The importance of examining early maladaptive schemas in the diagnosis and treatment of obsessive-compulsive disorder.

Introduction: The aim of the study was twofolded: to identify the early maladaptive schemas characteristic of obsessive-compulsive disorder in a Hungarian sample and, to examine the presence and severity of comorbid anxiety and depressive symptoms in the light of early maladaptive schemas. Methods: 112 participants (58 men and 54 women) diagnosed with OCD were involved in the study. The questionnaire package consisted of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Penn State Worry Questionnaire (PSWQ) and the Schema Questionnaire (SQ). Results: We identified five early maladaptive schemas with a direct effect on the manifestation of obsessive-compulsive symptoms: Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence, Insufficient Self-Control/Self-Discipline and Entitlement/Grandiosity (reversed effect). Based on the severity of the early maladaptive schemas, three significantly different groups could be identified in our sample: patients with mild, moderate and high schema-values. Among the groups significant differences can be found in the appearance and severity of compulsive symptoms, as well as in the presence of anxiety and depressive symptoms. But contrary to our expectations, not the severity, but the numberof the early maladaptive schemas showed a stronger correlation with the symptom variables. An additional result of our study derives from canonical correlation, addressing the relationship among early maladaptive schemas, OCD symptoms, anxiety and depressive symptoms from a new perspective. The results highlight that OCD is only one and not the most serious consequence of personality damage, indicated by early maladaptive schemas. Discussion: The results of our study suggest that obsessive-compulsive disorder can be divided into several subgroups, which can be separated in terms of symptom severity, comorbid psychiatric symptoms and personality impairment patterns. The relationship between OCD symptom severity and personality impairment seems to be not directly proportional. Our results strengthen the new dimensional view of OCD, which can determine the selection of the appropriate therapeutic treatment method beyond the diagnostic process.

Associations between lifestyle and comorbid anxiety and depression in pregnant women / 环境与职业医学

Background Anxiety and depression are common perinatal mental health issues that often occur together and can have serious negative effects on both maternal and infant health. Objective To examine the relationships between lifestyle factors and comorbid anxiety and depression (CAD) among pregnant women in Shanghai. Methods The study estimated the prevalence of CAD during the first, second, and third trimesters of pregnancy using the Self-rating Anxiety Scale (SAS) and Center for Epidemiological Studies-Depression (CES-D) based on data from the China National Birth Cohort (CNBC) embryonic-derived diseases with assisted reproductive technology (ART) sub-cohort. Information on demographics, sleep status, nutritional intake, and exercise during each trimester was collected through self-made questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and the Food Frequency Questionnaire (FFQ). Lifestyle factors (such as sleep status, nutritional intake, and exercise during each trimester) were analyzed using logistic regression and generalized linear mixed models (GLMM) to determine their impacts on the prevalence of CAD (yes or no) among pregnant women. Results A total of 2876 pregnant women were included in this study. The prevalence of CAD was 10.6% (305), 3.6% (103), and 5.5% (159) in the first, second, and third trimesters of pregnancy, respectively. The logistic regression analysis revealed that poor sleep quality throughout the entire pregnancy were statistically associated with an increased prevalence of CAD, and the odds ratios (OR) with 95% confidence intervals (CI) were 2.817 (1.845, 4.301), 2.840 (1.855, 4.347), and 9.316 (5.835, 14.876) for the first, second, and third trimesters, respectively, when compared to good sleep quality. Additionally, compared to an intake frequency of 7 times per week, the frequency of egg intake ≤3 times per week in the first trimester (OR=2.025, 95%CI: 1.197, 3.425) and the frequency of egg intake of 4–6 times per week (OR=1.896, 95%CI: 1.117, 3.216) or ≤3 times per week (OR=1.906, 95%CI: 1.082, 3.357) in the third trimester were associated with an increased risk of CAD (P<0.05). Moreover, when compared to a frequency of exercise >3 times per week, never or almost never exercising in the second trimester (OR=2.218, 95%CI: 1.220, 4.035) was associated with an increased risk of CAD (P<0.05). The GLMM analysis also demonstrated a significant association between poor sleep quality, lower exercise frequency, or lower intake frequency of vegetables, eggs, or milk and an increased risk of CAD (P<0.05). Conclusion The prevalence of CAD among pregnant women in Shanghai follows a U-shaped distribution, with the highest rate occurring in early pregnancy and the lowest rate in mid-pregnancy. Factors such as poor sleep quality, inadequate intake of vegetables, eggs, or milk, and lack of exercise during pregnancy may increase the risk of CAD. Implementing lifestyle interventions during pregnancy could potentially reduce the risk of mental health problems and improve the overall health of both mothers and babies.

Joint effects of recent stressful life events and adverse childhood experiences on perinatal comorbid anxiety and depression.

BACKGROUND: Stressful life events (SLEs) and adverse childhood experiences (ACEs) have been reported to be associated with perinatal depression (PND) or perinatal anxiety (PNA) alone; however, in most cases, majority of PND and PNA coexist and could lead to more serious health consequences. The independent effect of recent SLEs and their joint effects with ACEs on perinatal comorbid anxiety and depression (CAD) remain inadequately explored. METHODS: Based on a longitudinal study, 1082 participants receiving prenatal care in Ma'anshan, China were included. Women were recruited in the first trimester (T1: ≤14+ 6 weeks) and followed up at 15 ~ 27 weeks (T2), 28 ~ 40 weeks (T3), and postpartum (T4). Depression and anxiety status were assessed at all time points, while recent SLEs and ACEs were measured at T1. Logistic regression was conducted to examine the associations of SLEs with the risks of CAD at different time points, as well as their joint effects with ACEs on CAD. RESULTS: Approximately 38.5% of women experienced at least one SLE, which was significantly associated with higher risks of CAD at all time points (p < 0.05). As the number of SLEs increased, the risk of CAD increased (p for trend < 0.05). Specific types of SLEs were associated with CAD in different periods, while only interpersonal events were consistently associated with risks of CAD throughout the whole perinatal period. The joint effects of SLEs with ACEs on CAD were identified throughout the perinatal period, with the highest observed in the first trimester (aOR = 7.47, 95% CI: 3.73-14.95; p for trend < 0.001). CONCLUSION: Our study demonstrated independent associations of recent SLEs and their joint effects with ACEs with risks of perinatal CAD. SLEs combined with ACEs should be recognized as a major risk factor for perinatal CAD and managed at the earliest time to prevent and control CAD.

Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study.

OBJECTIVE: To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth. DESIGN: Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014. SETTING: Primary care, in the Netherlands. POPULATION: Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history. METHODS: Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth. MAIN OUTCOME MEASURES: Trajectories of CAD symptoms and physiological birth. RESULTS: Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1-persistently low levels of symptoms (reference class 1; 79.0%), group 2-intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3-persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47-0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders. CONCLUSIONS: This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth.

Comorbid Anxiety and Depression and Related Factors Among Pregnant and Postpartum Chinese Women During the Coronavirus Disease 2019 Pandemic.

Objective: To identify the prevalence of comorbid anxiety and depression (CAD) and analyze the relationship between CAD and sociodemographic and obstetric-related variables in pregnant and postpartum Chinese women during the COVID-19 pandemic. Methods: Participants were 2,237 pregnant and postpartum women (aged 19-47 years) who visited various medical institutions in China between February 28, 2020, and April 26, 2020. They were asked to complete an online survey assessing the anxiety and depression, obstetric characteristics, and sociodemographic variables. The women were grouped into the following categories in accordance with the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9): (a) CAD, (b) "anxiety only," (c) "depression only," and (d) "no depression or anxiety." After estimating the prevalence of CAD, "anxiety only," and "depression only," we carried out chi-squared tests and multiple logistic regression analysis to examine the related factors between these groups of pregnant and postpartum Chinese women. Results: Comorbid anxiety and depression, "anxiety only," and "depression only," occurred in 6.3, 5.8, and 3.9% of participants, respectively. The prevalence rates of CAD during the first, second, and third trimesters of pregnancy and the postpartum period were found to be 7.4, 6.5, 5.7, and 8.2%, respectively. The factors that differed among the groups were age (p < 0.05), marital status (p < 0.001), level of education (p < 0.05), family support (p < 0.001), and total live births (p < 0.001). "Poor family support" (odds ratio (OR): 1.90; 95% confidence interval (CI): 1.30-2.78; p = 0.0009) and "no birth" (OR: 1.91; 95% CI: 1.32-2.75; p = 0.0006) remained significant factors for the CAD group, while "poor family support" (OR: 2.16; 95% CI: 1.34-3.47; p = 0.0015) remained a significant factor for the "depression only" group when their results were compared to those of the "no depression or anxiety" group in the multiple logistic regression analysis. Conclusion: Pregnant and postpartum Chinese women with poor family support and primipara are at high risk for CAD during the COVID-19 pandemic. These results support the need for targeted perinatal programs to address CAD in pregnant and postpartum women during the pandemic period.

Prevalence and correlates of psychiatric morbidity, comorbid anxiety and depression among medical students in public and private tertiary institutions in a Nigerian state: a cross-sectional analytical study.

INTRODUCTION: the study assessed the prevalence and factors associated with psychiatric morbidity (an array of psychological disorders), and comorbid anxiety and depression among medical students in Ekiti State, Nigeria. METHODS: a cross-sectional study of medical students in two universities (one public and one private) in Ekiti state was conducted. A semi-structured questionnaire with adapted questions from the General Health Questionnaire and Hospital Anxiety and Depression Scale was used to obtain information on socio-demographic characteristics, psychiatric morbidity and comorbid anxiety and depression. Data was collected from April 2019 to August 2019. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21. RESULTS: a total of 944 medical students participated in the survey. The overall prevalence of psychiatric morbidity and comorbid anxiety and depression among the respondents was 25.0% (CI = 22.1-27.8) and 14.3% (CI = 12.3-16.5) respectively. The factors independently associated with psychiatric morbidity included being a student of a private institution [adjusted odds ratio [AOR] =6.533, [95% confidence interval [C.I] =3.298-12.940], average academic performance [AOR =1.711, [95% C.I =1.173-2.496], below average academic performance [AOR =2.425, [95% C.I =1.313-4.478], and having a father or a mother with highest level of formal education below first degree [AOR =3.147, [95% C.I =1.579-6.272] and [AOR =2.053, [95% C.I =1.074-3.927] respectively. The factors independently associated with comorbid anxiety and depression were being a student receiving less than one dollar equivalent per day as allowance [AOR = 1.953, [95% C.I = 1.135-3.360] and being a student from the Igbo ethnic group [AOR = 0.533, [95% C.I = 0.333-0.853]. CONCLUSION: the prevalence of psychiatry morbidity and comorbid anxiety and depression was high among medical students in Ekiti State, Nigeria. Periodic medical [mental health] screening for medical students may be appropriate to screen, detect and manage psychiatric comorbidities. This will help to ensure optimal mental health for this group of university students.

Comorbid Anxiety and Depression among Pregnant Pakistani Women: Higher Rates, Different Vulnerability Characteristics, and the Role of Perceived Stress.

Anxiety and depression commonly co-occur during pregnancy and may increase risk of poor birth outcomes including preterm birth and low birth weight. Our understanding of rates, patterns, and predictors of comorbid anxiety and depression is hindered given the dearth of literature, particularly in low- and middle-income (LMI) countries. The aim of this study is (1) to explore the prevalence and patterns of comorbid antenatal anxiety and depressive symptoms in the mild-to-severe and moderate-to-severe categories among women in a LMI country like Pakistan and (2) to understand the risk factors for comorbid anxiety and depressive symptoms. Using a prospective cohort design, a diverse sample of 300 pregnant women from four centers of Aga Khan Hospital for Women and Children in Pakistan were enrolled in the study. Comorbid anxiety and depression during pregnancy were high and numerous factors predicted increased likelihood of comorbidity, including: (1) High level of perceived stress at any time point, (2) having 3 or more previous children, and (3) having one or more adverse childhood experiences. These risks were increased if the husband was employed in the private sector. Early identification and treatment of mental health comorbidities may contribute to decreased adverse birth outcomes in LMI countries.

Comorbid anxiety and depression (CAD) at early stages of the pregnancy. A multicultural cross-sectional study.

INTRODUCTION: When anxiety and depression are comorbid (CAD), symptoms are more severe and the response to treatments is worse. Given the links between mood disorders and poor perinatal outcomes, CAD and its correlates deserve special clinical attention during pregnancy. The main objective of this study was to learn about the prevalence of comorbid anxiety and depression (CAD) in early stages of the pregnancy analyzing the relationship between CAD and cultural and sociodemographic factors. METHODS: We have studied a multicultural sample of 514 Turkish and Spanish pregnant women (264 in Málaga, 102 in Istambul and 148 in Antalya) recruited at the moment of their first pregnancy medical check-up between 10 and 12 weeks of pregnancy. These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg postnatal depression scale (EDS), the state and trait anxiety scale (STAI) and a series of questions related to health status, general mood, and sociodemographic variables. RESULTS: We found a CAD prevalence rate of 26.9% and a significant higher prevalence rate among Turkish women (47.6%) when compared to Spanish participants (9.5%) (p<0.001). The multivariate analysis showed that the lack of someone who provided emotional support was the variable that best predicted CAD symptoms. CONCLUSION: The CAD prevalence rate was high and significant differences were found depending on the geographic and cultural context.

12-month prevalence and concomitants of DSM-IV depression and anxiety disorders in two violence-prone cities in Brazil.

BACKGROUND: Estimating 12-month prevalence of depression, anxiety, and comorbid anxiety/depression in noninstitutionalized adults (age 15-75) in two violence-prone cities. METHODS: The Composite International Diagnostic Interview v2.1 (Portuguese), administered in population-representative surveys (age 15-75) in São Paulo (N = 2536) and Rio de Janeiro (N = 1208), yielded 12-month prevalence of violent events experienced, and DSM-IV diagnoses of depression and anxiety, which were classified into mutually exclusive groups: 1) no anxiety/depression; 2) anxiety only; 3) depression only; 4) comorbid anxiety/depression. Weighted analyses estimated 12-month prevalence, multinomial logistic regression compared the demographic characteristics of the diagnosis groups, and association with experienced violence. RESULTS: Twelve-month prevalence of anxiety alone, depression alone, and comorbid anxiety/depression was 12.7% (of whom 24.9% were also depressed), 4.9% (of whom 46.2% had anxiety), and 4.2% respectively for São Paulo; and 12.1% (18.2% of whom were depressed), 4.6% (37.0% with anxiety), and 2.7% respectively for Rio de Janeiro. All conditions were approximately twice as prevalent in women than in men in both cities. In São Paulo, comorbidity was associated with age under 60, depression alone was more prevalent among 30-59 year olds, but in 23-29 year-olds in Rio de Janeiro. Exposure to violence increased the odds of anxiety, depression, and their comorbidity. With rare exception, marital status, education, and race/ethnicity were not associated with anxiety, depression, or their comorbidity. LIMITATIONS: Cross-sectional design. CONCLUSIONS: Prevalence rates for all conditions were high, and particularly associated with exposure to violence. Means to ameliorate violence, and its mental health effects, particularly for women, are needed.

Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population.

OBJECTIVE: This study aimed to investigate the longitudinal effects of anxiety, depression, and their comorbidity on physical disorders and disability in an elderly Korean population. METHODS: In total, 1,204 community-dwelling elders were evaluated at baseline, and of these 909 (75%) were re-assessed two years later. Anxiety and depression were identified at baseline using questions from the community version of the Geriatric Mental State diagnostic schedule (GMS-B3). Participants were assessed for functional disability and for 11 physical disorders both at baseline and at follow-up. RESULTS: Anxiety alone was associated with the incidence of heart disease, depression alone with the incidence of asthma, and comorbid anxiety and depression with incidence of eyesight problem, persistent cough, asthma, hypertension, heart disease, and gastrointestinal problems. Comorbid anxiety and depression were associated with an increase in the number of physical disorders and the degree of disability during the two-year follow-up, compared to anxiety or depression alone or the absence of anxiety or depression. CONCLUSION: Anxiety, depression, and particularly their comorbidity should be assessed in the elderly population considering their longitudinal effects on physical disorders and disability. Future study is required to determine whether interventions aimed at these disorders can mitigate their impacts.

Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population

OBJECTIVE: This study aimed to investigate the longitudinal effects of anxiety, depression, and their comorbidity on physical disorders and disability in an elderly Korean population. METHODS: In total, 1,204 community-dwelling elders were evaluated at baseline, and of these 909 (75%) were re-assessed two years later. Anxiety and depression were identified at baseline using questions from the community version of the Geriatric Mental State diagnostic schedule (GMS-B3). Participants were assessed for functional disability and for 11 physical disorders both at baseline and at follow-up. RESULTS: Anxiety alone was associated with the incidence of heart disease, depression alone with the incidence of asthma, and comorbid anxiety and depression with incidence of eyesight problem, persistent cough, asthma, hypertension, heart disease, and gastrointestinal problems. Comorbid anxiety and depression were associated with an increase in the number of physical disorders and the degree of disability during the two-year follow-up, compared to anxiety or depression alone or the absence of anxiety or depression. CONCLUSION: Anxiety, depression, and particularly their comorbidity should be assessed in the elderly population considering their longitudinal effects on physical disorders and disability. Future study is required to determine whether interventions aimed at these disorders can mitigate their impacts.

Clinical Characteristics of Comorbid Anxiety and Depression after Cerebral Infarction / 中国康复理论与实践

@#Objective To determine the clinical characteristics of comorbid anxiety and depression after cerebral infarction. Methods All the patients enrolled were divided into post-stroke comorbid anxiety and depression (PSCAD) group (84 cases) and the control group (121 cases). Their condition of smoke, alcohol intake, education background, carotid plaque and brain blood vessels were investigated, and they were evaluated with Hamilton Anxiety Scale (HAMA), Hamilton Depressive Scale (HAMD), Barthel index, and Mini-Mental State Examination (MMSE). Results There was not significant difference in condition of smoke, alcohol intake, education background, carotid plaque and brain blood vessels between these groups （P＞0.05）, but were in total scores and all the factors scores of HAMA and HAMD （P＜0.05）. PSCAD group showed more obvious anxious mood, depressive mood, tension, insomnia, cognitive impairment and autonomic nervous symptoms. Psycho-anxiety, soma-anxiety, despair, guiltiness, decreased interest were also more significant in the PSCAD group. The scores of MMSE and Barthel index were also impaired. Conclusion The cognitive function and daily living ability are worse in the patients with PSCAD. The prominent symptoms includes: anxious mood, depressive mood, tension, insomnia, cognitive impairment, autonomic nervous symptoms, soma-anxiety, despair, guiltiness, decreased interest.

Clinical study of post-stroke comorbid anxiety and depression treated with integrated Chinese and western medicine / 中国康复理论与实践

@#ObjectiveTo evaluate the clinical effect of integrated Chinese and western medicine (ICWM) on the post-stroke comorbid anxiety and depression (PSCAD).Methods35 PSCAD patients were treated with ICWM therapy and scores of self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were analyzed statis tically before and after treatment.ResultsThe curi ng rate of PSCAD is about 74.29% and scores of SAS and SDS were significantly d ecreased after treatment (P<0.001).Conclusions The treatment of ICWM can produce a good effect on PSCAD.