Stress Depression and Anxiety - An Integrative Psychobiological Investigation

描述(申请人提供)：情绪障碍和焦虑症是美国最普遍的两类精神障碍，影响着相当多的人。特别是，严重抑郁障碍(MDD)和广泛性焦虑障碍(GAD)会带来巨大的个人和社会成本；此外，MDD和GAD是高度共存的。然而，令人惊讶的是，我们对这些疾病的独特和共同的心理生物学基础及其共病机制知之甚少。越来越多的研究表明，压力和痛苦，以及唤醒和调节的结构，与我们对MDD和GAD的理解密切相关。然而，这是第一次在一项研究中检查患有单纯MDD和GAD的个体的这些结构。具体目标包括：(1)使用标准化的实验室应激范例，调查被诊断为MDD和GAD患者的应激反应和调节；(2)检查这些个体在日常生活中的应激过程；(3)比较基于实验室的评估和对这些群体内部和跨群体的应激、反应性和调节的经验抽样评估。为了实现这些目标，所有参与者都将经历一次基线会议，其中包括症状严重程度、压力源、情感和情感调节的自我报告，然后是平衡的实验室会议和为期一周的自然主义经验抽样方案。在实验室会议期间，参与者的神经内分泌、自主神经和主观反应将被测量，因为他们接受了关于抑郁和焦虑的独立文献中使用的标准化应激源任务。在体验抽样期内，参与者的每日皮质醇、压力源报告、消极和积极的情绪、沉思和担忧将在他们的日常生活中进行衡量。将进行一套先进的、复杂的统计分析，以测试理论驱动的假设，这些假设涉及这些测量的平均水平和时间差异的组差异，同时，每个组内个人的这些结构之间的关键联系。其他分析将检查压力、反应性和调节措施与抑郁和焦虑症状的维度关系。这项研究计划将为申请者提供新知识领域和新方法方面的培训，包括抑郁-焦虑相互作用的心理生物学，神经内分泌和经验样本数据的收集和解释，内分泌和自主神经数据的整合，以及分层线性建模技术。这项研究以一种新颖和综合的方式解决了围绕MDD和GAD的问题和问题，这些发现将有助于阐明应激和反应性的性质，以及与这些情绪障碍相关的反应性和调节方面的困难。 公共卫生相关性：严重抑郁障碍(MDD)和广泛性焦虑障碍(GAD)是非常普遍、代价高昂且经常合并的精神疾病。这项研究的结果将有助于促进我们对这些障碍背后独特和共同的心理生物学机制的理解，阐明MDD和GAD共存时应激、反应和调节的性质，并为未来将实验室测量的心理生物学结构与日常生活中自然产生的心理生物学结构相结合的研究提供参考。这些研究发现，在多个水平和领域获得和分析，也将为未来的干预项目提供信息，这些项目将更好地针对这些障碍中情绪调节障碍的不同方面。

DESCRIPTION (provided by applicant): Mood and anxiety disorders are the two most prevalent classes of mental disorder in the United States, affecting a significant number of individuals. In particular, Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) confer significant personal and societal costs; moreover, MDD and GAD are highly comorbid. Yet, we know surprisingly little about the unique and shared psychobiological underpinnings of these disorders and the mechanisms underlying their comorbidity. A growing body of research reveals that the constructs of stress and distress, and of arousal and regulation, are germane to our understanding of MDD and GAD. This is the first research, however, to examine these constructs in individuals with pure and co-occurring MDD and GAD within a single study. Specific objectives include: (1) investigating stress reactivity and regulation in individuals diagnosed with co-occurring and non-co-occurring MDD and GAD using a standardized laboratory stress paradigm; (2) examining stress processes in daily life in these same individuals; and (3) comparing laboratory-based assessment with experience sampling assessment of stress, reactivity, and regulation within and across these groups. To achieve these aims, all participants will undergo a baseline session that includes self-reports of symptom severity, stressors, affect, and affect regulation, followed by a counterbalanced experimental laboratory session and a one-week naturalistic experience sampling protocol. During the laboratory session, participants' neuroendocrine, autonomic, and subjective responses will be measured as they undergo a standardized stressor task used in the independent literatures on depression and anxiety. During the experience sampling period, participants' diurnal cortisol, reports of stressors, negative and positive affect, rumination, and worry will be measured in the context of their daily lives. An advanced, sophisticated set of statistical analyses will be conducted to test theoretically-driven hypotheses regarding group differences in mean levels and temporal variance on these measures, and simultaneously, key associations among these constructs in individuals within each group. Additional analyses will examine the stress, reactivity, and regulation measures with regard to their dimensional relations to depression and anxiety symptomatology. This research program will provide the applicant with training in new areas of knowledge and new methodologies, including the psychobiology of depression-anxiety interactions, the collection and interpretation of neuroendocrine and experience sampling data, the integration of endocrine and autonomic data, and hierarchical linear modeling techniques. This study addresses questions and issues surrounding MDD and GAD in a novel and integrated manner, and these findings will help to elucidate the nature of stress and reactivity, and the difficulties in reactivity and regulation associated with these emotional disorders. PUBLIC HEALTH RELEVANCE: Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are highly prevalent, costly, and frequently comorbid psychiatric disorders. The results of this research will help to progress our understanding of the unique and shared psychobiological mechanisms underlying these disorders, to elucidate the nature of stress, reactivity, and regulation in co-occurring MDD and GAD, and to inform future studies integrating psychobiological constructs as measured in the laboratory with those arising naturalistically in daily life. These research findings, obtained and analyzed across multiple levels and domains, will also inform future intervention projects that will better target the diverse aspects of emotio dysregulation in these disorders.