Anxiety Issues & How to Make Your Anxiety Work for You Instead of Against You

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People with chronic pain may find it harder to regulate emotions

7/29/21

https://www.news-medical.net/news/20210 ... tions.aspx


More than three million Australians experience chronic pain: an ongoing and often debilitating condition that can last from months to years. This persistent pain can impact many parts of a person’s life, with almost half of people with chronic pain also experiencing major anxiety and depression disorders.

Now, a new study led by UNSW Sydney and NeuRA shows that people with chronic pain have an imbalance of neurotransmitters in the part of the brain responsible for regulating emotions.

This imbalance could be making it harder for them to keep negative emotions in check – and the researchers think persistent pain might be triggering the chemical disruption.

The findings are published today in the European Journal of Pain.

“Chronic pain is more than an awful sensation,” says senior author of the study Associate Professor Sylvia Gustin, a neuroscientist and psychologist at UNSW and NeuRA. “It can affect our feelings, beliefs and the way we are.

“We have discovered, for the first time, that ongoing pain is associated with a decrease in GABA, an inhibitive neurotransmitter in the medial prefrontal cortex. In other words, there's an actual pathological change going on.”

Neurotransmitters help communicate and balance messages between cells. While some amplify signals (called excitatory neurotransmitters), others weaken them (inhibitive neurotransmitters).

GABA, or γ-aminobutyric acid, is the main inhibitory neurotransmitter in the central nervous system. Its role in the medial prefrontal cortex – the part of the brain where emotional regulation happens – is to help dial down our emotions.

The research team used advanced neurological imaging to scan GABA content in the medial prefrontal cortex of 48 study participants, half of which experienced some form of chronic pain. A/Prof. Gustin says this relatively small sample size is typical for neurological imaging studies, which are costly to run.

The results show that participants with chronic pain had significantly lower levels of GABA than the control group – a pattern that was consistent regardless of their type of chronic pain.

" A decrease in GABA means that the brain cells can no longer communicate to each other properly. When there’s a decrease in this neurotransmitter, our actions, emotions and thoughts get amplified.”

- Sylvia Gustin, Associate Professor, UNSW

While the link between chronic pain and decreased levels of GABA has previously been found in animal studies, this is the first time it’s been translated to human studies.

A/Prof. Gustin says she hopes the findings are encouraging for people with chronic pain who may be experiencing mental health issues.

“It's important to remember it’s not you – there’s actually something physically happening to your brain,” she says.

“We don't know why it happens yet, but we are working on finding solutions on how to change it.”

Source:


University of New South Wales

Journal reference:

Kang, D., et al. (2021) Disruption to normal excitatory and inhibitory function within the medial prefrontal cortex in people with chronic pain. European Journal of Pain. doi.org/10.1002/ejp.1838.
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Study: 7 in 10 chronic pain sufferers delayed seeking medical advice during the pandemic

7/31/21


https://www.news-medical.net/news/20210 ... demic.aspx


7 in 10 UK chronic pain sufferers delayed seeking medical advice during the COVID-19 pandemic, leaving them feeling increased levels of stress, anxiety and worry, new research from Boston Scientific has revealed.

The research, which surveyed 502 UK chronic pain sufferers (those who suffer from continuous and long-term pain lasting more than 12 weeks), as well as 1,500 further respondents from across Italy, Germany and Spain, found that half (50%) of UK respondents had felt uncomfortable at the thought of a face-to-face appointment during the pandemic. While 35 per cent of those surveyed were open to having one in the near future, 15 per cent were unsure when they would feel comfortable again.

The delay in getting advice, guidance and treatment has negatively impacted those with chronic pain, with three in 10 (30%) UK respondents saying it has increased their level of stress and anxiety. Over a quarter (26%) have been left feeling worried about the future because of the current pain they are experiencing, and 25 per cent have not been able to go about their usual lives because of their pain.

When it comes to healthcare appointment formats, almost 7 in 10 (68%) respondents in the UK agreed face-to-face appointments are essential for the treatment of chronic pain, with 74 per cent disagreeing (27% somewhat, 47% strongly) when asked if video appointments were as effective as those in-person.

Chronic pain impacts approximately 100 million people across Europe. The reasons for long term pain might not be apparent and can vary greatly but can have serious negative effects on the quality of life of patients.

The research forms part of Boston Scientific’s Now You Hear Me campaign – which aims to raise awareness of chronic pain and its impact on patients’ lives, and to encourage patients to seek information on treatment options. The Now You Hear Me website aims to give these pain sufferers a face by showing the story of five pain patients in the UK, Germany, Italy and Spain in three videos.

Putting chronic pain in the spotlight

" Chronic pain can massively impact even simple everyday activities. The study results show that it is important to shine a light on patient groups who are struggling even more amidst the current situation. Pain is not necessarily visible from the outside, which is why it is so important to us to give a voice to those affected, and we hope to encourage those suffering from it to talk to their physician and discuss therapy options.”

- Vincent Sourdaine, Vice President Neuromodulation EMEA, Boston Scientific

Positively, in the UK, more than 1 in 5 (23%) survey respondents agreed the media had increased coverage of chronic pain during the pandemic, however 63 per cent agreed that compared to before the pandemic, there was more confusion around the difference between chronic pain and standard pain.

UK survey results compared to the rest of Europe


Across all markets, female respondents in the UK were the most likely to delay or avoid seeking medical advice for the treatment of new pain (34%). Women in Italy (19%), Germany (27%), and Spain (28%) were all less likely to do so.

Women in the UK were also the most likely to feel an increased level of stress and anxiety due to delaying visiting a health care practitioner, with 35 per cent agreeing with the statement. Unsurprisingly, 22 per cent of women in the UK admitted to feeling scared about the pain they were experiencing when delaying appointments – more than twice as many as among women in Germany (11%) and Italy (9%).

Alarmingly, about every sixth woman and every seventh man in the UK stated they were unable to do daily tasks they did before the pandemic as a result of delaying visiting a health care practitioner – with women in the UK the most affected of all four markets surveyed. The social factor added another dimension to the many challenges faced by pain patients: a fifth of men (20%) and women (21%) in the UK stated they were feeling more lonely or isolated – once again the highest share in the survey.

Source:

Boston Scientific
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Psychological distress continued to increase among U.S. men and women during the pandemic

9/9/21


https://www.news-medical.net/news/20210 ... demic.aspx


A new report finds that many men and women in the United States continued to experience psychological distress, depression, and anxiety half a year into the COVID-19 pandemic. Data show that during the pandemic, almost half (42%) of participants in the study reported at least mild psychological distress and 10% of participants reported moderate-to-severe psychological distress. Individuals with pre-existing health conditions, such as cancer, were more likely to report depressive symptoms during the pandemic.

The article appearing in the journal, Lancet Regional Health-Americas, took a unique look at changes in psychological distress. The report, led by Corinne Leach, senior principal scientist, American Cancer Society, used data from the American Cancer Study's Cancer Prevention Study-3 (CPS-3) cohort from two waves, 2018 and July- September 2020, to characterize levels of psychological distress among U.S. men and women during the COVID-19 pandemic.

The study also identified factors associated with increased depression and anxiety during the pandemic, including sociodemographic characteristics, stressors, and comorbid conditions associated with increased risk for poor COVID-19 outcomes. A secondary focus examined the association of these factors with longitudinal change in psychological distress. Financial stressors, such as loss of employment and reduced compensation, or work/life balance stressors, such as caregiving responsibilities, were also examined. According to the data, individuals with these types of life stressors more likely had an escalation of psychological distress during the pandemic.

The report suggests that adults are continuing to experience psychological distress beyond the initial lockdown period. The results of this and prior studies support the importance of regular mental health assessment and subsequent mental health support among those with a history of mental health issues and those who may be isolating to keep themselves safe from COVID-19 or other infections.

Results also highlight the importance of investigating the continued and long-term impact of the COVID-19 pandemic on mental health as social distancing, a factor previously associated with depression and anxiety, continues to be promoted over a year into the pandemic and as the world slowly opens again, potentially triggering different types of anxiety as people adjust to a new normal.

"Several learning opportunities for how to improve population mental health during and after pandemics, natural disasters, or other life-altering events have been created by the COVID-19 pandemic and regular mental health assessment by healthcare professionals is needed to better provide support for those at risk of developing, or those already experiencing, anxiety and depression," said the authors. "These data from the American Cancer Study's Cancer Prevention Study-3 (CPS-3) cohort in particular will help clinicians identify populations vulnerable to persistent mental health and other long-term issues to provide earlier clinical support."

Source:


American Cancer Society

Journal reference:

Leach, C.R., et al. (2021) Stressors and Other Pandemic-related Predictors of Prospective Changes in Psychological Distress. The Lancet Regional Health - Americas. doi.org/10.1016/j.lana.2021.100069.
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People with prior mental ill health hit harder by pandemic disruption

People who had higher pre-pandemic levels of depression or anxiety have been more severely affected by disruption to jobs and healthcare during the pandemic, according to a new study co-led by UCL researchers.

9/30/21


https://www.eurekalert.org/news-releases/929839


People who had higher pre-pandemic levels of depression or anxiety have been more severely affected by disruption to jobs and healthcare during the pandemic, according to a new study co-led by UCL researchers.

The study, published in The British Journal of Psychiatry and funded by UKRI, looked at data from 59,482 people who are surveyed regularly as part of 12 ongoing longitudinal studies in England. It found that people whose survey responses before the pandemic suggested higher levels of anxiety and depression symptoms were 24% more likely to have had delays to medical procedures, 12% more likely to lose their job, and 33% more likely to have had disruption to prescriptions or medication during the first eight to 10 months of the pandemic than those with average levels of anxiety and depression symptoms.

Those with more severe symptoms of depression or anxiety experienced a much greater likelihood of disruptions to jobs, income and healthcare, the study found.

Dr Praveetha Patalay (UCL), senior author of the paper, said: “Our findings highlight that the wider health and economic impacts of the pandemic have been disproportionately experienced by those with mental health difficulties, potentially leading to worsening longer term outcomes, even post-pandemic, for those already experiencing poor mental health.”

Professor Nishi Chaturvedi (MRC Unit for Lifelong Health and Ageing at UCL), who co-leads the Covid-19 Longitudinal Health and Wellbeing National Core study, said: “The anxiety and depression experienced by the participants of the study go beyond the mental ill health reported to GPs and healthcare services. This is a largely hidden group of people vulnerable to potentially long-lasting health and socioeconomic consequences of the pandemic.”

Lead author Dr Giorgio Di Gessa (UCL Institute of Epidemiology & Healthcare) said: “Policymakers should take these findings into account in the provision of future health care and economic support, as failing to address these disruptions risks widening health inequalities further. Special care should be taken by pharmacists and primary care staff to ensure people with mental health difficulties do not miss appointments, procedures and prescriptions.

“It is also important to note that pre-pandemic psychological distress was generally more common among women, younger generations, ethnic minorities, and those with fewer qualifications, meaning the overall impact of disruption on these groups is larger.”

Lead author Dr Michael Green (University of Glasgow) said: “During the pandemic, many people lost their jobs or lost their income and faced disruptions to healthcare*. Our study shows that this disruption was particularly likely to affect people with prior mental ill health.

“We need to ensure that healthcare and support for economic hardship are not overly difficult to access for these vulnerable people, especially as existing pandemic economic supports like furlough are removed.”

The work was conducted as part of the COVID-19 Longitudinal Health and Wellbeing National Core study, led by UCL researchers and funded by UKRI. The study involved researchers at UCL, King’s College London, the University of Glasgow, the University of Leicester, the University of Edinburgh, and the University of Bristol.

In each of the longitudinal studies, respondents answered questionnaires designed to assess mental health about three years before the pandemic on average. They later reported the disruptions they experienced between March and December last year.

The researchers compared disruptions faced by people whose responses showed “average” levels of anxiety and depression to disruptions affecting people with more anxiety and depression than average, regardless of whether they had a clinical diagnosis or were seeking treatment for a mental illness.

The research team looked at the disruptions of the pandemic in three areas: healthcare (medication access, procedures or surgeries, and appointments); economic activity (employment, income, or working hours); and housing (change of address or household composition). They found that people with prior mental ill health were more likely to face economic and healthcare disruption, but had no greater likelihood of housing disruption.

Professor Chaturvedi added: “UKRI support has enabled collaboration across 12 longitudinal cohort studies, allowing us to address critical pandemic-related questions that could not be answered any other way.”

* According to an Institute of Fiscal Studies (IFS) briefing note, during the early stage of the pandemic one in six people over the age of 50 reported having hospital treatment cancelled, with an additional one in 10 unable to visit or speak to their GP: https://ifs.org.uk/publications/15160

Journal


The British Journal of Psychiatry

DOI


10.1192/bjp.2021.132

Method of Research


Observational study

Article Title

Pre-pandemic mental health and disruptions to healthcare, economic, and housing outcomes during COVID –19: evidence from 12 UK longitudinal studies

Article Publication Date

30-Sep-2021
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Study reveals the global impacts of the pandemic on major depressive and anxiety disorders

10/11/21


https://www.news-medical.net/news/20211 ... rders.aspx


Cases of major depressive disorder and anxiety disorders increased by more than a quarter worldwide in 2020 due to the COVID-19 pandemic, according to the first global estimates of impacts of the pandemic on mental health, published in The Lancet.

In 2020, cases of major depressive disorder and anxiety disorders increased by 28% and 26%, respectively. Women were affected more than men, and younger people were more affected than older age groups. Countries with high COVID-19 infection rates and major reductions in the movement of people – a consequence of measures such as lockdowns and school closures – had the greatest increases in prevalence of major depressive disorder and anxiety disorders.

Even before the COVID-19 pandemic, major depressive disorder and anxiety disorders – which can increase the risk of other health outcomes such as suicide – were major contributors to the global burden of disease, affecting millions of men and women of all ages around the world.

" Our findings highlight an urgent need to strengthen mental health systems in order to address the growing burden of major depressive disorder and anxiety disorders worldwide. Promoting mental wellbeing, targeting factors contributing to poor mental health that have been made worse by the pandemic, and improving treatment for those who develop a mental disorder should be central to efforts to improve support services. Even before the pandemic, mental health-care systems in most countries have historically been under-resourced and disorganised in their service delivery. Meeting the added demand for mental health services due to COVID-19 will be challenging, but taking no action should not be an option."

- Dr Damian Santomauro, Lead Author, Queensland Centre for Mental Health Research, School of Public Health, University of Queensland, Australia

Until now, no studies had analysed the global impact of the COVID-19 pandemic on prevalence of major depressive disorder and anxiety disorders in 2020. Most previous work consisted of surveys in specific locations over a short time period.

The new study is the first to assess global impacts of the pandemic on major depressive disorder and anxiety disorders, quantifying the prevalence and burden of the disorders by age, sex, and location in 204 countries and territories in 2020.

A systematic literature review was performed to identify population survey data published between January 1, 2020, and January 29, 2021. Eligible studies reported prevalence of depressive or anxiety disorders that were representative of the general population and had a pre-pandemic baseline. Using a disease modelling meta-analysis tool, data from eligible studies was used to estimate changes in prevalence of major depressive disorder and anxiety disorders due to COVID-19 based on age, sex, and location, including in locations for which no eligible studies were available. Estimates of daily COVID-19 infection rate and movement of people were used as indicators of the impact of the pandemic on populations.

The systematic review identified 5,683 unique data sources, of which 48 (one of which reported across two regions) met inclusion criteria. Most studies were from Western Europe (22) and high-income North America (14), with others from Australasia (5), high-income Asia Pacific (5), East Asia (2), and central Europe (1).

The meta-analysis indicates that increased COVID-19 infection rate and reduced movement of people were associated with increased prevalence of major depressive disorder and anxiety disorders, suggesting that countries hit hardest by the pandemic in 2020 had the greatest increases in prevalence of the disorders.

In the absence of the pandemic, model estimates suggest there would have been 193 million cases of major depressive disorder (2,471 cases per 100,000 population) globally in 2020. However, the analysis shows there were 246 million cases (3,153 per 100,000), an increase of 28% (an additional 53 million cases). More than 35 million of the additional cases were in women, compared with close to 18 million in men.

Model estimates suggest there would have been 298 million cases of anxiety disorders (3,825 per 100,000 population) globally in 2020 had the pandemic not happened. The analysis indicates there were in fact an estimated 374 million cases (4,802 per 100,000) during 2020, an increase of 26% (an additional 76 million cases). Almost 52 million of the additional cases were in women, compared with around 24 million in men.

Younger people were more affected by major depressive disorder and anxiety disorders in 2020 than older age groups. The additional prevalence of these disorders peaked among those aged 20-24 years (1,118 additional cases of major depressive disorder per 100,000 and 1,331 additional cases of anxiety disorders per 100,000) and declined with increasing age.

Co-author Alize Ferrari, GBD mental disorders team lead at the Queensland Centre for Mental Health Research, School of Public Health, University of Queensland, Australia, said: "The COVID-19 pandemic has exacerbated many existing inequalities, and social determinants of mental health. Sadly, for numerous reasons, women were always more likely to be worse affected by the social and economic consequences of the pandemic. Additional caring and household responsibilities tend to fall on women, and because women are more likely to be victims of domestic violence, which increased at various stages of the pandemic.

"School closures and wider restrictions limiting young people's ability to learn and interact with their peers, combined with the increased risk of unemployment, also meant that young people were also more heavily impacted by major depressive disorder and anxiety disorders during the pandemic. It is crucial that policymakers take underlying factors such as these into account as part of measures to strengthen mental health services."

The authors acknowledge that their study was limited by a lack of high quality data on the effects of COVID-19 pandemic on mental health in many parts of the world, particularly low- and middle-income countries. As a result, they say extrapolated estimates generated for countries where data was lacking should be interpreted with caution, and call for improved data coverage and quality globally. Most available data was based on self-reported symptom scales that only estimate probable cases of major depressive disorder and anxiety disorders. More data from diagnostic mental health surveys representative of the general population – of which only three covered the study period – will improve understanding of the pandemic's effects on mental health. The prevalence of other mental disorders – such as eating disorders – might also have been affected by the COVID-19 pandemic, and the authors say these should be assessed as new mental health surveys are undertaken.

Writing in a linked Comment, Dr Maxime Taquet and Professor Paul Harrison, from the University of Oxford, and Professor Emily Holmes, from Uppsala University and the Karolinska Institute, who were not involved in the study, said: "The first global insight into the burden of depressive and anxiety disorders during the pandemic by Santomauro and colleagues starkly highlights the impact of the pandemic on mental health globally." They echo the study authors' calls for action to strengthen mental health systems, saying: "The study should therefore urgently incentivise more research to determine the fuller geographic distribution of depression and anxiety, the prevalence of depressive and anxiety disorders, and the underpinning mechanisms to improve mental health in the context of the COVID-19 pandemic globally."

Source:

The Lancet

Journal reference:

COVID-19 Mental Disorders Collaborators (2021) Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet. doi.org/10.1016/S0140-6736(21)02143-7.
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