The relation of depression and anxiety to measures of executive functioning in a mixed psychiatric sample.

The relationship between mood and executive functioning is of particular importance to neuropsychologists working with mixed psychiatric samples. The present study evaluated the relation of self-reported depression and anxiety to several common measures of executive functioning: the Wisconsin Card Sorting Test, the Trail Making Test, the Controlled Oral Word Association, and the Letter-Number Sequencing subtest of the Weschler Adult Intelligence Scale-III. Records from 86 adult patients evaluated in an outpatient psychiatry unit were examined. Correlations between self-reported depression or anxiety and most measures of executive functioning were small and non-significant. The variance predicted by depression or anxiety after controlling for age, gender, and IQ was minimal (typically < or =3.0%), even after conducting diagnostic subgroup analyses. These results suggest that impaired performance on measures of executive functioning is minimally related to self-reported depression and anxiety within mixed psychiatric settings.     

The outcome of episodic versus persistent adolescent depression in young adulthood

OBJECTIVE: Study of the impact of episodic and persistent depression on psychosocial and mental functioning of young adults. METHODS: In a longitudinal representative community sample, four groups of subjects were identified who were depressed either in pre-adolescence, late adolescence or young adulthood or persistently depressed across time, and compared among each other and with a young adult control group. The 90th percentile on one or two self-reported symptom scales (i.e., the Center for Epidemiological Depression Scale (CES-D) or the Anxious/Depressed subscale of either the Youth Self-Report (YSR) or the Young Adult Self-Report (YASR)) served as the cut-off for the depression groups. Outcome was studied with regard to various psychosocial variables including life events, coping, self-related cognitions, size and efficiency of the social network, perceived parental behaviour, family relations and mental functioning. RESULTS: For the large majority of psychosocial variables, the persistent depression group showed the most abnormal scores. The YASR profile of mental functioning at outcome of the persistent depression group was also clearly distinguishable by higher scores from all other groups on the majority of scales. On a few scales, the young adult episodic group was not significantly different from the persistent depression group. CONCLUSION: This study shows that persistent rather than episodic adolescent depression carries a risk for abnormal psychosocial and mental functioning in young adulthood. The study also reflects the burden of young adult depression.     

A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder

Studies of adults who have been diagnosed with, and treated for, bipolar disorder have shown that these patients exhibit impairment on measures of executive functioning. However, it is unclear whether executive dysfunction precedes the diagnosis of bipolar illness, or develops subsequent to its onset. Moreover, investigators have failed to control for the effects of premorbid attentional problems on cognitive performance in these patients. The present authors explored these questions using data from a longitudinal prospective study of individuals at risk for major mood disorder. Results revealed that 67% of participants who met criteria for bipolar disorder in young adulthood showed impairment on the Wisconsin Card Sorting Test (WCST) when they were assessed during adolescence, as compared with 17% of individuals with no major mood diagnosis, and 19% with unipolar depression. This association between performance on the WCST and bipolar illness was not accounted for by high rates of premorbid attentional disturbance. In fact, among participants with early attentional problems, only those who ultimately developed bipolar disorder exhibited impairment on the WCST. Early attentional problems that preceded unipolar depression or no mood disorder were not associated with executive dysfunction.     

The relation of self-report of mood and anxiety to CVLT-C, CVLT, and CVLT-2 in a psychiatric sample.

The relation between mood and cognitive status has been examined extensively over the years suggesting a significant impact of mood and potentially anxiety on memory. This relation is of particular interest to practitioners conducting evaluations in settings that regularly treat individuals diagnosed with psychiatric disorders. With this in mind, the present study sought to evaluate the impact of self-report of depression and anxiety on the California Verbal Learning Test-children's version (CVLT-C), the California Verbal Learning Test (CVLT), and the California Verbal Learning Test-2nd edition (CVLT-2) in a mixed psychiatric sample. Records from 107 patients aged 6-78 evaluated in an outpatient psychiatry unit were examined. Results indicated minimal predictive utility was provided from self-report symptoms of anxiety or depression on CVLT-C, CVLT, or CVLT-2: Trial 1, Trial 5, total score, Short Delay Free Recall, Short Delay Cued Recall, long delay free recall, or long delay cued recall performance above the variance predicted by age, gender, and Full Scale IQ. Additional variance predicted by depression as measured by the Beck Depression Inventory (BDI) and the Child Depression Inventory (CDI) or anxiety as measured by the State-Trait Anxiety Inventory (STAI) was less than 3.0% over that accounted for by the covariates for the great majority of measurements from the various CVLT versions. Exceptions included the CDI that tended to account for approximately 5.0% of the variance on all of the CVLT-C measures and the STAI that accounted for approximately 5.0-10.0% additional variance on the short and long delay measures of the CVLT-2. The present results suggest that performance on the various forms of the CVLT are minimally predicted by self-reported depression and anxiety in a psychiatric setting.     

The relation between frontal EEG asymmetry and the risk for anxiety and depression

Frontal asymmetry of EEG alpha power (FA) may index the risk for anxiety and depression. Evidence linking FA to the underlying biological mechanisms is scarce. This is unfortunate because FA has potential as a biological marker to support gene finding in anxiety and depression. We examined the heritability of FA in 732 twins and their singleton siblings, and established the genetic and environmental contribution to the relation between FA and the risk for anxiety and depression. Multivariate models showed that FA is heritable only in young adults (males 32% and females 37%) but not in middle-aged adults. A significant relation between FA and the risk for anxiety and depression was only found in young adult females. This relation was explained by shared genes influencing both EEG and disease risk. Future studies on asymmetry of left and right frontal brain activation should carefully consider the effects of sex and age.     

Depression and self-reported physical health in patients with coronary disease: mediating and moderating factors

OBJECTIVES: The purpose of this study was to define how the relation between depression and self-reported physical health in patients with coronary disease is modified by other patient-centered factors. METHODS: We conducted a prospective cohort study of 111 patients (members of a health maintenance organization) with angiographically documented coronary disease, examining factors (physical symptoms, psychological states and traits, and spousal support) modifying the relation between depression and patient-reported physical health 5 years later using multiple hierarchical regression models. RESULTS: Five regression models (all including demographic and disease severity covariates) were constructed to predict physical health from depression only (R2 = 0.22); depression plus angina and fatigue (R2 = 0.53); depression plus positive affect and novelty seeking and their interaction (R2 = 0.48); depression plus spousal support (R2 = 0.27); and depression, angina, fatigue, positive affect, and novelty seeking (overall model) (R2 = 0.65). Depression remained significant in each model, but the proportion of variance it predicted was diminished in the presence of the other variables (bivariate r = 0.39, partial r = 0.37-0.13). CONCLUSIONS: The effect of depression on self-reported physical health is significantly mediated by physical symptoms (angina and fatigue), personality states and traits (positive affect and novelty seeking), and spousal support. Positive affect and novelty seeking had more marked effects on physical health in the presence of more depression. Thus, a broad range of factors beyond the severity of coronary disease itself affect the perceived physical health of patients with coronary heart disease.     

The relationship between measures of psychopathology, intelligence, and memory among adults seen for psychoeducational assessment.

This study assessed the relationship between symptoms of psychopathology and cognitive functioning in clients completing comprehensive psychoeducational assessments at a university-based outpatient mental health clinic. Seventy clients (36 women, 34 men, mean age=28.8) completed the Wechsler Memory Scale-Third Edition (WMS-III), Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), and Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2). Partial correlations between the MMPI-2 clinical scales, WMS-III Index scores, WAIS-III Index scores, and WAIS-III IQ scores were not significant. Memory and Intelligence scores for clients with comorbid symptoms of depression and anxiety were comparable to scores for clients without comorbid symptomatology. Psychopathology factors accounted for 22% of the variance in the WAIS-III Full Scale IQ and 6.5% of the variance in the WMS-III General Memory Index. The results suggest that psychopathology as measured by the MMPI-2 may be minimally associated with intelligence and memory test performance in adults seen for psychoeducational assessment.     

Emotion Regulation Processes and Psychoform and Somatoform Dissociation in Adolescents and Young Adults with Cumulative Maltreatment

The relationship between childhood trauma and dissociative experiences is widely acknowledged. However, the association between emotion regulation difficulties (ERD), anxiety/depression and dissociation in adolescents and young adults with cumulative maltreatment (CM) remains unclear. The present study examined the role of ERD at both intrapersonal and interpersonal levels and anxiety/depression symptoms in the development of psychoform or somatoform dissociation in adolescents and young adults with CM. We assessed 58 participants with CM and 55 participants without childhood trauma history between the age of 12 and 22 years old. Participants completed self-reports of ERD, anxiety/depression, psychoform dissociation and somatoform dissociation. The results revealed that adolescents and young adults exposed to CM displayed high levels of psychoform and somatoform dissociation, ERD and anxiety/depression symptoms. It was also found that intrapersonal and interpersonal ERD predicted psychoform dissociation, whereas anxiety/depression predicted somatoform dissociation in adolescents and young adults with CM. Intrapersonal and interpersonal ERD and anxiety/depression are therapy targets for clinical interventions in adolescents and young adults with CM and dissociative symptoms.     

Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients

The Depression Anxiety Stress Scale (DASS) was designed to efficiently measure the core symptoms of anxiety and depression and has demonstrated positive psychometric properties in adult samples of anxiety and depression patients and student samples. Despite these findings, the psychometric properties of the DASS remain untested in older adults, for whom the identification of efficient measures of these constructs is especially important. To determine the psychometric properties of the DASS 21-item version in older adults, we analyzed data from 222 medical patients seeking treatment to manage worry. Consistent with younger samples, a three-factor structure best fit the data. Results also indicated good internal consistency, excellent convergent validity, and good discriminative validity, especially for the Depression scale. Receiver operating curve analyses indicated that the DASS-21 predicted the diagnostic presence of generalized anxiety disorder and depression as well as other commonly used measures. These data suggest that the DASS may be used with older adults in lieu of multiple scales designed to measure similar constructs, thereby reducing participant burden and facilitating assessment in settings with limited assessment resources.     

Age differences in symptoms of depression and anxiety: examining behavioral medicine outpatients

This study examined whether symptoms of depression and concomitant anxiety differed between older and younger medical outpatients referred to a behavioral medicine clinic. In a sample of 178 male veterans aged 21–83 years, older adults (60 years) reported lower overall depressive symptoms on the Beck Depression Inventory (BDI) and anxiety symptoms on the State-Trait Anxiety Inventory than did younger adults (<60 years). Depressive symptoms were highly prevalent. Among older adults, 60.0% scored 10 or higher on BDI and 33.8% scored 16 or higher. Among younger adults, 70.8% scored 10 or higher on BDI, and 48.7% scored 16 or higher. The age difference in overall depressive symptoms was driven by cognitive–affective symptoms. While older adults had lower cognitive–affective symptoms than did younger adults, the two groups did not differ on somatic-performance symptoms. These results suggest the importance of assessing cognitive–affective depressive symptoms in both older and younger male medical outpatients.     

Girls' and Mothers' Social Anxiety,Social Skills,and Loneliness: Associations After Accounting for Depressive Symptoms

This study examined, in 102 mother-daughter dyads, whether (a) girls' social skills and loneliness are related to girls' social anxiety, after adjusting for girls' depressive symptoms, and (b) mothers' social functioning (social anxiety, social skills, and loneliness) is related to girls' social anxiety, after accounting for girls' social functioning (social skills and loneliness) and mothers' and girls' depressive symptoms. After accounting for girls' depression, girls' loneliness (and not social skills) was related to girls' self-reported social anxiety and girls' social skills (and not loneliness) were related to mothers' reports of girls' social anxiety. Mothers' social functioning accounted for significant variance in girls' social anxiety, beyond that accounted for by girls' social functioning and mothers' and girls' depression. Mothers' loneliness and fear of negative evaluation showed significant relations to girls' social anxiety when variance attributable to other variables was partialed out, whereas mothers' social skills and social avoidance and distress did not. Directions for future research on social anxiety are highlighted.     

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

BACKGROUND: Hypomania/mania and depression are hypothesized to correspond to high and low expressions of behavioral activation system (BAS) activity, respectively, in bipolar individuals. In contrast, behavioral inhibition system (BIS) activity is hypothesized to regulate anxiety. The aim of the present study was to examine whether self-reported levels of BAS functioning in bipolar adolescents corresponded with levels of concurrent manic and depressive symptomatology. The secondary aim was to investigate whether self-reported BIS levels were associated with self-reported anxiety symptoms. METHODS: Twenty-five adolescents diagnosed with bipolar I, II or not otherwise specified were recruited from a treatment-development study. Adolescents were interviewed using the Depression and Mania Rating Scales of the Kiddie Schedule for Affective Disorders and Schizophrenia and given the Self-Report for Childhood Anxiety Related Disorders. Next, they completed the Behavioral Inhibition/Activation Scales. RESULTS: Contrary to hypotheses, adolescents with higher BAS levels exhibited less severe concurrent mania symptoms. Furthermore, levels of BAS sensitivity were not associated with concurrent levels of depression. As predicted, BIS scores correlated positively with self-reported anxiety scores. Adolescents reporting higher levels of the motor activity symptoms of mania also reported higher levels of anxiety symptoms. LIMITATIONS: The conclusions are based upon cross-sectional analyses in a small sample. CONCLUSIONS: In bipolar adolescents, mania and depression appear to be independent of self-reported behavioral activation levels. However, mood symptoms in adolescent patients are closely tied to components of anxiety, which may lead to diminished approach behaviors.     

Health e-Cards as a Means of Encouraging Help Seeking for Depression Among Young Adults: Randomized Controlled Trial

Background

There is a need to identify interventions that increase help seeking for depression among young adults.

Objective

The aim was to evaluate a brief depression information intervention employing health e-cards (personalized emails containing links to health information presented on a Web page).

Methods

A randomized controlled trial was carried out with 348 19- to 24-year-olds drawn from the community. Participants were randomized to receive one of three conditions, all of which delivered a short series of health e-cards. Two active conditions involved the delivery of depression information designed to increase help-seeking behavior and intentions and to improve beliefs and knowledge associated with help seeking. A control arm delivered information about general health issues unrelated to depression. The primary outcome was help-seeking behavior. Secondary outcomes were help-seeking intentions; beliefs about the efficacy of depression treatments and help sources; ability to recognize depression; knowledge of the help-seeking process; and depressive symptoms. The study’s primary focus was outcomes relating to formal help seeking (consultation with a general practitioner or mental health professional) but also targeted behaviors, intentions, and beliefs relating to informal help seeking.

Results

Relative to the control condition, depression health e-cards were not associated with an increase in formal help-seeking behavior, nor were they associated with improved beliefs about depression treatments; ability to recognize depression; knowledge of the help-seeking process; or depressive symptoms. Depression e-cards were associated with improved beliefs about the overall efficacy of formal help sources (z = 2.4, P = .02). At post-intervention, participants in all conditions, relative to pre-intervention, were more likely to have higher intentions of seeking help for depression from a formal help source (t ₆₄₁ = 5.8, P < .001) and were more likely to rate interpersonal psychotherapy as being helpful (z = 2.0, P = .047). Depression e-cards were not associated with any significant changes in informal help-seeking behavior, intentions, or beliefs.

Conclusions

The study found no evidence that providing depression information in the form of brief e-cards encourages help seeking for depression among young adults. Involvement in the study may have been associated with increased help-seeking intentions among participants in all conditions, suggesting that mechanisms other than depression information may increase help seeking.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN98406912; http://www.controlled-trials.com/ISRCTN98406912/ISRCTN98406912 (Archived by WebCite at http://www.webcitation.org/5k221KiMi)     

Emotional correlates of fluency test and Maze performance

This study tested the hypothesis that depression, anxiety, and bizarre thought content, as measured by MMPI-2 scales, would show a negative relationship with performance on widely used measures of executive functioning. Subjects were 70 male psychiatric patients who were ostensibly free of any neurologic disease or history of substance abuse. Correlational analyses were performed between age and education-corrected scores on the Controlled Oral Word Association Test (FAS), Design Fluency, and WISC-R Mazes, and scores on MMPI-2 scales D, PT , Anxiety, Fears, Obsessional Thinking, Depression, and Bizarre Mentation. The findings suggest that fluency and maze performance is (1) largely independent of measures of depression (D, DEP) and bizarre mentation (BIZ); (2) mildly associated with a measure of generalized anxiety (ANX); and (3) strongly related to an MMPI-2 measure of fearfulness (FRS).     

Girls' and mothers' social anxiety, social skills, and loneliness: associations after accounting for depressive symptoms.

This study examined, in 102 mother-daughter dyads, whether (a) girls' social skills and loneliness are related to girls' social anxiety, after adjusting for girls' depressive symptoms, and (b) mothers' social functioning (social anxiety, social skills, and loneliness) is related to girls' social anxiety, after accounting for girls' social functioning (social skills and loneliness) and mothers' and girls' depressive symptoms. After accounting for girls' depression, girls' loneliness (and not social skills) was related to girls' self-reported social anxiety and girls' social skills (and not loneliness) were related to mothers' reports of girls' social anxiety. Mothers' social functioning accounted for significant variance in girls' social anxiety, beyond that accounted for by girls' social functioning and mothers' and girls' depression. Mothers' loneliness and fear of negative evaluation showed significant relations to girls' social anxiety when variance attributable to other variables was partialed out, whereas mothers' social skills and social avoidance and distress did not. Directions for future research on social anxiety are highlighted.     

A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults

BACKGROUND: There is growing evidence for cognitive dysfunction in depressive and anxiety disorders. Nevertheless, the neuropsychological profile of young adult patients has not received much systematic investigation. The following paper reviews the existing literature on cognitive impairments in depressive and anxiety disorders particularly among young adults. Additionally, the focus of young adult age group and the effect of confounding variables on study results are discussed. METHODS: Electronic database searches were conducted to identify research articles focusing on cognitive impairments in depressive or anxiety disorders among young adults published in English during years 1990-2006. RESULTS: Cognitive impairments are common in young adults with major depression and anxiety disorders, although their nature remains partly unclear. Accordingly, executive dysfunction is evident in major depression, but other more specific deficits appear to depend essentially on disorder characteristics. The profile of cognitive dysfunction seems to depend on anxiety disorder subtype, but at least obsessive-compulsive disorder is associated with deficits in executive functioning and visual memory. The conflicting results may be explained by heterogeneity within study participants, such as illness status, comorbid mental disorders, and medication, and other methodological issues, including inadequate matching of study groups and varying testing procedures. LIMITATIONS: The study is a comprehensive review, but not a formal meta-analysis, due to methodological heterogeneity. CONCLUSIONS: Cognitive impairments are common in major depression and anxiety disorders. However, more research is needed to confirm and widen these findings, and to expand the knowledge into clinical practice. Controlling of confounding variables in future studies is highly recommended.     

Alcoholics' self-assessment of their neuropsychological functioning in everyday life

Self-reports of impairment in everyday cognitive and perceptuomotor functioning for the 6 months that preceded treatment were investigated in 60 male, middle-aged alcoholics and for a comparable time period in 60 nonalcoholic controls matched on age, education, and Shipley Vocabulary age. Alcoholics reported significantly more everyday impairment than did controls in memory, higher cognitive functions, language skills, and perceptual-motor function. Laboratory tests of neuropsychological performance revealed that the alcoholics were significantly poorer than controls on measures of memory, higher cognitive functions, and overall neuropsychological functioning, but test performances essentially were uncorrelated with self-reported everyday impairment and with self-reported levels of depression and anxiety. However, in both groups, measures of depression and anxiety were correlated significantly with self-perception of impairment. In alcoholics, quantity-frequency of drinking (QFI) was also correlated with reported impairment; chronicity was not. Multiple regression analyses indicate that in alcoholics, both quantity-frequency measures of alcohol intake and affective distress (depression, anxiety) made independent and roughly equal contributions to reported everyday impairment; in controls, only affective distress contributed significantly.     

Autobiographical Memory Specificity and Trauma in Inpatient Adolescents

Investigated the relation between memory specificity and self-reported trauma, depressive symptoms, and other emotional characteristics in a group of adolescent inpatients. Research with adults has shown that clinical depression is associated with a difficulty in retrieving specific autobiographical memories in response to cue words, and this pattern of overgeneral memory is related to the prognosis of depression. Research has also shown a clear positive association between self-reported trauma and overgeneral memory. This study's results showed that higher levels of trauma-both in terms of total number and in terms of severity or related distress-were associated with reduced autobiographical memory specificity (AM). None of the other emotional variables, such as depression, anxiety, worry, hopelessness, or subjective stress, were significantly related to the retrieval of specific memories. The results are reconcilable with Williams' (1996) developmental idea that a pattern of overgeneral AM retrieval originates in childhood trauma as a way of regulating affect.     

Depression, anxiety and neuropsychological test scores of candidates for coronary artery bypass graft surgery.

The effect of depression and anxiety upon neuropsychological test scores of candidates for coronary artery bypass graft (CABG) surgery was examined. Sixty patients were administered the Beck Depression Inventory II and the State-Trait Anxiety Inventory, along with a battery of neuropsychological tests. Regression analyses were conducted in which the neuropsychological test scores were predicted using age, education, depression, anxiety, and combined depression-anxiety scores. While age and education were significant predictors of several neuropsychological test measures, no significant regression analysis results were obtained for the depression, anxiety and combined depression-anxiety scores. Similarities and discrepancies between this research and previous studies are discussed. It appears that low levels of preoperative depression and anxiety states do not affect neuropsychological functioning among CABG candidates.     

Forgiveness, depression, and suicidal behavior among a diverse sample of college students

Depression and suicide are significant public health concerns for college-age young adults. Meaning-based characteristics, such as forgiveness, a voluntary coping process involving offering, feeling, or seeking a change from negative to positive cognitions, behaviors, and affect toward a transgressor, may buffer such poor mental health outcomes. Utilizing mediation analyses, we examined cross-sectional associations between forgiveness, depression, and suicidal behavior in a diverse student sample reporting mild to severe depressive symptoms. The effect of self-forgiveness on suicidal behavior was fully mediated by depression; self-forgiveness was associated with depression and, in turn, with suicidal behavior. Forgiveness of others was directly associated with suicidal behavior. Prospective research is needed, yet self and other-forgiveness may be appropriate targets for promotion in suicide prevention efforts.