Andreas Frick

Background: The Generalized Anxiety Disorder 7-item scale (GAD-7) could provide currently lacking data on anxiety levels among adolescents and young adults in Sweden. However, psychometric assessments of the scale are scarce in this population. Additionally, the structural validity of the scale needs to be examined further, given conflicting findings in other populations. The aim of this study was to psychometrically evaluate the GAD-7 among 15–29-year-olds using Rasch analysis and confirmatory factor analysis in a Swedish, general population sample. In addition, an iterative process explored if revised versions of the scale could be identified that fit the Rasch model in this sample. Methods: A random, age- and sex-stratified sample of 15–29-year-olds from the Swedish population register was drawn, from which stratified groups were randomly invited to participate. Data ( n = 590) were collected through a study-specific app. Rasch analyses included investigation of item fit, local independence, principal components analysis of standardized Rasch model residuals, response category functioning, measurement invariance, scale-to-sample targeting, and reliability. In addition, confirmatory factor analyses (CFA) were conducted and interpreted using dynamic, data-adaptive cutoffs. An exploratory, iterative process was undertaken aiming at scale refinement based on results for the GAD-7. Results: No Rasch analyses provided support for the unidimensionality of the GAD-7, which also displayed issues with disordered response categories and measurement invariance. The CFA found substantial misfit for the one-factor model. The exploratory scale refinement resulted in two abbreviated scales warranting further investigation: Items 1–3 fit the Rasch model as a unidimensional scale and demonstrated acceptable to good reliability. Items 5–7 had good fit after merging the two highest response categories, although demonstrated poor reliability. Conclusions: No analyses provided support for the unidimensionality of the GAD-7 among 15–29-year-olds in Sweden. While these findings do not support the use of a single sum score, they require confirmation in independent samples. Future research should evaluate whether the abbreviated, candidate scale comprising items 1–3 could be useful to assess anxiety in this population, including examination of criterion validity and the potential benefits of adding a response category to enhance both reliability and scale-to-sample targeting.

Background: Females undergo hormonal fluctuations throughout every menstrual cycle and numerously report corresponding symptoms of negative mood or decreased motivation, indicating an increased risk for affective disorders associated with altered motivational behaviour. Understanding whether sex hormones modulate sex/gender-specific behavioural variability in motivation could inform personalised interventions. Methods: To assess whether steroid hormone fluctuations and menstrual cycle phase modulate sex/gender-specific motivation, we examined 48 naturally cycling cisgender females and 46 cisgender males, aged 18–34, who performed a physical effort task while fasted (part 1, T0) and across four weeks (part 2, T1-T4). We obtained objective (invigoration and effort maintenance) and subjective (wanting and exertion) measures of motivation in response to food and monetary rewards. Menstrual cycle phases were determined based on cycle-day counting methods alongside plasma levels of estradiol, progesterone, and testosterone. We tested whether females show higher effort maintenance, males exhibit greater reward sensitivity, and explored whether motivational behaviour differs by sex/gender, cycle phase and hormonal variation. Results: Cross-sectionally, we replicated sex/gender specific reward sensitivity and valuation: Females showed more sustained effort, especially for small rewards, while males displayed more opportunistic approaches seeking monetary rewards. Longitudinally, motivation decreased during periovulatory and luteal phases, whereas levels of endogenous hormones explained little variance in instrumental effort beyond task incentives and sex/gender associations. Conclusions: Motivational behaviour in effort-based decision-making is more related to dynamic sex/gender-related factors and menstrual cycle phases overall than to short-term steroid hormone fluctuations. Our findings emphasise the importance of integrating biological, psychosocial, and physiological factors when investigating motivation. Our research has potential implications for personalised interventions and treatment of motivational deficits.

Background: Identifying predictors and mechanisms in the development of childhood internalizing (INT) and externalizing (EXT) problems is crucial for early intervention. Inhibitory control has been linked to INT and EXT, with emotion regulation (ER) potentially mediating these associations. However, specific pathways between early inhibitory control, ER, and later INT and EXT remain unclear. Additionally, regulation of distinct emotions (anger, fear, sadness, joy) may play a role. Methods: The sample included 94 typically developing children from the EFFECT study, a longitudinal project on the development of self‐regulation. At age 4, inhibitory control was measured using the Day/Night Stroop Task. At age 6, general ER, as well as regulation of specific emotions (anger, fear, sadness, and joy), were assessed using the Emotion Questionnaire (parent‐report). INT and EXT at ages 9–10 were measured using the Strengths and Difficulties Questionnaire (parent‐report). Correlational and path analyses were conducted. Results: No longitudinal associations were found between inhibitory control at 4 years and either INT or EXT at ages 9–10, or with ER at age 6. Consequently, we found no evidence of mediation by ER. General ER at 6 years emerged as a predictor of both INT and EXT at 9–10 years. While not statistically significant, effect sizes linking regulation of some specific emotions (anger, fear) with subsequent INT and EXT problems warrant further research. Conclusion: The results reflect the complexity of studying longitudinal effects of early inhibitory control. A modest sample size with attrition, and measurement constraints may have attenuated effects and limited generalizability. Meanwhile, our findings highlight ER as a target for intervention across both INT and EXT.

Females undergo hormonal fluctuations across every menstrual cycle, often experiencing mood changes or decreased motivation, indicating increased risk for affective disorders associated with altered motivation. To assess whether steroid hormone fluctuations and menstrual cycle phase modulate sex/gender-specific motivation, we examined 48 naturally cycling females and 46 males, aged 18-34, who performed a physical effort task while fasted (part 1, T0) and across four weeks (part 2, T1-T4). We obtained objective and subjective measures of motivation in response to food and monetary rewards, alongside plasma levels of estradiol, progesterone, and testosterone. Results revealed sex/gender specific reward sensitivity: Females showed more sustained effort, especially for small rewards, while males displayed opportunistic approaches seeking monetary rewards. Motivation decreased during periovulatory and luteal phases and high estradiol levels correlated with decreased motivation in females and males. Our findings emphasise the importance of integrating biological, psychosocial, and physiological factors in understanding and treating motivational deficits.

Background: Caffeine in doses above 400 mg, approximately four cups of coffee, induces panic attacks in 50% of individuals with panic disorder (PD) and elevates anxiety, but it is not known how individuals with PD respond to normally consumed doses or how caffeine interacts with emotional tasks. Aims: We hypothesized that 150 mg caffeine would increase subjective anxiety (primary outcome) as well as interoceptive attention and anxiety from bodily signals in patients with PD, and more so than in healthy controls (HCs). Additional analyses targeted panic attacks, emotional reactivity, avoidance behavior, and subjective exteroceptive attention. Methods: Twenty-nine patients with PD and 53 HC with low habitual caffeine consumption (⩽300 mg/week) abstained from caffeine 36 h before receiving 150 mg caffeine or placebo in a double-blind randomized crossover design 2–14 days apart. Results: Contrary to our hypotheses, caffeine did not increase subjective anxiety, interoceptive attention, or anxiety from interoceptive signals. Only one panic attack was noted, in the PD group after caffeine intake during the emotional reactivity task. In both PD and HC, caffeine increased skin conductance responses to neutral and emotional faces, augmented costly avoidance behavior, and impaired exteroceptive attention. These results indicate that low caffeine doses do not have differential anxiogenic effects in patients with PD and HC at rest, and that they increase arousal and avoidance behavior in both PD and healthy individuals. Conclusions: In conclusion, we suggest that recommendations for caffeine abstinence for patients with PD should be based on higher doses and ideally on individual assessments.

Caffeine in doses above 400 mg, equivalent to 4 cups of coffee, induces panic attacks in 50% of individuals with panic disorder (PD) and elevates anxiety, but it is still not known how individuals with PD respond to normally consumed doses or how caffeine interacts with emotional tasks. We hypothesized that 150 mg caffeine would increase subjective anxiety (primary outcome) as well as interoceptive attention and anxiety from bodily signals in patients with PD, and more so than in healthy controls (HC). Additional analyses targeted panic attacks, emotional reactivity, avoidance behavior, and subjective exteroceptive attention. Twenty-nine patients with PD and 53 HC with low habitual caffeine consumption (≤300 mg/week) abstained from caffeine 36 h before receiving 150 mg caffeine or placebo in a double-blind randomized crossover design 2-14 days apart. Contrary to our hypotheses, caffeine did not increase subjective anxiety, interoceptive attention, or anxiety from interoceptive signals in any of the groups. Only one panic attack was noted, in the PD group after caffeine intake during the emotional reactivity task. In both PD and HC caffeine increased skin conductance responses to neutral and emotional faces, augmented costly avoidance behavior, and impaired exteroceptive attention. These results indicate that low caffeine doses do not have differential anxiogenic effects in patients with PD and HC at rest, and that they increase arousal and avoidance behavior in both patients and healthy individuals. In conclusion, we suggest that recommendations for caffeine abstinence for patients with PD should be based on higher doses and ideally on individual assessments.

Perinatal affective disorders are common, but standard screening measures reliant on subjective self-reports might not be sufficient to identify pregnant women at-risk for developing postpartum depression and anxiety. Lower heart rate variability (HRV) has been shown to be associated with affective disorders. The current exploratory study aimed to evaluate the predictive utility of late pregnancy HRV measurements of postpartum affective symptoms. A subset of participants from the BASIC study (Uppsala, Sweden) took part in a sub-study at pregnancy week 38 where HRV was measured before and after a mild stressor (n = 122). Outcome measures were 6-week postpartum depression and anxiety symptoms as quantified by the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Anxiety Inventory (BAI). In total, 112 women were included in a depression outcome analysis and 106 women were included in an anxiety outcome analysis. Group comparisons indicated that lower pregnancy HRV was associated with depressive or anxious symptomatology at 6 weeks postpartum. Elastic net logistic regression analyses indicated that HRV indices alone were not predictive of postpartum depression or anxiety outcomes, but HRV indices were selected as predictors in a combined model with background and pregnancy variables. ROC curves for the combined models gave an area under the curve (AUC) of 0.93 for the depression outcome and an AUC of 0.83 for the anxiety outcome. HRV indices predictive of postpartum depression generally differed from those predictive of postpartum anxiety. HRV indices did not significantly improve prediction models comprised of psychological measures only in women with pregnancy depression or anxiety.