Structure of anxiety and the anxiety disorders: a hierarchical model.

Zinbarg RE, Barlow DH.

Psychology Department, University of Oregon, Eugene 97403-1227, USA. rzin oregon.uoregon.edu

The authors used a semistructured clinical interview and a self-report battery of questionnaires to measure key features of the anxiety disorders in a large sample of patients seeking treatment at an outpatient anxiety disorders clinic and in a no mental disorder group. Results were consistent with hierarchical models of anxiety and the anxiety disorders such as the model implicit in American Psychiatric Association (1987, 1994) and trait models positing a trait diathesis common to all the anxiety disorders. A higher order general factor differentiated each of the patient groups from the no mental disorder group. Several lower order factors provided the basis for differentiation among the patient groups. Conclusions regarding the degree to which models predicting a hierarchical structure of anxiety and the anxiety disorders are empirically supported must await replication of these results with additional samples.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8722999&dopt=Abstract anxiety medicine




Anxiety and depression in general practitioners: associations with type of practice, fundholding, gender and other personal characteristics.

Chambers R, Campbell I.

Centre for Primary Health Care, School of Postgraduate Medicine, University of Keele, Stoke Health Centre, Honeywall, Stoke-on-Trent, UK.

BACKGROUND. There is evidence both that a doctor's own well-being is closely associated with efficiency and positive attitude to patients, and that levels of stress, anxiety and depression in doctors are rising. OBJECTIVES. This postal survey aimed to measure anxiety and depression levels in general practitioners in 1994 and identify any associations with personal and practice characteristics. METHODS. All general practitioners with patients in Staffordshire were invited to complete the Hospital Anxiety and Depression (HAD) scale. RESULTS. Six hundred and twenty of 896 general practitioners replied (response rate 69%). No gender differences were found in rates of anxiety and depression; overall, 19% of respondents were 'cases' of anxiety and 22% others had borderline anxiety scores; 10% were 'cases' of depression and 16% others had borderline depression scores. Anxiety 'caseness' was associated with living alone, amount of on-call duties undertaken, and being fourth/fifth wave fundholders. Depression 'caseness' was associated with having little free time from practice work, amount of on-call, being single handed, and working in a non-training practice. CONCLUSIONS. The authors concluded that the level of mental ill-health in general practitioners is a matter of concern and is associated with workload.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8732330&dopt=Abstract anxiety medicine




The psychological effects of breast screening in terms of patients' perceived health anxieties.

Swanson V, McIntosh IB, Power KG, Dobson H.

Department of Psychology, University of Stirling, Glasgow.

This study aimed to assess and compare the impact of letter of invitation, initial breast screening mammography, and subsequent recall procedures on the level of anxiety over breast problems. The survey of females undergoing routine breast screening procedures in a primary care setting is part of the first wave of a national breast screening programme in the UK. Women aged 50-64 registered with six general practices (n = 2618) were invited by letter to attend for screening. Their self-perceived impact of receipt of invitation letter, attendance at initial screening, and recall, in terms of anxiety and concern about breast problems, was measured by a self-report questionnaire and the physical, emotional and social dysfunction subscales of the Psychological Consequences of Screening Mammography Questionnaire (PCQ). Overall, subjects' anxiety levels diminished between the receipt of their invitation letter and the completion of their screening examination. Subjects did not, however, respond to the letter of invitation and screening procedure in a homogeneous manner. In a sample of 1253, the letter of invitation reduced anxiety about breast problems in 39.7%, increased anxiety in 24.6%, and had no appreciable effect in 35.7%. In the 1280 who attended for breast screening, the examination procedure reduced anxiety about breast problems in 55.9%, increased anxiety in 12.8%, and had no appreciable effect in 31.3%. In a smaller sample (n = 33) who completed questionnaires at recall, there were significant increases in PCQ-measured anxiety. Throughout the study, the PCQ was sensitive to change in anxiety over breast problems. We conclude that screening procedures can either increase or reduce anxiety about breast problems, or have no appreciable effect. Subjects' perception of the impact of receiving the letter of invitation and undergoing the screening examination procedure is related to previous levels of concern over breast problems. Conclusions about the psychological effect of breast screening cannot be drawn without consideration of the time and place of the baseline assessment. Participants in breast screening programmes therefore cannot be considered a homogeneous entity. Caution should be exercised when assessing the impact of screening procedures on entire populations as this approach might mask an important diversity of response.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8733330&dopt=Abstract anxiety medicine




Which anxiety disorders may differentiate attention deficit hyperactivity disorder, combined type with dysthymic disorder from attention deficit hyperactivity disorder, combined type alone?

Vance A, Harris K, Boots M, Talbot J, Karamitsios M.

Department of Psychological Medicine, Monash University, Alfred Hospital Child and Adolescent Mental Health Service, Victoria, Australia. alasdair.vance med.monash.edu.au

OBJECTIVE: Attention deficit hyperactivity disorder, combined type (ADHD-CT), dysthymic disorder, and anxiety disorders frequently co-occur in primary school age children, although there have been no published data describing their association. We investigated the association of anxiety, defined from a parent or child perspective, with primary school-age children with ADHD-CT with and without dysthymic disorder. METHOD: One hundred and forty-six medication naive children with ADHD-CT were studied. Two groups with and without dysthymic disorder were formed to compare parent and child reports of anxiety, using categorical and continuous measures of anxiety, using logistic regression. RESULTS: Separation anxiety disorder and social phobia were associated with primary school-age children with ADHD-CT and dysthymic disorder, compared to children with ADHD-CT without dysthymic disorder. CONCLUSIONS: The recognition of dysthymic disorder and anxiety disorders and their management in primary school-age children with ADHD-CT is generally poorly understood. The identification and elucidation of composite anxiety and depressive phenomena that may be systematically investigated through longitudinal studies of epidemiologically derived samples is needed in this particular group of children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14511084&dopt=Abstract anxiety medicine




The Amsterdam Preoperative Anxiety and Information Scale (APAIS)

Moerman N, van Dam FS, Muller MJ, Oosting H.

Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, The Netherlands.

The purpose of the present study was to assess patients' anxiety level and information requirement in the preoperative phase. During routine preoperative screening, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Two hundred patients also completed Spielberger's State-Trait Anxiety Inventory (STAI-State). Patients were able to complete the questionnaire in less than 2 min. On factor analysis, two factors emerged clearly: anxiety and the need for information. The anxiety scale correlated highly (0.74) with the STAI-State. It emerged that 32% of the patients could be considered as "anxiety cases" and over 80% of patients have a positive attitude toward receiving information. Moreover, results demonstrated that 1) women were more anxious that men; 2) patients with a high information requirement also had a high level of anxiety; 3) patients who had never undergone an operation had a higher information requirement than those who had. The APAIS can provide anesthesiologists with a valid, reliable, and easily applicable instrument for assessing the level of patients' preoperative anxiety and the need for information.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8623940&dopt=Abstract anxiety medicine




A troubled youth: relations with somatization, depression and anxiety in adulthood.

Portegijs PJ, Jeuken FM, van der Horst FG, Kraan HF, Knottnerus JA.

Department of Psychiatry and Neuropsychology, University of Limburg, Maastricht, Netherlands.

BACKGROUND. Childhood experiences profoundly affect later functioning as an adult. Family practitioners are well-placed to discover the links between childhood troubles and later somatization, depression or anxiety. OBJECTIVES. We aimed to study the interrelation of somatization, depressive and anxiety disorders in frequently attending patients in general practice; to investigate whether these problems are related to a childhood history of illness experiences, deprivation, life events and abuse; and to determine the independent contributions of these childhood factors to the prediction of adult somatization, depressive and anxiety disorders. METHODS. One hundred and six adult general practice patients with high consultation frequency were studied. Somatization was operationalized as a more comprehensive version of DSM-III-R somatization disorder (5 complaints; SSI 5/5). For depression (ever depressive and/or dysthymic) and anxiety (panic, phobias and/or generalized anxiety) DSM-III-R criteria were used. Using a structured questionnaire we assessed illness experiences, deprivation of parental care, abuse (sexual/physical) and other life events before age 19. RESULTS. The overlap between somatization, depression and anxiety was largely accounted for by 16 patients with a triple problem: somatization and depression and anxiety. Somatization was specifically related to deprivation, depression to other life events. Abuse (prevalence 16%) independently predicted psychiatric problems in general. Youth experiences before age 12 were most important. CONCLUSIONS: The high prevalence of triple problems suggests a need to reconsider concepts like somatic anxiety and anxious depression. The specificity of the relation between deprivation and somatization and of the relation between other life events and depression indicates that distinct causal mechanisms (in youth) contribute to these problems.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8671097&dopt=Abstract anxiety medicine




Stress and stress-related hormones during in-vitro fertilization treatment.

Harlow CR, Fahy UM, Talbot WM, Wardle PG, Hull MG.

University of Bristol, Department of Obstetrics and Gynaecology, St Michael's Hospital, UK.

Whether stress and infertility are linked as cause or consequence is unclear, and there is no consensus on the most appropriate methods for measuring stress in infertile women. To address this question, we measured changes in biochemical and questionnaire-based assessments of stress in infertile women. Median baseline, follicular phase and pre-operative serum prolactin (229, 311 and 457 mIU/l) cortisol (278, 369 and 496 nmol/l) and state anxiety score (38, 40 and 49) respectively all increased during stimulated in-vitro fertilization (IVF) treatment. There was no such increase in a control group having similar laparoscopic surgery unrelated to infertility, or in women having unstimulated IVF without laparoscopy, suggesting that anxiety levels are greatest in stimulated IVF, increase as a result of the treatment, and are adequately reflected by state anxiety scores. Baseline serum prolactin in unstimulated IVF (384 mIU/l) was significantly higher than control (177 mIU/l), although this was not reflected in serum cortisol or state anxiety score. Trait anxiety was constant within and between groups, suggesting that stress is not contributing greatly to the infertility. Women who achieved a pregnancy had similar state anxiety scores to those who failed, suggesting that the degree of anxiety observed during IVF treatment is unlikely to influence the chance of pregnancy. There was a trend towards lower trait anxiety in women who became pregnant, but the numbers were small.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8671208&dopt=Abstract anxiety medicine




State and trait anxiety in adolescent suicide attempters.

Ohring R, Apter A, Ratzoni G, Weizman R, Tyano S, Plutchik R.

Department of Children and Adolescents, Geha Hospital, Beilinson Medical Center, Petah Tikva, Israel.

OBJECTIVE: To examine the relationship between anxiety and suicidal behavior in adolescents. METHOD: Forty-six adolescents who had been hospitalized in an inpatient psychiatric unit after a suicide attempt were compared on measures of anxiety and depression with 72 adolescent psychiatric inpatients who had no history of suicide attempts. RESULTS: The suicide attempters exhibited significantly higher levels of both state and trait anxiety. However, when controlling for depression, the attempters did not differ in their level of state anxiety from the nonattempters, but they still manifested significantly higher levels of trait anxiety than nonattempters. CONCLUSIONS: The results suggest that anxiety, both state and trait, is a risk factor for suicidal behavior in adolescents. Yet, only trait anxiety appears to be relatively independent of depression in its effect on suicidal behavior risk. These findings imply that clinicans should take into account anxiety, both state and trait, for assessment and treatment of adolescents at risk for suicidal behavior.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8720624&dopt=Abstract anxiety medicine




Differentiating anxiety and depression in older adults with generalized anxiety disorder.

Beck JG, Novy DM, Diefenbach GJ, Stanley MA, Averill PM, Swann AC.

Department of Psychology, University at Buffalo, State University of New York, Park Hall, Buffalo, New York 14260, USA. jgbeck buffalo.edu

To examine affect and cognition in differentiating anxiety and depression, 83 older participants with generalized anxiety disorder completed the Cognitive Checklist (CCL) and the Positive and Negative Affect Schedule (PANAS). A 3-factor solution was found for the PANAS: positive affect (PA), anxiety and anger (Negative Affect 1 [NA-1]), and guilt and shame (Negative Affect 2 [NA-2]). A 2-factor structure was noted for the CCL. Correlations with anxiety and depression measures suggested that the CCL Depression (CCL-D) subscale showed stronger correlations with depression, whereas the CCL Anxiety subscale did not uniquely correlate with anxiety. The NA-1 subscale correlated positively with measures of depression and anxiety, whereas the PA subscale showed negative correlations. Hierarchical regression suggested that the CCL-D subscale was a significant predictor of self-reported depression.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12847778&dopt=Abstract anxiety medicine