The Differential Assessment of State–Trait Anxiety and Depression in a Clinically Anxious Sample

Empirical investigation into anxiety and depression has led some researchers to question the conceptual distinctness of these constructs. N. S. Endler, B. J. Cox, J. D. A. Parker, and R. M. Bagby (1992) provided empirical evidence that state and trait anxiety (using the Endler Multidimensional Anxiety Scales; N. S. Endler, J. M. Edwards, and R. Vitelli, 1991) may be differentiated from depression (using the Beck Depression Inventory; A. T. Beck, 1978) in a student sample. The present study extended this research by employing a different sample, a clinical sample of panic disorder patients (N = 189). Further support for the conceptual distinctness of anxiety and depression is presented herein. The concept of a general distress factor that encompasses both constructs is also discussed.     

Caregiving for Patients in Vegetative and Minimally Conscious States: Perceived Burden as a Mediator in Caregivers’ Expression of Needs and Symptoms of Depression and Anxiety

Involvement of family members is crucial to provide daily informal caring to patients in vegetative state and minimally conscious state. Previous studies showed that perceived burden is a risk factor for informal caregivers as it increases psychophysical distress. This research further investigated the relationship between these factors and aimed at providing a model that thoroughly describes this mechanism of functioning. In the frame of a national survey on people with disorders of consciousness, 487 informal caregivers of children and adult patients in vegetative and minimally conscious state were administered measures of depression, anxiety, caregiver needs, and family strain. Regression models proposed by Baron and Kenny and the Sobel test were adopted to investigate the relationship between depressive and anxiety symptoms, perceived burden and needs expressed. Our study shows that the relation between those symptoms and needs is mediated by burden, where higher burden accentuates and lower burden mitigates the needs expressed by caregivers. Our findings demonstrate that psychosocial components of the burden perceived by caregivers of patients with disorders of consciousness play a key role in shaping those caregivers’ needs, especially their needs for information and communication. We recommend implementation of comprehensive steps to meet the needs of these caregivers, steps that incorporate improved economic and public health programs, social support, and use of psychological interventions to ameliorate caregivers’ psychological distress and decrease their burden.     

Childhood Anxiety/Withdrawal, Adolescent Parent–Child Attachment and Later Risk of Depression and Anxiety Disorder

Previous research has shown that children with high levels of early anxiety/withdrawal are at increased risk of later anxiety and depression. It has also been found that positive parent–child attachment reduces the risk of these disorders. The aim of this paper was to examine the extent to which positive parent–child attachment acted to mitigate the risk of later internalising disorders amongst children with high levels of early anxiety/withdrawal using data from a 30 years longitudinal study of a New Zealand birth cohort. The findings of this study showed that: (a) increasing rates of early anxiety/withdrawal were associated with an increased risk of later anxiety and depression; (b) positive parent–child attachment in adolescence was associated with a decline in the risk of later anxiety and depression; and (c) these associations persisted even after controlling for confounding factors. The implications of these findings for the role of parent–child attachment in mitigating the adverse effects of early anxiety/withdrawal are discussed. It is concluded that positive parent–child attachment in adolescence may act as a compensatory factor which buffers the adverse effects of childhood anxiety/withdrawal on risks of developing later anxiety and depression.     

Testing the Effectiveness of Brief Behavioral Activation Treatment for Depression—Revised: Changes in Depression,Anxiety, Dysfunctional Attitudes,and Mindfulness

We tested the effectiveness of Brief Behavioral Activation Treatment for Depression-Revised (BATD-R), and its impact on secondary outcomes: anxiety, dysfunctional attitudes, and mindfulness. It was expected that individuals who completed BATD-R would exhibit decreased depression, anxiety, and dysfunctional attitudes, as well as increased mindfulness. A sample of adults with depression (n?=?42) was recruited to complete the 10-week treatment. A healthy control group (n?=?38) was included for comparison. Outcomes (depression, anxiety, dysfunctional attitudes, and mindfulness) were assessed at pre-treatment, post-treatment or 10 weeks for the healthy control group, and three-month follow-up. At pre-treatment, the clinical group reported greater depression, anxiety, and dysfunctional attitudes, and less mindfulness than the healthy control group. At post-treatment, the clinical group reported decreased depressive symptoms, trait anxiety, and dysfunctional attitudes, and increased mindfulness, compared to pre-treatment. The control group did not exhibit changes across the 10 weeks. Clinical and healthy control group post-treatment scores did not differ. At three-month follow-up, the clinical group reported a slight increase in depressive symptoms from post-treatment, but still maintained lower depressive symptoms than pre-treatment. The clinical group maintained treatment gains in dysfunctional attitudes, and mindfulness. Results support the effectiveness of BATD-R and suggest BATD-R may influence dysfunctional attitudes and mindfulness.

     

The DAPP–SF as a Screener for Personality Disorder in a Forensic Setting

Studies on the Dimensional Assessment of Personality Pathology–Short Form (DAPP–SF) have shown its ability to identify treatment-seeking patients with personality disorders. This study focuses on its screening potential for personality disorder in 89 criminal suspects (77 men, 12 women; M age = 37.0 years) undergoing residential pretrial psychological assessments in a high-security setting. It was expected that Structured Interview for DSM–IV Personality (SIDP–IV) criteria met for personality disorder(s) would be associated with higher DAPP–SF scores. A floor effect was found in DAPP–SF scores: The forensic population reported less personality pathology than the general population. Only moderate associations between DAPP–SF and SIDP–IV outcome were found. Receiver operating characteristic analysis showed that some DAPP–SF subscales did not exceed chance level in their ability to screen for personality disorders. It is concluded that the DAPP–SF has limited usefulness as a screener for personality disorders in a forensic pretrial setting. Alternative forensic screening instruments are presented.     

The Association Between Muslim Religiosity and Young Adult College Students’ Depression,Anxiety, and Stress

Depression, anxiety, and stress are among major psychological disorders being predominant in present day. This study proposed to analyze the role of Muslim religiosity in male students showing these mental indications. A sample including 723 Pakistani young adults enrolled at college level was randomly chosen. Muslim Religiosity Measurement Scale and Depression, Anxiety and Stress Scale were utilized to gather information. Discoveries uncover an inverse relationship between conduct and affiliation with the symptoms of mental disorders, anxiety and stress among the respondents. Results bolster the incorporation of religious dimensions in psychological wellness and mental well-being thought of young adults in Pakistan.     

Confirmatory Factor Analysis of the Depression–Anxiety–Stress Scales in Depressed and Anxious Patients

The Depression–Anxiety–Stress Scales (DASS; P. F. Lovibond & S. H. Lovibond, 1995) have shown considerable promise in their ability to differentially assess depression and anxiety symptoms. Most of the work to date has relied on normal or predominantly anxious clinical samples. To extend this research to a predominantly depressed sample, a psychiatric sample from a mood disorders program (N = 439) was used to investigate the factor structure of the DASS. Confirmatory factor analyses indicated that a 3-factor model for the 21-item DASS was supported. A 3-factor model with crossloading items for the 42-item version showed no practical improvement. Further confirmatory analyses evaluated the ability of item subsets from the DASS to represent the constructs specified in the tripartite model (L. A. Clark & D. Watson, 1991). Strong support was obtained for the DASS to represent the construct of anhedonia and physiological hyperarousal, and their relative importance is consistent with predictions of the tripartite model in understanding the relationship between anxiety and depression.     

Experiential Avoidance and Anxiety Sensitivity: Independent and Specific Associations with Children’s Depression,Anxiety, and Social Anxiety Symptoms

Experiential avoidance (EA) is a key component in acceptance and commitment therapy (ACT) theory and research. EA is associated with a wide range of psychopathology in adults including anxiety, in particular social anxiety, and depression, yet little research exists on EA in youth. Anxiety sensitivity (AS), like EA, has been viewed as a form of distress tolerance or emotion regulation. In a sample of 124 children (age 10 to 12), this study examined the independent and specific relations of EA and AS to children’s depression, anxiety, and social anxiety symptoms, both before and after controlling for comorbid symptoms. EA and AS had independent associations with each of children’s depression, anxiety, and social anxiety; and EA had significantly stronger relations than AS with each of children’s social anxiety and anxiety. After controlling for depression, only EA (and not AS) was uniquely related to both children’s anxiety and social anxiety. After controlling for anxiety and social anxiety, only AS (and not EA) was uniquely related to depression. After controlling for depression and social anxiety, neither EA nor AS was significantly related to anxiety. In contrast, after controlling for depression and anxiety, EA (and not AS) showed a significant and unique relation to children’s social anxiety. These findings indicate: 1) there are distinctions between EA and AS; 2) EA and AS are overlapping yet independent correlates for each of depression, anxiety and social and anxiety; and 3) EA and AS show some differential relations with children’s depression, anxiety, and social anxiety when comorbid symptoms are considered. Theoretical and treatment implications are highlighted.     

Breathwork: An Additional Treatment Option for Depression and Anxiety?

Breathwork is an increasingly popular experiential approach to psychotherapy based on the use of a specific breathing technique, however, claims of positive mental health outcomes rely on anecdotal clinical evidence. To ascertain the likely efficacy of breathwork this review clarifies the approach and its theoretical assumptions and examines relevant empirical research relating to breathing inhibition, suppression of inner experience, and possible neurological and physiological effects. Additionally, research into mindfulness-based psychotherapy and yoga breathing-based interventions with comparable features to breathwork are examined. Findings suggest qualified support for the key theoretical assumptions of a three component breathwork model, referred to as Integrative Breathwork Therapy (IBT), and its possible utility in the treatment of anxiety and depression. Further research aimed at exploring specific efficacy of this approach for these disorders may yield a useful additional treatment option utilising a different process of change to existing treatments.     

Depression and Anxiety in Persons with Parkinson's Disease With and Without “On–Off” Phenomena

On–off phenomena in Parkinson's disease (PD) are unpredictable motor fluctuations associated with long-term levodopa use. Mood fluctuations have been found to coincide with the motor fluctuations in that depression and anxiety increase while the person with PD is in the off state. What has been relatively unexplored is whether those persons with PD who have on–off phenomena differ psychologically in fundamental ways from those who do not have on–off phenomena. In the present study, depression and anxiety symptoms were assessed in 36 persons with PD (n = 14 with on–off phenomena, n = 22 without on–off phenomena). All those with on–off phenomena were assessed in their on state. Those persons with PD with on–off phenomena had significantly higher levels of anxiety than those without on–off phenomena. However, both groups, regardless of on–off status, were mildly depressed. Neurobiological interpretations of the results implicate the locus coeruleus in the pathogenesis of both on–off phenomena and anxiety, whereas psychological interpretations of the results involve the issues of learned helplessness and control over health symptoms in PD.     

Is There an App for That? A Review of Popular Apps for Depression,Anxiety, and Well-Being

Smartphone apps for mental health (MH apps) and wellness reach millions of people and have the potential to reduce the public health burden of common mental health problems. Thousands of MH apps are currently available, but real-world consumers generally gravitate toward a very small number of them. Given their widespread use and the lack of empirical data on their effects, understanding the content within MH apps is an important public health priority. An overview of the content within these apps could be an important resource for users, clinicians, researchers, and experts in digital health. Here, we offer summaries of the content within highly popular MH apps. Our aim is not to provide comprehensive coverage of the MH app space. Rather, we sought to describe a small number of highly popular MH apps in three common categories: meditation and mindfulness, journaling and self-monitoring, and AI chatbots. We downloaded the two most popular apps in each of these categories (respectively: Calm, Headspace; Reflectly, Daylio; Replika, Wysa). These six apps accounted for 83% of monthly active users of MH apps. For each app, we summarize information in four domains: intervention content, features that may contribute to engagement, the app’s target audience, and differences between the app’s free version and its premium version. In the years ahead, rigorous evaluations of highly popular MH apps will be needed. Until then, we hope that this overview helps readers stay up-to-date on the content within some of the most widely used digital mental health interventions.     

The Anxiety Depression Distress Inventory–27 (ADDI–27): New Evidence of Factor Structure,Item-Level Measurement Invariance,and Validity

Three studies examining the factor structure and psychometric properties of the Anxiety Depression Distress Inventory–27 (ADDI–27) extended the initial instrument development studies for this recently introduced inventory. The ADDI–27 is an empirically derived short form of the Mood and Anxiety Questionaire–90 (MASQ–90) comprising three scales: Positive Affect, Somatic Anxiety, and General Distress. The main objectives of Study 1 (N = 700) were to examine the factor structure of the ADDI–27 and its measurement invariance across gender at the item level. The objective of Study 2 (N = 538) was to examine evidence for the convergent and discriminant validity of scores on the ADDI–27. The objective of Study 3 (N = 240) was to assess further evidence for the nomological network and convergent and discriminant validity of the ADDI–27 scores. Results of exploratory structural equation modeling yielded strong support for a 3-factor model, with approximate fit indexes meeting or exceeding the conventional cutoffs. With p ≤ .001 as the criterion for detecting noninvariance, results of measurement invariance analysis suggested that all of the ADDI–27 items were invariant across gender. Results of multivariate validity analyses across 2 studies provided support for the convergent and discriminant validity of scores on the ADDI–27 scales.     

Variations in Anxiety and Depression as a Function of ADHD Subtypes Defined by DSM-IV: Do Subtype Differences Exist or Not?

Concerns have been raised about the ability of diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) to distinguish subtypes that are clearly distinct from each other with regard to clinical correlates. One area of concern is that research regarding differences in anxiety and depression as a function of ADHD subtype has produced discrepant findings. This study was designed to systematically evaluate whether the ADHD subtypes differ with regard to level of internalizing symptoms. From a large pool of children referred to an ADHD center based in a pediatric hospital, children were differentiated into three groups: ADHD, Combined Type (ADHD/COM); ADHD, Inattentive Type (ADHD/I); and a non-ADHD, comparison group (COMP). Parent- and child-report measures using both dimensional and categorical methods were used to assess internalizing symptoms. The results indicated that children with ADHD/COM and ADHD/I had similar levels of anxiety and depression. Subtype differences related to parent-reported depression were accounted for by group differences in level of externalizing problems. The results were discussed with regard to their implications for refining the criteria used to differentiate children with ADHD into subtypes.     

The Clash of Medical Civilizations: Experiencing “Primary Care” in a Neoliberal Culture

An anthropologist describes how he found himself at the vortex of a “clash of medical civilizations:” neoliberalism and the international primary health care movement. His involvement in a $6 million social change initiative in medical education became a basis to unlock the hidden tensions, contradictions and movements within the “primary care” phenomenon. The essay is structured on five ethnographic stories, situated on a continuum from “natural” species-level primary care to “unnatural” neoliberal primary care. Food is an element of all tales. Taking the long view of history/prehistory permits us to better recognize ideological distortions in order to more capably transform medicine.     

Test–Retest Reliability of Dominic Anxiety and Depression Items Among Young Children

Assessing anxiety and depressive symptoms through direct interviewing of young children has been found to be particularly difficult utilizing standard interview methods. Test–retest reliability of selected anxiety and depression items from the revised Dominic (Valla, Bergeron, Bidaut-Russell, St-Georges, & Gaudet, 1997), a cartoon-based questionnaire based on DSM diagnostic criteria, was investigated among two geographically diverse samples (Los Angeles and St. Louis; N = 37). Overall, kappas were higher for the anxiety items than for the depression items. In both cities the sample included clinic and non-clinic cases of African-American, Hispanic/Latino, and Caucasian children age 6–8; kappas for the anxiety and depression items were higher among the clinic cases than for the community cases. Given the need for psychometrically sound measures for culturally diverse samples of children, this initial report suggests that the use of selected Dominic items holds promise as a cartoon-based assessment of young children.     

The Anxiety Sensitivity Index–3: Analyses of Dimensions,Reliability Estimates,and Correlates in Nonclinical Samples

Body image and self-steering behavior in a group of 40 African hospitalized paraplegics and two control groups of non-hospitalized Ss were investigated using the DAP and the PUTCO African TAT. It was hypothesized that the paraplegics would demonstrate a body image characterized by significant pathology and would have a higher loading on the passive-submission dimension than a control group of Ss. The results failed to substantiate the research hypotheses. Instead, the findings suggest that both groups were characterized by a field-dependent perceptual framework associated with indefinite body image boundaries and a lack of self-steering behavior. These findings are accounted for in terms of a developmental cultural interpretation.     

The Beck Anxiety Inventory–Trait (BAIT): A Measure of Dispositional Anxiety Not Contaminated by Dispositional Depression

If aesthetic aspects of art are objective and reside in the art. as Arnheim (1954) argues. then perceiving them may be akin to any other kind of reality testing. Further, if neurosis impairs reality testing, it would also impair aesthetic judgment, especially if aesthetic cues are vital and relevant to the human experience as Arnheim maintains. This hypothesis was investigated by administration of personality tests to measure neuroticism, especially Cattell's Sixteen Personality Factor Questionnaire (16PF), and art judgment tasks, especially Child's slide comparisons, to 105 University of Michigan undergraduates, The hypothesis was supported by a high negative correlation between the 16PF's neuroticism scale and art judgment, r = -.48; t (103) = -5.61 ,p < .0001. The results are discussed in terms of growth versus adjustment models of mental health, and the possible inhibiting role of verbalization over visualization in aesthetic perception.     

Crying as a Form of Parent–Infant Communication in the Context of Maternal Depression

In cases of maternal depression certain complex factors interfere with communication with the child. The present study sought to investigate forms of parent–infant communication in families in which the mother was experiencing postpartum depression. Particular emphasis was placed on analysis of crying patterns and on methods employed by parents to soothe the child. The study sample comprised 15 families in which the mother had a diagnosis of postpartum depression. Semi-structured interviews were performed, followed by qualitative content analysis. Results showed that depressed mothers—and, at times, their husbands—reported difficulties in communication with their child, particularly in distinguishing different types of cries and in ways of soothing the infant. Postpartum depression is discussed as a specific diagnosis, beyond its relational aspect, which affects the family as a whole.     

Exposure to Parents’ Negative Emotions as a Developmental Pathway to the Family Aggregation of Depression and Anxiety in the First Year of Life

Depression and anxiety load in families. In the present study, we focus on exposure to parental negative emotions in first postnatal year as a developmental pathway to early parent-to-child transmission of depression and anxiety. We provide an overview of the little research available on the links between infants’ exposure to negative emotion and infants’ emotional development in this developmentally sensitive period, and highlight priorities for future research. To address continuity between normative and maladaptive development, we discuss exposure to parental negative emotions in infants of parents with as well as without depression and/or anxiety diagnoses. We focus on infants’ emotional expressions in everyday parent–infant interactions, and on infants’ attention to negative facial expressions as early indices of emotional development. Available evidence suggests that infants’ emotional expressions echo parents’ expressions and reactions in everyday interactions. In turn, infants exposed more to negative emotions from the parent seem to attend less to negative emotions in others’ facial expressions. The links between exposure to parental negative emotion and development hold similarly in infants of parents with and without depression and/or anxiety diagnoses. Given its potential links to infants’ emotional development, and to later psychological outcomes in children of parents with depression and anxiety, we conclude that early exposure to parental negative emotions is an important developmental mechanism that awaits further research. Longitudinal designs that incorporate the study of early exposure to parents’ negative emotion, socio-emotional development in infancy, and later psychological functioning while considering other genetic and biological vulnerabilities should be prioritized in future research.