Depression and Anxiety

Dysphoria is a transdiagnostic symptom that causes considerable suffering. Implementation of established self-care and clinical treatment options, such as mindfulness and transcranial magnetic stimulation (TMS), is typically disjointed for conditions involving dysphoria. There is a need for a rapid progression of accessible treatments that can be efficacious across multiple comorbidities. In a pilot stepwise implementation study to assess feasibility and effectiveness, adult participants with dysphoria (depression, anxiety, PTSD, and/or chronic pain) went through a treatment course of VR mindfulness, then accelerated TMS (accel-TMS) over the left dorsolateral prefrontal cortex (left dlPFC), then accel-TMS over the dorsomedial prefrontal cortex (dmPFC). Participants who did not benefit from one treatment phase progressed to the next until remission or study completion. Twenty-four participants were enrolled with 23 in VR mindfulness (phase 1), 19 in accel-TMS left dlPFC (phase 2A), and 13 in accel-TMS dmPFC (phase 2B). For our primary outcome measure of the short form-36 emotional well-being subscale (paired -test), no significant change was found in phase 1 (, ), significant improvement was found in phase 2A (, ), and no significant change was found in the smaller sample of phase 2B (, ). Symptom improvement was largely supported by clinician-administered scales, with more significant changes found in accel-TMS left dlPFC and dmPFC. The benefits of VR mindfulness were limited; however, both accel-TMS phases showed a significant impact on secondary measures of depression, anxiety, and PTSD. This stepwise protocol shows promise in providing an approach to rapidly improve symptoms of dysphoria in transdiagnostic populations. This trial is registered with NCT05061745.

Social anxiety disorder (SAD) is widespread among university students and is associated with high costs for the society. While unguided internet- and mobile-based interventions (IMIs) may have short-term effects in reducing SAD symptoms, evidence for their long-term efficacy and cost-effectiveness is still limited. The aim of this study is to examine the 6-month outcomes of an IMI for university students with SAD. Participants were recruited via mass mails sent to enrolled students and included if they were at least 18 years old, met the diagnostic criteria of SAD in a structured clinical interview for DSM-IV axis I disorders (SCID-I), and provided written informed consent. In a prospective study designed as a two-armed randomized-controlled trial, 200 students (mean age 26.7 years) diagnosed with SAD were randomly assigned to an IMI or a waitlist control (WLC) condition. The IMI consisted of nine weekly sessions based on the cognitive-behavioral treatment model for social phobia by Clark and Wells. The primary outcome was SAD symptom severity assessed via the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). A health economic evaluation from a societal and healthcare perspective examined the costs related to the symptom-free status and quality-adjusted life years (QALYs) gained. Statistically significant differences in SAD symptom severity previously found at posttreatment favoring the IMI were maintained at a 6-month follow-up [SIAS (Cohen’s ; 95% CI, 0.30, 0.87) and SPS (Cohen’s ; 95% CI, 0.54, 1.1)]. From a societal perspective, at a willingness to pay (WTP) of €0, the intervention was found to have a 92% and 93% probability of cost-effectiveness compared with the WLC per symptom-free status and QALY gained, respectively. From a healthcare perspective, the likelihood of cost-effectiveness of the intervention was 97% per symptom-free status at a WTP of €1000 (US$1326) and 96% per QALY gained at a WTP of €6000 (US$7956). This IMI is effective in treating university students with SAD and has an acceptable likelihood of cost-effectiveness compared with WLC from a societal perspective. This intervention can be integrated into university healthcare to reach students with SAD as it is scalable, shows a high probability of cost-effectiveness, and overcomes known treatment barriers. This trial is registered with DRKS00011424.

People with social anxiety disorder (SAD) experience less positive affect (PA) and more negative affect (NA) than the general population, a pattern more similar to depression than other anxiety disorders. There is a dearth of research assessing whether PA is targeted effectively during treatment, even though this is an important emotional aspect for quality of life. The primary aim of this study was to examine daily changes in self-report PA and NA among a sample of partial hospital program (PHP) patients with SAD. A secondary aim was to examine baseline depression severity as a moderator of daily PA and NA change. Patients were adults () diagnosed with SAD seeking treatment at a typically 1–2-week transdiagnostic behavioral health PHP from September 2017 to September 2019. Patients completed (1) the International Positive and Negative Affect Schedule-Short Form (IPANAS-SF) each treatment day to assess affect and (2) the Patient Health Questionnaire-9 Item Version (PHQ-9) at baseline to assess depressive symptoms. Data from the first nine days of treatment were included in analyses: two-level multilevel model (MLM) analyses were used to address study aim 1, and baseline depression severity was added as a moderator to address study aim 2. Patients reported significant decreases in NA but no significant changes in PA over the course of PHP treatment. Additionally, there was no significant evidence of depression moderating NA change; however, depression did moderate PA change. These findings suggest that patients with SAD report significant decreases in NA but no change in PA over transdiagnostic group treatment, with increases in PA being stronger among patients with more severe depressive symptoms. PA captures an important emotional experience for living a fulfilling life, yet CBT-based treatments may not be effectively improving these areas. Future studies targeting PA in SAD treatment can inform whether doing so ultimately improves treatment outcomes for SAD.

Background. The prevalence of adolescent depression is continuously increasing, impacting the cognitive, emotional, and behavioral development of adolescents. Therefore, it is crucial to comprehend depression from the perspective of the social ecosystem, necessitating further empirical evaluation. Methods. This study utilized a case-control study design. The cases consisted of adolescents with depression (aged 13–18 years) admitted to a psychiatric hospital in Nanjing, Jiangsu Province, China, from November 2021 to July 2022, meeting the diagnostic criteria for depression in the 11th Edition of the International Classification of Diseases. Control group students, with a matching gender ratio in the same region, were randomly recruited. Logistic regression analysis was employed to investigate the factors associated with depression, with gender and age as covariates. Results. The study comprised 200 participants, with 44 (22.0%) males and 156 (78.0%) females. Multiple logistic regression analysis revealed that increased adolescent depression was associated with being an only child (, 95% CI: 1.106–6.492), living in urban areas (, 95% CI: 1.077–10.267), experiencing school bullying (, 95% CI: 2.044–40.408), having severe family dysfunction (, 95% CI: 1.109–37.995), and possessing low core self-evaluation (, 95% CI: 3.305–41.746). Odds ratios for each factor were statistically significant. Conclusions. Our results improve the evidence for associations between adolescent depression and core self-evaluation, school bullying, family function, living in urban areas, and being an only child. These findings should be taken into consideration in the assessment, intervention, and related policies for adolescent depression.

Background. Poverty-related stress plays a pivotal role in mediating the impact of poverty on behavioral health outcomes. However, existing research on adult poverty-related stress suffers from limited scope and inadequate measurement approaches. To address these shortcomings, our study undertakes a comprehensive investigation to develop and validate a multidimensional Poverty-Related Stress Scale (PRSS). Methods. A multistudy research design was employed to develop and validate the PRSS. Study 1 () established a multidimensional framework for poverty-related stress by exploring the factor structure and internal consistency of our measure. Study 2 () evaluated nuanced psychometric properties, including factorial validity, internal consistency, and temporal invariance, using confirmatory factor analyses (CFA) and modern exploratory structural equation models (ESEM). Lastly, Study 3 () examined the criterion validity of our scale by investigating its concurrent and predictive relationships with depression, anxiety, and flourishing. Results. The findings consistently supported a hierarchal ESEM model for overall poverty-related stress, reflecting the dynamic interaction among three stressors: noise disturbance, housing dysfunction, and financial distress. This model exhibited temporal invariance, with different studies reliably measuring distinct components of poverty-related stress. Concurrent validity was demonstrated by significant associations between overall poverty-related stress and theoretically relevant constructs, such as depression, anxiety, and flourishing, at different time points. Additionally, predictive validity was established, showing poverty-related stress measured at time 1 accounted for variations in depression, anxiety, and flourishing at time 2. The results provide robust evidence for the validity and reliability of the PRSS as a tool for measuring poverty-related stress and its underlying factors. Conclusions. Our findings offer compelling preliminary support for the utility of our measure. Further research and potential clinical applications are discussed to deepen the understanding of poverty-related stress and its implications for behavioral health outcomes.

Background. Lockdown restrictions during the COVID-19 pandemic exerted a strong impact on people’s quality of life and increased loneliness. This study evaluates the effect of the pandemic on loneliness in patients with burning mouth syndrome (BMS) compared with the general population. Methods. 100 BMS patients versus 100 healthy controls (HC) were recruited in five Italian centers. The 12-Item General Health Questionnaire (GHQ-12), the Depression Anxiety Stress Scales-21 (DASS-21), the Insomnia Severity Index (ISI), the short-form UCLA Loneliness Scale-8 (ULS-8), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Suicidal Ideation Attribute Scale (SIDAS) were administered. Results. BMS patients and HC showed high scores (16 [14-20.25] and 16 [14-18]) in the ULS-8. Statistically significant differences have been found considering the BMS patients lived with fewer relatives during the lockdown compared with the HC (2 [2-3] and 3 [2-4]; : 0.012) with a lower level of satisfaction in relationships with relatives (4 [1.75-5] and 5 [4-5]; ) and also in the DASS-21 total scores between the BMS patients and HC (16 [10-24.2] and 10 [4-17]; ). The multivariate logistic regression revealed that age, education, DASS-21, and MSPSS were the most predictive variables and could explain 34.68% of the variance in the ULS-8 score () in the BMS group. However, only the DASS-21 was significant in the HC group, explaining 10.11% of the variance of the ULS-8 (: 0.033). Conclusions. Both the patients and controls experienced deep loneliness during the pandemic. However, in the BMS group, loneliness was significantly correlated with age, a higher level of education and stress, and a lower level of satisfaction in relationships with relatives and social support perceived compared with the controls.