Mindfulness-Based Interventions for Anxiety and Depression

Background One in three college students experience significant depression or anxiety interfering with daily functioning. Resilience programs that can be administered to all students offer an opportunity for addressing this public health problem. The current study objective was to assess the benefit of a brief, universal resilience program for first‐year college students. Method First‐year students at a private, midwestern university participated. This trial used a pragmatic design, delivering the intervention within university‐identified orientation courses and was not randomized. The four‐session resilience program included goal‐building, mindfulness, and resilience skills. The comparison was orientation‐as‐usual. Primary outcomes included PROMIS® Depression and Anxiety and Connor‐Davidson Resilience Scale. Secondary and exploratory outcomes included the Perceived Stress Scale, Emotion Regulation, and Cognitive Behavioral Therapy (CBT) Skills Questionnaires, and Freiburg Mindfulness Inventory. Time by treatment interactions at post‐training and semester‐end were examined using linear mixed models. Results Analysis included 252 students, 126 who completed resilience programming and a matched comparison sample. Resilience programming did not relate to improvements in depression at post‐training (CI: −2.53 to 1.02; p = .404, d =−0.08), but did at semester‐end (95% CI: −4.27 to −0.72; p = .006, d = −0.25) and improvements in perceived stress were observed at post‐training (CI: −3.31 to −0.44; p = .011, d = −0.24) and semester‐end (CI: −3.30 to −0.41; p = .013, d = −0.24). Emotion regulation, mindfulness, and CBT skills increased, with CBT skills mediating clinical improvements. Conclusions Universal implementation of a brief, resilience intervention may be effective for improving college student mental health.

Introduction / objectives Management of anxiety and depression in rheumatoid arthritis (RA) patients is vital. Previous studies investigating this topic are conflicting, and this topic still has not been thoroughly investigated. This study aimed to clarify the association of disease activity with anxiety and depression after controlling for physical disability, pain, and treatment.Method We conducted a cross-sectional study of RA patients from the Kyoto University Rheumatoid Arthritis Management Alliance cohort. For assessments, we used the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety Depression Scale.Depression and anxiety were defined by a Hospital Anxiety Depression Scale score ≥8. We then performed multivariable logistic regression analyses. ResultsOf 517 participants, 17.9% had anxiety, and 28.2% had depression. The multivariable logistic regression analyses showed patients with DAS28-based non-remission had low association with anxiety (odds ratio [OR] [95% confidence interval {CI}], 0.93 [0.48-1.78]: p = 0.82) but slight association with depression (OR [95% CI], 1.45 [0.81-2.61]: p = 0.22). However, severity of the patient's global assessment (PtGA) on DAS28 was associated with anxiety (OR [95% CI], 1.15 [1.02-1.29]; p = 0.03) and depression (OR [95% CI], 1.21 [1.09-1.35]; p < 0.01). Additionally, HAQ-DI-based non-remission was associated with anxiety (OR [95% CI], 3.51 [1.85-6.64]; p < 0.01) and depression (OR [95% CI], 2.65 [1.56-4.50]; p < 0.01). Younger patients (OR [95% CI], 0.83 [0.68-1.01]; p = 0.07) and patients not treated with methotrexate (OR [95% CI], 0.67 [0 .40-1.13]; p = 0.13) tended to suffer from anxiety. Patients using steroids had a closer association with depression than those not using them (OR [95% CI], 1.66 [1.03-2.67]; p = 0.04).Conclusions Assessment of disease activity, PtGA, and HAQ-DI are important for assessing anxiety and depression in RA patients. Attention should be paid to improving PtGA and physical function.

Purpose of Review To determine the efficacy of mindfulness-based interventions (MBIs) on clinical and patient-reported outcomes in rheumatoid arthritis (RA). Recent Findings We identified randomized clinical trials from inception through April 2018 from MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, the Cochrane Library, and hand searches. After screening 338 references, we included five trials with one post-hoc analysis that evaluated MBIs and collectively included 399 participants. Outcome instruments were heterogeneous across studies. Three studies evaluated RA clinical outcomes by a rheumatologist; one study found improvements in disease activity. A limited meta-analysis found no statistically significant difference in the levels of DAS28-CRP in the two studies that evaluated this metric (− 0.44 (− 0.99, 0.12); I2 0%). Four studies evaluated heterogeneous psychological outcomes, and all found improvements including depressive symptoms, psychological distress, and self-efficacy. A meta-analysis of pain Visual Analog Scale (VAS) levels post intervention from three included studies was not significantly different between MBI participants and control group (− 0.58 (− 1.26, 0.10); I2 0%) although other studies not included in meta-analysis found improvement. Summary There are few trials evaluating the effect of MBIs on outcomes in patients with RA. Preliminary findings suggest that MBIs may be a useful strategy to improve psychological distress in those with RA.