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Background: As hypothesized in the Self-Regulatory Executive Function (S-REF) model, metacognitive beliefs are associated with anxiety and depression in adults. An important question is the extent to which such effects are present in children and adolescents, with the implication that the model may also apply to young people. The aim of this meta-analysis was to synthesize results on the nature and magnitude of associations between metacognitive beliefs and anxiety and depression in children and adolescents., Methods: Systematic searches were conducted to identify studies that investigated: (1) group differences in metacognitive beliefs in clinical compared to non-clinical samples or (2) correlations between metacognitive beliefs and symptoms of anxiety and depression., Results: Forty papers were identified comprising a total sample of 9,887 participants aged 7-18 years. Meta-analyses revealed that clinical samples endorsed significantly elevated metacognitive beliefs on four out of the five domains measured (i.e., negative beliefs about worry, cognitive confidence, need for control, and cognitive self-consciousness, with the only exception being positive beliefs about worry) compared to non-clinical samples with a small to large effect (Hedges' gs = 0.45-1.22). Moreover, all five domains of metacognitive beliefs were significantly and positively correlated with symptoms of anxiety and depression of a small to large effect (rs = .24-.53). Negative beliefs about worry showed the strongest relationship with clinical status and the magnitude of symptoms., Limitations: The number of studies did not allow for an evaluation of metacognitive beliefs at a disorder-specific level., Conclusions: In line with the S-REF model, our findings provide evidence of robust cross-sectional relationships between metacognitions and both anxiety and depression in childhood and adolescence., Competing Interests: Declaration of competing interest AT, LC, and MSO have no financial or non-financial interests to disclose. AW is the founder of MCT and a co-director of the Metacognitive Therapy Institute., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Generalized Anxiety Disorder-7 (GAD-7) is a widely used self-report that assesses generalized anxiety disorder symptomatology. Whilst previous studies have reported good-to-excellent psychometric properties across different languages, it remains unclear whether GAD-7 measures the same construct across Western and non-Western countries. Here, we tested the hypothesis that the GAD-7 is measurement invariant across Western and non-Western countries and the hypothesis that a less severe GAD symptomatology can be found in non-Western countries., Methods: The present study employed an online survey to examine the GAD-7's measurement invariance (MI) across community samples from Indonesia, Germany, and the USA (N = 2350). MI was computed using multiple-group confirmatory factor analyses with a general factor model of the GAD-7., Results: The general factor of the GAD-7 had good model fit and configural, metric, scalar, and residual MI across the three countries. No significant differences were found in mean scores (Indonesia, M = 1.78, SD = 0.64, Germany, M = 1.84, SD = 0.69, USA, M = 1.87, SD = 0.79; F (2, 1514) = 3.079, p = 0.046; Games-Howell post-hoc analysis, t Germany-Indonesia  = 1.720, p = 0.199; t Germany-USA  = 0.750, p = 0.734; t Indonesia-USA  = 2.330, p = 0.053)., Limitations: This study's online nature may have inflated cross-country similarities and reduced data generalizability., Conclusion: The full MI demonstrates the GAD-7 captures the same GAD construct across Western and non-Western countries. Inconsistent with the previous findings GAD severity levels were similar across countries. Despite some possible reservations, the GAD-7 appears to be a culturally fair GAD measure., Competing Interests: Declaration of competing interest None of the authors have conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: A critical challenge in the study and management of major depressive disorder (MDD) is predicting relapse. We examined the temporal correlation/coupling between depression and anxiety (called Depression-Anxiety Coupling Strength, DACS) as a predictor of relapse in patients with MDD., Methods: We followed 97 patients with remitted MDD for an average of 394 days. Patients completed weekly self-ratings of depression and anxiety symptoms using the Quick Inventory of Depressive Symptoms (QIDS-SR) and the Generalized Anxiety Disorder 7-item scale (GAD-7). Using these longitudinal ratings we computed DACS as random slopes in a linear mixed effects model reflecting individual-specific degree of correlation between depression and anxiety across time points. We then tested DACS as an independent variable in a Cox proportional hazards model to predict relapse., Results: A total of 28 patients (29 %) relapsed during the follow-up period. DACS significantly predicted confirmed relapse (hazard ratio [HR] 1.5, 95 % CI [1.01, 2.22], p = 0.043; Concordance 0.79 [SE 0.04]). This effect was independent of baseline depressive or anxiety symptoms or their average levels over the follow-up period, and was identifiable more than one month before relapse onset., Limitations: Small sample size, in a single study. Narrow phenotype and comorbidity profiles., Conclusions: DACS may offer opportunities for developing novel strategies for personalized monitoring, early detection, and intervention. Future studies should replicate our findings in larger, diverse patient populations, develop individual patient prediction models, and explore the underlying mechanisms that govern the relationship of DACS and relapse., Competing Interests: Declaration of competing interest RM has received consulting and speaking honoraria from AbbVie, Eisai, Janssen, Lallemand, Lundbeck, Neonmind, and Otsuka, and research grants from CAN-BIND, CIHR, Janssen, Nubiyota, OBI and OMHF. RWL has received honoraria for ad hoc speaking or advising/consulting, or received research funds, from: Abbvie, Asia-Pacific Economic Cooperation, Bausch, BC Leading Edge Foundation, Brain Canada, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, CAN-BIND Solutions, Carnot, Grand Challenges Canada, Healthy Minds Canada, Janssen, Lundbeck, Lundbeck Institute, Medscape, Michael Smith Foundation for Health Research, MITACS, Neurotorium, Ontario Brain Institute, Otsuka, Pfizer/Viatris, Shanghai Mental Health Center, Sunnybrook Health Sciences Center, Unity Health, Vancouver Coastal Health Research Institute, and VGH-UBCH Foundation. JAF has served on the Scientific Advisory Board for MRM Health NL and has received consulting/speaker fees from Klaire Labs, WebMD, Takeda Canada and Rothman, Benson, Hedges Inc. QSL is an employee of Janssen Research & Development, LLC and is a shareholder in Johnson & Johnson, which is the parent company of the Janssen companies. QSL declares that, except for income received from her primary employer, no financial support or compensation has been received from any individual or corporate entity over the past 3 years for research or professional service, and there are no personal financial holdings that could be perceived as constituting a potential conflict of interest. JJN is partially supported by a Marshall Fellowship Award from the UBC Institute of Mental Health. RU is supported by the Canada Research Chairs program. CS has received research funds from Clairvoyant Therapeutics, Otsuka, Eisai Inc. and served as an Advisory Board Member for Bayer, Pfizer, Eisai, Boheringer-Ingelheim. SHK has received engagements from Boehringer-Ingelheim, Janssen, Lundbeck, Merck, Neurotorium, Otsuka. CAN-BIND is an Integrated Discovery Program carried out in partnership with, and financial support from, the Ontario Brain Institute, an independent non-profit corporation, funded partially by the Ontario government. The opinions, results and conclusions are those of the authors and no endorsement by the Ontario Brain Institute is intended or should be inferred. Additional funding is provided by the Canadian Institutes of Health Research (CIHR), Lundbeck, Servier. Funding and/or in kind support is also provided by the investigators' universities and academic institutions. All study medications for the CAN-BIND-1 Trial were independently purchased at wholesale market values. The Wellness Monitoring Study was partially funded by Janssen Research & Development, LLC with research funding from Janssen to University Health Network., (Copyright © 2024. Published by Elsevier B.V.)

Family accommodation is a significant contributor to the maintenance and course of youth anxiety. There is also high co-occurrence of anxiety and irritability in youth. Research is lacking, however, on the influence of irritability in the association between anxiety and family accommodation, including among youth with clinically diagnosed anxiety disorders. We therefore examined this issue in a sample of clinic-referred anxious irritable and anxious nonirritable youth. Youth (N = 645, M age  = 9.86 years, SD = 2.92) and their parents completed diagnostic interviews and questionnaires assessing youth anxiety, irritability, and family accommodation. Based on both youth and parent ratings, family accommodation was significantly and positively associated with youth anxiety and irritability. Anxious irritable youth rated family accommodation significantly higher than anxious nonirritable youth. In addition, youth self-rated irritability levels significantly moderated the association between their anxiety and family accommodation. No moderation effect was found for the parent ratings. Based on the youth ratings, our overall findings show that parents of anxious irritable youth are more accommodating of their children's anxiety, compared with parents of anxious nonirritable youth. Anxiety levels also predict family accommodation more strongly in youth with lower levels of irritability. Our findings provide novel insights about accommodation behaviors in families of anxious irritable youth and suggest its potential utility as a treatment target when working with anxious irritable youth., (Copyright © 2024. Published by Elsevier Ltd.)

Tolin et al. (2004) developed the Chain of Contagion Task (CCT) to experimentally test the law of contagion and looming vulnerability (LV). In the CCT, contaminated pencils are brought into contact with clean pencils. The degree of contamination transferred to further new pencils refers to the level of biased contagious beliefs. Although this could be an important transdiagnostic tool, the usability of the original paradigm has been very laborious. Therefore, an imagery- and video-based CCT is introduced and validated in Study 1 in a nonclinical sample with 85 participants. In Study 2, the imagery-based CCT was validated in a clinical study with 15 participants diagnosed with contamination-related obsessive-compulsive disorder (C-OCD), 15 participants suffering from an anxiety disorder, and 15 nonclinical controls. The number of participants is consistent with those in Tolin's original sample and the statistical evaluation of Study 2 was preregistered. Both CCT could be validated and the results could be replicated. In the imagery-based CCT, the C-OCD group displayed significantly higher contamination ratings, avoidance tendencies and LV than the two control groups. We argue that this open access diagnostic instrument can be applied in research as well as in therapeutic practice (Download CCT videos and imagery: https://doi.org/10.5281/zenodo.7730459)., (Copyright © 2024 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)

Objective: There is growing interest in how peers' genotypes may influence health (i.e., peer social genetic effects). The authors sought to clarify the nature of peer social genetic effects on risk for drug use disorder, alcohol use disorder (AUD), major depression, and anxiety disorder., Method: Cox models were used with data from a population-based Swedish cohort (N=655,327). Outcomes were drug use disorder, AUD, major depression, and anxiety disorder registrations between ages 17 and 30 from medical, criminal, and pharmacy registries. The authors indexed peer social genetic effects with peers' family genetic risk scores (FGRSs) for the same disorders, which are personalized measures of genetic risk inferred from diagnoses in first- to fifth-degree relatives., Results: Across disorders, peer FGRSs predicted increased risks of proband registration (hazard ratio range, 1.01-1.59), with stronger effects for drug use disorder and AUD than for major depression and anxiety disorder. Peer social genetic effects were stronger for school classmates than for geographically proximal peers, and for peers from upper secondary school (ages 16-19) versus peers from lower secondary school (ages 7-16). Peer social genetic effects remained significant following statistical control for sociodemographic confounders, whether peers were affected, and peers' FGRS for educational attainment. Peer social genetic effects were more pronounced for probands at higher genetic risk., Conclusions: The genetic makeup of adolescents' peers has long-reaching consequences on risks for drug use disorder, AUD, major depression, and anxiety disorder. Individuals at high genetic risk are more sensitive to social genetic effects. Alternative hypotheses such as sociodemographic stratification, exposure to affected peers, and genetic predispositions for educational attainment did not explain the risk associated with peer social genetic effects for substance use and psychiatric disorders., Competing Interests: The authors report no financial relationships with commercial interests.

We aimed to assess the mental health of adults living in Ukraine one year after onset of the Russo-Ukrainian war, along with quality of life and coping strategies. Quota sampling was used to collect online survey data from 2364 adults aged 18-79 years living in Ukraine from April 5, 2023 to May 15, 2023. Among adults living in Ukraine, 14.4 % had probable post-traumatic stress disorder (PTSD), another 8.9 % had complex PTSD (CPTSD), 44.2 % had probable depressive disorder, 23.1 % had anxiety disorder and 38.6 % showed significant loneliness. In adjusted models, the number of trauma events experienced during the war showed a dose-response association with PTSD/CPTSD and was associated with depressive disorder and anxiety disorder. Quality of life domains, particularly physical quality of life, were negatively associated with PTSD/CPTSD, depressive disorder, anxiety disorder, and number of trauma events. Maladaptive coping was positively associated with depressive disorder, anxiety disorder, PTSD/CPTSD and loneliness. All quality of life domains were positively associated with using adaptive coping strategies. Mental health disorders are highly prevalent in adults living in Ukraine one year into the war. Policy and services can promote adaptive coping strategies to improve mental health and quality of life for increased resilience during war., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Background and Objectives: Drawing on affective events theory, the present study investigates relationships between daily interpersonal conflicts and negative and positive affective reactions, and tested whether trait neuroticism moderates immediate (same day) and persisting (next-day) affective reactions., Design and Methods: A sample of 53 Norwegian naval cadets completed a diary questionnaire for 30 consecutive days (total N  = 1590)., Results: As predicted, the findings showed that cadets reported more negative affect (but not less positive affect) on days they were confronted with affective events that were of a conflicting nature. In addition, the proposed interaction effects between daily conflict and neuroticism were significant for both negative and positive affect. Specifically, the immediate and persistent effects of daily conflicts on negative affect were strongest for individuals high (vs. low) in neuroticism. Moreover, individuals high in neuroticism reported less positive affect on days with conflicts, whereas individuals low in neuroticism reported more positive affect the two days following interpersonal conflicts., Conclusions: The findings contribute to affective events theory with important knowledge about the role of trait neuroticism in dealing with interpersonal conflicts in a natural work setting.

Youth of parents who are experiencing psychopathology are more likely to develop emotional concerns, and these mental health symptoms can have a deleterious impact on parents' mental health. However, the relationship between the presentation of specific symptoms in parents and youth is infrequently examined. Symptom network analysis is an analytic approach that is increasingly being used to better understand the relationship of symptoms within and between disorders and can also be used to examine symptom relations within a dyad. The present study used symptom network analysis to examine bidirectional relationships among depressive and anxiety psychopathology in a transdiagnostic sample of treatment-seeking youth and their primary caregiver. Parental anhedonia and child worthlessness exhibited the greatest centrality within the network, suggesting that these may act as risk and maintenance factors for parent-child psychopathology and may be important intervention targets. Findings support the use of symptom network analysis to inform an understanding of the complex relationships among parent and child depressive and anxiety symptoms. Future research should consider the use of network analytic methods to examine the temporal relationships between parent and child psychopathology and to inform joint parent-child interventions for those with internalizing concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Anorexia nervosa (AN) is characterised by dysfunctional cognitive biases but these have rarely been investigated in adolescents with AN. The present study systematically assessed cognitive biases in adolescents with AN and addressed the questions of content-specificity (i.e., do biases occur only for eating disorder-related information?) and disorder-specificity (i.e., are biases unique to individuals with AN?)., Methods: Cognitive biases on three information processing levels (attention, interpretation, memory) and for two types of information content (eating disorder-related, non-eating disorder-related) were assessed within a single experimental paradigm based on the Scrambled Sentences Task. 12-18-year-old adolescents with AN (n = 40) were compared to a healthy (HC; n = 40) and a clinical (girls with depression and/or anxiety disorders; CC; n = 34) control group., Results: Both clinical groups (AN and CC) showed pronounced negative interpretation and memory biases compared to the HC group, for both disorder-related and non-disorder-related information. Attention biases could not be analysed., Conclusion: The results support the hypothesis that adolescents with AN show negative cognitive biases but these were not limited to disorder-related information. Adolescents with depression and/or anxiety disorders showed similar biases, suggesting them to be transdiagnostic phenomena. Important implications for cognitive-behavioural theories of AN, subsequent cognitive bias modification studies in AN, as well as clinical practice are discussed., (© 2024 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Background and Objective: We examined the possibility that reactions to climate change take two forms: distress, which may be adaptive, and symptoms of mental disorders, which may not be., Design and Method: In a national sample of Polish adults ( n  = 1133), we measured climate change distress (experiencing unpleasant emotions and feelings due to climate change), climate-related symptoms of mental disorders (e.g., problems sleeping and problems working and planning), generalized anxiety, and depression., Results: Zero-inflated Poisson regression analyses of the occurrence of climate-related symptoms of mental disorders found two latent classes: People who experienced symptoms of the disorder and those who did not. For all eight symptoms, climate change distress predicted membership in the latent class of people who experienced a symptom, whereas how often people in the non-zero latent class experienced each symptom was positively related to generalized anxiety but was not related to distress or depression., Conclusions: These results suggest that reactions to climate change take two forms. Some people do not experience climate change-related symptoms of mental disorders, and some do. People who experience symptoms have higher levels of climate change distress, and the frequency with which they experience these symptoms is determined by their dispositional, generalized anxiety.

Interpersonal problems are common in individuals with generalized anxiety disorder (GAD) and improved interpersonal functioning is an important goal in treatment. In the metacognitive model of worry and generalized anxiety disorder, emotional distress and psychological dysfunction are related to two distinct types of worry. Particular emphasis is put on meta-worry which refers to "worry about worrying" or appraisal of worrying as threatening in itself. Meta-worry impairs effective mental regulation and might therefore be an important predisposition to self-regulate via others and thereof interpersonal problems. In the current study, we tested the prediction that meta-worry is uniquely associated with interpersonal problems in two samples. The first consisted of 135 individuals with analogue GAD and the second of 56 individuals with a diagnosis of GAD. Using hierarchical linear regressions controlling for anxiety, depression and worry, meta-worry showed a unique relationship with interpersonal problems in both samples. These findings indicate that meta-worry may be relevant to formulate and treat interpersonal problems in individuals with GAD.

Background: Generalized anxiety disorder (GAD)-characterised by excessive and uncontrollable worry-is the most frequently diagnosed anxiety disorder during pregnancy and the postpartum period. Identification of GAD often relies on assessment of its cardinal feature, pathological worry. The Penn State Worry Questionnaire (PSWQ) is the most robust measure of pathological worry to date but has not been extensively evaluated for use during pregnancy and the postpartum period. This study evaluated the internal consistency, construct validity, and diagnostic accuracy of the PSWQ in a sample of pregnant and postpartum women with and without a principal GAD diagnosis., Methods: One hundred forty-two pregnant and 209 postpartum women participated in this study. Sixty-nine pregnant and 129 postpartum participants met criteria for a principal diagnosis of GAD., Results: The PSWQ demonstrated good internal consistency and converged with measures assessing similar constructs. Pregnant participants with principal GAD scored significantly higher on the PSWQ than those with no psychopathology and postpartum participants with principal GAD scored significantly higher than those with principal mood disorders, other anxiety and related disorders, and no psychopathology. A cut-off score of 55 and 61 or greater was determined for detecting probable GAD during pregnancy and the postpartum period, respectively. Screening accuracy of the PSWQ was also demonstrated., Conclusions: This study underscores the robustness of the PSWQ as a measure of pathological worry and probable GAD and supports its use in the detection and monitoring of clinically significant worry symptoms during pregnancy and postpartum period.

Objectives: Patients in cognitive behavioural therapy (CBT) who are high in interpersonal sensitivity may have difficulty fully engaging in treatment because therapy sessions require intimate interpersonal interactions that are especially uncomfortable for these individuals. The current study tests the hypotheses that patients who are high in interpersonal sensitivity benefit less from CBT for symptoms of depression and anxiety, show a slower rate of change in those symptoms, and are more likely to drop out of treatment., Methods: Participants were 832 outpatients who received naturalistic CBT. We assessed interpersonal sensitivity before treatment began and depression and anxiety symptoms at every therapy session. We assessed early, premature, and uncollaborative termination after treatment ended. We constructed multilevel linear regression models and logistic regression models to assess the effects of baseline interpersonal sensitivity on the treatment outcome, the slope of change in depression and anxiety symptoms, and each type of dropout., Results: Higher baseline interpersonal sensitivity was associated with a slower rate of change and less overall change in anxiety but not depressive symptoms. Baseline interpersonal sensitivity was not a predictor of dropout., Conclusions: Interpersonal sensitivity at baseline predicts less change and a slower rate of change in anxiety symptoms. Early detection of elevated interpersonal sensitivity can help therapists take action to address these barriers to successful treatment and help scientists build decision support tools that accurately predict the trajectory of change in anxiety symptoms for these patients., (© 2024 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Purpose: There are discrepancies in mental health treatment outcomes between ethnic groups, which may differ between genders. NHS Talking Therapies for anxiety and depression provide evidence-based psychological therapies for common mental disorders. This study examines the intersection between ethnicity and gender as factors associated with psychological treatment outcomes. Aims were to explore by gender: (1) differences in psychological treatment outcomes for minoritized ethnic people compared to White-British people, (2) whether differences are observed when controlling for clinical and socio-demographic factors associated with outcomes, and (3) whether organization-level factors moderate differences in outcomes between ethnic groups., Methods: Patient data from eight NHS Talking Therapies for anxiety and depression services (n = 98,063) was used to explore associations between ethnicity and outcomes, using logistic regression. Stratified subsamples were used to separately explore factors associated with outcomes for males and females., Results: In adjusted analyses, Asian (OR = 0.82 [95% CI 0.78; 0.87], p < .001, 'Other' (OR = 0.79 [95%CI 0.72-0.87], p < .001) and White-other (0.93 [95%CI 0.89-0.97], p < .001) ethnic groups were less likely to reliably recover than White-British people. Asian (OR = 1.48 [95% CI 1.35-1.62], p < .001), Mixed (OR = 1.18 [95% CI 1.05-1.34], p = .008), 'Other' (OR = 1.60 [95% CI 1.38-1.84], p < .001) and White-other (OR = 1.18 [95% CI 1.09-1.28], p < .001) groups were more likely to experience a reliable deterioration in symptoms. Poorer outcomes for these groups were consistent across genders. There was some evidence of interactions between ethnic groups and organization-level factors impacting outcomes, but findings were limited., Conclusions: Across genders, Asian, 'Other' and White-other groups experienced worse treatment outcomes across several measures in adjusted models. Reducing waiting times or offering more treatment sessions might lead to increased engagement and reduced drop-out for some patient groups., (© 2024. The Author(s).)

Purpose: To examine the nature of positive and negative environmental change on clinical outcome in 210 patients presenting with anxiety and depression and followed up over 30 years., Methods: In addition to clinical assessments, major environmental changes, particularly after 12 and 30 years, were recorded in all patients by a combination of self-report and taped interviews. Environmental changes were separated into two major groups, positive or negative, determined by patient opinion., Results: In all analyses positive changes were found to be associated with better outcome at 12 years with respect to accommodation (P = 0.009), relationships (P = 007), and substance misuse (P = 0.003), with fewer psychiatric admissions (P = 0.011) and fewer social work contacts at 30 years (P = 0.043). Using a consolidated outcome measure positive changes were more likely than negative ones to be associated with a good outcome at 12 and 30 years (39% v 3.6% and 30.2% v 9.1%, respectively). Those with personality disorder at baseline had fewer positive changes (P = 0.018) than others at 12 years and fewer positive occupational changes at 30 years (P = 0.041). Service use was greatly reduced in those with positive events with 50-80% more time free of all psychotropic drug treatment (P < 0.001). Instrumental positive change had greater effects than imposed changes., Conclusions: Positive environmental change has a favourable impact on clinical outcome in common mental disorders. Although studied naturalistically in this study the findings suggest that if harnessed as a therapeutic intervention, as in nidotherapy and social prescribing, it would yield therapeutic dividends., (© 2023. The Author(s).)

Introduction: After rotator cuff repair (RCR), return to work and return to sports is affected by various psychosocial factors. The role of one of these factors - mood and anxiety disorders (MAD) - is still not clear. The primary objective of this study was to determine the influence of prior MAD on the return to work and return to sports after RCR. Our hypothesis was that patients with a history of MAD would take longer to return to work and to sports after RCR, and the rate of return would be lower, than for patients without MAD., Materials and Methods: This was a retrospective single-center study of patients who underwent arthroscopic RCR (distal supraspinatus tear). Patients who were employed and those who participated in sports before the surgery were included in the "working" and "sports" groups, respectively. The primary outcomes were the time to return to work and return to sports after surgery. The secondary outcomes were the ratio of patients returning to work and to sports at 3, 6 and 12 months; rate of return to same level of sports; need to change or stop working or sports. The effects of prior MAD on these various outcomes were determined using Bayesian multivariate analysis., Results: The "working" group consisted of 158 patients (of which 16.5% had MAD) and the "sports" group consisted of 118 patients (of which 17.8% had MAD). In those with a history of MAD, return to work was 21±11 weeks later and the return to sports was 17±8 weeks later than in those without MAD. There was a 98% probability that return to work or return to sports was delayed by at least 4 weeks in patients with history of MAD. The likelihood that patients with prior MAD who undergo RCR will completely abandon their sport was 2.8 times higher (OR=2.8 [1; 7.8])., Conclusion: We found a negative influence of prior MAD on the return to work and return to sports after RCR., Level of Evidence: III; retrospective case-control study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Exercise interventions show promise in the treatment of anxiety disorders, but effects on health-related quality of life (HR-QoL), work ability, and sick leave are little studied. We investigated these outcomes in a 12-week randomized controlled trial with a 1-year follow-up., Methods: Patients aged 18-65 (n = 222) with anxiety disorders from primary care centers in Gothenburg were randomized to a control group or one of two 12-week exercise intervention groups (low-intensity, [LI] and moderate/high-intensity, [HI]); 148 were evaluated at 12-weeks and 113 completed the 1-year follow-up. The EuroQol 5D (EQ5D; index and the visual analogue scale [VAS]), work ability score (WAS), presenteeism, and self-reported sick leave were assessed at baseline, 12 weeks, and 1 year. Improvements were defined by binary cut-offs for each scale. Binary logistic regression with odds ratios (OR) and 95 % confidence intervals (CI) were reported., Results: There were improved scores for EQ5D and WAS in the HI group compared to controls after 12 weeks (EQ5D index: 4.74 [1.91-11.7], EQ5D-VAS 4.00, [1.65-9.72], WAS 3.41 [1.24-7.37]) and 1 year (EQ5D index: 3.05 [1.05-8.81], EQ5D-VAS 3.20 [1.16-8.84], WAS 5.50 [1.85-16.3]). Post-hoc analysis showed higher ORs in participants on antidepressants (n = 75) (12-week EQ5D index: OR 9.95 [2.85-34.8]) and significant improvements in EQ5D scores for both intervention groups after 1 year. There were no between-group differences for presenteeism or sick leave., Limitations: Discontinuation was high, mostly early after randomization (n = 74), as is common for anxiety interventions., Conclusions: HI Exercise improves HR-QoL and work ability in anxiety patients, especially when combined with antidepressants., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Prior studies used exploratory bifactor analyses to examine the structure of the Neuroticism scale from the Short-scale Eysenck Personality Questionnaire-Revised (EPQ-RS). These studies revealed a general factor and two group factors-Anxious-Tense and Worried-Vulnerable. These factors were related to poorer mental health, but their associations with physical health differed, as did their genetic and neurobiological underpinnings. A later study found that their associations with the Big Five Inventory-2 Short Form's factors and facets differed. We reanalyzed data on 1,006 Spanish students who completed Spanish-language versions of the EPQ-RS and the Revised NEO Personality Inventory (NEO PI-R). Using confirmatory factor analysis, we showed that a model comprising the general factor and a group factor-Anxious-Tense-fit well. In later correlations, a joint factor analysis, and simultaneous multiple regressions, we showed that the EPQ-RS's general factor and the group factor had different patterns of associations with the NEO PI-R domains and facets. These associations were consistent with the definition of the EPQ-RS Neuroticism scale's general factor and that of the group factor. Further investigation into the EPQ-RS Neuroticism scale's structure can improve our understanding of neuroticism's relationship with health and other outcomes.

Background: Personality traits have been associated with eating disorders (EDs) and comorbidities. However, it is unclear which personality profiles are premorbid risk rather than diagnostic markers., Methods: We explored associations between personality and ED-related mental health symptoms using canonical correlation analyses. We investigated personality risk profiles in a longitudinal sample, associating personality at age 14 with onset of mental health symptoms at ages 16 or 19. Diagnostic markers were identified in a sample of young adults with anorexia nervosa (AN, n = 58) or bulimia nervosa (BN, n = 63) and healthy controls (n = 47)., Results: Two significant premorbid risk profiles were identified, successively explaining 7.93 % and 5.60 % of shared variance (R c 2 ). The first combined neuroticism (canonical loading, r s  = 0.68), openness (r s  = 0.32), impulsivity (r s  = 0.29), and conscientiousness (r s  = 0.27), with future onset of anxiety symptoms (r s  = 0.87) and dieting (r s  = 0.58). The other, combined lower agreeableness (r s  = -0.60) and lower anxiety sensitivity (r s  = -0.47), with future deliberate self-harm (r s  = 0.76) and purging (r s  = 0.55). Personality profiles associated with "core psychopathology" in both AN (R c 2  = 80.56 %) and BN diagnoses (R c 2  = 64.38 %) comprised hopelessness (r s  = 0.95, 0.87) and neuroticism (r s  = 0.93, 0.94). For BN, this profile also included impulsivity (r s  = 0.60). Additionally, extraversion (r s  = 0.41) was associated with lower depressive risk in BN., Limitations: The samples were not ethnically diverse. The clinical cohort included only females. There was non-random attrition in the longitudinal sample., Conclusions: The results suggest neuroticism and impulsivity as risk and diagnostic markers for EDs, with neuroticism and hopelessness as shared diagnostic markers. They may inform the design of more personalised prevention and intervention strategies., Competing Interests: Declaration of competing interest Dr. Banaschewski served in an advisory or consultancy role for ADHS digital, Infectopharm, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Roche, and Takeda. He received conference support or speaker's fee by Medice and Takeda. He received royalties from Hogrefe, Kohlhammer, CIP Medien, Oxford University Press. Dr. Poustka served in an advisory or consultancy role for Roche and Viforpharm and received speaker's fee by Shire. She received royalties from Hogrefe, Kohlhammer and Schattauer. The present work is unrelated to these relationships. The other authors report no biomedical financial interests or potential conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Traumatic brain injury (TBI) is defined as acquired cerebral damage caused by an external mechanical impact, which has the potential to lead to transient or enduring debilitation. TBI is associated with many forms of long-lasting psychiatric conditions, including anxiety disorders. As anxiety is highly debilitating by causing impaired social functioning and decreased quality of life for the afflicted, especially in the form of anxiety disorders such as generalized anxiety disorder, certain efforts have been made to explore the factors associated with it, and one such factor is TBI., Methods: We searched PubMed, Scopus, and Web of Science on January 26th, 2024 for observational case-control or cohort or cross-sectional studies assessing the incidence of anxiety symptoms or disorders in patients with TBI compared to healthy individuals or the same individuals if pre-TBI information regarding anxiety was available. We calculated the pooled incidence and relative risk (RR) and 95% confidence interval (95CI) using the inverse variance method. Publication bias was assessed using Eggers's regression test. Quality assessment was performed using the Newcastle-Ottawa scale. Sub-group analyses were conducted for the type of anxiety (anxiety disorder vs anxiety symptoms), TBI severity, and type of anxiety disorders., Results: The incidence rate of anxiety after traumatic brain injury was 17.45% (95CI: 12.59%, 22.31%) in a total of 705,024 individuals. Moreover, TBI patients were found to be 1.9 times as likely to have anxiety compared to their non-TBI counterparts [Random effects model RR = 1.90 [1.62; 2.23], p-value < 0.0001] using a population of 569,875 TBI cases and 1,640,312 non-TBI controls. Sub-group analysis revealed TBI severity was not associated with anxiety and generalized anxiety disorder was the most common type of anxiety disorder reported post-TBI., Conclusion: Patients who have experienced a TBI exhibit a significantly greater incidence of anxiety symptoms and anxiety disorders in the aftermath when compared to healthy individuals., (© 2024. The Author(s).)

Childhood trauma is widely recognized as a potential risk factor for psychiatric illness in adulthood, yet the precise mechanisms underlying this relationship remain incompletely understood. One proposed mechanism involves the impact of childhood trauma on personality development, particularly in relation to neuroticism, which may subsequently heighten susceptibility to psychiatric disorders. In this study, we aimed to investigate this hypothesis through an online survey involving 1116 participants (232 male, 21 %). Participants completed the Childhood Trauma Questionnaire (CTQ), assessing emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect, along with the Trait Self-Description Inventory (TSDI) for personality assessment and the PHQ-9 and GAD-7 clinical questionnaires for depression and anxiety symptoms evaluation, respectively. Our analyses revealed significant positive correlations between all facets of childhood trauma and neuroticism (all p < .01). Linear regression analysis demonstrated that emotional abuse significantly contributed to neuroticism (β = 0.267, p < .05), openness (β = 0.142, p < .05), and agreeableness (β = 0.089, p < .05), while sexual abuse was associated with agreeableness (β = 0.137, p < .01) Emotional neglect was negatively correlated with conscientiousness (β = -0.090, p < .01), extroversion (β = -0.109, p < .01) and agreeableness (β = -0.154, p < .01). Furthermore, linear regression analysis revealed that emotional abuse was positively and significantly correlated with PHQ-9 and GAD-7 scores (r = 0.330, p < .01 and r = 0.327, p < .01, respectively). Mediation analysis supported a significant mediating role of neuroticism in the association between childhood emotional abuse and both depression (PHQ-9) (z = 8.681, p < .01) and anxiety (GAD-7) (z = 9.206, p < .01). Notably, the correlation between childhood emotional abuse and psychiatric symptoms was attenuated but not eliminated after controlling for neuroticism, suggesting partial mediation. While our cross-sectional design precludes causal inference, our findings support the notion that childhood emotional abuse may contribute to increased neuroticism, thereby elevating vulnerability to affective disorders in adulthood. These results underscore the importance of considering personality factors in understanding the long-term consequences of childhood trauma on mental health outcomes., Competing Interests: Declaration of competing interest This study was funded by The Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), and King's College London. AHY and MFJ are supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King's College London. This report represents independent research funded by the National Institute for Health Research Biomedical Research Centre and South London and Maudsley National Health Service Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the National Health Service, National Institute for Health Research, or Department of Health. The authors report no conflicts of interest in relation to this work., (Copyright © 2024. Published by Elsevier B.V.)

Background: Temperament and character are useful in risk assessment and therapy of individuals in the anxiety-depression spectrum but understudied in South Korea., Objective: The study aimed to identify the temperament and character features associated with anxiety and/or depression in individuals with clinical disorders and in the general population., Methods: A representative sample of 1384 Korean adults over 18 years old (58 % female) were assessed with the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Temperament and Character Inventory (TCI). Multivariate analyses, including structural equation modeling and complex systems analysis, evaluated how personality influenced risk and resilience for anxiety and/or depression., Results: The three groups with anxiety and/or depression were strongly distinguished by temperament and character: (i) In AD (n = 58), Harm Avoidance and Reward Dependence were higher than in DD, and Self-directedness was higher than in AD+DD; (ii) In DD (n = 90), Persistence, Self-Directedness and Cooperativeness were higher than in AD+DD; and (iii) In AD+DD (n = 101), Harm Avoidance was highest and Persistence and Self-directedness were lowest (i.e., they were lowest in Resilience). Structural equation models confirmed these risk relations with strong character development reducing the adverse effects of emotional hyperreactivity from extreme temperaments., Limitations: Self-reports were measured only at one point in time, requiring collateral experimental data to support causal interpretation., Conclusions: Interactions of temperament and character are strongly predictive of risk and resilience to anxiety and/or depression by regulating both positive and negative affect. Character mediates the adverse effects of extreme temperaments on affect., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Impulsivity increases the risk for depression and anxiety. However, the granular pathways among them remain unknown. A network approach that moves from disorder-level analysis to symptom-level analysis can provide further understanding of psychopathological mechanisms. In this study, we examined the network structure of impulsivity and separate and comorbid symptoms of depression and anxiety., Methods: Regularized partial-correlation networks were estimated using cross-sectional data from 1047 Chinese participants aged 18-26 years (main dataset, mean age = 21.45 ± 2.01 years) and 325 Chinese participants aged 18-36 years (an independent replication dataset, mean age = 21.49 ± 3.73 years), including impulsivity-depression, impulsivity-anxiety, and impulsivity-depression-anxiety networks. The datasets were collected from 1 June 2023 to 4 August 2023 and from 27 April 2022 to 16 May 2022, respectively. Impulsivity, depression, and anxiety were assessed using Barratt Impulsiveness Scale Version 11, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7, respectively. Bridge centrality was analyzed, and a network comparison test (NCT) was conducted to investigate the differences between the main dataset and replication dataset., Results: The motor impulsivity dimension was revealed to be closely connected with individual symptoms of depression and anxiety regardless of whether they were in separate disorder forms or comorbid forms. In all the networks, motor impulsivity was the most important bridge node. The NCT showed comparable network connectivity and network structure between the main and replication datasets., Limitations: The use of cross-sectional data limited the inferences about the direction of causality between variables., Conclusions: These findings elucidate the psychopathological mechanisms underlying how impulsivity functions within depression, anxiety, and comorbidity and support that motor impulsivity is an important risk factor across different mental disorders and is responsible for comorbidity. The implications of these findings are discussed., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: While many studies have established a positive correlation between adolescents' internet addiction and mental health problems, most of these studies have overlooked the internal heterogeneity of Internet addiction. This study aims to identify latent profiles among adolescents based on their Internet addiction and to examine the differences in aggression, depression, and anxiety across these profiles., Methods: We conducted a survey involving 7422 adolescents and administered the Young's Internet Addiction Test, Aggression Behavior Questionnaire, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale. Latent profile analysis was utilized to categorize Internet addiction profiles among adolescents. Associations between Internet addiction profiles and related factors were examined using the Bolck-Croon-Hagenaars method., Results: Latent profile analysis suggested four profiles of Internet addiction, which were labeled: Regular, Risk, Low Internet addiction, and Internet addiction. The Internet addiction profile showed higher levels of aggression, depression, and anxiety than the Low Internet addiction profile. The Low Internet addiction profile had higher levels of aggression, depression, and anxiety than the Risk profile. The Risk profile demonstrated higher levels of aggression, depression, and anxiety when compared to the Regular profile., Limitations: Limitations include the cross-sectional design and the self-report measures., Conclusions: The identified Internet addiction profiles offer differential predictions for aggression, depression, and anxiety. These results underscore the significance of employing latent profile analysis when exploring the associations between Internet addiction and mental health issues., Competing Interests: Declaration of competing interest There is no conflict of interest for all named authors., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Competing Interests: Conflicts of interest H.L. reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB (all outside the submitted work). H.L. is Editor-in-Chief of JCPP Advances.

Introduction: Working on the frontline during the COVID-19 pandemic has been associated with increased risk to mental health and wellbeing in multiple occupations and contexts. The current study aimed to provide an insight into the rate of probable mental health problems amongst United Kingdom (UK) Government employees who contributed to the COVID-19 response whilst working from home, and to ascertain what factors and constructs, if any, influence mental health and wellbeing in the sample population., Method: This paper reports on the findings from two studies completed by UK Government employees. Study 1: A cross-sectional online survey, containing standardised and validated measures of common mental health disorders of staff who actively contributed to the COVID-19 response from their own homes. Binary logistic regression was used to assess factors associated with mental health outcomes. Study 2: A secondary data analysis of cross-sectional survey data collected across three timepoints (May, June, and August) in 2020 focusing on the wellbeing of employees who worked from home during the COVID-19 pandemic., Results: Study 1: 17.9% of participants met the threshold criteria for a probable moderate anxiety disorder, moderate depression, or post-traumatic stress disorder. Younger, less resilient, less productive individuals, with lower personal wellbeing and less enjoyment of working from home, were more likely to present with poorer mental health. Study 2: Found lower wellbeing was consistently associated with having less opportunities to look after one's physical and mental health, and having unsupportive line managers and colleagues., Conclusion: It is important to ensure UK Government employees' psychological needs are met whilst working from home and responding to enhanced incidents. It is recommended that workplaces should be seeking to continually build and improve employee resilience (e.g., through opportunities to increase social ties and support networks), essentially ensuring employees have necessary resources and skills to support themselves and others., (© 2024. The Author(s).)

Introduction: Fears and anxieties are a common cause of suffering for patients at the end of life. These are often either fears about dying - for example, fear of unbearable pain or fear of suffocation - or fear of death itself. If unrecognized and untreated, fears and anxieties can contribute to a considerable reduction in the quality of life in the last phase of life. Careful diagnosis of anxiety and fear is therefore crucial. Multimodal treatment, which includes psychotherapy and other non-pharmacological and - if necessary - pharmacological treatments, can provide significant relief., Competing Interests: Die Autoren haben keine Interessenkonflikte im Zusammenhang mit diesem Artikel deklariert., (© 2024 Aerzteverlag medinfo AG.)

Importance: Anxiety disorders are prevalent and undertreated among young adults. Digital mental health interventions for anxiety are promising but limited by a narrow range of therapeutic components and low user engagement., Objective: To investigate the efficacy of and engagement with Maya, a scalable, self-guided, comprehensive mobile cognitive behavioral therapy (CBT) intervention with embedded engagement features, comparing the effects of 3 incentive conditions., Design, Setting, and Participants: This randomized clinical trial recruited young adults aged 18 to 25 years with anxiety disorders through online advertisements and outpatient psychiatry clinics at Weill Cornell Medicine. Enrollment was between June 16, 2021, and November 11, 2022. Data analysis was performed from December 21, 2022, to June 14, 2024., Intervention: Participants received a 6-week program of the intervention and were randomized to 1 of 3 different text message-based incentive conditions (gain-framed, loss-framed, or gain-social support)., Main Outcomes and Measures: The primary outcome was change in anxious symptoms from baseline to end of treatment, as measured by the Hamilton Anxiety Rating Scale (HAM-A). The Anxiety Sensitivity Index and the Leibowitz Social Anxiety Scale scores were secondary measures., Results: The sample consisted of 59 participants (mean [SD] age, 23.1 [1.9] years; 46 [78%] female; 22 [37%] Asian, 3 [5%] Black, 5 [8%] Hispanic or Latino, 1 [2%] American Indian or Alaska Native, 25 [42%] White, and 6 [10%] >1 race; 32 [54%] college-educated and 12 [20%] graduate or professional school-educated; mean [SD] baseline HAM-A score, 15.0 [6.5]). Anxiety, measured by HAM-A, decreased across conditions from baseline to end of the intervention (mean difference, -5.64; 95% CI, -7.23 to -4.05), and symptomatic improvement was maintained at the week 12 follow-up (baseline to follow-up mean difference, -5.67; 95% CI, -7.29 to -4.04). However, there was no evidence that change in anxiety differed by incentive condition (loss-framed vs gain-social support mean difference, -1.40; 95% CI, -4.72 to 1.93; gain-framed vs gain-social support mean difference, 1.38; 95% CI, -1.19 to 3.96). Secondary anxiety measures (Anxiety Sensitivity Index and Liebowitz Social Anxiety Scale scores) showed a similar pattern of improvement, with no evidence of differences between incentive conditions. Participants completed most of the 12 sessions (mean [SD], 10.8 [2.1]; 95% CI, 10.3-11.4), and User Mobile Application Rating Scale app quality ratings exceeded the published threshold for acceptability at all study visits. There was no evidence that either session completion or app quality ratings differed by incentive condition., Conclusions and Relevance: In this randomized clinical trial of an app-based intervention for anxiety, the primary hypothesis that improvement in anxiety would be greatest in the condition using gain of points plus social incentives was not supported; however, the results suggest that a CBT application incorporating a full suite of CBT skills and embedded user engagement features was efficacious in improving symptoms in young adults with anxiety disorders. Given these findings, digital interventions represent a promising step toward wider dissemination of high-quality, evidence-based interventions., Trial Registration: ClinicalTrials.gov Identifier: NCT05130281.

Background: The use of online questionnaires to assess common mental disorders such as perinatal anxiety has spread due to the proliferation of Internet-based psychological interventions and research. This study analyses the validity and reliability of the online version of the Generalized Anxiety Disorder-7 (GAD-7) in a sample of pregnant and postpartum Spanish women., Method: A total of 3082 pregnant (n = 1260) and postpartum (n = 1822) women were recruited via the Internet and underwent three follow-up evaluations during a six-month period., Results: A one-factor solution was assigned by Exploratory Factor Analysis and confirmed by Confirmatory Factor Analysis for both pregnant (CFI = 0.998; RMSEA = 0.035) and postpartum (CFI = 0.998; RMSEA = 0.038) women. The one-factor model showed strict invariance across groups. Validity was confirmed by assessing correlations between GAD-7, the Edinburgh Postnatal Depression Scale, and the 10-item Posttraumatic Stress Disorder checklist at three time points. The reliability coefficient was .92 for the two groups., Conclusions: This study shows that the Spanish online GAD-7 version has good psychometric properties and can be used to assess anxiety symptoms during the perinatal period.

Anxiety is a pervasive emotional state where, phenomenologically, subjects often report changes in their experience of time and space. However, a systematic and quantified examination of time and space experience in terms of a self-report scale is still missing which eventually could also be used for clinical differential diagnosis. Based on historical phenomenological literature and patients' subjective reports, we here introduce, in a first step, the Scale for Time and Space Experience of Anxiety (STEA) in a smaller sample of 19 subjects with anxiety disorders and, in a second step, validate its shorter clinical version (cSTEA) in a larger sample of 48 anxiety subjects. The main findings are (i) high convergent and divergent validity of STEA with both Beck Anxiety Inventory (BAI) (r = 0.7325; p < 0.001) and Beck Depression Inventory (BDI) (r = 0.7749; p < 0.0001), as well as with spontaneous mind wandering (MWS) (r = 0.7343; p < 0.001) and deliberate mind wandering (MWD) (r = 0.1152; p > 0.05), (ii) statistical feature selection shows 8 key items for future clinical usage (cSTEA) focusing on the experience of temporal and spatial constriction, (iii) the effects of time and space experience (i.e., for both STEA and cSTEA scores) on the level of anxiety (BAI) are mediated by the degree of spontaneous mind wandering (MWS), (iv) cSTEA allows for differentiating high levels of anxiety from the severity of comorbid depressive symptoms, and (v) significant reduction in the cSTEA scores after a therapeutic intervention (breathing therapy). Together, our study introduces a novel fully quantified and highly valid self-report instrument, the STEA, for measuring time-space experiences in anxiety. Further we develop a shorter clinical version (cSTEA) which allows assessing time space experience in a valid, quick, and simple way for diagnosis, differential diagnosis, and therapeutic monitoring of anxiety., Competing Interests: Declaration of competing interest All authors declared no competing interests for this study. There are no other disclosures., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

While life expectancy of people living with HIV is increasing, their burden of non-communicable diseases, including mental health disorders, is growing as well. The aim of this study is to investigate the prevalence and identify the risk factors associated with mental health disorders among this population in Rwanda. This cross-sectional study enrolled people living with HIV from 12 HIV clinics across Rwanda using random sampling. Trained HIV nurses conducted the Mini International Neuropsychiatric Interview to estimate the prevalence of major depressive episode, post-traumatic stress disorder, and generalized anxiety disorder. Sociodemographic, psychosocial, and HIV-related data were also collected. Associated risk factors for being diagnosed with one of the mental health disorders were assessed using modified Poisson regression with robust error variance. Of 428 participants, 70 (16.4%) had at least one mental health disorder with major depressive episode being most prevalent (n = 60, 14.0%). Almost all participants were adherent to antiretroviral therapy (n = 424, 99.1%) and virally suppressed (n = 412, 96.9%). Of those diagnosed with a mental health disorder, only few were aware of (n = 4, 5.7%) or under treatment for this mental health disorder (n = 5, 7.2%). Mental health disorders were associated with experiences of HIV-related stigma and discrimination (aRR = 2.14, 95%CI 1.30-3.53, p = 0.003). The results demonstrate underdiagnosis and undertreatment of mental health disorders among Rwandan People Living with HIV. Using HIV nurses to diagnose mental health disorders could serve as a low-cost strategy for integrating mental health care with existing HIV services and could inspire the implementation in other low-resource settings., (© 2024. The Author(s).)

Objective: Eco-anxiety is a complex construct that has been created to grasp the psychological impact of the consequences of global warming. The concept needs a reliably valid questionnaire to better evaluate its impact on the risk of anxiety and depressive disorders. The Eco-Anxiety Questionnaire (EAQ-22) evaluates two dimensions: 'habitual ecological anxiety' and 'distress related to eco-anxiety'. However, a version in French, one of the world's widely spoken languages, was until now lacking. We aimed to translate and validate the French EAQ-22 and to evaluate the prevalence of the level of the two dimensions of eco-anxiety and the relationship with anxiety and depressive symptoms in a representative adult sample of the French general population., Methods: This study was performed under the auspices of the Institut national du sommeil et de la vigilance (INSV). Participants (18-65 years) were recruited by an institute specialized in conducting online surveys of representative population samples (quota sampling). Two native French speakers and two native English speakers performed a forward-backward translation of the questionnaire. The Hospital Anxiety and Depression scale (HAD) was administered to assess anxiety (HAD-A) and depressive (HAD-D) symptoms and for external validity. Internal structural validity and external validity were analysed., Results: Evaluation was performed on 1004 participants: mean age 43.47 years (SD=13.41, range: [19-66]); 54.1% (n=543) women. Using the HAD, 312 (31.1%) patients had current clinically significant anxiety symptoms (HAD-A>10) and 150 (14.9%) had current clinically significant depressive symptoms (HAD-D>10). Cronbach's alpha coefficient was 0.934, indicating very good internal consistency. Correlation between EAQ-22 and HAD scores was low (r[1004]=0.209, P<0.001), 'habitual ecological anxiety' was correlated less with HAD-A and HAD-D than 'distress related to eco-anxiety', indicating good external validity., Conclusion: This study validates the French EAQ-22 and paves the way for using the EAQ-22 as a global tool for assessing eco-anxiety. Further prospective studies are now required to better evaluate the impact of eco-anxiety on the occurrence of anxiety and depressive disorder., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

The comorbidity of depression and generalized anxiety have raised questions about the existing classification system. Based on the perspective of network analysis, the developmental relationship between psychological symptoms can be explored more clearly. The current study aimed to explore the longitudinal network association of depressive symptoms and generalized anxiety symptoms in non-clinical adolescents. The sample contained 1,947 Chinese adolescents (M age  = 13.93, SD = 1.71; 48.5% girls). Their depression (PHQ-9) and generalized anxiety (GAD-7) symptoms were assessed at baseline (T1) and 6-month follow-up (T2). Data was analyzed using a cross-lagged network analysis. Depressive symptoms and generalized anxiety symptoms were closely related and did not appear to be distinct categories in adolescence. More generalized anxiety symptoms predicted depressive symptoms rather than vice versa. After controlling for gender, and age, "Difficulty relaxing" presented the highest out-expected influence (out-EI) in the network, while "trouble concentrating", and "suicidal ideation" showed the lowest in expected influence (in-EI). Findings suggested that interventions for generalized anxiety symptoms may help reduce depressive symptoms among Chinese adolescents. Specifically, alleviating "difficulty relaxing" may improve overall mental health., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Anxiety sensitivity (AS), the trait-like fear of symptoms of anxiety, has been associated with eating disorder (ED) pathology broadly, bulimia nervosa (BN) symptoms specifically, and the anxiety disorders that are commonly comorbid with BN. AS, especially for physical symptoms specifically, maybe a risk and maintenance factor for BN and comorbid anxiety., Method: Adult participants with BN (n = 44) in a clinical trial comparing CBT to mindfulness and acceptance-based treatment (MABT) reported ED symptoms, trait anxiety, and AS through treatment and follow-up. We predicted that greater early reduction (i.e., within the first month of treatment) in AS would predict greater reductions in ED symptoms and trait anxiety at post-treatment and follow-up., Results: Early reductions in AS for physical concerns predicted lower ED symptoms and trait anxiety at post-treatment but not follow-up. Exploratory analyses indicated that treatment groups did not differ in either early or total change in AS, controlling for baseline AS., Discussion: Early reductions in AS may be an important treatment target for BN, and may additionally support reductions in anxiety. Future research should identify which components of CBT and MABT best target AS, to deliver these components early in treatment, when they can have maximum effect., Public Significance: Anxiety sensitivity, the fear of symptoms of anxiety, is associated with eating disorders (ED). In this study, participants in treatment for bulimia nervosa reported ED symptoms, trait anxiety, and anxiety sensitivity through treatment and follow-up. Greater early reductions in anxiety sensitivity predicted lower ED symptoms and trait anxiety at post-treatment. Future research should identify which elements of treatment best target anxiety sensitivity, to deliver them early in treatment., (© 2024 Wiley Periodicals LLC.)

Objective: Despite the high prevalence and comorbidity of alcohol consumption and anxiety, it is unclear whether alcohol consumption influences long-term anxiety. This study aimed to systematically review the literature on the long-term longitudinal effects of alcohol consumption on anxiety in adults., Methods: EMBASE, PsychInfo, Medline, and Web of Science databases were systematically searched from inception to April 12th, 2024. Articles analysing the relationship between alcohol consumption and anxiety symptoms or anxiety disorder diagnosis at least three-months later in adults were eligible. Articles were screened and extracted by two independent reviewers with study quality assessed using the Mixed Methods Appraisal Tool., Results: From 884 records, eight studies of mixed quality met inclusion criteria. One study using a sample representative of the USA population found low volume consumption was associated with lower long-term anxiety. All other studies used a convenience sample or a specific medical population sample. The significance and direction of the relationship between alcohol consumption and long-term anxiety in these studies varied, likely due to differences in alcohol consumption thresholds used and populations studied., Conclusions: A paucity of research on the longitudinal effects of alcohol consumption on anxiety was found, highlighting a significant gap in the research literature. Furthermore, existing research, primarily focussed on clinical subpopulations, has yielded mixed results. Further research is needed to explore the longitudinal dose dependent impact of alcohol consumption on anxiety using samples representative of national populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Late-Life Depression (LLD) is a prevalent mental health disorder that is often accompanied by cognitive impairments. The objective of this study is to investigate the influence of coexisting Generalized Anxiety Disorder (GAD) on both subjective and objective cognitive abilities in untreated LLD individuals., Methods: A total of 77 participants aged 60 years and above were recruited for this study, comprising 31 individuals with Major Depressive Disorder (LLD group), 46 with MDD and coexisting Generalized Anxiety Disorder (LLDA group), and 54 healthy controls (HC). Prior to the study, all patients had abstained from psychotropic medication for a minimum of two weeks. Comprehensive neuropsychological assessments were administered to all participants., Results: The LLDA group exhibited substantial disparities in memory, attention, processing speed,executive function,overall cognitive functioning, and subjective cognitive functioning when compared to the HC group. The LLD group displayed deficits in memory, SCWT-W in attention, SCWT-C in processing speed,overall cognitive functioning, and subjective cognitive functioning in comparison to the healthy controls. Although the LLD group achieved lower average scores in executive function, TMTA in processing speed, and DSST in attention than the HC group, no significant distinctions were identified between these groups in these domains. Linear regression analysis unveiled that anxiety symptoms had a significant impact on subjective cognitive deficits among MDD patients, but exhibited a milder influence on objective cognitive performance. After adjusting for the severity of depression, anxiety symptoms were found to affect TMTA in processing speed and subjective cognitive functioning in LLD patients., Conclusion: Late-Life Depression (LLD) exhibits pervasive cognitive impairments, particularly in individuals with generalized anxiety disorder, presenting a crucial target for future therapeutic interventions. Among elderly individuals with depression, anxiety symptoms significantly impact subjective cognitive functioning, suggesting its potential utility in distinguishing between depression-associated cognitive decline and pre-dementia conditions., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Our study examined the impact of sex, ADHD subtype, and comorbid illnesses (depression/anxiety) on the timing of diagnosis and treatment for ADHD., Method: To analyze ADHD patients, four health databases were used to assess subtype, comorbid mood, and antidepressant or anxiolytic drug exposure. Analyses were stratified by sex and age. Standardized mean differences measured intergroup differences., Results: Females with ADHD were identified at older ages and had higher rates of depression and anxiety diagnoses and treatments before and after their initial ADHD diagnosis. Predominantly inattentive ADHD patients were diagnosed later and more likely to receive mood disorder diagnosis and treatment than hyperactive impulsive ADHD patients., Conclusions: Results suggest a more complex ADHD presentation in females, potentially causing late diagnosis and delayed treatment., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JA, MMC, DMK, and US are employees of Janssen Research & Development, LLC, and shareholders of Johnson & Johnson (J&J) stock.

Background: Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood., Methods: We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published between 1/1/1990 and 12/31/2022 employing a behavioral task and/or physiological measures in individuals with hypochondriasis, illness anxiety disorder, and PHA more broadly., Results: Out of 9141 records identified, fifty-seven met inclusion criteria. Article quality varied substantially across studies, and was overall inadequate. Cognitive, behavioral, and affective findings implicated in PHA included health-related attentional and memory recall biases, a narrow health concept, threat confirming thought patterns, use of safety-seeking behaviors, and biased explicit and implicit affective processing of health-related information among other observations. There is initial evidence supporting a potential overestimation of interoceptive stimuli in those with PHA. Neuroendocrine, electrophysiology, and brain imaging research in PHA are particularly in their early stages., Limitations: Included articles evaluated PHA categorically, suggesting that sub-threshold and dimensional health anxiety considerations are not contextualized., Conclusions: Within an integrated cognitive-behavioral-affective and predictive processing formulation, we theorize that sub-optimal illness and health concepts, altered interoceptive modeling, biased illness-based predictions and attention, and aberrant prediction error learning are mechanisms relevant to PHA requiring more research. Comprehensively investigating the pathophysiology of PHA offers the potential to identify adjunctive diagnostic biomarkers and catalyze new biologically-informed treatments., Competing Interests: Declaration of competing interest D.L.P. has received royalties for a Springer Nature textbook on functional movement disorder; is a paid senior editor at Brain and Behavior; has received honoraria for a functional neurological disorder textbook and continuing medical education lectures; has received funding from the Sidney R. Baer Jr. Foundation unrelated to this work; and is on the editorial boards of The Journal of Neuropsychiatry & Clinical Neurosciences, Epilepsy & Behavior, and Cognitive and Behavioral Neurology. All other authors do not have any disclosures or other conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Suicide is a major public health concern, and anxiety is a prevalent developmental challenge in adolescents closely linked to suicidal behavior. This study aimed to assess the association between anxiety in adolescents and subsequent risk of suicidal behavior through a meta-analysis, offering crucial insights for suicide prevention., Methods: Six bibliographic databases were comprehensively searched to clarify the association between adolescents anxiety and subsequent risk of suicidal behavior. We used a fixed-effects model to determine the total pooled effect size estimate and reported odds ratios and the corresponding 95 % confidence intervals. Subgroup analysis, sensitivity analysis and publication bias analysis were conducted with Stata version 15.1., Results: The findings revealed a significant association between anxiety in adolescents and subsequent suicidal behavior (OR = 2.33, 95 % CI [2.00, 2.71]). Subgroup analyses indicated differences in mean effect size estimates based on clinical diagnoses and self-reported measures used to assess anxiety. The correlation strength between adolescent anxiety and subsequent suicidal behavior increased with a longer follow-up period. Furthermore, adolescents anxiety was associated with increased risk of subsequent suicidal ideation (OR = 1.97, 95 % CI [1.72, 2.25]) and attempts (OR = 3.56, 95 % CI [2.49, 5.07]). Finally, boys (OR = 2.41, 95 % CI [1.67, 3.47]) with anxiety had a greater risk of subsequent suicidal behavior than girls (OR = 2.02, 95 % CI [1.47, 2.78])., Conclusion: This study revealed that adolescents anxiety increases the risk of suicidal behavior, including suicidal ideation and attempts. Consequently, there is a critical need for timely interventions tailored to adolescents with anxiety to prevent future instances of suicide., Competing Interests: Declaration of competing interest The authors declare no conflict of interest, (Copyright © 2024 Elsevier B.V. All rights reserved.)

Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Identifying mechanisms of childhood abuse-adulthood psychopathology relations could facilitate preventive efforts, but most prior studies used cross-sectional or two-wave designs and did not test the effects of childhood maternal and paternal abuse separately. Our 18-year three-wave study thus determined if Wave 2 daily stress reactivity and risk appraisal severity mediated Wave 1 retrospectively-reported childhood maternal and paternal abuse on Wave 3 generalized anxiety disorder (GAD), major depressive disorder (MDD), panic disorder (PD), alcohol (AUD), and substance use disorder (SUD) self-rated symptom severity. Longitudinal structural equation modeling was employed, adjusting for Wave 1 psychopathology severity. Higher childhood maternal and paternal abuse consistently predicted greater future daily stress reactivity and risk appraisal, and these mediators subsequently predicted increased GAD, MDD, and PD, but not AUD and SUD severity. Daily stress reactivity and risk appraisal consistently mediated the pathways between childhood maternal and paternal abuse predicting heightened adulthood GAD, MDD, and PD (Cohen's d = 0.333-0.888) but not AUD and SUD severity. Mediation effect sizes were stronger for childhood maternal (24.5-83.0%) than paternal (19.5-56.0%) abuse as the predictor. The latent interaction between Wave 1 childhood maternal and paternal abuse did not moderate the effect of Wave 1 maternal or paternal abuse on any Wave 3 adulthood psychopathology severity through Wave 2 daily stress reactivity and risk appraisal. Our research emphasizes the urgent requirement for continuous evaluation and intervention initiatives in trauma-informed care, both in inpatient and outpatient treatment settings., Competing Interests: Declaration of competing interest None of the authors have any conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Patients with facial trauma often experience a psychological burden from their injuries. This study aimed to identify risk factors for adverse mental health outcomes in patients affected by facial trauma, using the 'Integrating Mental and Physical Healthcare: Research, Training and Services' (IMPARTS) screening tool. All patients >18 years of age who completed more than one IMPARTS screening tool in the Oral and Maxillofacial Trauma Clinic between 2019 and 2021 were included in this study. This tool was used to assess the risk of post-traumatic stress disorder (PTSD), generalized anxiety disorder, and depression. Included patients completed the IMPARTS questionnaire at initial follow-up (mean 18 days post-trauma) and one subsequent time point (mean 82 days). 167 patients were included in the study. On multivariable analysis, a history of psychiatric illness (P = 0.015) and interpersonal violence as the mechanism of injury (P = 0.010) were identified as predictive of risk of PTSD. Risk of PTSD was lower in zygomatic injuries (P = 0.001), while nasal involvement increased at-risk status for depression (P = 0.009). 47.3% of patients screened positive on initial IMPARTS assessment, while 35.3% screened positive on follow-up IMPARTS assessment. This study supports the IMPARTS tool in allowing the prompt identification of mental health adversity in facial trauma., Competing Interests: Competing interests None., (Copyright © 2024. Published by Elsevier Inc.)

Anxiety symptoms vary moment-to-moment within a day. One factor that may influence these variations is chronotype. Evening chronotypes prefer to engage in activities (e.g., sleep, physical and social activity) later in the day, and evening chronotype is implicated in psychopathology, including anxiety-related disorders. However, it is unknown whether chronotype influences diurnal variation in anxiety symptoms and whether these effects are amplified in individuals with a probable anxiety-related disorder. We examined the diurnal variation in anxiety symptoms and daily activities in morning and evening chronotypes with and without probable generalized anxiety disorder (GAD) or obsessive-compulsive disorder (OCD) in a community sample of adults (N = 410). Evening chronotypes reported higher anxiety symptoms, particularly in the evening hours, and lower engagement in daily activities, predominantly in the morning hours. Evening chronotypes with probable GAD or OCD reported worse anxiety symptoms in the evening. Our findings indicate that anxiety symptoms and engagement in daily activities fluctuate considerably across the day, and these patterns differ depending on chronotype. Evening chronotypes have more anxiety symptoms in the evening, despite preferring this time of day. Personalized treatment approaches that consider chronotype and target certain times of day may be efficient in alleviating peaks in anxiety symptoms., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rebecca Cox reports financial support was provided by National Institutes of Health. Leonie Balter reports financial support was provided by SU-Region Stockholm. Leonie Balter reports financial support was provided by Rut and Arvid Wolff Memorial Foundation. Rebecca Cox reports financial support was provided by International OCD Foundation. Rebecca Cox reports financial support was provided by American Academy of Sleep Medicine Foundation. Kenneth Wright reports a relationship with Circadian Therapeutics, LTD that includes: consulting or advisory. Kenneth Wright reports a relationship with DuPont Nutrition & Biosciences that includes: non-financial support. Kenneth Wright reports a relationship with Grain Processing Corporation that includes: non-financial support. Kenneth Wright reports a relationship with Friesland Campina Innovation Centre that includes: non-financial support. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Pilot Peer Support Programs (PPSP) have been introduced in Europe as a measure to facilitate commercial pilots' mental health help-seeking in a confidential and non-punitive manner. However, research is scarce regarding what promotes and prevents pilots from approaching PPSP., Aims: To investigate if, and in which way, different organizational and individual factors are associated with pilots' attitudes towards approaching PPSP, and to examine the prevalence of possible cases of depression and anxiety disorders among commercial pilots in Europe., Methods: Data were collected using an anonymous web-based survey (n = 4494), covering pilots' work conditions, health and flight safety. Logistic regression was used to determine the impact of objective and psychosocial work environment factors, mental health factors, and demographic factors., Results: Key findings were that just culture (odds ratio [OR] = 2.65, 95% confidence interval [CI] 1.97, 3.56), type of employment (OR = 0.60, 95% CI 0.46, 0.78), minimum guaranteed pay (OR = 1.98, 95% CI 1.48, 2.65), and symptoms of depression (OR = 0.62, 95% CI 0.50, 0.76) and anxiety (OR = 0.66, 95% CI 0.54, 0.80) significantly predicted pilots' attitude towards approaching PPSP. The prevalence of pilots scoring above threshold for possible depression (18%) and anxiety disorders (23%) were determined., Conclusions: Pilot Peer Support in its current form appears to be an insufficient means to facilitate pilots' mental health help-seeking, but could have an important preventive purpose. The findings could assist authorities and operators in developing measures to facilitate pilots' help-seeking, and improve mental health and flight safety., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Occupational Medicine.)

Background: Anxiety in pregnancy and postpartum is highly prevalent but under-recognised. To identify perinatal anxiety, assessment tools must be acceptable, relevant, and easy to use for women in the perinatal period., Methods: To determine the acceptability and ease of use of anxiety measures to pregnant or postpartum women (n = 41) we examined five versions of four measures: the Generalised Anxiety Disorder scale (GAD) 2-item and 7-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS). Cognitive interviews were used to examine ease of comprehension, judgement, retrieval and responding., Results: All measures were acceptable. Some items were deemed less relevant to the perinatal period e.g., difficulties sleeping. Ease of comprehension, judgement, retrieval and responding varied, with all measures having strengths and weaknesses. The SAAS and CORE-10 had the lowest mean number of problematic components. The GAD had the highest mean number of problematic components​. Non-binary response options were preferred. Preferences for time frames (e.g. one week, one month) varied. Qualitative data provides in-depth information on responses to each measure., Conclusions: Findings can be used to inform clinical guidelines and research on acceptable anxiety assessment in pregnancy and after birth., (© 2024. The Author(s).)

Aims: Alcohol use disorder (AUD) is a common mental disorder characterized by sex-gender differences (SGDs). The present study was aimed at evaluating attitudes displayed by Italian AUD treatment services towards investigating the presence of SGDs in their patients and implementing gender-specific treatments for female AUD patients., Methods: Potential SGDs were initially investigated in a sample of AUD outpatients, subsequently followed by a national survey on the adoption of specific interventions for female AUD outpatients., Results: The presence of SGDs was confirmed in a sample of 525 (332 men; 193 women) AUD outpatients, including a higher prevalence of anxiety and mood disorders, and episodes of violence and trauma among female AUD outpatients compared to males. Despite the presence of these SGDs, only <20% of a total of 217 Italian AUD treatment services reported the implementation of specific strategies for female AUD outpatients. The majority of services (94%) reported investigating episodes of violence and/or trauma, largely resorting to specific procedures only when these issues were detected., Conclusions: Our findings confirm the presence of SGDs among AUD outpatients, including a higher prevalence of anxiety and mood disorders and episodes of violence and trauma among females compared with males. However, only a small number of services have adopted a gender medicine approach in AUD treatment. These results underline the urgency of investigating the specific needs of female, male, and non-binary AUD patients in order to personalize and enhance the effectiveness and appeal of AUD treatment., (© The Author(s) 2024. Medical Council on Alcohol and Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Generalized anxiety (GA) is showing a high prevalence among adolescents nowadays; investigations on influencing factors and potential mechanisms are important to inform intervention development. The present two-wave study investigated the ways in which family functioning predicted GA six months later among adolescents, by considering the mediating role of self-identity and cognitive flexibility., Methods: Adolescents were recruited from 27 randomly selected classes in two secondary schools in Chongqing and Fujian Province, China. Survey questionnaires assessing family functioning, self-identity, cognitive flexibility and GA were obtained from 1223 adolescents (M age = 13.14, SD = 1.35) at two time points of the 6-month interval., Results: The association between family functioning (T1) and GA (T2) was significant (r= -0.152, p < 0.01). Self-identity and cognitive flexibility sequentially mediated the relationship between family functioning (T1) and GA (T2) (with the indirect effect = -0.005, 95% CI = -0.007~ -0.002) after controlling for age, gender, and GA at baseline. Cognitive flexibility also showed a significant and direct mediating effect (with the indirect effect = -0.008, 95% CI = -0.012 ~ -0.005)., Conclusion: Findings indicated that family functioning can be a protective factor of GA, and self-identity and cognitive flexibility act as a crucial role in the association between family functioning and GA. Future studies should adopt more time points and long-term follow-up assessments using more robust approaches to improve the reliability of the study findings. Findings may offer some implications that building a harmonious, open and warm family and guiding adolescents to develop self-identity as well as more flexible cognitive style could be helpful to prevent and cope with anxious emotion., (© 2024. The Author(s).)

Background: Emotional problems can be evaluated using categorical approaches to guide treatment choices focused on targeting specific disorders, or dimensional approaches to reduce symptom severity. Moreover, recent evidence points out the need to intervene in patients' quality of life (QoL), which often remains low even after the remission of emotional problems. Thus, assessment instruments are needed to provide information on diagnosis, symptom severity, and QoL. The present study aimed to provide diagnostic and QoL cutoffs for the Inventory of Depression and Anxiety Symptoms-II (IDAS-II)., Methods: 273 patients recruited from mental health services in Huelva (Spain) completed the IDAS-II, Mini International Neuropsychiatric Interview, and Short Form-36 Health Survey. Receiver operating characteristic curve analyses were used to establish cutoff values. Diagnostic, balanced, and screening cutoffs were provided for each IDAS-II scale to detect corresponding diagnoses and poor QoL., Results: The specific IDAS-II scales Suicidality, Panic, Social Anxiety, Claustrophobia, and Traumatic Intrusions showed adequate discrimination values for their corresponding diagnoses (suicidal behavior disorder, panic disorder, social anxiety disorder, agoraphobia, and post-traumatic stress disorder, respectively). Both the General Depression and Dysphoria scales showed adequate ability to detect major depressive disorder. The IDAS-II scales showed a higher discrimination ability for Mental Health-related QoL, than for General Health-related QoL., Conclusions: The diagnostic and QoL cutoffs expand the clinical utility of the IDAS-II in clinical practice and research, making it a comprehensive, detailed, and versatile self-report tool. The IDAS-II allows for the assessment of emotional problems consistent with the dimensional, categorical, transdiagnostic, and QoL approaches., (© 2024. The Author(s).)