Barriers to Help-Seeking in Young Women With Eating Disorders: A Qualitative Exploration in a Longitudinal Community Survey

Few with eating disorders (EDs) access evidence-based treatments. We conducted a prospective exploration of help-seeking by 57 community women with bulimic-type EDs using the Framework approach of familiarization, identifying themes, indexing, charting and mapping and interpretation. The mean age of the sample was 33 years. Results found women sought help for concerns regarding perceived (over) weight rather than for eating, although many women would have welcomed questions from professionals regarding eating behaviours. Empathy, providing information and hope were considered important features of health professionals to provide a positive experience of help-seeking. Specific personal barriers to treatment included low motivation, fear of stigma, and cost. Greater clinician and community awareness of and action on these issues would likely help close “the gap” for effective help-seeking by those with EDs.     

Determinants of Barriers to Treatment for Anxiety Disorders

The objectives of this study were to evaluate perceived unmet need for mental healthcare, determinants of unmet need, and barriers to care in individuals with social anxiety (SA) or panic disorder with agoraphobia (PDA) in Quebec. Data from 206 participants diagnosed with SA or PDA were collected using an online questionnaire. Correlational analyses and binary stepwise logistic regressions were conducted to explore determinants of perceived unmet need. Of the 206 participants, 144 (69.9%) reported instances of unmet need for treatment. Perceived unmet need was correlated with variables related to the severity of the disorder, such as comorbid depression, avoidance, duration of worry, interference with functioning, and time lapsed between the appearance of first symptoms and first consultation. Depression and avoidance emerged as predictors for perceived unmet need in the regression analysis. The most common barriers to treatment reported were concern about the cost of services (63.9%), not knowing where to go to get help (63.2%), lack of health insurance coverage (52.4%), and appointment wait times (52.1%). The results of this study demonstrate the need to overcome barriers to treatment engendered by avoidance behaviors associated with anxiety. Potential methods for achieving this objective include Internet outreach, support groups, and increased accessibility to public services.     

Advances and Barriers for Clinical Neuroimaging in Late-Life Mood and Anxiety Disorders

Purpose of Review

Mood and anxiety disorders are very commonly experienced by older adults and are becoming a growing concern due to the rapidly aging global population. Recent advances in neuroimaging may help in improving outcomes in late-life mood and anxiety disorders. The elucidation of mechanisms contributing to late-life mental health disorders may ultimately lead to the identification of novel therapeutic interventions. Alternatively, clinically validated imaging biomarkers may allow for the prediction of treatment response and identification of better therapeutic approaches in late-life mood and anxiety disorders.

Recent Findings

In community samples, late-life depression and late-life generalized anxiety disorder occur up to 38 and 15%, respectively, while late-life bipolar disorder is less common and occur in approximately 0.5% of the population. There are significant challenges in treating and improving outcome in late-life mood and anxiety disorders. Time to treatment response and treatment resistance are increased in older adults. Novel neuroimaging techniques have the potential to improve diagnostic and therapeutic outcome in late-life mood and anxiety disorders either through “personalized pharmacotherapy” or through identifying dysfunction regions/networks to be subsequently used for direct interventions such as transcranial magnetic stimulation.

Summary

This review will provide an overview of recent literature that substantiates the potential role of neuroimaging in clinical practice, as well as the barriers that must be overcome prior to clinical translation.

     

Perceptions of Mental Health and Help-Seeking Behavior in an Urban Community in Vietnam: An Explorative Study

This explorative study assesses perceptions of mental health and help-seeking behavior among adults in Vietnam. Methods included questionnaires (200) and focus group discussions (eight). Respondents were often unable to name specific mental illnesses. Frequently mentioned symptoms of mental illness were talking nonsense, talking/laughing alone and wandering. Pressure/stress and studying/thinking too much were often identified causes. Most respondents showed a preference for medical treatment options, often in combination with family care. The results show that perceptions of mental health and help-seeking behaviour are influenced by a lack of knowledge and a mix of traditional and modern views.     

The Impact of Psychiatric Disorders on Employment: Results from a National Survey (NESARC)

In this study we examine the longitudinal effects of psychiatric and substance use disorders on employment, in an employed population. The sample included respondents to the National epidemiologic survey on alcohol related conditions (NESARC) who were employed at Wave 1 (N = 22,407). Bivariate and multivariable analyses were conducted examining the associations between 12-month and new onset 12-month psychiatric diagnoses at Wave 1 and employment status at Wave 2. Past year and new onset 12-month depression, 12-month bipolar, new onset 12-month drug abuse, and 12-month and new onset 12-month drug dependence were associated with a decreased odds of being employed at Wave 2. This study suggests that it would be beneficial for employers to support their employees in participating in mental health treatment. Additionally, understanding how psychiatric disorders influence employment over the life course might inform the development of preemptive interventions to treat mental health symptoms.     

The Treatment of Anxiety Disorders in a Primary Care HMO Setting

Anxiety disorders are common, yet under diagnosed, in primary care settings. Many patients with anxiety and other psychiatric disorders do not seek care in mental health care settings. An integrated primary care/mental health model offers one approach to improving outcomes for patients with anxiety disorders. This model has been researched for the treatment of depression with positive results but has not been well studied for the treatment of anxiety disorders. We describe the results of care for a cohort of adult patients with Generalized Anxiety Disorder (GAD) and clinically significant anxiety secondary to Major Depressive Disorder (MDD) treated in an integrated model. Compared to a matched cohort of adults treated in a primary care setting with usual care, the intervention cohort experienced significantly improved reduction in symptoms of anxiety at 6 months. The intervention cohort also was significantly more satisfied with care.     

Assessment and Treatment of Anxiety Disorders in Children and Adolescents

This article reviews the current screening and assessment tools for anxiety disorders in children and adolescents, as well as evidence-based treatment interventions for these disorders. The following anxiety disorders are discussed: separation anxiety disorder, generalized anxiety disorder, specific phobia, panic disorder, social anxiety disorder (social phobia), and selective mutism. There are several well-studied screening and assessment tools to identify childhood anxiety disorders early and differentiate the various anxiety disorders. Evaluations of baseline somatic symptoms, severity, and impairment ratings of the anxiety disorders, and collecting ratings from several sources is clinically helpful in assessment and treatment follow-up. Cognitive-behavioral therapy (CBT) has been extensively studied and has shown good efficacy in treatment of childhood anxiety disorders. A combination of CBT and medication may be required for moderate to severely impairing anxiety disorders and may improve functioning better than either intervention alone. Selective serotonin reuptake inhibitors are currently the only medications that have consistently shown efficacy in treatment of anxiety disorders in children and adolescents. Despite proven efficacy, the availability of CBT in the community is limited. Current research is focusing on early identification of anxiety disorders in community settings, increasing the availability of evidence-based interventions, and modification of interventions for specific populations.     

Psychotic-Like Experiences in Major Depression and Anxiety Disorders: A Population-Based Survey in Young Adults

Objective: Population-based surveys have confirmed that psychotic-like experiences are prevalent in the community. However, it is unclear if these experiences are associated with common mental disorders. The aim of this study was to examine the prevalence of psychotic-like experiences in those with affective and anxiety disorders. Methods: Subjects were drawn from the Mater-University of Queensland Study of Pregnancy. Delusion-like experiences were assessed with the Peters Delusional Inventory (PDI). The Composite International Diagnostic Interview (CIDI) was used to identify individuals with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) lifetime diagnoses of major depression, anxiety disorder, substance use/dependence, and psychotic disorders. The influence of affective and anxiety disorders on PDI and CIDI psychosis-related items’ scores were assessed with logistic regression, with adjustments for age, sex, and the presence of the other comorbid psychiatric diagnoses. Results: Having either a lifetime diagnosis of major depressive disorder or an anxiety disorder was associated with significantly higher PDI total scores (highest vs lowest quartile adjusted odds ratios [ORs] and 95% confidence intervals [CIs] = 4.43, 3.09–6.36; 3.08, 2.26–4.20, respectively). The odds of endorsing any CIDI hallucination or delusion item was increased in those with a major depressive or anxiety disorder. The presence of current anxiety disorder symptoms was significantly associated with PDI score (OR = 5.81, 95% CI = 3.68–9.16). Conclusion: While psychotic-like experiences are usually associated with psychotic disorders, individuals with depression and anxiety are also more likely to report these symptoms compared with well individuals. Psychotic-like experiences are associated with a range of common mental disorders.     

The Treatment of Anxiety Disorders in Devout Christian Clients

Summary

Anxiety raises key spiritual concerns, such as control, letting go, fear, trust, and priorities for devout Christian clients. This article strives to increase the sensitivity of therapists to these spiritual concerns. While clinical interventions emphasize the management of anxiety, Christian spirituality points beyond mere coping with this disorder to a freedom from it. A review of biblical insights draws the conclusion that the spiritual antidote to anxiety is a radical trust rooted in an intimate relationship with God. A model for intervention is presented for helping devout Christian clients develop radical trust and intimate relationships through spiritual resources and spiritual dialogue.     

Anxiety Disorders in Persons with Developmental Disabilities: Empirically Informed Diagnosis and Treatment

Anxiety disorders are common in individuals with developmental disabilities (DDs), although they may not be diagnosed and treated as often as they are in patients without DDs. Patients with mental retardation, autism, and other pervasive developmental disorders may exhibit comorbid anxiety disorders, such as generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), phobias, and other anxiety symptoms at much higher rates than in the general population, but identification of these comorbid anxiety disorders may be made more difficult by the presence of the DD and concurrent difficulties with communication, other behavior problems, the lack of standardized assessments specific to diagnosing patients with DDs and psychiatric comorbidities, and the need for greater collateral sources of assessment information. In addition, systematic study of the treatment of anxiety in patients with DD is limited to a relatively small number of empirical studies done specifically in these patients along with case reports and theoretical reviews on the extension and modification of more well-studied treatments used for anxiety in patients without DDs. The present article reviews the literature on the prevalence, features, assessment and diagnosis of anxiety disorders in individuals with DDs, and also reviews empirical studies of pharmacological and psychological treatment of patients with comorbid anxiety and DD and summarizes the findings. Recommendations are made to guide treatment and further research in this area.