Psychometric properties of the Gotland Scale for Depression in Italian psychiatric inpatients and its utility in the prediction of suicide risk

The effectiveness of mindful hypnotherapy on difficulties in emotion regulation, mindfulness, and mental health in patients with major depressive disorder

BACKGROUND

More than 300 million people are affected by major depressive disorder, and despite advances in treatments over the past 50 years, this number is increasing worldwide. Due to the high prevalence and increasing numbers, along with problems in various aspects of the patient's life, new effective treatments are essential in this field.

MATERIALS AND METHODS

This study was a single-blinded randomized clinical trial. Thirty-four patients with major depressive disorder who were referred by clinical psychologists in the clinical psychology clinic of the Taleghani Hospital, Tehran, Iran, were selected by purposive sampling method and randomly assigned to the intervention and wait-list control groups. The Difficulties in Emotion Regulation Scale, the Five Facet Mindfulness Questionnaire, and the Mental Health Continuum Short Form were administered during the baseline and post treatment. Analyses of covariance and the repeated measures analysis of variance (ANOVA) procedure were performed to determine the difference between study groups.

RESULTS

The results of the analysis of covariance and repeated measures ANOVA showed a clinically significant decrease in difficulties in emotion regulation and a significant increase in mindfulness and mental health in the intervention group (P < 0.001). The mean score (standard deviation) of the difficulties in emotion regulation scores was 123.75 (21.10) in the experimental group at baseline and significantly decreased to 76.19 (26.45) and 68.00 (22.83) after the intervention and two-month follow-up, respectively (P < 0.001). Additionally, the mean scores (standard deviation) for mindfulness and mental health were 93.06 (8.23) and 19.63 (7.92), respectively, at baseline and significantly increased to 149.43 (16.99) and 51.62 (9.78), respectively, after the intervention and to 144.18 (20.55) and 48.50 (13.52) after a two-month follow-up (P < 0.001).

CONCLUSION

The results show that mindful hypnotherapy is an effective treatment for improving difficulties in emotion regulation, mindfulness, and mental health in patients with major depressive disorder.

The Effects and Differences of Social Support, Depression, and Vital Exhaustion during the COVID-19 Pandemic among International and Domestic University Students

BACKGROUND

Our study aimed to assess the differences between domestic and international students in terms of social support, vital exhaustion, and depression during the period of COVID-19 and to examine the relationships and potential effects of these factors on each other.

METHODS

The online cross-sectional survey was conducted via Google Forms^® at three time intervals during the pandemic.

RESULTS

Here, 1320, 246, and 139 students completed our questionnaires in the different time intervals. The international students reported significantly lower values in terms of perceived social support. Concerning depression, the international female students reported higher values than the domestic female students. Significant correlations were found in both samples between vital exhaustion and depression, as well as between perceived social support and depression.

CONCLUSION

In this study, the international students reported lower levels of perceived social support and higher levels of depression, particularly among females. The correlations between depression, social support, and vital exhaustion might highlight protective and risk factors. These findings emphasize the importance of addressing social support and mental health among university students, especially among international students who have a difficult time finding social support during times of stress, such as during the COVID-19 pandemic.

Character strengths sustain mental health and post-traumatic growth during the COVID-19 pandemic. A longitudinal analysis

OBJECTIVE

The COVID-19 pandemic has brought negative and positive changes in the general population, with some people experiencing post-traumatic growth after the first wave. Little research has focused, however, on personal factors potentially helping individuals cope with COVID-related difficulties. This study investigates the relations between character strengths, mental health, and post-traumatic growth.

DESIGN

Longitudinal (T1: April 2020; T2: December 2020-January 2021).

MAIN OUTCOME MEASURES

254 Italian adults (54 males; mean age = 36.05, SD = 14.04) completed questionnaires on character and mental health at T1, and on mental health and post-traumatic growth at T2.

RESULTS

General mental health was worse at T2 than at T1. Structural equation modelling showed that character, as a whole, had a significant direct effect on post-traumatic growth and mental health at T2, and an indirect effect mediated by post-traumatic growth. Furthermore, regression analyses evidenced that the virtue of transcendence was uniquely related to mental health at T2, while humanity was specifically associated with post-traumatic growth (after accounting for the other virtues).

CONCLUSION

Individuals' character strengths related to their mental health and post-traumatic growth during the COVID-19 pandemic, with evidence of post-traumatic growth mediating the relation between character and mental health.

The Perinatal Assessment of Paternal Affectivity (PAPA): Italian validation of a new tool for the screening of perinatal depression and affective disorders in fathers

BACKGROUND

Questionnaires for the screening of paternal perinatal psychological distress are based on clinical manifestations expressed by women, showing limitations in capturing the wide array of signs and symptoms exhibited by men. The current study aimed to validate the Perinatal Assessment of Paternal Affectivity, a new self-report tool for the screening of paternal depressive and affective disorder.

METHOD

This study used a cross-sectional design with a 3-month test-retest, involving respectively 385 (T1) and a sub-sample of 111(T2) fathers. Confirmatory factor analysis (CFA) was performed to test structural validity and concurrent validity was assessed by Spearman correlations. We assessed reliability using McDonald's ω and ordinal alpha. Group differences in PAPA scores based on sociodemographic were also tested.

RESULTS

The CFA reported a one factor structure as the optimal solution. The PAPA also showed adequate reliability and internal consistency as well as acceptable test-retest indices. Concurrent validity was confirmed by significant correlations between PAPA total score and standardized test scores. Non-Italian fathers and fathers who experienced recent stressful life events reported higher PAPA scores.

LIMITATIONS

Our sample was not homogeneous in terms of nationality and most of the participants, were from Northern Italy. Some risk factors associated with paternal parental psychological distress (e.g., unplanned pregnancy) have not been considered.

CONCLUSION

This study provides initial evidence of validity and reliability of the PAPA as a brief and sensitive screening tool to detect signs and symptoms of paternal affective disorder during both prenatal and postnatal period.

The Relationship Between Workplace Burnout and Male Depression Symptom Assessed by the Korean Version of the Gotland Male Depression Scale

Screening for depression in males is important because their symptoms differ from those of females, ranging from indications of aggression to attempts at suicide. Men and women differ in their responses to job stress. There are no tools that have been verified, developed, or translated for screening male depression in Korea. Our team translated the Gotland Male Depression Scale (GMDS) into Korean. The Korean version of GMDS (K-GMDS) and Maslach Burnout Inventory-General Survey (MBI-GS) were administered to 277 office workers in one public institution. Gender differences in each scale score were measured along with the correlation between the K-GMDS and the MBI-GS. There was no significant difference in the K-GMDS score between males and females, whereas females scored significantly higher on the MBI-GS (p < .001). The correlation between the K-GMDS total score and the MBI total score (male: r = .702, p < .001, female: r = .375, p < .001) and MBI subscale scores were higher in males than females. Gender moderated the relationship between total K-GMDS and total MBI scores (p < .001). The Korean version of the GMDS is suitable for screening male depression symptoms in the workplace. The results of the K-GMDS demonstrated a strong correlation between depressive symptoms and work-related burnout among men. This study can be used as a basis for studying male depression symptoms in Korea, which has not been studied extensively. This will prove beneficial for work environments.

Psychosocial effects of the quarantine during the first wave of the COVID-19 pandemic on the residents of the island of Brač

BACKGROUND

An unprecedented health and economic crisis in small island communities during the COVID-19 pandemic indicated the importance of studying its harmful effects on residents' mental health.

OBJECTIVES

To examine the differences in negative affectivity, perceived stressors, and social support both on the quarantined and not quarantined islands.

METHODS

A web-based survey and correlational cross-sectional research design were used, based on a nonprobabilistic convenience sampling method to select 613 Croatian islands' residents during May 2020. The participants completed the Depression, Anxiety and Stress Scale (DASS-21) and the General Information Questionnaire, data on their exposures to stressors during the COVID-19 pandemic and the perceived social support.

RESULTS

Compared with the nonquarantined residents of other islands, the island of Brač residents scored significantly higher on the symptoms of depression (M = 11.61; t = 2.13, P < 0.05) and stress (M = 13.06; t = 3.21, P = 0.001) subscales, receiving more support from religious communities (t = 2.34, P = 0.02) and less from the physicians (t = -2.68, P = 0.01). Lower sociodemographic status was associated with higher levels of depression, anxiety, and stress.

CONCLUSION

The COVID-19 pandemic highlighted the urgent need to protect mental health in isolated island areas specially for singles and people of low socioeconomic status.

Sex Differences in Depression-Like Behaviors in Adult Mice Depend on Endophenotype and Strain

Depression affects women nearly twice as frequently as men. In contrast, rodent models of depression have shown inconsistent results regarding sex bias, often reporting more depression-like behaviors in males. This sex discrepancy in rodents modeling depression may rely on differences in the baseline activity of males and females in depression-related behavioral tests. We previously showed that the baseline despair and anhedonia behaviors, major endophenotypes of depression, are not sex biased in young adolescent wild-type mice of C57BL/6N, DBA/2, and FVB/N strains. Since the prevalence of depression in women peaks in their reproductive years, we here investigated sex differences of the baseline depression-like behaviors in adult mice using these three strains. Similar to the results in young mice, no difference was found between adult male and female mice in behavioral tests measuring despair in both tail suspension and forced swim tests, and anhedonia in the sucrose preference test. We then extended our study and tested apathy, another endophenotype of depression, using the splash test. Adult male and female mice showed significantly different results in the baseline apathy-like behaviors depending on the investigated strain. This study dissects the complex sex effects of different depression endophenotypes, stresses the importance of considering strain, and puts forward a hypothesis of the inconsistency of results between different laboratories investigating rodent models of depression.

Associations between critical consciousness and well-being in a national sample of college students during the COVID-19 pandemic

Critical consciousness (CC) may promote well-being, particularly during the COVID-19 pandemic. In a national survey of 707 college students conducted in April 2020, we first validated the Short Critical Consciousness Scale (ShoCCS) among youth groups not often specifically examined in CC measurement (i.e., Asian, immigrant-origin, LGBQ+, and women youth). Next, we examined associations between ShoCCS subscales and validated measures of both anxiety (Generalized Anxiety Disorder-7) and hopefulness (The Individual-Differences Measure in Hopefulness). The ShoCCS achieved measurement invariance across racial/ethnic groups and immigrant-origin status, and partial invariance among LGBQ+ and women-identifying youth. We found critical reflection and action associated with anxiety for the full sample, but no evidence of moderation by sociodemographic factors. ShoCCS subscales were differentially associated with hopefulness for Asian youth and LGBQ+ youth. This study contributes to the evolution of CC measurement and extends the field by identifying well-being associations during the onset of the COVID-19 pandemic.

Do adolescents and young adults accessing the Emergency Room with substance use receive poor therapeutic indications at discharge? An observational retrospective study

PURPOSE

Emergency rooms (ERs) are usually the first point of contact with mental health services for adolescents with Substance Use Disorders (SUDs). However, only a minority of them receives proper treatment and follow-up indications, increasing the risk of relapses and poor prognosis. In this perspective, we sought to characterize and compare socio-demographic and clinical characteristics of adolescents with vs without SUDs accessing the ER, assessing potential differences in terms of discharge instructions.

METHODS

A sample of 557 ER accesses of patients aged 15-25 years old in need of a psychiatric evaluation or with a psychiatric diagnosis at discharge was retrospectively analyzed. Patients were divided in two subgroups according to the presence of SUDs.

RESULTS

About 32.1% of patients had SUDs when accessing the ER. Among these, 62% were unknown to any psychiatric services and 57% were at their psychiatric onset. Nevertheless, considering discharge instructions, patients with current substance use received less therapeutic indication or were less frequently referred to psychiatric facilities, than those without substance use (57.8% vs 42.2%, P = .002).

CONCLUSIONS

Substance abuse is strongly linked to psychopathology and ER accesses in young patients. However, we observed a large rate of SUDs patients unknown by any specialized mental health service, who received poor therapeutic and follow-up instructions at discharge. Improving communication between ER operators and young patients with SUDs could longitudinally reduce the risk of addiction and related disability, morbidity and mortality.

Psychometric properties and diagnostic capacity of the scale of resilience to suicide attempts-18

OBJECTIVE

Early detection of suicide attempts remains a handicap for suicide prevention. Most studies have focused on risk factors, but few have assessed protective factors that promote resilient outcomes, especially in subpopulations vulnerable to suicide re-attempts. This study aims to create and adapt a new Scale of Resilience to Suicide Attempts (SRSA), and to analyse its predictive validity and diagnostic capacity for the detection of suicide re-attempts at six months in people who have made a previous attempt.Design and main outcome measures: The psychometric properties and diagnostic capacity of the resulting SRSA-18 scale were assessed in 229 persons (where 133-58.1% were women, aged 18- to 76-year old) who had made a previous suicide attempt.

RESULTS

Factor analyses (AFE and AFC) yielded a three-dimensional structure with excellent goodness-of-fit indices RMSEA, high levels of reliability and adequate convergent validity with the Suicide Resilience Inventory-25 (SRI-25) scale. Additionally, the SRSA-18 has significant diagnostic power on suicide re-attempts across months of follow-up.

CONCLUSION

Reliable and valid protective factor-based instruments for the detection of future suicide re-attempts may help in the prevention of suicide-associated mortality in specific clinical subpopulations.

Effectiveness of assertive case management for patients with suicidal intent

The aim of this study was to examine the effectiveness of assertive case management intervention in preventing suicidal behaviour in self-poisoning patients. We conducted a secondary analysis of data from the ACTION-J study. Participants were self-poisoning patients with clear suicide intent admitted to emergency departments and with a primary psychiatric diagnosis (as per DSM-IV-TR axis 1). Patients were randomly assigned either to assertive case management or enhanced usual care. The primary outcome measure was the incidence of a first recurrent suicide attempt within 6 months. This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444). There were 297 self-poisoning patients in the intervention group and 295 in the control group. The primary outcome was significantly lower in the intervention group than in the control group. The incidence of a first recurrent suicide attempt within 1 and 3 months was also significantly lower in the intervention group, as was the number of overall self-harm episodes over the entire study period. Furthermore, the number of non-suicidal self-harm episodes and suicide attempts was significantly lower in the intervention group. Assertive case management is effective when promptly introduced in a hospital setting as an intervention following a suicide attempt, particularly for self-poisoning patients.

Childhood maltreatment and suicidality among women seeking mental health care: the mediating effect of borderline personality features, moderated by age

Although childhood maltreatment is known to elevate women's risk for suicidal ideation and behavior, research concerning the mechanisms involved remains limited. While borderline personality disorder (BPD) has been implicated as mediating this association, such effects may differ depending on women's age. The present study examined borderline personality features as a dispositional mediator of the relationship between childhood maltreatment and suicidality, with the moderating effect of age, among help-seeking women. A sample of 151 women attending community mental health clinics completed measures of childhood maltreatment, BPD features, suicidality, and psychological distress. Regression analyses tested moderated mediation, controlling for psychological distress across each path. Results indicated a significant interaction between childhood maltreatment and age in predicting borderline personality features, and significant moderated mediation in predicting suicidality. Borderline personality features significantly mediated the association between maltreatment and suicidality among younger--but not among older--women, with the mediation effect becoming stronger as women were younger. The findings indicate borderline personality features as particularly salient among young women in accounting for the maltreatment-suicidality association. Thus, interventions addressing BPD may warrant consideration for young women with suicidal ideation and history of childhood adversity.

Who is really at risk? The contribution of death anxiety in suicide risk and loneliness among older adults during the COVID-19 pandemic

Isolation and quarantine imposed during the COVID-19 pandemic increased the age-related risk for depression and suicide. However, not all older adults endure the same distress levels. We aimed to identify those at higher risk of depression, perceived loneliness, and suicide, comparing self-reports of depression, loneliness, suicide risk, and death anxiety among 277 participants in three age groups recruited through social media. Older adults reported fewer depression symptoms and lower distress levels but greater suicide risk. Death anxiety was found predictive of depression and suicidality, offering an important criterion for assessing who is really at risk among the non-homogeneous group of older adults.

Depression and prostate cancer: implications for urologists and oncologists

Many patients with prostate cancer experience severe levels of depression, which can negatively affect their treatment and disease course. Some prostate cancer treatments can increase the severity of a patient's depression, for example, by increasing anhedonia and erectile dysfunction. Depression is often thought of as a unitary phenomenon, but multiple subtypes can be distinguished. This variety of manifestations challenges the successful application of universal antidepressant treatment options and argues for a multi-symptom assessment process that considers a patient's disease burden and their particular form of depression. Inclusion of screening and detailed diagnosis of depression can be argued to be part of good practice, and clinicians are urged to consider when and how this might be accomplished within their urological practice.

Male depressive traits in relation to violent suicides or suicide attempts: A systematic review

BACKGROUND

Male sex is a consistently reported risk factor for violent suicide. It has been suggested that this association may be driven by so-called male depression - as operationalized by the Gotland Male Depression Scale (GMDS). The aim of this systematic review was to investigate if males dying by or attempting suicide with violent methods, display symptoms compatible with male depression.

METHODS

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search of PubMed, Embase and PsycINFO was performed using search terms covering: male sex, violent suicide/suicide attempt, and symptoms of male depression from the GMDS. Subsequently, a qualitative synthesis of studies meeting predefined inclusion criteria was carried out.

RESULTS

A total of 28 studies reporting on 91,933 violent suicides and 113 violent suicide attempts were included in the qualitative synthesis. The suicide/suicide attempt methods reported in these studies were predominantly shooting, hanging or drowning. The only two symptoms from the GMDS that was reported in relation to violent suicides/suicide attempts was overconsumption of alcohol or drugs and suicide attempts in the biological family. No studies had systematically assessed suicide victims or attempters for symptoms of male depression.

LIMITATIONS

Publication-, selection-, and information biases may have affected this review.

CONCLUSIONS

Symptoms of male depression are rarely reported in relation to violent suicides/suicide attempts. The most likely explanation for this finding is that there has been little focus on this potential association. Future studies should address this void.

The Psychometric Properties in the Chinese Version of the Reasons for Living Inventory and the Relationship with Suicidal Behaviors Among Psychiatric Patients in Taiwan

This study examines the reliability, factor structure, convergent, and construct validities of the Mandarin Chinese version of the Reasons For Living Inventory (RFL) among Taiwanese psychiatric patients. Demographical characteristics of patients who hold these adaptive cognitions and differences on the level of endorsement between suicidal and non-suicidal individuals were also investigated. All adult patients that had visited the psychiatric ambulatory clinic or had been admitted to the psychiatric ward in a general hospital in Taiwan over a 3-month period were consecutively invited to complete an inventory that included background information, the Mandarin Chinese versions of the RFL, the Suicidal Behaviors Questionnaire-Revised (SBQ-R), and the Beck Hopeless Scale (BHS). Of the 254 respondents aged 19 to 65 years, 47.2% had suicidal ideations or attempts within the past year. The original six-factor structure of the American version was confirmed to be acceptable. The Cronbach α was 0.964.Total scores on RFL were inversely and significantly correlated with that from BHS. Multivariate analysis with demographic data and items from SBQ-R revealed that higher scores on the RFL have been associated with married, have children or religious beliefs, fewer past and current suicidal ideations and attempts, fewer histories of suicidal threats, and a less self-reported likelihood of future suicide in our sample. The Mandarin version of the RFL inventory showed acceptable psychometric properties and could distinguish suicidal patients from non-suicidal ones.

Nightmares and suicide risk in psychiatric patients: The roles of hopelessness and male depressive symptoms

Although nightmares have been shown to increase the risk for suicide, less is known about the mechanisms underlying this relationship. In order to address this gap and guided by the hopelessness theory of suicide risk, we examined hopelessness and male depressive symptoms as risk factors for suicide while considering the frequency of and impairment due to nightmares. Data were collected from 172 psychiatrically hospitalized, adult patients (91 women, 81 men) with an average age of 39.15 (SD = 13.48) years. Patients were administered self-report measures of nightmare frequency/impairment, hopelessness, and male depressive symptoms, as well as undergoing a fully structured diagnostic clinical interview to determine diagnoses and suicide risk. Compared to patients with yearly or no nightmares, those with monthly or weekly nightmares reported nightmares reported higher levels of hopelessness, male depressive symptoms, and suicide risk. Male depressive symptoms significantly mediated the relation between hopelessness and suicide risk in patients who reported monthly to weekly nightmares, but not in those who reported yearly or no nightmares. Moreover, impairment due to nightmares was significantly and positively associated with male depression, but not hopelessness or suicide risk. The results also provide evidence and further understanding about possible mechanisms of emerging suicide.

Mediators in the Association Between Affective Temperaments and Suicide Risk Among Psychiatric Inpatients

BACKGROUND

Affective temperaments have been shown to be related to psychiatric disorders and suicidal behaviors. Less is known about the potential contributory role of affective temperaments on suicide risk factors. In the present study, we investigated whether the effect of affective temperaments on suicide risk was mediated by other variables, such as hopelessness, mentalization deficits, dissociation, psychological pain, and depressive symptoms.

METHODS

Several assessment instruments, including the Mini International Neuropsychiatric Interview (MINI); the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A); the Beck Hopelessness Scale (BHS); the Gotland Male Depression Scale (GMDS); the Dissociative Experiences Scale (DES); the Psychological Pain Assessment Scale (PPAS); and the Mentalization Questionnaire (MZQ), were administered to 189 psychiatrically hospitalized patients (103 women, 86 men) in Rome, Italy.

RESULTS

In single-mediator models, hopelessness, depressive symptoms, and mentalization, but not psychological pain or dissociation, were significant mediators in the association between prevalent temperament and suicide risk. In a multiple-mediator model, a significant indirect effect was found only for depression. Results demonstrated that patients with negative temperaments reported higher suicide risk, psychological pain, hopelessness, and depression, and less mentalization than patients with no prevalent temperament or hyperthymic temperaments.

CONCLUSIONS

Hopelessness, depression, and mentalization are all factors that mediate the relation between affective temperaments and suicide risk. Identifying factors that mediate the effects of affective temperamental makeup on suicide risk should enhance screening and intervention efforts.

Genetic association analysis of serotonin and signal transduction pathways in suicide attempters from an Italian sample of psychiatric patients

Genetic factors have been reported to contribute to the liability of suicide. We aimed to investigate functional polymorphisms in eight genes (serotonin transporter, SLC6A4; receptors, 5HTR1A, 1B, 5HTR2A; Tryptophan Hydroxylase, TPH1, TPH2; Monoamine Oxidase, MAOA and G Protein Subunit Beta 3, GNB3) to investigate their predictive value for suicide. The possible confounding effects of gender and phenotypic patients dissection were also valued. A sample of 111 consecutive psychiatric inpatients was recruited and assessed using specific psychometric instruments. Genomic DNA was isolated from peripheral white blood cell samples and polymorphisms were genotyped by pyrosequencing technology. Although no differences were observed between allele and genotype frequencies for all polymorphisms and suicide attempt (SA), a polygenic risk score was detected for three genes HTR2A (A-1438G), TPH1 and TPH2 increasing the prediction of SA risk (Thresh=0.43, p=0.038, R²=0.053). Moreover some nominal associations were obtained after gender and phenotypic dissection stratification (TEMPS-A, TEMPs-H, GSMD, SHSS, GAF, CGI) for SLC6A4 (5-HTTLPR), HTR1A (C-1019G), HTR2A (A-1438G), TPH1 (A799C) and GNB3 (C825T) genes, that were lost after Bonferroni correction. This is a first evidence that specific additive combinations of genes could increase the prediction of SA risk and that gender and phenotypic dissection could influence the association of the genes with SA. This could represent a further study also for future meta-analyses on larger samples.

Confirmatory Factor Analysis of the Gotland Male Depression Scale in an Australian Community Sample

Abstract. The Gotland Male Depression Scale (GMDS) was developed to improve the assessment and identification of depression in men by assessing symptoms that fall outside DSM-V/ICD-10 diagnostic criteria for depression. However, research findings from the GMDS have been markedly discrepant. Attempts to validate the latent GMDS factor structure using exploratory factor analysis (EFA) have yielded inconsistent results, bringing the validity and public health utility of the scale into question. The current study used confirmatory factor analysis to test the construct validity of five competing latent factor models identified from prior research. Data were obtained and analyzed separately from an Australian community sample of adult males (n = 318) and females (n = 345). Fit indices demonstrated the original GMDS two-factor model (distress, depression) to be a poor fit to the data. An alternative mixed three-factor model demonstrated improved model fit, although indices remained marginal. Results question the factor structure validity of the GMDS in the present sample and highlight the need for further psychometric development of the scale.

Thwarted interpersonal needs and suicide ideation: Comparing psychiatric inpatients with bipolar and non-bipolar mood disorders

Psychiatric inpatients are at heightened risk for suicide, and evidence suggests that psychiatric inpatients with bipolar mood disorders may be at greater risk for suicide ideation compared to those with non-bipolar mood disorders. There is a paucity of research directly comparing risk factors for suicide ideation in bipolar versus non-bipolar mood disorders in an inpatient sample. The current study sought to clarify the association between two constructs from the interpersonal theory of suicide (i.e., perceived burdensomeness and thwarted belongingness) in leading to suicide ideation among psychiatric inpatients with bipolar and non-bipolar mood disorders. Participants were (N=90) psychiatric inpatients with a bipolar (n = 20) or non-bipolar mood disorder (n=70; per their medical charts). Perceived burdensomeness, but not thwarted belongingness, was significantly associated with suicide ideation after adjusting for other covariates. This suggests perceived burdensomeness may play a key role in suicide ideation among psychiatric inpatients with any mood disorder and highlights the importance of assessment and intervention of perceived burdensomeness in this population. Contrary to our hypothesis, mood disorder group (i.e., bipolar versus non-bipolar) did not moderate the relations between perceived burdensomeness/thwarted belongingness and suicide ideation.

Inflammatory markers and suicidal attempts in depressed patients: A review

Major depressive disorder is a chronic and invalidating psychiatric illness and is associated with a greater risk of suicidal behaviors. In recent decades many data have supported a biological link between depressive states and inflammation. Pro-inflammatory cytokines have been found to rise, first of all TNF-α and IL-6. Suicidal behaviors have been consistently associated with increased levels of IL-6 and decreased levels of IL-2. The aim of this review is to investigate the relationship between inflammatory markers in depressed patients with or without suicidal attempts compared to healthy controls.

Factor Structure of the Gotland Scale of Male Depression in Two Samples of Men With Prostate Cancer: Implications for Treating Male Depression

Up to a quarter of all prostate cancer (PCa) patients suffer from clinically significant depression but treatments are inconsistent and short-lived in their efficacy. One possible reason could be that "male depression" is not adequately diagnosed by the criteria for major depressive disorder (MDD) used in many clinical settings. In response to this limitation, the Gotland Scale of Male Depression (GSMD) was developed to identify the extra symptoms of MDD in men. Although the factor structure of the GSMD has been reported in non-PCa samples, it has not been determined for this group of men. Two samples of PCa patients were recruited, 191 from Australia and 138 from the United Kingdom and all patients received the GSMD individually, plus a background questionnaire. Two-factor solutions were identified for each of the two samples. The Australian sample was characterized by changes in emotional and somatic function, followed by depressed mood. The U.K. sample exhibited the same two-factor solution but in reverse order of weighting. Targeted treatments for depression in PCa patients may benefit from identification of the loadings that individual patients have on these two GSMD factors so that specific clinical profiles and treatment needs may be based on this information about their depression.

Suicide in males and females with cardiovascular disease and comorbid depression

BACKGROUND

Myocardial infarction (MI) has been associated with an increased risk of suicide, further increased among individuals with a comorbid psychiatric illness. A paucity of studies have examined details of suicide among individuals with cardiovascular disease (CVD) and comorbid depression. We aimed to compare demographic, clinical and suicide-specific characteristics between suicide victims with CVD with depression (CVD+D) and without comorbid depression (CVD-D).

METHODS

Coroner data on suicide decedents with CVD (n=413) occurring in Toronto, Canada from 1998 to 2012 were collected. Characteristics were compared between the CVD+D and CVD-D groups. Regression analysis examined for gender differences in these groups.

RESULTS

CVD+D subjects compared to CVD-D were more likely to have had a past suicide attempt (p=0.008), and to have experienced a bereavement (p=0.008) or financial stressor (p=0.005) in the past year. Each of these variables remained significantly associated with the presence of depression after the regression analysis. Within the CVD+D group, females were more likely to die from suicide by self-poisoning (p<0.0001) and males by shooting (p=0.001).

LIMITATIONS

Psychological autopsies were not available. The definition of CVD was broad and the accuracy of its diagnosis could not be confirmed.

CONCLUSION

Individuals with CVD+D who died from suicide had significant differences in clinical characteristics and specific stressors compared to those without depression. These data may help to better characterize suicide risk and prevention in this vulnerable population.

Circulating microRNAs as a Novel Class of Potential Diagnostic Biomarkers in Neuropsychiatric Disorders

Neuropsychiatric diseases, such as schizophrenia, bipolar disorder (BD), major depressive disorder (MDD) and autism spectrum disorder (ASD), are a huge burden on society, impairing the health of those affected, as well as their ability to learn and work. Biomarkers that reflect the dysregulations linked to neuropsychiatric diseases may potentially assist the diagnosis of these disorders. Most of these biomarkers are found in the brain tissue, which is not easily accessible. This is the challenge for the search of novel biomarkers that are present in various body fluids, including serum or plasma. As a group of important endogenous small noncoding RNAs that regulate gene expression at post-transcriptional level, microRNAs (miRNAs) play a crucial role in many physiological and pathological processes. Previously, researchers discovered that miRNAs contribute to the neurodevelopment and maturation, including neurite outgrowth, dendritogenesis and dendritic spine formation. These developments underline the significance of miRNAs as potential biomarkers for diagnosing and prognosing central nervous system diseases. Accumulated evidence indicates that there are considerable differences between the cell-free miRNA expression profiles of healthy subjects and those of patients. Therefore, circulating miRNAs are likely to become a new class of noninvasive, sensitive biomarkers. Despite the fact that little is known about the origin and functions of circulating miRNAs, their essential roles in the clinical diagnosis and prognosis of neuropsychiatric diseases make them attractive biomarkers. In this review we cover the increasing amounts of dataset that have accumulated in the last years on the use of circulating miRNAs and their values as potential biomarkers in most areas of neuropsychiatric diseases.

Temperaments in completed suicides: Are they different from those in suicide attempters and controls?

BACKGROUND

Temperaments in completed suicides have never been assessed whereas there is substantial research on temperaments in attempted suicides and psychiatric patients.

METHODS

The significant others of 18 completed suicides participated in this study in order to provide an assessment of temperaments, hopelessness, depression and the suicide risk of their loved ones. The data were compared with data from 244 psychiatric patients of whom 83 had attempted suicide in the previous month. The following instruments were used: the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire (TEMPS-A), the Beck Hopelessness Scale (BHS), the Gotland Scale for Male Depression (GSMD), and the Mini International Neuropsychiatric Interview (MINI) module for assessing suicide risk.

RESULTS

Individuals who died by suicide more frequently had scores of 9 or higher on the BHS and higher MINI suicide risk scores compared with patients with mood disorders who had not attempted suicide in the previous month. Completed suicides also had lower scores on the TEMPS-A Cyclothymia and Anxiety scales and on the MINI suicide risk scale than mood disorder patients with a recent suicide attempt.

LIMITATIONS

Proxy assessment of variables through survivors can result in underestimation of psychiatric morbidity and other parameters investigated, and limits the generalization of our results

CONCLUSIONS

Our study adds information about temperamental subtypes and other variables in completed suicides and points to their difference from attempted suicides and non-suicidal psychiatric patients.

The Chinese Version of the Gotland Male Depression Scale (GMDS): Mokken scaling

OBJECTIVE

Invariant item ordering (IIO) is defined as the extent to which items have the same order for each respondent who completes a scale. IIO is crucial for establishing a scale hierarchy that is replicable across samples; however, no research has demonstrated IIO in the Gotland Male Depression Scale (GMDS). The aim of this study was to determine if an IIO hierarchy of depressive symptoms existed in a clinical sample of men who completed the GMDS.

METHODS

A convenience sample of 231 men (age: mean (SD) = 46.1 (11.0) yrs) who visited a men's health polyclinic in Taiwan and completed the GMDS. Mokken scale analysis was conducted to evaluate the psychometric properties of the GMDS.

RESULTS

All items on the GMDS formed a strong uni-dimensional scale (H=0.592). Except for item #9 (alcohol/drug abuse, or hyperactivity), IIO was found for the remaining 12 items (H(T)=0.366). These symptoms reflected the following hierarchy: positive family history (#13), complaining (#12), anxiety (#8), loss of vitality (#10), depressed mood (#11), indecisiveness (#6), aggression (#2), irritability (#5), stress (#1), burn-out (#3), fatigue (#4), and sleep problems (#7).

CONCLUSION

The GMDS is a psychometrically sound measure of depressive symptoms in Taiwanese male outpatients. The GMDS has both cumulative and hierarchical properties.

Gender differences in a cohort of major depressive patients: further evidence for the male depression syndrome hypothesis

BACKGROUND

Previous studies have shown that major depressive patients may differ in several features according to gender, but the existence of a specific male depressive syndrome remains controversial.

METHODS

As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 125 (27.7%) were of male gender, whereas 317 (72.3%) were female, after exclusion of bipolar I patients.

RESULTS

Compared to women, men were more often married, had more associated mixed features, with more bipolar disorder NOS, more hyperthymic temperaments, and less depressive temperaments. Women had an earlier age at onset of depression, more depressive episodes and suicide attempts. A higher family loading was shown in men for bipolar disorder, alcohol use disorder, impulse control disorders and suicide, whereas their family loading for major depressive disorder was lower. Men displayed more comorbidities with alcohol use, impulse control, and cardiovascular disorders, with lower comorbidities with eating, anxiety and endocrine/metabolic disorders. The following independent variables were associated with male gender: hyperthymic temperament (+), alcohol use disorder (+), impulse control disorders (+), and depressive temperament (-).

LIMITATIONS

The retrospective design and the lack of specific tools to assess the male depressive syndrome.

CONCLUSION

Study findings may lend support to the male depression syndrome concept and draw attention to the role of hyperthymic temperament, soft bipolarity as well as comorbidities as determinants of this syndrome. The latter could help recognize an entity which is probably underdiagnosed, but conveys a high risk of suicide and cardiovascular morbidity.

Validity of Gotland Male Depression Scale for male depression in a community study: the Sudurnesjamenn study

BACKGROUND

Several studies suggest a "male depressive syndrome", where not only the standard symptoms of major depressive disorder (MDD) but also symptoms of anxiety, anger, irritability and antisocial behaviour are prominent.

METHOD

In a community study, 534 males were screened for possible depression by the Gotland Male Depression Scale (GMDS) and Beck's Depression Inventory (BDI). For comparison psychiatrists examined a sub-sample of healthy and depressive males (n=137). The validity of the GMDS was compared both with the BDI and MDD diagnosis according to DSM-IV.

RESULTS

GMDS was as good as BDI for screening males. ROC-curve analysis gave AUC 0.945 (95% CI 0.923-0.968) for GMDS when tested against BDI. Second, when both scales were tested by ROC-curves against DSM-IV, the GMDS had AUC=0.861 (95% CI 0.800-0.921) and BDI had AUC=0.822 (95% CI 0.751-0.893). The estimated prevalence was 14-15%.

LIMITATIONS

Low participation rate (25%) in the screening phase.

CONCLUSION

GMDS is a valid screening tool for detecting male depression (MDD). Furthermore it is a short self-rating scale, easy to use in daily practice to screen for depression. Our results support recent reports of high prevalence of depressions in the community which supports active screening of males in clinical practice.

The influence of inflammatory cytokines in physiopathology of suicidal behavior

BACKGROUND

Based on the urgent need for reliable biomarkers in relation to suicide risk both for more accurate prediction as well as for new therapeutic opportunities, several researchers have been studied evidences of the potential participation of inflammatory processes in the brain, in particular cytokines, in suicide. The purpose of this review was to analyze the associations between inflammation markers and suicide.

METHODS

To achieve this goal, a systematic review of literature was conducted via electronic database Scopus using the Medical Subject Headings (MeSH) terms: "cytokines", "suicide" and "inflammation". Through this search it was found 54 articles. After analyzing them 15 met the eligibility criteria and were included in the final sample.

RESULTS

One of the most mentioned inflammatory markers was Interferon-α (IFN-α), a pro-inflammatory cytokine which has been shown to increase serum concentrations of pro-inflammatory cytokines such as interleukin (IL)-1, IL-6, tumor necrosis factor-a (TNF- α) and IFN-ϒ, which are factors increased suicide victims and attempters. In this line, IL-6 is not only found to be elevated in the cerebrospinal fluid of suicide attempters, even its levels in the peripheral blood have been proposed as a biological suicide marker. Another study stated that increased levels of IL-4 and IL-13 transcription in the orbitofrontal cortex of suicides suggest that these cytokines may affect neurobehavioral processes relevant to suicide.

LIMITATIONS

A lack of studies and great amount of cross-sectional studies.

CONCLUSION

Inflammation may play an important role in the pathophysiology of suicide, especially, levels of some specific inflammatory cytokines.

The associations among childhood maltreatment, "male depression" and suicide risk in psychiatric patients

In the current cross-sectional study, we aimed to investigate the presence and severity of "male" depressive symptoms and suicidal behaviors in psychiatric patients with and without a history of child abuse and neglect, as measured by the Childhood Trauma Questionnaire (CTQ), as well as to explore the associations among childhood maltreatment, "male depression" and suicide risk. The sample consisted of 163 consecutively admitted adult inpatients (80 men; 83 women). The patients were administered the CTQ, Gotland Male Depression Scale (GMDS), and Suicidal History Self-Rating Screening Scale (SHSS). Those with a moderate-severe childhood maltreatment history were more likely to be female (p<0.05) and reported more "male depression" (p<0.001) and suicidal behaviors (p<0.01) as compared to those not having or having a minimal history of child abuse and neglect. In the multivariate analysis, only the minimization/denial scale of the CTQ (odds ratio=0.31; p<0.001) and "male depression" (odds ratio=1.83; p<0.05) were independently associated with moderate/severe history of child maltreatment. The findings suggest that exposure to abuse and neglect as a child may increase the risk of subsequent symptoms of "male depression", which has been associated with higher suicidal risk.

Emerging role of microRNAs in major depressive disorder: diagnosis and therapeutic implications

Major depressive disorder (MDD) is a major public health concern. Despite tremendous advances, the pathogenic mechanisms associated with MDD are still unclear. Moreover, a significant number of MDD subjects do not respond to the currently available medication. MicroRNAs (miRNAs) are a class of small noncoding RNAs that control gene expression by modulating translation, messenger RNA (mRNA) degradation, or stability of mRNA targets. The role of miRNAs in disease pathophysiology is emerging rapidly. Recent studies demonstrating the involvement of miRNAs in several aspects of neural plasticity, neurogenesis, and stress response, and more direct studies in human postmortem brain provide strong evidence that miRNAs can not only play a critical role in MDD pathogenesis, but can also open up new avenues for the development of therapeutic targets. Circulating miRNAs are now being considered as possible biomarkers in disease pathogenesis and in monitoring therapeutic responses because of the presence and/or release of miRNAs in blood cells as well as in other peripheral tissues. In this review, these aspects are discussed in a comprehensive and critical manner.

Variability in Depressive Symptoms of Cognitive Deficit and Cognitive Bias During the First 2 Years After Diagnosis in Australian Men With Prostate Cancer

The incidence and contribution to total depression of the depressive symptoms of cognitive deficit and cognitive bias in prostate cancer (PCa) patients were compared from cohorts sampled during the first 2 years after diagnosis. Survey data were collected from 394 patients with PCa, including background information, treatments, and disease status, plus total scores of depression and scores for subscales of the depressive symptoms of cognitive bias and cognitive deficit via the Zung Self-Rating Depression Scale. The sample was divided into eight 3-monthly time-since-diagnosis cohorts and according to depression severity. Mean scores for the depressive symptoms of cognitive deficit were significantly higher than those for cognitive bias for the whole sample, but the contribution of cognitive bias to total depression was stronger than that for cognitive deficit. When divided according to overall depression severity, patients with clinically significant depression showed reversed patterns of association between the two subsets of cognitive symptoms of depression and total depression compared with those patients who reported less severe depression. Differences in the incidence and contribution of these two different aspects of the cognitive symptoms of depression for patients with more severe depression argue for consideration of them when assessing and diagnosing depression in patients with PCa. Treatment requirements are also different between the two types of cognitive symptoms of depression, and several suggestions for matching treatment to illness via a personalized medicine approach are discussed.

Conceptualising loneliness in adolescents: development and validation of a self-report instrument

This paper reports the development and psychometric evaluations of a multidimensional model of loneliness in Australian adolescents. In the first study a new instrument was designed and administered to 1,074 adolescents (ages 10-18 years, M = 13.01). An exploratory factor analysis from data supplied by 694 of these participants yielded a 4-factor structure (friendship, isolation, negative attitude to solitude, and positive attitude to solitude). Competing measurement models were then evaluated using confirmatory factor analysis with data from the remaining 380 participants; strong support was demonstrated for the conceptual model. Significant main effects were evident for geographical location (rural remote/urban), age and sex. In a second study, involving 235 Australian adolescents (ages 10.0-16 years, M = 13.8) the superiority of the first-order model represented by four correlated factors was confirmed. The findings have clinical and practical implications for professional groups represented by child and adolescent psychiatry, pediatric and clinical psychology services, researchers, and educators. Specifically, the new self-report instrument identifies adolescents who are at risk of loneliness and its associated adverse outcomes and in doing has the potential to offer new insights into prevention and intervention.

Characterization of patients with mood disorders for their prevalent temperament and level of hopelessness

BACKGROUND

Mood disorders (MD) are disabling conditions throughout the world associated with significant psychosocial impairment. Affective temperaments, as well as hopelessness, may play a significant role in the pathophysiology of MD. The present study was designed to characterize patients with MD for their prevalent affective temperament and level of hopelessness.

METHODS

Five hundred fifty-nine (253 men and 306 women) consecutive adult inpatients were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A), the Gotland Scale for Male Depression (GSMD), the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).

RESULTS

Higher cyclothymia and irritable temperaments were found in bipolar disorder-I (BD-I) patients compared to those with other Axis I diagnoses. Major depressive disorder (MDD) patients had lower hyperthymia than BD-I and BD-II patients and higher anxiety than patients with other Axis I diagnoses. Severe "male" depression was more common in BD-II patients compared to BD-I and MDD patients. BD-I patients and those with other axis I diagnoses reported lower BHS ≥9 scores than those with BD-II and MDD.

LIMITATIONS

The study had the limitations of all naturalistic designs, that is, potentially relevant variables were not addressed. Furthermore, the cross-sectional nature of the study did not allow conclusions about causation, and the use of self-report measures could be potentially biased by social desirability.

CONCLUSION

MDD patients were more likely to have higher anxious temperament, higher hopelessness and lower hyperthymic temperament scores, while BD-I patients more often had cyclothymic and irritable temperaments than patients with other Axis I diagnoses. The implications of the present results were discussed.

Symptom-based subtypes of depression and their psychosocial correlates: a person-centered approach focusing on the influence of sex

BACKGROUND

Reducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex has been widely accepted in depression research.

METHODS

The community-based sample included 373 males and 443 females from the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) manifesting depressive symptoms in the past 12 months. Latent Class Analysis (LCA) was performed separately by sex to extract sex-related depression subtypes. The subtypes were characterized by psychosocial characteristics.

RESULTS

Three similar subtypes were found in both sexes: a severe typical subtype (males: 22.8%; females: 35.7%), a severe atypical subtype (males: 17.4%; females: 22.6%), and a moderate subtype (males: 25.2%; females: 41.8%). In males, two additional subgroups were identified: a severe irritable/angry-rejection sensitive (IARS) subtype (30%) comprising the largest group, and a small psychomotor retarded subtype (4%). Males belonging to the severe typical subtype exhibited the lowest masculine gender role orientation, while females of the typical subtype showed more anxiety disorders. The severe atypical subtype was associated with eating disorders in both sexes and with alcohol/drug abuse/dependence in females. In contrast, alcohol/drug abuse/dependence was associated with the severe IARS subtype in males.

LIMITATIONS

The study had a cross-sectional design, allowing for no causal inferences.

CONCLUSIONS

This study contributes to a better understanding of sex-related depression subtypes, which can be well distinguished on the basis of symptom profiles. This provides the base for future research investigating the etiopathogenesis and effective treatment of the heterogeneous depression disorder.

Enoxacin Elevates MicroRNA Levels in Rat Frontal Cortex and Prevents Learned Helplessness

Major depressive disorder (MDD) is a major public health concern. Despite tremendous advancement, the pathogenic mechanisms associated with MDD are still unclear. Moreover, a significant number of MDD subjects do not respond to the currently available medication. MicroRNAs (miRNAs) are a class of small non-coding RNAs that control gene expression by modulating translation, mRNA degradation or stability of mRNA targets. The role of miRNAs in disease pathophysiology is emerging rapidly. Recently, we reported that miRNA expression is down-regulated in frontal cortex of depressed suicide subjects, and that rats exposed to repeated inescapable shock show differential miRNA changes depending on whether they exhibited normal adaptive responses or learned helpless (LH) behavior. Enoxacin, a fluoroquinolone used clinically as an anti-bacterial compound, enhances the production of miRNAs in vitro and in peripheral tissues in vivo, but has not yet been tested as an experimental tool to study the relation of miRNA expression to neural functions or behavior. Treatment of rats with 10 or 25 mg/kg enoxacin for 1 week increased the expression of miRNAs in frontal cortex and decreased the proportion of rats exhibiting LH behavior following inescapable shock. Further studies are warranted to learn whether enoxacin may ameliorate depressive behavior in other rodent paradigms and in human clinical situations, and if so whether its mechanism is due to upregulation of miRNAs.

Construct validity and reliability of the adult rejection sensitivity questionnaire: a comparison of three factor models

Objectives and Methods. The aim of the study was to investigate the construct validity of the ARSQ. Methods. The ARSQ and self-report measures of depression, anxiety, and hopelessness were administered to 774 Italian adults, aged 18 to 64 years. Results. Structural equation modeling indicated that the factor structure of the ARSQ can be represented by a bifactor model: a general rejection sensitivity factor and two group factors, expectancy of rejection and rejection anxiety. Reliability of observed scores was not satisfactory: only 44% of variance in observed total scores was due to the common factors. The analyses also indicated different correlates for the general factor and the group factors. Limitations. We administered an Italian version of the ARSQ to a nonclinical sample of adults, so that studies which use clinical populations or the original version of the ARSQ could obtain different results from those presented here. Conclusion. Our results suggest that the construct validity of the ARSQ is disputable and that rejection anxiety and expectancy could bias individuals to readily perceive and strongly react to cues of rejection in different ways.

Validity and clinical utilization of the Chinese version of the Gotland Male Depression Scale at a men's health polyclinic

INTRODUCTION

Symptoms of depression in males, such as aggression and irritability, are different from those in females. However, there are no adequate scales for detecting possible diagnoses in the Chinese population. The aim of this study was to assess whether the Chinese version of the Gotland Male Depression Scale (CV-GMDS) could identify male depression as effectively as the English version.

MATERIALS AND METHODS

A total of 231 male outpatients were sampled from a men's health polyclinic. We used questionnaires to evaluate the characteristics and mood status of participants, including the CV-GMDS, the Chinese version of the Beck Depressive Inventory II (CV-BDI-II), and the Chinese version of the Aging Males' Symptoms (CV-AMS) scale. Cronbach's α-coefficient and Levene's test were used to investigate internal consistency and homogeneity, respectively. External validity was evaluated using Spearman's correlation coefficient. A factor analysis was conducted to evaluate the conceptual structure of the CV-GMDS, and a regression analysis was used to determine the relationship of the CV-AMS scale with the CV-GMDS and CV-BDI-II.

RESULTS

The mean age of the 231 participants was 46.1 years (standard deviation 11.0). Of the participants, 36.8% (n=85) were found to have depression according to the CV-GMDS and 34.6% (n=80) according to the CV-BDI-II. The internal consistency of the CV-GMDS was demonstrated by a Cronbach's α of 0.933, and the test of homogeneity revealed a P-value of 0.762. The external validity for the CV-GDMS and CV-BDI-II was demonstrated by an intercorrelation of 0.835. The third and fourth items of the GMDS differed from the others, and the CV-GMDS showed a better relationship (R (2)=0.616) with the CV-AMS scale than the CV-BDI-II did.

CONCLUSION

The CV-GMDS is a satisfactory and suitable psychometric questionnaire for detecting depression among a Chinese-speaking middle-aged or older male population. The results of this study could be used as a basis for investigating specific male depression and aging symptoms.

The role of inflammatory cytokines in suicidal behavior: a systematic review

There is growing evidence that inflammatory mediators play a critical role in the pathophysiology of both major depression and suicidal behavior. Immunological differences have been reported in both major affective disorders and suicidal behavior. Specifically, increased levels of pro-inflammatory cytokines have been shown to correlate with the severity of depression and various cytokines have been identified as potentially important in understanding the pathophysiology of major affective disorders/suicidality. We aimed to conduct a systematic review of the current literature to investigate the association between inflammatory cytokines and suicidal behavior. Only articles from peer-reviewed journals were selected for inclusion in the present review. Most studies documented the association between suicidality and IL2, IL-6, IL-8, TNF-α and VEGF levels that have been found altered in suicidal behavior. The presence of major depressive disorder (MDD) with suicidal ideation/attempts was associated with differences in inflammatory cytokine profile when compared to that without suicidal ideation/attempts. Most suicide attempters or subjects with suicidal ideation showed an imbalance of the immune system but this does not imply the existence of a causal link. Also, not all studies demonstrated a positive correlation between inflammatory cytokines and suicidal behavior. Further additional studies should elucidate the molecular mechanisms of the immune activation pathways underlying suicidality.