Michelle G. Craske’s research while affiliated with University of California, Riverside and other places

Objective Previous research has found that social anxiety and depression are associated with occupational impairment, including unemployment and decreased productivity. However, longitudinal studies are limited to depression and only examine effects of anxiety cross‐sectionally. Furthermore, prior studies only measured occupational impairment dichotomously as either employed or unemployed. The present secondary data analysis sought to build upon these gaps and investigate bidirectional relationships between hours worked, measured continuously, and symptoms of social anxiety and depression over the course of 48 weeks following a brief intervention for job‐seekers with social anxiety disorder, many of whom reported elevated levels of depression. Employment was operationalized as the average number of hours spent working in a given week. Methods Two cross‐lagged panel models were tested to investigate these relationships in 250 diverse job‐seeking individuals (59.2% female, 40.8% Black or African‐American, and 16.4% Hispanic/Latine). Results In partial support of initial hypotheses, social anxiety and depression symptoms both negatively predicted subsequent hours worked. Hours worked did not predict subsequent social anxiety or depression symptoms. Conclusions This was the first study to investigate relationships among depression, social anxiety, and employment that operationalized employment as a continuous variable. The findings contribute novel information about the longitudinal impact of both social anxiety and depression on hours worked and suggest that symptoms of social anxiety or depression may serve as a barrier to seeking or maintaining employment. Interventions for unemployment should consider incorporating simultaneous treatment of social anxiety and depression.

Background Many adolescents in Uganda are affected by common mental disorders, but only a few affordable treatment options are available. Digital mental health interventions offer promising opportunities to reduce these large treatment gaps, but interventions specifically tailored for Ugandan adolescents are limited. Objective This study aimed to determine the feasibility and acceptability of the Kuamsha program, an intervention delivered through a gamified app with low-intensity telephonic guidance, as a way to promote mental health among adolescents from the general population in Uganda. Methods A 3-month pre-post single-arm trial was conducted with adolescents aged between 15 and 19 years living in Wakiso District, Central Uganda. The intervention was coproduced with adolescents from the study site to ensure that it was culturally acceptable. The feasibility and acceptability of the intervention were evaluated using an explanatory sequential mixed methods approach. Feasibility was assessed by collecting data on trial retention rates and treatment adherence rates. Acceptability was assessed through a questionnaire and in-depth interviews with participants following the conclusion of the intervention period. As a secondary objective, we explored the changes in participants’ mental health before and after the intervention. Results A total of 31 adolescents were recruited for the study. Results from the study showed high levels of feasibility and acceptability. Trial retention rates exceeded 90%, and treatment adherence was ≥80%. These results, evaluated against our predefined trial progression criteria, indicate a successful feasibility study, with all criteria exceeding the thresholds necessary to progress to a larger trial. App engagement metrics, such as time spent on the app and modules completed, exceeded existing literature benchmarks, and many adolescents continued to use the app after the intervention. In-depth interviews and questionnaire responses revealed high acceptability levels. Depressive symptoms trended toward reduction (mean difference: 1.41, 95% CI –0.60 to 3.42, Cohen d=0.30), although this was not statistically significant (P=.16). Supporting this trend, we also observed a reduction in the proportion of participants with moderate depressive symptoms from 32% (10/31) to 17% (5/29) after the intervention, but this change was also not significant (P=.10). Conclusions This study presents evidence to support the Kuamsha program as a feasible and acceptable digital mental health program for adolescents in Uganda. A fully powered randomized controlled trial is needed to assess its effectiveness in improving adolescents’ mental health.

The wide array of symptoms of and high comorbidity rates between unipolar depressive and anxiety-related disorders have raised questions about the relations among their symptoms. Factor analysis examines these relations, yet factor-analytic symptom-measurement models have relied on a single method of measurement and do not always replicate. We conceptually replicate and extend the trilevel model of anxiety and depression symptoms to encompass interviewer-rated symptoms. In the trilevel model, symptom-specific items load on three levels of factors: a narrow (or disorder-specific) factor, an intermediate-breadth factor, and a general-distress factor. The trilevel model fit well in this sample and fit better than comparison models that eliminated one of the three levels. Extension analysis successfully integrated interviewer-rating variables into the trilevel model—particularly for the broad and narrow levels. These results provide some support for the trilevel model and the use of interviewer ratings of symptoms. Research and treatment implications are discussed.

This study explores the capability of passive digital sensor data from smartphones and smartwatches to predict self-reported ecological momentary assessments (EMA) of affect, motivation, interest, and pleasure in activities in an unseen test sample. Using data from 245 depressed participants with high-to-low anhedonia (195 train, 50 test) generating 23,812 EMA sessions, we evaluated whether behaviors and physiological factors could detect subjective states. For 11 of 15 EMA questions asked, machine learning models exceeded random chance in the fully-held-out test sample, suggesting detectable signals between passive measures and subjective states. Dependent on the sensor type, the optimal aggregation periods ranged from 15 minutes to 3 hours, with generally at least two hours of data being required. Subgroup analyses revealed variations in model performance by demographics, depression severity, and anhedonia severity. These findings demonstrate the potential for passive digital sensing to help monitor aspects of mental health on a large scale.

Objective: The purpose of this randomized controlled trial was to test the effects of an online, coached mindfulness intervention on momentary negative affect (mNA) for youth with high levels of trait negative affectivity. Method: Participants were 111 youth ages 12 to 17 years old (M = 14.17, SD = 1.60). Youth self-identified as 68% female, 29% male, and 4.5% gender diverse; 54.55% identified as White; 31.82 reported being Hispanic/Latinx. Participants were selected for having high levels of trait negative affect and were randomized to receive either the mindfulness program or no intervention. We used ecological momentary assessment to measure stress and emotions and to derive measures of mNA comprised of stressor-independent and stressor-reactive negative affect. The ecological momentary assessment protocol involved participants completing a short survey/diary entry on Qualtrics four times per day for 5 days. Internalizing symptoms were assessed with the Patient Health Questionnaire–8, Generalized Anxiety Disorder–7, and the Screen for Child Anxiety Related Disorders. Results: The mindfulness intervention resulted in a significant reduction in stressor-reactive negative affect (t = 2.001, df = 96, p = .048; Cohen’s d = .40), but not stressor-independent mNA or overall mNA. Additionally, reductions in stressor-reactive negative affect significantly correlated with changes in internalizing symptomatology (standardized β = .26, p = .032). Conclusions: These results indicate that among youth with high levels of trait negative affectivity, a relatively affordable and accessible digital mindfulness program significantly reduced stressor-reactive negative affect. The absence of an effect on stressor-independent or overall average mNA suggests some specificity of the effects of mindfulness to stressor-reactive negative affect in an at-risk sample of adolescents.