To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The DSM-IV indicates severity of social phobia (SP) by the “generalized subtype”, when “most social situations” are feared. This specifier refers to the number of feared social situations, perhaps ignoring quantitative differences. We therefore compared specific and interaction-related vs. performance-related social fears according to clinical (age of onset, avoidance, impairment, comorbidities) and vulnerability characteristics (behavioural inhibition (BI), parental psychopathology and rearing).
Six social situations and SP along with their clinical characteristics were assessed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI) in a population-based sample of N=3,021 14-24 year olds. BI and parental rearing were assessed using self-report questionnaires. Parental psychopathology was assessed directly in parents via DIA-X/M-CIDI, supplemented by offsprings’ family-history reports.
Isolated social fears were rare, except for fear of taking tests and public speaking. The majority reported to fear two or more social situations. Compared to isolated fears of either interaction or performance situations, their co-occurrence was associated with lower age of onset, severe avoidance and impairment, more comorbid anxiety and depressive disorders. All social fears (in particular interaction-related fears) were associated with higher BI. Associations with parental psychopathology and unfavourable rearing were less consistent, albeit strongest for interaction-related fears.
Interaction-related fears may represent a more familial form of SP, while performance-related fears might be less impairing and originate from non-familial factors. The DSM-IV specifier of SP may overlook these differences when individuals with predominantly interaction-related fears are categorized as generalized SP-cases. Findings suggest considering alternative specifiers for SP in future diagnostic systems.
Psychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels.
The dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n = 83) and threshold anxiety disorders (n = 49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder).
Individuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders.
The self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.
Although associations between various somatic diseases and depression are well established, findings concerning the role of gender and anxiety disorders for these associations remain fragmented and partly inconsistent. Combining data from three large-scaled epidemiological studies in primary care, we aim to investigate interactions of somatic diseases with gender and anxiety disorders in the association with depression.
Self-reported depression according to the International Classification of Diseases, Tenth Edition (ICD-10) was assessed in n = 83 737 patients from three independent studies [DETECT (Diabetes Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment), Depression-2000 and Generalized Anxiety and Depression in Primary Care (GAD-P)] using the Depression Screening Questionnaire (DSQ). Diagnoses of depression, anxiety disorders and somatic diseases were obtained from treating physicians via standardised clinical appraisal forms.
In logistic regressions, adjusted for gender, age group and study, each somatic disease except for arterial hypertension and endocrine diseases was associated with self-reported depression (odds ratio, OR 1.3–2.6) and each somatic disease was associated with physician-diagnosed depression (OR 1.1–2.4). Most of these associations remained significant after additional adjustment for anxiety disorders and other somatic diseases. The associations with depression increased with a higher number of somatic diseases. Cardiovascular diseases (OR 0.8), diabetes mellitus (OR 0.8) and neurological diseases (OR 0.8) interacted with gender in the association with self-reported depression, while endocrine diseases (OR 0.8) interacted with gender in the association with physician-diagnosed depression. That is, the associations between respective somatic diseases and depression were less pronounced in females v. males. Moreover, cardiovascular diseases (OR 0.7), arterial hypertension (OR 0.8), gastrointestinal diseases (OR 0.7) and neurological diseases (OR 0.6) interacted with anxiety disorders in the association with self-reported depression, and each somatic disease interacted with anxiety disorders in the association with physician-diagnosed depression (OR 0.6–0.8). That is, the associations between respective somatic diseases and depression were less pronounced in patients with v. without anxiety disorders; arterial hypertension was negatively associated with self-reported depression only in patients with anxiety disorders, but not in patients without anxiety disorders.
A range of somatic diseases as well as anxiety disorders are linked to depression – and especially patients with co-/multi-morbidity are affected. However, interactions with gender and anxiety disorders are noteworthy and of relevance to potentially improve recognition and treatment of depression by physicians. Somatic diseases are associated more strongly with depression in males v. females as well as in patients without v. with anxiety disorders, primarily because women and patients with anxiety disorders per se are characterised by considerably increased depression prevalence that only marginally changes in the presence of somatic comorbidity.
Objectives: The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. Methods: One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1–18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. Results: An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. Conclusions: We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640–652)
An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI≥25 kg/m2) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naïve, HIV+ adults included 217 participants, 139 with BMI of 18·0–24·9 kg/m2 and seventy-eight participants with BMI≥25 kg/m2. The primary outcome was time to event (≥25 % decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell count<250 cells/µl and AIDS-defining conditions. Proportional survival hazard models were used to compare hazard ratios (HR) on time to events of HIV disease progression over 18 months. Higher baseline BMI was associated with significantly lower risk of an AIDS-defining condition during the follow-up (HR 0·218; 95 % CI 0·068, 0·701; P=0·011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0·855; 95 % CI 0·741, 0·987; P=0·033) and the combined outcome of having CD4 cell count≤250/µl and AIDS-defining conditions, whichever occurred earlier (HR 0·918; 95 % CI 0·847, 0·994; P=0·036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naïve participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.
To prospectively examine whether negative life events (NLE) and low perceived coping efficacy (CE) increase the risk for the onset of various forms of psychopathology and low CE mediates the associations between NLE and incident mental disorders.
A representative community sample of adolescents and young adults (N = 3017, aged 14–24 at baseline) was prospectively followed up in up to three assessment waves over 10 years. Anxiety, depressive and substance use disorders were assessed at each wave using the DSM-IV/M-CIDI. NLE and CE were assessed at baseline with the Munich Event List and the Scale for Self-Control and Coping Skills. Associations (odds ratios, OR) of NLE and CE at baseline with incident mental disorders at follow-up were estimated using logistic regressions adjusted for sex and age.
NLE at baseline predicted the onset of any disorder, any anxiety disorder, panic disorder, agoraphobia, generalised anxiety disorder, any depression, major depressive episodes, dysthymia, any substance use disorder, nicotine dependence and abuse/dependence of illicit drugs at follow-up (OR 1.02–1.09 per one NLE more). When adjusting for any other lifetime disorder prior to baseline, merely the associations of NLE with any anxiety disorder, any depression, major depressive episodes, dysthymia and any substance use disorder remained significant (OR 1.02–1.07). Low CE at baseline predicted the onset of any disorder, any anxiety disorder, agoraphobia, generalised anxiety disorder, any depression, major depressive episodes, dysthymia, any substance use disorder, alcohol abuse/dependence, nicotine dependence and abuse/dependence of illicit drugs at follow-up (OR 1.16–1.72 per standard deviation). When adjusting for any other lifetime disorder prior to baseline, only the associations of low CE with any depression, major depressive episodes, dysthymia, any substance use disorder, alcohol abuse/dependence, nicotine dependence and abuse/dependence of illicit drugs remained significant (OR 1.15–1.64). Low CE explained 9.46, 13.39, 12.65 and 17.31% of the associations between NLE and any disorder, any depression, major depressive episodes and dysthymia, respectively. When adjusting for any other lifetime disorder prior to baseline, the reductions in associations for any depression (9.77%) and major depressive episodes (9.40%) remained significant, while the reduction in association for dysthymia was attenuated to non-significance (p-value > 0.05).
Our findings suggest that NLE and low perceived CE elevate the risk for various incident mental disorders and that low CE partially mediates the association between NLE and incident depression. Subjects with NLE might thus profit from targeted early interventions strengthening CE to prevent the onset of depression.
There are inconclusive findings regarding whether danger and loss events differentially predict the onset of anxiety and depression.
A community sample of adolescents and young adults (n = 2304, age 14–24 years at baseline) was prospectively followed up in up to four assessments over 10 years. Incident anxiety and depressive disorders were assessed at each wave using the DSM-IV/M-CIDI. Life events (including danger, loss and respectively mixed events) were assessed at baseline using the Munich Event List (MEL). Logistic regressions were used to reveal associations between event types at baseline and incident disorders at follow-up.
Loss events merely predicted incident ‘pure’ depression [odds ratio (OR) 2.4 per standard deviation, 95% confidence interval (CI) 1.5–3.9, p < 0.001] whereas danger events predicted incident ‘pure’ anxiety (OR 2.3, 95% CI 1.1–4.6, p = 0.023) and ‘pure’ depression (OR 2.5, 95% CI 1.7–3.5, p < 0.001). Mixed events predicted incident ‘pure’ anxiety (OR 2.9, 95% CI 1.5–5.7, p = 0.002), ‘pure’ depression (OR 2.4, 95% CI 1.6–3.4, p < 0.001) and their co-morbidity (OR 3.6, 95% CI 1.8–7.0, p < 0.001).
Our results provide further evidence for differential effects of danger, loss and respectively mixed events on incident anxiety, depression and their co-morbidity. Since most loss events referred to death/separation from significant others, particularly interpersonal loss appears to be highly specific in predicting depression.
Threshold and subthreshold forms of generalized anxiety disorder (GAD) are highly prevalent and impairing conditions among adults. However, there are few general population studies that have examined these conditions during the early life course. The primary objectives of this study were to: (1) examine the prevalence, and sociodemographic and clinical characteristics of threshold and subthreshold forms of GAD in a nationally representative sample of US youth; and (2) test differences in sociodemographic and clinical characteristics between threshold and subthreshold forms of the disorder.
The National Comorbidity Survey-Adolescent Supplement is a nationally representative face-to-face survey of 10 123 adolescents 13 to 18 years of age in the continental USA.
Approximately 3% of adolescents met criteria for threshold GAD. Reducing the required duration from 6 months to 3 months resulted in a 65.7% increase in prevalence (5.0%); further relaxing the uncontrollability criterion led to an additional 20.7% increase in prevalence (6.1%). Adolescents with all forms of GAD displayed a recurrent clinical course marked by substantial impairment and co-morbidity with other psychiatric disorders. There were few significant differences in sociodemographic and clinical characteristics between threshold and subthreshold cases of GAD. Results also revealed age-related differences in the associated symptoms and clinical course of GAD.
Findings demonstrate the clinical significance of subthreshold forms of GAD among adolescent youth, highlighting the continuous nature of the GAD construct. Age-related differences in the associated symptoms and clinical course of GAD provide further support for criteria that capture variation in clinical features across development.
For leaders to generate credibility through audience costs, there must be mechanisms in place that enable citizens to learn about foreign policy failures. However, scholars have paid relatively little attention to variations among democracies in the extent to which the public is able to obtain this sort of information. We argue here that electoral institutions play this role by influencing the number of major political parties in a country and, with it, the extent and depth of opposition to the executive. Opposition leads to whistle-blowing, which makes it more likely that that the public will actually hear about a leader’s foreign policy blunders. The effectiveness of this whistle-blowing, however, is conditional on the public’s access to the primary conduit for communication between leaders and citizens: the mass media. We test these expectations statistically, demonstrating that leaders in systems with these attributes fare better with respect to their threats and the reciprocation of conflicts that they initiate. These findings suggest that democracies are not automatically able to generate credibility through audience costs and that the domestic institutions and political processes that link the public and leaders must be taken seriously.
Earlier clinical studies have suggested consistent differences between anxious and non-anxious depression. The aim of this study was to compare parental pathology, personality and symptom characteristics in three groups of probands from the general population: depression with and without generalized anxiety disorder (GAD) and with other anxiety disorders. Because patients without GAD may have experienced anxious symptoms for up to 5 months, we also considered GAD with a duration of only 1 month to produce a group of depressions largely unaffected by anxiety.
Depressive and anxiety disorders were assessed in a 10-year prospective longitudinal community and family study using the DSM-IV/M-CIDI. Regression analyses were used to reveal associations between these variables and with personality using two durations of GAD: 6 months (GAD-6) and 1 month (GAD-1).
Non-anxious depressives had fewer and less severe depressive symptoms, and higher odds for parents with depression alone, whereas those with anxious depression were associated with higher harm avoidance and had parents with a wider range of disorders, including mania.
Anxious depression is a more severe form of depression than the non-anxious form; this is true even when the symptoms required for an anxiety diagnosis are ignored. Patients with non-anxious depression are different from those with anxious depression in terms of illness severity, family pathology and personality. The association between major depression and bipolar disorder is seen only in anxious forms of depression. Improved knowledge on different forms of depression may provide clues to their differential aetiology, and guide research into the types of treatment that are best suited to each form.
The purpose of this study was to describe differences in activity participation between younger and older individuals with stroke to inform transition after stroke. This was a cross-sectional study with individuals six-months poststroke (n = 177). All individuals completed an outcomes assessment battery that included the Stroke Impact Scale, the Reintegration to Normal Living Index and the Activity Card Sort. The sample was divided into two groups: (1) Young — those under the age of 65 (n = 89); and (2) Old — those 65 or older (n = 88). Analysis was completed to examine differences between the groups on the primary outcome measures of the study and to look at differences between the groups on individual questions/items on the specific measures. The results of this study demonstrate: (1) significant differences in both the quantity and nature of activity participation prior to and after stroke between younger and older stroke survivors and (2) total scores and measures of central tendency do not necessarily provide therapists with the information they need to guide treatment. Rehabilitation professionals should focus on providing clients with the tools they will need to be successful in transitioning back to home and community environments once rehabilitation has ended.
Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition.
A total of 3021 community subjects (97.7% lifetime AU) aged 14–24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI.
Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition.
Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.
A Rembrandt masterpiece of science and art put together.
Bo Gritz, on the Oklahoma City bombing.
On the cover of Ron Rosenbaum's book Explaining Hitler is a compelling portrait of human contradiction. After your eyes leave the title, they are drawn to the background, where a photograph of an infant Adolph Hitler becomes more obvious. As one stares into the infant's eyes to search for clues, there are none to be found. This is a baby with all a baby's innocence, awe, and excitement of human life. The picture stands in stark contrast to the name that became synonymous with hatred and misery for millions. The simple juxtaposition of name and photo commands the observer to ask: between then and now, what happened?
The search for answers began with those who had fled an adult Hitler. Pioneering work by Theodor Adorno and his Frankfurt School colleagues resulted in an investigation called The authoritarian personality. Among other findings, their psychoanalytically based work emphasized childhood experiences feeding fascism. Yet their work fell short of linking punitive childhood experience directly to the adult genocidal mind. The lacuna was in part due to a lack of delineation between the groupings of perpetrators, bystanders, and rescuers. In spite of the shortcomings, Adorno and his colleagues made several important discoveries.
The first discovery of the Frankfurt school was that there were indeed personality components to antisemitic persons – specifically types who in thinking were rigid, fearful, and closed to new experience.
The diligent executors of inhuman orders were not born torturers, they were not, with few exceptions, monsters – they were ordinary men.
Can we explain bystander mindsets and actions? How much of bystander behavior is trait and how much is situationally based? Or, are there personality dispositions involved in being bystanders? Why do the vast majority of persons do nothing at times? The key question regarding bystanders is this: who becomes what kind of bystander and why and how do they differ from their perpetrator and rescuer counterparts?
A bystander is generally one who is present but refrains from involvement. Yet there is an active component to bystanders – they can temporarily perpetrate or at times rescue. With fewer dependency traits than perpetrators or rescuers, bystanders are vulnerable to social norms, and make choices of action as the situation dictates.
Conformity to cultural norms co-opts much of who they are. Social roles and social status are very important to the bystander, whose primary identity is social. Traditionally religious, though not extreme, politically conservative, and at times even liberal, the Tier II group is defined by its moderate stance between perpetrators and rescuers. Bystanders employ more sophisticated defenses and thinking compared to perpetrators.
The percentage of bystanders within a population may be between 50 and 65. Within Tier II there is a range of differences as well. No two bystanders are alike.
Genocide has tragically claimed the lives of over 262 million victims in the last century. Jews, Armenians, Cambodians, Darfurians, Kosovons, Rwandans, the list seems endless. Clinical psychologist Steven K. Baum sets out to examine the psychological patterns to these atrocities. Building on trait theory as well as social psychology he reanalyzes key conformity studies (including the famous experiments of Ash, Millgram and Zimbardo) to bring forth an understanding of identity and emotional development during genocide. Baum presents a model that demonstrates how people's actions during genocide actually mirror their behaviour in everyday life: there are those who destruct (perpetrators), those who help (rescuers) and those who remain uninvolved, positioning themselves between the two extremes (bystanders). Combining eyewitness accounts with Baum's own analysis, this book reveals the common mental and emotional traits among perpetrators, bystanders and rescuers and how a war between personal and social identity accounts for these divisions.
The history of the world is a history of hate and genocide. At one level, it is difficult to deny this reality. In the 1980s, anthropologists in Belgium found more than 30 wounded, battered, and perforated skulls, of men, women, and children, believed to be at least 7,000 years old. And while ethnic conflict and group hatred may not be the only motives for war, such enmity seems to play a large part in most armed conflicts around the world. Only 16 of the world's 193 countries currently remain untouched by war. At any given time, an average of 50 nations are engaged in armed conflict, with some employing children as young as 6 years of age in combat.
But the actual investigation, cataloguing, and defining of genocide is very recent. Following attorney/survivor Raphael Lemkin's (1900–1959) lead, Article 2 of the United Nation's Convention on the Prevention and Punishment of the Crime of Genocide defines genocide as:
any of the following acts committed with intent to destroy, in whole or in part, a national, ethnic, racial or religious group, as such: Killing members of the group; Causing serious bodily or mental harm to members of the group; Deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part; Imposing measures intended to prevent births within the group; and forcibly transferring children of the group to another group.