A randomized controlled trial of guided internet-delivered cognitive behaviour therapy for older adults with generalized anxiety.

This study aimed to establish the efficacy of guided Internet-delivered cognitive-behaviour therapy (ICBT) for older adults with generalized anxiety disorder (GAD) or subclinical GAD. Participants were randomized to receive seven modules of ICBT (n=24) or to a waiting list condition (WLC; n=22). Faster improvements in symptoms of anxiety and depression were observed for participants in the ICBT condition relative to the WLC, with large between-group effect sizes on the Generalized anxiety disorder-7 (d=.85) and the Patient health questionnaire (d=1.17) obtained at post-treatment. Further reduction in generalized anxiety symptoms was reported over the one-month follow-up. Treatment effects were replicated when control participants subsequently underwent treatment. Higher ratings of treatment credibility, but not expectancy, prior to ICBT predicted improvements over time. The results support the efficacy of ICBT as treatment for older adults with GAD.

Understanding health anxiety following breast cancer diagnosis.

Health anxiety is a persistent fear of illness or disease that often involves the misinterpretation of bodily symptoms as signs of serious illness. Evidence shows that health anxiety affects a proportion of women following a diagnosis of breast cancer, but there are some limitations to how health anxiety has been measured. The objectives of this study were to (1) provide an estimate of clinically elevated health anxiety in women after a diagnosis of breast cancer using a validated measure appropriate for medical populations and (2) understand patient, disease, and anxiety/vulnerability variables that predict health anxiety in this group. Canadian women (n = 137) diagnosed with breast cancer within the past five years completed an online survey measuring health anxiety, along with patient, disease, and anxiety/vulnerability variables. Clinically significant health anxiety was reported by 23.4% of the sample. The regression model revealed that younger age, more advanced stage of breast cancer, increased cognitive anxiety sensitivity, and greater body vigilance were significant unique predictors of health anxiety. These findings highlight that a proportion of women report substantial health anxiety following breast cancer diagnosis, with a combination of patient, disease, and anxiety/vulnerability variables associated with the experience. Further research is needed to better understand the impact of health anxiety in this population.

The Short Health Anxiety Inventory: a systematic review and meta-analysis.

INTRODUCTION: The Short Health Anxiety Inventory (SHAI) measures health anxiety in medical and non-medical contexts. OBJECTIVE: To review the literature pertaining to the psychometric properties of the SHAI in non-clinical, clinical, and medical samples. Meta-analysis was also conducted to examine the strength of associations between the SHAI and other constructs. METHODS: Direct search of digital databases for papers that cited the original SHAI publication. RESULTS: Seventy-eight papers were identified, with 42 providing relevant information. The SHAI has acceptable Cronbach's alpha scores, strong construct validity, and is sensitive to treatment. Discrepancies have been observed between the findings of factor analytic studies, largely as a result of varying methods used. Overall, there appears to be greatest support for the original two factors, with one factor assessing health anxiety and one factor assessing negative consequences of illness. As expected, individuals with hypochondriasis score higher as compared to non-clinical samples. The strongest association was observed between the SHAI and other measures of health anxiety, followed by measures related to health anxiety vulnerability, and then general anxiety and worry. CONCLUSIONS: The SHAI is a psychometrically sound tool for assessing health anxiety across samples. Future studies are needed, however, to assess test-retest reliability, incremental validity, and cut-off scores as well as use of the SHAI among diverse samples.

Dementia anxiety among older adult caregivers: an exploratory study of older adult caregivers in Canada.

BACKGROUND: Although caring for individuals with dementia is known to result in increased burden and depression among caregivers, little research has investigated caregiver's anxiety or concern about eventually developing dementia themselves (i.e. dementia anxiety). Existing research reports mixed findings regarding variables (e.g. relationship to care recipient, sex, education) that predict dementia anxiety among caregivers and non-caregivers. Potential relationships among burden, depression and dementia anxiety have not been extensively examined. The present study explored caregiver and care recipient factors as predictors of dementia anxiety in older adult caregivers. METHODS: A sample of 116 older adult caregivers answered demographic/background questions and completed a series of self-report measures assessing dementia anxiety, caregiver burden, depression, and the physical disability of the care recipient. RESULTS: The majority of caregivers were female, Caucasian, and reported caring for a spouse. Analyses revealed that background variables were generally not related to dementia anxiety, while depression and caregiver burden were significantly associated. Using linear regression analysis, it was found that a diagnosis of dementia in the care recipient and caregiver depression were both significant predictors of caregiver dementia anxiety. CONCLUSION: Health care providers should be aware that dementia anxiety is associated with caring for individuals with dementia as well as with depression. Dementia anxiety may place additional strain on caregivers of individuals who have dementia and are suffering from depression and thus should be the focus of future research.

The relation of pain and caregiver burden in informal older adult caregivers.

OBJECTIVE: Pain in older adults is highly prevalent and although informal caregiving is commonly provided by an older cohort, the relationship between pain and caregiving has seldom been examined. Our goal was to study the associations between caregiver pain, depression, and caregiver burden in a sample of older adult caregivers. DESIGN: Questionnaires were completed by 116 caregivers (mean age=73.34) to measure the caregivers' overall pain, chronic pain status, caregiver burden and its five dimensions, depression, and the care recipients' level of disability. Hierarchical linear regression analyses evaluated the extent to which care recipient and caregiver variables, including caregiver pain and depression, were related to high levels of caregiver burden. RESULTS: The overall level of pain reported by the caregiver was a significant predictor of overall caregiver burden and the emotional and physical dimensions of caregiver burden, whereas a number of care recipient variables (e.g., disability level) were significant predictors of the social, emotional, and time dependence dimensions of caregiver burden. CONCLUSIONS: This is the first study to investigate the relationships among caregiver pain and caregiver burden in informal older adult caregivers. We conclude that the role of caregiver pain has been greatly underestimated in the caregiver burden literature and suggest a need for interdisciplinary collaboration for effective management of caregiver burden in older adults.

An evaluation of an integrated model of relapse in depression.

BACKGROUND AND AIM: The present study evaluated an integrated model of the role of psychosocial factors in the prediction of relapse of Major Depressive Disorder over a one-year follow-up period. METHODS AND ANALYSES: A range of established variables, including life stress, cognitive-personality vulnerability factors, social support, and coping responses, were simultaneously considered in a series of prediction models, in an adult female sample of remitted depressed individuals. RESULTS: It was determined that interpersonal marked difficulties, social support, and emotion-oriented and avoidance-oriented coping provided the best-fitting and most parsimonious predictive model for depressive relapse at one-year follow-up. CONCLUSIONS: The examination of multifactorial models of risk represents a promising avenue for future research and theory development.

What impact does pregnancy have on anxiety about health?

BACKGROUND: A previous study suggests that health anxiety, or preoccupation and fears about ill health, is elevated during pregnancy. However, replication of this result is needed given several methodological weaknesses of the previous research. The current study refined earlier work by assessing health anxiety using two distinct measures and comparing scores to a control group and to established norms for healthy controls. The relationship of health anxiety to background variables such as parity and pregnancy complications was also explored. METHODS: A total of 252 women in the third trimester of pregnancy and 45 similarly aged non-pregnant women completed the Illness Attitudes Scale (IAS) and the newly developed Short Health Anxiety Inventory (SHAI). RESULTS: Compared to the non-pregnant sample and established scores for healthy controls, health anxiety was not elevated during pregnancy. Health anxiety was higher in women who experienced complications during pregnancy but was unrelated to other background variables. The IAS identified more individuals as health anxious than the SHAI. CONCLUSIONS: Contrary to previous research, health anxiety was not elevated during pregnancy. The IAS appeared to be susceptible to identifying women as health anxious due to greater health care utilization by pregnant women rather than higher health anxiety. Clinical recommendations and future directions for the assessment of health anxiety are outlined.

Prenatal fear of childbirth and anxiety sensitivity.

OBJECTIVE: Fear of childbirth (FOC) or what is historically referred to as tokophobia (a phobic state where a woman avoids childbirth despite desperately wanting a baby), is known to complicate the delivery process. In this study, the relationship of Anxiety Sensitivity (AS) to FOC was examined given that AS is a risk factor for other fears. Specifically, the contribution of three AS dimensions (physical, psychological or social concerns) relative to other factors (e.g., parity of the mother, trait anxiety) in accounting for FOC was explored. METHODS: Women in their final 4 months of pregnancy (n = 110) completed the Anxiety Sensitivity Index, the State-Trait Anxiety Inventory-Trait Scale and the Wijma Delivery Expectancy/Experience Questionnaire. RESULTS: Most demographic variables were non-significant in predicting FOC with the exception of participants' parity. Multiple regression analysis revealed that AS-physical concerns significantly predicted elevated FOC even after controlling for parity and trait anxiety; higher levels of AS-physical concerns, higher trait anxiety, and expecting a first child all independently predicted greater FOC. CONCLUSION: Variance in FOC is explained, in part, by AS-physical concerns. Further, AS-physical concerns are distinct from trait anxiety in predicting FOC. Similar to other fears, the results support the possibility that AS may be a risk factor for elevated FOC.