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Time Trends in Treated Incidence, Sociodemographic Risk Factors and Comorbidities: A Finnish Nationwide Study on Anxiety Disorders
Abstract
Introduction
Anxiety disorders (ADs) are common in childhood and adolescence and global estimates suggest they affect 6.5% of individuals under 19 years of age.Yet, there has been a lack of research on time trends and socio-demographic risks for children and adolescents who receive treatment for ADs.
Objectives
We aim to fill gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.
Methods
We used register data of all singleton children born in Finland from 1992-2006 and diagnosed with ADs from 1998-2012. Changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006. The 22,388 individuals with ADs were matched with 76,139 controls. Nested case-control design was used to study the socio-demographic risk factors.
Results
Comparing the 1992-1996 and 2002-2006 cohorts showed the cumulative incidence of treated ADs at the age of 10 increased from 0.3% to 1.2% (females) and 0.46% to 1.9% (males). Subjects had higher odds of being diagnosed with an AD if mothers had low SES (OR 1.49, 95% CI 1.42-1.58) and were single parents (OR 1.99, 95% CI 1.84-2.15) at birth. Unipolar depression was the most common psychiatric comorbidity (31.2%).
Conclusions
ADs diagnosed by specialized services increased from 1998-2012 in both genders. This could indicate real increase in overall ADs, an increase in seeking treatment or both phenomena. The findings on maternal socioeconomic status and single parenting help improve understanding of environmental risk for anxiety disorders among children and adolescents.
The Effect of Contamination Disgust on COVID-19-Related Anxiety
Abstract
Introduction
It is proven that high levels of disgust contribute to implementing protective behaviors. Investigators also discovered that the emotion of disgust plays a central role in determining anxiety related to the contraction of COVID-19. Few data are available about the role of the contamination disgust, a specific disgust domain, in this relationship.
Objectives
The effect of contamination disgust on COVID-19-related anxiety was investigated.
Methods
295 healthy subjects were enrolled through an online survey. They completed Disgust Scale-Revised (DS-R) and were asked to estimate their levels of Covid-19-related anxiety in 12 proposed situations. A total score was then calculated. An ANOVA model having Covid-19-related anxiety total score as dependent variable, and DS-R contamination disgust, age, and sex as predictors was estimated.
Results
The overall model was significant (F(3,291)=6.402, p<0.001) and explained 6.2% of total Covid-19 anxiety variance (R2=0.062). The effect of DS-R contamination disgust on Covid-19-related anxiety was positive, significant (B=0.974, t(291)=3.227, p=0.001) and explained 3.5% of Covid-19-related anxiety variance (partial η2=0.035). A significant effect of sex was detected (F(1,291)=4.919, p=0.027), with females having higher Covid-19-related anxiety than males, while no effect was detected for age (B=-0.024, t(291)=-0.884, p=0.377).
Conclusions
The presented data provide preliminary evidence for an effect of contamination disgust on Covid-19-related anxiety.
The Role of PACAP/PAC1R in PTSD: Effects on Fear Extinction via the Ventromedial Hypothalamus
Abstract
Introduction
The incidence and severity of posttraumatic stress disorder (PTSD) is higher in women than men because of environmental and biological factors. Specific mechanisms in the PACAP-PAC1R (pituitary adenylate cyclase-activating polypeptide and its type I receptor) system may confer PTSD risk in women. Interestingly, while the PACAP (ADCYAP1) - PAC1R (ADCYAP1R1) system is expressed highly in the hypothalamus, no relationship has been described for this pathway in the hypothalamus with fear processing or in PTSD.
Objectives
We studied whether the estrous/menstrual cycle at the moment of trauma predicts PTSD and the involvement of the PACAP neurons in the amygdala and hypothalamus during traumatic stress.
Methods
Mice: DREADDs, immunohistochemistry and behavior. Humans: fear-potentiated startle and questionnaires.
Results
Here, we show that acute stress immobilization (IMO) produces fear extinction impairments in female mice. Also, IMO elicits Adcyap1 and Adcyap1r1 mRNA upregulation in the hypothalamus, PACAP/c-Fos downregulation in the medial amygdala (MeA), and PACAP/FosB/ΔFosB upregulation in the ventromedial hypothalamus dorsomedial part (VMHdm) after fear extinction. We also found that women with the risk genotype of ADCYAP1R1 rs2267735 SNP show impaired fear extinction. In mice, DREADD-mediated inhibition of the MeA neurons projecting to the VMHdm during IMO rescues both PACAP upregulation in VMHdm and the fear extinction impairment. We ruled out contributions from inherent hormonal states showing that the menstrual or estrous cycle phase at the moment of trauma does not result in a vulnerable phenotype.
Conclusions
Our data suggest that the PACAP-PAC1R hypothalamic system may be a novel candidate to treat and prevent PTSD symptoms including fear dysregulations.
Causal Determinants of Complex PTSD in Syrian Refugee Children Living in Informal Settlements in Lebanon
Abstract
Introduction
Displaced refugee children with a history of war exposure are at risk of developing complex and severe forms of post-traumatic stress disorder (PTSD).
Objectives
Search for the most relevant causal predictors of complex PTSD in a prospective cohort of Syrian refugee children living in informal settlements in Lebanon (N=1007).
Methods
A latent class unsupervised analysis was carried out to determine clusters with complex PTSD presentation at the follow-up assessment. A new exploratory causal discovering modelling approach was applied using 97 multilevel psychosocial variables as predictors (Biazoli et al., 2021). Associations between discovered candidate causal factors assessed at baseline with a presumed diagnosis of complex PTSD one year later were calculated using a multiple logistic regression model.
Results
Several putative causal factors emerged: perceived social coherence of the neighbourhood (Positive Predictive Value increase: 1.22); impulsivity (1.25), self-efficacy (1.23) and depressive symptoms (1.15) at the parental level; positive home experiences (1.16) at the family level; and child-level factors such as being forced to work (1.22), being a victim of verbal or physical bullying (1.19), loneliness (1.17) and well-being (1.18). In further confirmatory multiple logistic regression analysis and after correction for multiple comparisons, verbal or physical bullying victimization (p=.005) and caregiver depressive symptoms (p=.0004) at baseline were associated with complex PTSD presentations one year later.
Conclusions
Our results support the need for a multi-level psychosocial care model to prevent psychological distress and promote mental health in refugee children. Specifically, our results suggest that programs tackling caregiver’s mental health and children’s exposure to violence might effectively prevent complex PTSD.
PTSD Symptoms and Coping Before and During COVID-19 Pandemic Among Help-Seeking Veterans: Prospective Cohort Study
Abstract
Introduction
The COVID-19 pandemic has threatened the mental health of individuals around the world. Ex-combatants have been repeatedly shown to be increased risk of experiencing social and psychological problems during emergencies.
Objectives
To compare the severity of overall posttraumatic stress disorder (PTSD) symptoms and PTSD clusters among help-seeking veterans before and during the COVID-19 pandemic. The second aim was to identify coping strategies used and track possible changes during the timeline.
Methods
Male war veterans receiving outpatient treatment at the Referral Center for PTSD were assessed at baseline (t1=12-18 months before the COVID-19 pandemic), during the first lockdown (March-June 2020) and 12 months after the beginning of the COVID-19 pandemic (March-June 2021). A total of 132 veterans participated in all three measurements. The Life Events Checklist for DSM-5 (LEC-5), PTSD Checklist for DSM-5 (PCL-5), and The Brief COPE were used.
Results
Exposure to COVID-19 pandemic related stressors increased over time. The great majority of participants (91.0%) followed the preventive measures. The severity of the overall PTSD symptoms significantly decreased during timeline (t1=56.9, 11.15; t2= 47.24, SD=12.87; t3= 44.1, SD=14.09). At t2, all participants still fulfilled the PTSD diagnostic criteria, and at t3, 23 participants (17.42%) did not meet all of the criteria for PTSD. The participants used adaptive coping rather than dysfunctional coping during the pandemic.
Conclusions
Despite the expectations of worsening the symptoms, help-seeking veterans with PTSD appeared to develop adaptive adjustment to the COVID-19 pandemic stressors, which is in line with the results of the recent longitudinal research and will be discussed.
Development of Posttraumatic Stress Disorder Symptoms After Intensive Care - How to Prevent It?
Abstract
Introduction
Over the last decade, there has been identified that critical illness survivors have high rates of psychiatric disorders such as posttraumatic stress disorder (PTSD). The experience of admission to intensive care units (ICU) and illusory memories may cause short and long-term psychological disorders.
Objectives
To evaluate psychiatric disorders, such as PTSD, after ICU discharge, and determine the prevalence, risk factors, and prevention strategies for PTSD in these patients.
Methods
Non-systematic review through research in PubMed. Addicionally, a case report will be exposed, after the patient was diagnosed with SARS‑CoV‑2 and stayed in ICU for more than 30 days.
Results
The development of PTSD has been related to the number of adverse memories patients recall from their ICU experience. Some studies have shown that approximately 47% of patients remember real facts and 34% have illusory memories relative to their stays in the ICU. There were identified some risk factor associated to the increased risk of post-ICU PTSD, such as early post-ICU memories or psychotic experiences, pre-ICU psychopathology, benzodiazepine sedation during ICU and substantial acute stress symptoms occurring < 1 month after exposure to a traumatic stressor.
Conclusions
High levels of anxiety and the development by patients of PTSD are being recognized as significant problems occurring after a stay in an ICU. The results of this study highlight the need to recognise the risk factors and to establish a early follow-up after ICU stay. This way is possible to identify patients who are at risk of developing acute PTSD-related symptoms, and early intervention can be institued.