Increased anxiety and depression among collegiate athletes with comorbid ADHD and history of concussion

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is prevalent among student-athletes when compared to the general population. Mental health disruptions (i.e., depression or anxiety) are common among student-athletes, and risk of experiencing depressive and anxious symptoms may be even greater among student-athletes that have incurred concussion.ObjectiveTo examine the influence of pre-existing ADHD and history of concussion on mental health in collegiate student-athletes.DesignRetrospective cross-sectional study.SettingNational Collegiate Athletic Association Division-I (NCAA) athletics.PatientsBetween 2010 and 2017, student-athletes at a Southeastern NCAA Division-I institution were surveyed as part of a Performance, Health, and Wellness Program. Analyses were conducted using a sample of 324 student athletes (212 female) with either a prior diagnosis of ADHD, a prior history of a sport-related concussion, both prior diagnosis of ADHD and a history of sport-related concussion, or neither (controls).Main outcome measure(s)Symptomatology associated with ADHD was characterized using the Behavior Assessment System for Children Self-Report of Personality College Version. The State-Trait Anxiety Inventory and the Center of Epidemiological Studies-Depression Scale examined anxious and depressive symptomatology.ResultsStudent-athletes with ADHD and a history of concussion had 16.4 times greater odds of exhibiting clinically significant symptoms of state anxiety and 7.9 times greater odds of exhibiting clinically significant symptoms of depression, relative to control student-athletes. Every participant with both a diagnosis of ADHD and a history of concussion exhibited clinically significant attentional problems.ConclusionsHaving both ADHD and a history of concussion may have a synergistic effect on mental health beyond that of ADHD and/or concussion alone. Additional longitudinal research is necessary to verify current findings. However, athletic trainers and other health care professionals are encouraged to be mindful of student-athletes with ADHD, as they may be more vulnerable to experiencing symptoms of depression and state anxiety with elevated inattentive behaviors following a concussion.     

Competence and control orientations as predictors of test anxiety in students: Longitudinal results

Abstract

The hypothesis that domain-specific self-related cognitions (self-concept of own competence and control orientations) are predictors of text anxiety in students is tested by longitudinal data. At the beginning and at the end of a school year the following variables were measured twice in a sample of 346 secondary school students (grades six to ten): (1) self-concept of own competence in mathematics, (2) three aspects of locus of control for problem-solving behavior (internality, powerful others control, and chance control), (3) generalized locus of control of reinforcement, (4) test anxiety as well as manifest anxiety. The cross-sequential developmental gradients point toward symmetries in the development of self-related cognitions and test anxiety. The results of cross-lagged correlation analyses show that the null hypothesis (no causal relations exist between the self-related cognitions and test anxiety) can be rejected for the domain-specific aspects of (a low) self-concept of own competence and locus of control (low internality and high chance control), which are confirmed as preceding test anxiety. However, longitudinal results also show that findings of cross-sectional studies tend to overestimate the relations between self-related cognitions and test anxiety in a developmental perspective.     

Associations between multiple health risk behaviors and mental health among Chinese college students

Although there is substantial evidence that health risk behaviors increase risks of premature morbidity and mortality, little is known about the multiple health risk behaviors in Chinese college students. Here, we investigated the prevalence of multiple health risk behaviors and its relation to mental health among Chinese college students. A cross-sectional study was conducted in Wuhan, China from May to June 2012. The students reported their health risk behaviors using self-administered questionnaires. Depression and anxiety were assessed using the self-rating depression scale and self-rating anxiety scale, respectively. A total of 2422 college students (1433 males) aged 19.7 ± 1.2 years were participated in the study. The prevalence of physical inactivity, sleep disturbance, poor dietary behavior, Internet addiction disorder (IAD), frequent alcohol use and current smoking was 62.0, 42.6, 29.8, 22.3, 11.6 and 9.3%, respectively. Significantly increased risks for depression and anxiety were found among students with frequent alcohol use, sleep disturbance, poor dietary behavior and IAD. Two-step cluster analysis identified two different clusters. Participants in the cluster with more unhealthy behaviors showed significantly increased risk for depression (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.83, 2.67) and anxiety (OR: 2.32; 95%CI: 1.85, 2.92). This study indicates that a relatively high prevalence of multiple health risk behaviors was found among Chinese college students. Furthermore, the clustering of health risk behaviors was significantly associated with increased risks for depression and anxiety.     

Loneliness predicts suicidal ideation and anxiety symptoms in long-term childhood cancer survivors

Background/ObjectiveLong-term childhood cancer survivors (CCS) are at risk for adverse late effects. However, not all of them are well understood. The present study addressed loneliness, a previously under-researched mental health risk in cancer survivor populations. We assessed the prevalence of loneliness and its impact on psychological symptoms over time. Method: A registry-based sample of N = 633 adult long-term CCS underwent medical and psychological assessments and took part in a follow-up survey 2.5 years later. Psychological symptoms (somatic, anxiety, depression symptoms, and suicidal ideation) were measured using the Patient Health Questionnaire. We calculated linear regression models of symptoms at follow-up to investigate the impact of loneliness over time (controlling for symptoms at baseline and relevant confounders). Results: Loneliness was reported by 17.70% of CCS. In multivariate linear regression analyses, loneliness was still predictive of more severe anxiety symptoms and suicidal ideation over two years later. Loneliness did not predict somatic and depression symptoms at follow-up (which increased with age). Conclusions: Loneliness affected a significant number of CCS and was a risk factor for persistent anxiety symptoms and suicidal ideation. The extent to which young cancer patients’ re-integration into society is successful could thus have important implications for well-being in adulthood.     

Safety behaviors were associated with greater anxious symptoms during the first year of the COVID-19 pandemic

Research shows that people who use safety behaviors are at greater risk factor for anxiety than people who do not use safety behaviors. However, the perception of some safety behaviors changed during the COVID-19 pandemic; behaviors that were once considered unnecessary or excessive were now commonplace (e.g., monitoring bodily symptoms, avoiding crowds). The purpose of this study was to determine the degree to which the pandemic changed the status of health-related safety behaviors as a risk factor for symptoms of anxiety. To this end, we tested the effect of safety behavior use on anxious symptoms during the first year of the pandemic using a longitudinal design with 8 time points and participants (n = 233) from over 20 countries. Despite possible changes in their perception, those engaging in high levels of safety behaviors reported the greatest levels of anxious symptoms throughout the pandemic year. However, the outcomes for safety behavior users were not all negative. Safety behavior use at baseline was the only predictor of participants' willingness to receive the COVID-19 vaccine (measured one year later).     

The durability of beneficial health effects associated with expressive writing

Abstract

This study examined the durability of benefits associated with expressive writing. Sixty-eight college undergraduates completed measures of physical and psychological health at the beginning of their first year and were then randomized to either an expressive writing or a control writing condition. Changes in physical health, psychological health (i.e., depression, stress, and anxiety), and academic performance were assessed two, four, and six months later. Findings indicated that participants assigned to the expressive writing condition reported less depression symptom severity at the two-month follow-up assessment relative to participants assigned to the control condition. However, these symptom reductions were not observed at any of the subsequent follow-up assessments. No significant changes were reported for physical health complaints, stress symptoms, anxiety symptoms, or academic performance. These findings suggest that, among first-year college students, expressive writing may provide some short-term relief for certain symptoms.     

Effects of lifestyle and stress on the employee and organization: Implications for promoting health at work

Abstract

This research was designed to determine the extent to which employee health and performance are predicted by lifestyle and stress. Data were collected from 345 employees working in a variety of organizations in southern California. Additionally, supervisors evaluated the work performance of the participating employees whom they directly supervised, and company records of employee health care costs were obtained. Hierarchical multiple regression analyses revealed (a) that physical lifestyle (i.e., exercise pattern, eating habits, and general health practices) predicted unique variance in vitality and positive well-being; (b) that psychosocial lifestyle (i.e., social relations, intellectual activity, occupational conditions, and spiritual involvement) predicted unique variance in vitality, positive well-being, anxiety, depression, lack of self-control, and somatic complaints; (c) that employee stress predicted unique variance in vitality, positive well-being, anxiety, depression, physician visits, somatic complaints, illness absences, and supervisory ratings of job performance, absenteeism and tardiness; (d) that physical lifestyle buffered the adverse consequences of stress for anxiety, depression, physician visits, and company health care costs; and (e) that there was a Physical x Psychosocial Lifestyle interaction for anxiety, depression, and lack of self-control. However, the employee lifestyle factors were not related to supervisory ratings of performance at work. The findings have direct implications for organizational health programs and policies.     

Loneliness,ageism, and mental health: The buffering role of resilience in seniors

IntroductionAgeism and loneliness are two relevant public health phenomena because of their negative impact on the senior's mental health. With the increase in average life expectancy, these tend to co-occur, which may increase the psychological distress (PD) of seniors. Resilience has been shown to be an important protective factor of seniors mental health, although its potential buffering role of public health risk factors with cumulative impact on mental health, such as loneliness and ageism, needs to be more studied.AimTo assess the potential mediator role of resilience between the effects of ageism and loneliness on PD in seniors.MethodsA sample of 349 Portuguese seniors aged 60 years and over was collected through an online survey and during the COVID-19 pandemic period. Seniors completed the Kessler Psychological Distress Scale (K6), the Short-Form of UCLA Loneliness Scale (USL-6), the Ambivalent Ageism Scale (AAS) and the Connor-Davidson Resilience Scale (CD-RISC-10). A mediation analysis model was developed with resilience as a mediating variable.ResultsThere were moderate to high levels of PD and moderate levels of ageism, loneliness and resilience. Resilience fully mediated the effect of ageism on PD and partially mediated the effect of loneliness on PD.ConclusionsResilience was an important protective factor of mental health against the effects of ageism, and partially protected mental health from the effects of loneliness among seniors. It is suggested that resilience be considered as a factor to be integrated in future intervention programs for mental health. The practical applicability of this study is discussed.     

Influence of response time frame on mood assessment

Abstract

Dental anxiety and the related avoidance of dental treatment can result in severe impairment of health. We investigated the influence on avoidance behavior of phobic severity, gender, characteristics related to generalized anxiety and depression, such as dysfunctional cognitions and sensitivity of bodily symptoms, as well as personality traits of self-efficacy and locus of control. Forty-eight dental phobics were given an initial assessment and avoidance behavior was determined by the degree of observance of three subsequent dental appointments. Principal component analysis revealed separate factors for trait and phobic anxiety as well as for avoidance and dysfunctional cognitions. Women showed a higher degree of avoidance than men. Regression analysis revealed a high desire for control over dental treatment combined with a low level of perceived control as the only significant predictor variable of avoidance. The results suggest that avoidance behavior in dental phobia could be reduced by extending patients’ control over treatment conditions.     

Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety

Internet-based cognitive behavior therapy (CBT) for severe health anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe health anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state health anxiety, b) improvement in health anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state health anxiety and improvement were baseline health anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, health anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe health anxiety.     

An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety

Background and Objectives: Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.

Methods: Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; M_age?=?19.53, SD?=?3.16, Range?=?18–45) who completed self-report measures for course credit.

Results: Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.

Conclusions: These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.     

The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n = 30) or control condition (n = 30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.     

Sociodemographic,Cognitive, and Emotional Determinants of Two Health Behaviors during SARS-CoV-2 Outbreak: An Online Study among French-Speaking Belgian Responders during the Spring Lockdown

To contain the SARS-CoV-2 infection rate, health authorities have encouraged the population to enhance protective behaviors such as physical distancing and handwashing. Behavioral sciences emphasize the role of sociocognitive determinants to explain health behaviors, while largely ignoring emotional factors. In a large online study (N > 4000), we investigated the role of sociodemographic, cognitive, emotional, and social factors that can facilitate or hinder handwashing and limitation of social contacts. Data were collected from March 18 until April 19, 2020, which corresponds to the spring lockdown and the first peak of the pandemic in Belgium. Logistic regressions showed that sociodemographic factors (gender, age, level of education) and the dimensions of the Theory of Planned Behavior (intentions, attitudes, perceived behavioral control and subjective norms) had a strong impact on health behaviors, but that emotional factors explained an additional part of the variance. Being more attentive/determined and frightened/anxious, along with scoring higher on health anxiety were related to a higher frequency of handwashing. In contrast, being enthusiastic/happy was related to lower adherence to limiting social contacts. Our results suggest that the type of predictors and the direction of associations depend on the type of health behavior considered. The role of specific emotional factors in addition to more classical predictors is discussed. The study offers new perspectives regarding the factors that are associated with the adherence to behaviors recommended to adopt when faced with a pandemic.     

We used to say “Zei gezunt!” (Be well!): Do American Jews still exhibit distinctive health behaviors?

ABSTRACT

A survey that includes a representative sample (n = 3,219) of older persons (age 60+) living in the Philadelphia area was used to determine if health status and health behaviors of older Jews differ from that of non-Jews. The survey includes questions about health status and health behaviors as well as sociodemographic characteristics. Responses of self-identified Jews, Catholics, and Protestants were compared. With only two exceptions there were no differences between Jews and non-Jews on questions about health status. In regard to health behaviors, Jews were more likely to follow standard recommendations such as seeing their physician on a regular basis or yearly screenings for certain cancers. We completed stepwise regressions with measures of socioeconomic status entered first and then Jewish status, as socioeconomic status is closely associated with health outcomes. Being Jewish continued to explain differences in health behaviors even when controlling for socioeconomic status. We also looked at the relation between attending religious services and health behaviors. Self-rated health was correlated with attendance for Protestants and for Catholics; it was not correlated with self-rated health for the Jews. All findings suggest the need for further study of the reason for the relation of health behavior to being Jewish.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

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.     

Self-presentational determinants of health risk behavior among college freshmen

Abstract

This study examined adolescents' use of unhealthy and potentially dangerous behaviors for self-presentational reasons. At the start of their first semester at college, 110 freshmen (M age = 18.2) completed trait measures of self-presentational concern. At the end of the semester they were asked about their use of health risk behaviors as impression management tactics. Seventy-five percent of respondents reported performing at least 1 risky behavior for self-presentational reasons during their first college semester. The most common behaviors were smoking, drinking, driving recklessly and performing dangerous stunts. The desire to be perceived as “cool” or a “risk-taker” often prompted healdi risks. Modest correlations between the trait measures and health risk behaviors provided additional evidence that self-presentational motives sometimes play a role in adolescent health risk behavior.     

Distortions in reports of health behaviors: The time span effect and illusory supefuority

Abstract

The occurreace of a time span effect and illusory superiority in self reports of health behaviors was tested. It was found that people report proportionally lower frequencies of both healthy and unhealthy behaviors if they give frequency estimations over a longer as compared to a shorter time span (time span effect). In addition, they report lower frequencies of unhealthy behaviors, and higher frequencies of healthy behaviors for themselves than for the average other (illusory superiority). For healthy but not for unhealthy behaviors a stronger illusory superiority effect was obtained in frequency reports for behavioral expectations as compared to past behaviors. Potential explanations and implications for subjective measurements of health behavior are discussed.     

Family of Origin Environment and Adolescent Bullying Predict Young Adult Loneliness

ABSTRACT

This study tested parental loneliness, family of origin environment, and a history of being bullied as predictors of loneliness in young adults. The role of social skills in young adults’ loneliness was also examined. Participants were 111 young-adult–parent dyads who completed measures of loneliness and the family communication environment. In addition, young adults completed measures of social skills and history of being bullied. Predictions were tested with structural equation modeling, path analysis, and multiple regression analysis. Results showed that parental loneliness and a history of being bullied were each significant predictors of young adult loneliness. A family environment that supported open communication was negatively associated with young adults’ loneliness. Parental loneliness and a history of being bullied each had direct effects on young adults’ loneliness as well as indirect effects through reduced social skills.