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To investigate the changes in Chinese residents’ psychological state and its influencing factors after the Wuhan shutdown on 23 Jan.
Two surveys were conducted on Feb 1-5 and Feb 20-24, separately, using an online self-administrated questionnaire among 3145 and 3814 participants, respectively. Subjective indicators of daily-life changes include level of attention, risk of infection, impact of daily life, self-perceived health status, and mental health help-seeking. And individual scores on changes in anxiety, depression, and stress were generated by 6-item, 4-item, and 3-item questions. A multivariate regression model was fitted in each survey, separately and combined.
A total of 6959 residents participated in the study, with 32.78% male and 67.22% female, people living in Wuhan and other cities in Hubei Province accounted for 25.22% and 18.85%, respectively. One week after the Wuhan shutdown, their anxiety, depression, and stress had all increased. Compared to the 1st survey, the changes in the scores of anxiety, depression, and stress in the 2nd survey were decreased (β=-1.220, -0.798, and -0.623, all p<0.001). The level of attention, risk of infection, and self-perceived health status tended to be positively associated with the changes in the scores of anxiety, depression, and stress.
The study showed that the lives and psychological conditions of residents had undergone negative changes after the Wuhan shutdown, but the measures taken during this period were effective. These results may provide guidance for public health policies in other countries and regions.
Ling Li’s chapter focuses on how the Party operates in the governance space in China, using the evolution of the disciplinary regime of the Chinese Communist Party to demonstrate what she sees as the defining feature of China’s single-party state: two separate seats of power and sources of legitimation which enable the Party to use a variety of ways to impose authoritarian control over state affairs. Her analysis of the particular organisational features of China’s Party-state draws on a description of the evolution of this dualism and on the historical development of anti-corruption institutions as an exemplar of how the Party governs through supervision and discipline in China. She connects this discussion with the contemporary development of the National Supervision Commission. In this way, the chapter presents an historical evolution that can explain the establishment of the Commission, which represents the apex of Party-state disciplinary and supervisory ambitions in China today.
Drug-induced liver injury (DILI) is a common adverse drug reaction leading to the interruption of tuberculosis (TB) therapy. We aimed to identify whether the hepatitis B virus (HBV) infection would increase the risk of DILI during first-line TB treatment. A meta-analysis of cohort studies searched in PubMed, Web of Science and China National Knowledge Infrastructure was conducted. Effect sizes were reported as risk ratios (RRs) and 95% confidence intervals (CIs) and calculated by R software. Sixteen studies with 3960 TB patients were eligible for analysis. The risk of DILI appeared to be higher in TB patients co-infected with HBV (RR 2.66; 95% CI 2.13–3.32) than those without HBV infection. Moreover, patients with positive hepatitis B e antigen (HBeAg) were more likely to develop DILI (RR 3.42; 95% CI 1.95–5.98) compared to those with negative HBeAg (RR 2.30; 95% CI 1.66–3.18). Co-infection with HBV was not associated with a higher rate of anti-TB DILI in latent TB patients (RR 4.48; 95% CI 0.80–24.99). The effect of HBV infection on aggravating anti-TB DILI was independent of study participants, whether they were newly diagnosed with TB or not. Besides, TB and HBV co-infection patients had a longer duration of recovery from DILI compared to non-co-infected patients (SMD 2.26; 95% CI 1.87–2.66). To conclude, the results demonstrate that HBV infection would increase the risk of DILI during TB therapy, especially in patients with positive HBeAg, and close liver function monitoring is needed for TB and HBV co-infection patients.
Health behavior was conducive to control the COVID-19 epidemic. This study aimed to determine the differences in health behaviors and related factors among rural-urban residents in China.
From February 14 to 22, 2020, the peak of COVID-19 epidemic in China, a total of 2449 participants(urban residents,1783(72.81%) and rural residents, 666 (27.19%)) were recruited by snowball sampling on WeChat and Tencent QQ social platforms. Data were collected through the Web-questionnaire guided by an information–motivation–behavioral skills model. Multiple-group structural equation model was applied to analyze the factors.
Rural residents had lower health behavior scores than urban residents, even after adjusting demographic characteristics (33.86 vs. 34.29, P=0.042, total score was 40). In urban and rural residents, motivation, behavioral skills and health risk stress had significant direct positive and negative influences effects on health behaviors, respectively. Information and positive perception of interventions had direct effects on health behaviors in rural residents, but not in urban residents. All the factors were mediated by behavioral skills in rural and urban residents.
This study suggest that the government should pay attention to substantial rural-urban disparities and implement different COVID-19 prevention and intervention policies for health behaviors targeting rural and urban residents.
To evaluate the effects of dietary Ca intake and Ca supplementation during pregnancy on low birth weight (LBW) and small for gestational age (SGA) infants.
A birth cohort study was conducted in 2010–2012 at the Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China.
A birth cohort study.
Totally, 9595 pregnant women who came to the hospital for delivery at 20 weeks of gestation or more, and who were 18 years of age or older.
Compared with non-users, Ca supplement users had a reduced risk of LBW infants (OR = 0·77, 95 % CI: 0·63, 0·95) and a reduced risk of nulliparous women giving birth to LBW infants (OR = 0·75, 95 % CI: 0·58, 0·98) (P < 0·05). More specifically, both the use of Ca supplement before conception and during pregnancy (OR = 0·44, 95 % CI: 0·19, 0·99) and during pregnancy only (OR = 0·80, 95 % CI: 0·65, 0·99) had the main effect of reducing risk of nulliparous women giving birth to LBW infants (P < 0·05). There was no association between Ca supplementation and SGA (OR = 0·87, 95 % CI: 0·75, 1·01) (P > 0·05). However, higher dietary Ca intake during pregnancy decreases the risk of both LBW (quartile 2: OR = 0·72, 95 % CI: 0·55, 0·94; quartile 3: OR = 0·68, 95 % CI: 0·50, 0·62) and SGA infants (quartile 2: OR = 0·77, 95 % CI: 0·63, 0·95; quartile 3: OR = 0·71, 95 % CI: 0·57, 0·88, quartile 4: OR = 0·71, 95 % CI: 0·57, 0·88) (P < 0·05).
Ca supplementation and adequate dietary intake of Ca during pregnancy are associated with a decreased risk of LBW infants born to nulliparous women.
The risk of environmental contamination by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the intensive care unit (ICU) is unclear. We evaluated the extent of environmental contamination in the ICU and correlated this with patient and disease factors, including the impact of different ventilatory modalities.
In this observational study, surface environmental samples collected from ICU patient rooms and common areas were tested for SARS-CoV-2 by polymerase chain reaction (PCR). Select samples from the common area were tested by cell culture. Clinical data were collected and correlated to the presence of environmental contamination. Results were compared to historical data from a previous study in general wards.
In total, 200 samples from 20 patient rooms and 75 samples from common areas and the staff pantry were tested. The results showed that 14 rooms had at least 1 site contaminated, with an overall contamination rate of 14% (28 of 200 samples). Environmental contamination was not associated with day of illness, ventilatory mode, aerosol-generating procedures, or viral load. The frequency of environmental contamination was lower in the ICU than in general ward rooms. Eight samples from the common area were positive, though all were negative on cell culture.
Environmental contamination in the ICU was lower than in the general wards. The use of mechanical ventilation or high-flow nasal oxygen was not associated with greater surface contamination, supporting their use and safety from an infection control perspective. Transmission risk via environmental surfaces in the ICUs is likely to be low. Nonetheless, infection control practices should be strictly reinforced, and transmission risk via droplet or airborne spread remains.
A high-carbohydrate diet could achieve a protein-sparing effect, but it may cause negative impacts on the growth condition of fish due to their poor utilisation ability of carbohydrate. How to reduce the adverse effects caused by a high-carbohydrate diet is important for the development of aquaculture. In the present study, we aimed to identify whether inulin could attenuate the metabolic syndrome caused by a high-carbohydrate diet in fish. Nile tilapia (Oreochromis niloticus) (1·19 (sd 0·01) g) were supplied with 35 % carbohydrate (CON), 45 % carbohydrate (HC) and 45 % carbohydrate + 5 g/kg inulin (HCI) diets for 10 weeks. The results showed that addition of inulin improved the survival rate when fish were challenged with Aeromonas hydrophila, indicating that inulin had an immunostimulatory effect. Compared with the HC group, the HCI group had lower lipid accumulation in liver and the gene expression analyses indicated that addition of inulin down-regulated genes related to lipogenesis and up-regulated genes relevant to β-oxidation significantly (P < 0·05). Higher liver glycogen and glucose tolerance were found in the HCI group compared with the HC group (P < 0·05). These results indicated that inulin could alleviate the metabolic syndrome induced by a high-carbohydrate diet. Furthermore, addition of inulin to a high-carbohydrate diet changed the intestinal bacterial composition and significantly increased the concentration of acetic acid and propionic acid in fish gut which have the potential to increase pathogen resistance and regulate metabolic characteristics in fish. Collectively, our results demonstrated a possible causal role for the gut microbiome in metabolic improvements induced by inulin in fish.
Corona Virus Disease 2019 (COVID-19) has presented an unprecedented challenge to the health-care system across the world. The current study aims to identify the determinants of illness severity of COVID-19 based on ordinal responses. A retrospective cohort of COVID-19 patients from four hospitals in three provinces in China was established, and 598 patients were included from 1 January to 8 March 2020, and divided into moderate, severe and critical illness group. Relative variables were retrieved from electronic medical records. The univariate and multivariate ordinal logistic regression models were fitted to identify the independent predictors of illness severity. The cohort included 400 (66.89%) moderate cases, 85 (14.21%) severe and 113 (18.90%) critical cases, of whom 79 died during hospitalisation as of 28 April. Patients in the age group of 70+ years (OR = 3.419, 95% CI: 1.596–7.323), age of 40–69 years (OR = 1.586, 95% CI: 0.824–3.053), hypertension (OR = 3.372, 95% CI: 2.185–5.202), ALT >50 μ/l (OR = 3.304, 95% CI: 2.107–5.180), cTnI >0.04 ng/ml (OR = 7.464, 95% CI: 4.292–12.980), myohaemoglobin>48.8 ng/ml (OR = 2.214, 95% CI: 1.42–3.453) had greater risk of developing worse severity of illness. The interval between illness onset and diagnosis (OR = 1.056, 95% CI: 1.012–1.101) and interval between illness onset and admission (OR = 1.048, 95% CI: 1.009–1.087) were independent significant predictors of illness severity. Patients of critical illness suffered from inferior survival, as compared with patients in the severe group (HR = 14.309, 95% CI: 5.585–36.659) and in the moderate group (HR = 41.021, 95% CI: 17.588–95.678). Our findings highlight that the identified determinants may help to predict the risk of developing more severe illness among COVID-19 patients and contribute to optimising arrangement of health resources.
To investigate homocysteine (Hcy) and folate levels, prevalence of hyperhomocysteinaemia (HHcy) and folate deficiency, which are affected by lifestyles in urban, agricultural and stock-raising populations.
This is a cross-sectional study.
Urban, agricultural and stock-raising regions in Emin, China.
Totally 1926 subjects – 885 (45·9 %) from urban, 861 (44·7 %) from agricultural and 180 (9·4 %) from stock-raising regions – were obtained using multistage stratified random sampling. Inclusion criteria encompassed inhabitants aged ≥15 years who resided at the current address for ≥6 months and agreed to participate in the study. Surveys on health behaviour questionnaires and physical examinations were conducted and blood samples collected.
The folate level of subjects from the stock-raising region was the lowest, followed by those from the agricultural region, and the highest in those from the urban region (3·48 v. 6·50 v. 7·12 ng/ml, P < 0·001), whereas mean Hcy showed no significant difference across regions. The OR for HHcy in stock-raising regions was 1·90 (95 % CI 1·11, 3·27) compared with the urban region after adjusting for all possible covariates. The OR for folate deficiency in stock-raising and agriculture regions was 11·51 (95 % CI 7·09, 18·67) and 1·91 (95 % CI 1·30, 2·82), respectively, compared with the urban region after adjusting for all possible covariates.
HHcy and folate deficiency are highly prevalent in stock-raisers, which is of important reference for HHcy control in Xinjiang, with a possibility of extension to others with approximate lifestyles.
Plant cyclophilin (CYP) is related to chloroplast photoprotection, redox and other growth and developmental regulatory processes and responds to stress and improves tolerance to saline–alkali stress. Besides, it exerts peptidyl-prolyl cis/trans isomerase activity to participate in protein synthesis and folding. In this study, Northern blot was used to analyse the CsCYP1A gene (a CYP gene isolated from a Chlorella species) (accession number: KY207381) of tolerant Chlorella vulgaris in soda saline–alkali soil. The result showed that the expression of the CsCYP1A gene was induced by NaHCO3, NaCl and sorbitol. Additionally, Agrobacterium tumefaciens was used to infect the callus of rice (Oryza sativa var. Longjing11) for genetic transformation. Molecular detection confirmed that transgenic seedlings overexpressing CsCYP1A were obtained by hygromycin selection. Treatment with NaCl and NaHCO3 at the five-leaf stage was performed in the seedlings, and the results showed that there were significant differences between the CsCYP1A overexpressed rice lines and non-transgenic (NT) Longjing11 in terms of plant height, fresh weight, chlorophyll content, malondialdehyde content and ascorbate peroxidase activity. The CsCYP1A overexpression rice lines had higher tolerance to NaCl and NaHCO3 than NT. The current findings indicate that CsCYP1A can enhance the tolerance of rice to saline–alkali stress possibly through its involvement in reactive oxygen scavenging pathways.
The aim of this study was to investigate the combined effect of n-3 fatty acids (EPA and DHA, at an EPA:DHA ratio of 150:500) and phytosterol esters (PS) on non-alcoholic fatty liver disease (NAFLD) patients. We conducted a randomised, double-blind, placebo-controlled trial. Ninety-six NAFLD subjects were randomly assigned to the following groups: the PS group (receiving 3·3 g/d PS); the FO group (receiving 450 mg EPA + 1500 mg DHA/d); the PS + FO combination group (receiving 3·3 g/d PS and 450 mg EPA + 1500 mg DHA/d) and the PO group (a placebo group). The baseline clinical characteristics of the four groups were similar. The primary outcome was liver:spleen attenuation ratio (L:S ratio). The percentage increase in liver–spleen attenuation (≤1) in the PS + FO group was 36 % (P = 0·083), higher than those in the other three groups (PS group, 11 %, P = 0·519; FO group, 18 %, P = 0·071; PO group, 15 %, P = 0·436). Compared with baseline, transforming growth factor-β (TGF-β) was significantly decreased in the three study groups at the end of the trial (PS, P = 0·000; FO, P = 0·002; PS + FO, P = 0·001) and TNF-α was significantly decreased in the FO group (P = 0·036), PS + FO group (P = 0·005) and PO group (P = 0·032) at the end of the intervention. Notably, TGF-β was reduced significantly more in the PS + FO group than in the PO group (P = 0·032). The TAG and total cholesterol levels of the PS + FO group were reduced by 11·57 and 9·55 %, respectively. In conclusion, co-supplementation of PS and EPA + DHA could increase the effectiveness of treatment for hepatic steatosis.
An atmospheric pressure microwave plasma tubular furnace apparatus (MPTF) for the rapid synthesis of carbon nanotubes (CNTs) has been developed. CNTs have been synthesized by an Argon-Hydrogen microwave plasma using ethanol vapor as carbon source with the furnace temperature of 800 °C at the atmospheric pressure. The synthesized CNTs have been analyzed by scanning electron microscopy (SEM), high resolution transmission electron microscopy (HRTEM), and are shown to be multi-walled and tangled and chemically connected to form a high-density network with the diameter at the range of 25-70 nm. The measurement of X-ray photoelectron spectroscopy (XPS) indicates that a large number of oxygenated functional groups grown on the surface of CNTs. These properties proved that the CNTs could be utilized as nanoscale templates for various applications.
Schizophrenia is a serious health problem worldwide. This systematic analysis aims to quantify the burden of schizophrenia at the global, regional and national levels using the Global Burden of Disease Study 2017 (GBD 2017).
We collected detailed information on the number of incidence cases, disability-adjusted life years (DALYs) and age-standardised incidence rate (ASIR) and age-standardised rate of DALYs (ASDR) during 1990–2017 from GBD 2017. The estimated annual percentage changes (EAPCs) in the ASIR and in the ASDR were calculated to quantify the temporal trends in the ASIR and ASDR of schizophrenia.
Globally there were 1.13 million (95% uncertainty interval [UI] = 1.00 to 1.28) incident schizophrenia cases and 12.66 million (95% UI = 9.48 to 15.56) DALYs due to schizophrenia in 2017. The global ASIR decreased slightly from 1990 to 2017 (EAPC = −0.124, 95% UI = −0.114 to −0.135), while the ASDR was stable. The number of incident cases, DALYs, ASIR and ASDR were higher for males than for females. The incident rate and DALYs rate were highest among those aged 20–29 and 30–54 years, respectively. ASIR and ASDR were highest in East Asia in 2017, at 19.66 (95% UI = 17.72 to 22.00) and 205.23 (95% UI = 153.13 to 253.34), respectively. In 2017, the ASIR was highest in countries with a high-moderate sociodemographic index (SDI) and the ASDR was highest in high-SDI countries. We also found that the EAPC in ASDR was negatively correlated with the ASDR in 1990 (P = 0.001, ρ = −0.23).
The global burden of schizophrenia remains large and continues to increase, thereby increasing the burden on health-care systems. The reported findings should be useful for resource allocation and health services planning for the increasing numbers of patients with schizophrenia in ageing societies.
Generating designs via machine learning has been an on-going challenge in computer-aided design. Recently, deep learning methods have been applied to randomly generate images in fashion, furniture and product design. However, such deep generative methods usually require a large number of training images and human aspects are not taken into account in the design process. In this work, we seek a way to involve human cognitive factors through brain activity indicated by electroencephalographic measurements (EEG) in the generative process. We propose a neuroscience-inspired design with a machine learning method where EEG is used to capture preferred design features. Such signals are used as a condition in generative adversarial networks (GAN). First, we employ a recurrent neural network Long Short-Term Memory as an encoder to extract EEG features from raw EEG signals; this data are recorded from subjects viewing several categories of images from ImageNet. Second, we train a GAN model conditioned on the encoded EEG features to generate design images. Third, we use the model to generate design images from a subject’s EEG measured brain activity. To verify our proposed generative design method, we present a case study, in which the subjects imagine the products they prefer, and the corresponding EEG signals are recorded and reconstructed by our model for evaluation. The results indicate that a generated product image with preference EEG signals gains more preference than those generated without EEG signals. Overall, we propose a neuroscience-inspired artificial intelligence design method for generating a design taking into account human preference. The method could help improve communication between designers and clients where clients might not be able to express design requests clearly.
Several observational studies have investigated the association of insomnia with psychiatric disorders. Such studies yielded mixed results, and whether these associations are causal remains unclear. Thus, we aimed to identify the causal relationships between insomnia and five major psychiatric disorders.
The analysis was implemented with six genome-wide association studies; one for insomnia and five for psychiatric disorders (attention-deficit/hyperactivity disorder, autism spectrum disorder, major depressive disorder, schizophrenia, and bipolar disorder). A heterogeneity in dependent instrument (HEIDI) approach was used to remove the pleiotropic instruments, Mendelian randomization (MR)-Egger regression was adopted to test the validity of the screened instruments, and bidirectional generalized summary data-based MR was performed to estimate the causal relationships between insomnia and these major psychiatric disorders.
We observed significant causal effects of insomnia on the risk of autism spectrum disorder and bipolar disorder, with odds ratios of 1.739 (95% confidence interval: 1.217–2.486, p = 0.002) and 1.786 (95% confidence interval: 1.396–2.285, p = 4.02 × 10−6), respectively. There was no convincing evidence of reverse causality for insomnia with these two disorders (p = 0.945 and 0.546, respectively). When insomnia was considered as either the exposure or outcome variable, causal estimates for the remaining three psychiatric disorders were not significant.
Our results suggest a causal role of insomnia in autism spectrum disorder and bipolar disorder. Future disease models should include insomnia as a factor for these two disorders to develop effective interventions. More detailed mechanism studies may also be inspired by this causal inference.
The present study investigated the effects of condensed tannins (CT) on intestinal immune function in on-growing grass carp (Ctenopharyngodon idella). A total of 540 healthy grass carp were fed six diets containing different levels of CT (0, 10·00, 20·00, 30·00, 40·00 and 50·00 g/kg diet) for 70 d and then challenged with Aeromonas hydrophila for 14 d. The results showed that, compared with the control group, dietary CT (1) induced intestinal histopathological lesions and aggravated enteritis; (2) decreased lysozyme and acid phosphatase activities, complement 3 (C3), C4 and IgM contents and down-regulated the Hepcidin, liver-expressed antimicrobial peptide (LEAP)-2A, LEAP-2B, Mucin2 and β-defensin-1 mRNA levels in the proximal intestine (PI), mid intestine (MI) and distal intestine (DI) (P < 0·05); (3) down-regulated the mRNA levels of anti-inflammatory cytokines transforming growth factor (TGF)-β1, TGF-β2 (not in MI and DI), IL-4/13A (not IL-4/13B), IL-10 and IL-11 partly correlated with target of rapamycin (TOR) signalling; and (4) up-regulated the mRNA levels of pro-inflammatory cytokines interferon-γ2, IL-1β, IL-6, IL-8 (not in PI), IL-12p35, IL-12p40, IL-15 and IL-17D partly related to NF-κB signalling in the intestine of on-growing grass carp. Overall, the results indicated that CT could impair the intestinal immune function, and its potential regulation mechanisms were partly associated with the TOR and NF-κB signalling pathways. Finally, based on the percentage weight gain and enteritis morbidity, the maximum allowable levels of CT for on-growing grass carp (232·22–890·11 g) were estimated to be 18·6 and 17·4 g/kg diet, respectively.
Multiple sulphur isotope compositions of sedimentary pyrites across the Ediacaran–Cambrian (Ed–C) transition and into the early Cambrian from the Xiaotan section, Yunnan, South China, are presented to explore the evolution of the sulphur cycle. The values of δ34Spy range from 13.5 ‰ to 35.8 ‰, and the values of Δ33Spy range from −0.044 ‰ to 0.063 ‰. The first-order observation of highly positive δ34Spy is consistent with sulphur isotope records from other sedimentary successions (with various degrees of enrichment in 34S), reflecting a common feature in cycling of sulphur among ocean basins. The positive values suggest that pyrite was formed in a depositional setting with limiting availability of sulphate that suppressed the expression of microbial fractionations. The first-order observation of a 10-million-year period of negative Δ33Spy beginning around the Ed–C boundary likely reflects changes in isotopic compositions of sulphur influx to the oceans. Such changes are suggested to be linked to a pulse of preferred weathering of sulphides (with negative Δ33S) relative to sulphate, which may reflect enhanced exposure of pyrites in continental margins due to reorganization of continents at this time. Both δ34Spy and Δ33Spy data imply low seawater sulphate levels, and possibly heterogeneity in sulphate concentrations in the world’s coastal oceans. The predictions about sulphur isotope signatures of evolved seawater (with highly positive δ34S and negative Δ33S) at the Xiaotan section are testable with future measurements of carbonate-associated sulphate (CAS), a proxy of ancient oceanic sulphate that carries information about the operation of sulphur cycling on a global scale.
Bipolar disorder (BD) is a severe psychiatric disorder associated with a high risk of suicide. This meta-analysis examined the prevalence of suicide attempts (SA) in patients with BD and its associated factors.
A systematic literature search was conducted in the PubMed, PsycINFO, EMBASE and Web of Science databases from their inception to 11 June 2018. The prevalence of SA in BD was synthesised using the random-effects model.
The search identified 3451 articles of which 79 studies with 33 719 subjects met the study entry criteria. The lifetime prevalence of SA was 33.9% (95% CI 31.3–36.6%; I2 = 96.4%). Subgroup and meta-regression analyses revealed that the lifetime prevalence of SA was positively associated with female gender, BD-I, BD Not Otherwise Specified and rapid cycling BD subtypes, income level and geographic region.
This meta-analysis confirmed that SA is common in BD and identified a number of factors related to SA. Further efforts are necessary to facilitate the identification and prevention of SA in BD. Long-term use of mood stabilisers coupled with psycho-social interventions should be available to BD patients to reduce the risk of suicidal behaviour.
To explore whether and how group cognitive-behavioural therapy (GCBT) plus medication differs from medication alone for the treatment of generalised anxiety disorder (GAD).
Hundred and seventy patients were randomly assigned to the GCBT plus duloxetine (n=89) or duloxetine group (n=81). The primary outcomes were Hamilton Anxiety Scale (HAMA) response and remission rates. The explorative secondary measures included score reductions from baseline in the HAMA total, psychic, and somatic anxiety subscales (HAMA-PA, HAMA-SA), the Hamilton Depression Scale, the Severity Subscale of Clinical Global Impression Scale, Global Assessment of Functioning, and the 12-item Short-Form Health Survey. Assessments were conducted at baseline, 4-week, 8-week, and 3-month follow-up.
At 4 weeks, HAMA response (GCBT group 57.0% vs. control group 24.4%, p=0.000, Cohen’s d=0.90) and remission rates (GCBT group 21.5% vs. control group 6.2%, p=0.004; d=0.51), and most secondary outcomes (all p<0.05, d=0.36−0.77) showed that the combined therapy was superior. At 8 weeks, all the primary and secondary significant differences found at 4 weeks were maintained with smaller effect sizes (p<0.05, d=0.32−0.48). At 3-month follow-up, the combined therapy was only significantly superior in the HAMA total (p<0.045, d=0.43) and HAMA-PA score reductions (p<0.001, d=0.77). Logistic regression showed superiority of the combined therapy for HAMA response rates [odds ratio (OR)=2.12, 95% confidence interval (CI) 1.02−4.42, p=0.04] and remission rates (OR=2.80, 95% CI 1.27−6.16, p=0.01).
Compared with duloxetine alone, GCBT plus duloxetine showed significant treatment response for GAD over a shorter period of time, particularly for psychic anxiety symptoms, which may suggest that GCBT was effective in changing cognitive style.