Patterns of cognitive-emotional change after cognitive-behavioural treatment in emotional disorders: A 12-month longitudinal cluster analysis.

INTRODUCTION: The aim of this study was to use cluster analysis based on the trajectory of five cognitive-emotional processes (worry, rumination, metacognition, cognitive reappraisal and expressive suppression) over time to explore differences in clinical and performance variables in primary care patients with emotional symptoms. METHODS: We compared the effect of adding transdiagnostic cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) according to cluster membership and sought to determine the variables that predicted cluster membership. 732 participants completed scales about cognitive-emotional processes, anxiety and depressive symptoms, functioning, and quality of life (QoL) at baseline, posttreatment, and at 12 months. Longitudinal cluster analysis and logistic regression analyses were carried out. RESULTS: A two-cluster solution was chosen as the best fit, named as "less" or "more" improvement in cognitive-emotional processes. Individuals who achieved more improvement in cognitive-emotional processes showed lower emotional symptoms and better QoL and functioning at all three time points. TAU+TD-CBT, income level, QoL and anxiety symptoms were significant predictors of cluster membership. CONCLUSIONS: These results underscore the value of adding TD-CBT to reduce maladaptive cognitive-emotional regulation strategies. These findings highlight the importance of the processes of change in therapy and demonstrate the relevance of the patient's cognitive-emotional profile in improving treatment outcomes.

Effect of Reliable Recovery on Health Care Costs and Productivity Losses in Emotional Disorders.

Despite the high economic costs associated with emotional disorders, relatively few studies have examined the variation in costs according to whether the patient has achieved a reliable recovery. The aim of this study was to explore differences in health care costs and productivity losses between primary care patients from a previous randomized controlled trial (RCT)-PsicAP-with emotional symptoms who achieved a reliable recovery and those who did not after transdiagnostic cognitive-behavioral therapy (TD-CBT) plus treatment as usual (TAU) or TAU alone. Sociodemographic and cost data were obtained for 134 participants treated at five primary care centers in Madrid for the 12-month posttreatment period. Reliable recovery rates were higher in the patients who received TD-CBT + TAU versus TAU alone (66% vs. 34%, respectively; chi-square = 13.78, df = 1, p < .001). Patients who did not achieve reliable recovery incurred more costs, especially associated with general practitioner consultations (t = 3.01, df = 132, p = .003), use of emergency departments (t = 2.20, df = 132, p = .030), total health care costs (t = 2.01, df = 132, p = .040), and sick leaves (t = 1.97, df = 132, p = .048). These findings underscore the societal importance of achieving a reliable recovery in patients with emotional disorders, and further support the value of adding TD-CBT to TAU in the primary care setting.

Variables Associated with Emotional Symptom Severity in Primary Care Patients: The Usefulness of a Logistic Regression Equation to Help Clinical Assessment and Treatment Decisions.

The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources.

Variables Associated with Emotional Symptom Severity in Primary Care Patients: The Usefulness of a Logistic Regression Equation to Help Clinical Assessment and Treatment Decisions

The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources. (AU)

Worry, rumination and negative metacognitive beliefs as moderators of outcomes of Transdiagnostic group cognitive-behavioural therapy in emotional disorders.

BACKGROUND: Despite the relevance of cognitive processes such as rumination, worry, negative metacognitive beliefs in emotional disorders, the existing literature about how these cognitive processes moderate the effect of treatment in treatment outcomes is limited. The aim of the present study was to explore the potential moderator effect of baseline cognitive processes-worry, rumination and negative metacognitive beliefs-on the relationship between treatment allocation (transdiagnostic cognitive-behavioural therapy -TD-CBT plus treatment as usual-TAU vs. TAU alone) and treatment outcomes (anxiety and depressive symptoms, quality of life [QoL], and functioning) in primary care patients with emotional disorders. METHODS: A total of 631 participants completed scales to evaluate worry, rumination, negative metacognitive beliefs, QoL, functioning, and anxiety and depressive symptoms. RESULTS: Worry and rumination acted as moderators on the effect of treatment for anxiety (b = -1.25, p = .003; b = -0.98, p = .048 respectively) and depressive symptoms (b = -1.21, p = .017; b = -1.34, p = .024 respectively). Individuals with higher baseline levels of worry and rumination obtained a greater reduction in emotional symptoms from the addition TD-CBT to TAU. Negative metacognitive beliefs were not a significant moderator of any treatment outcome. LIMITATIONS: The study assesses cognitive processes over a relatively short period of time and uses self-reported instruments. In addition, it only includes individuals with mild or moderate anxiety or depressive disorders, which limits generalization to other populations. CONCLUSIONS: These results underscore the generalization of the TD-CBT to individuals with emotional disorders in primary care with different cognitive profiles, especially those with high levels of worry and rumination.

El consumo de loot boxes como una nueva forma de azar en los videojuegos / Loot boxes use as a new form of gambling within video games

Las loot boxes son cajas dentro de los videojuegos que los usuarios pagan por abrir y obtener, al azar, un objeto cuyo valor inicialmente desconocen. Tanto la población adolescente como la adulta tiene fácil acceso a ellas, y se han relacionado con el juego de azar. El objetivo de este estudio fue examinar el consumo de loot boxes y explorar si se asociaba con culpabilidad, pérdida de control y malestar. Para ello, 475 participantes (266 adolescentes y 209 adultos) respondieron a un cuestionario ex profeso de elaboración propia. Los resultados mostraron que son los adolescentes los que más dinero invierten en cajas botín. Este gasto se ve aumentado cuando se anuncia nuevo contenido en las plataformas multimedia online (entre ellas, Twitch, YouTube). Además, no obtener los ítems que desean, lo cual es frecuente por su aleatoriedad, predice mayores niveles de culpabilidad y malestar, mientras que su obtención predice la posterior pérdida de control. Así, el 45,5% de los participantes refirieron culpabilidad tras la compra, el 50% malestar y el 17% pérdida de control. En síntesis, las loot boxes están cada vez más presentes en los entornos virtuales de los adolescentes y adultos, y dadas las consecuencias psicológicas y emocionales que parecen tener, es necesario seguir abordando esta problemática en futuras investigaciones en aras de prevenir y apoyar a la población vulnerable. (AU)

Loot boxes are items within video games which players pay to open and, ultimately, to randomly obtain an object whose value is initially unknown. Being easily accessible for both teenagers and adults, loot boxes have been associated with gambling. The purpose of this study was to explore the use of loot boxes and to analyze whether it is associated with guilt, loss of control, and emotional distress. To this end, 475 participants (266 adolescents and 209 adults) were surveyed on their habits regarding loot boxes and gaming. The results showed that teenagers invest more money in loot boxes than adults. This expenditure increases when a new item is announced on online platforms (Twitch, YouTube). Additionally, not obtaining the coveted items, which is common due to loot box randomness, predicts greater levels of guilt and emotional distress, while obtaining them predicts subsequent loss of control. Thus, 45.5% reported guilt over purchasing, 50% distress and 17% loss of control. Summarizing, loot boxes are increasingly present in video games, and owing to their psycho-emotional outcomes, it is necessary for future research to address this matter in order to develop prevention strategies and to provide support to vulnerable populations. (AU)

Efficacy of a Combined Acceptance and Commitment Intervention to Improve Psychological Flexibility and Associated Symptoms in Cancer Patients: Study Protocol for a Randomized Controlled Trial.

Psychological flexibility is a key concept of acceptation and commitment therapy (ACT). This factor has been linked with psychological wellbeing and associated factors, such as quality of life, in cancer patients. These and other positive results of acceptation and commitment therapy in cancer patients found in previous research could be enhanced by using mhealth tools. A three-arm randomized superiority clinical trial, with a pre-post-follow-up repeated measures intergroup design with a 1:1:1 allocation ratio is proposed. A hundred and twenty cancer patients will be randomly assigned to one of the following interventions: (1) face-to-face ACT + mobile application (app), (2) face-to-face ACT, and (3) Waitlist control group. The primary expected outcome is to observe significant improvements in psychological flexibility acceptance and action questionnaire- II (AAQ-II) in the face-to-face ACT + app group, after comparing baseline and post-treatment scores, and the scores will remain stable in the two assessment points, 3 and 6 months after the intervention. Secondary expected outcomes are significant increasing scores in quality of life (EORTC QLQ C-30) and post-traumatic-growth (PTGI-SF), and significant decreasing scores in anxiety and depression (HADS), insomnia (ISI) and fatigue (BFI) at the same assessment points. Also, it is expected that the scores of this group will be higher than the scores of the face-to-face ACT group and the waitlist control group. This study aims to assess the efficacy of a combined intervention (face-to face ACT + app) for psychological flexibility and associated symptoms in cancer patients. The results of this protocol may help to consider the use of acceptation and commitment therapy and mhealth applications in cancer settings as a valid therapeutic choice. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT05126823].

Emotion Regulation as a Moderator of Outcomes of Transdiagnostic Group Cognitive-Behavioral Therapy for Emotional Disorders.

The aim of this study was to examine the potential moderating effect of baseline emotion regulation skills-cognitive reappraisal and expressive suppression-on the relationship between treatment allocation and treatment outcomes in primary care patients with emotional symptoms. A total of 631 participants completed scales to evaluate emotion regulation, anxiety, depression, functioning, and quality of life (QOL). The moderation analysis was carried out using the SPSS PROCESS macro, version 3.5. Expressive suppression was a significant moderator in the relationship between treatment allocation and treatment outcomes in terms of symptoms of anxiety (b = -0.530, p = .026), depression (b = -0.812, p = .004), and QOL (b = 0.156, p = .048). Cognitive reappraisal acted as a moderator only in terms of QOL (b = 0.217, p = .028). The findings of this study show that participants with higher scores of expressive suppression benefited more from the addition of transdiagnostic cognitive-behavioral therapy to treatment as usual (TAU) in terms of anxiety and depressive symptoms, and QOL. Individuals with higher levels of cognitive reappraisal obtained a greater benefit in terms of QOL from the addition of psychological treatment to TAU. These results underscore the relevant role that emotion regulation skills play in the outcomes of psychological therapy for emotional symptoms.

Loot boxes use as a new form of gambling within video games. / El consumo de loot boxes como una nueva forma de azar en los videojuegos.

Loot boxes are items within video games which players pay to open and, ultimately, to randomly obtain an object whose value is initially unknown. Being easily accessible for both teenagers and adults, loot boxes have been associated with gambling. The purpose of this study was to explore the use of loot boxes and to analyze whether it is associated with guilt, loss of control, and emotional distress. To this end, 475 participants (266 adolescents and 209 adults) were surveyed on their habits regarding loot boxes and gaming. The results showed that teenagers invest more money in loot boxes than adults. This expenditure increases when a new item is announced on online platforms (Twitch, YouTube). Additionally, not obtaining the coveted items, which is common due to loot box randomness, predicts greater levels of guilt and emotional distress, while obtaining them predicts subsequent loss of control. Thus, 45.5% reported guilt over purchasing, 50% distress and 17% loss of control. Summarizing, loot boxes are increasingly present in video games, and owing to their psycho-emotional outcomes, it is necessary for future research to address this matter in order to develop prevention strategies and to provide support to vulnerable populations.

Las loot boxes son cajas dentro de los videojuegos que los usuarios pagan por abrir y obtener, al azar, un objeto cuyo valor inicialmente desconocen. Tanto la población adolescente como la adulta tiene fácil acceso a ellas, y se han relacionado con el juego de azar. El objetivo de este estudio fue examinar el consumo de loot boxes y explorar si se asociaba con culpabilidad, pérdida de control y malestar. Para ello, 475 participantes (266 adolescentes y 209 adultos) respondieron a un cuestionario ex profeso de elaboración propia. Los resultados mostraron que son los adolescentes los que más dinero invierten en cajas botín. Este gasto se ve aumentado cuando se anuncia nuevo contenido en las plataformas multimedia online (entre ellas, Twitch, YouTube). Además, no obtener los ítems que desean, lo cual es frecuente por su aleatoriedad, predice mayores niveles de culpabilidad y malestar, mientras que su obtención predice la posterior pérdida de control. Así, el 45,5% de los participantes refirieron culpabilidad tras la compra, el 50% malestar y el 17% pérdida de control. En síntesis, las loot boxes están cada vez más presentes en los entornos virtuales de los adolescentes y adultos, y dadas las consecuencias psicológicas y emocionales que parecen tener, es necesario seguir abordando esta problemática en futuras investigaciones en aras de prevenir y apoyar a la población vulnerable.

The role of cognitive factors in differentiating individuals with somatoform disorders with and without depression.

The present study, based on a cross-sectional design, was conducted in the primary care setting with patients presenting somatic symptoms suggestive of somatoform disorders (SFD). The main aim of the study was to determine whether cognitive variables could differentiate between patients with SFD alone and those who also present depressive symptoms suggestive of depression (SFD + depression). All participants (N = 796) completed validated self-report measures to assess somatic, depressive, and/or anxiety symptoms, as well as functional impairment, quality of life (QoL), and cognitive variables (worry, rumination, metacognition, cognitive distortions, and emotion regulation). Univariate and multivariate analyses (controlled for potential sociodemographic and clinical confounders) were performed. On the univariate analysis, significant differences between the SFD and SFD + depression groups were found in sociodemographic and clinical variables, functional impairment, QoL, and cognitive variables. On the multivariate analysis, the only significative variables associated with comorbid SFD + depression were anxiety (ß = 0.27; p < 0.001), physical and psychological QoL (ß = -0.10; p = 0.01; and ß = -0.21; p < 0.001, respectively), and marital status (ß = -65; p < 0.05). Cognitive variables were not significantly related to depressive symptoms in patients with SFD. These findings suggest that patients with SFD - with or without comorbid depression - share common cognitive processes and thus both groups could benefit from transdiagnostic cognitive therapy.

Moderators and predictors of treatment outcome in transdiagnostic group cognitive-behavioral therapy for primary care patients with emotional disorders.

OBJECTIVE: Transdiagnostic group cognitive behavior therapy (TD-GCBT) has shown to be efficacious in the treatment of emotional disorders in primary care. However, little is known about possible moderators or predictors of treatment outcome. We aimed to explore the potential predictors and moderators of outcome in a large multicentre randomized controlled trial comparing TD-GCBT plus treatment as usual (TAU) to TAU alone. METHOD: Putative demographic and baseline clinical variables were examined using the PROCESS macro as potential predictors/moderators of depressive and anxiety symptoms at posttreatment and 1-year follow-up. RESULTS: Analyses were based on a study completer sample of 1061 participants randomized to TD-CBT + TAU (n = 527) or TAU alone (n = 534), with 631 participants assessed at the posttreatment evaluation and 388 at the 1-year follow-up. Individuals working or with a partner among sociodemographic variables, and higher baseline comorbidities and more severity of symptoms among clinical variables obtained more benefits from adding TDCBT to TAU. Those taking medication before treatment obtained less benefits from the TD-GCBT than those without prescribed antidepressant medications, after controlling for baseline severity of symptoms. Overall, the moderating effect of clinical (but not sociodemographic) variables remained at 1-year follow-up. CONCLUSION: Findings support largely the generalization of the TD-GCBT for emotional disorders in primary care to a variety of sociodemographic and clinical groups. However, TD-GCBT seems to work to a greater extent for those individuals with a more severe clinical profile. Providing TD-GCBT before prescribing antidepressant medication and while people are still working may enhance the effects of adding this psychological treatment to TAU in primary care.

Factors differentiating panic disorder with and without comorbid symptoms of depression.

The aim of this study was to examine the sociodemographic and clinical differences between people with a probable diagnosis of panic disorder (PD) and those with PD and a probable comorbid diagnosis major depressive disorder (PD + MDD). We also sought to explore the potential contribution of cognitive variables to help differentiate between PD and PD + MDD. This was a subgroup analysis of 331 patients with PD symptoms who were included in the PsicAP clinical trial. All participants completed scales to evaluate panic, depression, somatization, cognitive and performance variables. A univariate analysis showed significant differences (p < .01) between the groups (PD vs PD + MDD) in clinical variables. Somatization was the best predictor of comorbid PD + MDD (ß = .346; p < .01). Cognitive variables do not appear to play an essential role in predicting the presence of depressive symptoms in people with a screen positive for PD. These findings appear to support a transdiagnostic treatment approach for PD, which may be useful regardless of whether comorbid depression is present or not. PRACTITIONER POINTS: Somatic symptoms were associated with a higher probability of be in the PD + MDD group. Cognitive variables do not play a relevant role in the differentiation of both groups. A transdiagnostic approach can be useful for the treatment of PD or PD + MDD group.

Emotional stability is related to 2D:4D and social desirability in women: Possible implications on subjective well-being and psychopathology.

Emotional stability-Neuroticism is a complex construct influenced by genetics and environmental factors. Women tend to exhibit higher neuroticism scores than men, which may be associated with an increased risk of suffering from some common mental conditions. Some authors have pointed out the influence of sex hormones, since they induce sexual differentiation of the brain that can lead to sex-specific behaviors. 2D:4D digit ratio is commonly used as a marker of prenatal sex hormones. In this study we analyzed whether there was an association between 2D:4D and personality measured through the BFQ in a homogeneous sample of 101 young women college students. We found a positive association between 2D:4D and emotional stability, as well as with its subdimensions emotion control and impulse control. This association could be quadratic and nonlinear. However, no association was found with the other four dimensions. We also measured anxiety, depression and global life satisfaction, variables related to neuroticism. We observed that emotional stability is positively associated to social desirability and global life satisfaction, and negatively related to anxiety and depression. On the other hand, we did not find any association between 2D:4D and anxiety, depression, and global life satisfaction. These results can be linked to other aspects such as subjective well-being and psychopathological symptoms. This study may help to better understand how these constructs are related and could lead to future projects to elucidated how these variables influence personality.

Disability and perceived stress in primary care patients with major depression / Discapacidad y estrés percibido en pacientes de atención primaria con depresión mayor

BACKGROUND: Major depressive disorder (MDD) is highly prevalent in the Spanish primary care (PC) setting and the leading cause of disability in Spain. The aim of this study was to evaluate several key psychometric properties of the Sheehan Disability Scale (SDS) in patients with or without MDD and varying degrees of symptom severity using the Patient Health Questionnaire-9 (PHQ-9). METHOD: A total of 1,704 PC patients participating in the PsicAP clinical trial completed the SDS and PHQ-9. We evaluated the factor structure, measurement invariance across gender, internal consistency, and the discriminative and predictive validity. RESULTS: Confirmatory factor analyses revealed a unifactorial model of the SDS containing 4 items (SDS-4) with the best model fit (CFI: .99; GFI: .99; TLI: 96; RMSEA: .10). This model contained the three life domain items (work, family, and social life) plus perceived stress (PS) with significant loadings. The internal consistency of the SDS-4 was acceptable in patients with or without MDD, regardless of symptom severity. The SDS-4 also showed good discriminative capacity and acceptable predictive validity in all subsamples. CONCLUSIONS: These findings support the use of the SDS-4 to assess depression-related disability in patients at Spanish primary care centres

ANTECEDENTES: el Trastorno Depresivo Mayor (TDM) es muy prevalente en la atención primaria (AP) española y es la principal causa de discapacidad en España. En este trabajo se estudiaron algunas propiedades psicométricas de la Escala de Discapacidad de Sheehan (SDS) en pacientes con o sin TDM y con varios niveles de severidad de síntomas, usando el Patient Health Questionnaire-9 (PHQ-9). MÉTODO: 1.704 pacientes de AP que participaron en el ensayo clínico PsicAP cumplimentaron la SDS y el PHQ-9. Se estudió la estructura factorial, medida de invarianza de género, consistencia interna, validez discriminativa y la validez predictiva. RESULTADOS: el análisis factorial confirmatorio mostró un modelo unifactorial con 4 ítems (SDS-4) con un buen ajuste (CFI: .99; GFI: .99; TLI: 96; RMSEA: .10). Este modelo contenía los tres ítems de esferas de la vida (trabajo, familia y vida social) más el ítem de estrés percibido con cargas significativas. La consistencia interna de la SDS-4 fue aceptable en pacientes con MDD y con diferente severidad de síntomas depresivos. También se halló una buena validez discriminativa y aceptable validez predictiva. CONCLUSIONES: nuestros hallazgos respaldan el uso de la SDS-4 cuando se evalúe la discapacidad relacionada con la depresión en centros de AP españoles

Social support as predictor of anxiety and depression in cancer caregivers six months after cancer diagnosis: A longitudinal study.

AIMS AND OBJECTIVES: To establish the predictive utility of specific social support domains for emotional well-being in cancer caregivers, six months after their partner's cancer diagnosis. BACKGROUND: In cancer caregivers, social support has been consistently related to anxiety and depression. There is little information, however, about the predictive utility of specific social support domains for psychological well-being in the first six months after a partner's cancer diagnosis. DESIGN: Longitudinal research study. METHODS: Sixty-seven caregivers of recently diagnosed cancer patients were recruited from the Reina Sofia University Hospital in Cordoba (Spain). Participants completed a set of questionnaires including the Berlin Social Support Scale (BSSS), the Hospital Anxiety and Depression Scale (HADS) and a socio-demographic questionnaire. Data were collected at two time points: T1 (30-45 days after diagnosis) and T2 (180-200 days after). TRIPOD checklist was used. RESULTS: Most of the caregivers were female (65%) and the partner of the patient (58%), with an average age of 51.63 years (SD = 13.25). Statistical differences were observed between the two assessment points for the social support domains of perceived emotional support, satisfaction with support and protective buffering. Logistic regression analysis showed that less physical and sports activity, more support seeking and less informational support received at T1 predicted anxiety at T2, while less perceived available support predicted depression. CONCLUSIONS: Accurate information and support from other members of the community and the promotion of physical and sports routines for cancer caregivers may help to alleviate symptoms of anxiety and depression in the first months after a partner's cancer diagnosis. RELEVANCE TO CLINICAL PRACTICE: Clinicians must pay attention to the social support needs and physical activity of caregivers in the first days after diagnosis, in order to prevent anxiety and depression.

Emotional stability is associated with the MAOA promoter uVNTR polymorphism in women.

BACKGROUND: Neuroticism is associated with low emotional stability, and it is characterized by a tendency to perceive ordinary situations as threatening and difficult to manage. This personality trait has been associated with psychological distress and predicts some mental disorders. Previous studies have shown that women tend to be more neurotic than men and, in general, females have also a higher incidence of anxious and depressive disorders. METHODS: We analyzed in a sample of 99 female university students (from 18 to 26 years old) if emotional stability, measured using the Big Five Questionnaire, was linked to polymorphic variants in candidate genes related to dopaminergic and serotonergic systems, and other personality variables. RESULTS: We found that emotional stability and its subdimensions are genetically associated with MAOA-uVNTR polymorphism. Thus, women carriers of the 3-repeat allele (lower MAO-A expression) showed higher levels of emotional stability. No associations were found with other polymorphisms analyzed, including COMT Val158 Met, 5-HTTLPR, and DAT 3'UTR VNTR. Furthermore, our results showed a negative correlation between emotional stability and depression, state anxiety, and trait anxiety. In fact, MAOA-uVNTR and trait anxiety also explained emotional stability and its subdimensions. We also found that other genetic characteristic, phenylthiocarbamide tasting, explained impulsivity, specifically tasters controlled impulses better than nontasters. CONCLUSION: Our results indicate that neuroticism might be regulated by MAOA and could be a common factor between different phenotypes, such as aggressive behaviors or personality disorders, observed in women with higher activity genotype who had been exposed to negative environments during childhood. This study could lead to a better understanding of the basis of emotional stability and could lead to future projects for this purpose.

Bilateral Prefrontal Cortex Anodal tDCS Effects on Self-reported Aggressiveness in Imprisoned Violent Offenders.

Reduced activity of the frontal lobes, and particularly of the prefrontal cortex, has been related with violent behavior, aggression and crime. The causal importance of prefrontal cortex activity for aggressive behaviors and the self-perception of aggressiveness needs however to be clarified. The aim of this study was to explore the effect of an anodal transcranial direct current stimulation protocol (tDCS, 1.5 mA, 15 min), which, according to previous studies, enhances cortical excitability, applied bilaterally over the prefrontal cortex on self-reported aggressiveness. Two imprisoned violent offender cohorts, discerned by the degree of aggressiveness (murderers vs. non-murderers), were included in this single-blind sham-controlled study. Self-reported aggressiveness was recorded before and after 3 tDCS sessions (one session per day). Four dimensions of aggression were evaluated by means of the standardized Buss-Perry Aggression Questionnaire (BAQ). In both inmate groups the results revealed an aggression-reducing effect of tDCS on the Physical aggression, Anger, and Verbal aggression dimensions of the BAQ. In the Hostility dimension, tDCS significantly reduced aggression only in the group of murderers. These results suggest that modulation of prefrontal cortex excitability by 3 consecutive sessions of tDCS reduces self-reported aggressiveness similarly in murderer and non-murderer samples.

Domain-specific associations between disability and depression, anxiety, and somatization in primary care patients.

This study explores the associations between different disability domains and the most prevalent symptoms of mental disorders in primary care patients (i.e. depression, anxiety, and somatization). A total of 1241 participants from 28 primary care centres completed self-report measures of depression, anxiety, and somatization. This same sample also completed the Sheehan Disability Scale (SDS) to assess functional impairment in work, social life, and family life domains. Associations between the symptoms and each disability domain were examined using hierarchical regression analyses. Depression emerged as the strongest predictor of all three disability domains. Somatization was associated only with the work domain, and anxiety was associated only with the family life domain. Clinical symptoms explained a greater proportion of the variance than sociodemographic variables. In primary care patients, depression, anxiety and somatizations were associated with distinct domains of disability. Early provision of effective treatments in the primary care setting may be crucial to reduce the societal burden of common mental disorders.

Factor structure and measurement invariance across various demographic groups and over time for the PHQ-9 in primary care patients in Spain.

The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demographic groups (i.e., gender, age, marital status, level of education, and employment situation) and over time. Both one-factor and two-factor re-specified models met all the pre-established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86), the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting.

Impacto económico y carga de los trastornos mentales comunes en España: una revisión sistemática y crítica / A systematic review and critique of the economic impact and burden of common mental disorders in Spain

Trastornos mentales comunes hace referencia a los más prevalentes, en especial trastornos de ansiedad, trastornos del ánimo y, a veces, somatizaciones. Se trata de desórdenes emocionales muy presentes en Atención Primaria, con un 49.2% de probables casos, presentando una frecuente asociación con varias enfermedades crónicas. Por su alta prevalencia, así como por el alto porcentaje de casos no tratados y el bajo porcentaje que siguen un tratamiento mínimamente basado en la evidencia, generan los mayores costes y carga entre los trastornos mentales. Sin embargo, existen diferentes enfoques y metodologías a la hora de cuantificar su impacto. El objetivo de este estudio es llevar a cabo una revisión sistemática y crítica de los estudios publicados sobre costes y carga de los trastornos mentales comunes en España desde el año 2006 que ayude a clarificar este campo. Los resultados muestran que, en la escasa literatura encontrada, solo 15 artículos cumplían criterios de inclusión; existen grandes diferencias en la metodología en cuanto a los costes a analizar y las fuentes de datos utilizadas y, por tanto, en los resultados. A pesar de la heterogeneidad, estos trastornos mentales comunes representaron el 2.2% del PIB, el 50% de los costes de todos los trastornos mentales, así como la primera causa de discapacidad (años vividos con discapacidad [AVD]) atribuida a una única enfermedad, la depresión. En conclusión, existe escasa literatura científica acerca de los costes y la carga de los trastornos mentales comunes en España. La gran diversidad en la metodología no permite llevar a cabo metaanálisis sobre este tema, por lo que sería recomendable definir criterios para unificar las futuras evaluaciones económicas en este campo

Common mental disorders include the most prevalent disturbances, especially anxiety and mood disorders, as well as somatizations in fewer cases. These disorders are frequently found in primary care (49.2% of probable cases) and are associated with high rates of several chronic illnesses. Given their high prevalence rates, in addition to high rates of untreated cases and low percentage of cases that follow a minimally evidence-based treatment, these disorders impose the greatest costs and burdens among all mental disorders. However, there are different approaches and methodologies when it comes to quantifying their impact. The aim of this study is to carry out a systematic review and critique of published studies since 2006, on the costs and burdens of common mental disorders in Spain. Only 15 studies met the inclusion criteria; there were large methodological differences in terms of the sources used, cost analyses and, hence, the results obtained. Despite the heterogeneity, these common mental disorders account for 2.2% of the GDP in Spain and are responsible for 50% of the costs of all mental disorders; depression on its own is the leading cause of disability (Years Lived with Disability [YLD]) worldwide. There is little literature on the costs and burdens of common mental disorders in Spain. The great diversity in methodologies restricts the meta-analysis on this subject. In conclusion, it would be recommendable to define standardized criteria for future studies in order to evaluate the impact of these disorders in a more rigorous way