Poor reading ability is associated with internalising symptoms in children; however, little research has been done with adolescents. The current study used self- and parent-report data from two cohorts of the Longitudinal Study of Australian Children (LSAC; N = 2222 and N = 2213) to test the longitudinal and bidirectional relationships between reading ability and internalising symptoms across adolescence (10/11 years, 12/13 years, 14/15 years, 16/17 years), and whether academic self-concept mediated these relationships. Adapted cross-lagged panel models found no significant longitudinal relationships between reading ability and later internalising symptoms or between internalising symptoms and later reading ability. There was a significant relationship between reading ability at 12/13 years and academic self-concept at 14/15 years, but no significant relationship between academic self-concept at 14/15 years and internalising symptoms at 16/17 years. Poor reading ability does not appear to increase adolescents’ risk of mental health problems either directly or indirectly.

Objectives: Internet-delivered cognitive behavioural therapy (iCBT) shows promise for treating anxiety and depression in older adults; however, existing trials have relied on programs developed for younger users that require high-level technological proficiency. This study: (1) co-designed an iCBT intervention for anxiety/depression in older adults, based on an established program; and (2) evaluated its efficacy and acceptability in a randomised controlled trial (RCT). Methods: Study 1 (Co-design): Ageing Wisely Online (AW Online) was co-designed with older people (N = 6) and clinicians (N = 7) using an iterative participatory design with focus groups, followed by user testing and refinement of a prototype. Study 2 (RCT): In a parallel-group RCT, 68 older adults (aged 65–89 years) with a diagnosed anxiety and/or depressive disorder were randomly allocated to AW Online or waitlist control. Results: Compared to waitlist, participants receiving AW Online showed significantly greater reductions in primary disorder severity, anxiety and depression severity on diagnostic and self-report measures, diagnostic remission, as well as improvements in quality of life, psychosocial functioning and overall mental health. AW Online demonstrated high acceptability (completion rates and satisfaction ratings). Conclusions: Ageing Wisely Online is an effective and acceptable iCBT intervention for anxiety and depression in older adults.

While low resting heart rate variability (HRV) is associated with various forms of psychopathology, patterns of specificity and non-specificity in the apparent transdiagnostic nature of resting HRV have not been systematically investigated. Existing research is dominated by disorder-specific studies, limiting conclusions about whether HRV reductions reflect mechanisms unique to particular diagnoses or a broader transdiagnostic vulnerability. Using the Hierarchical Taxonomy of Psychopathology (HiTOP) framework, this Stage 2 Registered Report synthesized evidence from 430 studies and 732 effect sizes (N = 62,264) to quantify associations between resting HRV and psychopathology at multiple levels of specificity—from individual disorders to higher-order spectra and superspectra. Across the hierarchy, lower resting HRV emerged as a robust correlate of most domains of psychopathology. For example, at the disorder level, lower resting HRV was significantly associated with schizophrenia, bipolar disorder, autism, generalized anxiety, panic disorder, borderline personality, posttraumatic stress disorder, and major depression, but not with obsessive-compulsive disorder, social anxiety, and attention-deficit/hyperactivity disorder. Psychotic conditions showed the strongest associations across all levels of the hierarchy, but sensitivity analyses indicated that these associations are likely influenced by study design and sample characteristics. Together with consistent moderator effects showing stronger HRV–psychopathology associations in samples with higher symptom severity, we conclude that decrements in resting HRV represent a transdiagnostic marker of systemic dysregulation reflecting illness severity rather than disorder-specific autonomic signatures.

The evidence for the structure of the Hierarchical Taxonomy of Psychopathology (HiTOP) model relies heavily on analyses of correlations among DSM diagnoses, which entrenches some of their limitations. In this study, we deconstructed the mental disorders covered in HiTOP into individual symptoms—with personality disorders represented via item-level assessment of the Alternative Model for Personality Disorders facets—and rebuilt the HiTOP model from the ground up. Participants self-selected into an online mental health study and were randomly split into primary (n = 11,762) and hold-out (n = 3,000) samples to identify a robust hierarchy of empirically derived constructs in the results, ranging from symptoms and syndromes to very broad ‘superspectra’ of psychopathology. In each sample, both hierarchical clustering and hierarchical principal components analyses were used; the final hierarchical structure was derived based on points of cross-sample and cross-method agreement. The resulting model was remarkably similar to the HiTOP model, including nearly all of the same subfactors, spectra, and superspectra—albeit with some reorganisation in the structure. The inclusion of broad hypomania/disinhibition and pathological introversion dimensions represented the most prominent differences compared to the current higher-order structure of HiTOP. The detailed lower-order constructs found here also mirrored many of the existing components and traits in HiTOP, as well as indicating some potential areas for revision. Finally, we re-mapped the disorders included in the Structured Clinical Interview for the DSM-5 onto the new model. Overall, the results suggest that the structural foundations of the HiTOP model are largely sound.

Cognitive bias modification of Interpretations (CBM-I) has been proposed as a promising mechanistically-focused intervention for social anxiety disorder (SAD). Although CBM-I modifies the interpretation biases associated with SAD, the effect sizes for symptomatic improvements are small. The efficacy of CBM-I may be improved by tailoring the content of the intervention to the targeted disorder (i.e., content-specificity). The current study examined whether content-specific CBM-I was associated with improved bias and symptom outcomes compared to non-content-specific CBM-I. Participants (N = 108, aged 18–35, M = 19.00, SD = 2.44) with elevated social anxiety symptoms were randomly allocated to receive a single session of content-specific or non-content-specific CBM-I. The content-specific group had significantly greater reductions in negative interpretation bias and social interaction anxiety symptoms than the non-content-specific group. There were no group differences for social observation anxiety. However, the non-content-specific group had a significantly larger reduction in state anxiety than the content-specific group. The results indicated that CBM-I for SAD may be improved by matching the content of the intervention to the disorder. Future research should replicate the results using multiple sessions and consider the importance of tailoring CBM-I to diagnostic presentation and specific biases.

Replacing irrational or unhelpful thoughts with more rationale and helpful ones is a core skill in Cognitive Behavioural Therapy, but there is limited research examining the neuropsychological mechanisms underpinning this process. This study examined age-differences in cognitive restructuring skill acquisition between children, younger adults and older adults; whether individual differences in cognitive flexibility influences the ability to learn cognitive restructuring across the lifespan; and whether cognitive flexibility explains age-differences in cognitive restructuring ability. Participants were 114 individuals with anxiety disorders, including 35 children (aged 7–12, M = 9.14, SD = 1.44), 32 younger adults (aged 18–53, M = 23, SD = 7.84) and 47 older adults (aged 61–78, M = 66.81, SD = 4.43). Participants completed neuropsychological measures of cognitive flexibility and learned cognitive restructuring, which was coded for quality and efficacy. More than half the participants of all ages showed good quality cognitive restructuring skill acquisition with only brief instruction. Older adults showed comparable cognitive restructuring skills to children, with slightly better skills among younger adults. However, after accounting for individual differences in cognitive flexibility, there were no age-differences in cognitive restructuring quality. Greater perseveration was associated with poorer cognitive restructuring skill acquisition in younger and older adults, and mediated age-differences in cognitive restructuring skill acquisition. Among younger and older adults, individual differences in perseveration, rather than chronological age, underpins the ability to learn cognitive restructuring. There is little evidence that cognitive flexibility plays a role in cognitive restructuring skill acquisition among children.

Sleep problems commonly co-occur alongside generalized and social anxiety, depression, and eating disorders in young people. Yet it is unclear if sleep disturbance conveys risk for these social-emotional disorders across early to middle adolescence and whether repetitive negative thinking (RNT) mediates this association. In this study, we examined longitudinal relationships between sleep (morning/eveningness, school-night sleep duration, and sleepiness), general and presleep RNT, and symptoms of generalized and social anxiety, depression, and eating disorders across 5 years. As part of the wider Risks to Adolescent Wellbeing Project, these constructs were assessed in a cohort of 528 youths over six annual waves of data collection, spanning ages 11 to 16. Cross-lagged panel models that examined direct, indirect, and bidirectional associations showed that worse adolescent sleep predicted increases in symptoms of generalized anxiety, social anxiety, depression, and eating disorders across each wave directly and indirectly through general and presleep RNT. Symptoms of social-emotional disorders did not predict worsening in sleep. Results suggest that sleep disturbance and RNT should be targeted simultaneously in the prevention and treatment of social-emotional disorders in adolescence, although limitations around the use of self-report and nondiagnostic symptom measures are noted.

Parenting is a modifiable factor proposed to underpin the transmission of anxiety and depression from parents to children. This study examined the role of parenting in the intergenerational transmission of anxiety and depression across pre‐ and early adolescence.

Individuals with social anxiety underestimate their social performance compared to observers (i.e., self-observer discrepancy). Cognitive models suggest that heightened attention to, and exaggerated perception of, physiological symptoms of anxiety results in the construction of (inaccurate) mental representations of their external appearance. This study examined the relative contribution of subjective physiological arousal, self-focused attention and objective physiological arousal in predicting self-observer discrepancies during a speech performance task. Participants with high (N = 39) and low (N = 36) levels of speech anxiety completed a 10-minute speech task, with continuous measurement of objective physiological arousal (heart rate and skin conductance), self-reported subjective physiological arousal and focus of attention. Speech performance quality was rated by participants and observers to assess self-observer discrepancy. There was higher self-observer discrepancy, self-focused attention and subjective physiological arousal in the high vs. low anxiety group, but no significant difference in objective physiological arousal. Subjective physiological arousal and self-focused attention predicted self-observer discrepancy, but objective physiological arousal did not. Results are consistent with cognitive models of social anxiety suggesting that cognitive and attentional biases, rather than differences in objective physiological experience, are key in understanding self-observer discrepancies in social anxiety.

Heart Rate Variability (HRV) can be quantified using a myriad of mathematical indices, but the lack of systematic and empirical comparison between these indices complicates the evaluation and interpretation of HRV data. This study assessed the reliability, consistency, and generalizability of the structural relationships among 89 HRV indices using a consensus-clustering approach. We analyzed 635 short-term resting-state electrocardiogram (ECG) recordings from two samples of college students with differing psychological profiles. Results from a sample with elevated internalizing symptoms (N=233)—collected across two sessions, one week apart—were compared to evaluate the test-retest reliability of the HRV clusters. To further assess the stability and generalizability of these HRV clusters beyond individuals with elevated internalizing symptoms, these results were compared with a second sample not selected based on psychological symptoms (N=203). We identified 19 clusters of 70 HRV indices with cross-method, test-retest, and cross-sample robustness. Based on the robust empirical convergence and the relative popularity of some HRV indices in the extant literature, we recommend 13 HRV indices for short-term recordings of resting-state HRV (under 10 minutes): RMSSD, SDNN, RSA (Porges-Bohrer or Peak-to-Trough method), RSA (Gates method), SD1/SD2 or CSI, ApEn or SampEn, HF or LnHF, DFA α1, DFA α2, one of the MDFA α1 features, one of the MDFA α2 features, one of the heart rate asymmetry indices, and one of the heart rate fragmentation indices. This approach mitigates the biases that can arise from redundant or highly correlated indices, facilitates clearer interpretation, and enhances the validity of conclusions drawn from HRV analyses.

ObjectiveThis study assessed older adults' preferences, attitudes, and motivations to understand and change their individual risk for developing dementia via screening in primary care settings.MethodEighty-six community-dwelling older adults (aged 60-91 years, M = 74.03, SD = 6.83) completed measures of behavioural intent to undergo dementia risk screening, response efficacy (i.e., belief that screening is useful), negative affective responses (e.g., risk screening results making individuals more scared about the future), motivation to change risk-related behaviours, level of social support, depression, and anxiety symptomatology.ResultsOverall, participants reported positive attitudes towards dementia risk screening and risk reduction. Two ordinal logistic regressions indicated that response efficacy was a significant predictor of behavioural intent to undergo dementia risk screening, whereas self-efficacy and family history of dementia were significant predictors of motivation to change risk-related behaviours. Barriers included lack of information, motivation, and self-control. Facilitators included access to formal and informal supports, and engagement with social and non-social activities.ConclusionsDementia risk screening and risk reduction in primary care may be more desirable for those with a family history of dementia, high response efficacy, and high self-efficacy. Addressing barriers such as lack of information, motivation, and self-control may improve older adults' engagement with dementia risk reduction. What is already known about this topic:Lifestyle factors can be modified to reduce dementia risk; however, an understanding of the role of motivation to change these behaviours is limited.Age, sex, family history of dementia, and dementia carer experience have been linked to motivation to reduce dementia risk.There is very limited understanding of people's behavioural intent to undergo dementia risk screening in primary care.What this topic adds:Overall, older adults had positive attitudes towards dementia risk screening and risk reduction in primary care settings, and screening results mostly did not induce fear about the future.Response efficacy was a significant predictor of behavioural intent to undergo dementia risk screening, whereas self-efficacy and family history of dementia were significant predictors of motivation to change risk-related behaviours.Barriers to behaviour change were lack of information, motivation, and self-control. Facilitators were formal and informal supports, and social and non-social activities.

STUDY OBJECTIVES:Perfectionism is a possible risk factor for insomnia, yet longitudinal evidence of this relationship in adolescence is lacking. Cross-sectional evidence suggests the nature of the relationship may differ based on biological sex, and the form of perfectionism, since socially prescribed and self-oriented critical perfectionism are conceptualised as maladaptive for wellbeing, while self-oriented striving may be adaptive or neutral. This study aimed to investigate longitudinal bidirectional relationships between total perfectionism, and sub-forms of perfectionism (i.e., socially prescribed, self-oriented critical, self-oriented striving perfectionism), and symptoms of insomnia, over the course of mid-adolescence. Longitudinal models were examined for males and females separately. METHODS:434 adolescents (Mage = 14.25, SD = 0.56, range = 13-16, 52 % male) completed questionnaire measures of perfectionism (Child-Adolescent Perfectionism Scale) and insomnia (Insomnia Severity Index) on three annual occasions (at approximately 14, 15 & 16 years of age). Data were from the larger Risks to Adolescent Wellbeing (RAW) Project. RESULTS:Biological sex did not moderate the association between insomnia symptoms and any form of perfectionism. Cross-lagged panel models showed no longitudinal relationship between self-oriented striving, nor self-oriented critical perfectionism and insomnia symptoms for males or females. Higher total perfectionism predicted moderate increases in insomnia symptoms for males and females, but insomnia symptoms did not predict changes in total perfectionism. Socially prescribed perfectionism and insomnia symptoms predicted large and moderate increases in one another over time, respectively, forming a perpetuating cycle. CONCLUSIONS:Results suggest that perfectionism may be an important risk factor for insomnia symptoms in adolescents.

Background: Little is known about the impact of short, low-intensity multidomain dementia risk reduction interventions in older adults. Objectives: To examine the effectiveness and feasibility of a low-intensity multidomain lifestyle intervention on dementia risk and dementia literacy in Australian older adults. Design: Single-group pre-post design. Setting: Community-dwelling. Participants: A total of 853 older Australians (Mean age=73.3 years, SD=6.1) recruited from the community. Intervention: A 3-month dementia risk reduction program, BRAIN BOOTCAMP, including education, personalised risk information, physical cues for healthier choices and goal setting and planning to target four modifiable risk factors of diet, exercise, cognitive activity and social interaction in older adults. Measurements: The 'LIfestyle for BRAin health' (LIBRA) index was used to assess participants' modifiable dementia risk based on 12 factors, with higher scores indicating greater risk. Dementia literacy was measured using a modified questionnaire derived from Dutch and British surveys, encompassing knowledge, risk reduction, and awareness aspects. Paired t-tests were used to compare dementia risk scores and dementia literacy before and after the program. Multivariate regressions were performed to identify sociodemographic and psychological factors associated with change in the LIBRA index. Results: Program attrition was high (58.3%). Participants who completed the program had decreased dementia risk scores (Cohen's d=0.59, p<0.001), increased dementia literacy and awareness (Cohen's d=0.64, p<0.001) and increased motivation to change lifestyle behaviors (Cohen's d=0.25-0.52, p<0.016). Participants with higher motivational beliefs had greater dementia risk reduction. Conclusions: Improving older adults' motivation and knowledge may help modify lifestyle behaviors to reduce dementia risk. However, program attrition remains a challenge, suggesting the need for strategies to enhance participant engagement and retention in such interventions.

Anxiety disorders are common, emerge during childhood, and pose a significant burden to society and individuals. Research evaluating the impact of anxiety on functional impairment and quality of life (QoL) is increasing; however, there is yet to be a systematic review and meta-analysis of these relationships in pediatric samples. This systematic review and meta-analysis were conducted to determine the extent of impairments in functioning and QoL that young people with anxiety disorders experience relative to their healthy peers, as well as sociodemographic and clinical moderators of these relationships. Studies were included when they compared young people (mean age range within studies 7–17 years) with a primary clinical anxiety disorder to a healthy comparison group and measured impairment and/or QoL via a validated instrument. A total of 12 studies met criteria for this review (N = 3,129 participants). A majority of studies (K = 9) assessed impairment as an outcome measure, and three assessed QoL outcomes. Meta-analysis of nine studies (N = 1,457 children) showed large relationships between clinical anxiety and life impairment (g = 3.23) with the strongest effects seen for clinician report (g = 5.00), followed by caregiver (g = 2.15) and child (g = 1.58) report. The small number of studies and diversity in methodology prevented quantitative investigation of moderating factors. In the systematic review of QoL outcomes, all three studies reported significantly poorer QoL for youth with anxiety disorders relative to unaffected peers. Findings support the importance of measuring functioning and QoL as outcomes in clinical research and practice among anxious young people. This study is registered with PROSPERO under the identification number CRD42023439040.

BACKGROUND:This systematic review and meta-analysis examined the efficacy of low intensity psychological interventions for older adults (60+ years) with clinical anxiety and/or depressive disorders. METHOD:Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression with an active or passive control condition (e.g., waitlist, treatment-as-usual or active control) in any setting. Low intensity psychological interventions (e.g., cognitive behaviour therapy [CBT]) targeted anxiety and/or depression as primary outcomes, were primarily self-help, and included support from trained practitioners/facilitators with <6 h total contact time (typically <30 min p/contact). RESULTS:Seven studies consisting of 304 older adults (65-78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = -0.62) and large effect sizes for anxiety (Cohen's d = -0.84) at post-treatment. LIMITATIONS:Results are limited by study design of included studies such that the efficacy of interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown. CONCLUSIONS:There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. More research is needed to examine efficacy compared to active control conditions, and among those over 80 years.

This three-wave panel study examined the prospective and bidirectional relationships between parental control of social media use, and parents’ and adolescents’ perceived time spent on social media over a 2-year period. Adolescents (52% males, T1: Mage = 12.19, SD = 0.52) and one of their parents (96% mothers, T1: Mage = 45.26, SD = 4.28) completed annual surveys (T1: N = 498, T2: N = 477 and T3: N = 440). Data were analysed using cross-lagged panel models. More adolescent time spent on social media predicted small decreases in parental control 1 year later, but parental control did not predict adolescent time on social media. More parental time spent on social media predicted small increases in adolescent time spent on social media 1 year later, but adolescent use did not predict parent use. Examining factors related to parental use, rather than restriction, may be more effective to reduce adolescents’ social media use.

Contrary to ageist stereotypes, anxiety disorders are less common in older compared with younger adults. However, anxiety is often under-recognized and undertreated in this population. Anxiety disorders affect around 1 in 10 older adults, are unremitting, and are associated with a range of negative outcomes, including increased risk of depression, cognitive and functional decline, physical health problems, increased healthcare use, and suicide. This article summarizes the epidemiology and risk factors of anxiety in later life, explores variations in symptom presentation compared with younger adults, and outlines recommendations for assessment and treatment.

Background: This study examined the long-term durability of cognitive behaviour therapy (CBT) for older adults with comorbid anxiety and depression 10 years after treatment, in comparison to an active control group. Method: Participants from a randomised controlled trial for older adults with comorbid anxiety and depression (Wuthrich et al., 2016) were re-contacted. Participants had received either group CBT or an active control treatment (Discussion Group). The final sample (N = 54; Aged 70-84, M age = 76.07, SD = 3.83; 59 % of the eligible original sample) completed a diagnostic interview, cognitive assessment and self-report measures of symptoms and quality of life. Results: CBT was associated with significantly improved long-term (10-year) efficacy for reducing anxiety and depression in older adults compared to the Discussion group. Effects included higher rates of remission (58 % remission of all diagnoses vs 27 %, 88 % of all depressive diagnoses vs 54 %, 63 % of all anxiety diagnoses vs 35 %, 67 % of primary diagnosis vs 42 %), lower rates of relapse (25-31 % vs 50-78 %) and lower rates of chronic treatment-resistance (8 % primary disorder vs 39 %, 21 % any disorder vs 58 %). Participants who showed an acute treatment response at post-treatment were 7-9 times more likely to be in remission after 10 years than those with residual symptoms. Limitations: Results may not generalise to those who do not complete CBT, and the time trajectory of symptom change is unclear. Conclusions: Long-term improvements in symptoms are specific to CBT. Results provide compelling evidence for CBT as an effective and durable treatment for late-life anxiety and depression.

Research has consistently shown that more physically attractive individuals are perceived by others to be happier and better psychologically adjusted than those perceived as less attractive. However, due to the lack of longitudinal research in adolescents, it is still unclear whether poor mental health predicts or is predicted by either objective or subjective attractiveness during this critical developmental period. The purpose of the current study was to examine prospective bidirectional associations between both subjective and objective ratings of attractiveness, life satisfaction and symptoms of social anxiety, depression and eating disorders (i.e., internalizing symptoms) from early to mid-adolescence. Participants (T1: N = 528, 49.9% girls; Mage = 11.19; SD = 0.55) were followed annually over four time points. The cross-lagged panel model results revealed evidence of prospective associations between both forms of attractiveness and life satisfaction and internalizing symptoms, which were driven more by changes in the mental health outcomes than by changes in the subjective and objective attractiveness ratings. The results also indicated that the pattern, strength, and direction of the associations tested were robust across boys and girls, and white and non-white ethnic groups. Overall, the findings suggest that it is important to find effective ways of educating adolescents who are unhappy with their appearance that making changes to improve their mental health, rather than focusing on their physical appearance, will have benefits not only for how they perceive themselves but also for how they are perceived by others.