Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis

IMPORTANCE

Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies.

OBJECTIVE

To provide a summary estimate of depression or depressive symptom prevalence among resident physicians.

DATA SOURCES AND STUDY SELECTION

Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms.

DATA EXTRACTION AND SYNTHESIS

Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression.

MAIN OUTCOMES AND MEASURES

Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire.

RESULTS

Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents.

CONCLUSIONS AND RELEVANCE

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.

Activity, stability and folding analysis of the chitinase from Entamoeba histolytica

Human amebiasis, caused by the parasitic protozoan Entamoeba histolytica, remains as a significant public health issue in developing countries. The life cycle of the parasite compromises two main stages, trophozoite and cyst, linked by two major events: encystation and excystation. Interestingly, the cyst stage has a chitin wall that helps the parasite to withstand harsh environmental conditions. Since the amebic chitinase, EhCHT1, has been recognized as a key player in both encystation and excystation, it is plausible to consider that specific inhibition could arrest the life cycle of the parasite and, thus, stop the infection. However, to selectively target EhCHT1 it is important to recognize its unique biochemical features to have the ability to control its cellular function. Hence, to gain further insights into the structure-function relationship, we conducted an experimental approach to examine the effects of pH, temperature, and denaturant concentration on the enzymatic activity and protein stability. Additionally, dependence on in vivo oxidative folding was further studied using a bacterial model. Our results attest the potential of EhCHT1 as a target for the design and development of new or improved anti-amebic therapeutics. Likewise, the potential of the oxidoreductase EhPDI, involved in oxidative folding of amebic proteins, was also confirmed.

Growth, immune responses and intestinal morphology of rainbow trout (Oncorhynchus mykiss) supplemented with commercial probiotics

The influence of two commercial probiotics on the growth, innate immune parameters and intestinal morphology of rainbow trout (Oncorhynchus mykiss) juveniles (initial weight: 16.4 ± 0.4 g) was evaluated. Two probiotic types: A, multi-species (Bacillus sp., Pedicoccus sp., Enterococcus sp., Lactobacillus sp.) and B, mono-species (Pediococcus acidilactici) were tested at two levels each (A1: 1.5 g kg(-1), 8.6 × 10(5) CFU g(-1); A2: 3 g kg(-1), 1.6 × 10(6) CFU g(-1); B1: 0.1 g kg(-1), 2.6 × 10(4) CFU g(-1); B2: 0.2 g kg(-1), 7.2 × 10(4) CFU g(-1)) versus an unsupplemented diet (C). Diets were distributed to sextuplicate tanks, three times a day to visual satiation for 8 weeks. Growth performance and immune responses (plasma lysozyme, ACH50, peroxidase and head kidney respiratory burst) were determined at 4 and 8 weeks of feeding. Body composition and intestine morphology were determined at the end of the feeding trial. At 8 weeks, the lower dose of multi-species probiotic (A1) improved growth rate, while both probiotic types improved feed conversion rate compared to the control animals, at the lower dose of multi-species (A1) and at the higher dose of mono-species (B2) probiotics. Body composition did not vary between treatments. At 4 weeks, ACH50 activity was significantly higher in fish fed higher dose of B probiotic (B2, 123.7 ± 50.6 vs 44.1 ± 7.7 U.ml(-1) in control). At 8 weeks, lysozyme activity was higher in fish fed A1 (13.1 ± 5.2 μg ml(-1)) diet compared to fish fed control diet (7.8 ± 1 μg ml(-1)). Plasma peroxidase and head-kidney respiratory burst did not differ among the dietary treatments. Villi length and integrity and goblet cell counting of a cross section of the anterior intestine were not significantly different between groups. Results suggest benefits in zootechnical performance and immune humoral responses using both probiotic types, in a dose dependent manner, without apparent alterations in intestinal morphology.

Probing cooperative liquid dynamics with the mean square displacement

Literature data for picosecond mean square displacements show that the anharmonicity explains only about half of the fragility (with different fractions for different glass formers). The other half must be ascribed to the Adam-Gibbs mechanism of a growing cooperatively rearranging region. One can measure both influences separately by a simultaneous measurement of liquid and crystal in the coexistence region.

Psychiatry, authoritarianism, and revolution: the politics of mental illness during military dictatorships in Argentina, 1966-1983

From 1966 to 1983, Argentina underwent a period of political radicalization as fascist regimes used terror to control its citizens and leftist guerrillas resorted to violence to spark revolution. During this politically volatile period, psychiatry transformed from an apolitical clinical specialty into an ideological tool used for both leftist resistance and military oppression. The largest psychiatric organization at the time, the Federación Argentina de Psiquiatras (FAP), became the center for a new politically committed brand of psychiatry in Argentina that united psychoanalysis and community psychiatry with Marxist theory. Though the military targeted and eventually dismantled the FAP and its leftist brand of psychoanalysis and community psychiatry, sectors of the government also paradoxically appropriated and reframed community-based psychiatric perspectives to pathologize leftist subversion and advance their own conservative ideology.

Acid-denatured Green Fluorescent Protein (GFP) as model substrate to study the chaperone activity of protein disulfide isomerase

Green fluorescent protein (GFP) has been widely used in several molecular and cellular biology applications, since it is remarkably stable in vitro and in vivo. Interestingly, native GFP is resistant to the most common chemical denaturants; however, a low fluorescence signal has been observed after acid-induced denaturation. Furthermore, this acid-denatured GFP has been used as substrate in studies of the folding activity of some bacterial chaperones and other chaperone-like molecules. Protein disulfide isomerase enzymes, a family of eukaryotic oxidoreductases that catalyze the oxidation and isomerization of disulfide bonds in nascent polypeptides, play a key role in protein folding and it could display chaperone activity. However, contrasting results have been reported using different proteins as model substrates. Here, we report the further application of GFP as a model substrate to study the chaperone activity of protein disulfide isomerase (PDI) enzymes. Since refolding of acid-denatured GFP can be easily and directly monitored, a simple micro-assay was used to study the effect of the molecular participants in protein refolding assisted by PDI. Additionally, the effect of a well-known inhibitor of PDI chaperone activity was also analyzed. Because of the diversity their functional activities, PDI enzymes are potentially interesting drug targets. Since PDI may be implicated in the protection of cells against ER stress, including cancer cells, inhibitors of PDI might be able to enhance the efficacy of cancer chemotherapy; furthermore, it has been demonstrated that blocking the reductive cleavage of disulfide bonds of proteins associated with the cell surface markedly reduces the infectivity of the human immunodeficiency virus. Although several high-throughput screening (HTS) assays to test PDI reductase activity have been described, we report here a novel and simple micro-assay to test the chaperone activity of PDI enzymes, which is amenable for HTS of PDI inhibitors.

Diffusion tensor imaging of incentive effects in prospective memory after pediatric traumatic brain injury

Few studies exist investigating the brain-behavior relations of event-based prospective memory (EB-PM) impairments following traumatic brain injury (TBI). To address this, children with moderate-to-severe TBI performed an EB-PM test with two motivational enhancement conditions and underwent concurrent diffusion tensor imaging (DTI) at 3 months post-injury. Children with orthopedic injuries (OI; n=37) or moderate-to-severe TBI (n=40) were contrasted. Significant group differences were found for fractional anisotropy (FA) and apparent diffusion coefficient for orbitofrontal white matter (WM), cingulum bundles, and uncinate fasciculi. The FA of these WM structures in children with TBI significantly correlated with EB-PM performance in the high, but not the low motivation condition. Regression analyses within the TBI group indicated that the FA of the left cingulum bundle (p=0.003), left orbitofrontal WM (p<0.02), and left (p<0.02) and right (p<0.008) uncinate fasciculi significantly predicted EB-PM performance in the high motivation condition. We infer that the cingulum bundles, orbitofrontal WM, and uncinate fasciculi are important WM structures mediating motivation-based EB-PM responses following moderate-to-severe TBI in children.

Pharmacogenetic screening of N-acetyltransferase 2, thiopurine s-methyltransferase, and 5,10-methylene-tetrahydrofolate reductase polymorphisms in Northwestern Mexicans

Specific information about the population pharmacogenetics can be the starting point to study the inheritance of these traits, to design individual drug therapy, and to develop new drugs rationally. Pharmacogenetic studies have been performed in some regions of Mexico, such as Central and Northeast, but this kind of study has not been conducted in the Northwest region so far. Here, we report the distribution of NAT2, TPMT, and MTHFR gene polymorphisms in Baja California, Mexico. We found that our population sample exhibits allele and genotype frequencies that are highly similar to those observed in Caucasian populations, although it should be noted that there are slight similarities with those determined in other populations. As allelic variants of drug-metabolizing enzymes are prevalent in our population, it is important to consider pharmacogenetic testing as part of the standard diagnostic protocols before medication.

Diffusion tensor imaging of the cingulum bundle in children after traumatic brain injury

Structural damage to the prefrontal-cingulate network has been implicated in cognitive and neurobehavioral deficits associated with traumatic brain injury (TBI). Forty-six children who had sustained moderate-to-severe TBI and 43 children with extracranial injury were imaged using diffusion tensor imaging (DTI). Decreased fractional anisotropy (FA) and increased apparent diffusion coefficient (ADC) values were found in the cingulum bundles bilaterally in the TBI group. Cingulum ADC was related to frontal lesion volume, injury severity, and injury mechanism. Finally, cingulum DTI parameters were related to cognitive control measures. DTI detects TBI-related injury to the cingulum, which may facilitate advances in assessment and treatment.

Structural and thermodynamic studies of n-butanol

We have conducted x-ray diffraction, calorimetric and Brillouin-scattering experiments on n-butanol between 77 and 300 K, aiming to explore the physical nature of the so-called 'glacial state' previously found in n-butanol as well as in triphenyl phosphite. In addition to our structural and thermodynamic studies of the liquid-glass transition and of the stable crystal state in n-butanol, we have found that the metastable 'glacial state' that can be obtained in the temperature range 125-160 K is not a second amorphous state, but rather the result of a frustrated or aborted crystallization process that produces plenty of nanocrystallites embedded in a disordered matrix. The crystalline order of these nanocrystallites of the 'glacial phase' is exactly the same as that well observed in the fully ordered stable crystal into which it transforms by heating above 160 K.

Concentration and temperature dependence of the refractive index of ethanol-water mixtures: influence of intermolecular interactions

The temperature and concentration dependence of the refractive index, nD(x, T), in ethanol-water mixtures agrees with previous data in the ethanol-rich concentration range. The refractive index versus concentration x determined at 20 degrees C shows the expected maximum at about 41 mol% water (22 mass% water). The temperature derivative of the refractive index, dnD/dT, shows anomalies at lower water concentrations at about 10 mol% water but no anomaly at 41 mol% water. Both anomalies are related to intermolecular interactions, the one in nD seems to be due to molecular segregation and cluster formation while the origin of the second one in dnD/dT is still not clear.

Thermal expansion of silver iodide-silver molybdate glasses at low temperatures

Ionic glasses obtained combining silver iodide and silver molybdate are characterized by quite low values of the glass transition temperature T(g) around 320-350 K, by high values of the dc ionic conductivity even at room temperature and by a peculiar behavior of the mechanical response at ultrasonic frequencies. In fact, at temperatures well below their glass transition temperature, these glasses exhibit an intense peak of acoustic attenuation well described by two different and almost overlapping relaxational contributions. Considering also that negative thermal expansion has been reported for some molybdate crystalline compounds, we have investigated in this work the thermal expansion of two silver iodomolybdate glasses (AgI)(1-x)(Ag(2)MoO(4))(x) for x=0.25 and x=0.33 in a wide temperature range (4.2-300 K) from cryogenic temperatures up to some 20 K below T(g) using a precision capacitance dilatometer aiming to understand whether the expansivity shows some possible fingerprint corresponding to the above-mentioned mechanical response. Two different measuring methods, a quasiadiabatic and a continuous one, have been used for the thermal expansion measurements. The results are discussed in comparison with the information obtained from previous investigations based on the extended x-ray absorption fine structure (EXAFS) technique and with the behavior of other ionic glasses.

Reduction in cerebral blood flow in areas appearing as white matter hyperintensities on magnetic resonance imaging

The purpose of this study was to examine cerebral blood flow (CBF) as measured by arterial spin labeling (ASL) in tissue classified as white matter hyperintensities (WMH), normal appearing white matter, and grey matter. Seventeen healthy older adults received structural and ASL MRI. Cerebral blood flow was derived for three tissue types: WMH, normal appearing white matter, and grey matter. Cerebral blood flow was lower in WMH areas relative to normal appearing white matter, which in turn, was lower than grey matter. Regions with consistently lower CBF across individuals were more likely to appear as WMH. Results are consistent with an emerging literature linking diminished regional perfusion with the risk of developing WMH.

A forward application of age associated gray and white matter networks

To capture patterns of normal age-associated atrophy, we previously used a multivariate statistical approach applied to voxel based morphometry that identified age-associated gray and white matter covariance networks (Brickman et al. [2007]: Neurobiol Aging 28:284-295). The current study sought to examine the stability of these patterns by forward applying the identified networks to an independent sample of neurologically healthy younger and older adults. Forty-two younger and 35 older adults were imaged with standard high-resolution structural magnetic resonance imaging. Individual images were spatially normalized and segmented into gray and white matter. Covariance patterns that were previously identified with scaled subprofile model analyses were prospectively applied to the current sample to identify to what degree the age-associated patterns were manifested. Older individuals were also assessed with a modified version of the Mini Mental State Examination (mMMSE). Gray matter covariance pattern expression discriminated between younger and older participants with high optimal sensitivity (100%) and specificity (90.5%). While the two groups differed in the degree of white matter pattern expression (t (75) = 5.26, P < 0.001), classification based on white matter expression was relatively low (sensitivity = 80% and specificity = 61.9%). Among older adults, chronological age was significantly associated with increased gray matter pattern expression (r (32) = 0.591, P < 0.001) but not with performance on the mMMSE (r (31) = -0.314, P = 0.085). However, gray matter pattern expression was significantly associated with performance on the mMMSE (r (31) = -0.405, P = 0.024). The findings suggest that the previously derived age-associated covariance pattern for gray matter is reliable and may provide information that is more functionally meaningful than chronological age.

Diffusion tensor imaging of hemispheric asymmetries in the developing brain

Diffusion tensor imaging (DTI) was performed in 39 right-handed children to examine structural hemispheric differences and the impact of age, socioeconomic status, and sex on these differences. Apparent diffusion coefficient (ADC) values were smaller in the left than in the right temporal, prefrontal, anterior internal capsular and the thalamic regions, and fractional anisotropy (FA) values were larger in the left than in the right internal capsule, thalamus, and cingulate. Significant region-by-sex interactions disclosed that the relation of DTI asymmetries to performance depended on sex including the relation of temporal lobes to reading comprehension and the relation of frontal lobes to solving applied mathematical problems.

Correlates of social problem solving during the first year after traumatic brain injury in children

Effects of pediatric traumatic brain injury (TBI) on social problem-solving were examined in a longitudinal study of 103 children with moderate-to-severe TBI (n = 52) or orthopedic injury (OI; n = 51) using the Interpersonal Negotiation Strategies task (INS). Children solved age-appropriate hypothetical social conflicts, with responses for four problem-solving steps scored by developmental level. The OI group performed better than the TBI group, but rate of change in performance over time did not differ between groups, suggesting improvement in children with TBI was not due to recovery from injury. Strong relations between INS performance and memory and language skills emerged, but emotional processing was only weakly related to INS performance. Frontal focal lesions influenced INS performance in younger (but not older) children with TBI. Diffusion tensor imaging (DTI), revealed strong relationships between the INS and increased apparent diffusion coefficient (ADC) measures indexing connectivity in the dorsolateral and cingulate regions in both TBI and OI groups, and in the temporal and parietal regions in the TBI group. These findings inform studies of social problem-solving skills during the first year post TBI. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

Ram effect: Adult rams induce a greater reproductive response in anestrous ewes than yearling rams

The introduction of rams to previously isolated anestrous ewes ensures induction of ovulation and estrus in part of the flock, and allows for the potential to conceive. However, there is little known about the desirable characteristics of the rams used to induce these behavioral and physiological responses. Adult rams may be more effective than young rams in induction of these responses. The primary aim of the present study was to compare the response in ewes stimulated by adult or yearling rams. During the non-breeding season, two groups of 121 ewes were stimulated with adult (AR) or yearling (YR) rams. When adult rams were used, significantly more ewes had ovulations (78.5 compared with 61.1%) and came into estrus (47.9 compared with 35.5%). There were more corpora lutea per ewe exposed to rams (0.95+/-0.59 compared with 0.65+/-0.51) and per ewe that had ovulations (1.18+/-0.41 compared with 1.06+/-0.25) and a greater conception rate (58.6 compared with 20.9%) as a result. Subsequently, to determine what signals led to the greater response to adult rams, the courtship behavior of adult and yearling rams toward anestrous ewes was compared in 46 pen tests. There were no significant differences in the frequency of any of the recorded courtship behaviors (anogenital sniffing: 21.9+/-3.4 versus 25.7+/-3.2; lateral approaches: 7.1+/-1.5 compared with 9.9+/-2.9; flehmen: 2.1+/-0.4 compared with 2.2+/-0.4; mount attempts: 0.1+/-0.1 compared with 0.1+/-0.1, for AR and YR, respectively), latency to the onset of courtship behavior (13.1+/-7.0 compared with 17.3+/-6.2s) or the time engaged in courtship behavior (173.1+/-24.6 compared with 199.0+/-26.5s). The difference in the signals produced by adult and yearling rams skin glands was assessed by stimulating ewes with masks containing wool from adult (n=45) or yearling (n=48) rams. More ewes had ovulations (24/45 compared with 11/48) and came into estrus (21/45 compared with 10/48) when wool from adult rams was used. As in Experiment 1, pregnancy and conception rates were greater when adult rams were used, another trial was designed to determine if there were differences in mating and mounting frequency between adult and yearling rams. Seven adult and six yearling rams were subjected to three pen tests each with three estrual ewes. Adult rams mounted more (21.7+/-4.5 compared with 9.8+/-0.7) and tended to ejaculate more frequently (2.9+/-0.5 compared with 1.8+/-0.4) than yearling rams. It is concluded that adult rams induce a greater reproductive response in anestrous ewes than yearling rams, inducing a greater ovulation percentage and estrous response in ewes, resulting in greater ovulation numbers, pregnancy and conception rates. This greater stimulation is, in part, explained by differences in the signals provided in the wool (presumably odors) produced by adult rams. The lesser percentage of pregnancies obtained when yearling rams are used may be explained by differences in mounting behaviors and ejaculation frequency.

Relationship between male-male and male-female sexual behavior in 5-6-month-old male lambs

To characterize male-male sexual behavior during lamb development, to relate it with lamb body and testicular growth, and with sexual behavior toward estrual ewes, 40 Milchschaf male lambs, weaned at 45 days of age, were kept with ewes that were nursing younger lambs. Experimental lambs were weighed and scrotal circumference was measured every 2 weeks. Male-male sexual behavior was observed during 1-2 h every 2 weeks after birth until 7 months of age. Observations were recorded more intensively (3-4 h on five different days) for 2 weeks (5-6 months of age) as male-male sexual behavior increased during that period. Both mounting and mounted lambs were identified. An individual mounting index (MI) was calculated. To study male-female sexual behavior, lambs were individually located with two estrual ewes, and during 5 min the number of ano-genital sniffing, lateral approaches, mounts, and mounts with ejaculation were recorded. From those data, a libido index was also calculated. Male-male mounts (n=308) were observed. Courtship behavior was displayed in 25% of interactions; mounts were accepted in 72.1% of attempted mounts. Mounts without previous courtship were accepted more frequently than mounts with previous courtship (P=0.002). Lamb weight and scrotal circumference were not different according to MI groups. Lambs that mounted more times estrual ewes (first tertile) had greater (P=0.04) MI (0.61+/-0.10) than lambs with medium (0.27+/-0.09) and less (0.30+/-0.10) MI. The regression between MI and heterosexual libido index was r=0.33 (P<0.05). In summary, intensive male-male sexual activity during a short period of male lamb development was observed. There was a positive relationship between sexual behavior of male lambs towards other male lambs and towards estrual ewes.

Structural analysis of dextran-based hydrogels obtained chemoenzymatically

This work reports the results of structural analysis in novel dextran-acrylate (dexT70-VA) hydrogels generated chemoenzymatically. Porous structure as well as hydrogel surface and interior morphologies were evaluated by mercury intrusion porosimetry (MIP), nitrogen adsorption (NA), and scanning electron microscopy (SEM) analyses, as a function of the degree of substitution (DS), and initial water content used in the preparation of the hydrogel. MIP analysis showed that the overall networks were clearly macroporous with pore sizes ranging from 0.065 to 10 microm. As expected, the average pore size decreased as DS increased and as initial water content decreased. Moreover, the porosity values ranged from 75 up 90%, which shows that these hydrogels present an interconnected pore structure. Nitrogen adsorption analyses showed that the specific surface area of dexT70-VA hydrogels increased either by increasing the DS or by decreasing the initial water content of the hydrogel. SEM results revealed that the surface of hydrogels with lower DS presented either a porous structure or a polymeric "skin" covering the pores, whereas hydrogels with higher DS were totally porous. Furthermore, the interior morphology varied according to the DS and the initial water content of the hydrogels. Finally, the average pore size was also determined from the swelling of hydrogel using a theoretical model developed by Flory-Rehner. The comparison of the SEM and MIP results with the ones obtained by the equilibrium swelling theory of Flory-Rehner shows that this approach highly underestimates the average pore size.