Anxiety and Depression in Medically Ill Older Adults

Anxiety and depression are extremely common in the elderly with medical problems. They can manifest not only as symptoms of a primary psychiatric illness, but also as physiologic sequelae of medical illnesses and medical treatments. Recognition and treatment of depression and anxiety in the medically ill is especially difficult. If these states go untreated, they result in higher morbidity and mortality, higher health care costs and utilization, and poorer functional status and outcomes. Three of the most common medical illnesses that afflict geriatric patients, cardiovascular disease, pulmonary disease, and rheumatoid arthritis, will be presented to illustrate the difficulty in recognizing depression and anxiety and the impact of treating these symptoms in the medically ill elderly. Multidisciplinary approaches combining optimal medication regimens and psychosocial interventions can be effective for treatment of anxiety and depression in the medically ill elderly.     

Cognitive-Behavioral Therapy: Innovations for Cardiopulmonary Patients With Depression and Anxiety

Medically ill patients face unique physical and emotional challenges that place them at increased risk for symptoms of depression and anxiety. Despite high prevalence and significant impact, depression and anxiety are infrequently treated in the medically ill because of a variety of patient, provider, and system factors. The current article describes the development of an innovative, modular-based cognitive-behavioral intervention (Adjusting to Chronic Conditions Using Education Support and Skills [ACCESS]) that integrates treatment for symptoms of anxiety and depression with medical disease self-management in patients with heart failure and chronic obstructive pulmonary disease. Data from 3 patients who participated in an ongoing open clinical trial are reviewed to illustrate the feasibility, acceptability, and potential strengths and limitations of this intervention.     

Depression Screening in Medically Ill Homecare Elderly

PURPOSE: This article provides data on a depression screening model (HOME) in acute home health care designed to detect clinical depression among medically ill homebound older patients. The model was developed to address the lack of mental health services in home health care settings and to specifically improve geriatric depression screening as part of routine care. Authors report on the concordance of homecare and research interview ratings of depression in older homecare patients. DESIGN AND METHODS: Using a prospective cohort design, data were collected from 289 elderly patients, aged 65 and older, from a large home health care agency to examine depression, cognitive functioning, medical comorbidity, functional status, and social isolation. Research interviews used the depression module of the structured clinical interview for DSM (SCID). RESULTS: The overall prevalence of major depression was 5.7 percent according to both homecare and research raters. The prevalence of subthreshold depressive disorder was 16.4 percent as reported by research raters. Observed agreement was 73 percent and kappa agreement was 0.42, indicating a fair to moderate agreement. We identified patient characteristics that may influence the accuracy of homecare worker estimates of depressive symptoms. IMPLICATIONS: Findings suggest that depression continues to be underdetected in medically ill homebound elderly patients. Ongoing training in depression screening methods, patient follow-up interviews, and appropriate referral would improve care of depressed elderly homecare patients.     

Some correlates of health locus of control among multicultural individuals

The relationship of locus of control to depression, anxiety, hostility, and physical health was assessed in a sample of multicultural college students (N = 162). Powerful Others Health Locus of Control was correlated with depression, anxiety, hostility, and recent physical symptoms while Chance Health Locus of Control (CHLC) was correlated with all of the above as well as chronic physical symptoms and major health problems. When controlling for a variety of health risk factors (viz., age, sex, body mass, exercise, smoking, salt, alcohol, and caffeine), only CHLC remained significant in the physical health models. Results support the cognitive model of mental health which emphasize the importance of adaptive beliefs. Specifically, they suggest that issues about control are related to negative affect and indicate that the often-cited relationship of an external locus of control to depression and anxiety also holds for hostility. The findings do not, however, support the view that anxiety and depression are associated with different types of external locus of control but rather suggest a unified set of locus of control beliefs underlying the three types of negative affect. In addition, evidence is provided for the external validity of the Multidimensional Health Locus of Control (MHLC) Scales with respect to mental health. Further, the results indicate that belief about one’s health may play a significant role in one’s physical health and that the health behavior model of the relationship between locus of control and physical health is insufficient to explain the relationship. As the Chance and Powerful Others MHLC scales were not related to health habits in this sample but were related to mental health (viz., depression, anxiety, and hostility), locus of control beliefs may be related to physical health via their relationship with mental health.     

成就目标定向与小学生数学学习投入的关系:学业拖延和数学焦虑的中介作用

采用问卷法对708名小学高年级学生进行调查,以考察成就目标定向、学业拖延、数学焦虑与数学学习投入之间的关系,结果显示：（1）掌握定向和表现-接近定向均能直接正向预测数学学习投入,而表现-回避定向的直接预测作用不显著;（2）掌握定向、表现-接近定向和表现-回避定向均能通过学业拖延来间接预测数学学习投入;（3）掌握定向和表现-回避定向均能通过数学焦虑来间接预测数学学习投入,但表现-接近定向不能通过数学焦虑来间接预测数学学习投入;（4）三种成就目标定向均能通过学业拖延经数学焦虑的多重中介作用来预测数学学习投入。这表明成就目标定向不仅能直接预测,还能通过学业拖延和数学焦虑的多重中介作用,来间接预测小学生数学学习投入。     

Telephone-Administered Cognitive Behavioral Therapy: A Case Study of Anxiety and Depression in Parkinson’s Disease

Parkinson’s disease (PD) is a chronic medical illness with a high incidence of psychiatric comorbidity, specifically depression and anxiety. Research on treatment of such psychiatric complications is scarce. Non-pharmaceutical treatment options are especially attractive. Cognitive behavioral therapy (CBT) is a psychotherapeutic treatment option that has been successful in other chronically medically ill populations with comorbid depression and anxiety. The current research had two aims. The first was to pilot the feasibility of screening and identifying PD patients with symptoms of anxiety and depression in a specialized outpatient clinic. The second aim was to pilot the feasibility of telephone-administered CBT for the treatment of depression and anxiety in persons with PD, which was done through a case series comparing telephone-administered CBT to a Support strategy. A fairly large portion (67.5%) of patients screened in the outpatient clinic were identified as having symptoms of anxiety and/or depression. Results also indicated that CBT delivered via the telephone is a useful approach for targeting psychiatric symptoms in this population. A case example is given to illustrate the clinical considerations associated with delivering therapy via telephone to persons with PD. This study was conducted at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. The first author was previously affiliated with the Houston Center for Quality of Care and Utilization Studies.     

中学生成就目标相关因素的发展研究

探索了影响中学生成就目标各因素间的相互关系及其对学业成绩的影响,并就此提出一个中学生学业活动的简洁模式。(1)中学生的认知参与和能力知觉、成就目标之间极显著正相关,学业焦虑和认知参与、能力知觉、成就目标之间显著负相关;两成就目标间的相关不显著;(2)能力知觉、认知参与、学业焦虑是学业成绩的有效预测因子。     

Bridging the Gap Between Hospital and Community-Based Mental Health Services

Depression and anxiety affect a person’s ability to move from hospital to community and engage in valued occupations. The purpose of this study was to understand the effectiveness of an occupational therapist-led transitional service for people with mood and anxiety disorders. Using a mixed-method design consisting of retrospective pre-post analysis of outcome measures and qualitative analysis of interviews with key stakeholders, statistically and clinically significant improvements were seen in depression and anxiety symptoms as well as occupational engagement after completion of the service. This study highlights the unique contributions of occupational therapist-led programing in mental health recovery.     

Depression, Psychological Resources, and Health-Related Quality of Life in Older Adults 75 and Above

The purposes of this study were (1) to compare psychological resources and health-related quality of life between two groups of community-dwelling elders, 75 years of age and older, with similar chronic illnesses, but with varying levels of depression, and (2) to examine the relationships among depression, psychological resources, and health-related quality of life. Fifty-two elders (14 men and 38 women) were divided into mildly (n = 18) and severely (n = 34) depressed groups based on their depression scores. There were no significant differences between the two groups for demographic and illness characteristics. There were significant differences for number of medications, mastery, health perceptions, mental health functioning, and well-being. Severely depressed elders had poorer health perceptions, and decreased mastery, functioning, and well-being as compared with mildly depressed elders. An explanatory model was developed using factor analysis that fit the data well. Health perceptions and mastery had direct influences on depression, and depression directly impacted well-being.     

中学生创新心理素质与心理健康的相关研究

采用自编的创新心理素质量表和中国中学生心理健康量表对558名中学生进行问卷调查,以探讨中学生创新心理素质和心理健康之间的关系。结果表明：(1)自编创新素质量表包括三个子量表,分别为创新意识、创新能力与竞争心量表,经检验三个子量表均具有较高的信度、效度。(2)中学生的创新心理素质整体处于中等偏上水平。(3)中学生创新心理素质与心理健康水平较为密切,创新意识与学习压力、抑郁、焦虑显著负相关,创新能力与学习压力、抑郁显著负相关,与适应不良显著正相关,竞争心与抑郁、焦虑、学习压力、总均分有着显著的负相关关系;心理健康水平高者其创新意识和竞争心较心理健康水平低者高;学习压力对创新意识和竞争心的预测作用较大,学习压力、适应不良和抑郁对创新能力的预测作用较大。     

A randomized trial of ACT bibliotherapy on the mental health of K-12 teachers and staff

The mental health challenges of some vocations present a challenge for current intervention models. Bibliotherapy focused on transdiagnostic processes that might both prevent and alleviate a range of mental health distress could be an effective and practical approach. K-12 school personnel (N = 236; 91% female; 30-60 years old) responding to a wellness-oriented program announcement were randomized to receive an Acceptance and Commitment Therapy (ACT) self-help volume or to a waitlist. Three-fourths were above clinical cutoffs in general mental health, depression, anxiety, or stress. Participants read the book for two months, completed exercises and quizzes, and after post assessment were followed for 10 weeks; waitlist participants were then also given the book with two months to complete it. Overall, participants showed significant improvement in psychological health. Significant preventive effects for depression and anxiety were observed along with significant ameliorative effects for those in the clinical ranges of depression, anxiety and stress. Follow up general mental health, depression, and anxiety outcomes were related to the manner in which participants used the workbook and to post levels of psychological flexibility.     

To Flourish or Languish,that is the question: Exploring the mental health profiles of Danish elite athletes

ObjectivesThe purpose of this study was (a) to investigate mental well-being and the prevalence of anxiety and depressive symptoms in Danish male and female elite athletes, (b) to identify latent profiles in athletes based on their mental health and ill health, and (c) to examine whether the different profiles vary in selected protective and risk factors concerning mental health.MethodsA total of 612 Danish athletes (M = 18.99, SD = 4.29) from 18 different sports completed an online version of the Holistic Athlete Mental Health Survey that assessed well-being, depression, and anxiety together with potential risk and protective factors (e.g., injuries, stress, sleep, social support, sport environment).ResultsOverall, 13.9% of athletes reported moderate or severe anxiety symptoms while 21.1% reported moderate or severe depressive symptoms. Female athletes had a significantly higher prevalence of anxiety and depressive symptoms and lower mental well-being scores than male athletes. Through a latent profile analysis, three distinctive mental health profiles (flourishing, moderate mental health, languishing) were discovered. MANOVA following Kruskal-Wallis tests revealed substantial differences between these profiles regarding their perception of social support, sport environment, and stressors from different life domains.Conclusions: Danish elite athletes display similar levels of anxiety and depressive symptoms as the Danish general population. Flourishing athletes report lower stress levels, receive higher support from the private and sport domain, and perceive their sport environment as more supportive than athletes who are languishing. A tailored approach is proposed to support athletes' mental health.     

Quality of Life,Anxiety and Depression in Soft Tissue Sarcomas as Compared to More Common Tumours: An Observational Study

The aim of this study is to compare the quality of life and the levels of anxiety and depression in a relatively large group of subjects undergoing chemotherapy for soft tissue sarcoma and a control group of subjects undergoing chemotherapy for the most common types of cancer. 56 soft tissue sarcoma affected patients and 56 patients with common tumours, homogeneous in regards to stages of disease and sociodemographic characteristics, were enrolled in two oncological centres in Turin, Italy. Quality of life was assessed by Functional Assessment of Cancer Therapy-General and anxiety and depression by Hospital Anxiety and Depression Scale. All patients had ongoing chemotherapy. The comparison between the two groups shows no difference in either quality of life or in anxiety and depression. There are instead gender differences, since females in the group of common tumours show higher levels of anxiety in comparison to those affected by sarcomas, while males show, at a lower degree, the opposite trend. This study suggest that levels of Quality of Life, anxiety and depression are similar in rare and common tumours. The majority of patients are able to cope with the disease in an adaptive manner. However, for some patients the disease poses a threat to their physical and mental integrity; psychological support of these patients may reduce the development of significant morbidity and help patients to better manage the course of the disease and the effects of the treatment.     

A comparison of health disparities among transgender adults in Colorado (USA) by race and income

Transgender individuals face heightened risks for discrimination, harassment, and violence that impact their psychosocial well-being and physical health. However, few studies have thoroughly examined the general physical and mental health of transgender adults or within-group health differences by race/ethnicity and income. To that end, after controlling for health insurance status, age, and engagement in exercise, this study asks: (a) Are transgender people of color more likely than White transgender individuals to experience poor health outcomes? and (b) Is lower annual household income among transgender adults associated with poorer health outcomes? The study analyzes secondary data from a survey of transgender adults (N = 417) in one state in the western United States using multiple linear regression and logistic regression models. Results showed that transgender people of color had significantly greater odds than their White counterparts of having arthritis/rheumatoid arthritis/gout/lupus/fibromyalgia, or asthma but lower odds of being told by a provider that they had depression. Having a lower income was significantly associated with worse general health as well as multiple indicators of poor physical and mental health, including depression, anxiety, and suicidal ideation. We discuss implications for health care delivery for transgender people and for future research.     

The correlations of psychological status,quality of life,self-esteem,social support and body image disturbance in Chinese patients with Systemic Lupus Erythematosus

This study aimed (i) to complement existing research by focusing on body image disturbance issues in Chinese Systemic Lupus Erythematosus (SLE) patients; (ii) to investigate how Chinese patients make sense of disease diagnosis and perceived cultural influences within the context of their SLE. A total of 118 SLE patients underwent standardized laboratory examinations and completed several questionnaires. Independent sample t-test, Mann–Whitney U-test, Chi-square test, and multivariate analysis using backward stepwise logistic regression model were used to analyze these data. We found 18.3% SLE patients had BID, which were significantly higher than the control group (.8%). SLE patients are more concerned about their physical changes caused by disease. There were significant correlations among personal health insurance, complication of diabetes, appearance of new rash, depression, anxiety, self-esteem and BID in patients with SLE. Meanwhile, logistic regression analysis revealed that appearance of new rash and high anxiety were significantly associated with BID in SLE patients. In conclusion, it is beneficial to pay attention to the physical and mental health of patients with rheumatic disease from the perspective of body image, to understand their needs and to provide effective and effective service for them.     

Relationship (in)congruency may differently impact mental health

BackgroundBeing involved in romantic relationships has historically been related to better mental health compared to being single. However, research exploring heterogeneity within these status groups is still understudied. Our study examined the role of (in)congruency between relationship desire, dismissal, satisfaction with relationship status, and current relationship status on the mental health measured in terms of anxiety, depression, insomnia, and romantic loneliness.MethodThe online questionnaire survey included 790 participants aged 18 – 40 (M = 26.51, SD = 5.60) at baseline and 421 at a 1-month follow-up. Participants represented five relationship statuses (single, casual dating, LAT relationships, cohabitation, and engagement/marriage).ResultsOur results suggest that greater relationship desire and dismissal at baseline were associated with higher anxiety and depression in casual daters one month later, while greater relationship desire was linked to lower anxiety for individuals in living apart together relationships (LATs). Higher relationship dismissal in casual daters and engaged/married individuals was associated with lower insomnia. Higher satisfaction with relationship status was associated with lower depression in single individuals and lower romantic loneliness in cohabitors and engaged/married individuals.ConclusionsThis study highlights that relationship (in)congruency may operate differently across various relationship status subgroups on mental health outcomes.     

Financial strain,social capital,and perceived health during economic recession: a longitudinal survey in rural Canada

Although the health consequences of financial strain are well documented, less is understood about the health-protective role of social capital. Social capital refers to a sense of community embeddedness, which is in part reflected by group membership, civic participation, and perceptions of trust, cohesion, and engagement. We investigated whether perceptions of social capital moderate the relation between financial strain and health, both mental and physical. This longitudinal study surveyed adults in two communities in rural Ontario where significant job losses recently occurred. Data were collected on financial strain, social capital, perceived stress, symptoms of anxiety and depression, and physical health on three occasions over 18 months (N's = 355, 317, and 300). As expected, financial strain positively related to perceived stress, poor physical health and symptoms of anxiety and depression, whereas social capital related to less stress, better physical health, and fewer symptoms of anxiety and depression. Effects of financial strain on perceived stress and depressive symptoms were moderated by social capital such that financial strain related more closely to perceived stress and depressive symptoms when social capital was lower. The findings underscore the health-protective role of community associations among adults during difficult economic times.     

A Review of Cognitive Behavioral Therapy for Panic Disorder in Patients with Chronic Obstructive Pulmonary Disease: The Rationale for Interoceptive Exposure

Panic disorder commonly co-occurs in patients with chronic obstructive pulmonary disease (COPD), and translational interventions are needed to address the fear of physiological arousal in this population. This paper examines the utility of interoceptive exposures (IE), a key component of cognitive behavioral therapy (CBT) for panic disorder, in patients with comorbid panic and COPD. Our translational review of the literature suggests that IE is supported by both cognitive- and learning-theory perspectives of panic, and that the breathing exercises associated with IE are safe and highly compatible with existing pulmonary rehabilitation exercises for COPD. Unfortunately, few research studies have examined the use of CBT to treat anxiety in COPD patients, and none have included IE. Given the strong theoretical and empirical support for the use of IE, we suggest that mental health providers should consider incorporating IE into CBT interventions for patients with comorbid panic and COPD.     

困境儿童孤独与社交焦虑对抑郁的影响——自尊的中介作用

为探讨困境儿童孤独、社交焦虑、抑郁和自尊的现状、特点、关系以及自尊在其中的中介作用,进而为困境儿童心理帮扶及救助提供依据。本研究使用儿童抑郁障碍自评量表、儿童孤独量表、儿童社交焦虑量表和自尊量表对重庆市17个区县1733名困境儿童进行调查。结果发现:(1)抑郁、社交焦虑和自尊存在性别差异,抑郁、孤独、社交焦虑和自尊存在年龄差异;(2)孤独和社交焦虑与抑郁呈显著正相关并显著预测抑郁,自尊与抑郁呈显著负相关并显著预测抑郁。(3)困境儿童的自尊在孤独和抑郁之间,社交焦虑和抑郁之间起中介作用。结果表明:困境儿童的孤独、社交焦虑既可直接影响其抑郁水平,也可通过自尊的中介作用间接影响其抑郁水平。     

Unusual but sound minds: Mental health indicators in spiritual individuals

Previous research has linked certain types of modern spirituality, including New Age and Pagan, with either benign schizotypy or insecure attachment. While the first view emphasizes a positive aspect of spiritual believers’ mental health (benign schizotypy), the second view emphasizes a negative aspect, namely the unhealthy emotional compensation associated with an insecure attachment style. This study addresses these two conflicting views by comparing a sample of modern spiritual individuals (N = 114) with a contrast group of traditional religious believers (N = 86). Measures of schizotypy and attachment style were combined with mental health scales of anxiety and depression. We further assessed death anxiety to determine whether modern spiritual beliefs fulfilled a similar function as traditional religious beliefs in the reduction of existential threat. Our results support a psychological contiguity between traditional and modern spiritual believers and reinforce the need to de‐stigmatize spiritual ideas and experiences. Using hierarchical regression, we showed that unusual experiences and ideas are the major predictor of engagement in modern spiritual practices. Anxiety, depression variables, and insecure attachment were not significant predictors of spirituality or correlated with them; on the other hand, the results show that spiritual believers report high social support satisfaction and this variable predicts involvement in modern spirituality. Further, spiritual practices were negatively correlated with and negatively predicted by death anxiety scores. Overall, the results strengthen the association between modern spirituality, good mental health, and general well‐being.