Women are more likely to suffer from anxiety than men

Tuesday June 7 2016

Everyone gets anxious, but persistent anxiety can affect daily life

"Women twice as likely as men to experience anxiety, research finds," The Guardian reports. A new review that attempts to get a global snapshot of the prevalence of anxiety disorders identifies a number of vulnerable groups.

There are various types of anxiety disorder, but generally they involve feelings of unease, such as worry or fear, that can be mild or severe and affect daily life. Having an overwhelming sense of anxiety that "takes over your life" is described as having a generalised anxiety disorder.

There are many factors that can trigger an anxiety disorder, such as stress, physical conditions, genetic background and hormonal imbalances.

The researchers found that women, young people and those with other chronic diseases were disproportionally affected. Across countries, women were found to be twice as likely to be affected as men.
 
The researchers call for further research to be carried out on the illness, as well as investigating which type of interventions have the greatest benefit. There is also a need for further study of anxiety prevalence in developing and under-developed parts of the world, as there was a lack of representation.

Although feelings of anxiety at certain times are completely normal, you should see your GP if anxiety is affecting your daily life or causing you distress.

Where did the story come from?

The study was carried out by researchers from the University of Cambridge and Westminster City Council. It was funded by the UK National Institute for Health Research. The study was published in the peer-reviewed clinical journal Brain and Behavior. It is available on an open-access basis and is free to read online.

While the media coverage was generally accurate, both the Mail Online and The Times claimed that the reasons why younger women had higher levels of anxiety were down to many of them being working mothers. This claim seems to be based on opinions, rather than any hard evidence presented in the study.

What kind of research was this?

This was a systematic review that aimed to collate evidence from other systematic reviews which had explored the prevalence of anxiety, to describe the burden of disease across population subgroups.

As the researchers mention, anxiety disorders contribute to significant disability and impairment to quality of life, and are the most prevalent mental health conditions in Europe. They place increasing demand upon health services across the globe, and are recognised as important determinants of poor health. This is the first reported study to attempt to provide a comprehensive synthesis of the findings from reviews undertaken on the global burden of anxiety.

Systematic reviews are one of the highest levels of evidence, but they are only as good as the studies they contain. The included reviews varied widely in their methods, the studies they had included and populations examined. Due to this variation, the researchers did not attempt to carry out a meta-analysis of their findings. Instead, they report the findings across the individual reviews.

What did the research involve?

The researchers searched three literature databases up to May 2015 to identify systematic reviews and meta-analyses that had reported the burden of anxiety across the globe.

Reviews could have looked at any anxiety disorder, including generalised, social anxiety or obsessive compulsive disorder, and use any method to assess anxiety. The researchers specifically searched for reviews including individuals suffering from other medical or mental health conditions (chronic or infectious disease, psychiatric conditions, and addiction) as well as those from vulnerable populations. Reviews on the treatment of anxiety were excluded.

Two researchers assessed the quality of the reviews and eligibility for inclusion, and extracted data.

The reviews included studies of people of all ages, from young children to people of old age, with the overall number of studies and individual study sample sizes varying. The method of anxiety assessment also varied between studies, from structured and unstructured interviews to self-reported questionnaires.

What were the basic results?

Results from the 48 studies were gathered to describe the global distribution of anxiety disorders. The main results were as follows:

• The general prevalence of anxiety disorders in healthy populations ranged from 3% to 25%.
• Women were found to be twice as likely to be affected as men (female: male ratio of 1.9:1). This was consistently the case across different countries and co-existing health conditions.
• Young adults under the age of 35 were also more often affected (2.5% to 9.1%).
• Prevalence was found to be highest in North America (7.7%, 95% confidence interval [CI] 6.8 to 8.8) and in North Africa/Middle East (7.7%, 95% CI 6.0 to 10.0).
• The lowest prevalence was found in East Asia (2.8%, 95% CI 2.2 to 3.4).

The prevalence was then described according to five common themes:

• addiction
• other mental and neurological disorders
• chronic physical diseases
• trauma
• vulnerable population subgroups

They found that, compared to healthy populations, the prevalence was higher in individuals with chronic conditions, who had a prevalence ranging from 1.4% to 70%.

How did the researchers interpret the results?

The researchers concluded: "Despite epidemiologic advances in this field, important areas of research remain under- or unexplored. There is a need for further studies on the prevalence of anxiety disorders. These recommendations can serve to guide the research agenda, and most importantly, help develop tailored and timely interventions."

Conclusion

This systematic review of previously gathered data compiled evidence from 48 studies to describe the global prevalence of anxiety disorders, which are placing increasingly high demand upon health services across the globe. The review gives us a general picture of the prevalence of these conditions worldwide and notes several themes.

It found that anxiety disorders are common across all population groups, but women and young people seem to be disproportionally affected. Anxiety prevalence was also higher in individuals with chronic conditions, though it is not possible to say whether mental health problems could be a contributing factor or a consequence.

Reviews were assessed for eligibility against a validated quality assessment tool. However, the researchers highlight the large variability in the methods of the reviews and the studies they included, which makes comparison of prevalence figures between the studies difficult.

For example, there was wide variation between reviews in:

• the overall number of studies they included and their sample sizes
• the ages of participants, with some reviews looking at older individuals and some looking at children (aged 6+)
• whether they were general population samples or those with specific physical or mental health conditions
• the tools used to assess anxiety
• whether they took account of other health, environmental or lifestyle factors

While this review is a useful indicator of the prevalence of anxiety disorders, it is unable to suggest causation – for example, why prevalence may be higher in women or younger adults. It is possible that this could be down to a complex interaction of biological and lifestyle factors. However, the direction of effect or the extent of influence of different factors remains unknown.

The researchers call for further research to be carried out on the course of the illness, as well as anxiety levels pre- and post-treatment. They also note the need for further study into developing and under-developed parts of the world, as there was a lack of representation of those areas, and for specific study into vulnerable subgroups of society.

Visit the NHS Choices Moodzone for more information about stress, anxiety and depression, and methods you can try to cope with and combat these feelings.  

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from NHS Choices: Behind the headlines http://ift.tt/1X8RjCL

'Friendly' virus repairs damaged liver cells (but only in mice)

Friday June 3 2016

There are more than 100 different types of liver disease

"Have scientists found a cure for alcoholism?," the Mail Online asks, missing the point of the research entirely.

Researchers were able to improve liver damage in mice, but this does not amount to curing an addiction to alcohol.

The study showed it was possible to create "bespoke friendly" viruses to infect cells known as myofibroblasts, which are cells associated with tissue repair. The virus passed on instructions that transformed the myofibroblasts into healthy liver cells in mice who had fibrosis (scarring) of the liver, known as cirrhosis.

Not all the experiments in the mice worked, but in those that did, the transformed liver cells looked and behaved normally, replaced some of the diseased liver cells, and led to less liver scarring.

Researchers will now attempt to refine this technique before seeing if it works in humans.  

Right now, this technique is not available as a new treatment. It represents one of the earliest stages of treatment discovery and development, which can take decades from start to finish.

If you do have a lifestyle that increases your risk of liver disease, such as heavy alcohol consumption, being obese, or injecting drugs, you should ask your GP for a liver function test. The symptoms of liver disease often only occur once it is too late to undo the damage.

Taking action to reduce your risk before this happens could restore your liver back to good health.

Where did the story come from?

The study was carried out by researchers from The University of California and funded by grants from the US National Institutes of Health.

The study was published in the peer-reviewed science journal Cell – Stem Cell.

The Mail Online's reporting was poor, failing on three main points.

Firstly, it asked an inappropriate question in its headline – "Have scientists found a cure for alcoholism?". A cure, or at least a partial repair, of liver damage would not amount to a cure for alcohol addiction. The headline confused alcohol with its main health consequence – alcoholic liver disease. There are many other consequences of chronic alcohol misuse – be it social, financial or mental health-related.

Secondly, nowhere in the article (let alone in the headline) did it mention that the study was on mice, so readers might naturally assume it involved people.

Thirdly, there are other causes of liver disease aside from alcohol, such as obesity (non-alcoholic fatty liver disease) or infection with the hepatitis C virus. The mice studied didn't have alcohol-induced liver disease.

What kind of research was this?

This was a laboratory study investigating a potential new treatment approach for liver fibrosis.

Liver fibrosis is the scarring and demise of your liver, following repeated cell damage and inflammation. Fibrosis can have many causes, including viruses (like hepatitis B and C), alcohol misuse, and fatty liver disease.

Despite the liver's somewhat unique ability to recover and regenerate, when liver cells are repeatedly damaged, such as through sustained heavy alcohol use, they gradually die and the organ stops working. Part of the damage is the build-up of collagen, which causes scarring and restricts blood flow.

The poorly functioning liver and restricted blood flow causes symptoms including jaundice, weight loss, swelling of the abdomen, vomiting blood and, ultimately, death.

The only cure for severe liver scarring, where the liver loses most of its functioning ability (liver failure), is a liver transplant. But there are not enough organs to meet demand, so medical researchers are always looking for alternatives.

What did the research involve?

The researchers reprogrammed types of cells called myofibroblasts into liver cells by injecting reprogramming instructions, via a "designer virus", into mice with liver disease.

Myofibroblasts were chosen as the target, as they produce the excess collagen which causes scarring.

The researchers carefully analysed whether the reprogrammed cells behaved like normal liver cells in the lab and had similar DNA and protein profiles. They also tested whether once injected they were able to grow, repair and replace some or all of the liver damage.

Part of the challenge was devising a safe and effective way to deliver the reprogramming instructions to the mice myofibroblast cells. They used adeno-associated virus 6 (AAV6) vectors to act as delivery vehicles.

This involved taking the packaging of a virus and modifying it, so instead of infecting a mouse and causing disease, it infects the mouse and makes the modifications they wanted – in this case, turning myofibroblasts into liver cells. This involves replacing and modifying the virus DNA – that instructs the virus cell – with DNA encoding instructions you want.

What were the basic results?

The researchers overcame the delivery and reprogramming challenges to influence some cells to change from myofibroblasts into liver cells by injecting the reprogramming instructions into the bloodstreams of the mice using different AAV vectors.

Not all of the vectors worked. But in those that did, not only did some cells change, they appeared to function like normal liver cells, were able to grow and multiply, and reduced the amount of problematic collagen.

This partially alleviated two of the main causes of liver fibrosis – liver cell death and collagen build up – in mice with liver disease.

How did the researchers interpret the results?

The researchers concluded: "Our study establishes the feasibility of in vivo reprogramming of myofibroblasts into fully functional hepatocytes [liver cells] using AAV vectors, a gene delivery tool that proved to be safe and effective in clinical trials of liver-directed gene therapy".

Conclusion

This study showed it was possible to engineer and inject instructions that transform myofibroblasts into liver cells in mice with liver disease, which is quite a feat. Not all delivery mechanisms, called vectors, worked, but in those that did, the new liver cells looked normal, replaced some of the dying cells, and led to less damage due to collagen build up.

Despite the alcoholism-related headline, the mice did not have alcohol-induced liver damage – although this is a major cause of liver damage in people.

This study serves to prove this approach is feasible, and was successful in doing this. Researchers will now need to refine the technique before testing to see if it works in human trials.  

The good news is the vector delivery system has been used in human trials before – although not containing the same liver cell transformation message – so has a better chance than normal of working in people.

Right now this technique is not available as a new treatment. It represents one of the earliest types of treatment development, which can take decades from start to finish.

Currently the only cure for severe liver scarring is an organ transplant, but many die while waiting for a transplant as need far outstrips supply. If you are not on the register, you could save lives by joining the NHS Organ Donor Register today.

The liver is tough and can regenerate itself, but it can only take so much damage. Moderating your alcohol consumption, maintaining a healthy weight, and reducing your risk of contracting hepatitis C (mainly spread by injecting drugs), will do much to keep your liver healthy. 

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from NHS Choices: Behind the headlines http://ift.tt/1Prze09