Depression and Anxiety最新文献

Anxiety is a significant mental health challenge for women of reproductive age worldwide, often contributing to broader psychological issues. However, research on anxiety prevalence among this demographic, particularly in Bangladesh, remains limited. This study addresses this gap by identifying potential predictors of anxiety among married women in Bangladesh. Using data from the nationally representative Bangladesh Demographic and Health Survey (BDHS) 2022, the generalized anxiety disorder (GAD-7) scale was employed to assess anxiety levels. Descriptive and inferential statistical analyses, including one-way ANOVA and stepwise multiple regression, were conducted to identify key predictors. The findings reveal that 25.8% of married women in Bangladesh experience mild to severe anxiety, with 4.1% reporting moderate to severe anxiety. A six-factor model derived from stepwise multiple regression explained 17.3% of the variance in anxiety levels. The most significant predictor was a history of terminated pregnancy, accounting for 6.8% of the variance (R² change = 0.068; p ≤ 0.001). Other notable predictors included pressure from spouses or family members (R² change = 0.038; p ≤ 0.001), educational status (R² change = 0.028; p < 0.001), religion (R² change = 0.019.; p = 0.018), continuation of education after marriage (R² change = 0.012; p = 0.030), and husband’s educational attainment (R² change = 0.007; p = 0.033). Additional factors such as employment after marriage, age at first sexual intercourse, and wealth status also played significant roles. The study highlights the substantial prevalence of anxiety among married women in Bangladesh, emphasizing the influence of socioeconomic along with other potential factors. Further research is needed to develop targeted interventions addressing socioeconomic and behavioral determinants, ensuring the mental well-being of married women.

Depression, anxiety, and trauma-related disorders commonly occur in the perinatal period, with high rates of comorbidity, and potentially adverse outcomes for women and children. Cognitive behavioral therapy (CBT) is an effective treatment, however less than half of new mothers experiencing symptoms seek treatment. This review was focused on factors affecting treatment engagement and outcome in a clinical perinatal population. A mixed-methods systematic review was conducted according to Cochrane Collaboration Guidelines. We included randomized controlled trials (RCTs) of individual CBT where at least 70% of women met diagnostic criteria for depression, anxiety, or trauma-related disorders during the perinatal period. Information on, and factors associated with treatment engagement, satisfaction, therapeutic alliance were examined as risk ratios (RRs). Twenty-eight studies relating to 19 RCTs, with 2557 participants were reviewed. Most studies examined CBT adapted to the perinatal context. Engagement was good overall, and high levels of satisfaction and therapeutic alliance were reported. A relationship was demonstrated between engagement and outcome in three studies. Dropout did not differ for studies of CBT compared to treatment as usual (TAU), but there was greater dropout for CBT across four studies where the guiding therapist/coach had a minimal level of psychological therapy training and qualifications (k = 4; n = 675; RR 2.38; CI 1.17–4.83). Findings indicate the importance of engagement, which may be optimized by adapting CBT to be relevant to the unique challenges faced by women in the perinatal period, and through therapeutic provision from therapists with at least a moderate amount of psychological therapy training and qualifications.

Background: Medication adherence among pediatric epilepsy patients is frequently suboptimal, and the complex interplay between parental social support, decision-making participation, treatment satisfaction, and parental anxiety in influencing medication adherence remains underexplored. This study investigates both the direct and indirect pathways linking these factors to medication adherence and examines the mediating role of treatment satisfaction and the moderating role of parental anxiety.

Methods: A cross-sectional study was conducted at three medical institutions between January 2020 and June 2024. Data on patient demographics and standardized scales measuring medication adherence, social support, communication and decision-making participation, treatment satisfaction, and parental anxiety were collected. Relationships among these variables were analyzed using structural equation modeling (SEM) and moderation analysis.

Results: A total of 1056 patients were included in the study, with a mean age of 8.86 ± 3.99 years; 51.7% were male. Path analysis showed that parental social support (STD = 0.344, p  < 0.001), communication and decision-making participation (STD = 0.392, p  < 0.001), and treatment satisfaction (STD = 0.090, p  < 0.05) had significant positive effects on medication adherence. Parental social support (STD = 0.483, p  < 0.001) and communication and decision-making participation (STD = 0.203, p  < 0.001) also strongly influenced treatment satisfaction. The indirect effects of social support and decision-making participation on medication adherence, mediated through treatment satisfaction, were statistically significant (p  < 0.05). Parental anxiety, as a moderating factor, weakened the positive effects of social support, decision-making participation, and treatment satisfaction on medication adherence (p  < 0.05).

Conclusion: This study systematically develops an integrated model linking parental social support, communication and decision-making participation, treatment satisfaction, and anxiety to medication adherence in pediatric epilepsy. It highlights the mediating role of treatment satisfaction and the moderating role of parental anxiety. Enhancing parental social support and communication, improving treatment satisfaction, and addressing parental anxiety are key strategies to promote medication adherence.

Background and Objectives: Young adults with a history of adverse childhood experiences (ACEs) may exhibit varying trajectories of complex post-traumatic stress disorder (CPTSD) symptoms over time. Unraveling the patterns of interactions between CPTSD symptoms across distinct trajectories is crucial. This study aimed to investigate the longitudinal relationships, changes, and central symptoms in CPTSD networks over time across distinct CPTSD trajectory groups.

Methods: This longitudinal study followed 1277 university students (47.5% male) who reported ACEs from China through three waves of surveys. ACEs were assessed at baseline, while symptoms of CPTSD were measured at all three time points. Growth mixture modeling (GMM) was used to identify CPTSD symptom trajectories, and cross-lagged panel network (CLPN) analysis estimated the longitudinal relationships among CPTSD symptoms within these trajectories.

Results: Two distinct and consistent CPTSD symptom trajectories were identified: a high-risk group and a resistance group. In the high-risk group, “disturbed relationships” (DRs) and “negative self-concept” (NSC) emerged as the strongest predictors of other symptoms at various time points. In the resilient group, the predictive influence of DR and NSC on other symptoms was attenuated. Instead, “affective dysregulation” (AD) emerged as the central symptom, demonstrating the strong predictive associations with other symptom domains.

Conclusions: These findings reveal directional relationships among symptoms in young adults. Symptoms related to disturbances in self-organization (DSO), identified through centrality indices, are key drivers of symptom network development in different CPTSD trajectories. Targeting these symptoms in interventions for young adults with ACEs may help prevent or reduce CPTSD progression.

Social anxiety (SA) and depressive symptoms frequently coexist, with the onset of SA typically preceding the onset of depression. Individuals experiencing SA-depression comorbidity exhibit increased functional impairments as compared to individuals without this comorbidity. Understanding the mechanisms that underlie the coexistence of SA and depressive symptoms can deepen our theoretical understanding regarding these conditions and contribute to depression prevention efforts. Recent theories suggest that low cognitive flexibility (CF) contributes to the development of depression and may play a role in the relationship between the disorders. However, empirical prospective findings are sparse. We examined whether CF moderates the link between SA and depressive symptoms in two independent preregistered studies: cross-sectional (n = 379) and longitudinal (n = 108, 2-year). Cross-sectionally, higher CF was linked to a weaker relationship between SA and depressive symptoms. Across time, among individuals with low CF at baseline, there was a positive association between SA at baseline and depressive symptoms 2 years later. No such association was found among individuals with high CF. These findings highlight the role of CF in the development of comorbid depressive symptoms among high SA individuals. It may contribute to the clinical prevention of depression through specific psychotherapeutic techniques targeted to enhance CF among SA patients. A preprint of this MS has previously been published.

Background: Given the historically high incidence of depressive disorders among children/adolescents, efforts to implement universally accessible primary psychological health care policies have been undertaken globally. However, the practical implementation and its association with depression risk reduction remain uncertain, particularly for underprivileged children/adolescents who are underrepresented in the current system.

Methods: A large-scale cohort of underprivileged children/adolescent population aged 6–18 was enrolled (n = 290,239). Subgroups with specific underprivileged conditions were identified, including de facto unattended children/adolescents (dfUCA), orphans, and children/adolescents facing especially difficult circumstances, “left-behind” and “single-parent” children/adolescents. A subgroup of matched typically developing individuals was also included. These subgroups underwent longitudinal assessments for the incidence of identifying depression on Oct 30, 2022 (baseline, before implementing primary psychological health care policy), May 21, 2023 (half year follow-up), and Oct 29, 2023 (1-year follow-up), respectively.

Results: At baseline, nearly twice as high incidence of depression was found in the underprivileged group (13.9%, 95% confidence interval [CI]: 13.7–14.1) as in the control group (7.5%, 7.2–7.7). After the implementation of the primary psychological policy, at the half year follow-up, a notable decrease in the incidence of depression was observed in both the underprivileged group (5.8%, relative risk reduction (RRR) = 51.6%, 51.5–51.7, p < 0.001) and the typically developing group (4.0%, RRR = 34.5%, 27.9–41.0, p < 0.001), particularly among orphan girls aged 12–18. The observed changes in depression incidence across all underprivileged populations were statistically noninferior compared to the typically developing group (all p < 0.001). At the 1-year follow-up, the observed benefits were consistent across all subgroups when compared to baseline. The average expenditure per child/adolescent was $1.6 in implementing such a health care policy.

Conclusions: Implementing the primary psychological health care policy is associated with a reduction in the citywide risk of depression among underprivileged children/adolescents in low–middle-income areas.

Background: This study aimed to: (1) compare the rates of change in the severity of depression and anxiety symptoms (primary outcomes) as well as internalized stigma and its components (shame with appearance [SWA], speech and social concerns [SSCs], sense of stigma [SS], and regret [R]; secondary outcomes) between the mindfulness-based stress reduction (MBSR) group and the treatment-as-usual (TAU) control group across three timepoints (T₀ = baseline assessment, prior to intervention; T₁ = postintervention, immediately after completion of intervention or at 8 weeks after commence of intervention; T₂ = follow-up assessment, 12 weeks after completion of intervention), and (2) evaluate the mediating effects of reductions in internalized stigma and its components on the relationship between MBSR and the severity of depression and anxiety symptoms among head and neck cancer (HNC) patients.

Methods: This multicenter, two-armed, parallel, and double-blind randomized controlled trial (RCT) recruited 110 HNC patients. All participants were assessed for the severity of depression and anxiety symptoms, and the degrees of internalized stigma and its components, at each timepoint.

Results: MBSR significantly reduced the severity of depression and anxiety symptoms and degrees of internalized stigma and its components across timepoints (T₀, T₁, and T₂). In contrast, no reduction in scores was observed in the TAU group. Furthermore, internalized stigma, SWA, and SSC partially mediated the relationship between MBSR and the severity of depression and anxiety symptoms. Sensitivity analyses confirmed that the changes in the severity of depression and anxiety symptoms and degrees of internalized stigma and its components according to intention-to-treat (ITT) analysis were similar to that of per-protocol (PP) and last observation carry forward (LOCF) analyses.

Conclusion: MBSR could be recommended as part of the treatment regimen for HNC patients.

Trial Registration: ClinicalTrials.gov identifier: NCT06991309

Background: Kashin–Beck disease (KBD) is an endemic osteoarthropathy, which occurs in children aged 3–12, with similarity to osteoarthritis (OA). Previous studies have shown significant depression symptoms in OA patients, yet no comparable research has been conducted in KBD patients.

Methods: We conducted a field investigation in KBD areas in Northwest China. Questionnaires were designed and used to assess demographic characteristics, clinical characteristics, and medical comorbidities. Patient Health Questionnaire-9 (PHQ-9) was included for the prevalence of depression. Finally, 440 subjects were clinically diagnosed and recruited. Depression was diagnosed when PHQ-9 ≥ 5 and classified into mild (5–9), moderate (10–14), and severe (≥ 15) groups. Logistic regression was also used to identify potential associated factors among KBD patients.

Results: Depression was present in 53.2% of patients in our KBD samples. Among them, 27.5% had mild depression, 18.4% had moderate depression, and 7.3% had severe depression. Being male (odds ratio [OR]: 0.296, 95% confidence interval [CI]: 0.180–0.486, p < 0.001) was an independent protective factor for depression, while the presence of comorbid chronic diseases (OR: 4.701, 95% CI: 2.292–9.640, p < 0.001), and a higher visual analog scale (VAS) pain level (OR: 5.275, 95% CI: 1.326–20.978, p = 0.018) were independent risk factors for depression in KBD patients.

Conclusion: This study is the first to investigate the prevalence of depression and associated factors among Chinese KBD patients, suggesting the significance of an early intervention for their mental issues.

Background: Depressive symptoms, pain, and frailty interactions in middle-aged and older adults do have longitudinal research support, yet the currently available evidence remains insufficient for a comprehensive understanding. This study aimed to examine their interrelationships and underlying mechanisms.

Methods: This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), which includes four assessments for depressive symptoms, pain, and frailty over 7 years. We included 4961 participants aged 45 years and older in our analysis. We employed cross-lagged panel models (CLPMs) and random intercept CLPMs (RI-CLPMs) to analyze the bidirectional temporal relationships at the between-person and within-person levels.

Results: Cross-lagged panel analysis revealed bidirectional associations between depressive symptoms and pain. A reciprocal predictive relationship was also identified between frailty and pain. After controlling individual differences with the RI-CLPM, depressive symptoms continued to positively predict pain during subsequent periods. However, the predictive effect of pain on subsequent depressive symptoms turned nonsignificant. Although a cross-lagged relationship remained between pain and frailty, it showed a declining trend.

Limitations: While engagement in depressive symptoms, pain, and frailty was assessed via questionnaire, long measurement intervals may not capture short-term fluctuations in the state of each variable.

Conclusions: This study differentiated within- and between-individual effects, uncovering distinct lagged effects of pain, depression, and frailty across levels. It underscored the importance of jointly assessing these conditions and integrating within- and between-individual differences to formulate and execute targeted interventions.

Aim: Youth is a time of a significant rise in depressive symptoms, particularly impacted by anxiety in females. However, the identification of the transition from anxiety to depression in young women remains ambiguous. This study collects data on brain structure and hormone levels in young women, intending to investigate the neurophysiological differences among women with anxiety disorders and comorbid anxiety and depression (CAD).

Methods: 53 young women were divided into three groups, namely an anxiety group, a CAD group, and a control group, aiming to explore the differences in brain structure and ovarian hormone levels.

Results: The CAD group exhibited significantly reduced gray matter volume (GMV) in the right superior frontal gyrus (SFG; 0.38 ± 0.05) and right middle occipital gyrus (MOG; 0.37 ± 0.04) compared to the anxiety (SFG: 0.41 ± 0.04; MOG: 0.41 ± 0.04) and control groups (SFG: 0.45 ± 0.04; MOG: 0.44 ± 0.03; all p  < 0.001). Cortical thickness in the right SFG was also significantly lower in the CAD group (2.81 ± 0.24) than in the anxiety (3.08 ± 0.21) and control groups (3.11 ± 0.19; p  < 0.001). Progesterone was negatively correlated with GMV in the right MOG (r = −0.48, p = 0.042) and SFG (r = −0.53, p = 0.020) only in the CAD group. Further, no significant associations were observed between estradiol levels and brain structure, nor between anxiety/depression scores and hormone or brain data (all p  > 0.070).

Conclusions: The change of brain structure in the SFG and MOG may be one of the mechanisms underlying the progression of symptoms from anxiety to CAD, which may also be related to the increase in progesterone, indicating the exacerbation of emotional disorders in young women.