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We previously developed the Tilburg Pregnancy Distress Scale (TPDS). The aim of the current study was to further assess its test-retest reliability, internal consistency, and construct and concurrent validity in 1739 pregnant women. TPDS scores during pregnancy were highly inter-correlated (r ≥ .70), with similar findings for its Negative Affect and Partner Involvement subscales. Pregnancy and delivery worries varied in different subgroups of women regarding their obstetric history. Nullipara reported more pregnancy- and delivery-related worries at all trimesters of pregnancy. Women with previous pregnancy-related complications reported more pregnancy-related worries, and those with previous delivery-related problems reported more delivery-related worries than women without these problems in the past. The TPDS seems to be a valid and reliable instrument to assess pregnancy-specific distress.

Aims: This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms., Methods: People with type 2 diabetes (n=1837) received a screening questionnaire assessing depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7). Eligible persons who scored above the cut-off score (PHQ-9≥7 or GAD-7≥8) were offered to participate in the trial., Results: In total, 798 people (43%) returned the screening questionnaire. Non-responders were more often female (53% vs 44%, p<0.001), had higher LDL cholesterol levels (Cohen's d=0.17, p=0.001) and a higher albumin/creatinine ratio (Cohen's d=0.08, p=0.01). In total, 130 people (18%) reported elevated depressive or anxiety symptoms. Twenty-seven persons agreed to participate in the trial. Factors related to participation were a high education level, a higher level of diabetes distress and a history of psychological problems., Conclusions: Using screening as recruitment resulted in a small number of participants in a treatment trial for anxiety and depression. Research is needed to investigate whether screening is also followed by a low uptake of treatment in primary care outside a RCT setting., (Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: Depression has been associated with increased all-cause mortality in people with type 2 diabetes., Aims: To test whether anhedonia, dysphoria and anxiety are differentially associated with all-cause mortality and examine symptom-specific behavioural or pathophysiological mechanisms., Method: A total of 1465 people completed the Edinburgh Postnatal Depression Scale in 2005 and were followed until death or 31 December 2010. Cox regression analyses compared survival time for people with a low v. high baseline dysphoria/anhedonia/anxiety score and identified mediating mechanisms., Results: After a mean follow-up of 1878 days (s.d. = 306), 139 participants had died. At all time points, people with anhedonia had an almost twofold increased mortality risk compared with those without anhedonia. Physical activity met criteria for mediation. Symptoms of dysphoria and anxiety were not associated with survival time., Conclusions: Symptoms of anhedonia predicted shorter survival time, whereas dysphoria/anxiety did not. Mechanistic pathways, in particular physical activity, should be explored further., (© The Royal College of Psychiatrists 2016.)

People with diabetes have a higher risk of emotional distress (anxiety, depression) than non-diabetic or healthy controls. Therefore, identification of factors that can decrease emotional distress is relevant. The aim of the present study was to examine (1) the association between facets of mindfulness and emotional distress; and (2) whether mindfulness might moderate the association between potential adverse conditions (stressful life events and comorbidity) and emotional distress. Analyses were conducted using cross-sectional data (Management and Impact for Long-term Empowerment and Success--Netherlands): 666 participants with diabetes (type 1 or type 2) completed measures of mindfulness (Five Facet Mindfulness Questionnaire-Short Form; FFMQ-SF), depressive symptoms (Patient Health Questionnaire; PHQ-9), and anxiety symptoms (General Anxiety Disorder assessment; GAD-7). Hierarchical multiple regression analyses showed significant associations between mindfulness facets (acting with awareness, non-judging, and non-reacting) and symptoms of anxiety and depression (β = -0.20 to -0.33, all p < 0.001). These mindfulness facets appeared to have a moderating effect on the association between stressful life events and depression and anxiety (all p < 0.01). However, the association between co-morbidity and emotional distress was largely not moderated by mindfulness. In conclusion, mindfulness is negatively related to both depression and anxiety symptoms in people with diabetes and shows promise as a potentially protective characteristic against the influence of stressful events on emotional well-being.

Background: Chronic obstructive pulmonary disease (COPD) and asthma are common chronic diseases that are frequently accompanied by depression and/or anxiety. However, symptoms of depression and anxiety are often not recognized and therefore not treated. Currently, only a few studies have tested new clinical approaches that could improve the treatment of co-morbid depression and anxiety in these groups of patients., Methods/design: The present randomized controlled study will be conducted within the framework of PoZoB (Praktijk Ondersteuning Zuid-Oost Brabant), a large primary care organization in the Netherlands. Patients with asthma/COPD and co-morbid anxiety/depression will be included in order to test the effectiveness of a disease management approach to treat these co-morbid disorders. Important elements of this approach are: 1) systematic screening to improve detection of anxiety and depression 2) treatment in case of positive screening 3) monitoring of anxiety and depression 4) intensified treatment in case of non-remission (stepped care)., Discussion: The present study is a large primary care study on the treatment of co-morbid depression and anxiety in patients with asthma and COPD. Strengths of this study are its randomized design, the focus on implementation in primary care and the fact that it applies the latest findings on the treatment of depression and anxiety. First results are expected in 2012/2013.

Background: Depression and anxiety are common co-morbid health problems in patients with type 2 diabetes. Both depression and anxiety are associated with poor glycaemic control and increased risk of poor vascular outcomes and higher mortality rates. Results of previous studies have shown that in clinical practice, treatment of depression and anxiety is far from optimal as these symptoms are frequently overlooked and undertreated., Methods/design: This randomised controlled trial will examine the effectiveness of a disease management programme treating symptoms of depression and anxiety in primary care patients with Type 2 diabetes. Patients will be randomized on patient level in 1:1 ratio. Random block sizes of 2 and 4 are used. The disease management programme consists of screening, stepped treatment and monitoring of symptoms (n = 80). This will be compared to care as usual (n = 80)., Discussion: The disease management model for co-morbid depression and anxiety in primary care patients with diabetes is expected to result in reduced symptoms of depression and anxiety, improved quality of life, reduced diabetes specific distress and improved glyceamic control, compared to care as usual., Trial Registration: Dutch Trial Register NTR2626.

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. Linked article: This article is commented on by Gustaf Rejnö, pp.506 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17389 This article includes Author Insights, a video abstract available at: https://vimeo.com/732411350 [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic affects the mental health status of perinatal women, which makes it important to gain insight into and to effectively measure specific stressors of the COVID-19 pandemic. Therefore, we aimed to develop a COVID-19 Perinatal Perception Questionnaire (COVID19-PPQ). In-depth interviews were conducted during the first national lockdown period with pregnant women, new mothers and perinatal healthcare professionals, resulting in (a) a 27-item pregnancy and (b) a 21-item postpartum scale. Explorative factor analyses (EFA) in sample Ia (N = 154) and Ib (N = 90), and confirmatory factor analyses (CFA) in sample IIa (N = 113) and IIb (N = 81) were conducted to test the psychometric properties of both scales. For the pregnancy scale, EFA suggested a three-factor solution (risk of infection, contact, future), which was confirmed by CFA and resulted in a final nine-item scale. For the postpartum scale, a three-factor solution (first postpartum week, COVID-19 measures, fear for infection) was suggested by EFA and confirmed by CFA, resulting in a final ten-item scale. Symptoms of depression and pregnancy-specific distress were significantly correlated with the pregnancy (sub)scale(s), while symptoms of postpartum depression and anxiety showed significant correlations with the COVID-19 measures and fear for infection subscale. The COVID19-PPQ seems to be a valid instrument for assessment of perinatal COVID-19-related stress perception, showing adequate psychometric properties for both the pregnancy and postpartum scale. Future research should examine the use of this instrument in clinical practice during new episodes of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

We thank Grogan and Srinivasan[1] for writing a letter with interesting comments on our previously published article by Hulsbosch et al.[2] In this paper we investigated the association between comorbid anxiety and depressive (CAD) symptoms during pregnancy, and the likelihood of a physiological birth (defined as birth at term, free from intervention during labour, with a healthy mother and baby). Grogan and Srinivasan[1] suggest investigation of whether there is an association in our cohort between traumatic birth and persistent anxiety during pregnancy. GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE Footnotes 1 A comment on the recently published letter by Grogan and Srinivasan: The effect of antenatal depressive and anxious symptoms on the rate of physiological births. [Extracted from the article]

People with diabetes have a higher risk of emotional distress (anxiety, depression) than non-diabetic or healthy controls. Therefore, identification of factors that can decrease emotional distress is relevant. The aim of the present study was to examine (1) the association between facets of mindfulness and emotional distress; and (2) whether mindfulness might moderate the association between potential adverse conditions (stressful life events and comorbidity) and emotional distress. Analyses were conducted using cross-sectional data (Management and Impact for Long-term Empowerment and Success-Netherlands): 666 participants with diabetes (type 1 or type 2) completed measures of mindfulness (Five Facet Mindfulness Questionnaire-Short Form; FFMQ-SF), depressive symptoms (Patient Health Questionnaire; PHQ-9), and anxiety symptoms (General Anxiety Disorder assessment; GAD-7). Hierarchical multiple regression analyses showed significant associations between mindfulness facets (acting with awareness, non-judging, and non-reacting) and symptoms of anxiety and depression (β = −0.20 to −0.33, all p < 0.001). These mindfulness facets appeared to have a moderating effect on the association between stressful life events and depression and anxiety (all p < 0.01). However, the association between co-morbidity and emotional distress was largely not moderated by mindfulness. In conclusion, mindfulness is negatively related to both depression and anxiety symptoms in people with diabetes and shows promise as a potentially protective characteristic against the influence of stressful events on emotional well-being. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders are prevalent and associated with poor prognosis in patients with coronary artery disease (CAD). However, studies examining screening of anxiety disorders in CAD patients are lacking. In the present study we evaluated the prevalence of anxiety disorders in patients with CAD and diagnostic utility of self-rating scales for screening of anxiety disorders Methods: Five-hundred and twenty-three CAD patients not receiving psychotropic treatments at initiation of rehabilitation program completed self-rating scales (Hospital Anxiety and Depression Scale or HADS; Spielberger State-Anxiety Inventory or SSAI; and Spielberger Trait-Anxiety Inventory or STAI) and were interviewed for generalized anxiety disorder (GAD), social phobia, panic disorder and agoraphobia (Mini-International Neuropsychiatric Interview or MINI). Results: Thirty-eight (7%) patients were diagnosed with anxiety disorder(s), including GAD (5%), social phobia (2%), agoraphobia (1%) and panic disorder (1%). Areas under the ROC curve of the HADS Anxiety subscale (HADS-A), STAI and SSAI for screening of any anxiety disorder were .81, .80 and .72, respectively. Optimal cut-off values for screening of any anxiety disorders were =8 for the HADS-A (sensitivity = 82%; specificity = 76%; and positive predictive value (PPV) = 21%); =45 for the STAI (sensitivity = 89%; specificity = 56%; and PPV = 14%); and =40 for the SSAI (sensitivity = 84%; specificity = 55%; PPV = 13%). In a subgroup of patients (n = 340) scoring below the optimal major depressive disorder screening cut-off value of HADS-Depression subscale (score <5), the HADS-A, STAI and SSAI had moderate-high sensitivity (range from 69% to 89%) and low PPVs (=22%) for GAD and any anxiety disorders. Conclusions: Anxiety disorders are prevalent in CAD patients but can be reliably identified using self-rating scales. Anxiety self-rating scales had comparable sensitivities but the HADS-A had greater specificity and PPV when compared to the STAI and SSAI for screening of anxiety disorders. However, false positive rates were high, suggesting that patients with positive screening results should undergo psychiatric interview prior to initiating treatment for anxiety disorders and that routine use of anxiety self-rating scales for screening purposes can increase healthcare costs. Anxiety screening has incremental value to depression screening for identifying anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: Approximately 20-40% of outpatients with diabetes experience elevated levels of emotional distress, varying from disease-specific distress to general symptoms of anxiety and depression. The patient's emotional wellbeing is related to other unfavorable outcomes, like reduced quality of life, sub-optimal self-care, impaired glycemic control, higher risk of complications, and increased mortality rates. The purpose of this study is to test the effectiveness of a new diabetes-specific, mindfulness-based psychological intervention. First, with regard to reducing emotional distress; second, with respect to improving quality of life, dispositional mindfulness, and selfesteem of patients with diabetes; third, with regard to self-care and clinical outcomes; finally, a potential effect modification by clinical and personality characteristics will be explored. Methods/Design: The Diabetes and Mindfulness study (DiaMind) is a randomized controlled trial. Patients with diabetes with low levels of emotional well-being will be recruited from outpatient diabetes clinics. Eligible patients will be randomized to an intervention group or a wait-list control group. The intervention group will receive the mindfulness program immediately, while the control group will receive the program eight months later. The primary outcome is emotional distress (anxiety, stress, depressive symptoms), for which data will be collected at baseline, four weeks, post intervention, and after six months follow-up. In addition, self-report data will be collected on quality of life, dispositional mindfulness, self-esteem, self-care, and personality, while complications and glycemic control will be assessed from medical files and blood pressure will be measured. Group differences will be analyzed with repeated measures analysis of covariance. The study is supported by grants from the Dutch Diabetes Research Foundation and Tilburg University and has been approved by a medical ethics committee. Discussion: It is hypothesized that emotional well-being, quality of life, dispositional mindfulness, self-esteem, selfcare, and blood pressure will improve significantly more in the mindfulness group compared to the control group. Results of this study can contribute to a better care for patients with diabetes with lowered levels of emotional well-being. It is expected that the first results will become available in 2012. Trial registration: Dutch Trial Register NTR2145. [ABSTRACT FROM AUTHOR]

Pregnancy distress among childbearing women is common and can negatively affect both mother and infant. Mindfulness-based interventions (MBIs) may have a positive effect on pregnancy distress but randomized controlled trials with sufficient power are lacking. The current study examined the effectiveness of an online self-guided MBI in pregnant women with pregnancy distress. Pregnant women with elevated pregnancy distress levels at 12 weeks of pregnancy, measured with the Edinburgh Depression Scale (EDS) and Tilburg Pregnancy Distress Scale negative affect (TPDS-NA), were randomized into an intervention group (online MBI, N = 109) or control group (care as usual, N = 110). The primary outcome was the change in pregnancy distress post-intervention and at eight-weeks-follow-up. Secondary outcomes were mindfulness skills (Three Facet Mindfulness Questionnaire-Short Form), rumination (Rumination-Reflection Questionnaire), and self-compassion (Self-Compassion Scale-Short Form) at post-intervention and follow-up in the intervention group. Significant improvements were found in pregnancy distress scores, but no significant differences between intervention and control group appeared. The MBI group showed improvements in mindfulness skills, rumination, and self-compassion. Low adherence to the intervention and assessment of secondary outcome measures in the intervention group only. An intervention trial with one of the largest samples (N = 219) provided no evidence of a significant effect of an online self-guided MBI in distressed pregnant women. An online MBI may be associated with an improvement in mindfulness skills, rumination, and self-compassion. Future research should address the effectiveness of MBI's with different formats (online and group-based combined) and examine a possible delayed effect. ClinicalTrials.gov : NCT03917745, registered on 4 March 2019. • Randomized controlled trial conducted in pregnant women with pregnancy distress. • The intervention group (N = 109) took part in an online mindfulness-based intervention. • The control group (N = 110) received care as usual. • Intervention and control group showed a similar decrease in pregnancy distress. • Intervention group showed improved mindfulness skills, rumination and self-compassion. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The DiaMind trial showed beneficial immediate effects of mindfulness-based cognitive therapy (MBCT) on emotional distress, but not on diabetes distress and HbA1c. The aim of the present report was to examine if the effects would be sustained after six month follow-up. Methods: In the DiaMind trial, 139 outpatients with diabetes (type-I or type-II) and a lowered level of emotional well-being were randomized into MBCT (n=70) or a waiting list with treatment as usual (TAU: n=69). Primary outcomes were perceived stress, anxiety and depressive symptoms, and diabetes distress. Secondary outcomes were, among others, health status, and glycemic control (HbA1c). Results: Compared to TAU, MBCT showed sustained reductions at follow-up in perceived stress (p <.001, d =.76), anxiety (p <.001, assessed by HADS d =.83; assessed by POMS d =.92), and HADS depressive symptoms (p =.004, d =.51), but not POMS depressive symptoms when using Bonferroni correction for multiple testing (p =.016, d =.48). No significant between-group effect was found on diabetes distress and HbA1c. Conclusion: This study showed sustained benefits of MBCT six months after the intervention on emotional distress in people with diabetes and a lowered level of emotional well-being. Trial registration: Dutch Trial Register NTR2145, http://www.trialregister.nl. [Copyright &y& Elsevier]

Objective: Occurrence of psychological distress in hypertensive patients could have a negative synergistic effect on future cardiovascular events (CVEs). The aim of this study was to determine the association between anxiety or depressive symptoms in elderly hypertensive primary care patients and the development of new CVEs and all-cause mortality.Methods: A prospective cohort study was conducted in five Dutch general practices between June 2010 and January 2012. Patients with primary care managed hypertension, aged 60-85 years, were included and completed the GAD-7 and PHQ-9, measuring anxiety and depressive symptoms respectively. The incidence of new CVEs (coronary event, cerebrovascular disease, atrial fibrillation and heart failure) and all-cause mortality at 8 years' follow-up was recorded by data extraction of the digital information systems.Results: Among the 555 included participants (mean age 70 ± 6.6 years; 56% female), 29 (5.2%) had a new coronary event, 42 (7.6%) a cerebrovascular disease, 57 (10.3%) atrial fibrillation, 22 (4%) heart failure and 68 (12.3%) died. Elevated anxiety and depression scores increased the risk of a coronary event independently and significantly by 12% (HR 1.12; 95% CI [1.04-1.22], p = 0.005) and 18% (HR 1.18; 95% CI [1.08-1.28], p < 0.0001), respectively, adjusted for relevant (Framingham) baseline covariates. No associations were found with regard to other CVEs and all-cause mortality.Conclusion: In a random sample of elderly primary care hypertension patients there was a significant association between psychological distress and the occurrence of new coronary events after 8 years' follow-up but not with other CVEs and all-cause mortality. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Research on emotional distress and mortality has largely focused on depression in men and in elderly populations. We examined the relation between anxiety and mortality in women at midlife, adjusting for depression. Study Design and Setting: At baseline, 5,073 healthy Dutch women aged 46–54 years (mean=50.4±2.1) and living in Eindhoven, completed a three-item anxiety scale (“being anxious/worried,” “feeling scared/panicky,” “ruminating about things that went wrong;” Cronbach''s α =0.77). The primary outcome was all-cause mortality at 10-year follow-up; secondary outcomes were cardiovascular and lung/breast cancer death. Results: At follow-up, 114 (2.2%) women had died at the mean age of 56.4±3.1 years. Lung cancer (23%), cardiovascular disease (18%), and breast cancer (15%) were the major causes of death. Smoking, living alone, and lower education were related to mortality, but depression was not. Adjusting for these variables, anxiety was associated with a 77% increase in mortality risk (hazard ratio [HR]=1.77, 95% confidence interval [CI]: 1.14–2.74, P =0.011). Anxiety was related to cardiovascular death (HR=2.77, 95% CI: 1.17–6.58, P =0.021); there was also a trend for lung cancer death (HR=1.91, 95% CI: 0.90–4.06, P =0.095) but not for breast cancer death. Conclusion: Anxiety predicted premature all-cause and cardiovascular death in middle-aged women, after adjustment for standard risk factors and depression. [Copyright &y& Elsevier]

Abstract: Background: Psychiatric morbidity is highly prevalent in the primary health care settings and it may be related to autoimmune thyroid disease (AITD). The aim of this study was to evaluate the impact of thyroid immunity, evident by hypo-echoic thyroid ultrasound pattern, on prevalence of depression and anxiety in a primary care setting. Methods: In a cross-sectional design, 504 consecutive primary care patients were invited to the study and 474 patients completed the study. They were screened for depression and anxiety using the Hospital Anxiety and Depression Scale (HADS), were interviewed for affective disorders using the Mini International Neuropsychiatric Interview, and were evaluated by ultrasonographic imagining of the thyroid gland. Results: Among patients with hypo-echoic thyroid (n =122) prevailed women and those patients were older than patients with normo-echoic thyroid (n =352). Women, but not men, with hypo-echoic thyroid compared to those with normo-echoic thyroid had higher scores on the anxiety subscale of the HADS (p =0.03). Among women with hypo-echoic thyroid, only those pre-menopause, but not those post-menopause, had greater prevalence of high scores on the depression subscale of the HADS (p =0.02) and a greater likelihood of using psychiatric medications (p =0.001). Limitations: Lack of cytological evaluation of the thyroid gland; lack of serum thyroid antibodies concentrations; and lack of thyroid hormone concentrations. Conclusions: Thyroid immunity is related to mood symptoms in primary care patients. These effects are gender specific and in women, they are most evident before menopause. [Copyright &y& Elsevier]