Digital health intervention finds link between anxiety and depression symptoms

A digital health intervention delivered via smartphone showed that current anxiety symptoms predicted current and later depressive symptoms.

In a 12-week, therapist-supported, smartphone-delivered digital health intervention for symptoms of anxiety and depression, researchers found that symptoms of the two conditions overlap and fluctuate together.

The intervention also demonstrated that anxiety symptoms predicted later depressive symptoms more strongly, compared with depressive symptoms predicting anxiety symptoms.

These findings were published in Journal of Clinical Psychology🇧🇷

The study included 290 participants, mostly female (79%), with a mean (SD) age of 39.64 (10.25) years. The study authors noted that more than half (54%) of the patients reported using psychotropic medications. In addition, all patients scored at least 5 on either the Patient Health Questionnaire (PHQ-9) or the Generalized Anxiety Questionnaire (GAD-7).

The smartphone-based intervention included a prespecified sequence of evidence-based modules integrating components of mindfulness-based stress reduction and cognitive therapy, cognitive behavioral therapy, and heart rate variability biofeedback (HRVB) training.

The authors used mixed linear models to analyze the simultaneous and delay relationships between anxiety and depression.

In 1 hypothesis, the authors predicted that an increase in anxiety would be linked to an increase in depression in the current week. In a second hypothesis, they also predicted that an increase in anxiety in the previous week would be followed by an increase in depression in the current week.

In support of the first prediction, the authors found that higher levels of anxiety during the current biweekly assessment were associated with greater depressive symptoms during the current biweekly assessment.

In support of the second hypothesis, higher levels of anxiety during the previous biweekly assessment were associated with greater depressive symptoms during the current biweekly assessment.

“Our results, limited by the lack of a comparison group, are consistent with day-to-day data that anxiety symptoms at the time t–1 were a stronger predictor of depressive symptoms at the time t than depressive symptoms at the moment t–1 predicting current anxiety levels t”, said the authors.

The authors also noted that these results “are far from conclusive but raise several questions,” adding that future studies would benefit from analyzing the effects of anxiety mediators and moderators on subsequent depressive symptoms and certain emotional effects of anxiety reduction.

“Third, it would be important to examine specific GAD-7 items that predict subsequent reductions in depression, such as being nervous and tense, worrying about multiple events, difficulty controlling worry, difficulty relaxing, irritability, and fear of an event. negative happening in the future,” they added.

Furthermore, due to the relationship between anxiety and depression, altering weekly treatment approaches based on changing levels of anxiety and depression may benefit patients more than the structured approach adopted in this specific intervention.

“For example, if a patient’s anxiety is greater than depression in a given week, the patient may benefit from psychoeducation about the cyclical nature of anxiety and depression and collaboration with the clinician to develop skills to mitigate a possible future mood deterioration,” the authors suggested.

Reference

Allende S, Forman-Hoffman VL, Goldin PR. Examining the temporal dynamics of anxiety and depressive symptoms during a therapist-supported smartphone-based intervention for depression: a longitudinal observational study. J Clin Psychol🇧🇷 Published online June 10, 2022. doi:10.1002/jclp.23401

Digital health intervention finds link between anxiety and depression symptoms

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