DSM-5 Criteria and Depression Severity: Implications for Clinical Practice

Role of Brain-Gut-Microbiota Axis in Depression: Emerging Therapeutic Avenues

The human gut microbiota plays a significant role in the pathophysiology of central nervous system-related diseases. Recent studies suggest correlations between the altered gut microbiota and major depressive disorder (MDD). It is proposed that normalization of the gut microbiota alleviates MDD. The imbalance of brain-gut-microbiota axis also results in dysregulation of the hypothalamicpituitary- adrenal (HPA) axis. This imbalance has a crucial role in the pathogenesis of depression. Treatment strategies with certain antibiotics lead to the depletion of useful microbes and thereby induce depression like effects in subjects. Microbiota is also involved in the synthesis of various neurotransmitters (NTs) like 5-hydroxy tryptamine (5-HT; serotonin), norepinephrine (NE) and dopamine (DA). In addition to NTs, the gut microbiota also has an influence on brain derived neurotrophic factor (BDNF) levels. Recent research findings have exhibited that transfer of stress prone microbiota in mice is also responsible for depression and anxiety-like behaviour in animals. The use of probiotics, prebiotics, synbiotics and proper diet have shown beneficial effects in the regulation of depression pathogenesis. Moreover, transplantation of fecal microbiota from depressed individuals to normal subjects also induces depression-like symptoms. With the precedence of limited therapeutic benefits from monoamine targeting drugs, the regulation of brain-gut microbiota is emerging as a new treatment modality for MDDs. In this review, we elaborate on the significance of brain-gut-microbiota axis in the progression of MDD, particularly focusing on the modulation of the gut microbiota as a mode of treating MDD.

Impact of antidepressant treatment on complete blood count parameters and inflammatory ratios in adolescents with major depressive disorder

Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are novel biomarkers of systemic inflammation in depression. This study aims to examines the impact of selective serotonin reuptake inhibitor (SSRI) treatment on complete blood count (CBC) parameters and inflammatory ratios in major depressive disorder (MDD). CBC parameters and inflammatory ratios were examined in a total of 45 drug-naive adolescents with MDD and were compared before and after SSRI treatment for 12 weeks and between responders and nonresponders. Following SSRI treatment in MDD, the red blood cell (RBC) count, hematocrit, and red cell distribution width (RDW) significantly increased. Hemoglobin tended to increase. The MCV, MCH, and MCHC values decreased significantly. White blood cell count, neutrophil percentage, monocyte count, and monocyte and basophil percentages decreased significantly. The percentage of lymphocytes significantly increased. The MLR decreased, whereas the NLR tended to decrease. Platelet count and PLR did not change significantly. A higher platelet count at baseline has been associated with non-response to SSRI treatment in patients with MDD. SSRI treatment increased RBC count, hematocrit, RDW, and lymphocyte percentage, and reduced MLR, and neutrophil and monocyte percentages in responders MDD. We suggest higher platelet counts at baseline as a potential predictor of nonresponders.

Probable depression and its correlates among undergraduate students in Johannesburg, South Africa

BACKGROUND

Depression is associated with high rates of morbidity and mortality. Globally, depression is higher among university students than the general population-making it a significant public health problem. Despite this, there is limited data on the prevalence in university students in the Gauteng province, South Africa. This study determined the prevalence of screening positive for probable depression and its correlates among undergraduate students at the university of the Witwatersrand, Johannesburg, South Africa.

METHODS

A cross-sectional study, using an online survey was conducted among undergraduate students at the University of the Witwatersrand in 2021. Patient Health Questionnaire (PHQ-2) was used to assess the prevalence of probable depression. Descriptive statistics was computed and conducted bivariate and multivariable logistic regression to identify factors associated with probable depression. Age, marital status, substance use (alcohol use, cannabis use, tobacco use, and other substance use) were included in the multivariable model apriori determined confounders and other factors were only added if they had a p-value <0.20 in the bivariate analysis. A p-value of 0.05 was considered statistically significant.

RESULTS

The response rate was 8.4% (1046/12404). The prevalence of screening positive for probable depression was 48% (439/910). Race, substance use, and socio-economic status were associated with odds of screening positive for probable depression. Specifically reporting white race (adjusted OR (aOR) = 0.64, 95% CI: 0.42, 0.96), no cannabis use (aOR = 0.71, 95% CI: 0.44-0.99), higher spending power in the form of having the most important things but few luxury goods (aOR = 0.50, 95% CI: 0.31, 0.80) and having enough money for luxury goods and extra things (aOR = 0.44, 95% CI: 0.26-0.76) were associated with lower odds of screening positive for probable depression.

DISCUSSION

In this study, screening positive for probable depression was common among undergraduate students at the University of the Witwatersrand, Johannesburg, South Africa and associated with sociodemographic and selected behavioral factors. These findings call for strengthening the awareness and use of counselling services among undergraduate students.

Post-COVID depression and its multiple factors, does Favipiravir have a protective effect? A longitudinal study of indonesia COVID-19 patients

BACKGROUND

Coronavirus disease (COVID-19) not only has a long-term effect on its survivors, it also affects their quality of life, including inducing depression as a possible manifestation of central nervous system disruption. Favipiravir shows promising efficacy as an antiviral drug for the treatment of COVID-19. However, its effect on the sequelae of COVID-19 has not been explored. Therefore, this study aims to assess the impact of Favipiravir and address the factors associated with post-COVID depression in Indonesia.

METHOD

This cohort study conducted a post-COVID-19 survey on Indonesian patients who were diagnosed by using real-time polymerase chain reaction (RT-PCR) and antigen tests until January 2022. An online questionnaire was distributed to obtain information on demographics, comorbidities, health behavior, symptoms, and treatment. The propensity technique was used to allocate the participants into the favipiravir and nonrecipient groups (1:1). The Patient Health Questionnaire-9 (PHQ-9) was used for outcome measurement. The cohort was followed up biweekly for 60 days after onset/diagnosis to determine the occurrence of depression. Cox regression analysis with an adjusted odds ratio and 95% confidence interval was used to estimate the effect of favipiravir on post-COVID-19 depression.

RESULTS

The data included the information of 712 participants, of whom 18.54% had depression within 60 days after onset/diagnosis. Depression was higher in the nonrecipient group (21.06%) than in the favipiravir group (16.01%). After adjustment by other factors, favipiravir prescription was found to be associated with depression (aOR 0.488, 95% CI 0.339-0.701 p < 0.001). In accordance with the PHQ-9 subset, favipiravir exerted a significant protective effect against depressive mood and loss of interest. However, patients living alone were prone to experiencing loss of interest (aOR 2.253, 95% CI 1.329-3.818, p = 0.003).

CONCLUSION

The data obtained in this preliminary survey suggested that favipiravir may be useful for preventing post-COVID depression. However, further study is needed. Moreover, the provision of mental health support, particularly to those who live alone, must be ensured.

TRIAL REGISTRATION

Registry NCT05060562.

Depression rates among African American inflammatory bowel disease patients at a large safety net hospital

AIM

Major depressive disorder is a prominent psychiatric illness in the United States. It has been found to be higher among patients with inflammatory bowel disease. However, few studies have focused on depression among minority populations with inflammatory bowel disease. Our study determined the prevalence of depression in minority patients with inflammatory bowel disease at our safety-net hospital, which serves a predominantly African American patient population.

METHODS

We conducted a single centre retrospective cohort study at a large, urban outpatient centre. We retrieved the electronic medical records of patients with inflammatory bowel disease who were seen in the gastroenterology clinic from December 2018-December 2019. Data on the severity of depression within the minority population, using the nine-question Patient Health Questionnaire, was obtained. The effects of age, sex, inflammatory bowel disease diagnosis, and comorbidities were analysed. A p-value <0.05 was considered statistically significant.

RESULTS

A total of IBD patients were included in the study, of which 46.7% were female and 53.3% were male. Mean age was 44 years. With regard to race, 88.4% were African American, 5.3% Asian, 2.1% Hispanic, 1.1% American Indian/Alaskan Native, and 3.2% multiracial. A total of 71.6% had Crohn's disease and 28.4% had ulcerative colitis. Overall prevalence of major depressive disorder was 25.3%; 45.8% had minimal, 8.3% mild, 33.3% moderate, and 12.5% severe depression. A total of 34.7% of patients were never screened for depression, and 13.8% had other psychiatric conditions. There was a difference in depression rates based on psychiatric conditions (p = 0.00), but no difference based on sex (p = 0.37), IBD subtype (p = 0.34), or medical conditions (p = 0.84).

CONCLUSIONS

Rates of depression among minority patients, predominantly African American, with inflammatory bowel disease were higher than previously reported for all patients with inflammatory bowel disease. Over 40% experienced moderate to severe depression. There was a low screening rate for depression. This data will be used to improve depression screening, especially among minorities.

Role of Probiotics and Diet in the Management of Neurological Diseases and Mood States: A Review

Alzheimer's (AD) and Parkinson's diseases (PD) are common in older people. Autism spectrum disorders (ASD), anxiety, depression, stress, and cognitive impairment are prevalent among people irrespective of age. The incidence of neurological disorders has been increasing in recent decades. Communication between the gut microbiota and the brain is intrinsically complicated, and it is necessary for the maintenance of the gut, brain, and immune functions of the host. The bidirectional link among the gut, gut microbiota and the brain is designated as the "microbiota-gut-brain axis." Gut microbiota modulates the host immune system and functions of tissue barriers such as gut mucosa and blood-brain barrier (BBB). Gut microbial dysfunction disturbs the gut-brain interplay and may contribute to various gut disorders, neurocognitive and psychiatric disorders. Probiotics could protect intestinal integrity, enhance gut functions, promote intestinal mucosal and BBB functions, and support the synthesis of brain-derived neurotrophic factors, which enhance neuronal survival and differentiation. Probiotics could be considered an adjunct therapy to manage metabolic and psychiatric diseases. Predominantly, Lactobacillus and Bifidobacterium strains are documented as potent probiotics, which help to maintain the bidirectional interactions between the gut and brain. The consumption of probiotics and probiotics containing fermented foods could improve the gut microbiota. The diet impacts gut microbiota, and a balanced diet could maintain the integrity of gut-brain communication by facilitating the production of neurotrophic factors and other neuropeptides. However, the beneficial effects of probiotics and diet might depend upon several factors, including strain, dosage, duration, age, host physiology, etc. This review summarizes the importance and involvement of probiotics and diet in neuroprotection and managing representative neurological disorders, injuries and mood states.

Effects of maternal trauma and associated psychopathology on atypical maternal behavior and infant social withdrawal six months postpartum

Maternal psychopathology given a history of maltreatment and domestic violence exposure increases the risk for child psychopathology. Infant social withdrawal is one warning sign of adverse developmental outcomes including child anxiety and depression. It remains unclear how maternal trauma-related psychopathology might affect infant social withdrawal six-months postpartum.

METHODS

One-hundred ninety-five women and their six-month-old infants were studied in an at-risk community sample. Maternal trauma history, posttraumatic stress (PTSD) and major depressive (MDD) disorders were assessed. Maternal and infant behaviors were coded from videotaped interactions.

RESULTS

Maternal trauma was correlated with atypical maternal behavior (AMB) and infant social withdrawal (p ≤ .001). PTSD and MDD, and comorbid PTSD/MDD predicted increased AMB (p ≤ .001) but only maternal MDD was predictive of infant social withdrawal (p ≤ .001). Effects of maternal MDD on infant withdrawal were mediated by AMB.

CONCLUSIONS

At six-months postpartum, maternal MDD was associated with infant withdrawal. AMB is an important target for early intervention.

Esketamine nasal spray in patients with treatment-resistant depression: the real-world experience in the French cohort early-access programme

OBJECTIVE

To present the first real-world data of patients with treatment-resistant depression (TRD) treated with esketamine through a French cohort Temporary Authorisation for Use (ATUc) programme.

METHODS

In 2019, the French Health Authorities exceptionally granted the first ATUc in psychiatry for TRD patients. Clinical characteristics, safety and efficacy data were reported by physicians. The ATUc ended ∼6 months after initiation.

RESULTS

The cohort (n = 66; median age 53.0 years; 62.1% female; 78.8% with severe major depressive episodes; resistance to a mean of 4.2 previous antidepressants) received esketamine treatment for a median of 30 days. Among 46 analysed patients, 22 (47.8%) achieved response (Montgomery-Åsberg Depression Rating Scale [MADRS] total score reduction ≥50.0%) and 17 (37.0%) achieved remission (MADRS total score of ≤12) at least once at a median of 18.5 (2.0-77.0) and 21.0 (2.0-46.0) days after initiation, respectively. By Week 4, patients had a 31.6% probability of achieving remission (Kaplan-Meier method). Sedation, somnolence, dizziness, hypertension, anxiety and dissociation were the most frequently reported (>10.0%) adverse events. No new safety signals were identified.

CONCLUSIONS

Patient characteristics of this cohort demonstrate high-level treatment resistance. The safety and efficacy of esketamine in patients with TRD in real-world clinical practice were consistent with Phase 3 trials.Key pointsPatients with treatment-resistant depression (TRD) exceptionally received esketamine nasal spray ahead of its launch through a French cohort Temporary Authorisation for Use (ATUc) programme.The clinical characteristics of 66 adult patients with TRD included in this cohort demonstrated a high-level of resistance to conventional treatments at the time of treatment request prior to esketamine initiation.No new safety signals were observed with esketamine initiation during the ATUc period compared with the Phase 3 clinical trials.The safety and efficacy of esketamine in the real world remain consistent with that established in Phase 3 clinical trials.The data collected during this ATUc also provide the first real-world data on the management and practical use of esketamine in a hospital setting in France.

A Cross-Sectional Study on the Prevalence of Depressive Symptoms and Its Associated Sociodemographic Factors in Peru during the COVID-19 Pandemic

The present study aims to analyze the prevalence of depressive symptoms and its sociodemographic-associated factors in Peruvian adults. Data was extracted from a nation-wide representative survey in which depression symptoms were measured with the PHQ-9 and sociodemographic information was extracted from household data. Depression severity rates were estimated for each symptom, and responses were modeled through the Rating Scale Model to obtain a depression measure used as dependent variable on a Generalized Mixed Linear Model. The most frequent depression symptoms were emotional, such as discouragement, sad mood, hopelessness, and lack of pleasure when doing activities. Our model showed that, after controlling the effects of all the variables considered, the most relevant predictors were gender, education level, physiographic region, age, marital status, and number of coresidents. Higher depression levels were found in women, people who did not complete higher education, participants living in the Highlands, older adults, single participants, and people living alone. Thus, interventions to promote or prevent depression severity during similar situations as the pandemic should focus on specific sociodemographic groups and their particular needs.

Prophylactic administration of rosmarinic acid ameliorates depression-associated cardiac abnormalities in Wistar rats: Evidence of serotonergic, oxidative, and inflammatory pathways

Psychiatric disorders and associated cardiac comorbidities have increased the risk of mortality worldwide. Researchers reported that depression increases the possibility of future cardiac abnormalities by approximately 30%. Therefore, there is an unmet need to develop therapeutic interventions to treat depression and associated cardiac abnormalities. The present study was conducted to evaluate the prophylactic effect of rosmarinic acid (RA) against chronic unpredictable stress (CUS)-induced depression associated cardiac abnormalities in Wistar rats. The CUS paradigm, which comprised several stressors, was employed for 40 days to induce depressive-like behavior and associated cardiac abnormalities in rats. Along with CUS, RA at a dose of 25 and 50 mg/kg was administered orally to two groups of animals for 40 days. Behavioral tests (forced swim test and sucrose consumption test) and molecular biomarkers (corticosterone and serotonin) were performed. Electrocardiography was performed before CUS (Day 0), Day 20, and Day 40 to study electrocardiogram parameters. Furthermore, changes in body weight, organ weight, tissue lipid peroxidation, glutathione, catalase, cTn-I, MMP-2, and proinflammatory cytokines (TNF-α and IL-6) were estimated. Our results showed that RA treatment caused a reduction in immobility period, adrenal hyperplasia, corticosterone level, tissue lipid peroxidation, cTn-I, MMP-2, proinflammatory cytokines, and QRS complex duration, while an increase in sucrose consumption, brain serotonin level, T-wave width, glutathione, and catalase activity as compared with the CUS-control group. The results of our study proved that RA administration ameliorates CUS-induced depression-associated cardiac abnormalities in rats via serotonergic, oxidative, and inflammatory pathways.

Metformin for the Improvement of Comorbid Depression Symptoms in Diabetic Patients: A Systematic Review

Diabetes mellitus and depression are chronic debilitating disorders and can occur comorbidly. They are thought to be linked not only through environmental and behavioral factors but through molecular mechanisms as well. Antidepressant medication and psychological therapy, standard treatments for depressive symptoms in Type 2 diabetes mellitus, are linked to high rates of treatment failure and non-adherence; therefore, understanding the molecular mechanisms linking diabetes and depression could lead to discovering new targets and developing novel therapeutics. Metformin is considered a first-line anti-diabetic medication for Type 2 diabetes mellitus, and several studies have discussed its antidepressant effect. Metformin is thought to promote neurogenesis, enhance spatial memory function and protect the brain against oxidative imbalance. This systematic review aims to compile information on metformin's effect on depression symptoms and assess current knowledge on the relationship between depression and diabetes. After reviewing several studies, we concluded that metformin might help treat comorbid depression in diabetic patients, but before it can be recommended as a depression medication, more extensive and better-designed trials are needed.

Biological Role of Nutrients, Food and Dietary Patterns in the Prevention and Clinical Management of Major Depressive Disorder

Major Depressive Disorder (MDD) is a growing disabling condition affecting around 280 million people worldwide. This complex entity is the result of the interplay between biological, psychological, and sociocultural factors, and compelling evidence suggests that MDD can be considered a disease that occurs as a consequence of an evolutionary mismatch and unhealthy lifestyle habits. In this context, diet is one of the core pillars of health, influencing multiple biological processes in the brain and the entire body. It seems that there is a bidirectional relationship between MDD and malnutrition, and depressed individuals often lack certain critical nutrients along with an aberrant dietary pattern. Thus, dietary interventions are one of the most promising tools to explore in the field of MDD, as there are a specific group of nutrients (i.e., omega 3, vitamins, polyphenols, and caffeine), foods (fish, nuts, seeds fruits, vegetables, coffee/tea, and fermented products) or dietary supplements (such as S-adenosylmethionine, acetyl carnitine, creatine, amino acids, etc.), which are being currently studied. Likewise, the entire nutritional context and the dietary pattern seem to be another potential area of study, and some strategies such as the Mediterranean diet have demonstrated some relevant benefits in patients with MDD; although, further efforts are still needed. In the present work, we will explore the state-of-the-art diet in the prevention and clinical support of MDD, focusing on the biological properties of its main nutrients, foods, and dietary patterns and their possible implications for these patients.

Unsupervised Machine Learning to Identify Depressive Subtypes

OBJECTIVES

This study evaluated an unsupervised machine learning method, latent Dirichlet allocation (LDA), as a method for identifying subtypes of depression within symptom data.

METHODS

Data from 18,314 depressed patients were used to create LDA models. The outcomes included future emergency presentations, crisis events, and behavioral problems. One model was chosen for further analysis based upon its potential as a clinically meaningful construct. The associations between patient groups created with the final LDA model and outcomes were tested. These steps were repeated with a commonly-used latent variable model to provide additional context to the LDA results.

RESULTS

Five subtypes were identified using the final LDA model. Prior to the outcome analysis, the subtypes were labeled based upon the symptom distributions they produced: psychotic, severe, mild, agitated, and anergic-apathetic. The patient groups largely aligned with the outcome data. For example, the psychotic and severe subgroups were more likely to have emergency presentations (odds ratio [OR] = 1.29; 95% confidence interval [CI], 1.17-1.43 and OR = 1.16; 95% CI, 1.05-1.29, respectively), whereas these outcomes were less likely in the mild subgroup (OR = 0.86; 95% CI, 0.78-0.94). We found that the LDA subtypes were characterized by clusters of unique symptoms. This contrasted with the latent variable model subtypes, which were largely stratified by severity.

CONCLUSIONS

This study suggests that LDA can surface clinically meaningful, qualitative subtypes. Future work could be incorporated into studies concerning the biological bases of depression, thereby contributing to the development of new psychiatric therapeutics.

Unraveling the mystery of white matter in depression: A translational perspective on recent advances

BACKGROUND

Numerous cortical and subcortical structures have been studied extensively concerning alterations of their integrity as well as their neurotransmitters in depression. However, connections between these structures have received considerably less attention.

OBJECTIVE

This systematic review presents results from recent neuroimaging as well as neuropathologic studies conducted on humans and other mammals. It aims to provide evidence for impaired white matter integrity in individuals expressing a depressive phenotype.

METHODS

A systematic database search in accordance with the PRISMA guidelines was conducted to identify imaging and postmortem studies conducted on humans with a diagnosis of major depressive disorder, as well as on rodents and primates subjected to an animal model of depression.

RESULTS

Alterations are especially apparent in frontal gyri, as well as in structures establishing interhemispheric connectivity between frontal regions. Translational neuropathological findings point to alterations in oligodendrocyte density and morphology, as well as to alterations in the expression of genes related to myelin synthesis. An important role of early life adversities in the development of depressive symptoms and white matter alterations across species is thereby revealed. Data indicating that stress can interfere with physiological myelination patterns is presented. Altered myelination is most notably present in regions that are subject to maturation during the developmental stage of exposure to adversities.

CONCLUSION

Translational studies point to replicable alterations in white matter integrity in subjects suffering from depression across multiple species. Impaired white matter integrity is apparent in imaging as well as neuropathological studies. Future studies should focus on determining to what extent influencing white matter integrity is able to improve symptoms of depression in animals as well as humans.

Blood Chromium Levels and Their Association with Cardiovascular Diseases, Diabetes, and Depression: National Health and Nutrition Examination Survey (NHANES) 2015-2016

Currently, there is no global consensus about the essentiality of dietary chromium. To provide evidence to this debate, an examination of blood chromium levels and common chronic health conditions was undertaken. Using a subsample from the 2015−2016 US National Health and Nutrition Examination Survey (n = 2894; 40 years+), chi-square and binary logistic regression analyses were conducted to examine blood chromium levels (0.7−28.0 vs. <0.7 µg/L) and their associations with cardiovascular diseases (CVDs; self-report), diabetes mellitus (DM; glycohemoglobin ≥5.7%), and depression (Patient Health Questionnaire-9 score ≥5), while controlling for socio-demographic (age/sex/income/education/relationship status) and health-related (red blood cell folate/medications/co-morbidities/body mass index (BMI)/substance use) factors. The sample was almost evenly distributed between men and women (n = 1391, 48.1% (men); n = 1503, 51.9% (women)). The prevalence estimates of low blood chromium levels tended to be higher among those with CVDs (47.4−47.6%) and DM (50.0−51.6%). Comparisons between those with low vs. normal blood chromium levels indicate men have increased odds of CVDs (adjusted odds ratio (aOR) = 1.86, 95% confidence interval (CI): 1.22−2.85, p < 0.001) and DM (aOR = 1.93, 95% CI: 1.32−2.83, p < 0.001) and lower odds of depression (aOR = 0.42, 95% CI: 0.22−0.77, p < 0.05). Dietary chromium may be important in the prevention and management of CVDs and DM for men. Continued exploration of chromium’s role in chronic diseases, including differences by biological factors, is needed.

Prevalence and Unmet Need for Mental Healthcare of Major Depressive Disorder in Community-Dwelling Chinese People Living With Vision Disability

Objective

Mental health services have been recognized as an essential part of the comprehensive eye care services, but data regarding the mental health of people living with vision disability (PLwVD) remain very limited. This study examined the epidemiology of major depressive disorder (MDD) among Chinese PLwVD, as well as their perceived needs for and utilization of mental health services.

Methods

By using stratified cluster sampling method, a total of 1,753 PLwVD were successfully recruited from 73 urban communities and 169 rural villages in Wuhan, China, and interviewed with the Mini-international Neuropsychiatric Interview 5.0. Standardized questions were used to measure perceived mental healthcare needs and use of mental health services of PLwVD with MDD.

Results

The one-month prevalence of MDD was 24.4%. Among the PLwVD with MDD, 26.0% perceived needs for mental healthcare and only 1.2% sought treatment from mental health specialists for their emotional problems. Factors associated with MDD were middle age [vs. young adulthood, odds ratio (OR) = 1.96, P < 0.001], older adulthood (vs. young adulthood, OR = 1.79, P = 0.004), being never-married (vs. married, remarried, and cohabiting, OR = 1.96, P < 0.001), being separated, divorced, and widowed (vs. married, remarried, and cohabiting, OR = 12.30, P < 0.001), a low level of objective social support (vs. high, OR = 1.83, P < 0.001), currently drinking (OR = 1.81, P < 0.001), having childhood-onset eye conditions (OR = 1.89, P = 0.005), and having difficulties in performing daily activities (OR = 2.78, P < 0.001).

Conclusions

Chinese PLwVD are at high risk for MDD and have a high level of unmet need for mental healthcare. Public strategies are warranted to improve the mental health literacy of PLwVD and make the mental health services available, accessible, and affordable for PLwVD.

Distinguishing the Effect of Time Spent at Home during COVID-19 Pandemic on the Mental Health of Urban and Suburban College Students Using Cell Phone Geolocation

The aim of this study was to assess the correlation of depression and anxiety with time spent at home among students at two universities-one urban and the other suburban-during the COVID-19 pandemic.

METHODS

Geolocation data from the smartphones of 124 participants were collected between February 2021 and May 2021. The level of depression was estimated by the PHQ-9 and PHQ-2 screening tools, and anxiety scores were estimated by the GAD-2 and GAD-7 screening tools.

RESULTS

51% of participants in the PHQ-9 surveys indicated mild to severe depression. Participants spent on average 75% of their time at home during COVID. Time spent at home had a positive correlation with the mental health of urban students but a negative correlation with suburban students. The relation between the time at home with mental health was stronger among female participants than among male participants. Correlations between female depression, anxiety, and time at home were significant.

CONCLUSIONS

Lockdown and distance learning contributed to the high levels of depression in university students. This research highlights the importance of time spent at home for mental health being during the pandemic and the importance of distinguishing between urban and suburban settings when formulating public health recommendations. Quality of time spent at home versus time spent outside differentiated the mental well-being of students located in different environments. Staying at home may be recommended for students without access to safe outdoor places as it is associated with lower levels of depression.

Brain differential gene expression and blood cross-validation of a molecular signature of patients with major depressive disorder

INTRODUCTION

The agreement between clinicians diagnosing major depressive disorder (MDD) is poor. The objective of this study was to identify a reproducible and robust gene expression marker capable of differentiating MDD from healthy control (HC) subjects.

MATERIALS AND METHODS

Brain and blood gene expression datasets were searched, which included subjects with MDD and HC. The largest database including different areas of brain samples (GSE80655) was used to identify an initial gene expression marker. Tests of robustness and reproducibility were then implemented in 13 brain and 7 blood independent datasets. Correlations between expression in brain and blood samples were also examined. Finally, an enrichment analysis to explore the marker biological meaning was completed.

RESULTS

Twenty-eight genes were differentially expressed in GSE80655, of which 23 were critical to differentiate MDD from HC. The accuracy obtained using the 23 genes was 0.77 and 0.8, before and after the forward selection model, respectively. The gene marker's robustness and reproducibility were between the range of 0.46 and 0.63 in the other brain datasets and between 0.45 and 0.78 for the blood datasets. Brain and blood expression tended to correlate in some samples. Thirteen of the 23 genes were related to stress and immune response.

CONCLUSION

A 23 gene expression marker was able to distinguish subjects with MDD from HC, with adequate reproducibility and low robustness in the independent databases investigated. This gene set was similarly expressed in the brain and blood and involved genes related to stress and immune response.

Evolutive Pattern of Major Depressive Disorder among Young Patients

Background: Major depressive disorder (MDD) in young patients represents a real public health problem, with a concerning increase in its prevalence. Aim of the study: To observe and to document relevant information regarding the particularities and the evolutive clinical patterns of MDD in young patients (18–50 years). Material and methods: We conducted a retrospective cross-sectional descriptive study on 68 patients diagnosed with MDD, aged 18–50 years, admitted to the First Department of Psychiatry of the Clinical County Hospital of Târgu Mureș, Romania between January 1, 2019 and September 30, 2020. Data regarding the patients’ psychiatric evaluation (primary and secondary diagnosis, relapses, associated personality disorders, autolytic attempts, treatment options, evolution, comorbidities) and psychological evaluation (HAM-D, HAM-A, GAF) were analyzed. Results: The highest prevalence of MDD was found in the 41–50 years age group (66%), followed by the 31–40 years age group (24%). Regarding the GAF and HAM-D scales, 90% of patients had scores in the range of 41–50 and >20 respectively. We found a high prevalence of personality disorders (75%), the most common being borderline personality disorder (27%). Younger patients (18–35 years) tended to recover quicker, with an average of 8.15 hospitalization days compared to older patients (36–50 years) who had an average of 12 days. Relapses were present in 55% of cases, being more frequent in women, and there was a 50% rate of relapse in subjects with no social support network. Autolytic attempts were present in 25% of cases and insomnia in 92%. Conclusions: MDD has a major impact on the patients’ global functionality and their quality of life. In our study, women were more vulnerable to develop MDD, while younger adults were less prone to develop MDD and they recovered more quickly.

The Impact of Chronic Unpredictable Mild Stress-Induced Depression on Spatial, Recognition and Reference Memory Tasks in Mice: Behavioral and Histological Study

Depression-induced cognitive impairment has recently been given more attention in research. However, the relationship between depression and different types of memory is still not clear. Chronic unpredictable mild stress (CUMS) is a commonly used animal model of depression in which animals are exposed to chronic unpredictable environmental and psychological stressors, which mimics daily human life stressors. This study investigated the impact of different durations of CUMS on various types of memory (short- and long-term spatial memory and recognition memory) and investigated CUMS’ impact on the ultrastructural level by histological assessment of the hippocampus and prefrontal cortex. Twenty male C57BL/J6 mice (6 weeks old, 21.8 ± 2 g) were randomly divided into two groups (n = 10): control and CUMS (8 weeks). A series of behavioral tasks were conducted twice at weeks 5–6 (early CUMS) and weeks 7–8 (late CUMS). A tail-suspension test (TST), forced swimming test (FST), elevated zero maze (EZM), elevated plus maze (EPM), open field test (OFT), and sucrose-preference test (SPT) were used to assess anxiety and depressive symptoms. The cognitive function was assessed by the novel object recognition test (NORT; for recognition memory), Y-maze (for short-term spatial memory), and Morris water maze (MWM: for long-term spatial memory) with a probe test (for reference memory). Our data showed that 8 weeks of CUMS increased the anxiety level, reported by a significant increase in anxiety index in both EPM and EZM and a significant decrease in central preference in OFT, and depression was reported by a significant increase in immobility in the TST and FST and sucrose preference in the SPT. Investigating the impact of CUMS on various types of memory, we found that reference memory is the first memory to be affected in early CUMS. In late CUMS, all types of memory were impaired, and this was consistent with the abnormal histological features of the memory-related areas in the brain (hippocampus and prefrontal cortex).

The Problem of Malnutrition Associated with Major Depressive Disorder from a Sex-Gender Perspective

Major depressive disorder (MDD) is an incapacitating condition characterized by loss of interest, anhedonia and low mood, which affects almost 4% of people worldwide. With rising prevalence, it is considered a public health issue that affects economic productivity and heavily increases health costs alone or as a comorbidity for other pandemic non-communicable diseases (such as obesity, cardiovascular disease, diabetes, inflammatory bowel diseases, etc.). What is even more noteworthy is the double number of women suffering from MDD compared to men. In fact, this sex-related ratio has been contemplated since men and women have different sexual hormone oscillations, where women meet significant changes depending on the age range and moment of life (menstruation, premenstruation, pregnancy, postpartum, menopause…), which seem to be associated with susceptibility to depressive symptoms. For instance, a decreased estrogen level promotes decreased activation of serotonin transporters. Nevertheless, sexual hormones are not the only triggers that alter neurotransmission of monoamines and other neuropeptides. Actually, different dietary habits and/or nutritional requirements for specific moments of life severely affect MDD pathophysiology in women. In this context, the present review aims to descriptively collect information regarding the role of malnutrition in MDD onset and course, focusing on female patient and especially macro- and micronutrient deficiencies (amino acids, ω3 polyunsaturated fatty acids (ω3 PUFAs), folate, vitamin B12, vitamin D, minerals…), besides providing evidence for future nutritional intervention programs with a sex-gender perspective that hopefully improves mental health and quality of life in women.

Self-reported depression and anxiety among COPD patients. A case-control study

BACKGROUND

Anxiety and depression are the most prevalent mental disorders worldwide. However, the exact mechanisms linking chronic obstructive pulmonary disease (COPD) with depression and anxiety have not been identified.

OBJECTIVES

To compare self-reported depression and anxiety among patients diagnosed with COPD in relation to healthy controls.

DESIGN AND SETTING

Case control study at a public hospital institution in Spain.

METHODS

We designed a case-control study. Patients were recruited using a consecutive sampling method from a single institution. Two groups were created: COPD and healthy controls. Data on medical history and demographic background were collected from the medical records. Self-reported depression levels were assessed using Beck's depression inventory (BDI). Self-reported anxiety was measured using the State-trait anxiety inventory (STAI).

RESULTS

Fifty-two patients with COPD and fifty healthy patients were included in this study. BDI scores were higher for COPD patients (10.23 ± 6.26) than in the control group (5.2 ± 6.56). STAI-state scores were higher for COPD patients (41.85 ± 12.55) than for controls (34.88 ± 9.25). STAI-trait scores were higher for COPD patients (41.42 ± 10.01) than for controls (34.62 ± 9.19).

CONCLUSIONS

This study showed that there were higher levels of depression and anxiety among COPD patients than among healthy controls.

Emerging Evidence for the Widespread Role of Glutamatergic Dysfunction in Neuropsychiatric Diseases

The monoamine model of depression has long formed the basis of drug development but fails to explain treatment resistance or associations with stress or inflammation. Recent animal research, clinical trials of ketamine (a glutamate receptor antagonist), neuroimaging research, and microbiome studies provide increasing evidence of glutamatergic dysfunction in depression and other disorders. Glutamatergic involvement across diverse neuropathologies including psychoses, neurodevelopmental, neurodegenerative conditions, and brain injury forms the rationale for this review. Glutamate is the brain's principal excitatory neurotransmitter (NT), a metabolic and synthesis substrate, and an immune mediator. These overlapping roles and multiple glutamate NT receptor types complicate research into glutamate neurotransmission. The glutamate microcircuit comprises excitatory glutamatergic neurons, astrocytes controlling synaptic space levels, through glutamate reuptake, and inhibitory GABA interneurons. Astroglia generate and respond to inflammatory mediators. Glutamatergic microcircuits also act at the brain/body interface via the microbiome, kynurenine pathway, and hypothalamus-pituitary-adrenal axis. Disruption of excitatory/inhibitory homeostasis causing neuro-excitotoxicity, with neuronal impairment, causes depression and cognition symptoms via limbic and prefrontal regions, respectively. Persistent dysfunction reduces neuronal plasticity and growth causing neuronal death and tissue atrophy in neurodegenerative diseases. A conceptual overview of brain glutamatergic activity and peripheral interfacing is presented, including the common mechanisms that diverse diseases share when glutamate homeostasis is disrupted.

The association between episodes of night eating and levels of depression in the general population

OBJECTIVE

Research has suggested that a correlation may exist between depressive mood and episodes of night eating. This study aimed to examine whether having episodes of night eating was associated with increased levels of depression.

METHOD

This study used data from the 2019 Korea Community Health Survey and the study population consisted of adults aged ≥19 years. Depression levels were measured using the Patient Health Questionnaire-9. We investigated the patients' general characteristics using t-tests and analysis of variance. The association between depression levels and episodes of night eating was analyzed using a multivariable linear regression analysis. Subgroup analysis was conducted based on daily sleep duration.

RESULTS

We analyzed 34,358 individuals and found higher average depression scores (β: 4.99, p < .001) in those with episodes of night eating than those without. Large effect sizes were found for differences in depression scores between participants with and without episodes of night eating. The magnitude of this increase was particularly pronounced in individuals who reported 9 or more hours of sleep per day.

DISCUSSION

An association was found between levels of depression and episodes of night eating as individuals with episodes of night eating were more likely to have higher depression scores. Our findings suggest the potential need to consider night eating when addressing the mental health of the general population.

Temporal Associations between Depression and Hostility in the Context of a Divorce Intervention

Divorce interventions have been found effective in reducing negative outcomes for newly divorced people, including depression and hostility. Typically, divorce interventions cover a variety of issues that may influence people's level of depression and hostility. However, it is unclear whether the interventions differentially affect the outcomes. That is, it may be that intervention participation leads to a reduction in depression, which is associated with a prospective reduction in hostility - or vice versa. The current study used a sample of 1,856 recently divorced Danes, who completed questionnaires at baseline, 3-, 6-, and 12-month post-divorce. Structural equation modeling revealed that while depression and hostility were concurrently associated, there were no prospective associations, except for baseline depression predicting 3-month hostility. Moreover, the associations did not differ by gender. The results suggest that the intervention content may have influenced both depression and hostility. These findings may be useful in guiding future divorce intervention developments.

Is Vitamin D Important in Anxiety or Depression? What Is the Truth?

PURPOSE OF REVIEW

Depression and anxiety are mood disorders that affect health and therefore quality of life and increase the global burden of disease. One of the possible mechanisms in the pathophysiology of these mood disorders has been reported as oxidative stress and inflammation. In the light of this information, it is important to determine the relationship between antioxidant nutrients (such as vitamin D) and these diseases. There are points where the brain regions involved in the pathophysiology of depression and anxiety and vitamin D metabolism intersect.

RECENT FINDINGS

Low vitamin D levels are associated with increased symptoms of depression and anxiety. For this reason, vitamin D screening should be performed in the prevention and treatment planning of these mood disorders. Vitamin D, which has antioxidant properties and activity in brain tissue, is important for mood disorders preventions or treatments but serum levels must be followed.

HIV, HSV, SARS-CoV-2 and Ebola Share Long-Term Neuropsychiatric Sequelae

Long COVID, in which disease-related symptoms persist for months after recovery, has led to a revival of the discussion of whether neuropsychiatric long-term symptoms after viral infections indeed result from virulent activity or are purely psychological phenomena. In this review, we demonstrate that, despite showing differences in structure and targeting, many viruses have highly similar neuropsychiatric effects on the host. Herein, we compare severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus 1 (HIV-1), Ebola virus disease (EVD), and herpes simplex virus 1 (HSV-1). We provide evidence that the mutual symptoms of acute and long-term anxiety, depression and post-traumatic stress among these viral infections are likely to result from primary viral activity, thus suggesting that these viruses share neuroinvasive strategies in common. Moreover, it appears that secondary induced environmental stress can lead to the emergence of psychopathologies and increased susceptibility to viral (re)infection in infected individuals. We hypothesize that a positive feedback loop of virus-environment-reinforced systemic responses exists. It is surmised that this cycle of primary virulent activity and secondary stress-induced reactivation, may be detrimental to infected individuals by maintaining and reinforcing the host's immunocompromised state of chronic inflammation, immunological strain, and maladaptive central-nervous-system activity. We propose that this state can lead to perturbed cognitive processing and promote aversive learning, which may manifest as acute, long-term neuropsychiatric illness.

Post-Stroke Depression: Prevalence, Associated Factors, and Relationship to Disability in a Tertiary Care Center in Sri Lanka

Background and Objectives  The prevalence of stroke in urban Sri Lanka is estimated at 10.4 per 1000 and is expected to rise. Post-stroke depression (PSD) is an independent predictor of poor long-term outcomes. It leads to suboptimal rehabilitation, decreased quality of life, and increased mortality and is under-recognized. The main objectives of this study were to estimate the prevalence of depression in stroke, assess factors associated with PSD, and assess the relationship of PSD to disability. Materials and Methods  A descriptive cross-sectional study was conducted at the Neurology and Medical Ward, National Hospital of Sri Lanka. Non-probability, consecutive sampling was used to collect data from patients with ischemic stroke admitted from January 2019 to January 2020. Patients with significant pre-existing depression, cognitive impairment, and language deficits were excluded. A structured, pre-tested interviewer-administered questionnaire was used to assess the prevalence and associated factors of PSD. Beck's Depression Inventory (BDI) was administered 3 months following the stroke to screen for depression. Modified Rankin Score (MRS) was used to assess disability on admission, discharge, and at 3 months. Results  Eighty-one stroke patients were screened. The mean age was 66.6 years (±standard deviation [SD]: 12.5). Male:female ratio was 1.2:1. Depression at 3 months of follow-up was observed in 35.8% (95% confidence interval [CI]: 25.4-47.2%) of participants. Following bivariate analysis, large vessel stroke ( p  < 0.001), cortical stroke ( p  < 0.001), frontal lobe lesions ( p  < 0.001), history of past stroke ( p  = 0.014), and sexual dysfunction ( p  = 0.026) were associated with increased risk of PSD. The odds of a person with severe disability developing PSD was 7.9 times more than a person with a less severe disability at discharge from hospital and at 3 months of follow-up (odds ratio [OR] =7.9; 95% CI: 2.7-23.3, p  = 0.000). Conclusions  PSD occurs in one-third of strokes, keeping with previous studies. The risk of having PSD is higher among patients with severe disabilities. The difference in risk factors identified compared with previous studies can be attributable to differences in methodology. Identifying risk factors for post-stroke depression is essential to mitigate the poor outcome.

[Prevalence and factors associated with depression in health personnel during the SARS-CoV-2 pandemic in the department of Piura, Peru]

INTRODUCTION

The COVID-19 pandemic has increased the magnitude of mental illnesses such as depression, not only in the general population, but also in health personnel. However, in Peru the prevalence is not known and the associated factors for developing depression in health personnel are not known.

OBJECTIVE

To determine the prevalence and identify the factors associated with depression in health personnel, in the context of the SARS-CoV-2 pandemic.

MATERIAL AND METHOD

An analytical cross-sectional study was carried out between the months of May-September in health establishments. A sample of 136 health workers were included and a survey was applied to collect the data. Depression as a dependent variable was measured using the Zung self-report scale. To identify the associated factors, the bivariate and multivariate analysis was performed by logistic regression with STATA v 14.

RESULTS

The prevalence of depression was 8.8% CI 95% (4.64-14.90), likewise, the antecedent of having a family member or friend died from COVID-19 with a p value of 0.017 and OR of 6.78 (CI: 1.39-32.90). On the other hand, the use of personal protective equipment (PPE) was found to be a protective factor against the development of depression with p value 0.003 and OR of 0.03 (CI: 0.004-0.32).

CONCLUSIONS

Approximately 1 in 10 among health professionals and technicians developed depression during the SARS-CoV-2 pandemic in this study. In addition, the history of having relatives or friends killed by COVID-19 was negatively associated with depression and the use of PPE was identified as a protective factor for depression.

Association between the dispositional optimism and depression in young people: a systematic review and meta-analysis

The objective of this study was to perform a meta-analysis of publications that reported the association between dispositional optimism and depression during youth, analyzing if the strength of this relationship varied according to potential factors. Systematic searches were carried out in APA PsycNet, Virtual Health Library, Embase, Web of Science, PubMed Central, and Scopus to collect English, Portuguese, or Spanish studies from 2009 onwards. Two reviewers selected the eligible articles, assessed the quality of each study, and extracted the data. For the synthesis of the results, a meta-analytic approach was used. We identified 4077 publications in the initial searches and 22 in the supplementary searches, from which 31 studies remained for analysis once the eligibility criteria were applied. The results showed a statistically significant negative association between dispositional optimism and depression in the young population, age being a factor that modifies the effect measure between these variables. This meta-analysis provides a consistent and robust synthesis on the interaction effect between dispositional optimism and depression in the young population. Based on these findings, early clinical admissions may effectively improve optimistic tendencies in young people, which could help them prevent depressive symptoms or episodes.

Serum plasminogen activator inhibitor-1 levels in patients with major depressive disorder vs. healthy controls: a systematic review and meta-analysis

INTRODUCTION

Major depressive disorder (MDD) is a severe mental health condition that affects millions of people worldwide. Etiologically, several factors may play a role in its development. Previous studies have reported elevated plasminogen activator inhibitor-1 (PAI-1) levels in patients with depression, suggesting that PAI-1 levels might be linked to the etiology of MDD.

METHODS

We systematically searched the following online databases: MEDLINE, Scopus, and Web of Science up to September 10, 2020, to identify studies in which PAI-1 levels were reported in subjects with MDD. Subsequently we used RevMan 5.3 to perform a meta-analysis of data extracted from the included studies using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PICO criteria for the search and analysis.

RESULTS

Six studies that reported mean ± standard deviation (SD) were included in the analysis, with a total of 507 MDD patients and 3,453 controls. The overall standardized mean difference (SMD) was 0.27 (95% confidence interval [95% CI] 0.01-0.53). PAI-1 serum levels were 0.27 SDs higher in MDD patients than in controls. The test for overall effect was significant (z = 2.04, p = 0.04). Substantial heterogeneity was detected among the studies, demonstrated by the inconsistency test (I² = 72%) and the chi-square test (χ² = 18.32; p = 0.003).

CONCLUSIONS

This systematic review and meta-analysis showed that MDD might be related to elevated PAI-1 levels. We propose larger prospective clinical studies to further investigate this clinical correlation and validate the clinical significance of these observations.

MicroRNAs as Critical Biomarkers of Major Depressive Disorder: A Comprehensive Perspective

Major Depressive Disorder (MDD) represents a major global health concern, a body-mind malady of rising prevalence worldwide nowadays. The complex network of mechanisms involved in MDD pathophysiology is subjected to epigenetic changes modulated by microRNAs (miRNAs). Serum free or vesicles loaded miRNAs have starred numerous publications, denoting a key role in cell-cell communication, systematically and in brain structure and neuronal morphogenesis, activity and plasticity. Upregulated or downregulated expression of these signaling molecules may imply the impairment of genes implicated in pathways of MDD etiopathogenesis (neuroinflammation, brain-derived neurotrophic factor (BDNF), neurotransmitters, hypothalamic-pituitary-adrenal (HPA) axis, oxidative stress, circadian rhythms...). In addition, these miRNAs could serve as potential biomarkers with diagnostic, prognostic and predictive value, allowing to classify severity of the disease or to make decisions in clinical management. They have been considered as promising therapy targets as well and may interfere with available antidepressant treatments. As epigenetic malleable regulators, we also conclude emphasizing lifestyle interventions with physical activity, mindfulness and diet, opening the door to new clinical management considerations.

Potential usefulness of complete blood count parameters and inflammatory ratios as simple biomarkers of depression and suicide risk in drug-naive, adolescents with major depressive disorder

We determined whether an elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were associated with depression in major depressive disorder (MDD), or suicide risk in MDD patients. A total of 137 adolescents with MDD who were antidepressant-naïve and 56 healthy controls (HC) were included. Recent suicidal behaviors were assessed. The NLR, PLR, and MLR were calculated from parameters obtained from a routine complete blood cell count parameters and compared between the MDD subgroups and HC. Cohen's d was calculated as a measure of effect size. The linear relationship between biomarkers with depression severity or suicidality severity was also analysed. Changes in CBC parameters and inflammatory ratios appeared to be more closely related to the suicidality severity than depressive severity. As compared with HC, the WBC count, neutrophil percentage, platelet count, NLR, and PLR were higher in MDD, whereas the lymphocyte percentage was lower. As compared to non-suicidal ideation (non-SI) MDD and HC, the lymphocyte percentage was decreased in MDD with suicidal attempts (SA), whereas monocyte count and MLR were increased. Suicidal attempts in MDD patients were associated with the lower lymphocytes percentage, as well as the elevated monocyte count and MLR.

Differential effects of ergometer-cycling and Whole-Body-Vibration training on serological BDNF and IGF-1 in the treatment of adolescent depression - is there an impact of BDNFp.Val66Met variants?

BACKGROUND

Pathogenesis and treatment of adolescent depression may be influenced by growth-factors, including brain-derived neurotrophic factor (BDNF) and insulin-like growth factor 1 (IGF-1). We investigated, if treatment response to two different add-on exercise-therapies in juvenile depression, differ in the changes of BDNF and IGF-1 serology. A subgroup analysis for genetic variations in BDNF p.Val66Met-variants was added.

METHODS

Included subjects in the study (N = 64), aged 13 to 17 years, were diagnosed with major depression, controls received inpatient treatment as usual (TAU). Intervention groups performed as add-on to TAU two different forms of exercise-therapy: endurance ergometer cycling (EC) and muscle strengthening whole body vibration (WBV). We expected both exercise-forms to increase BDNF and IGF-1 serology and by this pathway to improve depression scores significantly stronger than the control group.

RESULTS

None of the experimental groups showed significant changes in BDNF between measurement time points. However, after 6 weeks exercise, BDNF of both intervention groups were significantly higher compared to TAU,. The IGF-1 increase after 6 weeks intervention was significant for EC only. No correlations of BDNF and IGF-1 to depression scores were found. Group analysis in BDNF p.Val66Met variants showed a trend for better response in depression scores to exercise-treatment for the Val66Val group.

LIMITATIONS

A small sample size, the non-randomized controls and the neglect of psychosocial factors have to be considered as limitations.

CONCLUSIONS

Endurance and muscle strengthening trainings seem to influence serological BDNF and IGF-1 differentially. However, the changes in growth factors did not correlate to the decreases in depression scores. BDNF p.Val66Val variant seems to be more receptive for exercise treatment. Identifying biomarkers (growth factors, genetic variants) in adolescent depression could help to develop tailored treatment strategies.

Community support groups for men living with depression: barriers and facilitators in access and engagement with services

Approximately 10% of the general population will experience depression in adulthood. Concerningly, men with depression are more likely to take their own lives and less likely to seek professional support. Given men's preference for community-based support, this study employed interviews with service providers to explore the barriers and facilitators involved in community support groups for men living with depression. Nine interviews were conducted with service providers across Greater Manchester, UK. Data were analyzed via thematic analysis and revealed four themes: 'Mental Health as a Weakness,' 'Empowering Practice,' 'Trust and Security' and 'Group Support as a Gateway to Treatment.' Men living with depression experience identity conflict, which reduces help-seeking. Community support groups facilitate access and engagement with treatment by providing safe spaces to resolve internal conflicts. Gender-specific group support may facilitate access to support and address long waiting lists of statutory services. Implications for practice, policy and future research are discussed.

Associations Between Sad Feelings and Suicide Behaviors in the 2019 Youth Risk Behavior Survey: A Call for Action

Purpose: Suicide is the second leading cause of death among high school aged students in the United States. Significant risk factors for suicidal behaviors among youth include diagnoses of depression or other mental illnesses. The association between self-reported sad feelings and suicidal behaviors has been understudied in the literature among United States high school students. Methods: The 2019 National Youth Risk Behavior Survey (YRBS) school-based questionnaire, coordinated by the CDC, captured a nationally-representative sample (N = 13,677) of students' responses to health-related behaviors. National sex-stratified prevalences of sad feelings and suicidal behaviors were calculated. Adjusted weighted logistic regression was used to examine the association between self-reported sad feelings and suicidal behaviors. Results: Out of 13,677 high-school students, 35.8% of students self-reported sad feelings. Suicidal behaviors in the overall sample included 18.2% had seriously considered suicide, 15.2% made a plan on how they would attempt suicide, and 7.3% attempted suicide within the past 12 months. There was an 8-11-fold increased odds of all suicidal behaviors among those who reported sad feelings among both females and males. Conclusions: This study reveals a remarkably high prevalence of sad feelings among US youth, and underscores a significant association between self-reported sad feelings and suicidal behaviors among this population. The YRBS survey, routinely administered across US high school students, should be better leveraged to target interventions toward these high-risk youth in order to decrease the significant burden of suicidal behaviors among adolescents.

Direct and indirect links between children's socio-economic status and education: pathways via mental health, attitude, and cognition

A child's socio-economic environment can profoundly affect their development. While existing literature focusses on simplified metrics and pair-wise relations between few variables, we aimed to capture complex interrelationships between several relevant domains using a broad assessment of 519 children aged 7-9 years. Our analyses comprised three multivariate techniques that complimented each other, and worked at different levels of granularity. First, an exploratory factor analysis (principal component analysis followed by varimax rotation) revealed that our sample varied along continuous dimensions of cognition, attitude and mental health (from parallel analysis); with potentially emerging dimensions speed and socio-economic status (passed Kaiser's criterion). Second, k-means cluster analysis showed that children did not group into discrete phenotypes. Third, a network analysis on the basis of bootstrapped partial correlations (confirmed by both cross-validated LASSO and multiple comparisons correction of binarised connection probabilities) uncovered how our developmental measures interconnected: educational outcomes (reading and maths fluency) were directly related to cognition (short-term memory, number sense, processing speed, inhibition). By contrast, mental health (anxiety and depression symptoms) and attitudes (conscientiousness, grit, growth mindset) showed indirect relationships with educational outcomes via cognition. Finally, socio-economic factors (neighbourhood deprivation, family affluence) related directly to educational outcomes, cognition, mental health, and even grit. In sum, cognition is a central cog through which mental health and attitude relate to educational outcomes. However, through direct relations with all components of developmental outcomes, socio-economic status acts as a great 'unequaliser'.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-021-02232-2.

PhDepression: Examining How Graduate Research and Teaching Affect Depression in Life Sciences PhD Students

Graduate students are more than six times as likely to experience depression compared with the general population. However, few studies have examined how graduate school specifically affects depression. In this qualitative interview study of 50 life sciences PhD students from 28 institutions, we examined how research and teaching affect depression in PhD students and how depression in turn affects students' experiences teaching and researching. Using inductive coding, we identified factors that either positively or negatively affected student depression. Graduate students more commonly mentioned factors related to research that negatively affected their depression and factors related to teaching that positively affected their depression. We identified four overarching aspects of graduate school that influenced student depression: the amount of structure in teaching and research, positive and negative reinforcement, success and failure, and social support and isolation. Graduate students reported that depression had an exclusively negative effect on their research, primarily hindering their motivation and self-confidence, but that it helped them to be more compassionate teachers. This work pinpoints specific aspects of graduate school that PhD programs can target to improve mental health among life sciences graduate students.

Exploring the Role of Nutraceuticals in Major Depressive Disorder (MDD): Rationale, State of the Art and Future Prospects

Major depressive disorder (MDD) is a complex and common disorder, with many factors involved in its onset and development. The clinical management of this condition is frequently based on the use of some pharmacological antidepressant agents, together with psychotherapy and other alternatives in most severe cases. However, an important percentage of depressed patients fail to respond to the use of conventional therapies. This has created the urgency of finding novel approaches to help in the clinical management of those individuals. Nutraceuticals are natural compounds contained in food with proven benefits either in health promotion or disease prevention and therapy. A growing interest and economical sources are being placed in the development and understanding of multiple nutraceutical products. Here, we summarize some of the most relevant nutraceutical agents evaluated in preclinical and clinical models of depression. In addition, we will also explore less frequent but interest nutraceutical products which are starting to be tested, also evaluating future roads to cover in order to maximize the benefits of nutraceuticals in MDD.

Multi-gene Pharmacogenomic Testing That Includes Decision-Support Tools to Guide Medication Selection for Major Depression: A Health Technology Assessment

BACKGROUND

Major depression is a substantial public health concern that can affect personal relationships, reduce people's ability to go to school or work, and lead to social isolation. Multi-gene pharmacogenomic testing that includes decision-support tools can help predict which depression medications and dosages are most likely to result in a strong response to treatment or to have the lowest risk of adverse events on the basis of people's genes.We conducted a health technology assessment of multi-gene pharmacogenomic testing that includes decision-support tools for people with major depression. Our assessment evaluated effectiveness, safety, cost-effectiveness, the budget impact of publicly funding multi-gene pharmacogenomic testing, and patient preferences and values.

METHODS

We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias Tool and the Risk of Bias Assessment Tool for Nonrandomized studies (RoBANS) and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria.We performed a systematic literature search of the economic evidence to review published cost-effectiveness studies on multi-gene pharmacogenomic testing that includes a decision-support tool in people with major depression. We developed a state-transition model and conducted a probabilistic analysis to determine the incremental cost of multi-gene pharmacogenomic testing versus treatment as usual per quality-adjusted life-year (QALY) gained for people with major depression who had inadequate response to one or more antidepressant medications. In the reference case (with GeneSight-guided care), we considered a 1-year time horizon with an Ontario Ministry of Health perspective. We also estimated the 5-year budget impact of publicly funding multi-gene pharmacogenomic testing for people with major depression in Ontario.To contextualize the potential value of multi-gene pharmacogenomic testing that includes decision-support tools, we spoke with people who have major depression and their families.

RESULTS

We included 14 studies in the clinical evidence review that evaluated six multi-gene pharmacogenomic tests. Although all tests included decision-support tools, they otherwise differed greatly, as did study design, populations included in studies, and outcomes reported. Little or no improvement was observed on change in HAM-D17 depression score compared with treatment as usual for any test evaluated (GRADE: Low-Very Low). GeneSight- and NeuroIDgenetix-guided medication selection led to statistically significant improvements in response (GRADE: Low-Very Low) and remission (GRADE: Low-Very Low), while treatment guided by CNSdose led to significant improvement in remission rates (GRADE: Low), but the study did not report on response. Results were inconsistent and uncertain for the impact of Neuropharmagen, and no significant improvement was observed for Genecept or another unspecified test for either response or remission (GRADE: Low-Very Low). Neuropharmagen may reduce adverse events and CNSDose may reduce intolerability to medication, while no difference was observed in adverse events with GeneSight, Genecept, or another unspecified test (GRADE: Moderate-Very Low). No studies reported data on suicide, treatment adherence, relapse, recovery, or recurrence of depression symptoms.Our review included four model-based economic studies and found that multi-gene pharmacogenomic testing was associated with greater effectiveness and cost savings than treatment as usual, over long-term (i.e., 3-,5-year and lifetime) time horizons. Since none of the included studies was fully applicable to the Ontario health care system, we conducted a primary economic evaluation.Our reference case analysis over the 1-year time horizon found that multi-gene pharmacogenomic testing (with GeneSight) was associated with additional QALYs (0.03, 95% credible interval [CrI]: 0.005; 0.072) and additional costs ($1,906, 95% Crl: $688; $3,360). An incremental cost-effectiveness ratio was $60,564 per QALY gained. The probability of the intervention being cost-effective (vs. treatment as usual) was 36.8% at a willingness-to-pay amount of $50,000 per QALY (i.e., moderately likely not to be cost-effective), rising to 70.7% at a willingness-to-pay amount of $100,000 per QALY (i.e., moderately likely to be cost-effective). Evidence informing economic modeling of the reference case with GeneSight and other multi-gene pharmacogenomic tests was of low to very low quality, implying considerable uncertainty or low confidence in the effectiveness estimates. The price of the test, efficacy of the intervention on remission, time horizon, and analytic perspective were major determinants of the cost-effectiveness results. If the test price were assumed to be $2,162 (compared with $2,500 in the reference case), the intervention would be cost-effective at a willingness-to-pay amount of $50,000 per QALY; moreover, if the price decreased to $595, the intervention would be cost saving (or dominant) compared with treatment as usual.At an increasing uptake of 1% per year and a test price of $2,500, the annual budget impact of publicly funding multi-gene pharmacogenomic testing in Ontario over the next 5 years ranged from an additional $3.5 million in year 1 (at uptake of 1%) to $16.8 million in year 5. The 5-year budget impact was estimated at about $52 million.People with major depression and caregivers generally supported multi-gene pharmacogenomic testing because they believed it could provide guidance that fit their values. They hoped such guidance would speed symptom relief, would reduce side effects and help inform their medication choices. Some patients expressed concerns over maintaining confidentiality of test results and the possibility that physicians would sacrifice patient-centred care to follow pharmacogenomic guidance.

CONCLUSIONS

Multi-gene pharmacogenomic testing that includes decision-support tools to guide medication selection for depression varies widely. Differences between individual tests must be considered, as clinical utility observed with one test might not apply to other tests. Overall, effectiveness was inconsistent among the six multi-gene pharmacogenomic tests we identified. Multi-gene pharmacogenomic tests may result in little or no difference in improvement in depression scores compared with treatment as usual, but some tests may improve response to treatment or remission from depression. The impact on adverse events is uncertain. The evidence, however, is uncertain, and therefore our confidence that these observed effects reflect the true effects is low to very low.For the management of major depression in people who had inadequate response to at least one medication, some multi-gene pharmacogenomic tests that include decision support tools are associated with additional costs and QALYs over the 1-year time horizon, and maybe be cost-effective at the willingness-to-pay amount of $100,000 per QALY. Publicly funding multi-gene pharmacogenomic testing in Ontario would result in additional annual costs of between $3.5 million and $16.8 million, with a total budget impact of about $52 million over the next 5 years.People with major depression and caregivers generally supported multi-gene pharmacogenomic testing because they believed it could provide guidance that fit their values. They hoped such guidance would speed symptom relief, would reduce side and help inform their medication choices. Some patients expressed concerns over maintaining confidentiality of test results and the possibility that physicians would sacrifice patient-centred care to follow pharmacogenomic guidance.

A matched-control study on the effects of depressive disorders following open reduction and internal fixation for acetabular fractures

INTRODUCTION

The World Health Organization (WHO) postulates that depressive disorders (DD) will be the leading cause of morbidity and mortality by 2030. Studies evaluating the association of DD following open reduction and internal fixation (ORIF) for the treatment of acetabular fractures are limited. Therefore, the purpose of this matched-control study was to determine whether DD patients undergoing ORIF for acetabular fractures have higher rates of: (1) in-hospital lengths of stay (LOS); (2) readmissions; (3) medical complications; and (4) costs of care.

MATERIALS AND METHODS

A retrospective query from the 100% Medicare Standard Analytical Files (SAF) was performed to identify patients who underwent ORIF for acetabular fractures. The study group consisted of those patients with DD, whereas patients without the condition served as controls. Primary endpoints of the study were to compare in-hospital LOS, readmission rates, ninety-day medical complications, and costs of care. A p-value less than 0.01 was considered statistically significant.

RESULTS

The query yielded 7084 patients within the study (ORIF = 1187, control = 5897). DD patients were found to have significantly longer in-hospital LOS (11 days vs. 10 days, p < 0.0001); however, odds (OR) of readmission rates were similar (23.16 vs. 18.68%; OR: 0.91, p = 0.26). Multivariate regression demonstrated DD to be associated with significantly higher (67.69 vs. 25.54%; OR: 2.64, p < 0.0001) 90-day medical complications. DD patients had significantly higher day of surgery ($30,505.93 vs. $28,424.85, p < 0.0001) and total global 90-day costs ($41,721.98 vs. $37,330.16, p < 0.0001) of care.

CONCLUSION

After adjusting for covariates, DD is associated with longer in-hospital, complications, and costs of care in patients undergoing ORIF for the treatment of acetabular fractures, whereas readmission rates are similar. The study is vital as it can be used by orthopaedists and healthcare professionals to adequately educate these patients of the potential outcomes following their surgical procedure.

Socio-Demographic and Coping Correlates and Predictors of Depressive Symptoms Among Low-Income and Ethnic Minority Mothers At-Risk

This study identified coping and sociodemographic correlates and predictors of depressive symptoms in mothers at risk for clinical depression. A descriptive, cross-sectional design was employed. A convenience sample of 88 low-income or ethnic-minority mothers aged 21 to 45 completed a depression scale, demographic data sheet, and responded to an open-ended question. Content analysis, descriptive, and inferential statistics was used for data analysis. Exactly 42.5% of mothers reported high depressive symptoms (>16). Lower income levels (r = .342, p = .01) and head-of-household status (r = .220, p = .04) were significantly associated with higher depressive symptoms. Those who used social support coping had lower depressive symptoms than those who did not (t = 2.50, p = .014). Those using emotion-focused coping only had higher depressive symptoms than those using a mix of coping strategies (t = 2.60, p = .011). Healthcare providers can employ vigilant depression screening and encourage utilization of a mix of problem and emotion-focused coping strategies to reduce depressive symptoms and prevent clinical depression.

Relationship between initial self-perceived depressive symptoms and disease severity in working patients with first-onset major depressive disorder

The severity of major depressive disorder (MDD), which is related to the depressive symptoms, is a predictor of clinical outcomes and may be used to determine the appropriate treatment. However, there is a lack of systematic research on the relationship between early depressive symptoms and MDD severity. This study aimed to clarify the association between initial depressive symptoms and MDD severity in working patients. We assessed 118 patients aged over 20 years who visited the Neuropsychiatry Department of the Osaka City University Hospital following their first episode of MDD. Logistic regression analyses were performed to estimate the odds ratios (OR) with 95% confidence intervals (CI) for the associations between age, gender, marital status, working hours, and initial self-perceived depressive symptoms and MDD severity. Age and working hours were analyzed as continuous variables, and gender (man, woman), marital status (married, single) and severity (mild to moderate MDD, severe to very severe MDD) were analyzed as categorical variables. The most common initial self-perceived symptom was “depressed mood,” followed by “fatigue or loss of energy nearly every day.” The univariate analysis found no association between age, gender, marital status, or working hours and MDD severity. Initial self-perceived non-somatic symptoms were associated with increased odds of having severe MDD (odds ratio = 3.32, 95% confidence interval 1.46–7.58), and this association persisted in the adjusted model (odds ratio = 3.35, 95% confidence interval 1.47–7.60). Initial self-perceived non-somatic depressive symptoms are significantly associated with MDD severity at its first onset. Workplace support may lead to the early detection and treatment of working patients with non-somatic symptoms.