Tag: Anxiety Disorder

  • Study reveals impact of socioeconomic status on children’s anxiety in research settings

    Study reveals impact of socioeconomic status on children’s anxiety in research settings

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    When participating in research studies, moderately anxious or highly anxious children from minoritized groups are likely to be hypervigilant to threat, further compounding the effects of their general state of anxiety, a research study led by a University of California, Riverside, psychologist reports.

    The study, which involved the participation of 46 Inland Southern California preadolescent Latina girls (8–13 years), has implications also for children from families with low socioeconomic status. 

    “Psychological research is often conducted in white, educated, and affluent communities,” said Kalina Michalska, an associate professor of psychology, who led the research team. “People from minoritized groups or people with low income and/or limited access to education are often not exposed to scientific research, and have historically been exploited by science, which contributes to their discomfort or legitimate mistrust.”

    In the study, the girls first completed a laboratory testing session during which they and their caregivers reported on family demographics as well as the girls’ behavior, anxiety, and other mental health outcome measures. The girls then completed an emotion processing task while in an MRI scanner. They viewed images of fearful and happy faces projected into the scanner bore while the researchers measured their brain responses.

    “Trait anxiety” is a constant state of anxiety. “State anxiety” is defined as a momentary feeling of anxiety, the kind one might experience going to the doctor’s office to learn the results of tests or when giving a public lecture.

    The researchers found that among girls with average or high levels of trait anxiety, their state anxiety before being MRI-scanned was associated with greater brain responses -; specifically, an increased amygdala-hippocampal response -; to fearful faces (threat stimuli) versus happy faces. This means a generally anxious participant experienced high levels of momentary anxiety when situated in a distressing environment, such as the MRI scanner.

    Undergoing an MRI scan is anxiety-inducing not just for children but also, more generally, for people unfamiliar with the scanning environment.”


    Kalina Michalska, associate professor of psychology, UCR

    In the study, which appears in the open access journal BMC Psychiatry, girls who rated their families as having a lower community standing tended to have elevated pre-scan state anxiety, suggesting that factors such as social status can influence children’s reactions to the research environment.

    Michalska, an expert on pediatric anxiety disorders, urges neuroimaging researchers to control for state anxiety and help participants from all backgrounds feel as comfortable as possible during testing sessions. 

    “Without accounting for state anxiety, data from experiments such as ours could be misattributed to temperamental, environmental, or cultural factors rather than apprehension of the research environment,” she said.

    According to Michalska, when children who are at risk for anxiety disorder (trait anxiety) are anxious “in the moment” (state anxiety), the differences in brain activity are due to the momentary anxiety, not the anxiety disorder. 

    “When interpreting the data, it is important not to misattribute the findings to an anxiety disorder or to a whole community when it is only momentary and situational anxiety,” she said. “Brain responses in experiments like ours need to be attributed not necessarily to the fact that the participants are, say, Latina, but to their historical experiences with science. Our participants had high anxiety because they were entering a space that has historically been hostile to them.”

    Michalska is hopeful the team’s findings can lead to new conversations about mental health. 

    “Doctors can change the way they think about patients’ mental health and teachers can think differently about the mental health of their students,” she said. “Our data show that socioeconomic status can play a significant role in patients’ and students’ anxiety and suggest that the scanning environment may be particularly anxiety-inducing for participants who feel marginalized relative to other members of society.”

    Next, the researchers plan on measuring social experiences, such as parents’ experiences of ethnic racial discrimination and children’s experiences of the same. The researchers also plan to measure children’s vicarious experiences resulting from watching their parents’ encounters with ethnic racial discrimination. 

    Michalska was joined in the research by her former graduate student and first author of the paper Dana E. Díaz, now at Columbia University Irving Medical Center in New York, and Wan-Ling Tseng of Yale University in Connecticut.

    The research was funded by a grant from the Hellman Fellows Program and a National Institute of Health subaward from the UCR Center for Health Disparities Research.

    The title of the research paper is “Pre-scan state anxiety is associated with greater right amygdala-hippocampal response to fearful versus happy faces among trait-anxious Latina girls.”

    Source:

    Journal reference:

    Díaz, D.E., et al. (2024) Pre-scan state anxiety is associated with greater right amygdala-hippocampal response to fearful versus happy faces among trait-anxious Latina girls. BMC Psychiatry. doi.org/10.1186/s12888-023-05403-6.

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  • U.S. adults face distress, unequal mental health care access during the COVID-19 era

    U.S. adults face distress, unequal mental health care access during the COVID-19 era

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    U.S. adults experienced considerable psychological distress and adverse mental health effects as a result of the COVID-19 pandemic according to a study at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. Based on insurance claims, mental health care provider surveys, and electronic health records the research further revealed a decline in in-person outpatient mental health visits during the acute phase of the pandemic. Findings are reported in the Annals of Internal Medicine.

    The trends and patterns we observed in the United States align with reports globally concluding that several mental health problems, including depression, and generalized anxiety disorder, have become more prevalent during than before the pandemic.”


    Mark Olfson, MD, MPH, Professor of Epidemiology at Columbia Mailman School of Public Health, and Dollard Professor of Psychiatry, Medicine & Law at Columbia University Irving Medical Center 

    To characterize the psychological distress experienced, determine the level of outpatient mental health care, and describe patterns of in-person versus telemental health care, the researchers studied the responses of adults from the Medical Expenditure Panel Surveys by the Agency for Healthcare Research and Quality Component, a nationally representative survey of over 85,000 people. Psychological distress was measured with a 6-point scale range and outpatient mental health care use was determined via computer-assisted personal interviews.

    The rate of serious psychological distress among adults increased from 3.5 percent to 4.2 percent from 2018 to 2021. While outpatient mental health care increased overall as well — from 11.2 percent to 12.4 percent, the rate among adults with serious psychological distress decreased from 46.5 percent to 40.4 percent. Young adults (aged 18 to 44 years significantly increased outpatient mental health care but this pattern was not observed for the middle-aged (aged 45 to 64 years) and older adults (aged >65 years). Similarly, more employed adults reported outpatient mental health treatment care compared to the unemployed. 

    In 2021, 33 percent of mental health outpatients received at least one video visit. The likelihood of receiving in-person, telephone, or video mental health care varied across sociodemographic groups; percentages of video care were higher for younger adults than for middle-aged or older adults, women compared with men, college graduates compared with adults with less education, the seriously distressed, lower-income, unemployed, and rural patients.

    “Thanks to a rapid pivot to telemental health care, there was an overall increase during the pandemic of adults receiving outpatient mental health care in the United States. However, the percentage of adults with serious psychological distress who received outpatient mental health treatment significantly declined. Several groups also had difficulty accessing telemental health care including older individuals and those with lower incomes and less education,” observed Olfson. “These patterns underscore critical challenges to extend the reach and access of telemental health services via easy-to-use and affordable service options.” 

    “Increasing our understanding of the patterns we observed in terms of access to outpatient mental health care including in-person, telephone-administered, and internet-administered outpatient mental health services could inform ongoing public policy discussions and clinical interventions,” noted Olfson. “Identifying low-cost means of connecting lower-income patients to telemental health should be a priority, as well as increasing public investment to make access to high-speed broadband universal.”

    “The national profile of adults who receive outpatient mental health care via telemental health – the younger adult, the employed, higher-income, and privately insured adults, raises concerns about disparities in access to virtual mental health care,” said Olfson. “Unless progress is made in reducing these barriers, primary care clinicians will continue to encounter challenges in connecting their older, unemployed, and lower income patients to video-delivered outpatient mental health care.”

    Co-authors are Chandler McClellan and Samuel H. Zuvekas, Agency for Healthcare Research and Quality; Melanie Wall, Columbia Mailman School of Public Health; and Carlos Blanco, National Institute on Drug Abuse.

    Source:

    Journal reference:

    Olfson, M., et al. (2024). Trends in Psychological Distress and Outpatient Mental Health Care of Adults During the COVID-19 Era. Annals of Internal Medicine. doi.org/10.7326/m23-2824.

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  • Heavy cannabis use linked to increased risk of developing a new anxiety disorder

    Heavy cannabis use linked to increased risk of developing a new anxiety disorder

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    Twenty-seven percent of individuals who had an emergency department visit for cannabis use developed a new anxiety disorder within three years, according to new research.

    Led by researchers at the Bruyère Research Institute, University of Ottawa Department of Family Medicine, The Ottawa Hospital, and ICES, this is the largest study of the relationship between cannabis use and anxiety to date. The study published today in The Lancet’s open access journal eClinical Medicine included over 12 million individuals living in Ontario, Canada, between 2008 and 2019 who had never received a diagnosis or treatment for anxiety. The researchers used health record data from ICES to compare the risk of developing an anxiety disorder for individuals who had an emergency department (ED) visit for cannabis use compared to the general population.

    Our results suggest that individuals requiring emergency department treatment for cannabis use were both at substantially increased risk of developing a new anxiety disorder and experiencing worsening symptoms for already existing anxiety disorders.”


    Dr. Daniel Myran, Lead Author, Canada Research Chair in Social Accountability at the University of Ottawa, ICES Adjunct Scientist, Investigator at the Bruyère Research Institute, and a Clinician Investigator at The Ottawa Hospital

    Key findings of the study include:

    • Risk of a new anxiety disorder: Within three years, 27.5 percent of individuals who had an ED visit for cannabis use were diagnosed with a new anxiety disorder in an outpatient, ED or hospital setting compared to 5.6 percent of the general population-;a 3.9 fold increased risk after accounting for social factors and other mental health diagnoses. 
    • Risk of severe or worsening anxiety disorders: Within three years, 12.3 percent of individuals who had an ED visit for cannabis use had a hospitalization or an emergency department visit for an anxiety disorder compared to 1.2 percent of the general population-;a 3.7 fold increased risk after accounting for social factors and other mental health diagnoses. 
    • In individuals with an ED visit where cannabis was the main reason for a visit, the risk of having a hospitalization or ED visit for an anxiety disorder increased by 9.4 fold compared to the general population.
    • Men and women and individuals of all ages with an ED visit for cannabis use were at elevated risk of developing new anxiety disorders relative to the general population. Importantly, younger adults (10-24 years) and men were at particularly elevated risk.

    There is an ongoing debate about whether cannabis use causes individuals to develop anxiety disorders or if part of the relationship between cannabis use and anxiety reflects individuals self-medicating anxiety symptoms with cannabis. The current study finds that cannabis use may worsen anxiety and is the largest to date examining this question.

    Regardless of causality, the authors caution against using cannabis to treat symptoms of anxiety given the lack of evidence for its effect, that its use may delay other evidence-based treatments, and the potential risk that it may substantially worsen anxiety symptoms.

    “Cannabis use has rapidly increased in Canada over the past 15 years and there is a general sense that cannabis is relatively harmless or has health benefits. Our study cautions that in some individuals, heavy cannabis use may increase their risk of developing anxiety disorders,” says Dr. Myran.

    Source:

    Journal reference:

    Myran, D. T., et al. (2024) Development of an anxiety disorder following an emergency department visit due to cannabis use: a population-based cohort study. eClinicalMedicine. doi.org/10.1016/j.eclinm.2024.102455.

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