The epidemiology of depression across cultures

Major depressive disorder

Major depressive disorder (MDD) is a debilitating disease that is characterized by depressed mood, diminished interests, impaired cognitive function and vegetative symptoms, such as disturbed sleep or appetite. MDD occurs about twice as often in women than it does in men and affects one in six adults in their lifetime. The aetiology of MDD is multifactorial and its heritability is estimated to be approximately 35%. In addition, environmental factors, such as sexual, physical or emotional abuse during childhood, are strongly associated with the risk of developing MDD. No established mechanism can explain all aspects of the disease. However, MDD is associated with alterations in regional brain volumes, particularly the hippocampus, and with functional changes in brain circuits, such as the cognitive control network and the affective-salience network. Furthermore, disturbances in the main neurobiological stress-responsive systems, including the hypothalamic-pituitary-adrenal axis and the immune system, occur in MDD. Management primarily comprises psychotherapy and pharmacological treatment. For treatment-resistant patients who have not responded to several augmentation or combination treatment attempts, electroconvulsive therapy is the treatment with the best empirical evidence. In this Primer, we provide an overview of the current evidence of MDD, including its epidemiology, aetiology, pathophysiology, diagnosis and treatment.

Prevalence of and factors associated with depression among people living with HIV in France

OBJECTIVES

Depression is common among people living with HIV (PLWHIV) and is associated with poorer therapeutic outcomes and risky behaviours. We sought to estimate the prevalence of major depressive episode (MDE) across PLWHIV groups, to compare this with its prevalence in the general population and to assess factors associated with it.

METHODS

We used data from the Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS)-Vespa2 study, a national study on a representative sample of PLWHIV conducted in France in 2011. The short form of the depression module of the World Health Organization's Composite International Diagnostic Instrument (CIDI-SF) was used to characterize the occurrence of an MDE during the previous year. MDE prevalence was assessed among the various groups of PLWHIV and compared with that in the general population, accounting for the sociodemographic characteristics of the two populations, using multivariate Poisson regression models. The same method was used to assess associated factors.

RESULTS

MDE prevalence was 28.1% among PLWHIV, ranging from 10.9 to 55.7% across groups. Compared with the general population by sex, regardless of sexual orientation and origin, MDE prevalence was 5.1-fold higher in HIV-infected men who have sex with men [95% confidence interval (CI) 3.9-6.6], 3.1-fold higher in non-sub-Saharan African (SSA) heterosexual men (95% CI 2.2-4.4), 1.6-fold higher in SSA migrant men (95% CI 0.9-2.6), 2.6-fold higher in non-SSA heterosexual women (95% CI 2.1-3.3), and 1.9-fold higher in SSA migrant women (95% CI 1.5-2.5). In the HIV-infected population, MDE was positively related to unemployment, material deprivation, disclosure, experience of discrimination, and untreated hepatitis C, and negatively related to age.

CONCLUSIONS

The prevalence of depression varied across the different groups of PLWHIV, with levels much higher than in the general population. Moreover, there was a strong association with socioeconomic status and HIV experience.

Predictors of depression severity in a treatment-seeking sample

Background/Objective: Depression is a common mental health disorder and an emerging public health concern. Few studies have investigated prevalence and predictors of depression severity in the Irish context. To investigate the relative contribution of known risk factors that predicts depression severity in a treatment-seeking sample of adults in Ireland. Method: As part of a randomised controlled trial of an internet-delivered intervention for depression participants (N = 641) completed online screening questionnaires including BDI-II and information associated with common predictors of depression. Results: The mean score on the BDI-II was 24.13 (SD = 11.20). Several factors were shown to predict greater severity of depression in the sample including female gender, younger age, unemployment, being single or partnered as opposed to married, previous diagnosis of depression, recent experience of life stressors. Alcohol use, recent losses, knowing a suicide completer, education level, type of employment and income level were not found to be significant. Conclusions: The study contributes to the profiling of the incidence and predictors of severity of depression in an Irish context. The results confirm some of the known risk factors and highlight the need for further research to be carried out on screening for depression and increasing access to interventions.

Which Are the Most Burdensome Functioning Areas in Depression? A Cross-National Study

BACKGROUND

The study aimed to identify the most burdensome functioning domains in depression and their differential impact on the quality of life (QoL) of individuals from nine countries in Asia, Africa, Europe, and Latin America.

MATERIALS AND METHODS

Data from two multi-country projects-the World Health Organization's Study on Global Ageing and Adult Health (SAGE) and the Collaborative Research on Ageing in Europe (COURAGE)-were analyzed. Eight functioning domains (pain, mobility, self-care, cognition, interpersonal activities, domestic life, and work, sleep and energy, and affect) and QoL were assessed in 4051 individuals with depression.

RESULTS

The analyses of the pooled sample showed that affect (ß = -0.21, p < 0.001), domestic life and work (ß = -0.16, p < 0.001) and interpersonal activities (ß = -0.15, p < 0.001) were the most affected functioning domains. When the analysis was stratified by gender, women showed similar patterns to the total sample, whereas mobility, self-care, cognition and pain were not significant amongst men. The cross-national analysis revealed that difficulties in affect and interpersonal activities were common across countries, whereas the rest of the domains showed country variability. In addition, being a woman (ß = -0.05), being older (ß = 0.07), being married (ß = 0.05), not having a comorbid condition (ß = -0.03) and having a higher education (ß = 0.04) were all factors associated with higher levels of QoL.

CONCLUSION

There was a variation in the level of decrements in different functioning domains across countries. This is in line with the growing evidence that reporting functioning sum-scores obscures potential differences among people. Functioning tools should capture the distinctiveness among individuals in order to provide tailored responses.

Family Qualities, Self-Deprecation, and Depressive Symptoms of Zoroastrian Young Adults in Immigrant Families

The aim of this study was to examine family qualities and self-deprecation in relation to depressive symptoms of young adult Zoroastrians from immigrant families in North America. Using snowball sampling and online surveys, self-report data were collected from 171 Zoroastrian young adults (i.e., 18-30 years old) about their perception of cohesion in their families, conflict with their parents, and the extent that they met parental general expectations (e.g., not embarrassing the family). The findings from a path analysis showed that parent-child conflict and meeting parental expectations were indirectly related to depressive symptoms through self-deprecation. Also, higher family cohesion predicted lower levels of depressive symptoms among Zoroastrian young adults. These results are similar to findings in studies with non Zoroastrians. The results suggested prevention and interventions to decrease depressive symptoms could target self-deprecating thoughts as well as perceived family dynamics.

Increased plasma levels of competing amino acids, rather than lowered plasma tryptophan levels, are associated with a non-response to treatment in major depression

Lowered plasma tryptophan (TRP) and TRP/competing amino acid (CAA) ratio may be involved in the pathophysiology of major depression (MDD). Increased cortisol and immune-inflammatory mediators in MDD may affect the availability of TRP to the brain. We investigated whether baseline or post-treatment TRP, CAAs and TRP/CAA ratio are associated with a treatment response in MDD and whether these effects may be mediated by cortisol or immune biomarkers. We included 50 medication-free MDD patients with a depressive episode (DSM diagnosis) and assessed symptom severity with the Inventory of Depressive Symptomatology (IDS) before and after treatment as usual for 12 weeks (endpoint). Plasma levels of TRP, CAAs, the ratio, cortisol, CRP and 6 selected cytokines were assayed. The primary outcome was a 50% reduction in the IDS, while the secondary was a remission of the depressive episode. In IDS non-responders, CAAs increased and the TRP/CAA ratio decreased, while in IDS responders CAAs decreased and the TRP/CAA ratio increased from baseline to endpoint. In patients who were still depressed at endpoint TRP and CAAs levels had increased from baseline, while in remitted patients no such effects were found. Increases in CAAs were inversely correlated with changes in interleukin-1 receptor antagonist levels. The results show that increased CAA levels from baseline to endpoint are associated with a non-response to treatment in MDD patients. This suggests that the mechanism underpinning the CAA-related treatment resistance may be related to changes in immune pathways. CAA levels and amino acid metabolism may be new drug targets in depression.

Translation and validation of the Cardiac Depression Scale to Arabic

BACKGROUND

The Cardiac Depression Scale (CDS) has been designed to measure depressive symptoms in patients with heart disease. There is no Arabic version of the CDS. We translated and validated the CDS in an Arabic sample of patients with heart disease.

METHODS

Forward and back translation of the CDS was followed by assessment of cultural relevance and content validity. The Arabic version of the CDS (A-CDS) and the Arabic version of the Hospital Anxiety and Depression Scale (A-HADS) were then administered to 260 Arab in-patients with heart disease from 18 Arabic countries. Construct validity was assessed using exploratory factor analysis with polychoric correlations. Internal consistency was assessed using ordinal reliability alpha and item-to-factor polychoric correlations. Concurrent validity was assessed using Pearson's correlation coefficient between the A-CDS and the depression subscale of the A-HADS (A-HADS-D).

RESULTS

Cultural relevance and content validity of the A-CDS were satisfactory. Exploratory factor analysis revealed three robust factors, without cross-loadings, that formed a single dimension. Internal consistency was high (ordinal reliability alpha for the total scale and the three factors were .94, .91, .86, and .87, respectively; item-to-factor correlations ranged from .77 to .91). Concurrent validity was high (r=.72). The A-CDS demonstrated a closer to normal distribution of scores than the A-HADS-D.

LIMITATIONS

Sensitivity and specificity of the A-CDS were not objectively assessed.

CONCLUSIONS

The A-CDS appears to be a valid and reliable instrument to measure depressive symptoms in a representative sample of Arab in-patients with heart disease.

Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study

Anxiety and depressive symptoms are associated with adverse cardiovascular events after an acute myocardial infarction (MI). However, most studies focusing on anxiety or depression have used rating scales or self-report methods rather than clinical diagnosis. This study aimed to investigate the association between psychiatrist-diagnosed psychiatric disorders and cardiovascular prognosis.We sampled data from the National Health Insurance Research Database; 1396 patients with MI were recruited as the study cohort and 13,960 patients without MI were recruited as the comparison cohort. Cox proportional hazard regression models were used to examine the effect of MI on the risk of anxiety and depressive disorders.During the first 2 years of follow-up, patients with MI exhibited a significantly higher risk of anxiety disorders (adjusted hazard ratio [HR] = 5.06, 95% confidence interval [CI]: 4.61-5.54) and depressive disorders (adjusted HR = 7.23, 95% CI: 4.88-10.88) than those without MI did. Greater risk for anxiety and depressive disorders was observed among women and patients aged 45 to 64 years following an acute MI. Patients with post-MI anxiety had a 9.37-fold (95% CI: 4.45-19.70) higher risk of recurrent MI than those without MI did after adjustment for age, sex, socioeconomic status, and comorbidities.This nationwide population-based cohort study provides evidence that MI increases the risk of anxiety and depressive disorders during the first 2 years post-MI, and post-MI anxiety disorders are associated with a higher risk of recurrent MI.

Bone density and depressive disorder: a meta-analysis

BACKGROUND

The aim of this study was to evaluate the evidence of low bone mineral density (BMD) in depression. Low BMD is a major risk factor for osteoporotic fractures and frailty.

METHODS

The searched database was Pubmed, Meta-analysis included human studies in men and women fulfilling the following criteria: (1) assessment of BMD in the lumbar spine, the femur or the total hip; (2) comparison of BMD between depressed individuals and the healthy control group; (3) measurement of BMD using dual-energy X-ray absorptiometry (DEXA); and (4) data on the mean, standard deviation, or standard error of BMD.

RESULTS

Twenty-one studies were identified, encompassing 1842 depressed and 17,401 nondepressed individuals. Significant negative composite weighted mean effect sizes were identified for the lumbar spine (d = -0.15, 95%CL -0.22 to -0.08), femur (d = -0.34, 95%CL -0.64 to -0.05), and total hip (d = -0.14, 95%CL -0.23 to -0.05) indicating low BMD in depression. Examining men and women shows low bone density in the lumbar spine and femur in women and low bone density in the hip in men. The differences between men and women with MDD and the comparison group tended to be higher when examined by expert interviewers. Low bone density was found in all age groups.

CONCLUSIONS

Bone mineral density is reduced in patients with depressive disorders. The studies provide little evidence for potential relevant mediating factors.

A cross-sectional study to investigate the correlation between depression comorbid with anxiety and serum lipid levels

BACKGROUND

Depression is a common psychological disorder that severely threatens human health. Its pathology remains unclear, but it has been suggested to be associated with abnormal blood lipid metabolism.

OBJECTIVES

This study aimed to explore the changes in blood lipid levels in patients with depression accompanied or not by anxiety, and assess whether adjusting the clinical therapeutic strategy could be based on blood lipid test results, providing a novel insight into depression treatment.

METHODS

This was a cross-sectional study. We assessed 60 outpatients and inpatients diagnosed with depression from January 2013 to January 2014 who met the Chinese Classification of Mental Disorders version 3 (CCMD-3) criteria, with Hamilton Rating Scale for Depression (HAMD-24) ≥20. They were grouped into depression with anxiety (n=29) and depression without anxiety (n=31) groups by the Hamilton Anxiety Scale (HAMA).

RESULTS

TG levels were higher in the depression with anxiety group compared with patients without anxiety (P=0.045), which was confirmed by multifactorial analysis [P=0.017, OR=4.394, 95% CI (1.303-14.824)]. A negative correlation between anxiety score and HDL levels was observed in patients with depression (r=-0.340, P=0.046). Meanwhile, positive associations were obtained between retardation and LDL levels (r=0.307, P=0.017) as well as age at disease onset and total cholesterol levels (r=0.410, P=0.002).

CONCLUSION

TG levels differ in patients with depression accompanied by anxiety compared with those without anxiety.

External validation of the international risk prediction algorithm for major depressive episode in the US general population: the PredictD-US study

BACKGROUND

Multivariable risk prediction algorithms are useful for making clinical decisions and for health planning. While prediction algorithms for new onset of major depression in the primary care attendees in Europe and elsewhere have been developed, the performance of these algorithms in different populations is not known. The objective of this study was to validate the PredictD algorithm for new onset of major depressive episode (MDE) in the US general population.

METHODS

Longitudinal study design was conducted with approximate 3-year follow-up data from a nationally representative sample of the US general population. A total of 29,621 individuals who participated in Wave 1 and 2 of the US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and who did not have an MDE in the past year at Wave 1 were included. The PredictD algorithm was directly applied to the selected participants. MDE was assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule, based on the DSM-IV criteria.

RESULTS

Among the participants, 8 % developed an MDE over three years. The PredictD algorithm had acceptable discriminative power (C-statistics = 0.708, 95 % CI: 0.696, 0.720), but poor calibration (p < 0.001) with the NESARC data. In the European primary care attendees, the algorithm had a C-statistics of 0.790 (95 % CI: 0.767, 0.813) with a perfect calibration.

CONCLUSIONS

The PredictD algorithm has acceptable discrimination, but the calibration capacity was poor in the US general population despite of re-calibration. Therefore, based on the results, at current stage, the use of PredictD in the US general population for predicting individual risk of MDE is not encouraged. More independent validation research is needed.

The role of macrophages in anti-inflammatory activity of antidepressant drugs

Depression is a common disease influencing patients' quality of life, whose etiology involves complex interactions of environmental, genetic and immunological factors. The latter factors include proinflammatory activation of monocytes and macrophages and increased serum levels of proinflammatory cytokines, altogether formulated as the "macrophage theory of depression". Our current review summarizes the impact of the most commonly used antidepressant drugs on the immune response with special emphasis on the role of macrophages in the clinically observed effects. The anti-inflammatory action of antidepressants mainly results from their direct interaction with immune cells and from changes in the concentration and the relations of neurotransmitters sensed by these cells. The summarized data revealed that Mφs are one of the leading cell populations involved in drug-mediated immune effects that can be observed both in subjects with depression as well as in individuals not suffering from depression. Thus, currently reviewed immunomodulatory effects of the experimental use of different antidepressant drugs suggest the possibility of utilizing them in complex therapeutic strategies dedicated to various inflammatory and immune-mediated diseases. It is worth noting that an excessive inflammatory reaction is also associated with the pathogenesis of various cardiovascular, metabolic and neuro-endocrine diseases. Thus, the inclusion of antidepressants in the complex therapy of these disorders may have beneficial effects through the enhancement of the mood of the patient and alleviation of chronic inflammation. On the other hand, presented data suggest that the influence of chronically used antidepressants on anti-microbial and anti-tumor immunity could also be taken into consideration.

Recovery from major depressive disorder episode after non-pharmacological treatment is associated with normalized cytokine levels

BACKGROUND

Several lines of evidence show that the immune system is implicated in the pathophysiology of major depressive disorder (MDD) and that treatment with antidepressants affects cytokine and C-reactive protein (CRP) levels. Few studies have investigated immune markers during non-pharmacological treatment. In this follow-up study, we investigated whether CRP and elevated plasma cytokine levels observed before treatment of an acute episode of MDD are normalized during non-pharmacological treatment.

METHODS

We obtained clinical assessments and blood for CRP and cytokine analysis from 50 unmedicated MDD patients, and cytokine levels from healthy controls. The patients received 'therapy as usual' for 12 weeks, and the assessments were then repeated. Of the 43 completers, 29 patients did not receive medication.

RESULTS

In the patients receiving treatment without antidepressants, the depressive symptoms and the plasma levels of eight cytokines (interleukin (IL)-1Ra, IL-5,-6,-8,-10, G-CSF, IFN-γ, and TNF-α) were significantly reduced (P = 0.002-0.048). The cytokine levels were no longer different from the controls. The plasma CRP level did not change.

CONCLUSION

Cytokine plasma levels normalized during recovery from an acute depressive episode in MDD without antidepressant treatment. These findings may have implications for the understanding of the role of the immune system in depression and recovery from depression.

Depression symptoms across cultures: an IRT analysis of standard depression symptoms using data from eight countries

PURPOSE

Prevalence estimates of depression vary between countries, possibly due to differential functioning of items between settings. This study compared the performance of the widely used Hopkins symptom checklist 15-item depression scale (HSCL-15) across multiple settings using item response theory analyses. Data came from adult populations in the low and middle income countries (LMIC) of Colombia, Indonesia, Kurdistan Iraq, Rwanda, Iraq, Thailand (Burmese refugees), and Uganda (N = 4732).

METHODS

Item parameters based on a graded response model were compared across LMIC settings. Differential item functioning (DIF) by setting was evaluated using multiple indicators multiple causes (MIMIC) models.

RESULTS

Most items performed well across settings except items related to suicidal ideation and "loss of sexual interest or pleasure," which had low discrimination parameters (suicide: a = 0.31 in Thailand to a = 2.49 in Indonesia; sexual interest: a = 0.74 in Rwanda to a = 1.26 in one region of Kurdistan). Most items showed some degree of DIF, but DIF only impacted aggregate scale-level scores in Indonesia.

CONCLUSIONS

Thirteen of the 15 HSCL depression items performed well across diverse settings, with most items showing a strong relationship to the underlying trait of depression. The results support the cross-cultural applicability of most of these depression symptoms across LMIC settings. DIF impacted aggregate depression scores in one setting illustrating a possible source of measurement invariance in prevalence estimates.

Antidepressant activity of nociceptin/orphanin FQ receptor antagonists in the mouse learned helplessness

RATIONALE

Pharmacological and genetic evidence support antidepressant-like effects elicited by the blockade of the NOP receptor. The learned helplessness (LH) model employs uncontrollable and unpredictable electric footshocks as a stressor stimulus to induce a depressive-like phenotype that can be reversed by classical antidepressants.

OBJECTIVES

The present study aimed to evaluate the action of NOP receptor antagonists in helpless mice.

METHODS

Male Swiss mice were subjected to the three steps of the LH paradigm (i.e., (1) induction, (2) screening, and (3) test). Only helpless animals were subjected to the test session. During the test session, animals were placed in the electrified chamber and the latency to escape after the footshock and the frequency of escape failures were recorded. The effect of the following treatments administered before the test session were evaluated: nortriptyline (30 mg/kg, ip, 60 min), fluoxetine (30 mg/kg, ip, four consecutive days of treatment), and NOP antagonists SB-612111 (1-10 mg/kg, ip, 30 min) and UFP-101 (1-10 nmol, icv, 5 min). To rule out possible biases, the effects of treatments on controllable stressful and non stressful situations were assessed.

RESULTS

In helpless mice, nortriptyline, fluoxetine, UFP-101 (3-10 nmol), and SB-612111 (3-10 mg/kg) significantly reduced escape latencies and escape failures. No effects of drug treatments were observed in mice subjected to the controllable electric footshocks and non stressful situations.

CONCLUSIONS

Acute treatment with NOP antagonists reversed helplessness similarly to the classical antidepressants. These findings support the proposal that NOP receptor antagonists are worthy of development as innovative antidepressant drugs.

Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional's Help?

Background

The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question.

Method

This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple’s App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app’s download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month.

Results

A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29).

Conclusions

A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use the screening results provided by such apps.

Impact of psychological inflexibility on depressive symptoms and sleep difficulty in a Japanese sample

Background

Psychological inflexibility is a core concept in the acceptance and commitment therapy (ACT) model. The current study hypothesized and tested two models in which psychological inflexibility was linked with higher levels of depressive symptoms and sleep difficulty.

Results

To attain data, Japanese university students (N = 633) completed questionnaires related to psychological inflexibility, depressive symptoms, and sleep difficulty. Psychological inflexibility was significantly correlated with higher levels of both depressive symptoms (r = 0.61) and sleep difficulty (r = 0.39). Structural equation modeling showed that psychological inflexibility was associated with higher levels of depressive symptoms after controlling for the effect of sleep difficulty. Additionally, psychological inflexibility was correlated with higher levels of sleep difficulty after controlling for the effect of depressive symptoms. These findings might assist with motivating clinicians to use ACT for insomnia.

Conclusions

The current study found that greater psychological inflexibility was linked with high levels of depressive symptoms and sleep difficulties. These findings might assist with motivating clinicians to use ACT for insomnia.

The MD Blues: Under-Recognized Depression and Anxiety in Medical Trainees

Background

Mental health disease is under recognized in medical professionals.

Objective

To screen medical students (MS), residents and fellows for major depressive disorder (MDD) and generalized anxiety disorder (GAD) under the new era of work hour reform with age-matched controls from a large representative cross-sectional survey.

Methods

We conducted an anonymous online survey at a medical university in 2013–2014. We incorporated the Patient Health Questionnaire 2 (PHQ-2) to screen for MDD and the generalized anxiety disorder scale (GAD-7) to screen for GAD, along with additional questions on life stressors and academic performance. We compared these results to age-matched controls from the National Health and Nutrition Examination Survey (NHANES) database.

Results

126 residents/fellows and 336 medical students participated voluntarily. 15.1% and 15.9% of postgraduates as well as 16.4% and 20.3% of MS screened positive for MDD and GAD, respectively. When compared to national estimates, the prevalence of a positive screen for MDD was over five-fold higher in medical trainees compared to age-matched controls (16% vs. 2.8%, p<0.0001). Similarly, the prevalence of a positive screen for GAD was over eight-fold higher in medical trainees (19% vs. 2.3%, p<0.0001).The prevalence was consistently higher within age strata. 33.3% of postgraduates and 32% of MS believe there is a significant impact of depression or anxiety on their academic performance. For stress relief, one fifth of residents/fellows as well as MS reported alcohol use.

Conclusions

The stresses of medical education and practice may predispose trainees to psychopathological consequences that can affect their academic performance and patient care. The current study showed a significantly higher rate of MDD and GAD positive screens in medical trainees than the prevalence in an age-matched U.S. population, despite significant work hour reform for medical trainees. Increased awareness and support services are required at all levels of medical training. We propose that the ACGME and the Institute of Medicine may consider these findings when implementing future changes to work hour regulations.

Major depressive disorder and suicidal behavior among urban dwelling Ethiopian adult outpatients at a general hospital

BACKGROUND

We sought to evaluate the prevalence and correlates of major depressive disorder (MDD) and suicidal behavior among urban dwelling Ethiopian adults.

METHODS

This was a cross-sectional study of 1097 outpatient adults (≥18 years of age) in a major hospital in Addis Ababa, Ethiopia. Sociodemographic and lifestyle characteristics were collected via structured interviews. MDD and suicidal behavior were assessed using the Composite International Diagnostic Interview (CIDI) among all study participants. Multivariable logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

Prevalence estimates for lifetime and 12-month MDD were 18.0% and 6.7%, respectively. The prevalence of suicidal behavior during the previous year (i.e., suicidal ideation, plan or attempt) was 15.2% with approximately 4% having reported attempts. Overall, women were more likely to report suicidal behavior (17.8%) than men (11.3%). MDD odds were 1.53-fold higher among women as compared with men (aOR=1.53, 95% CI 1.05-2.23). Lifetime MDD was significantly associated with age, sex, marital status, and self-reported physical health. Participants reporting poor mental health had approximately 3-fold increased odds of MDD (OR=2.93; 95%CI: 1.05-2.23); those between 35 and 44 years old (aOR=1.92; 95%CI: 1.06-3.49) and those older than 55 years (aOR=2.54; 95%CI: 1.16-5.57) had higher odds of MDD. Similarly suicidal behavior was significantly associated with sex, marital status, and self-reported physical and mental health.

LIMITATIONS

This cross-sectional study utilized self-reported data from outpatients. Causality cannot be inferred, and results may not be fully generalizable.

CONCLUSIONS

Overall results show that MDD and suicidal behavior are highly prevalent among urban-dwelling Ethiopian adults. Women and middle-age adults constitute a high-risk group and may therefore benefit from targeted interventions.

A cross-sectional study of functional disabilities and perceived cognitive dysfunction in patients with major depressive disorder in South Korea: The PERFORM-K study

PERFORM-K was a cross-sectional observational study that investigated functional disability, productivity and quality of life in MDD outpatients in South Korea, and the associations of these with depressive symptoms, perceived cognitive dysfunction and other factors. A total of 312 outpatients who started antidepressant monotherapy underwent a single study interview. Physicians and patients assessed depression severity. Patients also assessed: perceived cognitive dysfunction, functional disability, impaired productivity and quality of life. Patients had moderate to severe depression (MADRS mean total score: 28.9±7.3), and reported marked functional disability (SDS mean total score: 16.7±8.6), impaired productivity (WPAI mean overall work productivity loss: 52.4±31.8%), perceived cognitive dysfunction (PDQ-D mean total score: 29.9±18.6) and impaired quality of life (EQ-5D mean utility index score of 0.726±0.192). Greater functional disability and impairment in daily activities were associated with more severe depression and greater perceived cognitive dysfunction. Irrespective of depression severity, patients with more severe perceived cognitive dysfunction reported worse work-related productivity outcomes (higher presenteeism and greater overall work productivity loss). PERFORM-K confirms the impact of MDD on functional status and well-being in South Korean patients, and highlights the importance of recognising cognitive dysfunction in clinical practice.

The importance of n-6/n-3 fatty acids ratio in the major depressive disorder

This review aims to clarify the relation between the ratio of omega-6 to omega-3 fatty acids and the development of depression. It is explained how these fatty acids are involved in the production of eicosanoids and how these fatty acids can affect the membrane fluidity, by their incorporation into membrane phospholipids. In addition, it is described how omega-3 derivatives are shown to regulate gene transcription. In view of the pathophysiology of depression, the mechanisms of how an altered ratio of omega-6 to omega-3 could be involved in depression are discussed. Possible mechanisms could include an increased production of pro-inflammatory cytokines, which can activate the HPA axis and a changed membrane fluidity, which potentially affects membrane bound enzymes, ion channels, receptor activity and neurotransmitter binding. In view of clinical trials, it is also discussed whether omega-3 supplementation could have a beneficial effect in the treatment of depressive patient. There are strong indications that an increased ratio of membrane omega-6 to omega-3 is involved in the pathogenesis of depression and so far, omega-3 supplementation has shown positive effects in clinical trials.

Stress, Sleep and Depressive Symptoms in Active Duty Military Personnel

BACKGROUND

The military is a unique occupational group and, because of this, military personnel face different kinds of stress than civilian populations. Sleep problems are an example. The purpose of this study was to investigate the relationship between sleep problems, depression level and coping strategies among military personnel.

MATERIALS AND METHODS

In this cross-sectional study, military personnel completed the Beck Depression Inventory, the Pittsburgh Sleep Quality Index and the Jalowiec Coping Scale.

RESULTS

An evaluation of the test scores showed that officers had better sleep quality and fewer depressive symptoms than enlisted personnel. Military personnel with higher educational levels and less physical illness also had fewer depressive symptoms. Officers and noncommissioned officers preferred problem-focused strategies. Those with higher Beck Depression Inventory and Pittsburgh Sleep Quality Index scores and those who drank alcohol frequently preferred affective-focused strategies.

CONCLUSIONS

Our results revealed that sleep quality, physical illness and alcohol consumption were associated with the mental health of military personnel. Treating these factors may improve the mental health of military personnel and enhance effective coping strategies.

Adherence to Alternative Healthy Eating Index in relation to depression and anxiety in Iranian adults

Earlier studies have shown a protective association between adherence to healthy eating guidelines and mental disorders in Western nations; however, data in this regard are limited from the understudied region of Middle East. We examined the association between adherence to healthy eating guidelines, as measured by Alternative Healthy Eating Index (AHEI)-2010, and prevalence of anxiety and depression in a large sample of Iranian adults. In this cross-sectional study, data on dietary intakes of 3363 adult participants were collected using a validated dish-based 106-item semi-quantitative FFQ. Adherence to healthy eating was quantified using AHEI-2010, as suggested by earlier publications. The Iranian validated version of Hospital Anxiety and Depression Scale was used to assess anxiety and depression in study participants. Data on other covariates were gathered using a pre-tested questionnaire. Overall, the prevalence of anxiety and depression was 15·2 % (males 10·8 % and females 18·3 %) and 30·0 % (males 22·9 % and females 35·1 %), respectively. After controlling for potential confounders, those in the top quartile of AHEI-2010 had a 49 % lower chance of anxiety (OR 0·51; 95 % CI 0·35, 0·72) and a 45 % lower odds of depression (OR 0·55; 95 % CI 0·42, 0·72), compared with those in the bottom quartile. Stratified analysis by sex revealed that women in the highest categories of AHEI-2010 had a 49 % lower odds of having anxiety and depression, after adjustment for confounders, but no significant association was found in men. In addition, among individuals who were 40 years old or younger, those with high adherence to AHEI-2010 were 58 and 51 % less likely to have anxiety and depression, compared with those with less adherence. Adherence to healthy eating was inversely associated with a lower chance of anxiety and depression in Iranian adults. Prospective studies are required to confirm these associations in Middle-Eastern populations.

Trajectory and Predictors of Depression and Anxiety Disorders in Mothers With the FMR1 Premutation

BACKGROUND

Although the FMR1 premutation is associated with elevated prevalence of psychiatric disorders, the longitudinal course of symptoms has not been established. The present study followed a sample of women with the FMR1 premutation to characterize the incidence, stability, and predictors of mood and anxiety disorders across a 3-year period.

METHODS

Participants included 83 women with the FMR1 premutation (mean age = 38.35) who completed the Structured Clinical Interview for DSM-IV Axis I Disorders at two time points, 3 years apart. Additional information was obtained regarding demographic, child, and biomedical (e.g., medication, menopause, CGG repeats) factors.

RESULTS

We found increased prevalence of major depressive disorder (MDD) and anxiety disorders over time, with adverse outcomes predicted by complex interactions among biological, behavioral, and environmental risk factors. Lifetime MDD increased from 46% to 54% and lifetime anxiety disorders increased from 28% to 35%. Midrange CGG repeats, elevated child problem behaviors, and divorced marital status conveyed elevated risk for psychiatric diagnoses. Primary ovarian insufficiency was highly prevalent (41%) but did not account for elevated rates of psychiatric diagnoses. Medication use was highly reported (41%), particularly in women with MDD or anxiety, with selective serotonin reuptake inhibitors reported as the most commonly used medication across diagnostic groups.

CONCLUSIONS

The elevated prevalence of depression and anxiety in women with the FMR1 premutation is a clear and pressing concern given the frequent occurrence of the FMR1 premutation in the general community and the adverse outcomes-at both individual and systems levels-associated with psychiatric disorders in this population.

p11 mediates the BDNF-protective effects in dendritic outgrowth and spine formation in B27-deprived primary hippocampal cells

BACKGROUND

p11 (S100A10) is a key regulator of depression-like behaviors and antidepressant drug response in rodent models. Recent studies suggest that p11 mediates the behavioral antidepressant action of brain-derived neurotrophic factor (BDNF) in rodents. BDNF improves neural plasticity, which is linked to the cellular actions of antidepressant drugs. In the present study, we investigated whether p11 regulated BDNF action on neural plasticity in vitro.

METHODS

We generated primary hippocampal cultures. p11 expression, total dendritic length, and spine density were investigated under toxic conditions induced by B27 deprivation, which causes hippocampal cell death.

RESULTS

B27 deprivation significantly decreased p11 expression. Treatment with BDNF significantly prevented the B27 deprivation-induced decrease in p11 levels in a concentration-dependent manner, whereas these concentrations had no effect on control cultures. B27 deprivation significantly reduced the total length of hippocampal dendrites and spine density. BDNF increased the total dendritic length and spine density in conditions with or without B27. Furthermore, p11 knockdown through small interfering RNA (siRNA) transfection blocked these effects. The overexpression of p11 in B27-deprived cells increased the total dendritic length and spine density, and treatment with BDNF potentiated these effects.

LIMITATION

This study should be confirmed in animal models of depression.

CONCLUSION

Taken together, our data suggest that BDNF-induced improvement in neural plasticity may depend on the regulation of p11 in hippocampal cells with B27 deprivation. These results provide evidence to strengthen the theoretical basis of a role for p11 in BDNF-induced antidepressant action.

Role of neuro-immunological factors in the pathophysiology of mood disorders

Mood disorders, despite the widespread availability of monoamine-based antidepressant treatments, are associated with persistently high rates of disability, together with elevated rates of mortality due to suicide, cardiovascular disease, and other causes. The development of more effective treatments has been hindered by the lack of knowledge about the etiology and pathogenesis of mood disorders. An emerging area of science that promises novel pathways to antidepressant and mood stabilizing therapies surrounds evidence that immune cells and their signaling play a major role in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD). Here, we review evidence that the release of neuroactive cytokines, particularly interleukins such as IL-1β, IL-6, and TNF-α, is altered in these disorders and discuss mechanisms such as the ATP-gated ion channel P2X7, through which cytokine signaling can influence neuro-glial interactions. Brain P2X7, an emerging target and antagonism of P2X7 holds promise as a novel mechanism for targeting treatment-resistant depression. We further discuss the role of microglia and astroglia in central neuroinflammation and their interaction with the peripheral immune system We present extant clinical evidence that bolsters the role of neuroinflammation and neuroactive cytokines in mood disorders. To that end, the role of clinical imaging by probing neuroinflammatory markers is also discussed briefly. Finally, we present data using preclinical neuroinflammation models that produce depression-like behaviors in experimental animals to identify neuroinflammatory mechanisms which may aid in novel neuroimmune target identification for the development of exciting pharmacological interventions in mood disorders.

Direct and Indirect Effects of Five Factor Personality and Gender on Depressive Symptoms Mediated by Perceived Stress

This study was designed to investigate associations among five factor personality traits, perceived stress, and depressive symptoms and to examine the roles of personality and perceived stress in the relationship between gender and depressive symptoms. The participants (N = 3,950) were part of a cohort study for health screening and examination at the Kangbuk Samsung Hospital. Personality was measured with the Revised NEO Personality Inventory (NEO-PI-R). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Perceived stress level was evaluated with a self-reported stress questionnaire developed for the Korea National Health and Nutrition Examination Survey. A higher degree of neuroticism and lower degrees of extraversion, agreeableness, and conscientiousness were significantly associated with greater perceived stress and depressive symptoms. Neuroticism and extraversion had significant direct and indirect effects (via stress as a mediator) on depressive symptoms in both genders. Agreeableness and conscientiousness had indirect effects on depression symptoms in both genders. Multiple mediation models were used to examine the mediational roles of each personality factor and perceived stress in the link between gender and depressive symptoms. Four of the personality factors (except openness) were significant mediators, along with stress, on the relationship between gender and depressive symptoms. Our findings suggest that the links between personality factors and depressive symptoms are mediated by perceived stress. As such, personality is an important factor to consider when examining the link between gender and depression.

The touchscreen operant platform for assessing cognitive functions in a rat model of depression

In the present study we assessed alterations in cognitive functions in a chronic mild stress (CMS) rat model of depression. Cognitive functions were assessed in two different tasks applying the translational operant platform touchscreen technology; the visual discrimination/acquisition task was used to assess the ability to perceive and distinguish visual stimuli and to assess associative stimulus-reward learning. The visual discrimination/reversal learning task was used to assess functional brain plasticity or reprogramming of previously acquired stimulus-reward associations. These tasks permit the dissociation of multiple cognitive domains. The CMS model is a validated depression model with the useful feature that rats upon stress exposure show a graduated, individual stress response allowing the segregation of rats into different phenotypes including stress-resilient and anhedonic-like subgroups. Anhedonic-like rats are less likely to acquire the pairwise discrimination task, and they have a slower acquisition rate than controls. In the reversal learning task, resilient rats performed significantly better than anhedonic-like rats over time and 50% passed criterion as opposed to 25% for controls and only 14% for anhedonic-like rats. This indicates that resilient rats have higher cognitive flexibility than anhedonic-like rats. Thus they perform better in learning a novel task, which at the same time potentially implies an increased ability to inhibit previously rewarded behavior.

Incidence of Major Depressive Disorder: Variation by Age and Sex in Low-Income Individuals: A Population-Based 10-Year Follow-Up Study

Major depressive disorder (MDD), the most prevalent mental disorder is a global public health issue. The aim of this study was to assess the association between low income and major depressive disorder (MDD) by age and sex. The National Health Insurance Research Database (NHIRD) of Taiwan was used to retrieve data. A total of 1,743,948 participants were eligible for the study. Low-income individuals were identified from 2001 and 2003 (specifically, Group Insurance Applicants, ie, category"51" or "52") and followed from 2004 to 2010. MDD was identified using the ICD-9-CM 296.2 and 296.3 codes. Among non-low-income individuals, the MDD incidence rates increased with age in both males and females, that is, 0.35, 0.93, 0.97, 1.40 per 10,000 person-months for males and 0.41, 1.60, 1.89, 1.95 per 10,000 person-months for females aged 0 to 17, 18 to 44, 45 to 64, and ≥65 years, respectively. Low-income females (18-44 years) and males (45-64 years) had the highest incidence of MDD, which was 3.90 and 3.04, respectively, per 10,000 person-months. Among low and non-low-income individuals, the MDD incidence rates were higher in the females than males in all age groups. Males aged 45 to 64 and 0 to 17 years had highest hazard ratios (HR) of 2.789 (95% confidence interval [CI], 1.937-4.014) and 2.446 (95% CI, 1.603-3.732), respectively. The highest HRs for females were 2.663 (95% CI, 1.878-3.775) and 2.219 (CI, 1.821-2.705) in the 0 to 17 and 18- to 44-year age groups. Low income was not found to serve as a risk factor for the development of MDD in males and females aged ≥65 years. Among the non-low-income males and females, the incidence rates of MDD were found to increase with age. Low income was found to serve as a significant risk factor for MDD only in individuals under age 65.

Mental health of Canadian Armed Forces Veterans: review of population studies

Introduction. The mental health of Canadian Armed Forces (CAF) populations emerged as an important concern in the wake of difficult CAF deployments in the 1990s. This article is the first comprehensive summary of findings from subsequent surveys of mental health and well-being in CAF Veterans, undertaken to inform mental health service renewals by CAF Health Services and Veterans Affairs Canada (VAC). Methods. Epidemiological findings in journal publications and government reports were summarized from four cross-sectional national surveys: a survey of Veterans participating in VAC programs in 1999 and three surveys of health and well-being representative of whole populations of Veterans in 2003, 2010, and 2013. Results. Although most Veterans had good mental health, many had mental health problems that affected functioning, well-being, and service utilization. Recent Veterans had a higher prevalence of mental health problems than the general Canadian population, earlier-era Veterans, and possibly the serving population. There were associations between mental health conditions and difficult adjustment to civilian life, physical health, and multiple socio-demographic factors. Mental health problems were key drivers of disability. Comparisons with other studies were complicated by methodological, era, and cultural differences. Discussion. The survey findings support ongoing multifactorial approaches to optimizing mental health and well-being in CAF Veterans, including strong military-to-civilian transition support and access to effective mental and physical health services. Studies underway of transitioning members and families in the peri-release period of the military-to-civilian transition and longitudinal studies of mental health in Veterans will address important knowledge gaps.

Potentially Traumatic Events, Posttraumatic Stress Disorder, and Depression among Adults in Puerto Rico

The aims of the current study were to examine the prevalence of potentially traumatic events (PTEs), posttraumatic stress disorder (PTSD; data available in males only), and depressive symptoms in a Puerto Rican sample of 678 adult caretakers (50% female) of twins participating in the Puerto Rican Infant Twin Study. The World Health Organization Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was utilized to assess rates of PTEs, PTSD, and depression among male participants while an abbreviated version of the CIDI 3.0 and the Mood and Feelings Questionnaire were administered to females to assess PTEs and depressive symptoms. Significantly more males than females reported exposure to a PTE (76.6% vs. 44.2%, χ(2) = 64.44, p < 0.001). In males, endorsement of multiple PTEs was associated with increased level of PTSD symptomatology (β = 0.33, p < 0.001). With regard to depression, a similar dose-response relationship was found in both males and females, with depressive symptoms increasing as number of PTEs increased (βs = 0.15, 0.16, ps < 0.05). Exposure to an attack with a weapon was significantly associated with increased depression symptoms in both males and females (βs = 0.24, 0.20, ps < 0.01, respectively). These findings highlight the need for identification of putative risk and resilience factors among PTE-exposed individuals in Puerto Rico.

A Cross-Cultural Study of the Cognitive Model of Depression: Cognitive Experiences Converge between Egypt and Canada

INTRODUCTION

Models of depression that arise in the West need to be examined in other regions of the world. This study examined a set of foundational hypotheses generated by Beck's cognitive model of depression among depressed individuals in Egypt and Canada.

METHOD

We recruited 29 depressed and 29 non-depressed Egyptians and compared their results with those of 35 depressed and 38 non-depressed Canadians. Depression status was ascertained using a structured interview, scores on the Beck Depression Inventory, and scores on the Psychiatric Diagnostic Screening Questionnaire. Participants completed questionnaires designed to measure the frequency of negative and positive automatic thoughts (ATQ-N, BHS, and ATQ-P), and dysfunctional attitudes (DAS).

RESULTS

Depressed individuals in both countries had significantly more negative thoughts about self and future, greater frequency of dysfunctional attitudes, and diminished positive self-thoughts in comparison to non-depressed individuals. Egyptians generally showed significantly more dysfunctional attitudes than their Canadian counterparts.

DISCUSSION

The four hypotheses that were tested were supported among the depressed Egyptian sample, which is consistent with the cognitive model. Implications for the cognitive-behavioral model and treatment for this group of sufferers are discussed.

Sex differences in sleep, anhedonia, and HPA axis activity in a rat model of chronic social defeat

Repeated bouts of a major stressor such as social defeat are well known to induce a depression phenotype in male rats. Despite strong evidence and acknowledgement that women have a two-fold lifetime greater risk of developing major depression compared to men, the inclusion of female rats in studies employing social defeat are very rare; their absence is attributed to less aggressive interactions. This study sought to compare in male and female rats the impact of repeated social defeat, three times per week for four weeks, on the development of changes in sleep architecture and continuity, sucrose preference as a measure of anhedonia, changes in body weight, and basal plasma corticosterone levels. We found significant reductions in rapid eye movement sleep (REMS) during the light phase in both females and males, and significant increases in numbers of vigilance state transitions during the early dark phase in females but not in males. Additionally, females exhibited significantly greater reductions in sucrose intake than males. On the other hand, no sex differences in significantly elevated basal corticosterone levels were evident, and only the males exhibited changes in body weight. Taken together these findings suggest that the inclusion of female rats in studies of social defeat may offer greater insights in studies of stress and depression.

Gender-Related Factors for Depressive Symptoms in Turkish Adolescents

PROBLEM

Currently more adolescents suffer from mental health problems than compared to the past.

PURPOSE

This study was designed to extend the knowledge of depressive symptoms in adolescence and to determine the gender-related factors associated with it.

METHODS

The study sample consisted of (N = 487) adolescents. The Children's Depression Inventory (CDI), Multidimensional Scale of Perceived Social Support (MSPSS), Strengths and Difficulties Questionnaire (SDQ-S), and UCLA loneliness scale (UCLA-LS) were completed by the participants.

FINDINGS

Among the study population, 26.6% (n = 130) scored ≥ 19 on the CDI, which was the cut-off point. UCLA-LS, hyperactivity and conduct problems, and peer problems subscale scores of SDQ-S were found significantly higher in males (p < .05). Emotional symptoms, pro-social behavior subscale scores of SDQ-S, and a family member, a friend subscale scores of MSPSS were found significantly higher in females (p < .05). For males, loneliness and hyperactivity and conduct problems, while for females, emotional symptoms and loneliness (p < .05) were predictive variables. Pro-social behavior and perceived family member support were protective variables for females scoring high enough to be diagnosed with depression (p < .05).

CONCLUSION

We suggest further studies to confirm these results as well as establishing strategies for better detection of depressive symptoms when working on adolescents.

Social Rhythm and Mental Health: A Cross-Cultural Comparison

Background

Social rhythm refers to the regularity with which one engages in social activities throughout the week, and has established links with bipolar disorder, as well as some links with depression and anxiety. The aim of the present study is to examine social rhythm and its relationship to various aspects of health, including physical health, negative mental health, and positive mental health.

Method

Questionnaire data were obtained from a large-scale multi-national sample of 8095 representative participants from the U.S., Russia, and Germany.

Results

Results indicated that social rhythm irregularity is related to increased reporting of health problems, depression, anxiety, and stress. In contrast, greater regularity is related to better overall health state, life satisfaction, and positive mental health. The effects are generally small in size, but hold even when controlling for gender, marital status, education, income, country, and social support. Further, social rhythm means differ across Russia, the U.S., and Germany. Relationships with mental health are present in all three countries, but differ in magnitude.

Conclusions

Social rhythm irregularity is related to mental health in Russia, the U.S., and Germany.

Electroconvulsive therapy increases temporal gray matter volume and cortical thickness

Electroconvulsive therapy (ECT) is a treatment of choice for severe and therapy resistant forms of major depressive episodes (MDE). Temporal brain volume alterations in MDE have been described for more than two decades. In our prospective study we aimed to investigate individual pre-post ECT treatment whole brain gray matter (GM) volume changes (quantified with voxel-based morphometry) in a sample of 18 patients with MDE. In addition, we studied the effect of ECT on voxel-based cortical thickness in cortical brain regions. The most prominent longitudinal GM increases (significant at a whole brain corrected level) occurred in temporal lobe regions. Within specific region of interest analyses we detected highly significant increases of GM in the hippocampus and the amygdala and to a lesser extent in the habenula (left p=0.003, right p=0.032). A voxel based cortical thickness analysis revealed an increase in cortical temporal regions (basically temporal pole and insula) further corroborating our cortical voxel-based morphometry results. Neither GM decreases or white matter increases nor correlations of GM changes with basic psychopathological parameters were detected. We corroborate earlier findings of hippocampal and amygdala GM volume increase following an acute ECT series in patients with MDE. Temporal GM volume increase was significant on a whole brain level and further corroborated by a cortical thickness analysis. Our data widely exclude white matter loss as an indirect cause of GM growth. Our data add further evidence to the hypothesis that ECT enables plasticity falsifying older ideas of ECT induced "brain damaging".

Caregiver burden and vocational participation among parents of adolescents with CF

AIM

Cystic fibrosis (CF) require parents to make significant lifestyle changes to accommodate their children's treatments. We examined the impact of CF-related caregiving on parents' occupational adjustment and labor supply in terms of organizational changes, presenteeism, and absenteeism.

METHODS

Nineteen Italian CF referral centers joined the LINFA group. We enrolled 168 adolescents with the disease and their parents (n = 225) in a cross-sectional survey research. Patients and their parents answered a self-administered questionnaire (child: SF-12, satisfaction with life, MRC Dyspnea scale; parent: caregiver burden scale, short depression-happiness scale, self-rated health, socio-demographic factors). A pediatrician recorded clinical information (pulmonary exacerbations, CF-related complications, treatment, BMI percentile, Fev1 %).

RESULTS

Patients mean age was 16 ± 2.6 and mean BMI percentile was 42.1 ± 29.1; 92 patients (55%) had FEV1 % > 80. Mean parents' age was 45.9 ± 5.9 years, and 59% were women; 75% of women and 24% of men reported to be the primary caregiver. Only 12% had a graduate or post-graduate degree and 56.4% were employed. Approximately 34% of parents reported short depression-happiness scale scores suggestive of clinical depression. Higher caregiving strain was associated with increased likelihood of changing job, work shift schedule, or giving up career opportunities in order to fulfill their caregiving role and increased productivity losses due to family leaves and presenteeism.

CONCLUSION

Caregiving burden is a relevant and frequent issue among parents of adolescent patients with cystic fibrosis. We showed that the humanistic and vocational impact of caring for young patients with the disease is striking and demands health-care and welfare supportive actions.

Preferences for Exercise as a Treatment for Depression

Depression is a leading cause of disability worldwide, but most depressed individuals do not receive treatment. There is now significant support for physical exercise as an effective alternative treatment for depression, which may be more accessible than traditional psychiatric treatments. Little is known about preferences for exercise as a depression treatment.

METHOD

A total of 102 individuals (50% female, mean age = 39 (SD=13.1; range: 18-62), 83% Caucasian) with likely major depression completed an online survey of exercise for depression treatment preferences and barriers to increased exercise. Results are reported by gender due to well established gender differences in exercise preferences.

RESULTS

Both genders reported a high level of interest in an exercise for depression program. On average, participants preferred an individual walking program that was coached, asked them to engage in one longer bout multiple times per week, and was provided in home. However, there was significant variability within and between genders. Lack of motivation, mood, and fatigue were reported as barriers to exercise by the majority of participants of both genders.

CONCLUSION

The majority of those with depression have interest in an exercise for depression program, but symptoms of depression are seen as significant barriers. Future studies should use these results to design exercise for depression programs. The variability and gender differences in our results suggest that flexible programs may be needed.

Electroconvulsive therapy suppresses the neurotoxic branch of the kynurenine pathway in treatment-resistant depressed patients

BACKGROUND

Neuroinflammation is increasingly recognized as contributing to the pathogenesis of depression. Key inflammatory markers as well as kynurenic acid (KYNA) and quinolinic acid (QUIN), both tryptophan metabolites, have been associated with depressive symptoms and suicidality. The aim of the present study is to investigate the peripheral concentration of cytokines and tryptophan and kynurenine metabolites in patients with unipolar treatment-resistant depression before and after electroconvulsive therapy (ECT), the most effective treatment for depression.

METHODS

Cytokines in plasma from patients with major depressive disorder (MDD; n = 19) and healthy volunteers (n = 14) were analyzed with electrochemiluminescence detection. Tryptophan and kynurenine metabolites were detected with high-performance liquid chromatography (HPLC) and LC/MS. KYNA was analyzed in a second healthy control cohort (n = 22).

RESULTS

Patients with MDD had increased plasma levels of interleukin (IL)-6 compared to healthy volunteers (P < 0.05). We also found an altered kynurenine metabolism in these patients displayed by decreased plasma levels of KYNA (P < 0.0001) as well as a significantly increased QUIN/KYNA ratio (P < 0.001). Plasma levels of tryptophan, kynurenine, and QUIN did not differ between patients and controls. Treatment with ECT was associated with a significant decrease in the plasma levels of tryptophan (P < 0.05), kynurenine (P < 0.01), and QUIN (P < 0.001), whereas plasma levels of KYNA did not change. The QUIN/KYNA ratio was found to significantly decrease in ECT-treated patients (P < 0.05). There was a significant inverse correlation between symptom severity and kynurenine levels at baseline (r = -0.67, P = 0.002).

CONCLUSIONS

This study confirms an imbalanced kynurenine pathway in MDD supporting the hypothesis of a netstimulation of N-methyl-D-aspartic acid (NMDA) receptors in the disorder. Treatment with ECT profoundly decreased QUIN, an NMDA-receptor agonist previously suggested to be implicated in the pathogenesis of depression, an effect that might have bearing for the good clinical outcome of ECT.

Involvement of monoaminergic system in the antidepressant-like effect of (octylseleno)-xylofuranoside in the mouse tail suspension test

Depression is one of the most commonly diagnosed neuropsychiatric disorders and several studies have demonstrated a role for selenium in mood disorders. For this reason, the present study investigated the role of the monoaminergic system in the antidepressant-like action of (octylseleno)-xylofuranoside (OSX), an organoselenium compound, in the tail suspension test (TST) in mice. For this purpose, OSX (0.001–10 mg/kg) was administered orally (p.o.) 30 min prior to testing, and all of the tested doses reduced the immobility time in the TST without changing the locomotor activity measured in the open field test (OFT). Furthermore, the antidepressant-like effect of OSX (0.01 mg/kg, p.o.) in the TSTwas prevented by pre-treatment in mice with ketanserin (1 mg/kg, intraperitoneal route (i.p.); a 5-HT2A/2C receptor antagonist),WAY100635 (0.1mg/kg, subcutaneous (s.c.); a selective 5-HT1A receptor antagonist), p-chlorophenylalaninemethyl ester-PCPA (100mg/kg, i.p.; a selective inhibitor of tryptophan hydroxylase), prazosin (1 mg/kg, i.p.; an α1-adrenoceptor antagonist), yohimbine (1 mg/kg, i.p.; an α2-adrenoceptor antagonist), SCH233390 (0.05 mg/kg, s.c., a dopaminergic D1 receptor antagonist) and sulpiride (50 mg/kg, i.p., a dopaminergic D2 receptor antagonist), but not with ondansetron (1 mg/kg, i.p.; a selective 5-HT3 receptor antagonist). Taken together, these data demonstrate that OSX has a potent antidepressant like effect in TST at lower doses (0.001–10 mg/kg), which is dependent on its interaction with the serotonergic, noradrenergic and dopaminergic systems.

Neighborhood settings, types of social capital and depression among immigrants in Toronto

PURPOSE

Few studies consider the associations between neighborhood social capital and immigrant's mental health. We examined associations between bonding, bridging and linking social capital and depression among immigrants in Toronto neighborhoods.

METHODS

We used data on immigrants from the neighborhood effects on health and well-being (NEHW) study, conducted in 47 randomly selected greater Toronto area neighborhoods (sample = 916), and a study of one low-income, immigrant receiving neighborhood (IRN) (sample = 600). We conducted logistic regression models for depression (Epidemiologic Studies Depression Scale, CES-D) and social capital types: bonding (social cohesion and informal social control), bridging (group membership) and linking (engagement in political activities), while adjusting for different covariates.

RESULTS

The prevalence of depression was 22.9 % in IRN and 21.4 % in NEHW. The associations between social capital types and depression differed in each sample. Lower social cohesion (bonding) was associated with higher depression in NEHW only. Lower linking social capital (never participated in political activities) was associated with lower depression in IRN only. These associations were consistent after adjustment for different covariates.

CONCLUSIONS

Results suggest that social cohesion might have a protective effect from depression among immigrants in NEHW. In IRN, lower linking social capital associated with lower depression might reflect opposite direction association. Bridging social capital was not associated with depression in either sample, indicating that current community building might be insufficient to impact depression. Different pathways might explain how depression among immigrants is impacted by social capital types operating in different neighborhood settings; this could be examined in future longitudinal studies.

Cognitive remission: a novel objective for the treatment of major depression?

BACKGROUND

Cognitive dysfunction in major depressive disorder (MDD) encompasses several domains, including but not limited to executive function, verbal memory, and attention. Furthermore, cognitive dysfunction is a frequent residual manifestation in depression and may persist during the remitted phase. Cognitive deficits may also impede functional recovery, including workforce performance, in patients with MDD. The overarching aims of this opinion article are to critically evaluate the effects of available antidepressants as well as novel therapeutic targets on neurocognitive dysfunction in MDD.

DISCUSSION

Conventional antidepressant drugs mitigate cognitive dysfunction in some people with MDD. However, a significant proportion of MDD patients continue to experience significant cognitive impairment. Two multicenter randomized controlled trials (RCTs) reported that vortioxetine, a multimodal antidepressant, has significant precognitive effects in MDD unrelated to mood improvement. Lisdexamfetamine dimesylate was shown to alleviate executive dysfunction in an RCT of adults after full or partial remission of MDD. Preliminary evidence also indicates that erythropoietin may alleviate cognitive dysfunction in MDD. Several other novel agents may be repurposed as cognitive enhancers for MDD treatment, including minocycline, insulin, antidiabetic agents, angiotensin-converting enzyme inhibitors, S-adenosyl methionine, acetyl-L-carnitine, alpha lipoic acid, omega-3 fatty acids, melatonin, modafinil, galantamine, scopolamine, N-acetylcysteine, curcumin, statins, and coenzyme Q10. The management of cognitive dysfunction remains an unmet need in the treatment of MDD. However, it is hoped that the development of novel therapeutic targets will contribute to 'cognitive remission', which may aid functional recovery in MDD.

Cognitive distortions mediate depression and affective response to social acceptance and rejection

BACKGROUND

The emotional context insensitivity (ECI) hypothesis suggests individuals with depression have blunted affective responses to both positive and negative events. We tested ECI in a social context to examine how depression relates to affective responses to social acceptance and rejection outcomes. Furthermore, we aimed to identify cognitive mechanisms linking depression with affective response to social feedback. Finally, we tested whether these processes are similar for social anxiety.

METHOD

90 participants (age 18-26 years; 53 women) completed the two-visit Chatroom task. At Visit 1 they rated their expectations about being liked by 60 peers. At Visit 2 they completed self-reports of depressive and social anxiety symptoms, and of cognitive flexibility, then received acceptance or rejection feedback from each peer and rated their affective response.

RESULTS

Greater depressive symptoms related to negative expectancy bias, lower cognitive flexibility, and less positive affective response to acceptance, but did not relate to rejection. Negative expectations and cognitive flexibility mediated the relationship between depressive symptoms and affective response for acceptance; only negative expectations mediated rejection responses. These cognitive mechanisms were not related to social anxiety.

LIMITATIONS

A community sample was used to assess depression. Rumination and current mood state were omitted as potential predictors of affective response.

CONCLUSIONS

Findings support the ECI framework. Depression but not social anxiety interferes with positive and negative affect through cognitively mediated dampening of emotional response to social acceptance and rejection. Emotion regulation strategies in depression therapy can target social flexibility to improve alignment of affective reactions to social outcomes.