Scared to Death: Reflections on Panic and Anxiety in the Field

This paper examines reflections about researcher emotions and the experience of having panic attacks and panic disorder as a result of fieldwork. Anxiety and panic are sparsely discussed in methodological appendices and handbooks about qualitative research, and the embodiment of mental health in the field has received even less attention. I have two aims in the paper: to describe the experience of panic attacks and to open a discussion about panic and anxiety attacks in the field. The failure to address mental health problems as a result of fieldwork can negatively impact expert and fledgling ethnographers, and should be remedied.     

Suicidal Ideation and Comorbid Disorders in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Population at Risk

ABSTRACT

The purpose of this study was to examine the level of suicidal ideation and comorbid disorders (major depressive disorder, generalized anxiety disorder) among adolescents and young adults with diagnosed Asperger's syndrome (AS). A cross-sectional study using a self-administrated mail questionnaire and a Web-based questionnaire were used. Two samples were selected for this study. The first sample used snowball sampling, starting with parents of adolescents and young adults with diagnosed AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who visited Web sites for parents and individuals with diagnosed autism spectrum disorder. The sample included 10 adolescents and young adults with diagnosed AS. Fifty percent of the sample had a clinically significant level of suicidal ideation, 20% met criteria for a diagnosis of major depressive disorder, and 30% met criteria for generalized anxiety disorder.     

Obsessive-Compulsive Spectrum Disorder Symptoms in College Students

Abstract

Objective: This study investigated the occurrence of obsessive-compulsive spectrum disorders (OCSDs) and associated symptomology in college students. Participants: Participants included 358 undergraduate students. Results: Results suggest that clinically significant levels of OCSD symptoms are relatively common. Additionally, OCSD symptoms co-occurred with each other and anxiety symptoms in general, yet not significantly with impulsivity symptoms. Conclusions: Given their prevalence in college students and potentially debilitating nature, it is important to increase awareness of OCSDs so that health professionals can better identify and treat symptoms of these disorders.     

The College Student Psychiatric Emergency: II Diagnosis and Disposition

Abstract

Student psychiatric emergencies are a cause of great concern on college campuses, and they merit further study. The authors elucidate some of the characteristics of 1,156 visits to a hospital psychiatric emergency department made by 933 students over an eight-year period. The diagnoses given to students in emergencies were found to be equally divided among psychosis, neurosis, personality disorder, and “other.” Only about 30% of the students' visits to the psychiatric emergency department resulted in admission to the hospital; the implications, for college mental health programs, of having 70% of psychiatric emergencies returned to campus is discussed.

“Prevention of Acute Mountain Sickness by Dexamethasone,” T. Scott Johnson, et al. Acute mountain sickness is a syndrome that occurs when unacclimatized persons ascend rapidly to high altitudes. It is postulated that cerebral edema causes its symptoms. Since dexamethasone is useful in treating some forms of cerebral edema, we investigated its role in the prevention of acute mountain sickness. Using a double-blind crossover design, we exposed eight young men to a simulated altitude of 4570 m (15,000 ft) on two occasions. By random assignment, each subject received dexamethasone (4 mg every 6 hours) or placebo for 48 hours before and throughout the 42-hour exposure. The presence of symptoms of acute mountain sickness was established by two methods: a questionnaire and an interview by a physician. Dexamethasone significantly reduced the symptoms of acute mountain sickness. During dexamethasone treatment, the cerebral-symptom score (mean ± S.E.) decreased from 1.09 ± 0.18 to 0.26 ± 0.08, and the respiratory-symptom score decreased from 0.64 ± 0.09 to 0.31 ± 0.06 (both, P < 0.05). As judged by the interviewing physician, the symptom score decreased from 1.10 ± 0.11 to 0.28 ± 0.07 (P = 0.01). We conclude that dexamethasone may be effective in preventing the symptoms of acute mountain sickness. (New England Journal of Medicine 1984;310:683–6.)     

Interactive association between negative emotion regulation and savoring is linked to anxiety symptoms among college students

Abstract

Objective: This study tested the interactive relationships between college students’ perceived capability of regulating negative emotions and savoring positive emotions on mental health outcomes, including anxiety and depressive symptoms. Participants: Participants were healthy undergraduates (n?=?167) recruited from two universities in Hong Kong. Methods: Students completed four scales assessing their perceived capability of using strategies to regulate negative and positive emotions and their anxiety and depressive symptoms. Results: Findings revealed that both anxiety and depressive symptoms were negatively linked to perceived capabilities of regulating negative emotions and savoring positive emotions. Furthermore, regulating negative emotions interacted with savoring positive emotions to predict anxiety symptoms. Conclusions: The need to simultaneously perform negative and positive emotion regulation is highlighted. The results suggest the priority of regulating negative emotions over savoring positive emotions in alleviating anxiety symptoms. Nevertheless, enhancing positive emotion shows greater benefits for those who are less adept at regulating negative emotions.     

Perceived Discrimination and Its Associations With Mental Health and Substance Use Among Asian American and Pacific Islander Undergraduate and Graduate Students

Abstract

Objectives: Racial discrimination experiences can negatively affect health. This study examined perceived discrimination and its relationship with mental health and substance use among Asian American and Pacific Islander (API) undergraduate and graduate students. Participants: A total of 113 API students aged 18–35 completed the study during February–June, 2011. Methods: The authors conducted a cross-sectional, anonymous survey online. Dependent variables included mental health (depressive, anxiety, and somatic symptoms) and substance use (alcohol problems, use of tobacco, marijuana or hashish, and other illegal drugs). Results: Students’ perceived discrimination were significantly, positively associated with depressive, anxiety, and somatic symptoms, but not with substance use. Ethnic identity moderated the relationship between perceived discrimination and somatic symptoms, but not depressive or anxiety symptoms. Conclusions: These findings suggested the negative effect of racial discrimination on API students’ mental health. The buffering effect of ethnic identity may increase resilience in these students when they face racial discrimination.     

Time and support do not heal all wounds: Mental health correlates of past bullying among college students

Abstract

Objective: We examined whether perceptions of being bullied during middle and high school were associated with depressive, anxiety, and posttraumatic stress disorder (PTSD) symptoms during college. We also examined whether perceived social support (PSS) mediated the association between bullying and symptoms, and explored whether parental, peer, or other sources of support was most beneficial. Participants: Undergraduates (N?=?270) from an urban commuter college in the Northeast participated during Spring 2013 or Fall 2015. Methods: Psychometrically sound self-report measures were used to assess symptoms and perceptions of bullying and social support. Results: As hypothesized, bullying was associated with more symptoms, and PSS significantly mediated the associations between bullying and symptoms of PTSD and depression. Conclusion: The college years provide another opportunity to address the effects of middle and high school bullying. Receiving current support for past bullying is beneficial but is not enough, college counseling services are needed to reduce symptoms.     

A Preliminary Understanding of Search Words used by Children,Teenagers and Young Adults in Seeking Information about Depression and Anxiety Online

Abstract

There is a dearth of research related to mental health search word literacy for under 25's. The knowledge of a young person's mental health information search practices is piecemeal, derived from general search literacy studies. A young person’s access to mental health information online is highly due to the level of stigma and poor mental health literacy surrounding depression and anxiety. This study explored what search words young people aged 5–26 (N?=?630) used to identify information and/or help for depression and anxiety. The research hypothesis was supported that those under age 13 would have a more limited use of “disorder” phrases (compared to “thoughts/feeling” phrases) in their search for mental health information related to their symptoms. All age and gender groups were as likely to use thoughts/feelings terms, however, those over 13?years were almost three times more likely to combine their thoughts/feelings terms with disorder terms, compared to those less than 13?years. Results give indication that search engine optimization by expert mental health sources should take into account feeling-based vocabulary used by specific age and gender groups, in order to guide these young people to authoritative mental health information.     

Trends in college students’ mental health diagnoses and utilization of services, 2009–2015

Abstract

Objective: To examine changes in diagnoses/treatment for 12 mental health (MH) conditions, previous use of campus MH services, and willingness to seek MH services in the future. Participants: ACHA–NCHA II participants from 2009 to 2015 (n?=?454,029). Methods: Hierarchical binary logistic regression with step 1 controlling for demographics and step 2 considering time. Results: Time was significant except for bipolar disorder, bulimia, and schizophrenia with increases for all conditions except substance abuse. Anxiety (OR?=?1.68), panic attacks (OR?=?1.61), and ADHD (OR?=?1.40) had the highest odd ratios. Use of MH services at current institution (OR?=?1.30) and willingness to utilize services in the future (OR?=?1.37) also increased over time. Conclusions: Based on a national sample, self-reported diagnoses/treatment of several MH conditions are increasing among college students. This examination of a variety of MH issues can aid college health professionals to engage institutional stakeholders regarding the resources needed to support college students’ MH.     

Cognitive Variables

Abstract

The literature indicates systematic attempts have been made to combine the approach of cognitive therapy with behavior therapy. The following paper reflects that much research has been done in this area showing great promise. Certainly the cognitive variable is significant in the treatment of human behavior, yet it can not be considered in isolation of other dimensions of behavior. Significant contributions have been made in the treatment of depression, phobias, anxiety, and panic attacks. Treatment elements have been applied to a diverse range of conditions, yet practice research has not documented statistical evidence of the effectiveness of the results. Further study needs to isolate the aspect of treatment that is producing the outcome. Greater attention needs to be given to the generalization and maintenance of treatment. Certainly the inclusion of cognitive variables in the assessment of human behavior enables comprehensive treatment of the individual. The authors indicate that further clinical research is needed to isolate specific predictors for using cognitive therapy alone or in a combined regimen.     

Attention-deficit/hyperactivity disorder–specific stimulant misuse,mood, anxiety,and stress in college-age women at high risk for or with eating disorders

ABSTRACT

Objective: To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. Participants: Four hundred forty-eight college-age women aged 18–25 at high risk for or with a clinical or subclinical eating disorder. Methods: Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. Results: Greater eating disorder pathology, objective binge eating, purging, eating disorder–related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. Conclusions: ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.     

Panic Disorder and Self States: Clinical and Research Illustrations

Patients who suffer from panic attacks are often deeply distressed by the symptoms of panic and their aftermath. Alarming physiological symptoms (i.e., dizziness, shakiness, and abdominal distress) are typically accompanied by a sense of imminent doom. This article presents a formulation of panic disorder that assumes that panic results from selfobject failures, leading to fragmentation and disorganizing experiences. Early selfobject responses to panic set the stage for the meanings of panic in subsequent development. A single clinical case, along with examples from research, illustrates the benefit of focusing on developmental processes and unconscious and preconscious fantasies.     

Styles of Physician Advice About Smoking Cessation in College Students

Abstract

Objective: To examine whether young adult cigarette smokers who were in the precontemplation and contemplation stages of change for smoking cessation would differ in their evaluations of vignettes depicting 2 types of physician advice. Participants: Fifty-seven young adult cigarette smokers who were undergraduate students (49.1% female, mean age = 20.4 years) attending an urban university. Methods: Participants evaluated 2 written vignettes. Both vignettes depicted physicians using patient-centered communication styles. One vignette depicted a physician giving a patient direct advice to quit smoking and the other a physician using a motivational style of advice. Data were collected from September 2004 through May 2005. Results: Participants rated the motivational advice vignette as significantly more favorable compared to the direct advice vignette on all assessed dimensions (global satisfaction, general satisfaction, physician affective style, physician technical style, and physician communication style). Conclusion: Smokers preferred the motivational advice style to simple patent-centered advice.     

Perfectionism,Anxiety, and Depressive Distress: Evidence for the Mediating Role of Negative Automatic Thoughts and Anxiety Sensitivity

Abstract

Objective: This study assessed a mediational model in which negative automatic thoughts and anxiety sensitivity were hypothesized to mediate the relationship between perfectionism cognitions and depressive and anxiety symptoms. Participants: Participants were undergraduate students from an urban Canadian university. The data were collected from July 2009 to August 2010. Methods: In a cross-sectional evaluation, 992 undergraduate participants completed questionnaires that assessed perfectionism cognitions, negative automatic thinking, anxiety sensitivity, and anxiety and depressive symptoms. Results: Mediational analysis confirmed the role of anxiety sensitivity and negative automatic thoughts in mediating the association between perfectionistic cognitions, anxiety symptoms, and depressive distress. Furthermore, in line with previous studies, nearly a third of students displayed an elevated prevalence of anxiety and depressive symptoms. Conclusions: This study further clarified the associations and mediating relationships among mood states associated with perfectionism.     

Anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD): Cross-informant,sex, and subtype differences

Objective: This study examined symptoms of anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD). Participants: Data were collected between March 2011 and March 2016 from 150 college students with ADHD and 150 college students without ADHD. Method: Participants with ADHD were compared to a sex- and ethnicity-matched control group. For the ADHD group, parent and self-report of anxiety and depression were also compared. Results: College students with ADHD self-reported significantly higher anxiety and depressive symptoms than did students without ADHD. Scores on parent-report measures of anxiety and depressive symptoms were significantly higher than scores on self-report measures. Significant sex differences were found for participants with ADHD, with females showing higher depressive and anxiety symptoms than males. Parent-reported anxiety symptoms were higher for those with inattentive type ADHD compared to combined type ADHD. Conclusion: The current study highlights the importance of multi-informant assessment in ADHD evaluations for college-aged adults.     

Diagnostic sequence of cocaine use disorder in relation to other mental health conditions among college students

Abstract

Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among college students to inform treatment of cocaine use disorder (CUD). Method: Using electronic medical records from the psychiatric clinic at the student health care center of a large, public university from 2005 to 2015, patients diagnosed with CUD were identified. Their top mental health conditions were identified and assessed to see whether the first diagnosis of these conditions was made (1) before, (2) at the same time as, or (3) after the first diagnosis of CUD. Results: Among the 50 CUD patients, their most common mental health comorbidities were alcohol use disorder, anxiety, depression, and cannabis use disorder. Anxiety and depression were likely to be diagnosed before CUD; alcohol and cannabis use disorders were likely to be diagnosed concurrently with CUD. Conclusion: Diagnostic sequencing can be used to inform screening, workup, and treatment for patients with CUD.     

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

Abstract

Background: Malnutrition is common in subjects undergoing hemodialysis and is associated with increased morbidity and mortality. Studies investigating factors associated with malnutrition and effect of various interventions to treat these patients are needed. We aimed to screen older and young patients undergoing chronic hemodialysis, for malnutrition, and seek its association with clinical factors including anxiety and depression and laboratory variables including urea/creatinine ratio (UCR).

Methods: Duration of hemodialysis treatment, medications taken, anthropometric measurements and routine laboratory results were recorded. Mini nutritional assessment and Beck anxiety and Beck depression inventories were applied. Study variables between subjects with malnutrition, malnutrition risk and normal nutritional states were compared. Older and younger patients were also compared regarding malnutrition and laboratory results. Linear regression analysis was performed to seek independent factors associated with malnutrition score.

Results: Clinical and laboratory data except for UCR were found to be similar among young and older patients. UCR increased, while albumin, body mass index and weight circumference decreased along with worse nutritional state. Low albumin level, body mass index and UCR and higher hemoglobin level and depression score were independent factors associated with malnutrition.

Conclusion: In addition to routinely used markers of malnutrition UCR may provide additional information regarding malnutrition in this population.     

Coping and Regulating Emotions: A Pilot Study of a Modified Dialectical Behavior Therapy Group Delivered in a College Counseling Service

Abstract

Objective: To analyze the efficacy of a pilot program, aimed at treating college students with borderline personality disorder (BPD) using short-term, modified group dialectical behavior therapy at an Australian college counseling service (CCS). Participants: Seventeen enrolled college students aged between 18 and 28 (76.5% female), with a diagnosis of BPD completed the program between November 2009 and November 2010. Methods: Participants attended 8 2-hour group therapy sessions, held at the CCS during semester. Participants were assessed for levels of depression, anxiety, BPD traits, and coping strategies, at commencement and completion of the program. Results: There was a reduction in symptoms of depression and BPD traits, and an increase in adaptive coping skills, including problem solving, and constructive self-talk. There was no reduction in anxiety. Conclusions: The findings indicate promise for short-term treatment of college students with BPD. Implications and limitations are discussed, with emphasis on replication with a control group.     

Parent–Child Conflict and Suicide Rumination in College Students: The Mediating Roles of Depressive Symptoms and Anxiety Sensitivity

Abstract

Objective: Parent–child conflict, depressive symptoms, and anxiety sensitivity have each been identified as risk factors for suicide ideation in college students. This study examined the relations among these risk factors and suicide rumination utilizing transition theory to guide the hypothesized relations. Participants: Undergraduate college students participated in this study in the spring of 2012 (January to May). Methods: Participants completed self-report measures of parent–child conflict, depressive symptoms, anxiety sensitivity, and suicide rumination, among other measures. Hypothesized pathways and mediation were tested using path analysis. Results: Suicide rumination was positively and uniquely predicted by depressive symptoms, anxiety sensitivity, and parent–child conflict. The relation between parent–child conflict and suicide rumination was, in part, accounted for by depressive symptoms and anxiety sensitivity. Conclusions: Results suggest that it would be advisable for clinicians to assess for students’ conflicts with their parents in conjunction with their levels of depression and anxiety when assessing for suicide risk.