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Maladaptive personality, the motivational systems, and intolerance of uncertainty play important roles in the statistical explanation of depression and anxiety. Here, we notably examined for the first time whether symptoms of depression, anxiety, health anxiety, and fear of COVID-19 share similar associations (e.g., variance explained) with these important dispositional dimensions. For this cross-sectional study, data from 1001 participants recruited in Germany (50% women; mean age = 47.26) were collected. In separate models, we examined the cross-sectional associations of the symptoms of depression, anxiety, health anxiety, and fear of COVID-19 with the Personality Inventory for DSM Short Form Plus scales, the Behavioral Inhibition System / Flight–Fight–Freeze System / Behavioral Activation System scales, and Intolerance of Uncertainty scales. Relative weight analyses were used to determine the within-model importance of the different scales in the prediction of the symptoms. All in all, our study showed that maladaptive personality and intolerance of uncertainty dimensions are more important sets of predictors of the studied outcomes (with which depressive and anxious symptomatology feature very similar associations) than are the motivational system dimensions. Within predictor sets, the scales with the most important predictors were: Negative Affectivity, the Behavioral Inhibition System, and Burden due to Intolerance of Uncertainty. Our findings highlight the relevance of focusing behavioral targets of psychotherapy on these within-set traits and identify potential research priorities (maladaptive personality and intolerance of uncertainty) in relation to the symptoms of interest.

Trypophobia is characterised by an aversion to or even revulsion for patterns of holes or visual stimuli featuring such patterns. Past research has shown that trypophobic stimuli trigger emotional and physiological reactions, but relatively little is known about the antecedents, prodromes, or simply covariates of trypophobia. The goals of this study were (a) to draw the contours of the nomological network of trypophobia by assessing the associations of symptoms of trypophobia with several constructs that were deemed relevant from past research on anxiety disorders and specific phobias, (b) to compare such associations with those found for symptoms of spider phobia and blood and injection phobia (alternative dependent variables), and (c) to investigate the main effect of gender on symptoms of trypophobia and replicate the association of gender with symptoms of spider phobia and blood and injection phobia (higher scores for women). Participants (N = 1,134, 53% men) in this cross-sectional study completed an online questionnaire assessing the constructs of interest. Most assessed constructs typically associated with anxiety disorders (neuroticism, conscientiousness, anxiety sensitivity, trait anxiety, disgust sensitivity, and disgust propensity) were also associated with trypophobia in the predicted direction. All of these constructs were also associated with spider phobia and blood and injection phobia. Behavioral inhibition was negatively associated with trypophobia and spider phobia-contrary to what was expected, but positively with blood and injection phobia. We found no gender difference in trypophobia, whereas women scored higher on spider phobia and blood and injection phobia. Although some differences were observed, the nomological network of trypophobia was largely similar to that of spider phobia and blood and injection phobia. Further studies are needed to clarify similarities and dissimilarities between trypophobia and specific phobia.

The COVID-19 pandemic has been repeatedly associated with poor mental health. Previous studies have mostly focused on short time frames such as around the first lockdown periods, and the majority of research is based on self-report questionnaires. Less is known about the fluctuations of psychological states over longer time frames across the pandemic. Twitter timelines of 4,735 users from London and New York were investigated to shed light on potential fluctuations of several psychological states and constructs related to the pandemic. Moving averages are presented for the years 2020 and 2019. Further, mixed negative binomial regression models were fitted to estimate monthly word counts for the time before and during the pandemic. Several psychological states and constructs fluctuated heavily on Twitter during 2020 but not during 2019. Substantial increases in levels of sadness, anxiety, anger, and concerns about home and health were observed around the first lockdown periods in both cities. The levels of most constructs decreased after the initial spike, but negative emotions such as sadness, anxiety, and anger remained elevated throughout 2020 compared to the year prior to the pandemic. Tweets from both cities showed remarkably similar temporal patterns, and there are similarities to reactions found on Twitter following other previous traumatic events.

The diagnosis of somatisation disorder in DSM-IV was based on 'medically unexplained' symptoms, which is unsatisfactory. To determine the value of a total somatic symptom score as a predictor of health status and healthcare use after adjustment for anxiety, depression and general medical illness. Data from nine population-based studies (total n = 28 377) were analysed. In all cross-sectional analyses total somatic symptom score was associated with health status and healthcare use after adjustment for confounders. In two prospective studies total somatic symptom score predicted subsequent health status. This association appeared stronger than that for medically unexplained symptoms. Total somatic symptom score provides a predictor of health status and healthcare use over and above the effects of anxiety, depression and general medical illnesses.

BackgroundDigital therapeutics (DTx) show promise in bridging mental healthcare gaps. However, treatment selection often relies on availability and trial-and-error, prolonging suffering and increasing costs. Personalised prediction models could help identify individuals benefiting most from specific DTx.ObjectiveThe aim of this secondary analysis was to establish a machine learning-based prediction model for positive treatment outcomes in patients with depressive or anxiety symptoms after 8 weeks of internet-delivered cognitive behavioural therapy (iCBT).MethodsWe analysed a large real-world dataset of patients from the online therapy unit iCBT programme in Saskatchewan, Canada (2013–2021). Clinically significant changes in depressive symptoms or anxiety were measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7). We trained six prediction models using sociodemographic and mental health-related factors at baseline, compared model performances and calculated Shapley values for feature importance.FindingsData from 4175 patients using 34 features for prediction, identified by least absolute shrinkage and selection operator regression, showed the Gradient Boosted Model (gbm) and logistic regression (log) performed best, with balanced accuracies of 0.76, 95% CI (0.70 to 0.83) and 0.70, 95% CI (0.63 to 0.77). Shapley values indicated GAD-7 scores at baseline as the most important predictor of clinically significant improvement, along with mental health history and sociodemographic variables.ConclusionsThe gbm and log models achieved comparable accuracy in predicting clinically significant improvement after iCBT, supporting the use of simpler, interpretable methods in clinical practice.Clinical implicationsThese findings could help improve mental health treatment selection, iCBT assignment, enhance effectiveness and optimise treatment for patients.Trial registration numberNCT05758285.

Background/Objective: Prolonged stress can overwhelm coping resources, leading people to seek mental health care. Acceptance and commitment therapy (ACT) is an intervention that enhances well-being and reduces distress, assumedly by means of increasing psychological flexibility (PF). We examined the association between a total increase in PF during an intervention and decreases in stress and increases in well-being during and after the intervention. Method: The intervention was a randomized controlled trial of an ACT-based self-help intervention. Participants were 91 individuals reporting elevated levels of work-related stress. Measurements were completed at preintervention, postintervention, and 3-month follow-up. Results: Structural equation models revealed that the total increase in PF during the intervention was negatively associated with a decrease in stress (b=-0.63, SE=0.14, p<.001) and positively associated with an increase in well-being during the intervention (b=0.48, SE=0.11, p<.001), but not with a decrease in stress (b=0.03, SE=0.27, p>.05) and well-being (b=-0.04, SE=0.39, p>.05) following the intervention. Conclusions: Our study provides empirical support for decreasing stress and promoting well-being through ACT and emphasizes the potential of PF in promoting well-being. Antecedentes/Objetivo: El estrés prolongado puede inhibir los recursos de adaptación, llevando a las personas a solicitar servicios de salud mental. La Terapia de Aceptación y Compromiso (ACT) es una intervención que fomenta el bienestar y reduce la ansiedad, presuntamente mediante el aumento de la flexibilidad psicológica (PF). Examinamos la asociación entre un aumento total en PF durante una intervención y el descenso del estrés y el aumento del bienestar durante y después de la intervención. Método: En un ensayo aleatorio controlado de una intervención de autoayuda con base en ACT participaron 91 individuos con niveles elevados de estrés laboral. Completaron mediciones pre, post y seguimiento a tres meses. Resultados: Modelos de ecuaciones estructurales revelaron que el aumento total en PF durante la intervención está negativamente asociado a la reducción del estrés (b=-0,63, SE=0,14, p<0,001) y positivamente asociado con el aumento del bienestar durante la intervención (b=0,48, SE=0,11, p<0,001), pero no con el descenso del estrés (b=0,03, SE=0,27, p>0,05) y el bienestar (b=-0,04, SE=0,39, p>0,05) después de la intervención. Conclusiones: Se proporciona base empírica de la reducción del estrés y el fomento del bienestar mediante ACT, enfatizando el potencial de PF para fomentar el bienestar.

There has been little research exploring the relationship between personality traits, self-esteem, and stigmatizing attitudes toward those with mental disorders. Furthermore, the mechanisms through which the beholder’s personality influence mental illness stigma have not been tested. The aim of this study is to examine the relationship between Big Five personality traits, self-esteem, familiarity, being a healthcare professional, and stigmatization. Moreover, this study aims to explore the mediating effect of perceived dangerousness on the relationship between personality traits and desire for social distance. We conducted a vignette-based representative population survey ( N  = 2207) in the canton of Basel-Stadt, Switzerland. Multiple regression analyses were employed to examine the associations between personality traits, self-esteem, familiarity, and being a healthcare professional with the desire for social distance and perceived dangerousness. The mediation analyses were performed using the PROCESS macro by Hayes. Analyses showed associations between personality traits and stigmatization towards mental illness. Those who scored higher on openness to experience ( β  = − 0.13, p  < 0.001), ( β  = − 0.14, p  < 0.001), and those who scored higher on agreeableness ( β  = − 0.15, p  < 0.001), ( β  = − 0.12, p  < 0.001) showed a lower desire for social distance and lower perceived dangerousness, respectively. Neuroticism ( β  = − 0.06, p  = 0.012) was inversely associated with perceived dangerousness. Additionally, high self-esteem was associated with increased stigmatization. Personal contact or familiarity with people having mental disorders was associated with decreased stigmatization. Contrarily, healthcare professionals showed higher perceived dangerousness ( β  = 0.04, p  = 0.040). Finally, perceived dangerousness partially mediated the association between openness to experience (indirect effect = −  .57, 95% CI [− .71, − 0.43]) as well as agreeableness (indirect effect = − 0.57, 95% CI [− 0.74, − 0.39]) and desire for social distance. Although the explained variance in all analyses is < 10%, the current findings highlight the role of personality traits and self-esteem in areas of stigma. Therefore, future stigma research and anti-stigma campaigns should take individual differences into consideration. Moreover, the current study suggests that perceived dangerousness mediates the relationship between personality traits and desire for social distance. Further studies are needed to explore the underlying mechanisms of such relationship. Finally, our results once more underline the necessity of increasing familiarity with mentally ill people and of improving the attitude of healthcare professionals towards persons with mental disorders.

BackgroundThe use of coercive measures is an increasingly debated aspect of psychiatric treatment. Considering the multitude of negative effects, patients, clinicians, and ethicists alike have called for a more cautious application of coercion. It therefore remains important to investigate which organizational characteristics have the potential to facilitate efficient coercion reduction. The same holds true for the efficient reduction of symptom severity during inpatient treatment.MethodsThe current study compared 22 Swiss psychiatric clinics treating 45,095 cases regarding their relative efficiency in treating cases without coercion given their staff resources. To this end, we applied a Data Envelopment Analysis to clinical routine data. We focused specifically on inefficiencies attributable to management factors independent of the clinics’ total staff numbers. We further compared the clinics’ relative efficiencies regarding changes of self-reports and third-person reports of symptom severity during inpatient stays.ResultsEfficiency scores suggest that on average, the clinics could improve the percentage of cases treated without coercion by 9% and the changes of symptom severity by 34% (for third-person ratings) or 18% (for self-reports) while keeping staff numbers constant. An analysis of specific coercion types revealed that the potential for efficiency improvements via management was highest for movement restrictions. We found no effect of clinic size on efficiency scores regarding any of the outcome measures.ConclusionsOur results underline the importance of management factors beyond staff resources (e.g., staff trainings or changes in ward structure and treatment concepts) for the efficient reduction of coercion and psychiatric symptoms during inpatient stays.

In this proof-of-concept study, we used a systems perspective to conceptualize and investigate treatment-related dynamics (temporal and cross-sectional associations) of symptoms and elements related to the manifestation of a common functional somatic syndrome (FSS), Globus Sensations (GS). We analyzed data from 100 patients ( M  = 47.1 years, SD  = 14.4 years; 64% female) with GS who received eight sessions of group psychotherapy in the context of a randomized controlled trial (RCT). Symptoms and elements were assessed after each treatment session. We applied a multilevel graphical vector-autoregression (ml GVAR) model approach resulting in three separate, complementary networks (temporal, contemporaneous, and between-subject) for an affective, cognitive, and behavioral dimension, respectively. GS were not temporally associated with any affective, cognitive, and behavioral elements. Temporally, catastrophizing cognitions predicted bodily weakness (r = 0.14, p  < 0.01, 95% confidence interval (CI) [0.04–0.23]) and GS predicted somatic distress (r = 0.18, p  < 0.05, 95% CI [0.04–0.33]). Potential causal pathways between catastrophizing cognitions and bodily weakness as well as GS and somatic distress may reflect treatment-related temporal change processes in patients with GS. Our study illustrates how dynamic NA can be used in the context of outcome research.

Background Although subthreshold conditions are associated with impairment in numerous disorders, research on obsessive–compulsive disorder (OCD) below the diagnostic threshold of DSM-IV in the general population is limited. Purpose To estimate the DSM-IV 12-month prevalence, comorbidity and impairment of OCD, subthreshold OCD (i.e., fulfilling some but not all core DSM-IV criteria), and obsessive–compulsive symptoms (OCS) (i.e., endorsement of OCS without fulfilling any core DSM-IV criteria) in a general population sample. Methods Data from the German National Health Interview and Examination Survey–Mental Health Supplement ( N  = 4181, age 18–65 years), based on the standardized diagnostic Munich Composite International Diagnostic Interview. Results The 12-month prevalence of OCD was 0.7%, subthreshold OCD was 4.5%, and OCS was 8.3%. Subjects in all three groups showed higher comorbidity (odds ratios [ORs] ≥ 3.3), compared to those without OCS. The OCD, subthreshold OCD and OCS were all associated with increased odds of substance abuse/dependence-, mood-, anxiety- and somatoform disorders, with especially strong associations with possible psychotic disorder (ORs ≥ 4.1) and bipolar disorders (ORs ≥ 4.7). Participants in all three groups showed higher impairment (ORs ≥ 3.1) and health-care utilization (ORs ≥ 2.4), compared to those without OCS, even after controlling for covariates. Conclusions Individuals with subthreshold OCD and OCS, not currently captured by DSM-IV OCD criteria, nevertheless show substantial comorbidity, impairment and health-care utilization. This should be taken into account in future conceptualization and classification of OCD and clinical care.