Journal of Anxiety Disorders最新文献_第6页

Understanding climate anxiety and potential impacts on pro-environment behaviours 了解气候焦虑及其对亲环境行为的潜在影响

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-06-18 DOI: 10.1016/j.janxdis.2025.103049

Zac Coates, Scott Brown, Michelle Kelly

Previous studies have identified harmful social, physical, and mental impacts due to climate change. Anxiety due to climate change or “climate anxiety” may be an adaptive or reasonable response to a real threat; however, it may also be associated with considerable functional impairment of associated behaviours. In this study, we examined the relationship between climate anxiety and pro-environment behaviours, via an online discrete choice experiment, with 374 participants recruited from prolific academic and undergraduate university recruitment program. This experiment included our discrete choice measure of pro-environment behaviours and self-report survey items examining climate anxiety, general anxiety, death anxiety, and locus of control. We found that a moderate level of climate anxiety may be optimal for making pro-environmental choices, with this group having significantly more eco-friendly choices than participants in the low or high climate anxiety groups. We also examined the relationships between climate anxiety and three other psychological concepts, locus of control, general anxiety, and death anxiety, and found that these 3 factors were positively related to climate anxiety. These findings may indicate that some additional negative mental health outcomes are associated with high levels of climate anxiety. This study provides evidence for the use of discrete choice experiments when examining pro-environment behaviours, which may allow future studies to further examine various other trade-offs or factors such as the cost that participants are willing to “pay” for an eco-friendly option.

以前的研究已经确定了气候变化对社会、身体和精神的有害影响。气候变化引起的焦虑或“气候焦虑”可能是对真实威胁的适应性或合理反应；然而，它也可能与相关行为的相当大的功能损害有关。在这项研究中，我们通过一项在线离散选择实验，研究了气候焦虑和亲环境行为之间的关系，该实验招募了374名来自多产的学术和本科大学招聘计划的参与者。本实验包括我们对亲环境行为的离散选择测量和自我报告调查项目，研究气候焦虑、一般焦虑、死亡焦虑和控制点。我们发现，适度的气候焦虑水平可能是做出亲环境选择的最佳选择，这一群体比低或高气候焦虑组的参与者有更多的环保选择。我们还研究了气候焦虑与其他三个心理概念——控制点、一般焦虑和死亡焦虑之间的关系，发现这三个因素与气候焦虑呈正相关。这些发现可能表明，一些额外的负面心理健康结果与高水平的气候焦虑有关。这项研究为在研究亲环境行为时使用离散选择实验提供了证据，这可能允许未来的研究进一步研究各种其他权衡或因素，如参与者愿意为环保选择“支付”的成本。

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引用次数: 0

Altered resting-state amygdala-cerebellar functional connectivity is associated with intolerance of uncertainty in patients with obsessive-compulsive disorder: A longitudinal study 静息状态杏仁核-小脑功能连接的改变与强迫症患者对不确定性的不耐受有关：一项纵向研究

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-06-13 DOI: 10.1016/j.janxdis.2025.103048

Qihui Guo , Rongrong Zhu , Huixia Zhou , Dongmei Wang , Xiangyang Zhang

Objectives

Intolerance of uncertainty (IU) plays an important role in the pathology of obsessive-compulsive disorder (OCD). The amygdala and anterior insula (AI) appear to be important neural correlates of IU. However, the relationship between altered resting-state functional connectivity (rsFC) and IU in OCD patients has not been reported.

Methods

This study recruited 39 patients with OCD and 45 healthy controls (HC). IU was measured using the Intolerance of Uncertainty Scale (IUS). The seed-to-voxel method was used to construct rsFC maps. Between-group differences in rsFC and their correlations with IU were analyzed. Following an eight-week psychological intervention, OCD patients underwent a second assessment. The association between rsFC changes and IU changes was investigated.

Results

OCD patients exhibited significantly higher IUS scores. Significant alterations in rsFC were observed between the left amygdala and the left cerebellum posterior lobe (CPL), as well as between the left AI and the left cuneus in OCD patients. In the OCD group, only the left amygdala - left CPL rsFC significantly correlated with IUS scores. No significant correlations were found between rsFC and IUS scores in the HC group. Longitudinal analysis revealed that changes in the left amygdala - left CPL rsFC were significantly associated with changes in IUS scores.

Conclusions

This study establishes amygdala-cerebellar rsFC as a specific neural signature of IU in patients with OCD, patterns absent in healthy controls. Moreover, the amygdala-cerebellar rsFC displayed longitudinal coupling with IU changes. These findings provide novel insights into the neural mechanisms of OCD pathology.

目的不确定性不耐受（IU）在强迫症（OCD）病理中起重要作用。杏仁核和前岛（AI）似乎是IU的重要神经关联。然而，OCD患者静息状态功能连接改变（rsFC）与IU之间的关系尚未报道。方法招募强迫症患者39例，健康对照45例。IU采用不确定度不耐受度量表（IUS）测量。采用种子到体素的方法构建rsFC地图。分析rsFC的组间差异及其与IU的相关性。经过8周的心理干预后，强迫症患者接受了第二次评估。研究了rsFC变化与IU变化之间的关系。结果socd患者IUS评分明显增高。在强迫症患者中，左杏仁核和左小脑后叶（CPL）、左AI和左楔叶之间的rsFC发生了显著变化。在强迫症组中，只有左杏仁核-左CPL rsFC与IUS评分显著相关。HC组rsFC与IUS评分无显著相关性。纵向分析显示，左杏仁核-左CPL rsFC的变化与IUS评分的变化显著相关。结论本研究确立了杏仁核-小脑rsFC是强迫症患者IU的特异性神经特征，而这种特征在健康对照组中不存在。此外，杏仁核-小脑rsFC表现出与IU变化的纵向耦合。这些发现为强迫症病理的神经机制提供了新的见解。

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引用次数: 0

PTSD and cognition in older adults: A systematic literature review 老年人PTSD与认知：系统文献综述

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-06-11 DOI: 10.1016/j.janxdis.2025.103047

Jasmijn E. van Rossum , Semmy Op den Camp , Renske Uiterwijk , Kay Deckers , Vasiliki Orgeta , Bernice J.A. Gulpers , Sjacko Sobczak

Post-traumatic stress disorder (PTSD) is a disabling mental health disorder affecting psychosocial functioning and quality of life. This systematic review is the first to summarize existing global literature on the relationship between PTSD and specific domains of cognitive function in the general population of older adults. We searched PsycINFO, Medline and CINAHL up until November 1st 2024. Studies were included if they were longitudinal cohort or cross-sectional studies of adults aged 60 years and over with a clinical diagnosis of PTSD or subthreshold PTSD symptoms, reporting on any domain of cognitive functioning using a standardised measure. Eighteen good or satisfactory quality articles met criteria for this review, of which three were longitudinal cohort studies and fifteen were cross-sectional studies. PTSD was associated with significant accelerated general cognitive decline and possible accelerated decline in attention and memory over time. Older adults with PTSD additionally performed significantly worse on measures of global cognitive function and memory compared to those without PTSD. For executive function results were mixed; two studies showed significant negative associations, whereas four other studies showed no significant differences between individuals with and without PTSD. Proactive screening of individuals with PTSD for cognitive decline and an additional focus of PTSD treatment on cognitive functioning are needed.

创伤后应激障碍（PTSD）是一种影响社会心理功能和生活质量的致残性精神健康障碍。本系统综述首次总结了现有的全球文献中关于PTSD与老年人特定认知功能领域之间关系的研究。我们检索了PsycINFO， Medline和CINAHL，直到2024年11月1日。研究包括对60岁及以上的成年人进行的纵向队列或横断面研究，这些成年人临床诊断为PTSD或阈下PTSD症状，使用标准化测量报告任何领域的认知功能。18篇质量良好或令人满意的文章符合本综述的标准，其中3篇为纵向队列研究，15篇为横断面研究。随着时间的推移，创伤后应激障碍与显著加速的一般认知能力下降以及可能加速的注意力和记忆力下降有关。此外，与没有PTSD的老年人相比，患有PTSD的老年人在整体认知功能和记忆方面的表现明显更差。执行功能的结果好坏参半；两项研究显示了显著的负相关，而另外四项研究显示患有和没有创伤后应激障碍的个体之间没有显著差异。需要对PTSD患者进行认知能力下降的主动筛查，并将PTSD治疗的额外重点放在认知功能上。

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引用次数: 0

Affective forecasting during a horror attraction: Insights into Intolerance of Uncertainty 恐怖吸引中的情感预测：对不确定性的不容忍的洞察

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-06-07 DOI: 10.1016/j.janxdis.2025.103046

L. FitzGibbon , J. Morriss , M. Clasen , S. Wake , R. Nesbit , M. Malmdorf Andersen , H.F. Dodd

In this field study, we examined for the first time how Intolerance of Uncertainty influences expectations about negative, positive, and anxiety-related affect alongside the accuracy of those expectations. The study was conducted at a horror attraction, which offers an immersive, uncertain and threat-related experience. Participants (n = 1029) completed a measure of forecasted negative, positive and anxiety-related affect prior to the experience. Immediately after the experience, they rated their actual subjective experience of each of these affective states. Additionally, confidence ratings were reported for each forecasted emotion so that metacognitive awareness of forecasting accuracy could be assessed. Results showed that participants high in IU anticipated and actually experienced less positive affect, more anxiety-related affect and more negative-affect compared to those low in IU. IU predicted bias (overestimations) in emotional forecasts for negative affect, but not for positive or anxiety-related affect. The findings demonstrate that IU may be related to affective forecasting, which has implications for transdiagnostic models and treatment of psychopathology.

在这项实地研究中，我们首次研究了不确定性不耐受如何影响对消极、积极和焦虑相关影响的预期，以及这些预期的准确性。这项研究是在一个恐怖景点进行的，它提供了一种身临其境的、不确定的、与威胁相关的体验。参与者（n = 1029）在体验之前完成了预测消极、积极和焦虑相关影响的测量。体验结束后，他们立即对每种情感状态的实际主观体验进行评分。此外，报告了每个预测情绪的信心评级，以便评估预测准确性的元认知意识。结果显示，与低IU的参与者相比，高IU的参与者预期并实际经历了更少的积极影响，更多的焦虑相关影响和更多的消极影响。IU预测了负面影响的情绪预测偏差（高估），但没有预测积极或焦虑相关的影响。研究结果表明，IU可能与情感预测有关，这对跨诊断模型和精神病理学治疗具有重要意义。

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引用次数: 0

Effectiveness of the implementation of transdiagnostic PsicAP-CV protocol for anxiety and depression in primary care: A Stepped Wedge Cluster Randomised Trial 在初级保健中实施跨诊断PsicAP-CV方案治疗焦虑和抑郁的有效性：一项阶梯楔形聚类随机试验

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-06-06 DOI: 10.1016/j.janxdis.2025.103045

Gabriel Esteller-Collado , Virtudes Pérez-Jover , Carlos Van-der Hofstadt Román , Elisabeth Malonda-Vidal , Anna Llorca-Mestre , Maider Prieto-Vila , María Carpallo-González , César González-Blanch , Paloma Ruíz-Rodríguez , Juan Antonio Moriana , Antonio Cano-Vindel , Roger Muñoz-Navarro

Introduction

Anxiety and depressive disorders represent a public health challenge, with high prevalence rates and considerable impact on quality of life (QoL) and functioning. Despite evidence supporting the efficacy of transdiagnostic cognitive behavioural therapy (TD-CBT), its implementation in settings such as primary care (PC) remains limited. The aim of this paper is to analyse the results of the PsicAP-CV, a clinical trial evaluating the effectiveness and implementation of TD-CBT in the PC setting.

Methods

The study included 320 patients from the PsicAP-CV trial, a Stepped Wedge Cluster-Randomised Trial (SW-CRT). Symptoms of anxiety and depression were assessed, as well as QoL and functioning. Linear models were used to study treatment effects on outcomes and rates of recovery, reliable recovery and deterioration were calculated.

Results

findings indicate that TD-CBT is more effective than treatment-as-usual (TAU) in reducing symptoms of anxiety and depression, as well as improving QoL and functioning. In addition, although the overall reduction in symptomatology was similar between patients who received immediate treatment (EG₁) and those who received delayed treatment (EG₂), there was a trend in favour of the EG₁ group in the recovery indicators.

Discussion

these findings confirm the efficacy of TD-CBT for treating common mental disorders in PC and point to SW-CRT designs as a feasible and ethically sound avenue for implementing and scaling these evidence-based interventions within public health systems. They also support the broader integration of psychologists into PC, thus offering a scalable model that can significantly improve access to and outcomes of mental health care.

Trial registration

EURADICT 2013-001955-11/ISRCTN58437086.

焦虑和抑郁障碍是一项公共卫生挑战，患病率高，对生活质量（QoL）和功能有重大影响。尽管有证据支持跨诊断认知行为疗法（TD-CBT）的有效性，但其在初级保健（PC）等环境中的实施仍然有限。本文的目的是分析PsicAP-CV的结果，PsicAP-CV是一项评估TD-CBT在PC环境下的有效性和实施的临床试验。方法本研究纳入320例来自PsicAP-CV试验的患者，这是一项阶梯楔形聚类随机试验（SW-CRT）。评估焦虑和抑郁症状，以及生活质量和功能。采用线性模型研究治疗对预后的影响，并计算恢复率、可靠恢复率和恶化率。结果表明，TD-CBT在减轻焦虑和抑郁症状、改善生活质量和功能方面比常规治疗（TAU）更有效。此外，尽管在接受立即治疗（EG1）和延迟治疗（EG2）的患者之间，症状的总体减少是相似的，但在恢复指标方面，有一种有利于EG1组的趋势。讨论这些发现证实了TD-CBT治疗PC患者常见精神障碍的有效性，并指出SW-CRT设计是在公共卫生系统中实施和扩展这些循证干预措施的可行和合乎道德的途径。他们还支持将心理学家更广泛地整合到个人电脑中，从而提供了一个可扩展的模型，可以显着改善获得精神卫生保健的机会和结果。试验注册号euradict 2013-001955-11/ISRCTN58437086。

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引用次数: 0

Conditional probability of posttraumatic stress disorder in the Canadian Armed Forces: A longitudinal study 加拿大武装部队创伤后应激障碍的条件概率：一项纵向研究

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-06-02 DOI: 10.1016/j.janxdis.2025.103038

Sarah M. Kowall , Natalie Mota , Essence Perera , Nisali Muthumuni , Shay-Lee Bolton

Background

Posttraumatic stress disorder (PTSD) can be impacted by the type of trauma exposure. This is important to consider when evaluating the likelihood of having PTSD among Canadian veterans, which previous literature has not examined. The aim of this study was to: 1) Examine the prevalence and conditional probability of PTSD over a 16 year period by trauma type, differentiating by sex, and 2) Explore this relationship by worst trauma type.

Methods

We examined the prevalence of PTSD by sex among those with any exposure to 26 traumatic events, and used logistic regressions to examine trauma type and PTSD. The conditional probability of having PTSD over the 16-year follow-up period (2002–2018) and in the past year was calculated using population attributable fractions (PAFs). Identical analyses were used to examine the conditional probability of PTSD related to a self-reported ‘worst event’.

Results

Over the 16-year follow-up, we found that males showed higher conditional likelihood of developing PTSD from exposure to sexual trauma while females showed a higher conditional likelihood of developing PTSD from exposure to an accidentrelated trauma. For the probability of PTSD conditional on the worst event, accidentrelated or sexual trauma in females, and sexual and deployment-related trauma in males showed the highest PAF and strongest relationship.

Conclusion

This research supports differences in PTSD prevalence depending on the type of traumatic exposure. Importantly, different patterns of conditional probability of PTSD emerged by sex. These findings can provide important information for mental health providers within the military treating multiple traumas.

背景创伤后应激障碍（PTSD）可能受到创伤暴露类型的影响。在评估加拿大退伍军人患创伤后应激障碍的可能性时，这一点很重要，因为以前的文献没有研究过这一点。本研究的目的是：1)根据创伤类型和性别区分，检查16年来PTSD的患病率和条件概率；2)通过最严重的创伤类型探讨这种关系。方法对26例创伤性事件暴露者的PTSD患病率进行性别分析，并采用logistic回归分析创伤类型与PTSD的关系。使用人口归因分数（paf）计算16年随访期间（2002-2018年）和过去一年患创伤后应激障碍的条件概率。同样的分析被用于检查与自我报告的“最坏事件”相关的PTSD的条件概率。结果在16年的随访中，我们发现男性暴露于性创伤后患PTSD的条件可能性更高，而女性暴露于事故相关的创伤后患PTSD的条件可能性更高。对于以最坏事件为条件的创伤后应激障碍的概率，女性与事故或性创伤有关，男性与性和部署有关的创伤显示最高的PAF和最强的关系。结论本研究支持创伤暴露类型对PTSD患病率的影响。重要的是，PTSD的条件概率模式因性别而异。这些发现可以为军队中治疗多重创伤的心理健康提供者提供重要信息。

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引用次数: 0

FOMO’s apprehension of missing out and constant connection desire dimensions differentially correlate with problematic smartphone and social media use, but not with depression or generalized anxiety FOMO对错过和持续联系欲望维度的担忧与智能手机和社交媒体的问题使用存在差异，但与抑郁或广泛性焦虑无关

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-05-28 DOI: 10.1016/j.janxdis.2025.103037

Jon D. Elhai , Silvia Casale , Rachel A. Bond

The fear of missing out (FOMO) involves an apprehension of missing out on rewarding experiences, and a desire to continually stay connected with people. However, this two-dimension conceptualization of FOMO has not been properly empirically examined. We examined this two-factor model using confirmatory factor analysis in 326 American college students, and 433 Italian participants recruited through social media. We discovered that in both samples, the two-factor model fit well; e.g., the US sample’s comparative fit index (CFI) = .990, Tucker-Lewis Index (TLI) = .985; Italian sample’s CFI = .941, TLI = .917. The two-factor model fit significantly better than a one-factor model in both samples (ps<.001) (though magnitude of differences was small, with CFI differences ranging from .001–.007). In both samples, problematic social media use severity was more correlated (ps<.001) with FOMO’s constant connection desire factor (US sample r = .749; Italian sample r = .845) than apprehension of missing out factor (US sample r = .622; Italian sample r = .500). In the American sample, problematic smartphone use severity also correlated more (p < .001) with constant connection desire (r = .668) than apprehension of missing out (r = .587). However, in the American sample depression severity correlated equally (ps>.05) with FOMO’s constant connection desire (r = .466) and apprehension of missing out (r = .503) factors; generalized anxiety disorder symptoms also equally correlated (ps>.05) with FOMO’s constant connection desire (r = .470) and apprehension of missing out (r = .508). We discuss implications of our findings for measurement of FOMO, and FOMO’s relationship with problematic Internet use and negative affectivity.

错失恐惧（FOMO）包括对错过有益经历的担忧，以及与人保持联系的渴望。然而，这种FOMO的二维概念化尚未得到适当的实证检验。我们使用验证性因子分析对326名美国大学生和433名通过社交媒体招募的意大利参与者进行了检验。我们发现，在两个样本中，双因素模型拟合良好；例如，美国样本的比较拟合指数(CFI) = 。990， Tucker-Lewis指数(TLI) = .985；意大利样品的CFI = 。941, tli = .917。在两个样本中，双因素模型的拟合效果明显优于单因素模型（ps<.001）（尽管差异幅度很小，CFI差异范围为0.001 - 0.007）。在两个样本中，有问题的社交媒体使用严重程度与FOMO的恒定连接欲望因子(美国样本r = .749；意大利样本r = .845)大于对遗漏因子的理解(美国样本r = .622；意大利样本r = .500)。在美国的样本中，有问题的智能手机使用严重程度与持续的连接欲望（r = .668）的相关性（p <； .001）也高于对错过的担忧（r = .587）。然而，在美国样本中，抑郁严重程度与FOMO的持续连接欲望（r = .466）和错过恐惧（r = .503）因素同等相关（ps> 0.05）；广泛性焦虑障碍症状与FOMO的持续联系欲望（r = .470）和对错过的恐惧（r = .508）也同样相关（ps> 0.05）。我们讨论了我们的研究结果对FOMO测量的影响，以及FOMO与有问题的互联网使用和消极情感的关系。

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引用次数: 0

Trajectories of grief-related psychopathology: A decade after the MH17 plane disaster 与悲伤相关的精神病理学轨迹：MH17空难十年后

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-05-23 DOI: 10.1016/j.janxdis.2025.103036

Lieke C.J. Nijborg , Gerben J. Westerhof , Justina Pociūnaitė-Ott , Maarten J.J. Kunst , Jos de Keijser , Lonneke I.M. Lenferink

Violent losses increase the risk for prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). Little is known about the course of grief-related psychopathology in the long term. Hence, we examined their latent trajectories, overlap, and predictors to enhance our understanding of differential long-term responses to violent loss. MH17-bereaved people (N = 299) completed annual self-report measures from one to nine years post-loss. Prolonged grief (PG), posttraumatic stress (PTS), and major depression (MD) symptom trajectories were identified using latent class growth modeling. Overlap in trajectory membership was examined using frequencies. Predictors of trajectory membership were examined using multinomial regression analyses. Four PG symptom trajectories emerged: low (41.0 %), moderate decreasing (34.2 %), high (13.5 %), and recovered (11.3 %). Four PTS symptom trajectories emerged: low (56.2 %), recovered (19.6 %), moderate increasing (17.6 %), and high (6.6 %). Four MD symptom trajectories emerged: low (55.7 %), moderate (19.6 %), moderate decreasing (15.1 %), and high (9.5 %). The findings indicate that if people report psychopathology, this often entails PGD by itself, and sometimes in combination with PTSD and MDD, yet rarely PTSD or MDD by itself. Around one in 20 people was assigned to all three high symptom trajectories. Different predictors were found across disorders. To conclude, most MH17-bereaved people reported low grief-related psychopathology, yet one in six reported high grief-related psychopathology levels (i.e., at least probable PGD, PTSD, or MDD) nearly a decade later. There is no indication of a delayed onset of grief-related psychopathology.

暴力损失增加了长期悲伤障碍（PGD）、创伤后应激障碍（PTSD）和重度抑郁症（MDD）的风险。从长期来看，人们对悲伤相关的精神病理过程知之甚少。因此，我们研究了它们的潜在轨迹、重叠和预测因素，以增强我们对暴力损失的不同长期反应的理解。mh17遇难者（N = 299）在失联1 - 9年后完成了年度自我报告。使用潜在类别增长模型确定了长期悲伤（PG）、创伤后应激（PTS）和重度抑郁（MD）的症状轨迹。使用频率检查轨迹隶属度的重叠。运用多项回归分析检验轨迹隶属度的预测因子。出现了四种PG症状轨迹：低（41.0 %）、中度减轻（34.2% %）、高（13.5 %）和恢复（11.3 %）。出现了四种PTS症状轨迹：低（56.2% %）、恢复（19.6% %）、中度增加（17.6% %）和高（6.6% %）。出现了四种MD症状轨迹：低（55.7% %）、中度（19.6 %）、中度减轻（15.1 %）和高（9.5 %）。研究结果表明，如果人们报告精神病理，这通常伴随着PGD本身，有时会合并PTSD和MDD，但很少单独出现PTSD或MDD。大约每20人中就有一人被分配到所有三个高症状轨迹。在不同的疾病中发现了不同的预测因子。综上所述，大多数mh17丧亲者报告的与悲伤相关的精神病理程度较低，然而近十年后，六分之一的人报告了与悲伤相关的精神病理水平较高（即至少可能患有PGD、PTSD或MDD）。没有迹象表明与悲伤相关的精神病理延迟发作。

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引用次数: 0

Burden of anxiety disorders among older adults aged ≥ 55 years in 204 countries and territories, 1990–2021: A population-based study 1990-2021年204个国家和地区年龄≥ 55岁老年人焦虑症负担：一项基于人群的研究

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-05-20 DOI: 10.1016/j.janxdis.2025.103026

Bingyi Wang , Qiqiao Zhang , Ke Liu , Leiwen Fu , Cailing Ao , Peng Zhang , Chaohua Lan , Qiongfang Wu , Fang Yang , Yong Lu , Xiaobing Fu , Yan Li

Background

Despite anxiety disorders being a significant public health concern, studies assessing their global burden among older adults are limited. We aimed to analyse trends in the global burden of anxiety disorders in older adults aged ≥ 55 years.

Methods

Data on the incidence and disability-adjusted life-years (DALYs) for anxiety disorders were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Temporal trends were quantified using estimated annual percentage changes.

Results

In 2021, global DALYs for anxiety disorders were estimated at 8.21 million (95 % UI 5.62–11.48 million), nearly 2.5 times higher than in 1990, with an age-standardised rate of 552.7 DALYs (95 % UI 378.1–772.5) per 100,000 population. Between 1990 and 2021, the age-standardised DALY rate (ASDR) remained stable (−0.05 % [95 % CI −0.16–0.05]), with minimal differences between men (0.04 % [−0.05–0.12]) and women (−0.08 % [−0.21–0.05]). The 55–59 age group showed the highest ASDR (538.5 [361.3–767.7] per 100,000 population). The highest increases in ASDR were observed in the low-middle (0.15 % [0.03–0.28]) and low sociodemographic index regions (0.09 % [0.02–0.15]). The regions with the highest ASDRs were Latin America, Western Europe, and High-income North America.

Conclusion

While global trends in anxiety disorders among older adults remained stable, the total burden increased significantly, with marked regional disparities. Tailored mental health interventions, early detection, and treatment in primary care are essential to reduce the future burden of anxiety disorders in older adults, especially in low and middle-income countries.

尽管焦虑症是一个重要的公共卫生问题，但评估老年人全球负担的研究有限。我们的目的是分析年龄≥ 55岁的老年人全球焦虑症负担的趋势。方法从全球疾病、伤害和风险因素负担研究（GBD） 2021中检索焦虑症的发病率和残疾调整生命年（DALYs）数据。使用估计的年百分比变化来量化时间趋势。结果2021年，全球焦虑症DALYs估计为821万（95 % UI 562 - 1148万），比1990年高出近2.5倍，年龄标准化率为每10万人552.7 DALYs（95 % UI 378.1-772.5）。1990年至2021年间，年龄标准化DALY率（ASDR）保持稳定（- 0.05 %[95 % CI - 0.16-0.05]），男性（0.04 %[- 0.05 - 0.12]）和女性（- 0.08 %[- 0.21-0.05]）之间的差异极小。55 ~ 59岁人群ASDR最高，为538.5[361.3 ~ 767.7]/ 10万人。ASDR在中低（0.15 %[0.03-0.28]）和低社会人口指数地区（0.09 %[0.02-0.15]）的增幅最大。asdr最高的地区是拉丁美洲、西欧和高收入的北美。结论尽管全球老年人焦虑障碍趋势保持稳定，但总体负担明显增加，且地区差异明显。量身定制的精神卫生干预措施、早期发现和初级保健治疗对于减轻老年人焦虑症的未来负担至关重要，特别是在低收入和中等收入国家。

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引用次数: 0

CBT-based self-help guided by a lay provider for generalized anxiety in older adults: A randomized controlled trial 老年人广泛性焦虑的外行医师指导下基于cbt的自助：一项随机对照试验

IF 4.8 2区医学 Q1 PSYCHIATRY

Journal of Anxiety Disorders

Pub Date : 2025-05-20 DOI: 10.1016/j.janxdis.2025.103028

Philippe Landreville , Patrick Gosselin , Sébastien Grenier , Pierre-Hugues Carmichael

Treatments for generalized anxiety disorder (GAD) that circumvent the barriers to accessing mental health care in older adults are needed. The main goal of this multisite randomized controlled trial was to evaluate the efficacy of CBT-based self-help guided by a lay provider (LP) for generalized anxiety (i.e., threshold or subthreshold GAD) in older adults. Participants (≥ 60 years) were block randomized based on diagnosis to an experimental (n = 75) or wait-list control group (n = 75). Experimental group participants used a manual presenting CBT-based readings and exercises and received brief weekly support calls by LPs. Groups were similar in terms of sociodemographic characteristics and initially did not differ significantly on outcomes. At post-treatment, the experimental group showed greater improvement across both primary outcomes (i.e., worry tendency, p < .0001, Standardized mean difference [SMD] = −1.5971, and GAD severity, p < .0001, SMD = −1.1639) and most additional outcomes (e.g., targeted psychological vulnerabilities, depressive symptoms, sleep difficulties, and GAD diagnosis) with small to large effect sizes (SMD = −0.4358 to −1.5402). The experimental group also showed maintenance of treatment effects or other improvements at 6- and 12-month follow-up. Participants in the control group who completed the treatment after their waiting period also improved on worry tendency (SMD = −1.2477) and GAD severity (SMD = −0.8443) and most of the other variables (SMD = −0.3728 to −1.0154). Results demonstrate that self-help guided by a LP is effective for treating GAD in older adults and that the improvements are sustained after treatment.

需要治疗广泛性焦虑症（GAD），以绕过老年人获得精神卫生保健的障碍。这项多地点随机对照试验的主要目的是评估由外行提供者（LP）指导的基于cbt的自助治疗老年人广泛性焦虑（即阈值或阈下广泛性焦虑症）的疗效。根据诊断将参与者（≥60岁）分组随机分为实验组（n = 75）或等候名单对照组（n = 75）。实验组的参与者使用一本手册，介绍基于cbt的阅读和练习，并接受有限合伙人每周简短的支持电话。各组在社会人口学特征方面相似，最初在结果上没有显着差异。在治疗后，实验组在两项主要结果（即担忧倾向，p <； ）上都有更大的改善。0001，标准化平均差[SMD] = - 1.5971，与GAD严重程度，p <； 。0001, SMD = - 1.1639)和大多数附加结果（例如，目标心理脆弱性、抑郁症状、睡眠困难和广泛性焦虑症诊断）具有小到大的效应量（SMD = - 0.4358至- 1.5402）。在6个月和12个月的随访中，实验组也显示出治疗效果的维持或其他改善。在等待期后完成治疗的对照组参与者在焦虑倾向（SMD = - 1.2477）和GAD严重程度（SMD = - 0.8443）以及大多数其他变量（SMD = - 0.3728至- 1.0154）方面也有所改善。结果表明，LP指导下的自助对治疗老年人广泛性焦虑症是有效的，并且治疗后改善持续。

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引用次数: 0