Predicting Response to an Internet-Delivered Parenting Program for Anxiety in Early Childhood

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3–6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules.     

Depressed and Anxious COPD Patients: Predictors of Psychotherapy Engagement from a Clinical Trial

This study examined patient-level factors associated with engagement in mental health treatment in a sample of medically ill patients with clinically significant symptoms of depression and/or anxiety. A total of 248 patients was enlisted from a randomized controlled trial of cognitive-behavioral therapy for depression and anxiety in patients with chronic obstructive pulmonary disease (COPD). Logistic regression analysis was used to predict mental health engagement, defined as attending at least one intervention session. Results indicated that patient-perceived mastery over COPD was negatively related to mental health engagement. Further, mastery was the only significant predictor of mental health engagement after controlling for patient demographic characteristics, severity of COPD, depression, and anxiety. To improve engagement for medically ill patients with comorbid mental health difficulties, clinicians should explore patients’ attitudes about their mental health within the context of their perceived ability to cope with their medical disease.     

Counselor performance in treating anxiety and depressive symptoms in integrated care: A client outcomes study

Depression and anxiety are two of the most common mental disorders treated in Integrated Primary and Behavioral Healthcare programs. We investigated the within and between performance differences of mental health counselors on anxiety and depressive symptomatology in an integrated service with a sample of 1573 clients and 10 licensed professional counselors. The results of growth curves within the framework of Multilevel Modeling showed significant within and between performance differences among counselors treating anxiety and depressive symptoms. Some counselors performed better in treating anxiety symptoms while others did better treating depression. Implications for counselor education, client care, and legislation are provided.     

iCOPE With COVID-19: A Brief Telemental Health Intervention for Children and Adolescents During the COVID-19 Pandemic

The COVID-19 pandemic has prompted extensive disruptions to the daily lives of children and adolescents worldwide, which has been associated with an increase in anxiety and depressive symptoms in youth. However, due to public health measures, in-person psychosocial care was initially reduced, causing barriers to mental health care access. This study investigated the feasibility, acceptability and preliminary effectiveness of iCOPE with COVID-19, a brief telemental health intervention for children and adolescents to address anxiety symptoms. Sessions were provided exclusively using videoconferencing technology. Feasibility and acceptability were measured with client satisfaction data. The main outcome measure for effectiveness was anxiety symptom severity measured using the Screen for Child Anxiety and Related Disorders (SCARED). Results indicated that the treatment was well accepted by participants. Significant reductions in anxiety were noted for social anxiety, and were observed to be trending towards a mean decrease for total anxiety. The findings suggest that this brief telemental health intervention focused on reducing anxiety related to COVID-19 is acceptable and feasible to children and adolescents. Future research using a large sample and with a longer follow-up period could inform whether symptom decreases are sustained over time.     

Optimism,well-being,depressive symptoms,and perceived physical health: a study among Stroke survivors

The investigation of the relation of positive personality characteristics to mental and physical health among Stroke survivors has been a neglected area of research. The purpose of this study was to examine the relationship between optimism, well-being, depressive symptoms, and perceived physical health among Stroke survivors. It was hypothesized that Stroke survivors’ optimism would explain variance in their physical health above and beyond the variance explained by demographic variables, diagnostic variables, and mental health. One hundred seventy-six Stroke survivors (97 females, 79 males) completed the Revised Life Orientation Test, the Center for Epidemiological Studies Depression Scale, two items on perceived physical health from the 36-item Short Form of the Medical Outcomes study, and the Identity scale of the Illness Perception Questionnaire. Pearson correlations, hierarchical regression analyses, and the PROCESS approach to determining mediators were used to assess hypothesized relations between variables. Stroke survivors’ level of optimism explained additional variance in overall health in regression models controlling for demographic and diagnostic variables, and mental health. Analyses revealed that optimism played a partial mediator role between mental health (well-being, depressive symptoms and total score on CES-D) variables and overall health.     

Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment

Background and Objectives: This study examined prospective associations between changes in mental health symptoms (posttraumatic stress disorder [PTSD], depression) and health-related quality of life (physical health, psychological well-being) for veterans with PTSD. Design: This study focused on 139 patients who completed a residential treatment program for PTSD in the Veterans Health Administration. Methods: Patients completed the veteran-specific, 12-item Medical Outcomes Study Short Form, PTSD Checklist – Military version, and Beck Depression Inventory at pre-treatment, discharge, and a four-month follow-up. When accounting for demographic factors, combat exposure, and baseline scores on the respective outcome variables (e.g. mental health, physical health, PTSD, and depressive symptoms), a series of multivariate analyses were conducted for treatment-related changes in mental and physical health on the outcome measures. Results: Reductions in PTSD symptomatology during the treatment period were prospectively linked with better health-related outcomes at the four-month follow-up. In addition, improved physical health and psychological well-being during treatment were each similarly associated with better PTSD and depression outcomes in the months following treatment. Conclusions: Addressing concerns in mental and physical health might have synergistic effects across both domains, supporting the need for holistic models and integrated health care strategies for treating veterans with PTSD.     

Personal and appearance-based rejection sensitivity in body dysmorphic disorder

Although rejection sensitivity may be an important feature of body dysmorphic disorder (BDD), no studies have examined rejection sensitivity in a clinical sample and compared types of rejection sensitivity in individuals with BDD. Personal and appearance-based rejection sensitivity scores in forty-six patients diagnosed with BDD were compared with published norms. Associations between rejection sensitivity, BDD severity, and other clinical variables were examined. Personal and appearance-based rejection sensitivity scores were 0.6 and 1.1 standard deviation units above published norms, respectively. Greater personal rejection sensitivity was associated with more severe BDD and depressive symptoms, poorer mental health, general health, and physical and social functioning. Greater appearance-based rejection sensitivity was associated with more severe BDD and depressive symptoms, and poorer general health. Appearance-based rejection sensitivity contributed more unique variance to BDD severity than personal rejection sensitivity did; however, personal rejection sensitivity contributed more unique variance to general health than appearance-based rejection sensitivity did.     

Predictors of depressive symptoms among breast cancer patients during the first year post diagnosis

It is important to identify predictors of psychological health among breast cancer patients that can be relatively easily identified by medical care providers. This article investigates the role of one class of such potential predictors: easily identified demographics that have potential social and/or practical implications. Specifically, we examined whether income, marital status, presence of children in the home, education, travel distance, age and rurality interact with time to predict psychological health over the first year post diagnosis. Two hundred and twenty five breast cancer patients receiving radiation treatment completed four surveys over the course of 13 months that included measures of both their physical health and depressive symptoms. The results revealed that women who were not married had children living in the home or had to travel long distances to receive radiation treatment reported higher levels of depressive symptoms across the entire study. Women with lower incomes reported increased depressive symptoms, but only after the completion of treatment. Younger women reported elevated depressive symptoms during initial treatment, but this effect dissipated after the completion of treatment. The current results suggest that demographic patient characteristics may indeed be useful in identifying both when and for whom depressive symptoms are particularly likely to be problematic.     

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.     

Lesbians and their sisters as a control group: demographic and mental health factors

Lesbians and their heterosexual sisters were compared on demographic variables and mental health subscales, so that the feasibility of using heterosexual sisters as a control group for lesbians could be investigated. Lesbians were significantly more educated, more likely to live in urban areas, and more geographically mobile than their heterosexual sisters. Heterosexual sisters were more likely than lesbians to be married and homemakers, to have children, and to identify with a formal religion. There was no difference in mental health, but lesbians had higher self-esteem. When all respondents were included, bisexual women had significantly poorer mental health than did lesbians and heterosexual women. This is the first study to use sisters as a control group in lesbian research.     

An Open Trial Investigation of a Transdiagnostic Group Treatment for Children With Anxiety and Depressive Symptoms

The current study investigates the feasibility and preliminary outcomes associated with a transdiagnostic emotion-focused group protocol for the treatment of anxiety disorders and depressive symptoms in youth. Twenty-two children (ages 7 to 12; M = 9.79) with a principal anxiety disorder and varying levels of comorbid depressive symptoms were enrolled in an open trial of the Emotion Detectives Treatment Protocol (EDTP; Ehrenreich-May & Bilek, 2009), an intervention adapted from existent unified protocols for the treatment of emotional disorders among adults and adolescents. Results indicate that participants experienced significant improvements in clinician-rated severity of principal anxiety disorder diagnoses (d = 1.38), the sum of all anxiety and depressive disorder severity ratings (d = 1.07), and child-reported anxiety (d = 0.47) and parent-reported depressive symptoms (d = 0.54) at the posttreatment assessment. EDTP had good retention rates and reports of high satisfaction. Thus, preliminary evidence suggests that EDTP is a feasible and potentially efficacious treatment of youth anxiety disorders and co-occurring depressive symptoms. Children experiencing a range of internalizing symptoms may benefit from this more generalized, emotion-focused treatment modality, as it offers flexibility to families and the mental health clinician, while maintaining a concurrent focus on the provision of cognitive-behavioral treatment skills vital to the amelioration of anxiety and depressive disorder symptoms in youth.     

Predictors of depressive symptoms among resettled unaccompanied refugee minors

This study investigated the level and predictors of depressive symptoms among unaccompanied refugee minors after resettlement in Norway. Participants (N = 414) were resettled in 26 municipalities from all regions of the country. The average length of resettlement time was 3.4 years. They originated from 33 different countries, mainly Afghanistan (n = 116), Somalia (n = 74), Sri Lanka (n = 41) and Iraq (n = 43). Participants completed a self-report questionnaire administered in groups. Findings show that unaccompanied minors are a high-risk group for mental health problems also after resettlement in a new country. A multilevel model predicting depressive symptoms from individual and contextual demographic factors indicated that, controlling for post-traumatic stress, females had more symptoms than males and Somalis had fewer symptoms than participants from other countries. Variation in symptom levels as a function of gender and ethnic background indicates that some groups may have inherent protective or vulnerability factors that need to be further studied to understand differences in psychosocial adaptation among unaccompanied minors. Further, findings imply that researchers, policy makers and mental health care workers need to expand their attention beyond the first phases of arrival of unaccompanied asylum seeking and refugee minors to the continuing experience of mental health problems after resettlement.     

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.     

The mediating role of anxiety in self-reported somatic complaints of depressed adolescents

This study examined the mediating role of anxiety in the self-reports of somatic complaints in 96 depressed adolescent inpatients. Sixty-four subjects with major depressive episodes and comorbid anxiety disorders (MDE-A) determined from the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) reported significantly more somatic complaints than 32 adolescents having major depressive episodes without comorbid anxiety (MDE). An analysis of covariance demonstrated that, with anxiety symptoms controlled, MDE and MDE-A groups did not differ significantly in somatic complaints. A hierarchical multiple-regression analysis revealed that, with demographic and anxiety symptoms controlled, depressive symptoms did not contribute to the explanation or prediction of somatic complaints. The results suggest that anxious, but not depressive symptoms, are independently associated with somatic complaints. The results are discussed in light of new affective models of psychopathology.     

Synergistic effects of pain and alcohol use in relation to depressive and anxiety symptoms among Latinos in primary care

Although past work has shown that alcohol use co-occurs with anxiety/depression among Latinos, little work has examined the variables that qualify such associations. The present investigation sought to address whether pain severity (i.e. pain intensity and/or pain-related disability, respectively) moderated relations between hazardous drinking and depressive/anxious arousal symptoms among an economically disadvantaged Latino sample recruited from a primary care medical setting. Participants included 253 adult Latinos (M_age = 38.5 years, SD = 10.8; 86.6% female) who attended a community-based primary care clinic. There was a significant interaction of hazardous drinking with pain intensity in relation to depressive symptoms and significant interactions of hazardous drinking and pain-related disability in relation to depressive and anxious arousal symptoms. Hazardous drinking was associated with more severe depressive/anxious arousal symptoms only when pain intensity/disability was high. This is the first study to demonstrate the moderating role of pain intensity and disability in associations between hazardous drinking and anxiety/depression among Latinos in a primary care medical setting.     

家庭累积风险与青少年心理健康的关系——心理资本的补偿效应和调节效应

对1473名初、高中生进行问卷调查,考察家庭累积风险与青少年心理健康的关系以及心理资本的补偿效应和调节效应。结果发现：（1）家庭累积风险负向预测生活满意度,正向预测焦虑/抑郁;（2）心理资本正向预测生活满意度,负向预测焦虑/抑郁;（3）心理资本只能调节家庭累积风险与焦虑/抑郁的关系,表现为心理资本缓冲家庭累积风险对青少年焦虑/抑郁的不利影响。因此,改善家庭环境和培养心理资本是提升青少年心理健康的重要途径,需注意心理资本的培育对焦虑/抑郁和生活满意度作用的差异。     

Attachment Anxiety,Depressive Symptoms,and Adolescent Dating Violence Perpetration: A Longitudinal Mediation Analysis

Adolescent dating violence (ADV) is a prevalent public health issue that has been linked to many negative effects, including attachment anxiety and depressive symptoms. Previous literature suggests that the negative mental states characteristic of attachment anxiety could be associated with dating violence perpetration. Similarly, the negative mental states characteristic of depression have also been linked to perpetration, and might potentially increase an anxiously attached individual’s likelihood of engaging in dating violence perpetration. This study used a 10-month longitudinal design with a sample of 140 middle school and high school students from Southern California. Participants ranged in age from 13 to 18 years and were ethnically diverse. The study aimed at exploring depressive symptoms as a potential mediator for the relationship between attachment anxiety and ADV perpetration. Positive associations were found between attachment anxiety and perpetration (10 months after), attachment anxiety and depressive symptoms (10 months after), and between depressive symptoms and perpetration (both 10 months after). Furthermore, depressive symptoms partially mediated the relationship between attachment anxiety and ADV perpetration (10 months after). These findings have implications for the development of empirically driven school-based prevention and intervention programs.     

Positively biased appraisals in everyday life: when do they benefit mental health and when do they harm it?

To promote optimal mental health, is it best to evaluate negative experiences accurately or in a positively biased manner? In an attempt to reconcile inconsistent prior research addressing this question, we predicted that the tendency to form positively biased appraisals of negative experiences may reduce the motive to address those experiences and thereby lead to poorer mental health in the context of negative experiences that are controllable and severe but lead to better mental health in the context of controllable negative experiences that are less severe by promoting positive feelings without invoking serious consequences from unaddressed problems. In 2 longitudinal studies, individuals in new marriages were interviewed separately about their ongoing stressful experiences, and their own appraisals of those experiences were compared with those of the interviewers. Across studies, spouses' tendencies to form positively biased appraisals of their stressful experiences predicted fewer depressive symptoms over the subsequent 4 years among individuals judged to be facing relatively mild experiences but more depressive symptoms among individuals judged to be facing relatively severe experiences. Furthermore, in Study 2, these effects were mediated by changes in those experiences, such that the interaction between the tendency to form positively biased appraisals of stressful experiences and the objectively rated severity of initial levels of those experiences directly predicted changes in those experiences, which in turn accounted for changes in depressive symptoms. These findings suggest that cognitive biases are not inherently positive or negative; their implications for mental health depend on the context in which they occur.     

Maternal mental health,child care quality,and children's behavior

Moderating effects of non-parental preschool child care quality on the impact of maternal mental health risks on children's behavioral and mental health outcomes were examined. The paper presents data both on the concurrent buffering effects on children at the age of 4 ½ while they are in child care as well as on the longitudinal effects on the children two years later in the first grade. Study participants included 294 mothers, fathers, their children, their children's non-parental caregivers in preschool child care programs and their children's first grade teachers from the Wisconsin Study of Families and Work. Using regression models to examine moderation, we found that in low quality child care, children exposed to elevated maternal depressive symptoms and anger showed more behavioral problems and worse prosocial functioning. In contrast, children in high quality child care did not present higher symptoms in relation to elevated mother mental health risks. Significant moderating effects were found in both concurrent and longitudinal analyses. Results point to potential buffering effects of high quality care for children faced with adverse family factors.     

Storying endometriosis: Examining relationships between narrative identity,mental health,and pain

We examined whether narratives related to mental health and pain in 120 women with endometriosis. Participants wrote narratives about endometriosis, rated the narratives on centrality to identity and positive and negative self-change, and completed measures of depressive symptoms, life-satisfaction, pain intensity and pain symptoms. Narratives were content-coded for themes of agency and communion. Higher centrality to identity, more negative self-change, and lower agency and communion were related to poorer mental health. Higher centrality to identity was associated with more pain symptoms. Narrative measures predicted mental health beyond pain intensity, pain symptoms, and neuroticism. The results indicate that how women with endometriosis narrate their illness is connected to mental health.