抑郁焦虑共病研究及其辩证思维

抑郁、焦虑障碍是临床上很常见的两种疾病,两者之间的症状具有重叠性,共病率很高;目前由于两者的病因和发病机制不太明了,很难做出全面系统的判断.对抑郁、焦虑共病现象采取辩证的思维方法、科学的研究方法,以期探讨共病现象的本质及其规律,为临床诊断、治疗、预防提供更全面、更有效的措施与方案.     

青少年感恩与问题行为的关系:学校联结的中介作用

采用青少年感恩量表、学校联结量表、青少年外化问题行为调查表和焦虑抑郁量表对1217名中学生进行调查,考察了青少年感恩与其问题行为的关系,以及学校联结的同学支持、教师支持和学校归属感三大成分在其中的系列中介作用。结果表明:(1)青少年感恩与其外化问题行为和内化问题行为(以焦虑抑郁为指标)均显著负相关;(2)学校联结三大成分在感恩与其外化和内化问题行为之间均起着系列中介作用,即感恩对青少年学校归属感既有直接影响,也通过增强同学支持和教师支持间接促进其发展,进而学校联结的三成分共同作用减少青少年的外化和内化问题行为。     

抑郁焦虑共病研究及其辩证思维

抑郁、焦虑障碍是临床上很常见的两种疾病,两者之间的症状具有重叠性,共病率很高;目前由于两者的病因和发病机制不太明了,很难做出全面系统的判断。对抑郁、焦虑共病现象采取辩证的思维方法、科学的研究方法,以期探讨共病现象的本质及其规律,为临床诊断、治疗、预防提供更全面、更有效的措施与方案。     

负性生活事件与初中生内化问题：反刍思维的中介作用与同伴依恋的调节作用

基于素质-压力模型及依恋的内部工作模式理论,研究考察了反刍思维在负性生活事件与初中生内化问题关系中的中介作用,以及同伴依恋的调节作用。研究从武汉和商丘两所初中三个年级共选取800名初中生,采用问卷法对其负性生活事件、反刍思维、同伴依恋及抑郁和焦虑情况进行调查。结果显示：(1)在控制性别、年龄、年级、独生与否后,负性生活事件对初中生抑郁和焦虑均具有显著正向预测作用;(2)反刍思维能够在负性生活事件与抑郁和焦虑的关系中起中介作用;(3)反刍思维在负性生活事件与初中生抑郁、焦虑关系中的中介作用会受到同伴依恋的调节;(4)同伴依恋能够调节负性生活事件与抑郁之间的关系,但在负性生活事件与焦虑之间的调节作用不显著。研究结果揭示了负性生活事件对青少年内化问题产生影响的心理机制,为引导青少年提升同伴依恋水平,促进心理健康发展提供了有益建议。     

自闭症谱系障碍个体的焦虑：发生机制、评估与治疗

自闭症谱系障碍是一种神经发育性障碍, 主要表现为社会交往互动障碍和重复刻板性行为。焦虑或焦虑障碍常被认为是自闭症个体最普遍的共病之一。焦虑与自闭症之间的关系尚不明确, 自闭症个体的焦虑与无法忍受不确定性、杏仁核功能和体积、情绪调节策略、消极思维存在一定关联; 目前已经开发出专门用于自闭症个体焦虑的评估工具; 修订版认知行为疗法对自闭症个体焦虑的治疗取得了良好效果。未来的研究应着重探索自闭症个体焦虑的认知与神经机制, 检验专用评估工具的有效性, 继续关注现代技术(如虚拟现实技术)对自闭症个体焦虑的治疗效果。     

校园排斥对初中生内外化问题的影响:同伴关系与核心自我评价的中介作用

该研究探讨了校园排斥和初中生内外化问题的关系,结合资源保存理论,进一步考察同伴关系（条件性资源）与核心自我评价（人格特质资源）对该效应的链式中介作用。采用青少年校园现实受排斥量表、同伴关系量表、核心自我评价量表、焦虑抑郁量表和外化行为倾向量表,对辽宁省2所中学540名初中生进行调查。结果表明：（1）校园排斥对于初中生的内化及外化问题均具有正向预测作用;（2）同伴关系、核心自我评价在校园排斥与内化问题中起完全中介作用,而在校园排斥与外化问题中起部分中介作用。具体而言,校园排斥通过三条路径影响内外化问题：一是同伴关系的单独中介作用;二是核心自我评价的单独中介作用;三是同伴关系—核心自我评价的链式中介作用。     

校园排斥对初中生内外化问题的影响:同伴关系与核心自我评价的中介作用

该研究探讨了校园排斥和初中生内外化问题的关系,结合资源保存理论,进一步考察同伴关系（条件性资源）与核心自我评价（人格特质资源）对该效应的链式中介作用。采用青少年校园现实受排斥量表、同伴关系量表、核心自我评价量表、焦虑抑郁量表和外化行为倾向量表,对辽宁省2所中学540名初中生进行调查。结果表明：（1）校园排斥对于初中生的内化及外化问题均具有正向预测作用;（2）同伴关系、核心自我评价在校园排斥与内化问题中起完全中介作用,而在校园排斥与外化问题中起部分中介作用。具体而言,校园排斥通过三条路径影响内外化问题：一是同伴关系的单独中介作用;二是核心自我评价的单独中介作用;三是同伴关系—核心自我评价的链式中介作用。     

流动儿童同伴侵害的特点及与内化问题的循环作用关系:一项追踪研究

本研究采用纵向设计,以北京市426名四、五年级流动儿童为被试,进行连续4次的追踪测查,考察流动儿童同伴侵害的特点及其与内化问题的动态相互作用关系。结果发现:(1)打工子弟学校流动儿童的同伴侵害与内化问题水平比公立学校流动儿童高;流动儿童的流动性越大,同伴侵害和内化问题越多。(2)控制了性别、年级、家庭社会经济地位(SES)和流动性后,从T1到T2,同伴侵害与孤独感为相互作用关系,且同伴侵害可以显著预测抑郁,但对社交焦虑的预测作用不显著,而从T2到T4,同伴侵害和3种内化问题的相互作用模式完全一致,即T2时的社交焦虑、抑郁和孤独感显著预测T3的同伴侵害,进而显著预测T4的社交焦虑、抑郁和孤独感。(3)抑郁、孤独感与同伴侵害的循环作用在两类流动儿童中具有较强的稳定性,而在社交焦虑和同伴侵害的模型中,打工子弟学校流动儿童的同伴侵害对社交焦虑的作用比公立学校流动儿童更大。可见,同伴侵害和内化问题呈循环作用关系,未来预防/干预研究可以聚焦于减少流动儿童的同伴侵害或内化问题的角度打破二者的恶性循环,帮助他们建立良好的人际关系,构建良性循环,促进他们的积极发展。     

躯体疾病和抑郁障碍共病的诊断、评估及治疗原则

躯体疾病和抑郁障碍共病已经成为一个越来越严重的临床和全球公共健康问题.共病的躯体疾病与抑郁障碍之间存在着双向的联系,即一种疾病对另一种疾病的发生、发展、预后以及治疗有消极的作用.本文就躯体疾病和抑郁障碍共病的流行病学、临床评估、诊断及治疗原则作一综述.     

情绪通路异常与认知情绪偏差:慢性痛与抑郁症共病的神经心理机制

慢性疼痛与抑郁症具有高度共病性,但迄今尚无成熟理论能够阐释二者共病的神经心理机制。对慢性痛与抑郁的脑机制研究提示,慢性痛和抑郁常常涉及到相似的情绪脑区活动的异常改变;与此相对应的是,行为学研究发现,疼痛患者与抑郁患者在加工疼痛或抑郁相关信息时表现出了模式相似的认知情绪偏差(CAB)。近年来,越来越多证据趋于一致,指出慢性痛和抑郁共有的情绪通路异常变化可能导致了相似的信息加工异常,是二者共病的神经心理基础,而认知情绪偏差则在行为上反映了这种变化,并且很可能是共病发生、发展及维持的重要因素。     

An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample

Epidemiological studies of categorical mental disorders consistently report that gender differences exist in many disorder prevalence rates and that disorders are often comorbid. Can a dimensional multivariate liability model be developed to clarify how gender impacts diverse, comorbid mental disorders? We pursued this possibility in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093). Gender differences in prevalence were systematic such that women showed higher rates of mood and anxiety disorders, and men showed higher rates of antisocial personality and substance use disorders. We next investigated patterns of disorder comorbidity and found that a dimensional internalizing-externalizing liability model fit the data well, where internalizing is characterized by mood and anxiety disorders, and externalizing is characterized by antisocial personality and substance use disorders. This model was gender invariant, indicating that observed gender differences in prevalence rates originate from women and men's different average standings on latent internalizing and externalizing liability dimensions. As hypothesized, women showed a higher mean level of internalizing, while men showed a higher mean level of externalizing. We discuss implications of these findings for understanding gender differences in psychopathology and for classification and intervention.     

Examining a dimensional representation of depression and anxiety disorders' comorbidity in psychiatric outpatients with item response modeling

The current study replicated, in a sample of 2,300 outpatients seeking psychiatric treatment, a previous study (R. F. Krueger & M. S. Finger, 2001) that implemented an item response theory approach for modeling the comorbidity of common mood and anxiety disorders as indicators along the continuum of a shared latent factor (internalizing). The 5 disorders examined were major depressive disorder, social phobia, panic disorder/agoraphobia, specific phobia, and generalized anxiety disorder. The findings were consistent with the prior research. First, a confirmatory factor analysis yielded sufficient evidence for a nonspecific factor underlying the 5 diagnostic indicators. Second, a 2-parameter logistic item response model showed that the diagnoses were represented in the upper half of the internalizing continuum, and each was a strongly discriminating indicator of the factor. Third, the internalizing factor was significantly associated with 3 indexes of social burden: poorer social functioning, time missed from work, and lifetime hospitalizations. Rather than the categorical system of presumably discrete disorders presented in DSM-IV, these 5 mood and anxiety disorders may be alternatively viewed as higher end indicators of a common factor associated with social cost.     

Using item response theory to understand comorbidity among anxiety and unipolar mood disorders

The authors hypothesized that anxiety and unipolar mood disorders are often comorbid because each disorder indicates a broad, higher order factor. In a clinical subsample of the nationally representative National Comorbidity Survey participants (N = 251), a one-factor model fit the correlations among 7 dichotomous anxiety and unipolar mood diagnoses. Following the lead provided by literature on the structure of emotional and behavioral problems in children, we labeled this factor internalizing. Item response theory was used to explore how each diagnosis mapped onto the internalizing factor. The test information function derived from the 7 diagnoses suggested that they measure primarily the higher end of the factor. In addition, very high scores on internalizing (meeting criteria for 6-7 disorders) were associated with increased social costs, a phenomenon not well captured by the "comorbidity" concept. The results underscore the need to develop clinical assessment instruments that span the full range of the internalizing factor and measure both the shared and distinctive features of anxiety and unipolar mood disorders in a graded, continuous fashion.     

Temporomandibular disorders: evidence for significant overlap with psychopathology.

Data were analyzed for 277 acute and chronic temporomandibular disorder (TMD) patients to determine if there was a relationship between psychological and physical diagnoses. A significant (p < .01) relationship existed among the following: combined past or current mood disorder-personality disorder and muscle disorder; combined current mood, anxiety, or substance use disorder-personality disorder and muscle disorder; and combined current anxiety disorder-personality disorder and muscle disorder. This study further confirmed other research that has found that significant psychopathology exists in TMD. More important, this psychopathology appears to be linked primarily to muscle disorders, as opposed to disc or joint disorders, within the rubric of TMD.     

Structure and Etiology of Co-occurring Internalizing and Externalizing Disorders in Adolescents

Several studies suggest that a two-factor model positing internalizing and externalizing factors explains the interrelationships among psychiatric disorders. However, it is unclear whether the covariation between internalizing and externalizing disorders is due to common genetic or environmental influences. We examined whether a model positing two latent factors, internalizing and externalizing, explained the interrelationships among six psychiatric disorders (major depressive disorder, generalized anxiety disorder, separation anxiety disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) in adolescents, and whether there are common genetic and environmental influences on internalizing and externalizing latent factors. Multivariate behavior genetic analyses of data from 1162 twin pairs and 426 siblings ascertained from the general population via the Colorado Center for Antisocial Drug Dependence (CADD) were conducted. We found support for a model positing two latent factors (internalizing and externalizing). These factors were moderately heritable and influenced by significant common genetic and nonshared environmental influences. These findings suggest that co-occurrence of internalizing and externalizing psychopathology in adolescents results from both genetic and environmental influences.     

Distress Tolerance as a Familial Vulnerability for Distress-Misery Disorders

Low perceived distress tolerance (DT), a trait-like individual difference factor reflecting one’s perceived ability to withstand aversive affective states, has been linked with current internalizing and substance use disorders (SUDs). However, perceived DT has not been systematically evaluated as a familial, transdiagnostic vulnerability factor for internalizing and SUDs. The current study tested whether perceived DT runs in families and whether it is reduced among individuals with versus without remitted internalizing/SUD psychopathology. Perceived DT and internalizing/SUDs were measured in 638 individuals (nested within 256 families). Analyses also adjusted for the effects of neuroticism to test whether DT was a specific vulnerability factor independent of temperamental negative affect. Analyses revealed that perceived DT was lower in individuals with remitted distress (i.e., major depression, generalized anxiety disorder, posttraumatic stress disorder) but not fear disorders (i.e., panic disorder, social anxiety disorder, specific phobia, obsessive-compulsive spectrum disorders) relative to healthy controls, and the effect of distress-misery disorder history remained significant when adjusting for neuroticism. Perceived DT was not significantly different among individuals with versus without a remitted SUD. There were no effects for comorbid SUD and distress-misery disorders. Finally, perceived DT was also significantly correlated within families, suggesting that it runs in families. Overall, results suggest that independent of neuroticism, low perceived DT is a familial vulnerability for distress (but not fear or substance use) disorders.     

Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population

Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.     

Higher-order structure in the trajectories of depression and anxiety following sudden involuntary unemployment

Recent work on comorbidity finds evidence for hierarchical structure of mood and anxiety disorders and symptoms. This study tests whether a higher-order internalizing factor accounts for variation in depression and anxiety symptom severity and change over time in a sample experiencing a period of major life stress. Data on symptoms of depression, chronic worry, and social anxiety were collected five times across seven months from 426 individuals who had recently lost jobs. Growth models for each type of symptom found significant variation in individual trajectories. Slopes were highly correlated across symptom type, as were intercepts. Multilevel confirmatory factor analyses found evidence for a higher-order internalizing factor for both slopes and intercepts, reflective of comorbidity of depression and anxiety, with the internalizing factor accounting for 54% to 91% of the variance in slopes and intercepts of specific symptom sets, providing evidence for both a general common factor and domain-specific factors characterizing level and change in symptoms. Loadings on the higher order factors differed modestly for men and women, and when comparing African American and White participants, but did not differ by age, education, or history of depression. More distal factors including gender and history of depression were strongly associated with internalizing in the early weeks after job loss, but rates of change in internalizing were associated most strongly with reemployment. Findings suggest that stressors may contribute in different ways to the common internalizing factor as compared to variance in anxiety and depression that is independent of that factor.     

Evidence-Based Practice in Family Therapy and Systemic Consultation II

Evidence for the effectiveness of family-based treatments from critical literature reviews and controlled trials is considered for the following list of adult-focused problems: marital distress, psychosexual problems, anxiety disorders, mood disorders, psychotic disorders, alcohol abuse, chronic pain, and the family management of neurologically impaired adults. Evidence-based practices which may be used within the context of marital and family therapy and systemic consultation arising from the review are discussed.     

Mood,Anxiety, and Substance‐Use Disorders and Suicide Risk in a Military Population Cohort

There are meager prospective data from nonclinical samples on the link between anxiety disorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 U.S. Air Force service members, with 227 suicides over follow‐up. Mental disorder diagnoses including anxiety, mood, and substance‐use disorders (SUD) were based on treatment encounters. Risk for suicide associated with anxiety disorders were lower compared with mood disorders and similar to SUD. Moreover, the associations between mood and anxiety disorders with suicide were greatest within a year of treatment presentation.