Negative affect interacts with perceptual affective biases

Converging evidence has linked the anterior mid-cingulate cortex to negative affect, pain and cognitive control. It has previously been proposed that this region uses information about punishment to control aversively motivated actions. Studies on the effects of lesions allow causal inferences about brain function; however, naturally occurring lesions in the anterior mid-cingulate cortex are rare. In two studies we therefore recruited 94 volunteers, comprising 15 patients with treatment-resistant depression who had received bilateral anterior cingulotomy, which consists of lesions made within the anterior mid-cingulate cortex, 20 patients with treatment-resistant depression who had not received surgery and 59 healthy control subjects. Using the Ekman 60 faces paradigm and two Stroop paradigms, we tested the hypothesis that patients who received anterior cingulotomy were impaired in recognizing negative facial affect expressions but not positive or neutral facial expressions, and impaired in Stroop cognitive control, with larger lesions being associated with more impairment. Consistent with this hypothesis, we found that larger volume lesions predicted more impairment in recognizing fear, disgust and anger, and no impairment in recognizing facial expressions of surprise or happiness. However, we found no impairment in recognizing expressions of sadness. Also consistent with the hypothesis, we found that larger volume lesions predicted impaired Stroop cognitive control. Notably, this relationship was only present when anterior mid-cingulate cortex lesion volume was defined as the overlap between cingulotomy lesion volume and Shackman's meta-analysis-derived binary masks for negative affect and cognitive control. Given substantial evidence from healthy subjects that the anterior mid-cingulate cortex is part of a network associated with the experience of negative affect and pain, engaging cognitive control processes for optimizing behaviour in the presence of such stimuli, our findings support the assertion that this region has a causal role in these processes. While the clinical justification for cingulotomy is empirical and not theoretical, it is plausible that lesions within a brain region associated with the subjective experience of negative affect and pain may be therapeutic for patients with otherwise intractable mood, anxiety and pain syndromes.

To provide a model to estimate human resource needs for community-based mental health services in South Africa. A situation analysis was conducted of current community-based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders. For a population of 100,000 people, 7.3-23.8 full-time equivalent staff would be required to provide services in outpatient services, 14.9-41.6 in day care and 11.5-23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data. The model fills a gap, particularly in low- and middle-income countries, where community-based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.

Use of Outpatient Mental Health Services by Depressed and Anxious Children as They Grow Up

Research exploring psychological dysfunction as a predictor of smoking cessation success may be limited by nonoptimal predictor variables (i.e., categorical psychodiagnostic measures vs. continuous personality-based manifestations of dysfunction) and imprecise outcomes (i.e., summative point-prevalence abstinence vs. constituent cessation milestone measures). Accordingly, this study evaluated the unique and overlapping relations of broad-spectrum personality traits (positive emotionality, negative emotionality, and constraint) and past-year psychopathology (anxiety, mood, and substance use disorder) to point-prevalence abstinence and three smoking cessation milestones: (a) initiating abstinence, (b) first lapse, and (c) transition from lapse to relapse. Participants were daily smokers (N = 1365) enrolled in a smoking cessation treatment study. In single-predictor regression models, each manifestation of internalizing dysfunction (lower positive emotionality, higher negative emotionality, and anxiety and mood disorder) predicted failure at one or more cessation milestone(s). In simultaneous predictor models, lower positive and higher negative emotionality significantly predicted failure to achieve milestones after controlling for psychopathology. Psychopathology did not predict any outcome when controlling for personality. Negative emotionality showed the most robust and consistent effects, significantly predicting failure to initiate abstinence, earlier lapse, and lower point-prevalence abstinence rates. Substance use disorder and constraint did not predict cessation outcomes, and no single variable predicted lapse-to-relapse transition. These findings suggest that personality-related manifestations of internalizing dysfunction are more accurate markers of affective sources of relapse risk than mood and anxiety disorders. Further, individuals with high trait-negative emotionality may require intensive intervention to promote the initiation and early maintenance of abstinence.

Background: Psychiatric disorders such as anxiety and depression are shown to be common when diagnosed with early-onset cancer, often defined as cancers diagnosed in adults <50 years of age. We hypothesize that the mental health of early-onset cancer survivors is negatively affected compared to late-onset cancer survivors. Methods: We identified cancer survivors in the Medical Expenditure Panel Survey 2021 Full Year Consolidated Data File. We categorized cancer survivors as early-onset (≤ 50 years of age) and late-onset (> 50 years of age). We examined the proportion of mood and anxiety disorders, and the proportion of antidepressant and antianxiety medication use among the early and late-onset cancer survivors. We conducted chi-square tests and multivariable logistic regression models by adjusting for sex and race. Results: We identified 291 early-onset cancer survivors (mean age 41 years, 71% female) and 2556 late-onset cancer survivors (mean age 71 years, 56% female). Among the early-onset cancer survivors, 18% had mood disorders (17% took antidepressants) and 20% had anxiety disorders (6% took antianxiety medication). In comparison, 12% late-onset cancer survivors had mood disorders (21% took antidepressants) and 13% had anxiety disorders (8% took antianxiety medication). Early-onset cancer survivors were more likely to develop mood (Adjusted Odds Ratio (aOR)=1.45; 95% CI=1.06 - 1.99) and anxiety (aOR=1.42; 95% CI=1.05 - 1.92) disorders compared to late-onset cancer survivors. However, there were no differences in receiving antidepressants (aOR=0.79; 95% CI=0.57 - 1.09) or antianxiety (aOR=0.69; 95% CI=0.41 - 1.16) medication between early and late-onset cancer survivors when adjusting for sex and race. Conclusion: Early-onset cancer survivors had an elevated risk of acquiring psychiatric disorders such as mood and anxiety disorders than late-onset cancer survivors, but treatment was suboptimal. Clinician and patient awareness can help narrow the gaps of treatment for early-onset cancer survivors. Table 3. Odds Ratio for early-onset vs. late-onset cancer survivors (*Sex and Race adjusted) Variables Crude Odds Ratio Adjusted Odds Ratio * Mood Disorders 1.48 (1.09 - 2.00) 1.45 (1.06 - 1.99) Anxiety Disorder 1.52 (1.13 - 2.03) 1.42 (1.05 - 1.92) Antidepressants 0.80 (0.59 - 1.10) 0.79 (0.57 - 1.09) Antianxiety 0.70 (0.42 - 1.17) 0.69 (0.41 - 1.16) Citation Format: Jayden H. Lee, Jaejin An. Mental health of early-onset and late-onset cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4859.

BackgroundTo evaluate the association between mood and anxiety disorders and thyroid autoimmunity in a community sample. Methods: A community based sample of 222 subjects was examined. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview Simplified (CIDIS), according to DSM-IV criteria. All subjects underwent a complete thyroid evaluation including physical examination, thyroid echography and measure of serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase autoantibodies (anti-TPO).Results16.6% of the overall sample had an anti-TPO value above the normal cut-off. Subjects with at least one diagnosis of anxiety disorders (OR = 4.2, C.L. 95% 1.9–38.8) or mood disorders (OR = 2.9, Cl 95% 1.4–6.6, P < 0.011) were positive for serum anti-TPO more frequently than subjects without mood or anxiety disorders. A statistically significant association with anti-TPO+ was found in Anxiety Disorder Not Otherwise Specified (OR = 4.0, CL 95% 1.1–15.5), in Major Depressive Episode (OR = 2.7, CL 95% 1.1–6.7) and Depressive Disorder Not Otherwise Specified (OR = 4.4, S CL 95% 1–19.3).ConclusionsThe study seems to suggest that individuals in the community with thyroid autoimmunity may be at high risk for mood and anxiety disorders. The psychiatric disorders and the autoimmune reaction seem to be rooted in a same (and not easy correctable) aberrancy in the immuno-endocrine system. Should our results be confirmed, the findings may be of great interest for future preventive and case finding projects.

To evaluate the prevalence of severe insomnia symptoms and the extent to which they are associated with daytime impairments in comorbid mood and anxiety disorders. Nationally representative cross-sectional survey. National Comorbidity Survey-Replication (NCS-R). There were 5,692 NCS-R respondents with no mood or anxiety disorder (n = 3,711), mood disorders only (n = 327), anxiety disorders only (n = 1,137), and coexisting mood and anxiety disorders (n = 517). N/A. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders and severe insomnia symptoms in the past year were assessed using the World Health Organization (WHO) Composite International Diagnostic Interview. The World Health Organization Disability Assessment Schedule (WHO-DAS) indexed eight domains of daytime impairment in the past 30 days, which included self-care, mobility, cognition, social functioning, time out of role, and four components of productive role functioning. Respondents with comorbid mood and anxiety disorders had significantly higher rates of severe insomnia complaints (42.1-62.8%) relative to the three other groups. Severe insomnia complaints were also significantly more prevalent in individuals with mood (25.2-45.6%) or anxiety disorders only (24.9-45.5%) relative to those with no disorder (12.4-24.3%). Moreover, endorsing a severe insomnia complaint in the past year was associated with increased days of impairment across all past-month WHO-DAS domains for respondents with mood-anxiety comorbidity. For the remaining groups, severe insomnia complaints were related to increased days of impairment across all domains except self-care, and additionally mobility for the group with mood disorders only. Comorbid mood and anxiety disorders are associated with high rates of severe insomnia complaints, which were independently associated with substantial functional impairment.

To study the prevalence of psychiatric comorbidity based on reference standard diagnostic criteria in patients with human immunodeficiency virus (HIV). Psychiatric illness is common in patients with HIV and has been associated with negative health behaviors and poorer clinical outcomes. Among those persons with psychiatric illness, psychiatric comorbidity (multiple simultaneous diagnoses) is associated with increased psychiatric severity and higher HIV risk behaviors. A total of 152 consecutively presenting HIV+ patients at an academic medical center in the southeastern US completed a modified Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4(th) Edition) that assessed mood, anxiety, and substance use disorders in the past year and past month. Fifty percent and 33% of patients had a past-year and past-month diagnosis, respectively. The most common diagnoses were mood disorders (32% past year/21% past month) followed by anxiety (21%/17%) and substance use disorders (22%/11%). Half of those with past-year disorders and 40% of those with past-month disorders met the criteria for multiple diagnoses. Of those with a mood disorder in the past month, 53% also had an anxiety or substance use disorder; of those with an anxiety disorder, 62% also had a mood or substance use disorder; and of those with a substance use disorder, 63% also had a mood or anxiety disorder. Psychiatric comorbidity was associated with younger age, White non-Hispanic race/ethnicity, and greater HIV symptomatology. Comorbidity of mood, anxiety, and substance use disorders was the exception rather than the rule in this sample. Potential co-occurring disorders should be considered for HIV+ patients presenting with a psychiatric diagnosis.

There are meager prospective data from nonclinical samples on the link between anxiety disorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 U.S. Air Force service members, with 227 suicides over follow-up. Mental disorder diagnoses including anxiety, mood, and substance-use disorders (SUD) were based on treatment encounters. Risk for suicide associated with anxiety disorders were lower compared with mood disorders and similar to SUD. Moreover, the associations between mood and anxiety disorders with suicide were greatest within a year of treatment presentation.

The ability to distinguish self-generated stimuli from those caused by external sources is critical for all behaving organisms. Although many studies point to a sensory attenuation of self-generated stimuli, recent evidence suggests that motor actions can result in either attenuated or enhanced perceptual processing depending on the environmental context (i.e., stimulus intensity). The present study employed 2-AFC sound detection and loudness discrimination tasks to test whether sound source (self- or externally-generated) and stimulus intensity (supra- or near-threshold) interactively modulate detection ability and loudness perception. Self-generation did not affect detection and discrimination sensitivity (i.e., detection thresholds and Just Noticeable Difference, respectively). However, in the discrimination task, we observed a significant interaction between self-generation and intensity on perceptual bias (i.e. Point of Subjective Equality). Supra-threshold self-generated sounds were perceived softer than externally-generated ones, while at near-threshold intensities self-generated sounds were perceived louder than externally-generated ones. Our findings provide empirical support to recent theories on how predictions and signal intensity modulate perceptual processing, pointing to interactive effects of intensity and self-generation that seem to be driven by a biased estimate of perceived loudness, rather by changes in detection and discrimination sensitivity.

Where perception meets belief updating: Computational evidence for slower updating of visual expectations in anxious individuals

Ruminative response style is associated with a negative bias in the perception of emotional facial expressions in healthy women without a history of clinical depression

Emotion perception biases may precipitate problematic interpersonal interactions in families affected with borderline personality disorder (BPD) and lead to conflictual relationships. In the present study, the authors investigated the familial aggregation of facial emotion recognition biases for neutral, happy, sad, fearful, and angry expressions in probands with BPD (n = 89), first-degree biological relatives (n = 67), and healthy controls (n = 87). Relatives showed comparable accuracy and response times to controls in recognizing negative emotions in aggregate and most discrete emotions. For sad expressions, both probands and relatives displayed slower response latencies, and they were more likely than controls to perceive sad expressions as fearful. Nonpsychiatrically affected relatives were slower than controls in responding to negative emotional expressions in aggregate, and fearful and sad facial expressions more specifically. These findings uncover potential biases in perceiving sad and fearful facial expressions that may be transmitted in families affected with BPD.

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Objective:Mental and substance use disorders are the leading causes of disability worldwide. Contemporary estimates of prevalence, severity and impairment are essential for service planning. This study provides estimates of prevalence, severity, impairment and demographic correlates of mental and substance use disorders in 2020–22 and changes in prevalence since 2007.Methods:Data were from the two Australian National Surveys of Mental Health and Wellbeing conducted in 2020-22 (N = 15,893) and 2007 (N = 8841). Descriptive statistics report prevalence of lifetime and 12-month mental and substance use disorder by sex and age, proportion of people with each mental disorder by levels of severity (mild, moderate and severe) and mean days out of role by mental disorder class (mood, anxiety, substance use). Logistic regression analyses examined demographic correlates of mental disorder class and assessed changes over time.Results:The lifetime prevalence of any mental or substance use disorder in 2020–22 was 40.2%. The 12-month prevalence was 20.2% (mood disorder - 7.4%, anxiety disorder - 15.7% and substance use disorder - 3.1%). Mood disorders were associated with significant impairment. The prevalence of mental disorders has changed over time, with mood and anxiety disorders increasing and substance use disorders decreasing. These changes were most evident among young adults.Conclusion:Mental disorders are common in Australia. Impairment associated with mental disorders remains significant. Particular focus should be paid to young adults aged 16–25 years who have shown the largest increases in anxiety and mood disorder prevalence over the past 13 years.