Disability and Poor Quality of Life Associated With Comorbid Anxiety Disorders and Physical Conditions

Sareen, Jitender; Jacobi, Frank; Cox, Brian J.; Belik, Shay-Lee; Clara, Ian; Stein, Murray B.

doi:10.1001/archinte.166.19.2109

Cited by 312 publications

(267 citation statements)

References 82 publications

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“…The large body of clinical literature suggesting a causal relationship between psychosocial distress and physical illness (Levine, Covino et al 1996;Katon 2003;Tarrier, Gregg et al 2005;Flaherty, Thompson et al 2006;Heim, Wagner et al 2006;Sareen, Jacobi et al 2006) supports the view that the isolation rearing impairment of wound healing resulted from the associated brain and behavior changes we found. Nonetheless, to firmly establish whether these changes are cause or consequence of this relationship, further investigation is needed.…”

Section: Relation Between Isolation Rearing and Impaired Wound Healingsupporting

confidence: 79%

“…In addition to its detrimental impact on mental health (Kaufman, Plotsky et al 2000;Heim and Nemeroff 2001;Rutter 2002;Schilling, Aseltine et al 2007), psychosocial adversity also detrimentally impacts physical health (Flaherty, Thompson et al 2006;Heim, Wagner et al 2006;Sareen, Jacobi et al 2006). In addition, we and others have shown that patients with psychiatric difficulties have worse medical outcomes (Levine, Covino et al 1996;Katon 2003;Tarrier, Gregg et al 2005) and are at heightened risk for sustaining subsequent physical injuries (Rockwell, Dimsdale et al 1988;Swenson, Dimsdale et al 1991).…”

Section: Introductionmentioning

confidence: 99%

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Isolation rearing impairs wound healing and is associated with increased locomotion and decreased immediate early gene expression in the medial prefrontal cortex of juvenile rats

Levine¹,

Leeder²,

Parekkadan³

et al. 2008

Neuroscience

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In addition to its maladaptive effects on psychiatric function, psychosocial deprivation impairs recovery from physical illness. Previously, we found that psychosocial deprivation, modeled by isolation rearing, depressed immediate early gene (IEG) expression in the medial prefrontal cortex (mPFC) and increased locomotion in the open field test (Levine, Youngs et al. 2007). In the present study, we examined whether similar changes in behavior and gene expression are associated with the maladaptive effects of psychosocial deprivation on physical injury healing. After weaning, anesthetized rats were subjected to a 20% total body surface area third degree burn injury and were subsequently either group or isolation reared. After four weeks of either isolation or group rearing (a period that encompasses rodent childhood and early adolescence), rats were sacrificed, and their healing and gene expression in the mPFC were assessed. Locomotion in the open field test was examined at 3 weeks post burn injury. We found that: 1) gross wound healing was significantly impaired in isolation reared rats compared to group reared rats, 2) locomotion was increased and IEG expression was suppressed for isolation reared rats during burn injury healing, 3) the decreased activity in the open field and increased IEG expression was greater for burn injury healing group reared rats than for uninjured group reared rats, 4) the degree of hyperactivity and IEG suppression was relatively similar between isolation reared rats during burn injury compared to uninjured isolation reared rats, 5) behavioral hyperactivity to novelty (the open

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Section: Relation Between Isolation Rearing and Impaired Wound Healingsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Isolation rearing impairs wound healing and is associated with increased locomotion and decreased immediate early gene expression in the medial prefrontal cortex of juvenile rats

Levine¹,

Leeder²,

Parekkadan³

et al. 2008

Neuroscience

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“…[52][53][54] The adverse symptoms and functional impairments associated with obesity 55,56 and obesity-related chronic conditions could increase the risk of anxiety. 6,11,12,57 Obesogenic lifestyle factors such as caloric dense diets and lack of physical activity could contribute to the development or maintenance of anxiety disorders. 58 Conversely, it is possible for anxiety disorders to lead to weight gain.…”

Section: Anxiety Time Referencementioning

confidence: 99%

“…Further, they are known to increase the risk of a number of poor health outcomes such as chronic conditions, poor quality of life and mortality. [3][4][5][6] Obesity may be a risk factor for anxiety disorders. Obesity is an increasingly prevalent disease, 7 characterized by excess bodyweight, and estimated to be one of the most important contributors to the burden of disease worldwide.…”

Section: Introductionmentioning

confidence: 99%

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The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis

2009

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Anxiety disorders are the most prevalent mental disorders in developed countries. Obesity is hypothesized to be a risk factor for anxiety disorders but evidence supporting an association between these two conditions is not clear. The objectives of this paper were to systematically review the literature for a link between obesity and anxiety disorders in the general population, and to present a pooled estimate of association. We performed a systematic search for epidemiological articles reporting on obesity (explanatory variable) and anxiety disorders (outcome variable) in seven bibliographical databases. Two independent reviewers abstracted the data and assessed study quality. We found 16 studies (2 prospective and 14 cross-sectional) that met the selection criteria. Measures of effect from prospective data were mixed but cross-sectional evidence suggested a positive association between obesity and anxiety. The pooled odds ratio from cross-sectional studies was 1.4 (confidence interval: 1.2-1.6). Subgroup analyses revealed a positive association in men and women. Overall, a moderate level of evidence exists for a positive association between obesity and anxiety disorders. Questions remain regarding the role of obesity severity and subtypes of anxiety disorders. The causal relationship from obesity to anxiety disorders could not be inferred from current data; future etiologic studies are recommended.

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Disorder-Specific Impact of Coordinated Anxiety Learning and Management Treatment for Anxiety Disorders in Primary Care

Craske¹,

Stein²,

Sullivan³

et al. 2011

Arch Gen Psychiatry

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124

111

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Context Anxiety disorders commonly present in primary care where evidence-based mental health treatments often are unavailable or suboptimally delivered. Objective Compare evidence-based treatment for anxiety disorders to usual care in primary care, for principal and comorbid generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD) and posttraumatic stress disorder (PTSD). We hypothesized superiority of CALM for principal anxiety disorders and comorbid disorders. Design A randomized, controlled trial comparing CALM intervention with Usual Care, at baseline, 6-month, 12-month and 18-month follow-ups. Setting 17 primary care clinics in the United States. Patients Referred primary care sample, 1004 patients, with principal DSM-IV diagnoses of GAD (n=549), PD (n=262), SAD (n=132), or PTSD (n=61), mean 43.7 years (SD=13.7), 70.9% female,. 80% completed 18-month follow-up. Interventions CALM (computer-guided CBT and/or pharmacotherapy recommendations) and Usual Care. Main Outcome Measures Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity-Self Report scale, Social Phobia Inventory, and PTSD Checklist-Civilian Version. Results CALM was superior to Usual Care for principal GAD at 6-month (−1.61; 95% CI = −2.42 to −.79), 12-month (−2.34; 95% CI = −3.22 to −1.45) and 18-month (−2.37; 95% CI = −3.24 to −1.50), PD at 6-month (−2.00; 95% CI = −3.55 to −0.44) and 12-month (−2.71; 95% CI = −4.29 to −1.14), and SAD at 6-month (−7.05; 95% CI = −12.11 to −2.00) outcomes. CALM was superior to Usual Care for comorbid SAD at 6-month (−4.26; 95% CI = −7.96 to −0.56), 12-month (−8.12, 95% CI = −11.84 to −4.40) and 18- month (−6.23, 95% CI = −9.90 to −2.55) outcomes. Effect sizes favored CALM, but were not statistically significant for other comorbid disorders. Conclusions CALM (CBT and psychotropic recommendations) is more effective than Usual Care for principal anxiety disorders, and to a lesser extent, comorbid anxiety disorders that present in primary care.

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Disability and Poor Quality of Life Associated With Comorbid Anxiety Disorders and Physical Conditions

Abstract: Anxiety disorders are independently associated with several physical conditions in the community, and this comorbidity is significantly associated with poor quality of life and disability.

Cited by 312 publications

References 82 publications

Isolation rearing impairs wound healing and is associated with increased locomotion and decreased immediate early gene expression in the medial prefrontal cortex of juvenile rats

Isolation rearing impairs wound healing and is associated with increased locomotion and decreased immediate early gene expression in the medial prefrontal cortex of juvenile rats

The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis

Disorder-Specific Impact of Coordinated Anxiety Learning and Management Treatment for Anxiety Disorders in Primary Care

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