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Journal of Clinical Oncology : Official... Jun 2023To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors.
PURPOSE
To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors.
METHODS
A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted.
RESULTS
The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations.
RECOMMENDATIONS
It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
Topics: Humans; Adult; Acceptance and Commitment Therapy; Depression; Ethnicity; Minority Groups; Anxiety; Survivors; Neoplasms
PubMed: 37075262
DOI: 10.1200/JCO.23.00293 -
Annals of Internal Medicine Nov 2022To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To what extent the COVID-19 pandemic and its containment measures influenced mental health in the general population is still unclear.
PURPOSE
To assess the trajectory of mental health symptoms during the first year of the pandemic and examine dose-response relations with characteristics of the pandemic and its containment.
DATA SOURCES
Relevant articles were identified from the living evidence database of the COVID-19 Open Access Project, which indexes COVID-19-related publications from MEDLINE via PubMed, Embase via Ovid, and PsycInfo. Preprint publications were not considered.
STUDY SELECTION
Longitudinal studies that reported data on the general population's mental health using validated scales and that were published before 31 March 2021 were eligible.
DATA EXTRACTION
An international crowd of 109 trained reviewers screened references and extracted study characteristics, participant characteristics, and symptom scores at each timepoint. Data were also included for the following country-specific variables: days since the first case of SARS-CoV-2 infection, the stringency of governmental containment measures, and the cumulative numbers of cases and deaths.
DATA SYNTHESIS
In a total of 43 studies (331 628 participants), changes in symptoms of psychological distress, sleep disturbances, and mental well-being varied substantially across studies. On average, depression and anxiety symptoms worsened in the first 2 months of the pandemic (standardized mean difference at 60 days, -0.39 [95% credible interval, -0.76 to -0.03]); thereafter, the trajectories were heterogeneous. There was a linear association of worsening depression and anxiety with increasing numbers of reported cases of SARS-CoV-2 infection and increasing stringency in governmental measures. Gender, age, country, deprivation, inequalities, risk of bias, and study design did not modify these associations.
LIMITATIONS
The certainty of the evidence was low because of the high risk of bias in included studies and the large amount of heterogeneity. Stringency measures and surges in cases were strongly correlated and changed over time. The observed associations should not be interpreted as causal relationships.
CONCLUSION
Although an initial increase in average symptoms of depression and anxiety and an association between higher numbers of reported cases and more stringent measures were found, changes in mental health symptoms varied substantially across studies after the first 2 months of the pandemic. This suggests that different populations responded differently to the psychological stress generated by the pandemic and its containment measures.
PRIMARY FUNDING SOURCE
Swiss National Science Foundation. (PROSPERO: CRD42020180049).
Topics: Humans; Anxiety; COVID-19; Depression; Mental Health; Pandemics; SARS-CoV-2
PubMed: 36252247
DOI: 10.7326/M22-1507 -
Journal of Integrative and... Jan 2022The research aim was to perform a systematic review and meta-analysis evaluating the ability of acupressure to reduce anxiety. Randomized controlled trials were... (Meta-Analysis)
Meta-Analysis Review
The research aim was to perform a systematic review and meta-analysis evaluating the ability of acupressure to reduce anxiety. Randomized controlled trials were obtained through a search of electronic medical databases (four in English and one in Chinese) from inception to October 5, 2020. Two authors searched the databases, evaluated studies' methodological quality, and performed data extraction independently. The final studies for analysis were identified after discussion with the third author. We obtained 27 studies for our systematic review and meta-analysis. Eight studies had a low overall risk of bias, and 13 had some bias concerns with methodological quality. According to the results, acupressure significantly reduced patient anxiety (standardized mean difference = 1.152; 95% confidence interval: 0.847-1.459, < 0.001), and the study heterogeneity was high ( = 299.74, < 0.001, = 91.333%). Two studies reported acupressure-associated adverse events. We also performed a sensitivity analysis by omitting one outlier study, which had the largest effect size; however, high heterogeneity remained ( = 87.816%). A subgroup analysis revealed significant differences between participant types ( = 46.573, < 0.001), levels of methodological quality ( = 6.228, = 0.044), and massage equipment ( = 4.642, = 0.031). Our meta-analysis suggests that acupressure can alleviate anxiety. Acupressure was more effective for inpatients and preoperative patients when finger massage was applied. In individuals with anxiety and a stable hemodynamic status, acupressure could be a promising treatment option. However, the substantial heterogeneity across studies means that any inference from the results should be performed cautiously.
Topics: Acupressure; Anxiety; Anxiety Disorders; Humans; Massage
PubMed: 35085025
DOI: 10.1089/jicm.2020.0256 -
Clinical Child and Family Psychology... Jun 2021Individuals with cystic fibrosis (CF) are at high risk of clinically significant anxiety, which can be related to lower treatment adherence and poorer health outcomes.... (Review)
Review
Individuals with cystic fibrosis (CF) are at high risk of clinically significant anxiety, which can be related to lower treatment adherence and poorer health outcomes. Additionally, up to half of the parents/caregivers of children with CF experience clinically significant anxiety. Research has focussed on CF youth aged 13 years and older, leaving anxiety among school-aged children (aged 6-12 years) largely unstudied. This review aimed to synthesize research on anxiety among children with CF and their parents, examining prevalence, risk factors, and relationships between parent and child factors. Four electronic databases were searched, and publications were included if participants were children (or parents of children) with CF with a mean age between 6 and 12 years, and a standardized anxiety measure was used. Data from fourteen studies were extracted for descriptive synthesis; however, no studies focussed exclusively on the age range of 6-12 years. Results generally indicated that anxiety is highly prevalent in both child and parent populations; anxiety was the most prevalent mental health condition among children with CF, and anxiety was higher among CF populations than control populations among both children and parents. However, there were disparities, with some papers finding low rates of anxiety, and results on the relationship between anxiety and health outcomes varying greatly. Several risk factors were identified, but few were corroborated. There is an overall deficiency of research in this area, particularly examining the relationships between parent and child anxiety, and anxiety and health outcomes. Further research on suitable screening and intervention practices is also required.
Topics: Adolescent; Anxiety; Anxiety Disorders; Caregivers; Child; Cystic Fibrosis; Humans; Parents
PubMed: 33660071
DOI: 10.1007/s10567-021-00345-5 -
Psychological Medicine Jan 2021Background: Growing evidence from observational studies indicates a high prevalence of anxiety in asthma. However, prevalence rates of coexisting anxiety symptoms and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Background: Growing evidence from observational studies indicates a high prevalence of anxiety in asthma. However, prevalence rates of coexisting anxiety symptoms and comorbid anxiety disorders vary widely across studies. We aimed to evaluate the associations between anxiety and asthma and provide more precise comorbidity estimates.
METHODS
We systematically reviewed the literature from case-controlled studies and conducted a meta-analysis to evaluate the pooled prevalence estimates and risks of anxiety symptoms and anxiety disorders in asthma individuals. Screening, data extraction, and quality assessment were undertaken following PRISMA guidelines for preferred reporting of systematic reviews and meta-analysis. A random-effects model was used to calculate pooled prevalence rates. Meta-analysis was conducted using Review Manager 5.3. Multiple databases including PubMed, ScienceDirect, PsychINFO, and PsycARTICLES were searched for publications before 1 December 2019. The review protocol was registered on PROSPERO (ref: CRD42020176028).
RESULTS
In total, 19 studies involving 106813 participants were included. The pooled prevalence of anxiety symptoms and anxiety disorders in individuals with asthma was 0.32 (95% CI 0.22-0.43) and 0.24 (95% CI 0.13-0.41), respectively. The risks of coexisting anxiety symptoms and comorbid anxiety disorders were significantly higher in asthma patients than in non-asthma controls indicated by OR 1.89 (95% CI 1.42-2.52; Z = 4.37; p < 0.001) and OR 2.08 (95% CI 1.70-2.56; Z = 6.97; p < 0.001), respectively. Anxiety symptoms and anxiety disorders occur at increased frequency among patients with asthma.
CONCLUSIONS
Our findings highlight the need for appropriate assessments for these comorbid conditions, which may help to identify a subgroup of patients who might benefit from interventions designed to reduce anxiety and enhance the quality of life.
Topics: Anxiety; Asthma; Case-Control Studies; Humans
PubMed: 33431086
DOI: 10.1017/S0033291720005097 -
Journal of Psychosomatic Research Feb 2022The association between a low socioeconomic status and poor health, also known as social inequalities in health, has been shown in numerous studies. This also applies to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The association between a low socioeconomic status and poor health, also known as social inequalities in health, has been shown in numerous studies. This also applies to most mental illnesses, such as somatization or anxiety disorders. It is unclear, however, whether social inequalities are evident in health anxiety as well. Therefore, this review and meta-analysis systematically examines social inequalities in health anxiety.
METHODS
A systematic literature search was conducted covering all studies published until August 2021. The databases PubMED, Web of Science, PsycINFO, and PSYNDEX were screened to identify quantitative studies using validated tools to measure health anxiety and examining the association with socioeconomic status. Meta-analytic methods were applied by using random-effect models. The study quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool.
RESULTS
Overall, 37 studies were eligible for meta-analysis. Effect sizes of 27 studies using screening scales and 10 studies using diagnostic interviews to measure health anxiety were calculated separately. Meta-analyses revealed a significant association between socioeconomic status and health anxiety (r - 0.14, 95%-CI -0.18 to -0.09 (screening scales) and OR 0.63, 95%-CI 0.43 to 0.92 (diagnostic interviews)), indicating a lower risk for health anxiety in people with higher socioeconomic status.
CONCLUSION
Findings suggest that the health-related disadvantage of socially deprived people is also evident regarding health anxiety. This should be considered in programs to reduce social inequalities in health. PROSPERO registration number CRD42021237550.
Topics: Anxiety; Anxiety Disorders; Delivery of Health Care; Humans; Social Class; Socioeconomic Factors
PubMed: 34954602
DOI: 10.1016/j.jpsychores.2021.110706 -
Psychological Medicine Jan 2023Interpretation bias (i.e. the selective negative interpretation of ambiguous stimuli) may contribute to the development and maintenance of health anxiety. However, the... (Meta-Analysis)
Meta-Analysis Review
Interpretation bias (i.e. the selective negative interpretation of ambiguous stimuli) may contribute to the development and maintenance of health anxiety. However, the strength of the empirical evidence for this association remains a topic of debate. This study aimed to estimate the association between health anxiety and interpretation bias and to identify potential moderators of this association. Chinese-language databases (CNKI, VIP, and Wanfang), English-language databases (Web of Science, PubMed, PsycINFO, and Scopus), and German-language databases (Psyndex and PubPsych) were searched for relevant studies. There were 36 articles (39 studies) identified by this search ( = 8984), of which 32 articles (34 studies) were included in the meta-analysis ( = 8602). Results revealed a medium overall effect size ( = 0.67). Statistically equivalent effect sizes were observed for patients diagnosed with clinical health anxiety ( = 0.58) and subclinical health anxiety ( = 0.72). The effect sizes for threat stimuli that were health related ( = 0.68) and not health related ( = 0.63) did not differ significantly. The effect size for studies using an offline paradigm ( = 0.75) was significantly higher than that for studies using an online paradigm ( = 0.50). It is concluded that health anxiety is significantly and robustly associated with interpretation bias. These findings are of central importance for the advancement of models and treatment of health anxiety.
Topics: Humans; Anxiety; Anxiety Disorders; Bias
PubMed: 36349699
DOI: 10.1017/S0033291722003427 -
Complementary Therapies in Medicine Jun 2022The aims of this review were to 1) summarise the breadth and types of research regarding the impact of aquatic exercise on mental health completed to date, 2) provide a... (Review)
Review
OBJECTIVES
The aims of this review were to 1) summarise the breadth and types of research regarding the impact of aquatic exercise on mental health completed to date, 2) provide a clear indication of the intervention type, volume, measurement tools used, and populations best served in relation to this activity and its effectiveness and 3) to identify domains within the literature that can be developed so recommendations can be made for future investigations.
METHOD
A scoping review was performed under the PRISMA guidelines. A systematic search of Pubmed, SPORTDiscus, PsycInfo and Google Scholar databases was conducted. Studies observing the effect of aquatic exercises on mental health and related parameters were considered for inclusion. The data from the selected studies were then extracted and analysed methodically.
PRIMARY CONDITIONS MEASURED
Depression, anxiety, mood, self-esteem, and psychological well-being were the primary mental states for which findings could be clearly extracted.
RESULTS
Of the 1635 articles that resulted from the search, 23 articles met all inclusion criteria. Of these, 12 were randomised controlled trials. Cumulatively, the findings of this review trend towards aquatic exercise being effective in generating positive changes in mental health.
CONCLUSION
Aquatic exercise, specifically winter swimming, leisure swimming, competitive swimming and aquatic aerobics, can be a promising conservative therapy for mental health management. However, it is recommended that further research be conducted to solidify these findings and establish the long-term effects of this intervention on mental health.
Topics: Anxiety; Exercise; Humans; Mental Health; Self Concept
PubMed: 35218906
DOI: 10.1016/j.ctim.2022.102820 -
Journal of Medical Internet Research Nov 2023Anxiety disorders rank among the most prevalent mental disorders worldwide. Anxiety symptoms are typically evaluated using self-assessment surveys or interview-based... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anxiety disorders rank among the most prevalent mental disorders worldwide. Anxiety symptoms are typically evaluated using self-assessment surveys or interview-based assessment methods conducted by clinicians, which can be subjective, time-consuming, and challenging to repeat. Therefore, there is an increasing demand for using technologies capable of providing objective and early detection of anxiety. Wearable artificial intelligence (AI), the combination of AI technology and wearable devices, has been widely used to detect and predict anxiety disorders automatically, objectively, and more efficiently.
OBJECTIVE
This systematic review and meta-analysis aims to assess the performance of wearable AI in detecting and predicting anxiety.
METHODS
Relevant studies were retrieved by searching 8 electronic databases and backward and forward reference list checking. In total, 2 reviewers independently carried out study selection, data extraction, and risk-of-bias assessment. The included studies were assessed for risk of bias using a modified version of the Quality Assessment of Diagnostic Accuracy Studies-Revised. Evidence was synthesized using a narrative (ie, text and tables) and statistical (ie, meta-analysis) approach as appropriate.
RESULTS
Of the 918 records identified, 21 (2.3%) were included in this review. A meta-analysis of results from 81% (17/21) of the studies revealed a pooled mean accuracy of 0.82 (95% CI 0.71-0.89). Meta-analyses of results from 48% (10/21) of the studies showed a pooled mean sensitivity of 0.79 (95% CI 0.57-0.91) and a pooled mean specificity of 0.92 (95% CI 0.68-0.98). Subgroup analyses demonstrated that the performance of wearable AI was not moderated by algorithms, aims of AI, wearable devices used, status of wearable devices, data types, data sources, reference standards, and validation methods.
CONCLUSIONS
Although wearable AI has the potential to detect anxiety, it is not yet advanced enough for clinical use. Until further evidence shows an ideal performance of wearable AI, it should be used along with other clinical assessments. Wearable device companies need to develop devices that can promptly detect anxiety and identify specific time points during the day when anxiety levels are high. Further research is needed to differentiate types of anxiety, compare the performance of different wearable devices, and investigate the impact of the combination of wearable device data and neuroimaging data on the performance of wearable AI.
TRIAL REGISTRATION
PROSPERO CRD42023387560; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387560.
Topics: Humans; Artificial Intelligence; Anxiety; Anxiety Disorders; Algorithms; Databases, Factual
PubMed: 37938883
DOI: 10.2196/48754 -
The Journal of Maternal-fetal &... Dec 2023To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters.
OBJECTIVE
To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters.
METHODS
A literature search of the PubMed database and www.clinicaltrials.gov from January 1990 through June 2020 was conducted. A PRISMA review of the available literature regarding the incidence and prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) following natural disasters was performed. A natural disaster was defined as one of the following: pandemic, hurricane, earthquake and post-political conflict/displacement of people. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcome was the prevalence of maternal anxiety, depression and PTSD in the post-disaster setting. Two independent extractors (I.F. & H.G.) assessed study quality using an adapted version of the Effective Public Health Practice Project Quality Assessment tool. Given the small number of studies that met inclusion criteria, all 22 studies were included, regardless of rating. Data were extracted and aggregate rates of depression, anxiety, and PTSD were calculated to provide synthesized rates of maternal mental health conditions among participants.
RESULTS
Twenty-two studies met the inclusion criteria. A total of 8357 pregnant or birthing persons in the antepartum and postpartum periods were studied. The prevalence of post-pandemic anxiety, depression and PTSD were calculated to be 48.2%, 27.3%, and 22.9%. Post-earthquake depression and PTSD rates were 38.8% and 22.4%. The prevalence of post-hurricane anxiety, depression and PTSD were 17.4%, 22.5%, and 8.2%. The rates of post-political conflict anxiety, depression and PTSD were 48.8%, 31.6% and 18.5%.
CONCLUSION
Given the high rates of anxiety, depression and PTSD among pregnant and birthing persons living through the challenges of natural disasters, obstetrician-gynecologists must be able to recognize this group of patients, and provide a greater degree of psychosocial support.
Topics: Pregnancy; Female; Humans; Stress Disorders, Post-Traumatic; Depression; Retrospective Studies; Prospective Studies; Anxiety; Earthquakes
PubMed: 37031972
DOI: 10.1080/14767058.2023.2199345