Exhaustion is differentiable from depression and anxiety: evidence provided by the SF-36 vitality scale

Stress-related exhaustion is an increasingly focused phenomenon, although scientifically not yet fully conceptualised. This is perhaps partly due to the fact that the distinction between exhaustion and other already established concepts, such as depression, is not clear. This study explores whether exhaustion can be differentiated from depression and anxiety, by means of introducing the SF-36 vitality scale as a strategy for the measurement of exhaustion. The Malm? Shoulder and Neck Study cohort, in this study including 12,607 middle-aged men and women, was utilized. Depression and anxiety were assessed by the general health questionnaire (GHQ). Factor analysis was performed in order to potentially discriminate between the included measures. Factor analysis showed that all four exhaustion items of the (inverted) SF-36 vitality scale loaded on a single factor, separate from the GHQ depression and anxiety factors. These results support the notion that exhaustion can be distinguished from depression and anxiety, providing an empirical foundation for defining exhaustion as a unique concept. Furthermore, since SF-36 has been widely used in clinical and epidemiological studies, the benefits of using the SF-36 vitality scale in the assessment of exhaustion could be substantial.     

Impact of average household income and damage exposure on post‐earthquake distress and functioning: A community study following the February 2011 Christchurch earthquake

Post‐traumatic stress, depression and anxiety symptoms are common outcomes following earthquakes, and may persist for months and years. This study systematically examined the impact of neighbourhood damage exposure and average household income on psychological distress and functioning in 600 residents of Christchurch, New Zealand, 4–6 months after the fatal February, 2011 earthquake. Participants were from highly affected and relatively unaffected suburbs in low, medium and high average household income areas. The assessment battery included the Acute Stress Disorder Scale, the depression module of the Patient Health Questionnaire (PHQ‐9), and the Generalized Anxiety Disorder Scale (GAD‐7), along with single item measures of substance use, earthquake damage and impact, and disruptions in daily life and relationship functioning. Controlling for age, gender and social isolation, participants from low income areas were more likely to meet diagnostic cut‐offs for depression and anxiety, and have more severe anxiety symptoms. Higher probabilities of acute stress, depression and anxiety diagnoses were evident in affected versus unaffected areas, and those in affected areas had more severe acute stress, depression and anxiety symptoms. An interaction between income and earthquake effect was found for depression, with those from the low and medium income affected suburbs more depressed. Those from low income areas were more likely, post‐earthquake, to start psychiatric medication and increase smoking. There was a uniform increase in alcohol use across participants. Those from the low income affected suburb had greater general and relationship disruption post‐quake. Average household income and damage exposure made unique contributions to earthquake‐related distress and dysfunction.     

Modified CBT using visualization for Autism Spectrum Disorder (ASD), anxiety and avoidance behavior – a quasi‐experimental open pilot study

In recent studies it has been suggested that Cognitive Behavior Therapy (CBT) is beneficial to people with Autism Spectrum Disorder (ASD) but that the method needs to be modified in relation to their cognitive profile. The aim of this study is to measure the effect of modified CBT, that is, using visualized language throughout the entire session for clients with ASD and anxiety and avoidance behavior. The modification of CBT in this study consists of focusing on CBT protocols for anxiety disorders and depression, while visualizing and systematizing “the invisible” in the conversation, in order for the clients to understand the social, cognitive and emotional context of self and others and how they should interact to avoid misunderstandings. ASD clients may need help to detect the invisible code of social interaction and communication. The level of anxiety and the frequency of target behavior were measured. Four assessments were made, two at the pre‐assessment, and one in mid‐therapy and end of therapy respectively. Generally, results suggest no improvement during pre‐treatment period but a significant improvement during treatment. The values of the clients' psychological, social and occupational ability to function improved on the Global Function Rating scale. The preliminary conclusion of this pilot study indicates that the use of visualized language throughout the CBT therapy sessions is a promising modification of current CBT protocols for individuals with ASD. After manualization, larger studies with randomized controlled study designs can replicate or challenge these results.     

Increasing access to low‐intensity interventions for childhood anxiety: A pilot study of a guided self‐help program for Scandinavian parents

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low‐intensity formats of parent‐delivered CBT may improve access to treatment. Our aim was to develop and pilot‐test the acceptability and effect of a low‐intensity therapist‐guided parent‐delivered group program for anxious children (age 7–12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist‐time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre‐ and post‐treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty‐one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent‐to‐treat analyses revealed significant reductions in anxiety and depressive symptoms from pre‐ to post‐treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self‐reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.     

Gender differences in subjective well-being, self-esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: findings from the Nord-Trøndelag Health Study

Derdikman‐Eiron, R., Indredavik, M. S., Bratberg, G. H., Taraldsen, G., Bakken, I. J. & Colton, M. (2011). Gender differences in subjective well‐being, self‐esteem and psychosocial functioning in adolescents with symptoms of anxiety and depression: Findings from the Nord‐Trøndelag health study. Scandinavian Journal of Psychology52, 261–267. Gender differences in the prevalence of symptoms of anxiety and depression during adolescence are well documented. However, little attention has been given to differences in subjective well‐being, self‐esteem and psychosocial functioning between boys and girls with symptoms of anxiety and depression. The aim of this study was to investigate gender differences in the associations between such symptoms and subjective well‐being, self‐esteem, school functioning and social relations in adolescents. Data were taken from a major population‐based Norwegian study, the Nord‐Trøndelag Health study (HUNT), in which 8984 (91% of all invited) adolescents, aged 13–19 years, completed an extensive self‐report questionnaire. Although prevalence rates of symptoms of anxiety and depression were higher in girls than in boys, a significant interaction between gender and symptoms of anxiety and depression was found in respect of each of the following outcome variables: subjective well‐being, self‐esteem, academic problems, frequency of meeting friends and the feeling of not having enough friends. These interactions indicate that the associations between symptoms of anxiety and depression and lower subjective well‐being and self‐esteem, more academic problems in school and lower social functioning were stronger for boys than for girls. Our findings may contribute to an earlier assessment and more efficient treatment of male adolescent anxiety and depression.     

An investigation of the psychometric properties of the Eating Disorder Symptom Impact Scale within an Australian sample

Caring for patients with an eating disorder (ED) is associated with a high level of burden and psychological distress. Currently, the Eating Disorder Symptom Impact Scale (EDSIS) is the only scale that measures the specific impact of caring for a patient with an ED. The initial development study within a British sample of carers indicated that the EDSIS has a four‐factor structure. The aim of the current study was to confirm the factor structure of the EDSIS within an Australian sample of carers. One hundred and fifty‐four carers completed the EDSIS. In contrast to the initial study, a six‐factor structure was derived explaining 69.66% of the variance: guilt, social isolation, confrontational behaviours, binge–purge difficulties, mealtime difficulties, and illness awareness. Reliability was acceptable (Cronbach's alpha range 0.69–0.88). Five of the six factors were moderately correlated with the General Health Questionnaire‐12 (r range = 0.24–0.51). A six‐factor solution may be a valid alternative for the EDSIS.     

Effectiveness of the Hamilton Anxiety Rating Scale with Older Generalized Anxiety Disorder Patients

To expand the collection of instruments available for assessment of anxiety in the elderly, this report examined the original and revised Hamilton anxiety scales in a sample of 50 older adults diagnosed with Generalized Anxiety Disorder (GAD) and 93 normal community participants (ages 55–82). Although the revised anxiety scale had better discriminant validity (lower correlation with the revised Hamilton depression scale) than the original anxiety and depression scales, a considerable amount of shared variance still existed (41% shared variance, GAD sample alone; 17% control sample alone; 74% shared variance, both samples combined). Near-perfect group classification was possible using 7 items from the original anxiety scale and 10 items from the revised anxiety scale. Results are discussed in light of their implications for use of the Hamilton anxiety rating scale with older anxiety-disordered patients.     

情绪劳动与抑郁及焦虑的关系：情绪耗竭的中介作用

本研究探讨情绪劳动与抑郁、焦虑的关系,着力考察情绪耗竭在二者之间的中介作用。采用情绪劳动量表、情绪耗竭量表和SCL-90对328名零售业员工进行调查。结果表明：表面行为与情绪耗竭、抑郁及焦虑没有显著相关;深度行为对情绪耗竭、抑郁及焦虑有显著的负预测作用;情绪耗竭在情绪劳动与抑郁及焦虑之间起完全中介作用。     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

Does a short self‐compassion intervention for students increase healthy self‐regulation? A randomized control trial

The primary aim of this study was to examine the effects of a two‐week self‐compassion course on healthy self‐regulation (personal growth self‐efficacy and healthy impulse control) and unhealthy self‐regulation (self‐judgment and habitual negative self‐directed thinking) in university students. We also examined the effects on self‐compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting‐list control group in a multi‐baseline randomized control trial. Healthy self‐control was measured by the Personal Growth Initiative Scale (PGIS) and the Self‐Control Scale; unhealthy self‐control was measured by the Non‐judgement subscale from the Five‐Facet Mindfulness Questionnaire (reversed) and the Habit Index of Negative Thinking (HINT). Secondary outcomes were measured by the State‐Trait Anxiety Inventory (STAI‐trait), the Major Depression Inventory (MDI), and the Self‐Compassion Scale (SCS). A 2 × 3 repeated measures analysis of variance (ANOVA) showed gains for the intervention‐group in personal growth self‐efficacy and healthy impulse‐control and reductions in self‐judgment and habitual negative self‐directed thinking, as well as increases in self‐compassion and reductions in anxiety and depression. After all participants had completed the course, the groups were combined and repeated measures ANOVAs showed that changes remained at six‐month follow‐up for personal growth self‐efficacy, self‐judgment and habitual negative self‐directed thinking; as well as for self‐compassion, anxiety and depression. Concluding, a short self‐compassion course seems an effective method of increasing self‐compassion and perceived control over one's life for university students, as well as increasing mental health.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.     

Acute Stress Disorder in Greek Cypriots Visiting the Occupied Areas

Following 30 years of war-driven displacement, in 2003 Cypriots were allowed to visit the occupied areas. The present study investigates whether visiting the occupied areas under peaceful conditions could be a traumatic experience potentially leading to Acute Stress Disorder (ASD). Of the 163 participants who completed self-report questionnaires measuring ASD, depression, anxiety, social support, and stress, 138 visited the occupied areas; out of these, 31 met criteria for ASD, 14 reported experiencing symptoms for over a month and 13 continued to experience symptoms at the time of data collection. Results suggest that visiting the occupied areas may constitute a traumatic experience.     

Symptoms of depression in Swedish fathers in the postnatal period and development of a screening tool

Methods for detecting depression in fathers after the birth of their child are scarce. The Edinburgh Postnatal Depression Scale (EPDS), used to screen mothers for postpartum depression (PPD), lacks somatization and externalizing items. This potentially decreases its sensitivity in detecting depression in fathers, as many men actually express depression with somatization or externalizing symptoms. The present study assessed depressive symptoms in fathers of children 0–18 months old, and evaluated whether addressing both typical depression and externalizing, so‐called “depressive equivalent” symptoms, might be more suitable for such assessment. The Beck Depression Inventory‐II (BDI‐II), EPDS, and Gotland Male Depression Scale (GMDS) were responded to by 447 Swedish fathers online. Among participants, 27% reported depressive symptoms above the BDI‐II cut‐off suggestive of depression. Most fathers reported both traditional and depressive equivalent symptoms and a subgroup expressed exclusively depressive equivalent symptoms. Consistently, a scale combining items from the EPDS and GMDS showed higher sensitivity than the EPDS alone in identifying fathers with elevated depressive symptoms, at equal levels of specificity. Our findings suggest that a combination of EPDS and depressive equivalent symptom items results in a more suitable instrument for screening for depression in fathers during the postnatal period.     

Affect regulation and Depressive Personality Disorder

Depressive Personality Disorder (DPD) has been under consideration for inclusion in the Diagnostic and Statistical Manual of Mental Disorders since 1994; yet, few studies have been published that test whether those with DPD have affective experiences that are characterized exclusively by depression and negative affect. One hundred ninety-seven undergraduate students were interviewed for DPD and Borderline Personality Disorder with the Personality Disorder Interview for DSM-IV (Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995), in order to control for frequently co-occurring BPD which is characterized by affective lability. Participants also were administered measures of affective lability, affective intensity, anxious and depressive states, and more trait-like manifestations of depression, anxiety, and anger. Results indicate that those with DPD may be described as having a mood state characterized by transitions from a baseline neutral mood to one of anxiety, with their experiences being more prominently depressed and dysphoric. They also have tendencies toward angry hostility, though they may not report frequent shifts from a baseline neutral mood to anger. Those with DPD also report intense, frequent experiences of depression and dysphoria, with many shifts between depression and anxiety.     

Stress and Health in Spanish Women1

This study examines the relationship between stress and health in a sample of 1,566 women aged between 18 and 65 years. Multiple regression analyses were conducted using the scaled version of the General Health Questionnaire (GHQ‐28) scales as the dependent variables, and 21 personal and social variables as predictors. The women with more severe depression, anxiety, and somatic and social dysfunction symptoms were those who had a more emotional coping style and greater work role dissatisfaction. Moreover, depression, anxiety, and social dysfunction symptoms were predicted by low self‐esteem, while depression, anxiety, and somatic symptoms were predicted by chronic stress. The women with more symptoms of anxiety and depression were those who have experienced more life events and have low perceived social support. Women with Type‐A behavior patterns were found to suffer more anxiety and somatic symptoms. Women who exercise more hours per week had fewer somatic symptoms, and those with a more rational coping style suffered less social dysfunction.     

Psychometric evaluation and normative data for a Swedish version of the Patient Health Questionnaire 15‐Item Somatic Symptom Severity Scale

The lack of an available Swedish version of the Patient Health Questionnaire 15‐Item Somatic Symptom Severity Scale (PHQ‐15) motivated the present psychometric evaluation of such a version as well as providing normative data for the PHQ‐15. Data from 3,406 individuals who took part in the Västerbotten Environmental Health Study in Sweden were used. The respondents constitute a random sample, aged 18 to 79 years, stratified for age and sex. They responded to a Swedish translation of the PHQ‐15 as well as the Hospital Anxiety and Depression Scale, the Perceived Stress Scale, and the Shirom Melamed Burnout Questionnaire for assessment of convergent validity. The distribution of PHQ‐15 scores was positively skewed and mesokurtic in shape, and the internal consistency of the PHQ‐15 was satisfactory. Correlation coefficients between PHQ‐15 score and the measures of anxiety, depression, stress and mental/physical exhaustion indicate satisfactory validity. Normative data for PHQ‐15 scores as well as for categories of somatic symptom severity are provided. The favorable psychometric properties of the Swedish version of the PHQ‐15 suggest use of this instrument for quantification of somatization in Swedish and similar populations, and has the advantage of available normative data.     

Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation

The aim of this study was to evaluate the relationship between alexithymia and social anxiety symptoms in female outpatients with dermatological disorder. Fifty consecutive patients sent to a psychiatry outpatient clinic for consultation from a dermatology outpatient clinic were included in the study. Social anxiety symptoms showed significant correlations with depression, trait anxiety, alexithymia and global psychiatric symptom severity. A multivariate analysis of covariance demonstrated that subscales of the Liebowitz Social Anxiety Scale (LSAS) were related to alexithymia and trait anxiety. The “difficulty in describing feelings” (DDF) dimension of alexithymia and trait anxiety appear to be important factors in this relationship between social anxiety and alexithymia. Results of this study suggest that patients with dermatological disorder may benefit from both treatment of social anxiety symptoms and learning how to regulate their affects and emotional expression.     

POSTPARTUM BONDING DIFFICULTIES AND ADULT ATTACHMENT STYLES: THE MEDIATING ROLE OF POSTPARTUM DEPRESSION AND CHILDBIRTH‐RELATED PTSD

Despite decades of research demonstrating the role of adult attachment styles and early mother–infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirth‐related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeks’ postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh Postnatal Depression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infant‐focused anxiety, mediated by postpartum depression but not childbirth‐related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirth‐related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirth‐related PTSD and postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.     

The Yale-Brown Obsessive-Compulsive Scale: Confirmatory Factor Analytic Findings

The psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have recently been heavily examined. Specifically, a number of researchers have been interested in determining the factor structure of this scale to find whether it best forms a one, two, or three factor model. The present study continued this examination by considering different scaling models using confirmatory factor analysis with a sample of individuals diagnosed with Obsessive-Compulsive Disorder (OCD). One hundred and forty-six individuals diagnosed with OCD participated and were administered the Y-BOCS and scales measuring depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). It was found that the Y-BOCS forms two different two-factor models. One model consisted of an obsessions and compulsions factor; the other composed of disturbance and symptom severity factors. It was likewise found that depression and anxiety were related to both factors in one model (disturbance and symptom severity). The finding that depression was related to obsessions and anxiety to compulsions was found, as in a previous factor analysis of the Y-BOCS. These findings suggest that OCD may be best characterized as a multidimensional syndrome that may not be adequately examined by a single unitary factor as described in the Y-BOCS.     

The Kids' Empathic Development Scale (KEDS): A multi‐dimensional measure of empathy in primary school‐aged children

Empathy is an essential building block for successful interpersonal relationships. Atypical empathic development is implicated in a range of developmental psychopathologies. However, assessment of empathy in children is constrained by a lack of suitable measurement instruments. This article outlines the development of the Kids' Empathic Development Scale (KEDS) designed to assess some of the core affective, cognitive and behavioural components of empathy concurrently. The KEDS assesses responses to picture scenarios depicting a range of individual and interpersonal situations differing in social complexity. Results from 220 children indicate the KEDS measures three related but distinct aspects of empathy that are also related to existing measures of empathy and cognitive development. Scores on the KEDS show age and some gender‐related differences in the expected direction.