CLASSIFICATION OF ANXIETY DISORDERS COMORBID WITH MAJOR DEPRESSION: COMMON OR DISTINCT INFLUENCES ON RISK?

The impact of matching for reproductive status on the comparison of magnetic spectroscopic measurements of glutamate and gamma-aminobutyric acid + in the medial prefrontal cortex of women with major depression

OBJECTIVES

The role played by medial prefrontal cortex (MPFC) glutamate (Glu) and gamma-aminobutyric acid (GABA) in the pathophysiology and the treatment of major depression (MD) is increasingly recognized. Although measurements of MPFC GABA and Glu have been shown to be sensitive to physiological fluctuations of female hormones, none of the magnetic resonance spectroscopy (MRS) investigations of MPFC Glu and GABA in MD have controlled for possible bias effect of the reproductive stage of the women included.

METHODS

MPFC Glu and GABA+ (which include homocarnosine and macromolecules) referenced to creatine and phosphocreatine, were measured via magnetic resonance spectroscopy (MRS) using a 3-Tesla magnet in 24 women with MD and 24 healthy women paired for reproductive status. All participants were unmedicated.

RESULTS

There were no statistical differences in either MPFC Glu [95 % CI: (-0.025, 0.034)] or MPFC GABA+ [95 % CI: (-0.005, 0.017)] between women with MD and healthy controls.

CONCLUSIONS

Our investigation does not support abnormalities in measurement of MPFC Glu and GABA in MD women when stringent control for reproductive status is performed. As a result of the inherent limitations of MRS methodology, our results do not preclude glutamatergic and GABAergic dysregulations in the MPFC of women with MD.

The genetic contribution to the comorbidity of depression and anxiety: a multi-site electronic health records study of almost 178 000 people

BACKGROUND

Depression and anxiety are common and highly comorbid, and their comorbidity is associated with poorer outcomes posing clinical and public health concerns. We evaluated the polygenic contribution to comorbid depression and anxiety, and to each in isolation.

METHODS

Diagnostic codes were extracted from electronic health records for four biobanks [N = 177 865 including 138 632 European (77.9%), 25 612 African (14.4%), and 13 621 Hispanic (7.7%) ancestry participants]. The outcome was a four-level variable representing the depression/anxiety diagnosis group: neither, depression-only, anxiety-only, and comorbid. Multinomial regression was used to test for association of depression and anxiety polygenic risk scores (PRSs) with the outcome while adjusting for principal components of ancestry.

RESULTS

In total, 132 960 patients had neither diagnosis (74.8%), 16 092 depression-only (9.0%), 13 098 anxiety-only (7.4%), and 16 584 comorbid (9.3%). In the European meta-analysis across biobanks, both PRSs were higher in each diagnosis group compared to controls. Notably, depression-PRS (OR 1.20 per s.d. increase in PRS; 95% CI 1.18-1.23) and anxiety-PRS (OR 1.07; 95% CI 1.05-1.09) had the largest effect when the comorbid group was compared with controls. Furthermore, the depression-PRS was significantly higher in the comorbid group than the depression-only group (OR 1.09; 95% CI 1.06-1.12) and the anxiety-only group (OR 1.15; 95% CI 1.11-1.19) and was significantly higher in the depression-only group than the anxiety-only group (OR 1.06; 95% CI 1.02-1.09), showing a genetic risk gradient across the conditions and the comorbidity.

CONCLUSIONS

This study suggests that depression and anxiety have partially independent genetic liabilities and the genetic vulnerabilities to depression and anxiety make distinct contributions to comorbid depression and anxiety.

Decreased GABA+ ratios referenced to creatine and phosphocreatine in the left dorsolateral prefrontal cortex of females of reproductive age with major depression

BACKGROUND

It has been suggested that the dorsolateral prefrontal cortex (DLPFC), especially the left DLPFC, has an important role in the pathophysiology and the treatment of major depressive disorder (MDD); furthermore, the contributory and antidepressant role of γ-aminobutyric acid (GABA) is increasingly recognized. Given that most female patients with MDD are of reproductive age, we sought to assess in vivo baseline GABA levels in the left DLPFC among unmedicated females of reproductive age with depression.

METHODS

We compared healthy females and females with MDD. Both groups were of reproductive age. We confirmed absence of current or past psychiatric diagnosis among healthy controls or a current diagnosis of MDD via a structured interview. We measured GABA+ (including homocarnosine and macromolecules), referenced to creatine and phosphocreatine, via magnetic resonance spectroscopy using a 3 Tesla magnet.

RESULTS

We included 20 healthy controls and 13 participants with MDD. All participants were unmedicated at the time of the study. All females were scanned during the early follicular phase of the menstrual cycle. Levels of GABA+ in the left DLPFC were significantly lower among participants with MDD (median 0.08) than healthy controls (median 0.10; U = 66.0, p = 0.02, r = 0.41).

LIMITATIONS

When we adjusted for fit error as a covariate, we lost statistical significance for left DLPFC GABA+. However, when we adjusted for signal-to-noise ratio, statistical significance was maintained.

CONCLUSION

Our results suggest that GABA+ levels in the left DLPFC may vary by depression status and should be examined as a possible treatment target.

Correlates and consequences of anxiety and depressive symptom trajectories during early treatment for alcohol use

We investigated whether latent trajectories of anxiety and depressive symptoms were associated with clinically relevant variables including treatment attrition among individuals seeking treatment for alcohol use. Participants were drawn from 78 addiction treatment centers and included individuals in treatment for alcohol use, had in-treatment data, and screened positive for anxiety (n = 6147) or depressive symptoms (n = 6197) at intake. Anxiety and depressive symptoms were measured weekly during the first month of treatment. Three trajectories of anxiety symptoms (i.e., Persistent Moderate Anxiety Symptoms, Remitting Moderate Anxiety Symptoms, and Remitting Mild Anxiety Symptoms) and depressive symptoms (i.e., Increasing Moderate Depressive Symptoms, Persistent Moderate Depressive Symptoms, and Remitting Mild Depressive Symptoms) were identified. Women, younger individuals, and individuals who endorsed greater past month benzodiazepine use and depressive symptoms at intake were more likely to be in the Persistent Moderate Anxiety Symptoms trajectory relative to the Remitting Mild Anxiety Symptoms subgroup. Women, individuals who screened positive for anxiety at intake, and individuals reporting past month heroin use were more likely to be in the Increasing Moderate Depressive Symptoms trajectory relative to the Remitting Mild Depressive Symptom trajectory. Trajectories characterized by persistent moderate anxiety and depressive symptoms during the first month of treatment were more likely to drop out of treatment compared to individuals who reported low symptom levels. Findings indicate heterogeneity in the clinical course of anxiety and depressive symptoms among individuals in treatment for alcohol use and highlight that persistently high anxiety and depressive symptoms may pose an impediment to successful treatment completion. Results also demonstrate the importance of considering demographic and clinical characteristics at treatment intake as they may have significant implications for the unfolding of anxiety and depressive symptoms during treatment and subsequent outcomes.

Effects of psychological capital and social support availability on anxiety and depression among Chinese emergency physicians: Testing moderated mediation model

Introduction

Anxiety often precedes depression, and the pathway from anxiety to depression may be affected by multiple exposures. Our research aims to explore the mediating effect of the social support availability (SSA) between anxiety and depression and how it is moderated by psychological capital.

Methods

A cross-sectional study was conducted among Chinese emergency physicians at the top-level general hospitals in eastern China. Data were collected via the questionnaire including anxiety and depression subscales of Symptom Checklist-90, Psychological Capital Questionnaire as well as Social Support Rating Scale. The PROCESS v3.4 macro was employed to assess the mediating role of SSA and a moderating role of psychological capital.

Results

A total of 536 valid samples were filtered. Anxiety, depression, SSA, and psychological capital were significant correlated. Anxiety was positively associated with depression (β = 0.82, p < 0.001), and the SSA mediated the relationship between anxiety and depression (indirect effect = 0.013, 95%BootCI [0.005, 0.023]). Psychological capital (specifically, self-efficacy, hope and resilience) further played a moderating role in the relationship between SSA and depression (β = 0.06, p < 0.01).

Conclusion

The mental health of emergency physicians should be concerned. In order to decrease anxiety and depression, SSA and psychological capital should be increased as the interventions for emergency physicians.

Disordered eating concerns, behaviors, and severity in young adults clustered by anxiety and depression

OBJECTIVES

Little is known about how anxiety and depression in combination relate to eating disorder concerns (eating, shape, and weight concern) and behaviors (restraint eating, binge eating, and purging) indicative of eating disorder symptom severity. This study examined links among disordered eating concerns, behaviors, and severity clustered by depression and anxiety.

METHODS

College students (n = 1792) completed a survey comprised of the Generalized Anxiety Disorder Scale (GAD-7), 2-item Patient Health Questionnaire (PHQ-2) assessing Major Depressive Disorder (MDD), and Eating Disorder Exam Questionnaire (EDE-Q) assessing concerns and behaviors indicative of disordered eating.

RESULTS

Cluster analysis yielded four groups: not depressed or anxious to subclinical, moderate, and high depression and anxiety. Analysis of variance (ANOVA) indicated overall eating disorder severity scores increased significantly as GAD and MDD increased, suggesting that as anxiety and depression rise in tandem, disturbed eating severity rises. Results revealed that even at subclinical levels, disordered eating concerns, behaviors, and overall severity scores increase.

DISCUSSION

Future interventions aiming to reduce disordered eating in young adults may be strengthened by incorporating depression and anxiety management strategies. A screening for subclinical anxiety and depression (Mixed Anxiety and Depression Disorder [MADD]) may be helpful in providing early intervention to resolve disordered eating behaviors before they become entrenched.

Geriatric Depression and Inappropriate Medication: Benefits of Interprofessional Team Cooperation in Nursing Homes

An investigation of inappropriate medication use in treatment of depressivity in institutionalized older adults, based on a nurse-led evaluation of functional status and depressive symptoms in nursing home residents. Methods: A cross-sectional multicenter study was performed using records from 1087 residents cared for in fifteen nursing homes (NHs) in the Czech Republic. Inclusion criteria were being a permanent resident of one of the facilities, being 60 years of age or older, having a Geriatric Depression Scale score of 6 or more, and having a Mini Mental State examination score 10 or more. The final sample for analysis included 317 depressed NH residents. Results: 52 percent of NH residents with depressivity had no antidepressant treatment. Benzodiazepines were the only medication in 16 percent of depressed residents, and were added to antidepressant treatment in 18 percent of residents. Benzodiazepine users had significantly higher GDS scores compared to non-users (p = 0.007). Conclusion: More than half of depressed NH residents remained without antidepressant treatment. Residents inappropriately treated with benzodiazepines were more depressed than residents treated with antidepressants only, or even not treated at all. Cooperation of the interprofessional team in the screening of depressive symptoms has the potential to improve the quality of care.

Comparative Proteomics of Rat Olfactory Bulb Reveal Insights into Susceptibility and Resiliency to Chronic-stress-induced Depression or Anxiety

Chronic stress causes the abnormality of olfactory bulb (OB) in both anxiety and depression, however, the unique and common neurobiological underpinnings are still poorly understood. Previously, we built the three groups by chronic mild stress (CMS), depression-susceptible (Dep-Sus): with depression-like behavior, anxiety-susceptible (Anx-Sus): with anxiety-like behavior and insusceptible (Insus): without depression- and anxiety-like behaviors. To continuously explore the protein expression changes in these three groups, comparative quantitative proteomics analysis was conducted on the rat OB as crucial part of the olfactory system. Next, bioinformatics analyses were implemented whereas protein expressions were independently analyzed by parallel reaction monitoring (PRM) or Western blot (WB). The OB-proteome analysis identified totally 133 differentially expressed proteins as a CMS response. These deregulated proteins were involved in multiple functions and significant pathways potentially correlated with phenotypes of maladaptive behavior of depression or anxiety as well as adaptive behavior, and hence might act as potential candidate protein targets. The subsequent PRM-based or WB-based analyses showed that changes in Nefl, Mtmr7 and Tk2; Prkaca, Coa3, Cox6c2, Lamc1 and Tubal3; and Pabpn1, Nme3, Sos1 and Lum were uniquely associated with Dep-Sus, Anx-Sus, and Insus groups, respectively. These phenotype-specific deregulated proteins were primarily involved in multiple metabolic and signaling pathways, suggesting that the identical CMS differently impacted the olfactory protein regulation system and biological processes. To sum up, our present data as a useful proteomics underpinning provided the common and distinct molecular insights into the biochemical understanding of OB dysfunction underlying susceptibility and resiliency to chronic-stress-induced anxiety or depression.

[Comorbidity of depression and anxiety in clinical practice]

OBJECTIVE

The study was the comparative characterization of depressed patients depending on the presence of comorbid anxiety.

MATERIAL AND METHODS

Thirty patients of the Clinic of neuroses named after acad. I.P. Pavlov Clinic of Neuroses. Comparison groups included 15 patients with comorbid anxiety and depressive disorders and 15 patients with depressive disorder without comorbid anxiety. The groups were comparable by sex and age. Clinical-catamnestic, clinical-therapeutic, and clinical-scale methods, including the Hamilton Depression and Anxiety Scales, were used during the study.

RESULTS

The structure of clinically diagnosed comorbid anxiety and depressive disorders was shown to be characterized by high representation of somato-vegetative symptoms and higher level of depression in comparison to depressive disorder without comorbid anxiety. According to psychometric assessment results, the level of anxiety did not differ in comparison groups, while clinically, according to ICD-10 criteria, anxiety was not diagnosed, indicating a discrepancy between clinical and scale assessments of anxiety and depressive disorders and greater accuracy of clinical and scale assessment of the condition. The effectiveness of combined treatment, including psychotropic therapy and psychotherapy, was lower in patients with comorbidity of anxiety and depression according to parameters of the degree of reduction of psychopathological symptoms, duration of treatment, and quality of remission. The structure of incomplete remission was similar in patients with comorbid anxiety and depressive disorders and depression.

CONCLUSION

The obtained data suggest the expediency of continuous systematization of affective disorders and the need to improve the diagnostic criteria of comorbid anxiety and depressive disorders on the basis of combined clinical and scale assessment.

Burden and psychological symptoms among caregivers of patients with solid tumor cancers

PURPOSE

To evaluate factors associated with burden reported by caregivers of people undergoing treatment for solid tumor cancers.

METHODS

A secondary analysis of baseline data collected in a cancer symptom management trial was conducted guided by the Organizing Framework for Caregiver Interventions. A total of 349 caregivers completed the Caregiver Reaction Assessment Tool evaluating caregiver burden; Bayliss Comorbidity Tool; and PROMIS-29 version1.0-Anxiety and Depression Short Forms. Multivariable linear models were used to examine the associations of Caregiver Reaction Assessment Tool subscales (caregiver self-esteem, family support, financial, schedule, and health burden) with caregiver sociodemographic characteristics, comorbidities, anxiety, and depression.

RESULTS

The majority of caregivers were female and spouses/partners who resided with the patient. Being female, Asian, a spouse of the patient, employed, and having a higher level of anxiety and depressive symptoms were significantly associated with lower caregiver self-esteem, and higher perceived schedule and health burden. Caregiver anxiety and depressive symptoms were also significantly associated with lack of family support and higher financial burden.

CONCLUSIONS

Clinicians should consider factors that contribute to higher perceived burden for caregivers when they are engaged in home-based supportive care for patients undergoing cancer treatment.

Early- and late-onset postpartum depression exhibit distinct associated factors: the IGEDEPP prospective cohort study

OBJECTIVE

To identify risk factors for early- and late-onset postpartum depression (PPD) among a wide range of variables, including sociodemographic characteristics, childhood trauma, stressful life events during pregnancy and history of personal and family psychiatric disorders, and to assess the contribution of each risk factor.

DESIGN

Nested case-control study in a prospective longitudinal cohort study.

SETTING

Eight maternity departments in the Paris metropolitan area, France.

SAMPLE

A cohort of 3310 women with deliveries between November 2011 and June 2016.

METHODS

Cases were women with early- or late-onset PPD. Controls were women without depression during pregnancy or the postpartum period. Logistic regression adjusted on sociodemographic variables was performed for each outcome and a multivariable model was proposed based on a stepwise selection procedure.

MAIN OUTCOME MEASURES

Early- and late-onset PPD assessed at 2 months and 1 year postpartum, respectively.

RESULTS

Stressful life events during pregnancy have a dose-response relationship with both early- and late-onset PPD.

CONCLUSIONS

Early- and late-onset PPD presented distinct patterns of determinants. These results have important consequences in terms of prevention and specific care.

TWEETABLE ABSTRACT

Early- and late-onset postpartum depression are associated with stressful life events and psychiatric history.

Impact of Divergent Thinking Training on Teenagers' Emotion and Self-Efficacy During the COVID-19 Pandemic

Currently due to the COVID-19 pandemic, young people are experiencing a decrease in self-efficacy and an increase in mental illness. Though previous studies have shown that self-efficacy and divergent thinking training are positively related, little is known about the impact of divergent thinking training on self-efficacy and emotions. Therefore, our study seeks this answer to support teenagers injured psychologically during disastrous periods. We randomly assigned 70 students to a 2 (time: pretest, post-test) × 2 (groups: divergent thinking training, controlled) mixed design. Participants in the experimental group were given a 9-day divergent thinking training with the theme of "writing down 10 novel functions of the mask," while those in the control group spent 10 min each day recording what they ate. The self-efficacy, anxiety, depression, and stress of two groups were measured before and after training. Results showed that, compared to the control group, self-efficacy ceased decreasing while anxiety decreased for the experimental group. These findings confirm the positive effect of divergent thinking on teenagers. Implications and limitations are discussed.

The emotional dance with depression: A longitudinal investigation of OULA® for depression in women

The primary purpose of this pilot study was to evaluate OULA®, a dance fitness program with a strong emphasis on processing emotions through dance, as an intervention for depression in women diagnosed with major or persistent depressive disorders. 53 women were eligible for participation. Women attended OULA® for 12 weeks and then abstained from OULA® during week 13. For the primary outcome, depression severity was measured using the Hamilton Depression Rating Scale (HAM-D), and secondary outcomes were measured using the Beck Anxiety Index (BAI) and the Subjective Happiness Scale (SHS). After the abstinence week, women were offered 3-months of optional additional OULA®. HAM-D, BAI and SHS scores were collected at weeks 2, 4, 5-14 and at the end of the 3-month optional OULA® phase. Results from linear mixed effects repeated models show that during the 12-week intervention period and at week 26, HAM-D scores significantly decrease each week compared to baseline. Further, BAI scores significantly decrease starting at week 5 and through the end of the intervention period and at week 26. Moreover, SHS scores increased significantly for four of the weeks during the intervention period and at week 26. The results from this study suggest that OULA® may be a useful intervention for decreasing depression and anxiety severity in women with depression but may not be helpful for improving subjective happiness.

Anxiety, depression and associated factors among recently divorced individuals

Background: In divorce research, studies using large samples, very recently divorced individuals and validated measures of depression and anxiety with available background populations for comparison are missing.Aims: This study aimed to investigate symptoms of depression and anxiety among recently divorced Danes and assess the explanatory power of relevant sociodemographic- and divorce-related variables on these symptoms.Methods: The study utilized an online cross-sectional design and a total of 1856 Danish citizens recruited through the Danish State Administration. Average scores for depression and anxiety were compared to the Danish background population and regression analyses were conducted to assess the explanatory power of sociodemographic- and divorce characteristics on symptoms of depression and anxiety.Results: Divorcees reported significantly higher levels of both depressive and anxiety symptoms than the background population with a large proportion of the sample scoring equal to or higher than generally recommended cut-off values for risk of suffering from a psychiatric diagnosable case of depression or anxiety. Both sociodemographic- and divorce characteristics were predictive of symptoms of depression and anxiety.Conclusion: The findings underline the relevance of public health intervention targeting symptoms of depression and anxiety among recently divorced individuals.

Comorbid Conditions in Relation to Controlled Substance Abuse

Dental patients who experience comorbid psychiatric and medical conditions present an elevated risk of medication misuse, abuse, substance use disorders, and overdose. The authors review the role of notable comorbidities in predicting the development of substance use disorder, including medical, psychiatric, and other psychosocial factors that can be assessed in general dental practice. Psychiatric disorders commonly cooccur with substance abuse, and these typically include anxiety disorders, mood disorders (major depression, bipolar), posttraumatic stress, as well as sleep and eating disorders. Medical disorders commonly found to be present with substance use disorders are also reviewed, including common cardiovascular and pulmonary disorders.

Prefrontal-amygdala connectivity in trait anxiety and generalized anxiety disorder: Testing the boundaries between healthy and pathological worries

BACKGROUND

Current brain-based theoretical models of generalized anxiety disorder (GAD) suggest a dysfunction of amygdala-ventromedial prefrontal cortex emotional regulatory mechanisms. These alterations might be reflected by an altered resting state functional connectivity between both areas and could extend to vulnerable non-clinical samples such as high worriers without a GAD diagnosis. However, there is a lack of information in this regard.

METHODS

We investigated differences in resting state functional connectivity between the basolateral amygdala and the ventromedial prefrontal cortex (amygdala-vmPFC) in 28 unmedicated participants with GAD, 28 high-worriers and 28 low-worriers. We additionally explored selected clinical variables as predictors of amygdala-vmPFC connectivity, including anxiety sensitivity.

RESULTS

GAD participants presented higher left amygdala-vmPFC connectivity compared to both groups of non-GAD participants, and there were no differences between the latter two groups. In our exploratory analyses, concerns about the cognitive consequences of anxiety (the cognitive dimension of anxiety sensitivity) were found to be a significant predictor of the left amygdala-vmPFC connectivity.

LIMITATIONS

The cross-sectional nature of our study preclude us from assessing if functional connectivity measures and anxiety sensitivity scores entail an increased risk of GAD.

CONCLUSIONS

These results suggest a neurobiological qualitative distinction at the level of the amygdala-vmPFC emotional-regulatory system in GAD compared to non-GAD participants, either high- or low-worriers. At this neural level, they question previous hypotheses of continuity between high worries and GAD development. Instead, other anxiety traits such as anxiety sensitivity might confer a greater proneness to the amygdala-vmPFC connectivity alterations observed in GAD.

Emotional regulation training for intensive and critical care nurses

Professional quality of life is related to psychological well-being for nurses with implications for quality patient care. This study evaluated the effectiveness of emotional regulation training on depression, anxiety and stress, and professional quality of life for intensive and critical care nurses. In this experimental comparison trial, 60 intensive and critical care nurses were randomly assigned to treatment and wait-list control groups. The treatment group received six sessions of emotional regulation training, while the wait-list control group received no treatment. Outcome measures were: the Cognitive Emotion Regulation Questionnaire; the Depression, Anxiety and Stress Scale; and the Professional Quality of Life Scale in a pre-post design. The treatment group demonstrated greater improvements in burnout and compassion satisfaction compared with the wait-list control group. No significant reduction in compassion fatigue was found compared with controls. Some cognitive coping strategies improved in the treatment group compared with controls, with greater reductions in depression, anxiety, and stress. This study indicates the benefits of implementing emotional regulation training programs to improve psychological well-being and professional quality of life for intensive and critical care nurses.

Anxiety comorbidities in patients with major depressive disorder: the role of attachment

Objectives: Attachment connects mood expressions and is related to the psychopathology of depression and anxiety. However, whether insecure attachment can predict the risk of an increased number of anxiety comorbidities in patients with major depressive disorder (MDD) remains unclear.Methods: Sixty-six patients with MDD were recruited in this cross-sectional study. Depression, anxiety and insecure attachment among patients were assessed accordingly. Patients' disease characteristics and psychopathology were evaluated using a structured psychiatric MINI interview, the 17-item Hamilton Depression Rating Scale, and the 21-item Beck Anxiety Inventory, while the attachment was assessed with the Chinese self-reporting version of the Attachment Style Questionnaire.Results: We found that 74.2% of MDD patients had at least one anxiety comorbidity, and 24.2% of MDD patients had multiple anxiety comorbidities. Common anxiety comorbidities included generalised anxiety disorder, panic disorder, agoraphobia, and post-traumatic stress disorder. The patients who had multiple anxiety comorbidities exhibited lower secure attachment levels and higher anxious/preoccupied and avoidant attachment levels.Conclusions: Anxious/preoccupied attachment is associated with an increased risk of multiple anxiety comorbidities in MDD patients. A longitudinal study with a larger sample size is needed to identify the causal relationship of anxious/preoccupied attachment and anxiety comorbidities during the course of MDD.

Transdiagnostic Dimensions towards Personality Pathology and Childhood Traumatic Experience in a Clinical Sample: Subtype Classification by a Cross-sectional Analysis

Psychiatric disorders are highly heterogeneous syndromes often explained by underlying and internalized personality disorder(PD) traits that are affected by externalized childhood trauma experiences(CTE). The present study investigated the differential subtype model by examining the association between PD traits and CTE in a clinical sample with transdiagnostic psychopathology. Outpatients(n = 2090) presenting for psychiatric treatment completed self-reported measures of PD traits(Personality Diagnostic Questionnaire) and the childhood adversity(Child Trauma Questionnaire). Canonical variates were generated by canonical correlation analysis(CCA) and then used for hierarchical cluster analysis to produce subtypes. A support vector machine(SVM) model was used and validated using a linear kernel to assess the utility of the extracted subtypes of outpatients in clinical diagnosis classifications. The CCA determined two linear combinations: emotional abuse related dissociality PD traits(antisocial and paranoid PD) and emotional neglect related sociality PD traits(schizoid, passive-aggressive, depressive, histrionic, and avoidant PD). A cluster analysis revealed three subtypes defined by distinct and relatively homogeneous patterns along two dimensions, and comprising 17.5%(cluster-1, n = 365), 34.8%(cluster-2, n = 727), and 47.8%(cluster-3, n = 998) of the sample, each with distinctive features of PD traits and CTE. These subtypes suggest more distinct PD trait correlates of CTE manifestations than were captured by clinical phenomenological diagnostic definitions. Our results highlight important subtypes of psychiatric patients that highlight PD traits and CTE that transcend current diagnostic boundaries. The three different subtypes reflect significant differences in PD and CTE characteristics and lend support to efforts to develop PD and childhood trauma targeted psychotherapy that extends to clinical diagnosis-based interventions.

Transdiagnostic Tailored Internet- and Mobile-Based Guided Treatment for Major Depressive Disorder and Comorbid Anxiety: Study Protocol of a Randomized Controlled Trial

Introduction: Depression is highly prevalent and often accompanied by comorbid anxiety disorder. Internet-based interventions have shown to be one effective treatment modality; however, comorbidities are often not targeted. Transdiagnostic tailored internet-and mobile-based interventions (IMIs) might be promising to overcome such issues. Aim: This study aims to evaluate the efficacy, moderators, and cost-effectiveness of a transdiagnostic tailored internet- and mobile-based guided intervention for depression and comorbid anxiety in individuals with major depressive disorder (MDD). Method: Two-hundred participants with MDD will be randomly assigned to an 8-week guided self-help internet intervention (IC) or a 6-month wait-list control group (WLC). Participants of the IC will receive weekly content-focused feedback on module completion as well as monitored adherence reminders from an eCoach. The primary outcome is clinician-rated depression severity (QIDS-C) at post-assessment assessed by diagnostic raters blind to study condition. Secondary outcomes include, e.g., change in diagnostic status (MDD and anxiety disorders), remission and response rates, disorder symptom severity, health related quality of life, incongruence related to needs and values, and behavioral activation. Assessments will take place at baseline (T1), post-assessment (T2), 6-month follow-up (T3), and 12-month follow-up in the IC. Data will be analyzed on an intention-to-treat basis and per protocol. A large number of a priori defined moderators of treatment outcome will be assessed at baseline and tested in predicting treatment outcome. Cost-effectiveness will be evaluated from a societal perspective. Discussion: The present study will provide evidence on the efficacy, potential cost-effectiveness, and moderators of a transdiagnostic tailored guided internet- and mobile-based treatment protocol.

TRIAL REGISTRATION

German Register of Clinical Studies DRKS00011690 (https://www.drks.de/drks_web/).

Family and Personality Predictors of Clinical Depression and Anxiety in Emerging Adults: Common, Distinctive, or a Vulnerability Continuum?

There is an ongoing debate on the relationship between depression and anxiety, but data on similarities and differences in their predictor profiles are scarce. The aim of our study was to compare family and personality predictors of these disorders among 220 "emerging adults." As such, two clinical groups with noncomorbid depressive and anxiety disorders, and one healthy control group were assessed by sociodemographic questionnaires, Structured Clinical Interview for DSM-IV Disorders and NEO Personality Inventory, Revised. We found significant overlap in family and personality risk profiles, with increasing effect size for predictors common to anxiety and depression when the categories "no disorder-anxiety disorder-depressive disorder" were considered as existing along a continuum. Among the contributing factors we assessed, family psychiatric history, family structure and conflicts with parents were more significant than personality traits. Our study indicates that emerging adults may be more vulnerable to depression than anxiety in the presence of family and personality risk factors.

A holistic approach to factors affecting depression in haemodialysis patients

Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.

Effects of Hint1 deficiency on emotional-like behaviors in mice under chronic immobilization stress

BACKGROUND

Histidine triad nucleotide-binding protein 1 (HINT1) is regarded as a haplo-insufficient tumor suppressor and is closely associated with diverse neuropsychiatric diseases. Moreover, HINT1 is related to gender-specific acute behavior changes in schizophrenia and in response to nicotine. Stress has a range of molecular effects in emotional disorders, which can cause a reduction in brain-derived neurotrophic factor (BDNF) expression in the hippocampus, resulting in hippocampal atrophy and neuronal cell loss.

METHODS

This study examined the role of HINT1 deficiency in anxiety-related and depression-like behaviors and BDNF expression in the hippocampus under chronic immobilization stress, and investigated whether the sex-specific and haplo-insufficient effects exist in emotional-like behaviors under the same condition.

RESULTS

In a battery of behavior tests, the results of the control group, not exposed to stress, showed that knockout (KO) and heterozygosity (HT) of Hint1 had anxiolytic-like and antidepression-like effects on the male and female mice. However, both male and female Hint1-KO mice showed elevated anxiety-related and antidepression-like behavior under chronic immobilization stress; moreover, both male and female Hint1-HT mice displayed elevated anxiety-related behavior and increased depression-like behavior under chronic immobilization stress. There were no significant differences in general locomotor activity between Hint1-KO and -HT mice and their wild-type (WT) littermates. Hint1-KO mice under basal and chronic immobilization stress conditions expressed more BDNF in the hippocampus than did Hint1-HT and WT mice; overall, there were no significant sex differences in emotional-like behaviors of Hint1-KO and -HT mice. Additionally, Hint1-HT mice showed haplo-insufficient effects on emotional-like behaviors under basic conditions, rather than under chronic immobilization stress.

CONCLUSIONS

Both male and female HINT 1 KO and HT mice had a trend of anxiolytic-like behavior and antidepression-like behavior at control group. However, both male and female HINT1 KO mice showed elevated anxiety-related and antidepression-like behavior under chronic immobilization stress; moreover, both male and female HINT1 HT mice displayed elevated anxiety-related behavior and increased depression-like behavior under chronic immobilization stress.

The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis

To date, the precise prevalence of co-morbidity of anxiety and depression in the perinatal period is not well known. We aimed to estimate the prevalence of co-morbid anxiety and depression in the antenatal and postnatal periods. Systematic searches of multiple electronic databases were conducted for studies published between January 1950 and January 2016. We included 66 (24 published and 42 unpublished) studies incorporating 162 120 women from 30 countries. Prevalence of self-reported antenatal anxiety symptoms and mild to severe depressive symptoms was 9.5% [95% confidence interval (CI) 7.8-11.2, 17 studies, n = 25 592] and of co-morbid anxiety symptoms and moderate/severe depressive symptoms was 6.3% (95% CI 4.8-7.7, 17 studies, n = 27 270). Prevalence of a clinical diagnosis of any antenatal anxiety disorder and depression was 9.3% (95% CI 4.0-14.7, 10 studies, n = 3918) and of co-morbid generalized anxiety disorder and depression was 1.7% (95% CI 0.2-3.1, three studies, n = 3085). Postnatally between 1 and 24 weeks postpartum, the prevalence of co-morbid anxiety symptoms and mild to severe depressive symptoms was 8.2% (95% CI 6.5-9.9, 15 studies, n = 14 731), while co-morbid anxiety symptoms and moderate/severe depressive symptoms was 5.7% (95% CI 4.3-7.1, 13 studies, n = 20 849). The prevalence of a clinical diagnosis of co-morbid anxiety and depression was 4.2% (95% CI 1.9-6.6, eight studies, n = 3251). Prevalence rates did not differ with regard to year of publication, country income, selection bias and attrition bias. The results suggest that co-morbid perinatal anxiety and depression are prevalent and warrant clinical attention given the potential negative child developmental consequences if left untreated. Further research is warranted to develop evidence-based interventions for prevention, identification and treatment of this co-morbidity.

Pharmacological Management of Anxiety Disorders in the Elderly

Anxiety disorders are common in the elderly. Additionally, anxiety symptoms often accompany co-morbid psychiatric, medical, as well as neurodegenerative diseases in the older population. Anxiety in the elderly, often accompanied by depression, can lead to worsening physical, cognitive and functional impairments in this vulnerable population. Antidepressants are considered first line treatment. Both SSRIs and SNRIs are efficacious and well-tolerated in the elderly. Some SSRIs are strong inhibitors of the cytochrome P450 hepatic pathway whereas others have less potential for drug interaction. Those antidepressants with more favorable pharmacokinetic profiles should be considered first-line in the treatment of anxiety. Mirtazapine and vortioxetine are also considered safe treatment options. Buspirone may have benefit, but lacks studies in elderly populations. Although tricyclic/tetracyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) may be effective in the elderly, their side effect and safety profiles are suboptimal and thus are not recommended in late-life. Benzodiazepines and beta blockers should generally be avoided when treating anxiety in the elderly. There is not enough evidence to support the use of antipsychotics or mood stabilizers given their risk of problems in both the long and short term. In addition, antipsychotics have a black box warning for increased mortality in elderly patients with dementia.

Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder

The comorbidity of major depressive disorder (MDD) and generalized anxiety disorder (GAD) is common and often predicts poorer outcomes than either disorder alone. This study aimed to examine the prevalence of comorbid GAD and its association with quality of life (QOL) among MDD patients. A total of 1225 psychiatric outpatients were screened using the Hospital Anxiety and Depression Scale (HADS). Those who scored ≥8 on the HADS were interviewed using DSM-IV criteria by two senior psychiatrists. Patients diagnosed with MDD were further assessed using the 9-item Patient Health Questionnaire, Social Support Rating Scale, Pittsburgh Sleep Quality Index, and World Health Organization QOL Scale, brief version (WHOQOL-BREF). Ultimately, 667 patients were diagnosed with MDD, of 71.7% of whom had GAD. Compared to those with MDD alone, comorbid patients had lower scores on the physical (38.64 ± 10.35 vs.36.54 ± 12.32, P = 0.026) and psychological (35.54 ± 12.98 vs. 30.61 ± 14.66, P < 0.001) domains of the WHOQOL-BREF. The association between comorbid GAD and poor QOL on the two domains remained statistically significant in the multiple linear regression (unstandardized coefficients: −1.97 and −4.65, P < 0.001). In conclusion, the prevalence of comorbid GAD in MDD patients is high, and co-occurring GAD may exacerbate impaired physical and psychological QOL in Chinese MDD patients.

Epilepsy and secondary perceived stigma in a social setting: A night at the theater

Stigma impacts >50% of persons with epilepsy (PWE) and is a key factory in quality of life. Stigma can be both enacted (external factors) and felt (internal factors). In this article, felt/perceived stigma is more broadly defined as a combination of internal factors and perceptions of external factors. Secondary perceived stigma is felt/perceived stigma by a third party. A key, but often underappreciated, consideration in felt/perceived stigma may occur when a seemingly innocuous statement by a speaker is perceived as stigmatizing by the PWE and/or even by an unintended third party. This autobiographic short report addresses secondary perceived stigma in a social setting, the theater.

Shortened telomere length in patients with depression: A meta-analytic study

BACKGROUND

Accelerated telomere shortening is associated with stress-related cell damage and aging. Patients with depression have been shown to have shortened life expectancy and to be associated with multiple age-related systemic diseases. Previous studies have examined leukocyte telomere length (LTL) in patients with depression, but have shown inconsistent results.

METHODS

We conducted meta-analyses by pooling relevant results strictly from all eligible case-control studies for cross-sectional comparison of LTL between depressive patients and control subjects (16 studies involving 7207 subjects). The effect sizes (shown as Hedges' g) of each individual study were synthesized by using a random effects model.

RESULTS

Our analysis revealed telomere length is significantly shorter in subjects with depression in comparison to healthy controls (Hedges' g = -0.42, p = 1 × 10(-5), corresponding to r = -0.21). Significant heterogeneity among studies examining LTL in subjects with depression was found (Q = 116.07, df = 16, I(2) = 86.21%, p < 1 × 10(-8)), which can possibly be explained by methods used in measuring telomere length (Q = 18.42, df = 2, p = 1 × 10(-4)). There was no significant publication bias, nor moderating effect of age, female percentage, or illness duration of depression on synthesized results.

CONCLUSIONS

Our results support the hypothesis that depression is associated with accelerated cell aging. Future studies are required to clarify whether the association is mediated through environmental stress, and whether effective treatment can halt cell aging.