Health-related quality of life in Parkinson's disease after pallidotomy and deep brain stimulation

This study explored the multidimensional outcome of three neurosurgical interventions for Parkinson's disease (PD): pallidotomy (N = 23), pallidal deep brain stimulation (DBS) (N = 9), and thalamic DBS (N = 7). All patients completed the Sickness Impact Profile (SIP) and the Beck Depression Inventory. Pallidotomy patients also completed the Profile of Mood States, the Beck Anxiety Inventory, and a disease-specific quality of life (QOL) measure, the Parkinson's Disease Questionnaire (PDQ-39). Three months after surgery, all neurosurgical groups showed significant improvements in mood and function, including physical, psychosocial, and overall functioning. Pallidal DBS and pallidotomy patients who completed additional QOL measures reported decreased anxiety and tension, increased vigor, improved mobility and ability to perform activities of daily living, and decreased perceived stigma. Psychosocial dysfunction scores from the SIP were related to depressed mood both at baseline (r = .42) and at followup (r = .45), but the physical dysfunction subscale was not related to mood at either time point, suggesting that disruption of social relationships due to PD may have more impact on affective distress than physical symptoms alone. Results suggest that neurosurgical interventions for PD improve disabling PD motor symptoms and also improve several domains of quality of life.     

The Interaction of Extraversion and Anxiety Sensitivity on Social Anxiety: Evidence of Specificity Relative to Depression

Neuroticism and extraversion have been linked to the etiologies and course of anxiety and mood disorders, such that neuroticism is broadly associated with numerous disorders and extraversion is most strongly associated with social anxiety and depression. While previous research has established the broad associations between temperament and emotional disorders, less is known about the specific, proximal factors that are associated with them, and very few studies have situated these risk factors into a larger etiological model that specifies how they may relate to one another. The current study examined the interaction of extraversion and anxiety sensitivity (AS) in predicting social anxiety symptoms in a large, diagnostically diverse clinical sample (N = 826). Symptoms were assessed with self-report and dimensional interview measures, and regression analyses were performed examining the main effects and interaction of extraversion and AS (examining both total and lower-order components) on social anxiety. Results showed that at higher levels of AS, the inverse relationship between extraversion and social anxiety was stronger, and the social concerns component of AS is responsible for this effect. This interaction was also observed with regard to depression symptoms, but the interaction was not present after accounting for shared variance (i.e., comorbidity) between depression and social anxiety symptoms. Clinical and theoretical implications of the results are discussed.     

The Role of Relationships in Understanding the Alexithymia–Depression Link

Alexithymia is associated with increased depressive symptoms in both clinical and community samples. One way that alexithymia may lead to depression is through its impact on interpersonal relationships. Individuals with alexithymia report lower perceived social support, intimacy, and relationship satisfaction. Furthermore, poor relationship functioning is a clear risk factor for depressive symptoms. Given the established alexithymia–depression link and marital dysfunction–depression link, a logical next step is to examine whether relationship dysfunction (low social support, intimacy, negative relationship behaviours, and relationship dissatisfaction) mediates the association between alexithymia and depressive symptoms. The hypothesized mediation model was assessed in a sample of 104 community couples with two analytical approaches—first with cross‐sectional measures using path analysis and second with daily diary measures collected over a seven‐day period using a multilevel modelling approach. Poor relationship functioning mediated the association between alexithymia and depressed mood in the daily diary data and partially mediated that association with the cross‐sectional measures. These results identify alexithymia as an important variable in understanding the marital functioning–depression association, and this finding has implications for treatment. Copyright © 2012 European Association of Personality Psychology     

Temporal patterns of anxious and depressed mood in generalized anxiety disorder: a daily diary study

Research suggests that anxiety disorders tend to temporally precede depressive disorders, a finding potentially relevant to understanding comorbidity. The current study used diary methods to determine whether daily anxious mood also temporally precedes daily depressed mood. 55 participants with generalized anxiety disorder (GAD) and history of depressive symptoms completed a 21-day daily diary tracking anxious and depressed mood. Daily anxious and depressed moods were concurrently associated. Daily anxious mood predicted later depressed mood at a variety of time lags, with significance peaking at a two-day lag. Depressed mood generally did not predict later anxious mood. Results suggest that the temporal antecedence of anxiety over depression extends to daily symptoms in GAD. Implications for the refinement of comorbidity models, including causal theories, are discussed.     

Biases in affective forecasting and recall in individuals with depression and anxiety symptoms

The authors used experience sampling to investigate biases in affective forecasting and recall in individuals with varying levels of depression and anxiety symptoms. Participants who were higher in depression symptoms demonstrated stronger (more pessimistic) negative mood prediction biases, marginally stronger negative mood recall biases, and weaker (less optimistic) positive mood prediction and recall biases. Participants who were higher in anxiety symptoms demonstrated stronger negative mood prediction biases, but positive mood prediction biases that were on par with those who were lower in anxiety. Anxiety symptoms were not associated with mood recall biases. Neither depression symptoms nor anxiety symptoms were associated with bias in event prediction. Their findings fit well with the tripartite model of depression and anxiety. Results are also consistent with the conceptualization of anxiety as a "forward-looking" disorder, and with theories that emphasize the importance of pessimism and general negative information processing in depressive functioning.     

Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process

A sample of 116 patients with unipolar mood disorders referred to a specialist research clinic were assessed to investigate (a) whether rumination is a transdiagnostic process that is related to co-morbid Axis I and II symptoms and diagnosis in depressed patients; (b) whether common findings in the depressive rumination literature could be replicated in a recurrent depressed sample. Consistent with the transdiagnostic hypothesis, rumination was positively associated with both depression and anxiety, brooding was related to co-morbid obsessive-compulsive disorder and generalized anxiety disorder, and rumination was associated with traits associated with borderline personality disorder, most notably self-report of unstable relationships and inconsistent sense of self. As predicted, rumination was equivalent in currently depressed and formerly depressed patients, suggesting that rumination is not simply dependent on mood state or clinical status. As predicted, the brooding subtype most strongly correlated with depressed and anxious symptoms, consistent with previous observations that brooding is the more maladaptive form of rumination. As predicted, rumination was associated with reports of sexual abuse. Inconsistent with previous findings, there was no gender difference in rumination.     

Self-schemas and risk for depression: a prospective study

The role of depressive self-schemas in vulnerability to depression was explored in a longitudinal design. Five groups of subjects hypothesized to be at differential risk for depression according to a schema model were identified: depressed schematic, depressed nonschematic, nondepressed schematic, nondepressed nonschematic, and a psychopathology control. They were followed regularly for 4 months with self-report and clinical interview measures of depression. There was no evidence of risk for depression associated with schema status apart from initial mood and no interaction of life stress events and schemas. In a second experiment with the same subjects, it was shown that depressive self-schemas do not exert an ongoing, active influence on everyday information processing; instead current mood affected information processing. Remitted depressed persons resembled nondepressed rather than depressed ones. The results support Kuiper and colleagues' distinction between concomitant and vulnerability schemas, and help to clarify differences between cognitions that are symptoms or correlates of depression and those that may play a causal role under certain conditions.     

Cognitive Function in Parkinson's Disease: Association with Anxiety but Not Depression

To reexamine the relationships of depression, anxiety and cognitive impairment in Parkinson's disease (PD), 27 patients with idiopathic PD received two measures of depression, the State-Trait Anxiety Inventory, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Contrary to some earlier studies, measures of depression, even those that separated mood from somatic symptoms, were not correlated with any measure of cognitive performance. By contrast, measures of anxiety were signifiantly and negatively correlated with all RBANS indexes. Because anxiety and depression are partially overlapping psychiatric disorders, inconsistent reports concerning the relationship of depression and cognition in PD may have arisen because different studies included varying proportions of depressed patients who were also highly anxious.     

Self-Report Differentiation of Anxiety and Depression in a Mood Disorders Sample

Several lines of research suggest there is considerable overlap between anxiety and depression and that it is difficult to distinguish between these two constructs. However, a few studies utilizing factor analytic procedures have provided evidence that anxiety and depression can be differentiated when measures of these constructs are considered at the item level. In addition, there is some evidence that differentiation can be accomplished in samples experiencing high levels of anxiety (i.e., a clinically anxious sample; B. J. Cox, R. P. Swinson, L. Kuch, & J. Reichman, 1993). In the present study, this research strategy was extended to a sample of patients with high levels of depressed mood (i.e., a mood disorders sample; N = 378). Their responses to widely used measures of depression (i.e., Beck Depression Inventory; A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) and anxiety (i.e., Spielberger State-Trait Anxiety Inventory—State subscale; C. D. Spielberger, R. L. Gorsuch, & R. E. Lushene, 1970) were entered into a principal-components analysis with oblique rotation. A 4-factor solution was retained. This solution was comprised of factors representing anxiety, anxiety absent (a reverse scored factor), cognitive symptoms of depression, and somatic/vegetative symptoms of depression. These findings indicated that anxiety and depression, as emotional states, can be differentiated within a mood disorders sample, using existing popular self-report measures. The clinical and research implications of these findings are briefly discussed.     

Menstrual Reactivity: The Role of Gender-Specificity,Anxiety Sensitivity,and Somatic Concerns in Self-Reported Menstrual Distress

To determine the impact of gender roles, anxiety sensitivity, and somatic concerns on self-reported menstrual distress, two studies were conducted. In the first study using 278 primarily Caucasian college females, anxiety-sensitivity level, not current menstrual cycle phase, influenced reports of menstrual symptom severity and depression. Regardless of cycle phase at the time of self-report, women high in anxiety sensitivity reported significantly more depressed mood, trait anxiety, and retrospective menstrual symptoms. In the second study of 158 primarily Caucasian college females varying in anxiety sensitivity levels, adherence to sex role stereotypes, feminist beliefs, and illness attitudes were examined. Participants also completed measures of general premenstrual, most-recent premenstrual, and current menstrual symptoms. Women high in anxiety sensitivity reported the highest levels of sex-specificity, feminist embeddedness, and illness attitudes, with sex-specificity accounting for significant variance in current menstrual symptoms. Results are discussed within the context of the menstrual reactivity hypothesis, which proposes that beliefs surrounding the menstrual cycle and body sensations expectancies contribute to self-reports of greater menstrual distress. Women high in anxiety sensitivity appear to represent one subgroup vulnerable to menstrual reactivity.     

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.     

Psychosocial Functioning in Children and Adolescents with Gastrointestinal Complaints and Disorders

The current study examined the prevalence and presentation of psychosocial symptoms in pediatric patients and their parents presenting for first time appointments at a gastroenterology (GI) clinic compared to healthy controls (HC). One hundred GI patients, aged 8-17 years, and their mothers were compared to 100 age- and gender-matched HC on measures of child and parental behavioral/psychosocial functioning, depression, and anxiety. Results revealed significant correlations between mother- and child-reported internalizing behaviors and psychological symptoms. Significant group differences were observed in internalizing problems, adaptive and social skills, and leadership competency, as well as parental interpersonal sensitivity, depression, phobic anxiety, and number of psychological symptoms. GI patients are at increased risk for psychosocial and social dysfunction compared to healthy peers. Psychosocial factors should be considered when assessing patients in GI clinics. Patients might benefit from treatment plans that involve adjunctive behavioral intervention to assist patients in managing their conditions.     

Interpersonal functioning and depressive symptoms in childhood: Addressing the issues of specificity and comorbidity

Research has supported linkages between depression and social impairment in youngsters, but has often focused on depressive symptoms in isolation. We collected data on depressive, anxiety, and externalizing symptoms in 161 school children. Information about interpersonal competence was gathered from several sources, including children, teachers, and behavioral observations. Depressive symptoms were found to be related to difficulties in multiple areas of competence, including maladaptive social problem-solving styles, conflict-negotiation and affect-regulation deficits, and peer rejection. Comparisons of the relative contributions made by depressive and anxiety symptoms to the prediction of functioning yielded some evidence for a specific relation between depressive symptoms and impairment. Children with cooccurring internalizing and externalizing symptoms generally suffered from the most social dysfunction. If replicated in clinical samples, findings such as these may help to guide intervention efforts with depressed children.We thank Daphne Isenberg, Margie Limon, Leslie Scher, and Jennifer Silverman for their assistance in various aspects of this study. We would also like to express our appreciation to the participating children and teachers and to the UCLA Bruin Kids Day Camp.     

Social anxiety and perceptions of likeability by peers in children

The current study aimed to investigate the discrepancy between self-reported and peer-reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi-informant measures when studying the relation between social anxiety and social functioning in children.     

Questionnaire Assessment Potentially Overestimates Anxiety in Parkinson's Disease

Assessment of anxiety in Parkinson's disease (PD) is complicated by symptoms, such as trembling and shaking, that the two disorders have in common. This symptom overlap produces a potential for overestimation of the rate and severity of anxiety when assessed by self-report questionnaire. The purpose of this study is to estimate the extent to which anxiety scores in PD patients might be overestimated by two commonly-used mood state questionnaires. Fifty-nine patients with PD were administered the Beck Anxiety Inventory and the Profile of Mood States. Results indicate that the rate of clinically significant anxiety on these measures is indeed higher than the rate of clinical anxiety as determined by interview alone, suggesting the potential for overestimation of anxiety in PD when using self-report questionnaires.     

Humor styles impact the relationship between symptoms of social anxiety and depression

Recent research suggests that examining humor styles may contribute to our understanding of clinical problems, such as risk and resiliency. The goal of the current study was to examine whether humor styles moderate the association between social anxiety and depressive symptoms in an unselected sample. Three-hundred and six participants (66% female) at a large Southern US university completed self-report measures of humor styles and symptoms of social anxiety and depression. Regression analyses suggested that affiliative and self-defeating humor styles individually moderated the relationship between social anxiety and depressive symptoms. Clinical implications regarding the monitoring of humor use as a means of understanding the maintenance of depressive symptoms among socially anxious individuals are discussed.     

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.     

Differential Item Functioning of the Symptoms of Major Depression by Race and Ethnicity: An Item Response Theory Analysis

This study examines the psychometric properties, and particularly differential item functioning (DIF) due to racial and ethnic group, of the criteria for a major depressive episode using a large sample (N?=?1,063) of outpatients seeking treatment for mood and anxiety disorders. DIF was evaluated using multiple group confirmatory factor analysis. Item thresholds fell along a continuum with the core features of depressed mood and anhedonia, along with fatigue, being endorsed at lower levels of depression, and change in appetite and suicidal ideation endorsed at more severe levels of depression. Item discriminations, reflecting an item’s ability to discriminate between lower and higher levels of depression, were highest for depressed mood and anhedonia, and lowest for change in appetite and suicidal ideation. When examining model fit among the racial groups we did not find differences in symptom functioning, providing support for the use of these symptoms across diverse groups. This is of particular importance given the paucity of studies examining this question using a semi-structured clinician administered instrument to a clinical sample.     

Mental state decoding in past major depression: Effect of sad versus happy mood induction

Individuals with mild depression show an enhanced ability to read or “decode” others' mental states. The goal of the present study was to investigate whether this pattern of performance is related specifically to the pathology of depression or whether it is simply a feature of the transient dysphoric state. Forty-one undergraduates with a previous episode of major depression and 52 undergraduates with no depression history participated in a mental state decoding task following a sad versus happy mood induction. Previously depressed participants were significantly more accurate in their mental state judgements than were the never-depressed participants, suggesting that enhanced mental state decoding may be a specific feature of depression in remission. Furthermore, previously depressed participants whose positive mood increased in response to the happy mood induction showed a poorer level of performance on the task, similar to that observed in the never-depressed group. Thus, a happy mood may have induced a somewhat less accurate, but perhaps more adaptive, approach to processing social information. These findings were robust after controlling for current level of depression and anxiety symptoms, intensity of response to the mood induction, response times, and performance on a control task.     

The tripartite model for assessing symptoms of anxiety and depression: psychometrics of the Dutch version of the mood and anxiety symptoms questionnaire

AIM: The tripartite model conceptualizes symptoms of depression and anxiety in three groups: low positive affect and anhedonia, which is specific to depression, somatic arousal, which is unique to anxiety, and nonspecific general distress. The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure these symptom domains. This study reports on the psychometric properties of the Dutch translation of the MASQ. METHOD: The questionnaire was completed by a population-based sample and by patients with anxiety and/or mood disorders. Scores of these respondent groups were compared to assess the discriminant validity of the MASQ and evaluate the appropriateness of the tripartite model. RESULTS: The psychometric properties of the translated MASQ were highly satisfactory. In accordance with the model, we found the MASQ to comprise three main scales, which discriminate well between subgroups of patients with mood and anxiety disorders. DISCUSSION: Overall, like the English version the Dutch translation of the instrument appears to be a reliable and valid measure of symptoms of depression and anxiety, conceptualized as comprising three groups of symptoms. The Dutch MASQ is better able to distinguish unique aspects of mood and anxiety disorders than other self-report instruments.