Mid Sweden University

Anxiety and depression commonly occur together resulting in worse health outcomes than when they occur in isolation. We aimed to determine whether the genetic liability for comorbid anxiety and depression was greater than when anxiety or depression occurred alone. Data from 12,792 genotyped twins (ages 38–85) were analysed, including 1,986 complete monozygotic and 1,594 complete dizygotic pairs. Outcomes were prescription of antidepressant and anxiolytic drugs, as defined by the World Health Organization Anatomical Therapeutic Chemical Classification System (ATC) convention, for comorbid anxiety and depression (n = 1028), anxiety only (n = 718), and depression only (n = 484). Heritability of each outcome was estimated using twin modelling, and the influence of common genetic variation was assessed from polygenic scores (PGS) for depressive symptoms, anxiety, and 40 other traits. Heritability of comorbid anxiety and depression was 79% compared with 41% for anxiety and 50% for depression alone. The PGS for depressive symptoms likewise predicted more variation in comorbid anxiety and depression (adjusted odds ratio per SD PGS = 1.53, 95% CI = 1.43–1.63; ΔR2 = 0.031, ΔAUC = 0.044) than the other outcomes, with nearly identical results when comorbid anxiety and depression was defined by International Classification of Diseases (ICD) diagnoses (adjusted odds ratio per SD PGS = 1.70, 95% CI = 1.53–1.90; ΔR2 = 0.036, ΔAUC = 0.051). Individuals in the highest decile of PGS for depressive symptoms had over 5 times higher odds of being prescribed medication for comorbid anxiety and depression compared to those in the lowest decile. While results on a predominant role of depressive symptoms may have been biased by the size and heterogeneity of available data bases, they are consistent with the conclusion that genetic factors explain substantially more variation in comorbid anxiety and depression than anxiety or depression alone.

The Sussex-Oxford Compassion Scales (SOCS) are recently developed measures of compassion, which have showed support for a five-factor structure for both other-compassion (SOCS-O) and self-compassion (SOCS-S). The study aimed to validate the Swedish translations of both the SOCS-O and the SOCS-S. A sample of adult participants was randomly split into either an exploratory sample (N = 403) or a replication sample (N = 402). The exploratory sample was used for both exploratory factor analysis and confirmatory factor analysis. In the replication sample, we (1) used CFA to validate results from the exploratory sample, (2) assessed measurement invariance for different groups (gender, nationality, age), and (3) evaluated psychometric properties using local fit. Results from both sub-samples support the presence of five-factor models for both SOCS-O (using 19 items) and SOCS-S (using 20 items). For both scales, measurement invariance is supported for all grouping variables, and local psychometric properties indicate good internal consistency with fairly good discriminant and convergent validity. This study supports the five-factor model of both other-compassion and self-compassion, respectively, and shows that the Swedish versions of both SOCS-O and SOCS-S are reliable and valid instruments that can be used to index compassion with general adult populations in Sweden and Finland. 

Background: This study assessed the factor structure and psychometric properties of the Swedish version of the Empathic Experience Scale (EES), a recently developed scale for empathic traits (Innamorati et al., 2019). According to previous research, EES has two dimensions: Vicarious Experience and Intuitive Understanding. Methods: We used a split-sample method with a combination of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for an adult population (N = 805) from both Sweden and Finland. Results: Our findings support previous research, favoring a two-factor model over a unidimensional model. The final model provided support for measurement invariance across different grouping variables. Consistent with previous research on empathic traits, women obtained higher scores on both dimensions of the scale compared to men. Furthermore, the EES showed high internal consistency, good discriminant, and convergent validity. 

Background: The objective of this study was to revisit the question concerning whether athletes are better than non-athletes at fundamental cognitive abilities, such as inhibitory control, in addition to also focusing on motivational dispositions and possible sex differences. Adding the latter could be crucial since both inhibitory control and motivational dispositions, such as approach and avoidance, are central to goal-directed behavior. Methods: This study’s sample was composed of 93 participants (40 males): 29 biathletes; 30 alpine skiers; and 34 non-athletes. A non-sport-specific stop-signal task was used for the assessment of inhibitory control in terms of response inhibition, and the motivational dispositions were assessed with the BIS/BAS scales. Results: The results showed that there were no differences between the two different sports or non-athletes with regard to response inhibition. However, females showed significantly slower response inhibition than males (p = 0.018) and scored significantly higher on the trait variable BIS (p < 0.001). Conclusions: The results from this study suggest that it might be meaningful to explore the contribution of sex differences and motivational dispositions on response inhibition in conjunction with different types of sports. 

Background: White blood cells or leukocytes, which have a variety of immunological functions, have been shown to migrate in and out of the blood stream in response to different types of stressors (Davis et al., 2008). Hence, leukocyte profiling can be used to measure stress related immune activation. In the present study we employed a psychosocial stress task to assess whether emotional arousal cause leukocyte migration. Methods: We used the Trier Social Stress Test (TSST) to induce psychosocial stress. Emotional arousal was assessed with ECG, self-report measures, and blood sampling. Results: We found an increase in heart rate from baseline throughout the TSST (p < .001) and increased blood cortisol levels directly and 30 minutes after the TSST compared to baseline (p < .001). We found an increase in total Leukocyte count after the stress task (p < .001) with a return to baseline at 30, 60 and 90 minutes after (p < .001). Conclusion: The results of our study indicate that psychosocial stress triggers a physiological response manifesting as increased heart rate, cortisol levels, and leukocyte count. Our findings suggest that emotional arousal might be a key factor in inducing an immune response under stressful conditions. It is important to note that the leukocyte count returned to baseline levels within 30 minutes following the stress task, suggesting a transient and adaptive response of the immune system to social stress. Our findings support the idea that the body's physiological and immune responses to stress are interconnected and influenced by emotional states.

Psychiatric disorders are common, and reliable measures are crucial for research and clinical practice. A cross-diagnostic construct that can be used to index treatment outcomes as well as prevalence of psychological ill health is psychological flexibility. The aim of this study was to validate a Swedish version of the Multidimensional Psychological Flexibility Inventory (MPFI). The MPFI has 12 subscales, six of which measure flexibility, and six that measure inflexibility. Using confirmatory factor analysis in a community sample of 670 participants, we found that a model with 12 factors had the best fit to the data(CFI = .955). All 12 subscales showed adequate reliability (CRs = .803-.933) and the factor structure was similar across age groups and gender. Findings suggest that the Swedish version ofthe MPFI is a reliable instrument that can be used to index psychological flexibility. Potential areas for improvement of the instrument are discussed.

Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/ urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between ru-ral and urban patients with ACS. 

Background

Polygenic scores (PGSs) harness the potential to provide an overall measure of individuals’ genetic liability to develop a disease (Torkamani et al., 2018), though much research is still needed. The aim of the present study was to predict prescription of pharmacological treatment of anxiety or depression from PGSs.

Methods

The target sample comprised two cohorts of genotyped Swedish twins (n = 11037). Cases were defined as individuals prescribed pharmacological treatment of depression (n = 1129) or anxiety (n = 1446). We constructed 6 PGSs based on GWAS on MDD diagnosis, Anxiety, Schizophrenia, Neuroticism scores, the GAD-7 scale, and the PHQ-9. Data were analyzed by logistic regression models with change in pseudo-R2 (above the baseline model with sex, age, cohort, and 20 ancestral PCs) following the inclusion of PGSs to predict the risk of anxiety or depression medication. All results corrected for multiple comparisons.

Results

Predictive performance was estimated to ΔR2depression = 0.028; ΔR2anxiety = 0.025 when all PGSs were included in the same model, with PGS for MDD being the single best predictor for both anxiety and depression. Individuals in the top 10% of the PGS distribution had greater odds of drug prescription (ORdepression = 1.82; CI95% = 1.53—2.17; ORanxiety = 1.65; CI95% = 1.40—1.95), while the bottom 10% had decreased risk (ORanxiety = 0.56; CI95% = 0.45—0.70; ORdepression = 0.58; CI95% = 0.45—0.74) compared to the remaining 90% of the distribution.

Conclusions

PGSs can predict drug prescription for anxiety and depression in an independent sample.

Background: In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. Methods: The study is a randomised controlled trial, where 90 patients with a discharge diagnosis of MINOCA or TS who also report symptoms of stress or anxiety will be randomised 2–6 weeks after their cardiac event. The treatment consists of 10 weeks of Internet-based cognitive behaviour therapy (CBT) and starts immediately after randomisation for the treatment group. The control group receives usual care. Main outcomes are symptoms of anxiety measured with the Hospital Anxiety and Depression scale, anxiety subscale, and perceived stress measured with the Perceived Stress Scale, 14-item version, 10 weeks after randomisation. Secondary measures include cardiac specific anxiety, symptoms of post-traumatic stress, quality of life, cortisol measured in hair and physiological stress responses (heart rate variability, blood pressure and saliva cortisol) during a stress procedure. Ten weeks after randomisation, the control group will also receive treatment. Long-term follow-up in the self-report measures mentioned above will be conducted 20 and 50 weeks after randomisation where the total group’s development over time is followed, and the groups receiving intervention early versus late compared. Discussion: At present, there are no randomised studies evaluating psychological treatment for patients with MINOCA or TS. There is an urgent need for treatment alternatives aiming at relieving stress and anxiety considering the high mental stress and anxiety levels observed in MINOCA and TS, leading to decreased quality of life. CBT aiming at reducing mental stress has been shown to be effective regarding prognosis in patients with coronary artery disease. The current protocol describes a randomised open-label controlled trial evaluating an Internet-based CBT program for reduction of stress and anxiety in patients with increased mental stress and/or anxiety with a discharge diagnosis of either MINOCA or TS. Trial registration: ClinicalTrials.govNCT04178434. Registered on 26 November 2019. 

Previous self-report measures of attachment have used different assessment approaches, and a common conceptualization is using a dimensional perspective in which attachment is measured with two factors: attachment anxiety and attachment avoidance. The Experiences in Close Relationships—Relationship Structures Questionnaire (ECR-RS) has, prior to this study, been assessed for psychometric properties regarding specific relationships, but not in a shorter version for close relationships in general. In this paper, we present a Swedish translation of the ECR-RS Global nine-item version assessed for factor structure and psychometric properties by using a cross-validation approach with two separate adult samples. In Study 1 (N = 492), participants were randomly split into two subsamples. Using an exploratory factor analysis (EFA), the first subsample was used for finding the best-fitting model while the second subsample was used to test the a priori model using confirmatory factor analysis (CFA). In Study 2 (N = 806), we set out to validate the factor structure yet again by using CFA. Results from the EFA supported a two-factor structure with six items for attachment avoidance and three items for attachment anxiety. In the validation of the factor structure using CFA, both studies showed that all model-fit indices were good only after some modification, including removal of one avoidance item. Methodological reasoning and implications are discussed. The final eight-item model showed good internal consistency, as well as good convergent and discriminant validity, and multi-group invariance tests for gender and age showed no violations to invariance. Findings are encouraging to use this short global attachment self-report instrument, but further validation is advised.