Anxiety Disorders: Bjelland I

Shear MK, Bjelland I, Beesdo K, Gloster AT, Wittchen HU. · School of Social Work, Columbia University, New York, USA. · Int J Methods Psychiatr Res. · Pubmed #17623395 No free full text.

Abstract: Anxiety disorders, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), comprise a relatively heterogeneous group of clinical conditions that range from specific phobias to obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). The grouping under one heading refers to the fact that these seemingly heterogeneous disorders share a number of common psychopathological features and also share at least some common principles in treatment. Among the shared elements are broadly defined prototypical anxiety reactions, panic attacks, anticipatory anxiety, avoidance behaviour, a predominantly early onset, and relatively high persistence rates over time. Many of the shared diagnostic features of anxiety disorders are by their nature dimensional, and hundreds of psychometric scales have been developed to measure these diagnostic constructs across anxiety disorder and for specific diagnostic classes. This paper explores different types of dimensional approaches used in the literature and discusses how an integrated categorical/dimensional strategy might enhance the usefulness of the DSM-V. We suggest the use of cross-cutting dimensional ratings that might ultimately lead to an improved classification model. We also suggest that a staging approach to illness, based upon supplementary dimensional rating could provide useful information for clinical and research purposes.

Bjelland I, Dahl AA, Haug TT, Neckelmann D. · Department of Public Health and Primary Health Care, Section for Preventive Medicine, Haukeland Hospital, Armauer Hansen Building, University of Bergen, N-5021, Bergen, Norway. · J Psychosom Res. · Pubmed #11832252 No free full text.

Abstract: OBJECTIVE: To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS). METHOD: A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression? RESULTS: Most factor analyses demonstrated a two-factor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from.40 to.74 (mean.56). Cronbach's alpha for HADS-A varied from.68 to.93 (mean.83) and for HADS-D from.67 to.90 (mean.82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range.49 to.83. CONCLUSIONS: HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.

Bjelland I, Dahl AA. · Seksjon for forebyggende medisin, Universitetet i Bergen, Armauer Hansens hus Haukeland Sykehus. · Tidsskr Nor Laegeforen. · Pubmed #10533410 No free full text.

Abstract: Mixed symptoms of anxiety and depression are highly prevalent among patients with psychic complaints. The number and duration of symptoms and the degree of impairment determines whether the condition fulfils the criteria for an anxiety and depressive disorder. Increasing attention is now being given to the clinical significance of subsyndromal anxiety and depression because of the functional impairment inflicted. Epidemiological studies and clinical experience show that comorbidity of anxiety and depressive disorders is highly prevalent. This may partly be attributed to common genetic causes; partly to environmental causes. Concurrent anxiety and depression pose a challenge in term of differential diagnoses. The treatment of such co-morbid disorders also calls for some special precautions.

Jacka FN, Overland S, Stewart R, Tell GS, Bjelland I, Mykletun A. · University of Melbourne, Department of Clinical and Biomedical Sciences: Barwon Health, Vic., Australia. · Aust N Z J Psychiatry. · Pubmed #19085527 No free full text.

Abstract: OBJECTIVE: Systemic inflammation is associated with both the dietary intake of magnesium, and depression. Limited experimental and clinical data suggest an association between magnesium and depression. Thus, there are reasons to consider dietary magnesium as a variable of interest in depressive disorders. The aim of the present study was to examine the association between magnesium intake and depression and anxiety in a large sample of community-dwelling men and women. This sample consisted of 5708 individuals aged 46-49 or 70-74 years who participated in the Hordaland Health Study in Western Norway. METHODS: Symptoms of depression and anxiety were self-reported using the Hospital Anxiety and Depression Scale, and magnesium intake was assessed using a comprehensive food frequency questionnaire. RESULTS: There was an inverse association between standardized energy-adjusted magnesium intake and standardized depression scores that was not confounded by age, gender, body habitus or blood pressure (beta=-0.16, 95% confidence interval (CI)=-0.22 to -0.11). The association was attenuated after adjustment for socioeconomic and lifestyle variables, but remained statistically significant (beta=-0.11, 95%CI=-0.16 to -0.05). Standardized magnesium intake was also related to case-level depression (odds ratio (OR)=0.70, 95%CI=0.56-0.88), although the association was attenuated when adjusted for socioeconomic and lifestyle factors (OR=0.86, 95%CI=0.69-1.08). The inverse relationship between magnesium intake and score and case-level anxiety was weaker and not statistically significant in the fully adjusted models. CONCLUSION: The hypothesis that magnesium intake is related to depression in the community is supported by the present findings. These findings may have public health and treatment implications.

Oyane NM, Bjelland I, Pallesen S, Holsten F, Bjorvatn B. · Department of Public Health and Primary Health Care, University of Bergen, Norway. · J Affect Disord. · Pubmed #17573120 No free full text.

Abstract: BACKGROUND: The purpose of this study was to assess how seasonal changes in mood and behaviour were associated with depression and anxiety symptoms in a sample from a general population, and to investigate how prevalence figures were affected by month of questionnaire completion. METHODS: The target population included all individuals in the Hordaland county (Norway) born 1953-57 (N=29,400). In total, 8598 men (57% response rate) and 9983 women (70% response rate) attended the screening station. Half of the men (randomly chosen) and all of the women were offered a questionnaire to fill in with items on seasonality. This was measured using the Global Seasonality Score (GSS), a central component of the Seasonal Pattern Assessment Questionnaire (SPAQ). The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression. Both questionnaires were completed by 2980 men (68.9%) and 8074 women (80.9%). RESULTS: Seasonality was positively associated with levels of both anxiety and depression regardless of the season the interview took place. In subjects with a low/moderate degree of seasonality there were modestly higher levels of depressive symptoms during November through March than the other months. LIMITATIONS: We had a substantial number of non-responders. CONCLUSIONS: Our results raise the possibility of seasonality being a separate dimensional trait associated with both anxiety and depression.

Raeder MB, Steen VM, Vollset SE, Bjelland I. · Dr. Einar Martens' Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Helse Bergen HF, N-5021 Bergen, Norway. · J Affect Disord. · Pubmed #17184843 No free full text.

Abstract: BACKGROUND: Clinical trials suggest that omega-3 fatty acids improve the outcome of depression. This study aimed to evaluate the association between intake of cod liver oil, rich in omega-3 fatty acids, and high levels of symptoms of depression and anxiety in the general population. METHODS: We used data from the "The Hordaland Health Study '97-'99" (HUSK), a population based cross-sectional health survey from Norway including 21,835 subjects aged 40-49 and 70-74 years. Symptoms of depression and anxiety were measured by The Hospital Anxiety and Depression Scale (HADS). We used logistic regression to study associations. RESULTS: Among the participants, 8.9% used cod liver oil daily. A total of 3.6% had high levels of depressive symptoms. The prevalence of such depressive symptoms among the subjects who used cod liver oil daily was 2.5%, as compared to 3.8% in the rest of the population. The users of cod liver oil were significantly less likely to have depressive symptoms than non-users after adjusting for multiple possible confounding factors (odds ratio=0.71, 95% confidence interval 0.52 to 0.97). These factors included age, gender, smoking habits, coffee consumption, alcohol consumption, physical activity, and education. In addition, we found that the prevalence of high levels of depressive symptoms decreased with increasing duration (0-12 months) of cod liver oil use (multivariate adjusted test for trend, P=0.04). We were only able to study this latter association in a subset of the population aged 40-46 years. LIMITATIONS: Data are cross sectional. CONCLUSIONS: The findings indicate that regular use of cod liver oil is negatively associated with high levels of depressive symptoms in the general population.

Hildrum B, Mykletun A, Stordal E, Bjelland I, Dahl AA, Holmen J. · Department of Psychiatry, Hospital Namsos, Norwegian University of Science and Technology, N-7800 Namsos, Norway. · J Epidemiol Community Health. · Pubmed #17183016 No free full text.

Abstract: BACKGROUND: Low blood pressure has mainly been regarded as ideal, but recent studies have indicated an association with depression in elderly people. OBJECTIVE: To investigate whether low blood pressure is associated with anxiety and depression in the general population. DESIGN: Cross-sectional study. SETTING: Participants in the population-based Nord-Trøndelag Health Study (HUNT-2, 1995-7), Norway. PARTICIPANTS: 60,799 men and women aged 20-89 years filled in the Hospital Anxiety and Depression Scale as part of a general health study. Systolic and diastolic blood pressure was classified in age-stratified and sex-stratified centile groups. MAIN RESULTS: Compared with participants with systolic blood pressure within the 41-60 centile (reference) group, the odds ratio for anxiety was 1.31 (95% confidence intervals (CI) 1.16 to 1.49), for depression 1.22 (95% CI 1.03 to 1.46), and for comorbid anxiety and depression 1.44 (95% CI 1.24 to 1.68) in the group with < or =5 centile systolic blood pressure. Slightly weaker associations were found of low diastolic blood pressure with anxiety and depression. These associations were similar across sex and age groups. Physical impairment, smoking and angina pectoris influenced the associations only marginally, whereas stroke, myocardial infarction, use of drugs for hypertension, body mass index and several other covariates had no influence. CONCLUSIONS: This study represents epidemiological evidence for an association of low blood pressure with anxiety and depression, which is not caused by cardiovascular disease.

Skarstein J, Bjelland I, Dahl AA, Laading J, Fosså SD. · Department of Psychosocial Oncology, Norwegian Radium Hospital, University of Oslo, Oslo, Norway. · J Psychosom Res. · Pubmed #16125514 No free full text.

Abstract: OBJECTIVE: The aim of this study was to examine the association between haemoglobin levels, anxiety disorder, and depression in cancer patients. METHODS: Cancer patients attending The Norwegian Radium Hospital (NRH) rated themselves on the Hospital Anxiety and Depression Scale (HADS). Five hundred thirty-two patients also had valid measurements of haemoglobin at the same time. The associations between tertile haemoglobin levels (7.0-12.3 g/dl, 12.4-13.8 g/dl, 13.9-17.1 g/dl) and HADS-defined anxiety disorder and depression were analysed by logistic regression. RESULTS: HADS-defined depression was identified in 116 cases (22%) and anxiety disorder in 149 (28%). The haemoglobin levels of the lower and middle tertiles were associated with depression (OR=3.85, 95% CI: 2.06-7.21, and OR=2.45, 95% CI: 1.25-4.81, respectively). Adjustment for covariates did not change the association significantly. No association between haemoglobin and anxiety disorder was found. CONCLUSION: In cancer patients, the risk of depression increases with decreasing haemoglobin levels. This should be taken into account when treatment of anaemic or depressed cancer patients is decided upon.

Stordal E, Bjelland I, Dahl AA, Mykletun A. · Department of Psychiatry, Hospital Namsos, Namsos, Norway. · Scand J Prim Health Care. · Pubmed #14531503 No free full text.

Abstract: OBJECTIVE: To examine the relationship between anxiety disorders and depression and various somatic health problems in the general population. DESIGN: Cross-sectional study with survey methods and clinical examinations. SETTING: The Health Study of Nord-Trøndelag, Norway (the HUNT study). PARTICIPANTS: 60869 individuals aged 20-89 years. MAIN OUTCOME MEASURES: Anxiety disorder, depression and their comorbidity are categorized based on scores on the Hospital Anxiety and Depression Scale. All somatic health variables are self-reported, while blood pressure, height and weight are measured. Multivariate nominal logistic regression analyses are used to investigate the relationship between somatic variables and the anxiety/depression categories. RESULTS: Most somatic health variables show a stronger association with comorbid anxiety disorder/depression than with anxiety disorder or depression alone. About one-third of individuals reporting somatic health problems also have anxiety disorder and/or depression. CONCLUSION: Somatic health problems carry a high risk of both anxiety disorder and depression. Active identification and treatment of these co-occurring mental disorders are of practical importance.

Bjelland I, Tell GS, Vollset SE, Refsum H, Ueland PM. · Department of Public Health and Primary Health Care, Locus for Homocysteine and Related Vitamins, University of Bergen, Norway. · Arch Gen Psychiatry. · Pubmed #12796225 links to  free full text

Abstract: BACKGROUND: An association between depression and folate status has been demonstrated in clinical studies, whereas data are sparse on the relationship between depression and other components of 1-carbon metabolism such as vitamin B12, homocysteine, and the methylenetetrahydrofolate reductase 677C-->T polymorphism. The relationship between anxiety and these components is less well known. This study examined the associations between folate, total homocysteine, vitamin B12, and the methylenetetrahydrofolate reductase 677C-->T polymorphism, and anxiety and depression in a large population-based study. METHODS: Anxiety and depression, measured by the Hospital Anxiety and Depression Scale, were assessed in 5948 subjects aged 46 to 49 years (mean, 47.4 years) and 70 to 74 years (mean, 71.9 years) from the Hordaland Homocysteine Study cohort. By means of logistic regression models, anxiety and depression scores were examined in relation to the factors listed above. RESULTS: Overall, hyperhomocysteinemia (plasma total homocysteine level > or =15.0 micro mol/L [> or =2.02 mg/dL]) (odds ratio, 1.90; 95% confidence interval, 1.11-3.25) and T/T methylenetetrahydrofolate reductase genotype (odds ratio, 1.69; 95% confidence interval, 1.09-2.62), but not low plasma folate or vitamin B12 levels, were significantly related to depression without comorbid anxiety disorder. Plasma folate level was inversely associated with depression only in the subgroup of middle-aged women. None of the investigated parameters showed a significant relationship to anxiety. CONCLUSION: Our results provide further evidence of a role of impaired 1-carbon metabolism in depression.