Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: A complex network analysis

Barthel, Abigail L.; Pinaire, Megan; Curtiss, Joshua; Baker, Arthur M.; Brown, Mackenzie; Hoeppner, Susanne S.; Bui, Éric; Simon, Naomi M.; Hofmann, Stefan G.

doi:10.1016/j.jad.2020.08.077

Cited by 22 publications

(16 citation statements)

References 47 publications

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“… 63 QOL is a multidimensional concept that measures one’s overall wellbeing, involving physical and mental health aspects. Previous studies found that the QOL was negatively associated with “Fatigue” and “Trouble relaxing” in patients with depression, 28 , 64 which was confirmed in this study. We found that edges between QOL and “Fatigue”, and between QOL and “Trouble relaxing” were the two strongest connections in clinicians.…”

Section: Discussionsupporting

confidence: 90%

“… 27 A recent NA (N=226) on the association between anxiety, depression and sleep in patients with generalized anxiety disorder (GAD) found that “Anhedonia” was the most central symptom. 28 However, the NA study was limited by a small sample size. A recent review on NA suggested that a large sample size should be used in future studies.…”

Section: Introductionmentioning

confidence: 99%

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Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

Cai¹,

Zhao²,

Xing³

et al. 2022

NSS

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Background A high proportion of clinicians experienced common anxiety, insomnia and depression during the COVID-19 pandemic. This study examined the item-level association of comorbid anxiety and insomnia symptoms among clinicians who suffered from depressive symptoms during the late stage of the COVID-19 pandemic using network analysis (NA). Methods Clinicians with depressive symptoms (with a Patients Health Questionnaire (PHQ-9) total score of 5 and above) were included in this study. Anxiety and insomnia symptoms were measured using the Generalized Anxiety Disorder Scale - 7-item (GAD-7) and Insomnia Severity Index (ISI), respectively. Network analysis was conducted to investigate the network structure, central symptoms, bridge symptoms, and network stability of these disturbances. Expected influence (EI) was used to measure the centrality of index. Results Altogether, 1729 clinicians were included in this study. The mean age was 37.1 [standard deviation (SD)=8.04 years], while the mean PHQ-9 total score was 8.42 (SD=3.33), mean GAD-7 total score was 6.45 (SD=3.13) and mean ISI total score was 8.23 (SD=5.26). Of these clinicians, the prevalence of comorbid anxiety symptoms (GAD-7≥5) was 76.8% (95% CI 74.82–78.80%), while the prevalence of comorbid insomnia symptoms (ISI≥8) was 43.8% (95% CI: 41.50–46.18%). NA revealed that nodes ISI7 (“Interference with daytime functioning”) (EI=1.18), ISI4 (“Sleep dissatisfaction”) (EI=1.08) and ISI5 (“Noticeability of sleep problem by others”) (EI=1.07) were the most central (influential) symptoms in the network model of comorbid anxiety and insomnia symptoms in clinicians. Bridge symptoms included nodes PHQ3 (“Sleep”) (bridge EI=0.55) and PHQ4 (“Fatigue”) (bridge EI=0.49). Gender did not significantly influence the network structure, but “having the experience of caring for COVID-19 patients” significantly influenced the network structure. Conclusion Central symptoms and key bridge symptoms identified in this NA should be targeted in the treatment and preventive measures for clinicians suffering from comorbid anxiety, insomnia and depressive symptoms during the late stage of the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

Cai¹,

Zhao²,

Xing³

et al. 2022

NSS

View full text Add to dashboard Cite

show abstract

“…Specifically, employment status was a significant predictor of QOL among individuals with anxiety disorders [17]. Additionally, a network analysis of individuals with GAD demonstrated strong connections between GAD and two areas of QOL: satisfaction with working ability and ability to engage in daily activities [54]. Adults with GAD also demonstrated more impairment in work productivity and activity in addition to lower QOL compared with adults without GAD [21].…”

Section: Occupational Functioningmentioning

confidence: 94%

“…Depression comorbidity emerged as a particularly notable correlate with QOL in anxiety disorders. Depression symptoms demonstrated a strong inverse correlation with QOL among individuals with GAD and PD [15,54]. Among individuals with SAD, only those with comorbid depression or OCD reported greater disability and lower QOL than those without comorbidity [52•].…”

Section: Comorbiditymentioning

confidence: 99%

Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research

Wilmer

Anderson

Reynolds

2021

Curr Psychiatry Rep

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Purpose of Review Anxiety disorders are highly prevalent conditions that have a detrimental impact on quality of life (QOL), particularly when left untreated. In the present review, we summarize recent literature, published within the last 3 years, on QOL in anxiety disorders, with a focus on factors that may play a role in the relationship between anxiety and QOL. Recent Findings We organize our findings into four categories: (1) subjective distress, (2) behavioral responses, (3) functional impairment, and (4) clinical factors. Results indicate that greater anxiety symptom severity is linked with poorer QOL, and cognitive behavioral therapies for anxiety yield positive effects on QOL. Additional transdiagnostic mechanisms are highlighted, including anxiety sensitivity, distress tolerance, emotion regulation, and avoidant coping. We examine the role of functional impairment, and we discuss factors related to treatment, including comorbidity and longitudinal effects. We also consider early research from the COVID-19 pandemic. Summary Understanding the underlying factors that contribute to QOL detriments provides important insight into the impact of anxiety disorders and identifies targets for enhancing QOL through treatment.

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“…Fifth, forced abstinence may induce a withdrawal syndrome as has been inferred in rodents by various anxiety-anhedonia measures, including vocalization ( Covington and Miczek, 2003 ), marble burying ( Basso et al, 1999 ), intracranial self-stimulation ( Stoker and Markou, 2011 ), and glucose/sucrose intake ( Carroll and Lac, 1987 ). While withdrawal from cocaine is often considered milder than withdrawal from other drugs of abuse due to the general lack of physical symptoms, negative physiological states such as anxiety or anhedonia could influence sleep ( Horvath et al, 2016 ; Barthel et al, 2020 ) or the response to SD ( Minkel et al, 2012 ; Goldstein et al, 2013 ) and the presence of withdrawal symptoms have been noted in a subset of human cocaine users ( Brower et al, 1988 ; Sofuoglu et al, 2003 ). Withdrawal was not assessed as part of the current experiments, but would be a useful feature for future studies, particularly as it may describe an additional source of individual variability.…”

Section: Discussionmentioning

confidence: 99%

Arousal-Mediated Sleep Disturbance Persists During Cocaine Abstinence in Male Mice

Bjorness

Greene

2022

Front. Neurosci.

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Acute cocaine disturbs sleep on a dose-dependent basis; however, the consequences of chronic cocaine remain unclear. While the arousal promotion following cocaine has been well-established, effects of cocaine on sleep after termination of chronic cocaine exposure appear variable in human subjects with few studies in non-human subjects. Here, a within-subjects design (outcomes normalized to baseline, undisturbed behavior) and between-subjects design (repeated experimenter-administered cocaine vs. experimenter-administered saline) was used to investigate sleep homeostasis and sleep/waking under repeated cocaine/saline exposure and prolonged forced abstinence conditions in mice. Overall, during the forced abstinence period increases in arousal, as determined by sleep latency and gamma energy, persisted for 2 weeks. However, the sleep response to externally enforced sleep deprivation was unchanged suggesting that sleep disruptions during the forced abstinence period were driven by enhancement of arousal in the absence of changes in sleep homeostatic responses.

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Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: A complex network analysis

Cited by 22 publications

References 47 publications

Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

Network Analysis of Comorbid Anxiety and Insomnia Among Clinicians with Depressive Symptoms During the Late Stage of the COVID-19 Pandemic: A Cross-Sectional Study

Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research

Arousal-Mediated Sleep Disturbance Persists During Cocaine Abstinence in Male Mice

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