SE regarding assertion also predicted depression scores over a 12-wk follow-up.