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Few studies have examined the longitudinal courses of anxiety disorders in military members. This study examined the prevalence and predictors of courses of any anxiety disorder in members and veterans of the Canadian Armed Forces, including no lifetime, remitted, new onset, and persistent/recurrent anxiety disorder. The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a 16-year follow-up of n = 2941 participants from the Canadian Community Health Survey: Canadian Forces Supplement in 2002. Diagnoses of any DSM-IV anxiety disorder (i.e., generalized anxiety, social anxiety, and/or panic disorder) in 2002 and 2018 were used to create four anxiety course groups. A large proportion of the sample (36.3 %; new onset = 24.6 %, remitting = 6.9 %, and persistent/recurrent = 4.8 %) met criteria for an anxiety disorder during one or both time points. Factors at baseline and/or between 2002 and 2018, including income, education, military rank, comorbidity of PTSD or depression, deployment history, and traumatic events, were positively associated with most anxiety courses relative to no anxiety in analyses. Targeted interventions are needed to help mitigate anxiety disorders among this population. Social support and active coping were protective factors for most anxiety courses and may need to be incorporated into targeted interventions., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Posttraumatic stress disorder (PTSD) and physical health conditions commonly co-occur and are both prevalent among military personnel. This study examined how courses of PTSD (no PTSD, remitted, new onset, persistent/recurrent) are associated with physical health conditions, among a population-based sample of Canadian military personnel., Method: We analyzed data from the 2002 Canadian Community Health Survey-Mental Health and Well-being-Canadian Forces supplement (CCHS-CF) and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS; N = 2941). Multivariable logistic regressions examined associations between PTSD courses (reference = no PTSD) and physical health conditions., Results: In general, physical health conditions were more prevalent among symptomatic PTSD courses compared to no PTSD. After adjustment, new onset PTSD was associated with increased odds of all physical health conditions with the exception of ulcers and cancer (AOR range: 1.41-2.31) and remitted PTSD was associated with increased odds of diabetes (AOR = 2.31)., Conclusion: Results suggest that new onset PTSD may be most strongly associated with physical health conditions. Findings may inform targeted screening and intervention methods among military personnel with PTSD and physical health conditions., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: There is growing recognition of illness-induced post-traumatic stress disorder (PTSD), defined by illness being the index trauma that induces PTSD symptoms. This is the first study to examine 1) the lifetime prevalence of illness-induced PTSD among military personnel and veterans, and its 2) sociodemographic, military, trauma, and physical health condition correlates., Methods: Participants completed the 2002 Canadian Community Health Survey-Mental Health and Well-being - Canadian Forces (N = 5155) and the 2018 Canadian Armed Forces Members and Veterans Mental Health Survey follow-up (n = 2941). A semi-structured clinical interview assessed PTSD, which we categorized as "illness-induced" or "other trauma-induced" PTSD based on the index trauma in those participating in both timepoints. To ensure representativeness of our study sample, we used baseline weights created by Statistics Canada to report weighted prevalence estimates and inferential statistics., Results: The estimated lifetime prevalence of PTSD among the full sample was 22% and 1.5% had lifetime illness-induced PTSD. Among those with lifetime PTSD, the proportion of participants with illness-induced PTSD was 8.3% (91.7% met criteria for other trauma-induced PTSD). In an unadjusted model, the prevalence of illness-induced PTSD was greater for females (13.7%) than males (7.2%), and for those who were not deployed in both 2002 (5.7%) and 2018 (7.1%; unadjusted odds ratio (OR) range: 2.05-3.72). In a multinomial model adjusting for sociodemographic and military characteristics, compared to those with other trauma-induced PTSD, those with illness-induced PTSD had elevated rates of PTSD persistence (24.1% vs. 11.9%; RRR = 6.06, 95% CI [1.21-30.25]) and lower rates of remission (7.8% vs. 19.9%)., Conclusion: Results highlight differences between illness-induced PTSD and other trauma-induced PTSD, primarily the potential chronicity of this manifestation. This may have implications for assessment strategies and targeted interventions., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Criterion E2 ("reckless or self-destructive behavior") was added to the DSM-5 posttraumatic stress disorder (PTSD) criteria to reflect the established association between PTSD and risky and unhealthy behaviors (RUBs); however, previous research has questioned its clinical significance. To determine whether criterion E2 adequately captures reckless/self-destructive behavior, we examined the prevalence and associations of RUBs (e.g., substance misuse, risky sexual behaviors) with criterion E2 endorsement. Further, we examined associations between criterion E2 and psychiatric conditions (e.g., depressive disorders, anxiety disorders) in a population-based sample of trauma-exposed adults. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed lifetime DSM-5 psychiatric conditions and self-reported RUBs. Among trauma-exposed adults (n = 23,936), multiple logistic regressions examined criterion E2's associations with RUBs and psychiatric conditions. After adjusting for covariates, all RUBs were associated with E2 endorsement (AOR range: 1.58-3.97; most prevalent RUB among those who endorsed E2: greater substance use than intended [57.0 %]) except binge eating, and E2 endorsement was associated with increased odds of PTSD, bipolar disorder, substance use disorders, and schizotypal, borderline, and antisocial personality disorders (AOR range: 1.65-2.75), and decreased odds of major depressive disorder (AOR = 0.76). Results support the clinical significance of criterion E2 through identifying associated RUBs and distinct correlates. These results may inform screening and intervention strategies for at-risk populations., (Copyright © 2020. Published by Elsevier Ltd.)

Few studies have investigated anxiety sensitivity (AS) in the context of inflammatory arthritis (IA), despite evidence of a relationship between AS and pain. This study examined cross-sectional and longitudinal relationships between AS and indicators of IA severity in 148 participants with IA. AS and its factors (social, physical, cognitive) were self-reported. Arthritis severity was physician-assessed (disease activity scales) and self-reported (physical function; pain and fatigue). Cross-sectional correlations assessed the association between AS and arthritis severity outcomes. Longitudinal multivariable mixed-effect regressions assessed the association of AS total and AS factors at each visit with disease severity outcomes. All AS factors were significantly and positively correlated (at the same visit) with function, pain, and fatigue. AS total significantly predicted pain, fatigue, and function. Cognitive AS significantly predicted fatigue, and physical AS significantly predicted pain and fatigue. Social AS significantly predicted pain, fatigue, function and weighted joint count (articular burden). AS is associated with several indicators of disease severity among those with IA; unique findings emerged across factors with the broadest disease impact by social AS. The AS factors, especially social AS, may contribute to the development and severity of IA symptoms, which may have implications for interventions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Trauma and post-traumatic stress disorder (PTSD) have been associated with a variety of physical conditions; however, their relationship with cancer is unclear., Methods: Using the cross-sectional 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; N = 36,309), we examined the association between trauma, PTSD and cancer (breast, gastrointestinal, 'other', and 'any'). Respondents were categorized into three groups: no-trauma, trauma-exposed, and PTSD using DSM-5 criteria. We conducted cancer- and sex-stratified regression analyses to examine the relationship between PTSD and cancer using the non-trauma exposed group as the reference., Results: Cancer prevalence was significantly greater in PTSD than trauma-exposed and no-trauma exposed respondents, and greater in trauma-exposed than no-trauma exposed respondents. After adjusting for covariates, odds of cancer were significantly greater in PTSD compared to non trauma-exposed respondents for 'any' cancer (adjusted odds ratio [AOR]: 2.99; 95% CI=[2.31, 3.88], gastrointestinal (GI) cancer (AOR: 17.48; 95% CI=[8.09, 37.77]), and 'other' cancer (AOR: 3.21; 95% CI=[2.41, 4.27]). Breast cancer was non-significant. Although both males and females with PTSD had significantly increased odds of 'any', GI, and 'other' cancer, differential findings emerged across sexes for those who were trauma exposed, compared to non-trauma exposed., Conclusion: Traumatic exposure and PTSD appear to be associated with cancer. The comorbid relationship between traumatic exposure, PTSD and cancer differs by cancer type and sex., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to: 1) Establish the prevalence of co-occurring chronic pain conditions (i.e., arthritis, back pain, and migraines) and generalized anxiety disorder (GAD), and 2) Examine levels of pain severity, disability, and work absenteeism among comorbid chronic pain conditions and GAD., Methods: Data were analyzed from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH; N = 25,113). Chi-square analyses assessed whether significant differences existed in pain severity in those with comorbid chronic pain and GAD versus pain conditions alone. Multivariable regressions examined the association between comorbid chronic pain and GAD with functional outcomes., Results: The weighted prevalence of GAD among those with chronic migraines, arthritis and back pain was 6.9%, 4.4%, and 6.1% respectively, compared to 2.6% among the entire sample. Severity of pain was increased among those with comorbid chronic pain and GAD compared with chronic pain conditions alone. Migraine was the only pain condition that was significantly associated with disability in our most stringent adjustment model. After controlling for other psychiatric disorders, comorbid GAD and chronic pain was not associated with work absenteeism., Conclusion: Chronic pain is common among the Canadian population and is associated with substantial disability. Results demonstrated that GAD is prevalent among chronic pain conditions, and comorbidity is associated with greater pain severity. GAD in the context of migraines, in particular, may represent an important treatment target to reduce disability., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Suicidal behaviors are of significant concern for the individuals displaying such behavior and for service providers who encounter them. Using nationally representative samples of Canadian and American adults, we aimed to examine: whether age moderates the relationship between having any anxiety disorder and suicide ideation (SI), the prevalence of SI among younger and older adults, and whether age and individual anxiety disorders were differentially associated with SI. Age moderated the relationship between any anxiety disorder and SI among Americans only. Past-year SI was less prevalent among older, compared to younger, adults; though, nearly every anxiety disorder was associated with increased odds of SI among younger and older Canadian and American adults after controlling for covariates. Effect sizes were particularly large for older American adults, but were coupled with large confidence intervals. Findings contribute to a growing literature suggesting that SI in the context of anxiety is a highly prevalent and complex mental health problem across the adult lifespan., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The purpose of this study was to examine and validate social anxiety disorder subtypes using the nationally representative National Comorbidity Survey Replication (N=9282). Generalized and non-generalized subtypes were defined as fearing at least 8 (i.e., most) and fewer than 7 of 14 possible social situations, respectively, following the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Results indicated that in those with social anxiety disorder, the odds of having comorbid major depression, a comorbid anxiety disorder, and suicidal ideation were significantly greater in the generalized subtype. However, differences were no longer significant when adjusting for the number of feared social situations. Results further indicated that the number of feared social situations was significantly associated with comorbid major depression, a comorbid anxiety disorder, and suicidal ideation. These findings call into question the validity of DSM-IV-defined subtypes and provide additional support for the notion that clinicians and researchers should consider viewing this disorder on a single continuum with greater number of feared situations associated with greater clinical severity., (Copyright 2009 Elsevier Ltd. All rights reserved.)