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Background: People living in nursing homes face the risk of visiting the emergency department (ED). Outreach services are developing to prevent unnecessary transfers to ED. Aims: We aim to assess the performance of acute care services provided to people living in nursing homes or long‐term homecare, focusing on ED transfer prevention, safety, cost‐effectiveness and experiences. Materials & Methods: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Studies were eligible for inclusion if they were peer‐reviewed and examined acute outreach services dedicated to delivering care to people in nursing homes or long‐term homecare. The service models could also have preventive components. The databases searched were Scopus and CINAHL. In addition, Robins‐I and SIGN checklists were used. The primary outcomes of prevented ED transfers or hospitalisations and the composite outcome of adverse events (mortality/Emergency Medical Service or ED visit after outreach service contact related to the same clinical condition) were graded with GRADE. Results: Fifteen relevant original studies were found—all were observational and focused on nursing homes. The certainty of evidence for acute outreach services with preventive components to prevent ED transfers or hospitalisations was low. Stakeholders were satisfied with these services. The certainty of evidence for solely acute outreach services to prevent ED transfers or hospitalisations was very low and inconclusive. Reporting of adverse events was inconsistent, certainty of evidence for adverse events was low. Conclusion: Published data might support adopting acute outreach services with preventive components for people living in nursing homes to reduce ED transfers, hospitalisations and possibly costs. If an outreach service is started, it is recommended that a cluster‐randomised or quasi‐experimental research design be incorporated to assess the effectiveness and safety of the service. More evidence is also needed on cost‐effectiveness and stakeholders' satisfaction. Systematic review registration number: PROSPERO CRD42020211048, date of registration: 25.09.2020. [ABSTRACT FROM AUTHOR]

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When producing mono-axially stretched films made of amorphous polycarbonate, a self-reinforcement is generated due to the stretching process. This leads to an increase of the strength and stiffness. The mono-axial stretching process is conducted at temperatures above the glass transition temperature, whereas better mechanical properties are obtained at higher stretching temperatures. However, the film tends to adhere to the rolls, especially at temperatures from 10°C above the glass transition temperature. The rolls of the mono-axial stretching unit are made of an induction hardened and polished quenched and tempered steel 1.7225 - 42CrMo4. This work reports on the investigation of the detachment behavior of polycarbonate on different coatings as a function of the temperature and contact time. The main intention is to find a suitable coating on which the polycarbonate film adheres only slightly at temperatures clearly exceeding the glass transition temperature. POLYM. ENG. SCI., 56:786-797, 2016. © 2016 Society of Plastics Engineers [ABSTRACT FROM AUTHOR]

Organosilane self-assembled monolayers (SAMs) are commonly used for modifying a wide range of substrates. Depending on the end group, highly hydrophobic or hydrophilic surfaces can be achieved. Silanization bases on the adsorption, self-assembly and covalent binding of silane molecules onto surfaces and results in a densely packed, SAM. Following wet chemical routines, the quality of the monolayer is often variable and, therefore, unsatisfactory. The process of self-assembly is not only affected by the chemicals involved and their purity but is also extremely sensitive to ambient parameters such as humidity or temperature and to contaminants. Here, a reliable and efficient wet-chemical recipe is presented for the preparation of ultra-smooth, highly ordered alkyl-terminated silane SAMs on Si wafers. The resulting surfaces are characterized by means of atomic force microscopy, X-ray reflectometry and contact angle measurements. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

An analytic methodology was developed to predict the fatigue life of a structure experiencing stationary, Gaussian random vibration excitation. This method allows the estimation of fatigue life using a frequency domain method, where only the input power spectral density and damping factor are required. The methodology uses linear elastic fracture mechanics for fatigue crack propagation and accounts for the frequency shifting that occurs due to fatigue crack evolution. Good results have been obtained comparing the analytic model to both finite element analysis (FEA) and experimental results, for mild-steel cantilever beams. [ABSTRACT FROM AUTHOR]

Background: We examined social approachability judgments in a psychiatric population that frequently experiences interpersonal difficulties and reduced social satisfaction, individuals with generalized social phobia (gSP). Methods: Our objective was to broaden the understanding of the social cognitive tendencies of individuals with gSP by systematically investigating their interpretation of positive facial expressions. We hypothesized that approachability ratings would be lower for positive as well as negative emotional faces in the gSP group compared to the healthy comparison group. Each participant evaluated 24 emotional faces presented on a computer screen. Participants first labeled the faces as either happy, disgust, or angry in emotional expression, and then they rated each face's approachability. Analysis of variance and post hoc analyses were used to identify group, emotion, and group by emotion rating differences. Results: Happy face approachability ratings were higher than disgust and anger in both groups. The central finding was that individuals with gSP rated happy faces as less approachable than the healthy participants and that degree of social anxiety was associated with lower approachability ratings within the gSP sample. Explicit approachability judgments of negative faces did not differ as predicted. Conclusions: Consistent with earlier indirect evidence of interpretation biases of positive social emotional information, this study reveals that individuals with gSP demonstrate explicit, subjective social interpretation biases of overtly positive social feedback. The therapeutic relevance of these results is discussed. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

The Feldkamp algorithm is widely accepted as a practical conebeam reconstruction method for three-dimensional x-ray computed tomography. We introduce focus of attention, an effective and simple to implement datadriven preprocessing scheme, for identifying a convex subset of voxels that include all those relevant to the object under study. By concentrating on this subset of voxels during reconstruction, we reduce the computational demands of the Feldkamp algorithm correspondingly. To achieve further speed-up, all computations are distributed across a cluster of inexpensive, dual-processor PCs. We present experimental work based on mouse data obtained from the MicroCAT which is a high-resolution x-ray computed tomography system for small animal imaging. This work shows that focus of attention can cut the overall computation time in half without affecting the image quality. The method is general by nature and can easily be adapted to apply to other geometries and modalities as well as to iterative reconstruction algorithms. © 2003 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 12, 229–234, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ima.10027 [ABSTRACT FROM AUTHOR]

Summary We study the influence of metal roughness on the near-field distribution generated by an aperture or an apertureless (scattering) probe. Different experimental parameters are investigated: roughness magnitude, aperture form, distribution of the roughness. Our results show that aluminium roughness has a dramatic impact on the emission characteristics of a near-field probe and in particular on its polarization sensitivity. Apertureless or scattering probes appear to be less sensitive to roughness and to provide a well confined field even with a somewhat rough probe. [ABSTRACT FROM AUTHOR]

Evaluating whether someone's behavior is praiseworthy or blameworthy is a fundamental human trait. A seminal study by Hamlin and colleagues in 2007 suggested that the ability to form social evaluations based on third-party interactions emerges within the first year of life: infants preferred a character who helped, over hindered, another who tried but failed to climb a hill. This sparked a new line of inquiry into the origins of social evaluations; however, replication attempts have yielded mixed results. We present a preregistered, multi-laboratory, standardized study aimed at replicating infants' preference for Helpers over Hinderers. We intended to (1) provide a precise estimate of the effect size of infants' preference for Helpers over Hinderers, and (2) determine the degree to which preferences are based on social information. Using the ManyBabies framework for big team-based science, we tested 1018 infants (567 included, 5.5-10.5 months) from 37 labs across five continents. Overall, 49.34% of infants preferred Helpers over Hinderers in the social condition, and 55.85% preferred characters who pushed up, versus down, an inanimate object in the nonsocial condition; neither proportion differed from chance or from each other. This study provides evidence against infants' prosocial preferences in the hill paradigm, suggesting the effect size is weaker, absent, and/or develops later than previously estimated. As the first of its kind, this study serves as a proof-of-concept for using active behavioral measures (e.g., manual choice) in large-scale, multi-lab projects studying infants., (© 2024 John Wiley & Sons Ltd.)

Attachment theory proposes that young children's experiences with their caregivers has a tremendous influence on how children navigate their social relationships. By the end of early childhood, intergroup contexts play an important role in their social life and children build strong ties to their ingroups. Although both domains relate to the same psychological processes-children's affective ties to others-surprisingly very little research has addressed how children's attachment relates to their intergroup attitudes and behavior. In this study, we investigate the link. For that purpose, 5-year-old children (n = 100) first underwent the German Attachment Story Completion Task (GEV-B). Then we allocated children into minimal groups based on T-Shirt color and assessed their intergroup attitudes and intergroup behavior. Results showed that while most children showed a strong and robust ingroup bias in their attitudes and behavior, children with an insecure-ambivalent attachment representation treated in- and outgroup similarly. Overall, this study provides novel perspectives on the relationship between children's attachment representation and their interactions in the social world. RESEARCH HIGHLIGHTS: This study provides novel insights into the relationship between children's attachment security and the development of intergroup bias in a minimal group context Children with secure, insecure-avoidant and disorganized attachment representation showed a strong intergroup bias in explicit attitudes and behavior Children with insecure-ambivalent attachment representation displayed no intergroup bias Insecure-ambivalent attachment representations might be detrimental to the formation of ingroup attachment., (© 2024 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

Children's moral self-concept (MSC) has been proposed to relate to prosocial behaviour. However, systematic assessments of their inter-relations are scarce. Therefore, this longitudinal study investigated the development, structure and inter-relation of prosocial behaviours and the MSC in childhood, using three measurement points at ages 4, 5 and 6 years. We assessed children's MSC and helping, sharing and comforting behaviours in a laboratory setting. Confirmatory factor analyses revealed a three-dimensional MSC structure at 5 and 6 years, but not at 4 years. There was inconsistent stability across time points regarding prosocial behaviour and MSC. For the comforting domain, but not the other domains, cross-lagged relations between self-concept and behaviour were present. Moreover, helping behaviour and self-concept were inter-related at 6 years. Results provide support for reciprocal associations between MSC and prosocial behaviour, albeit only in the comforting domain. They highlight the importance of distinguishing between types of prosocial behaviour and corresponding dimensions of the self-concept, as different developmental trajectories and associations emerge., (© 2024 The Authors. British Journal of Developmental Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Developmental science has experienced a vivid debate on whether young children prioritize goals over means in their prediction of others' actions. Influential developmental theories highlight the role of goal objects for action understanding. Yet, recent infant studies report evidence for the opposite. The empirical evidence is therefore inconclusive. The current study advanced this debate by assessing preschool children's verbal predictions of others' actions. In five experiments (N = 302), we investigated whether preschool children and adults predict agents to move towards their previous goal (that is, show goal-related predictions) or predict agents to move along the same movement path that they pursued before. While Experiments 1a, 1b and 1c presented young children and adults with animated agents, Experiments 2a and 2b presented participants with human grasping action. An integrative analysis across experiments revealed that children were more likely to predict the agent to move along the same movement path, Z = -4.574, p ≤ 0.0001 (r = 0.304). That is, preschool children were more likely to predict that agents would move along the same trajectory even though this action would lead to a new goal object. Thus, our findings suggest that young children's action prediction relies on the detection of spatial and movement information. Overall, we discuss our findings in terms of theoretical frameworks that conceive of action understanding as an umbrella term that comprises different forms and facets in which humans understand others' actions. RESEARCH HIGHLIGHTS: We investigated whether preschool children predict agents to move towards their previous goal or to move along the same movement path that they pursued before. Unlike adults, preschool children predicted that agents would move along the same trajectory even though this action would lead to a new goal. Adults' goal-based predictions were affected from contextual details, whereas children systematically made path-based predictions. Young children's action prediction relies on the detection of spatial and movement information., (© 2023 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

Children's moral self-concept (MSC) has been proposed to relate to prosocial behaviour. However, systematic assessments of their interrelations are scarce. The current study examines the early development, structure, stability and interrelation of three key prosocial behaviours and the corresponding dimensions of the moral self-concept. To this end, we use a longitudinal approach with three measurement points during the preschool years at ages 4, 5 and 6 years. We assess three prosocial dimensions of children's MSC through a puppet-interview. In addition, behavioural measures of children's helping, sharing and comforting were administered in a laboratory setting. By examining the longitudinal associations between MSC and prosocial behaviours, this study will provide valuable insights into the complex nature of prosocial development in early childhood., (© 2023 The Authors. British Journal of Developmental Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Developmental theories have proposed caregiver reactions, in particular caregivers' moral reasoning with their children, as crucial factors in children's developing morality. Yet, empirical evidence is scarce and mainly restricted to laboratory contexts. Here, we used the ambulatory assessment method to investigate how caregiver responses to moral transgressions longitudinally relate to children's emerging moral agency. On the first measurement point, mothers (N = 220) reported on nine consecutive evenings on a moral transgression of their 5- to 46-month-olds', their emotional and verbal reactions, and how in turn their child reacted. Five months later, mothers reported on their child's aggressive and prosocial (helping, sharing, comforting) behavior. Our results demonstrated that (1) caregiver reasoning supported children's sharing and comforting behavior and was related to lower levels of children's aggressive behavior half a year later, that (2) caregiver reasoning reactions supported children's negative evaluations of their own transgressions while compliance-based caregiver reactions (e.g., physical interventions, reprimands) were predictive of children's subsequent emotional distress and anger, and that (3) caregiver social conformity and reflective functioning abilities emerged as determinants of caregiver negative moral emotions. Thus, this study uses an innovative methodological approach to uncover key characteristics of caregiver moral reactions supporting the development of morality., (© 2022 The Authors. Infancy published by Wiley Periodicals LLC on behalf of International Congress of Infant Studies.)

Middle childhood seems to be crucial for the emergence of a moral identity, that is, an evaluative stance of how important it is for someone's sense of self to be moral. This study investigates the effects of moral identity on the neural processing of moral content in 10-year-old children. Participants were presented with scenes portraying prosocial and antisocial behavior, while electroencephalographic responses were collected. Analyses of event-related potentials (ERPs) showed that, for children with a strong moral identity, antisocial scenes elicited a greater early posterior negativity (EPN) as compared to prosocial scenes. Thus, for children with a strong moral identity, antisocial scenes capture more attentional resources than prosocial ones in early processing stages. In contrast to previous findings with adults, the implicit moral self-concept was not related to any ERP differences. Overall, the results show that, even in its developmental emergence, moral identity relates to the neurocognitive processing of third-party moral content. Together, the study supports the social-cognitive model of the development of moral identity, according to which moral identity is based on a chronical activation of moral schemas that guide a person's perception of the social world., (© 2022 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

Genetic variability is being discussed as a source of inter-individual differences in Theory of Mind development. Previous studies documented an association between variations in DRD4 VNTR 48 bp, OXTR rs53576, COMT rs4680, and Theory of Mind task performance. As empirical evidence on these associations is sparse, we conducted a preregistered replication attempt of a study reporting a link between DRD4 VNTR 48 bp and false belief understanding in 50-month-old children [Lackner, C., Sabbagh, M. A., Hallinan, E., Liu, X., & Holden, J. J. (2012). Developmental Science, 15(2), 272-280.]. Additionally, we attempted a replication of studies on the role of OXTR rs53576 and COMT rs4680 in Theory of Mind. In both replication attempts, we did not find any evidence for associations between the sampled genetic markers and Theory of Mind ability in a series of analyses. Extending the replication attempt of Lackner et al., we employed longitudinal data from several tasks and measurement points, which allowed us to run follow-up robustness checks with more reliable scores. These extensive analyses corroborated our null finding. This comprehensive non-replication is important to balance current research on genetic markers of Theory of Mind. In a combined evaluation of our own and previous studies, we point to substantial methodological issues that research on the genetic basis of Theory of Mind development faces. We conclude that these limitations currently prevent firm conclusions on genetic influences on Theory of Mind development., (© 2021 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

Recent metacognitive research using a partial knowledge task indicates that a firm understanding of 'knowing about knowing' develops surprisingly late, at around 6 years of age. To reveal the mechanisms subserving this development, the partial knowledge task was used in a longitudinal study with 67 children (33 girls) as an outcome measure at 5;9 (years;months). In addition, first- and second-order false belief was assessed at 4;2, 5;0, and 5;9. At 2;6, perspective taking and executive abilities were evaluated. Metacognition at 5;9 was correlated with earlier theory of mind and perspective taking - even when verbal intelligence and executive abilities were partialled out. This highlights the importance of perspective taking for the development of an understanding of one's own mind., (© 2020 The Authors. British Journal of Developmental Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

According to attachment theory, internal working models of attachment affect the way in which social and emotional information is processed. The current study examined this theoretical claim by investigating the association between attachment security and attention to facial emotional expressions in 5-year-old children. Attachment security was assessed on a representational level using an Attachment Story Completion Task. Children's attention to facial emotional expressions was measured during an eye-tracking task. Gaze data (fixation duration) were collected during the presentation of pictures displaying five different facial emotional expressions (neutral, angry, fearful, sad, and happy) of unfamiliar persons. Moreover, the Emotionality-Activity-Sociability Temperament Inventory was used to control for children's temperament and was filled out by children's mothers. Regression analyses revealed that attachment security was a significant predictor of children's attention to neutral and sad expressions while controlling for age, gender, and temperament. Moreover, a t-test revealed that securely attached children looked longer at the fearful expression than insecurely attached children. These findings provide direct evidence that even on a basic perceptional level attachment security is a predictor of children's emotional information processing. Statement of contribution What is already known on this subject? Attachment representations substantially affect the way in which emotional information is processed. Insecure attachment representations are negatively related to children's attention to emotional stimuli. What does this study add? Eye-tracking technology was used to measure children's visual attention to facial emotional expressions. Secure attachment was related to prolonged visual attention to neutral and negative facial emotional expressions. Attachment security influences children's emotional information processing even on a basic perceptual level., (© 2019 The Authors. British Journal of Developmental Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Recent research has provided evidence for a substantial impact of children's peer status on positive and adaptive development. The current study investigated how 3- to 7-year-old preschoolers' (N = 118) sharing behaviour and sharing expectations towards a friend and a non-friend relate to their popularity among their peers. Children distributed resources between themselves and a friend as well as themselves and a non-friend and predicted another protagonist's behaviour in the same situation. In addition, teachers rated children's problematic behaviour and peers rated children's peer status. Multilevel analysis revealed that preschoolers' sharing expectations towards their friends but not sharing behaviour predicted their peer status above and beyond the impact of problematic behaviour. Age did not emerge as an independent predictor. These findings suggest that knowledge about prosociality in the form of sharing expectations is an important aspect in children's adaptive social development and stress the relevance of children's knowledge about the social world for their social life. Statement of contribution What is already known on this subject? Prosocial behaviour in general relates positively to peer status. Problem behaviour relates negatively to peer status. Sharing behaviour and sharing expectations become more selective over the preschool years. What does this study add? Sharing expectations and to a lesser extent sharing behaviour relate to peer status. Sharing expectations predict peer status above and beyond the impact of problem behaviour. Differential sharing expectations predict peer status as well as simple sharing expectations., (© 2019 The British Psychological Society.)

Three experiments with 18- to 35-month-old children (n = 169) studied toddler-caregiver interactions when being confronted with another person in need. In particular, we explored whether toddlers would request their caregiver to help a needy other when they are not able to help themselves. Children observed another person who needed help to accomplish a task, but were either not able to provide help as the object was out of reach (Experiment 1) or because an obstacle prevented children from interacting with the other person (Experiments 2, 2b). The experiments revealed the same developmental trend with 2.5-year-olds selectively involving their caregiver to help the needy other. The results are interpreted in terms of toddlers' motivation to see others helped and with respect to their developing ability to actively involve others to regulate their emotions., (Copyright © International Congress of Infant Studies (ICIS).)

Research has demonstrated that sharing with others is rewarding, suggesting a proximal mechanism of humans' extraordinary tendency to engage in prosocial behavior. The current study explored the cognitive basis of the relation between generosity and happiness early in ontogeny. We demonstrate that preschool children understand the relation between generosity and happiness. Moreover, our results show that children's emotion ratings are predictive for their subsequent sharing behavior. This finding provides evidence for the theoretical claim that prosocial behavior may be related to the anticipation of positive feelings, and that this mechanism may explain early instances of generosity in preschool children., (© 2016 John Wiley & Sons Ltd.)

Prior work shows that children selectively learn from credible speakers. Yet little is known how they treat information from non-credible speakers. This research examined to what extent and under what conditions children may or may not learn from problematic sources. In three studies, we found that children displayed trust toward previously inaccurate speakers. Children were equally likely to extend labels from previously accurate and inaccurate speakers to novel objects. Moreover, they expected third parties to share labels provided by previously inaccurate speakers. Only when there was clear evidence that the speakers' information was wrong (as in the case when speakers' perceptual access to the information was blocked), did young children reject the label. Together, the findings provide evidence that young children do not completely ignore the labels supplied by non-credible speakers unless there is strong reason to do so., (Copyright © 2016 Cognitive Science Society, Inc.)

In two experiments, it was investigated how preverbal infants perceive the relationship between a person and an object she is looking at. More specifically, it was examined whether infants interpret an adult's object-directed gaze as a marker of an intention to act or whether they relate the person and the object via a mechanism of associative learning. Fourteen-month-old infants observed an adult gazing repeatedly at one of two objects. When the adult reached out to grasp this object in the test trials, infants showed no systematic visual anticipations to it (i.e. first visual anticipatory gaze shifts) but only displayed longer looking times for this object than for another before her hand reached the object. However, they showed visual anticipatory gaze shifts to the correct action target when only the grasping action was presented. The second experiment shows that infants also look longer at the object a person has been gazing at when the person is still present, but is not performing any action during the test trials. Looking preferences for the objects were reversed, however, when the person was absent during the test trials. This study provides evidence for the claim that infants around 1 year of age do not employ other people's object-directed gaze to anticipate future actions, but to establish person-object associations. The implications of this finding for theoretical conceptions of infants' social-cognitive development are discussed., (2011 Blackwell Publishing Ltd.)

This paper investigates a two-stage model of infants' imitative learning from observed actions and their effects. According to this model, the observation of another person's action activates the corresponding motor code in the infants' motor repertoire (i.e. leads to motor resonance). The second process guiding imitative behavior results from the observed action effects. If the modeled action is followed by a salient action effect, the representation of this effect (i.e. perceptual code) will be associated with the activated motor code. If the infant later aims to obtain the same effect, the corresponding motor program will be activated and the model's action will therefore be imitated. Accordingly, the model assumes that for the imitation of novel actions the modeled action needs to elicit sufficient motor resonance and must be followed by a salient action effect. Using the head touch imitation paradigm, we tested these two assumptions derived from the model. To this end, we manipulated whether the actions demonstrated to the infants were or were not in the motor repertoire, i.e. elicited stronger or less strong motor resonance, and whether they were followed by salient action effects or not. The results were in line with the proposed two-stage model of infants' imitative learning and suggest that motor resonance is necessary, but not sufficient for infants' imitative learning from others' actions and their effects., (© 2011 Blackwell Publishing Ltd.)

We had previously identified the clock gene D-box binding protein (Dbp) as a potential candidate gene for bipolar disorder and for alcoholism, using a Convergent Functional Genomics (CFG) approach. Here we report that mice with a homozygous deletion of DBP have lower locomotor activity, blunted responses to stimulants, and gain less weight over time. In response to a chronic stress paradigm, these mice exhibit a diametric switch in these phenotypes. DBP knockout mice are also activated by sleep deprivation, similar to bipolar patients, and that activation is prevented by treatment with the mood stabilizer drug valproate. Moreover, these mice show increased alcohol intake following exposure to stress. Microarray studies of brain and blood reveal a pattern of gene expression changes that may explain the observed phenotypes. CFG analysis of the gene expression changes identified a series of novel candidate genes and blood biomarkers for bipolar disorder, alcoholism, and stress reactivity., ((c) 2008 Wiley-Liss, Inc)

Generalized anxiety disorder (GAD) is a relatively common mental disorder in the general population, afflicting approximately 3% of community residents during their lifetime. It is not a benign condition, since significantly increased disability and dysfunction are found in GAD subjects compared to non-GAD subjects. For decades GAD has frequently been observed in the context of other mental and substance abuse disorders. Initially the weight of clinical opinion indicated that GAD was a residual disease which should only be diagnosed when other mental disorders are not present. More recently there has been a growing recognition that comorbidity is a fundamental characteristic of the course and nature of GAD. In a series of secondary analyses conducted in subjects in the National Comorbidity Study database, we found that 8 out of 10 subjects with lifetime GAD also had a comorbid mood disorder during their lifetime. We found unipolar disorders to be four times more common in GAD than bipolar disorders (67% vs. 17%), providing indirect support for the previously reported observation that GAD and major depression may share a common genetic diathesis. In addition, our analyses support the conclusion that when comorbid mood disorders are present in GAD, a significant increase in associated disability and dysfunction is also found. Thus this comorbid relationship has important implications for clinical course and outcome.