Anxiety and depression in the working population using the HAD Scale--psychometrics, prevalence and relationships with psychosocial work characteristics.

Andrea H, Bultmann U, Beurskens AJ, Swaen GM, van Schayck CP, Kant IJ.

Department of General Practice, Maastricht University, Maastricht, The Netherlands. helene.andrea deviersprong.nl

BACKGROUND:The purposes of this study were: 1) to explore the psychometric properties of the HAD Scale in the working population, 2) to determine the prevalence of anxiety and depression on two severity levels among employees, and 3) to examine whether psychosocial work-related determinants for both categories of mental health problems may differ. METHODS: Data were taken from 7482 employees participating in the epidemiological Maastricht Cohort Study on Fatigue at Work. Anxiety and depression were measured with the easy to administer self-report Hospital Anxiety and Depression (HAD) Scale, while several questionnaires and self-formulated questions were used to measure psychosocial work-related characteristics. RESULTS: A principal component analysis indicated that the HAD Scale enables measuring anxiety and depression as separate constructs among employees. On a subclinical level, prevalences of anxiety and depression were both considerable: anxiety prevalences were 8.2 % for males and 10 % for females, and depression prevalences were 7.1% for males and 6.2% for females. Regarding self-reported psychosocial work characteristics, in multivariate regression analyses partly differential cross-sectional associations were found for anxiety and depression. CONCLUSIONS: The results indicate that subclinical anxiety and depression are considerable in the working population and provide suggestive evidence that diagnosing, preventing or managing anxiety and depression among employees may require focusing on different aspects of their psychosocial work environment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15300374&dopt=Abstract anxiety medicine




Endotoxin exposure in early life alters the development of anxiety-like behaviour in the Fischer 344 rat.

Walker FR, March J, Hodgson DM.

Laboratory of Neuroimmunology, School of Behavioural Sciences, University of Newcastle, Newcastle 2308, NSW, Australia. rohan.walker newcastle.edu.au

Previous research in the rat has demonstrated that neonatal exposure to bacterial endotoxin alters the level of anxiety-like behaviour displayed in adulthood. Currently, however, little is known about the emergence and development of this type of behaviour. Given the ability of neonatal endotoxin exposure to alter neural substrates involved in regulating anxiety, we tested the hypothesis that it may also alter the developmental trajectory of anxiety-like behaviour in the rat. Male Fischer 344 neonatal rats were treated with endotoxin (0.05 mg/kg lipopolysaccharide from Salmonella enteriditis) or vehicle on postnatal days 3 and 5. Age related changes in anxiety-like behaviour were subsequently investigated using the elevated plus maze apparatus at three developmental time points; adolescence (43 days), adulthood (80 days) and senescence (400 days). Neonatal endotoxin exposure was found to significantly increase circulating levels of corticosterone on postnatal days 3 and 5 at 4 h postadministration (P < 0.05). Additionally, endotoxin exposure was found to markedly alter anxiety-like behaviour in adulthood and senescence (P < 0.05). Specifically, adult and senescent endotoxin treated animals displayed significantly more anxiety-like behaviour than vehicle treated controls. Interestingly no significant differences in anxiety-like behaviour were observed between treatment groups during adolescence. These findings highlight the importance of the early life microbial environment in the development of emotional behaviour and suggests that neonatal infection may be an important predictor of susceptibility to anxiety related disorders in adult life.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15302111&dopt=Abstract anxiety medicine




Depression and anxiety: a comparison of older-aged Greek-born immigrants and Anglo-Australians.

Kiropoulos LA, Klimidis S, Minas H.

Department of Psychiatry and Centre for International Mental Health, School of Population Health, University of Melbourne, Melbourne, Victoria 3053, Australia.

OBJECTIVE: To compare depressive and anxiety illness in an older-aged sample of Greek-born (GB) immigrants who were likely to have been excluded from the National Survey of Mental Health and Wellbeing due to their lack of fluency in the English language and for whom rates of mental disorder are unknown, with a comparably recruited sample of Anglo-Australians (AA). METHOD: One hundred and forty-six GB and 146 AA respondents with a mean age of 68 years living in Melbourne and recruited through social clubs, completed the Beck Depression Inventory-II (BDI-2) and the State-Trait Anxiety Inventory (STAI) in addition to socio-demographic and other background questions. RESULTS: Greek-born respondents exhibited higher depression and anxiety scores and reported more depressive and anxiety symptomatology than the AA respondents. More GB respondents (17.1%) were likely to be included in the moderate to severe BDI-2 depression categories than AA (4.1%). Greek-born respondents (43.1%) were more likely to be included in the higher anxiety categories (i.e. score 41-80) of the STAI than the AA (15.8%). However, when controlling for health, economic and social factors there was no difference in the BDI-2 measures between the two groups. Despite controlling for these factors the GB still scored more highly on STAI measures than AA respondents. CONCLUSIONS: No differences were found between groups on measures of depression once controlling for age, education and occupational level, current financial status, marital status, household composition, current work status, physical health and stress. Such factors were also shown to influence group-differences anxiety but they not entirely explain group differences. Higher anxiety in GB respondents were likely to have been determined through the effects of additional but unmeasured cultural and immigrant status factors. Psychological morbidity in immigrants is best accounted for by considering the influence of social, health and other living conditions in addition to the effects of culture or immigrant status.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15324336&dopt=Abstract anxiety medicine




Is pregnancy anxiety a distinctive syndrome?

Huizink AC, Mulder EJ, Robles de Medina PG, Visser GH, Buitelaar JK.

Department of Child and Adolescent Psychiatry and Rudolf Magnus Institute, University Medical Centre Utrecht, The Netherlands. A.C.Huizink erasmusmc.nl

OBJECTIVE: Assessment of general anxiety during pregnancy may underestimate anxiety specifically related to pregnancy. Pregnancy anxiety rather than general anxiety has been shown to predict birth outcome and neuroendocrine changes during pregnancy. Therefore, a questionnaire on pregnancy anxieties was used to test their structure, and to examine their associations with general anxiety and depression. METHOD: Nulliparous pregnant women with a normal risk status (N=230) filled in a 34-item questionnaire on pregnancy-related anxiety and other questionnaires covering general anxiety and depression. These questionnaires were filled in at 15-17, 27-28, and 37-38 weeks of gestation. RESULTS: A three-factor model of pregnancy anxiety was found by means of confirmatory factor analysis, reflecting 'fear of giving birth', 'fear of bearing a handicapped child' and 'concern about one's appearance'. General anxiety and depression measures explain only a small part of the variance of these fears. CONCLUSION: Pregnancy anxiety should be regarded as a relatively distinctive syndrome. Its measurement enables researchers and clinicians to address issues of prediction, identification and risk reduction more precisely and perhaps more effectively in the future.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15324989&dopt=Abstract anxiety medicine




Antenatal maternal anxiety is linked with atypical handedness in the child.

Glover V, O'Connor TG, Heron J, Golding J; ALSPAC Study team.

Wolfson and Weston Research Centre for Family Health, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK. v.glover imerial.ac.uk

BACKGROUND: Animal studies have shown that prenatal stress is linked with altered laterality in the offspring. AIMS: The aim of this study was to test the hypothesis that antenatal maternal anxiety was associated with altered lateralisation in children, as demonstrated by mixed handedness. STUDY DESIGN AND SUBJECTS: We used the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective longitudinal study that has followed women since pregnancy. The final analysis included data on 7431 mother-child pairs. Maternal anxiety was measured at 18- and 32-week gestation and 8 weeks postnatally using a self-report inventory. Child handedness was assessed at 42 months using an established maternal report scale. Information on maternal and paternal handedness, as well as data on possible confounding variables such as obstetric and antenatal risks, were also assessed. RESULTS: Univariable analysis showed that antenatal anxiety at 18 weeks was associated with mixed-handedness in the child, OR=1.28 (95% CI 1.09-1.50, p<0.01). Although boys were more likely than girls to be mixed handed, the link with antenatal anxiety was similar. There was no significant association with antenatal anxiety at 32 weeks. Multivariable analyses indicated that maternal anxiety at 18 weeks of pregnancy predicted an increased likelihood of mixed-handedness in the child (OR=1.23, 95% CI 1.02-1.48, p<0.05), independently of parental handedness, obstetric and other antenatal risks, and postnatal anxiety. CONCLUSION: This result provides further evidence for a link between antenatal anxiety and fetal programming in humans.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15324991&dopt=Abstract anxiety medicine




Anxiety, threat perception abnormalities, and emotional reasoning in nonclinical Dutch children.

Muris P, Merckelbach H, Schepers S, Meesters C.

Department of Medical, Clinical, and Experimental Psychology, Faculty of Health Sciences, Maastricht University, The Netherlands. p.muris dep.unimaas.n

Examined the relation between childhood anxiety and threat-perception abnormalities using vignettes in which external (i.e., exposure to potential threat cues) and internal (i.e., experience of anxiety responses) information were systematically varied. Nonclinical children (N = 156) aged 8 to 13 years completed anxiety questionnaires and were then exposed to 3 types of stories: ambiguous stories, ambiguous + anxiety-response stories, and nonthreatening stories. From children's responses to these stories, a number of threat-perception indexes were derived. Results showed that both external and internal information inflated children's perception of threat. Further, high levels of anxiety were accompanied by enhanced threat perception in response to external threat cues. Finally, little evidence was found that high levels of anxiety, and in particular of anxiety sensitivity, were associated with a greater tendency to use internal information (i.e., emotional reasoning). Potential avenues for future studies on anxiety-related threat-perception distortions are briefly discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12881033&dopt=Abstract anxiety medicine




Immune parameters in patients with anxiety or depression during psychotherapy.

Atanackovic D, Kroger H, Serke S, Deter HC.

Department of Oncology and Hematology, Medical University Clinic Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. datanackov aol.com

BACKGROUND: Numerous studies have described distinctive immunological findings in patients with depression. In contrast, only very little is known about the possible influence of anxiety disorders on the immune system. It is also unknown whether treatment with psychotherapy alone has any influence on immunological variations in patients with psychiatric disorders. METHODS: We measured immunological and psychological parameters in patients with minor depression (N=10) or anxiety disorder (N=13) over an 8-week course of inpatient psychotherapy. Data for patients and a group of healthy controls (N=11) were recorded three times in 4-week intervals. A FACS analysis revealed the composition of lymphocyte subpopulations. The production of reactive oxygen species (ROS) by phagocytes was analyzed using lucigenin-enhanced chemiluminescence. RESULTS: On admission, patients with anxiety disorder showed a markedly elevated ratio of CD4(+) (T helper) versus CD8(+) (T suppressor/cytotoxic) lymphocytes compared to healthy controls (P<0.001) and minor depressives (P<0.01). The increased ratio in patients with anxiety disorder could mainly be attributed to a reduced count in CD8(+) T cells compared to healthy controls (P<0.01) and depressives (P<0.05). There were no differences between patients with depression and healthy controls with respect to the CD4(+)/CD8(+) ratio. We did not observe any differences in the production of ROS by phagocytes in patients compared to healthy controls. The CD4(+)/CD8(+) ratio remained elevated in patients with anxiety disorders during the following 8 weeks. There were no significant changes in this parameter over the course of the inpatient treatment. Limitations: As a pilot study on the immune status in patients with anxiety disorders, the study's main limitation is the relatively low number of patients observed. CONCLUSIONS: In this study we demonstrated for the first time marked immunological changes in patients with anxiety disorders. In addition, our results provide preliminary evidence that these immunological variations are not reversible by an 8-week course of inpatient psychotherapy alone.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15337324&dopt=Abstract anxiety medicine




A descriptive and comparative study of the prevalence of depressive and anxiety disorders in low-income adults with type 2 diabetes and other chronic illnesses.

Thomas J, Jones G, Scarinci I, Brantley P.

Mayo Clinic, Nicotine Dependence Center, Rochester, Minnesota 55905, USA. thomas.janet mayo.edu

OBJECTIVE: To determine whether type 2 diabetes contributes to the presence of depressive and anxiety disorder diagnoses in low-income adults with hypertension, asthma, and/or arthritis. RESEARCH DESIGN AND METHODS: Using a cross-sectional design, this study administered a structured diagnostic interview to low-income primary care patients diagnosed with type 2 diabetes, hypertension, arthritis, and asthma, as well as to those with no chronic illness (n = 326), to determine the 12-month prevalence of depressive and anxiety disorders. A logistic regression (LR) model was used to assess whether a diagnosis of depression and/or anxiety was associated with type 2 diabetes after adjusting for known risk factors. RESULTS: A high prevalence rate of depressive and/or anxiety disorders was found in the total sample (29%) and in all three illness groups: type 2 diabetes (36%), other chronic illnesses (24%), and no chronic illness (31%). Using LR, a main effect was detected for illness group when age and education were controlled (chi(2) = 22.66, df 4, P = 0.000). Specifically, the odds of occurrence of a depressive and/or anxiety disorder in those with comorbid type 2 diabetes were twice that in the nondiabetic, chronically ill comparison group (odds ratio 2.26, 95% CI 1.28-4.01, P = 0.005). CONCLUSIONS: These results suggest a positive contribution of type 2 diabetes to increased rates of depressive and/or anxiety disorders in patients with hypertension, asthma, and/or arthritis and support prior research that type 2 diabetes may serve as an indicator of depression and anxiety in low-income adults treated in primary care clinics.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12882854&dopt=Abstract anxiety medicine




Is joint hypermobility related to anxiety in a nonclinical population also?

Bulbena A, Agullo A, Pailhez G, Martin-Santos R, Porta M, Guitart J, Gago J.

Department of Psychiatry, Hospital del Mar, Barcelona, Spain. abulbena acmcb.es

This study examines the association between joint hypermobility syndrome and anxiety in a nonclinical sample. Subjects (N = 526) receiving a medical check-up were assessed with the Hospital del Mar hypermobility criteria and the State-Trait Anxiety Inventory. Scores for trait anxiety, and to a lesser extent state anxiety, were significantly higher among subjects with joint hypermobility syndrome than among subjects without this syndrome (median trait anxiety scores for women: 17 versus 11; median scores for men: 13 versus 1). These findings indicate that the association of joint hypermobility syndrome and anxiety holds even for subjects with no psychiatric diagnosis. Therefore, it seems that this benign connective tissue disorder is a predisposing factor for trait anxiety. However, it is necessary to further explore and define the biological basis of this syndrome, as well as its associations and clinical expressions, which interact with great complexity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15345789&dopt=Abstract anxiety medicine