Pub Date : 2025-08-01Epub Date: 2025-06-06DOI: 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.
{"title":"Effectiveness of the implementation of transdiagnostic PsicAP-CV protocol for anxiety and depression in primary care: A Stepped Wedge Cluster Randomised Trial","authors":"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","doi":"10.1016/j.janxdis.2025.103045","DOIUrl":"10.1016/j.janxdis.2025.103045","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (EG<sub>1</sub>) and those who received delayed treatment (EG<sub>2</sub>), there was a trend in favour of the EG<sub>1</sub> group in the recovery indicators.</div></div><div><h3>Discussion</h3><div>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.</div></div><div><h3>Trial registration</h3><div>EURADICT 2013-001955-11/ISRCTN58437086.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103045"},"PeriodicalIF":4.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01Epub Date: 2025-06-30DOI: 10.1016/j.janxdis.2025.103050
Franciska Rehberg, Lydia Rihm, Ariane Göbel, Freya Thiel, Verena C S Büechl, Manon Even, Susan Garthus-Niegel
Background: Despite a growing body of literature, understanding of the relationship between maternal symptoms of perinatal posttraumatic stress disorder (PTSD) and the emerging mother-infant bond (MIB) remains limited. This systematic review and meta-analysis elucidates this association considering both general PTSD (gPTSD) symptoms (i.e., not originating from childbirth) as well as childbirth-related PTSD (CB-PTSD) symptoms.
Methods: A comprehensive literature search screening for articles published until 10/03/2024 was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes were estimated with random effects models.
Results: The systematic review includes 22 studies (9472 participants) and indicates a positive association between perinatal PTSD symptoms and impaired MIB. However, the relationship might be explained by confounding factors (e.g., depressive symptoms, general psychological distress). Meta-analyses suggest a small to moderate positive association (r = .32) between postnatal gPTSD symptoms and impaired MIB (n = 8) and a moderate positive association (r = .38) between CB-PTSD symptoms and impaired MIB (n = 15). Additional exploratory meta-analyses indicate that within the CB-PTSD construct, general rather than childbirth-related PTSD symptoms are more strongly related to MIB (n = 5).
Limitations: Heterogeneity across studies, methodological complexities in distinguishing perinatal PTSD subtypes, and a small number of studies should be noted.
Conclusions: The results indicate differential associations between gPTSD versus CB-PTSD and MIB. However, further research is required to fully elucidate the relationship between maternal perinatal PTSD and MIB and the role of individual symptom domains to inform the targeted development of interventions.
{"title":"Perinatal PTSD and the mother-infant bond: A systematic review and meta-analysis.","authors":"Franciska Rehberg, Lydia Rihm, Ariane Göbel, Freya Thiel, Verena C S Büechl, Manon Even, Susan Garthus-Niegel","doi":"10.1016/j.janxdis.2025.103050","DOIUrl":"10.1016/j.janxdis.2025.103050","url":null,"abstract":"<p><strong>Background: </strong>Despite a growing body of literature, understanding of the relationship between maternal symptoms of perinatal posttraumatic stress disorder (PTSD) and the emerging mother-infant bond (MIB) remains limited. This systematic review and meta-analysis elucidates this association considering both general PTSD (gPTSD) symptoms (i.e., not originating from childbirth) as well as childbirth-related PTSD (CB-PTSD) symptoms.</p><p><strong>Methods: </strong>A comprehensive literature search screening for articles published until 10/03/2024 was conducted. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes were estimated with random effects models.</p><p><strong>Results: </strong>The systematic review includes 22 studies (9472 participants) and indicates a positive association between perinatal PTSD symptoms and impaired MIB. However, the relationship might be explained by confounding factors (e.g., depressive symptoms, general psychological distress). Meta-analyses suggest a small to moderate positive association (r = .32) between postnatal gPTSD symptoms and impaired MIB (n = 8) and a moderate positive association (r = .38) between CB-PTSD symptoms and impaired MIB (n = 15). Additional exploratory meta-analyses indicate that within the CB-PTSD construct, general rather than childbirth-related PTSD symptoms are more strongly related to MIB (n = 5).</p><p><strong>Limitations: </strong>Heterogeneity across studies, methodological complexities in distinguishing perinatal PTSD subtypes, and a small number of studies should be noted.</p><p><strong>Conclusions: </strong>The results indicate differential associations between gPTSD versus CB-PTSD and MIB. However, further research is required to fully elucidate the relationship between maternal perinatal PTSD and MIB and the role of individual symptom domains to inform the targeted development of interventions.</p>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"103050"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01Epub Date: 2025-07-19DOI: 10.1016/j.janxdis.2025.103053
Adrian Meule, Leonie Seufert, David R. Kolar
Emetophobia refers to a specific fear of vomiting. There are only few original research studies on this condition and no study that has meta-analytically synthesized findings to describe the characteristics of persons with emetophobia. To this end, we extracted data from 31 reports and—as we examined different dependent variables—each meta-analysis was based on five to 21 samples. The pooled mean age of persons with emetophobia was 29 years but was reduced to 21–27 years when adjusting for publication bias. The pooled mean age of disorder onset was 10 years. The pooled proportion of females was 91 %. The pooled proportions of reporting fear of vomiting oneself, fear of seeing others vomit, or both, were 47 %, 11 %, and 39 %. The most common comorbid mental disorders were social anxiety disorder, depression, and generalized anxiety disorder. The pooled point prevalence of emetophobia was 5 %. Higher emetophobic symptomatology moderately related to higher disgust propensity and higher anxiety, and weakly related to higher depressive symptomatology. This meta-analysis is the first to quantify that most adults with emetophobia are in early adulthood but the disorder started in childhood, almost all are women, the primary locus of fear is vomiting oneself, the most common comorbid mental disorders are other anxiety and affective disorders, and higher emetophobic symptomatology relates to a more general tendency to be easily disgusted and to be anxious. Studies based on representative samples to obtain reliable estimates on the prevalence of emetophobia are needed.
{"title":"Emetophobia (fear of vomiting): A meta-analysis","authors":"Adrian Meule, Leonie Seufert, David R. Kolar","doi":"10.1016/j.janxdis.2025.103053","DOIUrl":"10.1016/j.janxdis.2025.103053","url":null,"abstract":"<div><div>Emetophobia refers to a specific fear of vomiting. There are only few original research studies on this condition and no study that has meta-analytically synthesized findings to describe the characteristics of persons with emetophobia. To this end, we extracted data from 31 reports and—as we examined different dependent variables—each meta-analysis was based on five to 21 samples. The pooled mean age of persons with emetophobia was 29 years but was reduced to 21–27 years when adjusting for publication bias. The pooled mean age of disorder onset was 10 years. The pooled proportion of females was 91 %. The pooled proportions of reporting fear of vomiting oneself, fear of seeing others vomit, or both, were 47 %, 11 %, and 39 %. The most common comorbid mental disorders were social anxiety disorder, depression, and generalized anxiety disorder. The pooled point prevalence of emetophobia was 5 %. Higher emetophobic symptomatology moderately related to higher disgust propensity and higher anxiety, and weakly related to higher depressive symptomatology. This meta-analysis is the first to quantify that most adults with emetophobia are in early adulthood but the disorder started in childhood, almost all are women, the primary locus of fear is vomiting oneself, the most common comorbid mental disorders are other anxiety and affective disorders, and higher emetophobic symptomatology relates to a more general tendency to be easily disgusted and to be anxious. Studies based on representative samples to obtain reliable estimates on the prevalence of emetophobia are needed.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103053"},"PeriodicalIF":4.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01Epub Date: 2025-07-08DOI: 10.1016/j.janxdis.2025.103051
Alexandra N. Brockdorf , Lauren E. Simpson , David DiLillo
The co-occurrence between pain and posttraumatic stress disorder (PTSD) is commonly explained by the mutual maintenance model, which proposes that each condition exacerbates the other. We tested this model by examining within-day associations between pain and PTSD using a three-week ecological momentary assessment (EMA) design. Young adult cisgender women (N = 82) who experienced sexual assault and reported PTSD symptoms and probable alcohol misuse completed three self-report surveys per day assessing momentary pain intensity and PTSD symptoms. Results from a dynamic structural equation model supported hypotheses, such that pain predicted greater PTSD symptoms four hours later and PTSD symptoms predicted greater pain. However, exploratory follow up analyses revealed differential findings by cluster, such that intrusions, negative alterations in cognition and mood, and hyperarousal each predicted subsequent pain, whereas pain predicted only later hyperarousal. Findings add nuance to our understanding of the mutual maintenance model and point to hyperarousal symptoms as a key symptom cluster linking daily pain and PTSD among women who have experienced sexual assault. Findings underscore the potential value of targeting hyperarousal symptoms in integrative interventions.
{"title":"Bidirectional associations between PTSD symptoms and pain in daily life among women survivors of sexual assault","authors":"Alexandra N. Brockdorf , Lauren E. Simpson , David DiLillo","doi":"10.1016/j.janxdis.2025.103051","DOIUrl":"10.1016/j.janxdis.2025.103051","url":null,"abstract":"<div><div>The co-occurrence between pain and posttraumatic stress disorder (PTSD) is commonly explained by the mutual maintenance model, which proposes that each condition exacerbates the other. We tested this model by examining within-day associations between pain and PTSD using a three-week ecological momentary assessment (EMA) design. Young adult cisgender women (<em>N</em> = 82) who experienced sexual assault and reported PTSD symptoms and probable alcohol misuse completed three self-report surveys per day assessing momentary pain intensity and PTSD symptoms. Results from a dynamic structural equation model supported hypotheses, such that pain predicted greater PTSD symptoms four hours later and PTSD symptoms predicted greater pain. However, exploratory follow up analyses revealed differential findings by cluster, such that intrusions, negative alterations in cognition and mood, and hyperarousal each predicted subsequent pain, whereas pain predicted only later hyperarousal. Findings add nuance to our understanding of the mutual maintenance model and point to hyperarousal symptoms as a key symptom cluster linking daily pain and PTSD among women who have experienced sexual assault. Findings underscore the potential value of targeting hyperarousal symptoms in integrative interventions.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103051"},"PeriodicalIF":4.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01Epub Date: 2025-06-07DOI: 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.
{"title":"Affective forecasting during a horror attraction: Insights into Intolerance of Uncertainty","authors":"L. FitzGibbon , J. Morriss , M. Clasen , S. Wake , R. Nesbit , M. Malmdorf Andersen , H.F. Dodd","doi":"10.1016/j.janxdis.2025.103046","DOIUrl":"10.1016/j.janxdis.2025.103046","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103046"},"PeriodicalIF":4.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01Epub Date: 2025-07-25DOI: 10.1016/j.janxdis.2025.103055
Philip Hyland , Marcus Broughill , Mark Shevlin , Chris R. Brewin
Background
This study empirically tested several predictions arising from the Memory and Identity (M&I) Theory of ICD-11 Complex PTSD (CPTSD). Specifically, it examined the psychometric properties of two measures—the Experiences of Traumatic Memories Questionnaire (ETMQ) and the Trauma Identity Questionnaire (TIQ)—and tested relationships between different types of trauma exposure, disturbances in memory and identity, and CPTSD symptoms.
Methods
Data were collected from a non-probability based representative sample of the general adult population of the United Kingdom (N = 975), and latent variable modelling was used to test all hypotheses.
Results
Confirmatory factor analytic results provided support for the psychometric properties of the ETMQ and TIQ as measures of traumatic memories and negative identities. Multiple traumatization and interpersonal forms of trauma were associated with more disturbances in trauma memories and negative identities. Seven of the nine model-predicted associations between trauma memories, negative identities, and CPTSD symptoms were observed, including a link between a fragmented sense of self and emotional numbing.
Conclusions
Results support core elements of the M&I Theory, highlighting trauma memory and identity disturbances as key mechanisms in CPTSD.
{"title":"Memory and identity processes in ICD-11 complex posttraumatic stress disorder: Tests of a new theory","authors":"Philip Hyland , Marcus Broughill , Mark Shevlin , Chris R. Brewin","doi":"10.1016/j.janxdis.2025.103055","DOIUrl":"10.1016/j.janxdis.2025.103055","url":null,"abstract":"<div><h3>Background</h3><div>This study empirically tested several predictions arising from the Memory and Identity (M&I) Theory of <em>ICD-11</em> Complex PTSD (CPTSD). Specifically, it examined the psychometric properties of two measures—the Experiences of Traumatic Memories Questionnaire (ETMQ) and the Trauma Identity Questionnaire (TIQ)—and tested relationships between different types of trauma exposure, disturbances in memory and identity, and CPTSD symptoms.</div></div><div><h3>Methods</h3><div>Data were collected from a non-probability based representative sample of the general adult population of the United Kingdom (<em>N</em> = 975), and latent variable modelling was used to test all hypotheses.</div></div><div><h3>Results</h3><div>Confirmatory factor analytic results provided support for the psychometric properties of the ETMQ and TIQ as measures of traumatic memories and negative identities. Multiple traumatization and interpersonal forms of trauma were associated with more disturbances in trauma memories and negative identities. Seven of the nine model-predicted associations between trauma memories, negative identities, and CPTSD symptoms were observed, including a link between a fragmented sense of self and emotional numbing.</div></div><div><h3>Conclusions</h3><div>Results support core elements of the M&I Theory, highlighting trauma memory and identity disturbances as key mechanisms in CPTSD.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"114 ","pages":"Article 103055"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-05-20DOI: 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.
{"title":"Burden of anxiety disorders among older adults aged ≥ 55 years in 204 countries and territories, 1990–2021: A population-based study","authors":"Bingyi Wang , Qiqiao Zhang , Ke Liu , Leiwen Fu , Cailing Ao , Peng Zhang , Chaohua Lan , Qiongfang Wu , Fang Yang , Yong Lu , Xiaobing Fu , Yan Li","doi":"10.1016/j.janxdis.2025.103026","DOIUrl":"10.1016/j.janxdis.2025.103026","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103026"},"PeriodicalIF":4.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-04-24DOI: 10.1016/j.janxdis.2025.103022
Siyuan Wang , Madeline M. Rodenbaugh , Casey Straud , Nicole H. Weiss , Ateka A. Contractor
Emerging research indicates an important role of positive emotion processes in posttraumatic stress disorder (PTSD) symptomatology. To extend this research, we utilized a network approach to examine associations between PTSD symptom clusters (intrusions, avoidance, negative alterations in cognition and mood [NACM], alterations in arousal and reactivity [AAR]) and dysregulated positive emotion processes (levels of positive affect, self-focused positive rumination, emotion-focused positive rumination, dampening, impulse control difficulties, difficulties engaging in goal-directed behaviors, nonacceptance of positive emotions). Specifically, we examined differential relations between PTSD symptom clusters and positive emotion processes, and symptoms that most strongly connected these constructs (i.e., communities). The sample included 191 trauma-exposed adults recruited from Amazon’s MTurk ( Mage = 38.54 ± 10.99 years, 53.4 % women, 63.4 % with probable PTSD). A regularized Guassian Graphic Model consisting of four nodes representing the PTSD symptom clusters’ community and seven nodes representing the positive emotion processes' community was generated. The strongest positive associations across communities were the NACM-dampening and the AAR-dampening edges. Bridge symptoms with the highest inter-community connectivity were dampening, AAR, intrusions, NACM, and impulse control difficulties. Overall, this study indicates the importance of incorporating positive emotion processes in the conceptualization of PTSD. Our results also highlight that dampening of positive emotions and difficulties with impulse control while experiencing positive emotions may be meaningful targets in PTSD treatment.
{"title":"Exploring the co-occurrence of posttraumatic stress disorder symptoms and dysregulated positive emotion processes: A network analysis","authors":"Siyuan Wang , Madeline M. Rodenbaugh , Casey Straud , Nicole H. Weiss , Ateka A. Contractor","doi":"10.1016/j.janxdis.2025.103022","DOIUrl":"10.1016/j.janxdis.2025.103022","url":null,"abstract":"<div><div>Emerging research indicates an important role of positive emotion processes in posttraumatic stress disorder (PTSD) symptomatology. To extend this research, we utilized a network approach to examine associations between PTSD symptom clusters (intrusions, avoidance, negative alterations in cognition and mood [NACM], alterations in arousal and reactivity [AAR]) and dysregulated positive emotion processes (levels of positive affect, self-focused positive rumination, emotion-focused positive rumination, dampening, impulse control difficulties, difficulties engaging in goal-directed behaviors, nonacceptance of positive emotions). Specifically, we examined differential relations between PTSD symptom clusters and positive emotion processes, and symptoms that most strongly connected these constructs (i.e., communities). The sample included 191 trauma-exposed adults recruited from Amazon’s MTurk ( <em>M</em><sub>age</sub> = 38.54 ± 10.99 years, 53.4 % women, 63.4 % with probable PTSD). A regularized Guassian Graphic Model consisting of four nodes representing the PTSD symptom clusters’ community and seven nodes representing the positive emotion processes' community was generated. The strongest positive associations across communities were the NACM-dampening and the AAR-dampening edges. Bridge symptoms with the highest inter-community connectivity were dampening, AAR, intrusions, NACM, and impulse control difficulties. Overall, this study indicates the importance of incorporating positive emotion processes in the conceptualization of PTSD. Our results also highlight that dampening of positive emotions and difficulties with impulse control while experiencing positive emotions may be meaningful targets in PTSD treatment.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103022"},"PeriodicalIF":4.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-05-08DOI: 10.1016/j.janxdis.2025.103025
Aleiia J.N. Asmundson , Michelle M. Paluszek , Jordana L. Sommer , Shay-Lee Bolton , Jitender Sareen , Tracie O. Afifi , Renée El-Gabalawy , Gordon J.G. Asmundson
Background
Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent, comorbid, and debilitating conditions in the military. The present study was designed to examine the prevalence of chronic pain conditions (i.e., migraines, back problems, arthritis) across PTSD courses (i.e., no PTSD, remitted, new onset, persistent/recurrent) and examine the association between PTSD course and the presence and onset of chronic pain conditions in a population-representative sample of Canadian military members. Methods: Cross-tabulations and logistic regressions were conducted on data (n = 2941) from the 2002 Canadian Community Health Survey Mental Health and Well-being Canadian Forces Supplement and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey. Results: The prevalence of chronic pain conditions across PTSD courses ranged from 8 % to 61 %, with no PTSD consistently having the lowest prevalence. After adjusting for covariates, respondents with new onset PTSD had elevated odds of back problems (AOR=1.43, 95 % CI [1.10–1.90], p < .05), arthritis (AOR=1.46, 95 % CI [1.06–2.00], p < .05), and a new onset chronic pain condition more broadly (AOR=1.66, 95 % CI [1.15–2.39], p < .01), compared to those with no PTSD. Those with remitted PTSD had greater odds of migraines (AOR=2.43, 95 % CI [1.29–4.58], p < .01), while those with persistent PTSD had lower odds of back problems (AOR=0.45, 95 % CI [0.23–0.88], p < .05), compared to those with no PTSD. Conclusion: Findings indicate that the prevalence and type of chronic pain that co-occurs with PSTD in Canadian military members varies as a function of the course of PTSD. This underscores the importance of evaluating pain in those with PTSD and suggests that the course of PTSD is a relevant consideration in case conceptualization and treatment planning.
背景：创伤后应激障碍（PTSD）和慢性疼痛是军队中非常普遍、合并症和衰弱性疾病。本研究旨在研究慢性疼痛状况（如偏头痛、背部问题、关节炎）在创伤后应激障碍病程（即无创伤后应激障碍、缓解、新发、持续/复发）中的患病率，并研究PTSD病程与慢性疼痛状况的存在和发作之间的关系。方法：对2002年加拿大社区卫生调查《加拿大军人心理健康与福祉补编》和2018年加拿大武装部队成员和退伍军人心理健康随访调查的数据（n = 2941）进行交叉表列和logistic回归分析。结果：创伤后应激障碍病程中慢性疼痛的患病率从8% %到61% %不等，无创伤后应激障碍的患病率始终最低。协变量调整后,受访者与新出现创伤后应激障碍的几率升高背部问题(优势比= 1.43,95 % CI [1.10 - -1.90], p & lt; . 05),关节炎(优势比= 1.46,95 % CI [1.06 - -2.00], p & lt; . 05),和一个新的出现慢性疼痛条件更广泛(优势比= 1.66,95 % CI [1.15 - -2.39], p & lt; . 01),而那些没有创伤后应激障碍。与无PTSD患者相比，PTSD缓解者偏头痛发生率更高（AOR=2.43, 95 % CI [1.29-4.58], p <； .01），而持续性PTSD患者背部问题发生率更低（AOR=0.45, 95 % CI [0.23-0.88], p <； .05）。结论：研究结果表明，加拿大军人PTSD并发慢性疼痛的患病率和类型随PTSD病程的变化而变化。这强调了评估创伤后应激障碍患者疼痛的重要性，并表明创伤后应激障碍的病程是病例概念化和治疗计划的相关考虑因素。
{"title":"Longitudinal course of posttraumatic stress disorder and chronic pain conditions: A population-based study of Canadian military personnel over 16 years","authors":"Aleiia J.N. Asmundson , Michelle M. Paluszek , Jordana L. Sommer , Shay-Lee Bolton , Jitender Sareen , Tracie O. Afifi , Renée El-Gabalawy , Gordon J.G. Asmundson","doi":"10.1016/j.janxdis.2025.103025","DOIUrl":"10.1016/j.janxdis.2025.103025","url":null,"abstract":"<div><h3>Background</h3><div>Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent, comorbid, and debilitating conditions in the military. The present study was designed to examine the prevalence of chronic pain conditions (i.e., migraines, back problems, arthritis) across PTSD courses (i.e., no PTSD, remitted, new onset, persistent/recurrent) and examine the association between PTSD course and the presence and onset of chronic pain conditions in a population-representative sample of Canadian military members. Methods: Cross-tabulations and logistic regressions were conducted on data (n = 2941) from the 2002 Canadian Community Health Survey Mental Health and Well-being Canadian Forces Supplement and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey. Results: The prevalence of chronic pain conditions across PTSD courses ranged from 8 % to 61 %, with no PTSD consistently having the lowest prevalence. After adjusting for covariates, respondents with new onset PTSD had elevated odds of back problems (AOR=1.43, 95 % CI [1.10–1.90], <em>p</em> < .05), arthritis (AOR=1.46, 95 % CI [1.06–2.00], <em>p</em> < .05), and a new onset chronic pain condition more broadly (AOR=1.66, 95 % CI [1.15–2.39], <em>p</em> < .01), compared to those with no PTSD. Those with remitted PTSD had greater odds of migraines (AOR=2.43, 95 % CI [1.29–4.58], <em>p</em> < .01), while those with persistent PTSD had lower odds of back problems (AOR=0.45, 95 % CI [0.23–0.88], <em>p</em> < .05), compared to those with no PTSD. Conclusion: Findings indicate that the prevalence and type of chronic pain that co-occurs with PSTD in Canadian military members varies as a function of the course of PTSD. This underscores the importance of evaluating pain in those with PTSD and suggests that the course of PTSD is a relevant consideration in case conceptualization and treatment planning.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103025"},"PeriodicalIF":4.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-05-20DOI: 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.
{"title":"CBT-based self-help guided by a lay provider for generalized anxiety in older adults: A randomized controlled trial","authors":"Philippe Landreville , Patrick Gosselin , Sébastien Grenier , Pierre-Hugues Carmichael","doi":"10.1016/j.janxdis.2025.103028","DOIUrl":"10.1016/j.janxdis.2025.103028","url":null,"abstract":"<div><div>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 (<em>n</em> = 75) or wait-list control group (<em>n</em> = 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, <em>p</em> < .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.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"113 ","pages":"Article 103028"},"PeriodicalIF":4.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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