Predictors of change in depressive symptoms over time: Results from the Australian Longitudinal Study on Women's Health

Prevalence of mental disorders among Australian females: Comparison according to motherhood status using Australian birth cohort data

PURPOSE

Studies examining mental disorders among women have primarily focused on either depression, anxiety, or substance use disorders and not included the broader spectrum of mental disorders. Mixed evidence exists on the prevalence rates of mental disorders among mothers. This study compares the prevalence of different mental disorders and mental comorbidities between mothers and non-mothers and assesses correlates of mental disorders among mothers.

METHODS

A population-based birth cohort design was adopted, consisting of 40,416 females born in Queensland, Australia, in 1983/84. Linked administrative data from hospital admissions were used to identify mental disorders. Cumulative incidence curves of different mental disorders were created separately for mothers and non-mothers.

RESULTS

Mental disorder prevalence among females by age 29-31 years was 7.8% (11.0% for mothers and 5.2% for non-mothers). Mothers were overrepresented in almost all categories of mental disorders, with overrepresentation becoming more pronounced with age. Mothers with a mental disorder were more likely to be unmarried, Indigenous, young at birth of first child, have greater disadvantage, and have a single child, compared to mothers without a mental disorder. Nearly half of the mothers (46.9%) had received a mental disorder diagnosis before having their first child.

CONCLUSIONS

Mothers, particularly unmarried, Indigenous, having greater disadvantage, and younger at birth of first child, represent a unique group with high vulnerability to mental disorders, that begins in childhood and is amplified with age. Presence of significant mental disorder comorbidities among females highlights the critical importance of a comprehensive, integrated approach to prevent and address multiple comorbidities.

For Whom and for How Long Does the "Be a Mom" Intervention Work? A Secondary Analysis of Data From a Randomized Controlled Trial Exploring the Mid-Term Efficacy and Moderators of Treatment Response

This study explored clinical and sociodemographic moderators of treatment response to "Be a Mom", an internet-based cognitive behavioral therapy (iCBT) intervention, from baseline to postintervention, in women at high risk for postpartum depression (PPD). The study also assessed the stability of women's treatment gains from baseline to 4-months postintervention (follow-up). This open-label randomized controlled trial (RCT) involved a sample of 1,053 postpartum Portuguese women identified as being at high risk for PPD (i.e., having a score of 5.5 or higher on the Postpartum Depression Predictors Inventory-Revised); participants were allocated to "Be a Mom" intervention group or a waiting-list control group, and completed self-report measures at baseline, postintervention, and a 4-month follow-up (554 women completed follow-up assessments). Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale, and flourishing/positive mental health was assessed with the Mental Health Continuum. Regression models and linear mixed models were used to examine moderators of treatment and the mid-term efficacy of the "Be a Mom" intervention, respectively. The results revealed that treatment completion, higher depression scores at baseline, and higher income levels were linked to greater symptom reduction and positive mental health enhancement. Moreover, the efficacy of the "Be a Mom" intervention was supported at the 4-month follow-up. The "Be a Mom" intervention appears to be an effective iCBT tool for reducing psychological distress and enhancing positive mental health in women at risk for PPD, with therapeutic improvements maintained over a 4-month period.

Residential greenspace and anxiety symptoms among Australian women living in major cities: A longitudinal analysis

Despite an increasing number of studies demonstrating the potential mental health benefits of greenspace, few longitudinal studies have been reported. We aimed to assess associations between two metrics of residential greenspace exposure and anxiety symptoms in a cohort of Australian women living in major cities. Our study comprised 3,938 women, born between 1973 and 78. Anxiety symptoms in the previous month were assessed at follow-up every three years during 2003-2018, using the anxiety subscale of the Goldberg Anxiety and Depression Scale. The three-month seasonal average normalized difference vegetation index (NDVI) was estimated from 30 m Landsat satellite images in a 500 m buffer (NDVI500m) around participants' address at each survey (higher NDVI indicates more green vegetation). The annual fractional cover of non-photosynthesising vegetation was estimated (fNPV500m, with higher values indicating greater levels of dead leaf litter or dry grass). A generalised estimating equation assessed associations between greenspace measures and anxiety symptoms (as odds ratios [ORs]), adjusting for repeated outcomes and individual-level covariates. Additional analyses focused on women experiencing substantial changes in between-survey exposure due to moving, and adjusting for nitrogen dioxide (NO2) and fine particulate matter (PM2.5) exposure, among others. A standard deviation (SD) (0.12 units) increase in NDVI500m was significantly associated with lower odds of anxiety symptoms (OR: 0.96, 95% CI: 0.93-0.99) in the adjusted model. An SD (5.2%) increase in annual fNPV500m was consistent with the direction expected for that exposure, but not significant in the adjusted model (OR: 1.03, 95% CI: 0.99-1.07). NDVI500m was modestly attenuated when air pollutants were adjusted for, while fNPV500m only became significant when PM2.5 was adjusted for. Between-survey contrasts had no clear effect for NDVI500m. Moving to a higher fNPV500m area, compared with a similar fNPV500m area, was consistently associated with anxiety symptoms (OR: 1.15, 95% CI: 1.02-1.31). NDVI500m was generally associated with lower odds of anxiety symptoms, while fNPV500m was generally associated with higher odds of anxiety, depending on the covariates considered.

Predictors of change in depressive symptoms in older and multimorbid patients: a longitudinal analysis of the multicare cohort

BACKGROUND

Depression in older adults is becoming an increasing concern. As depressive symptoms change over time, it is important to understand the determinants of change in depressive symptoms. The aim of our study is to use a longitudinal study design to explore the predictors of change, remission and incident depression in older patients with multimorbidity.

METHODS

Data from the MultiCare cohort study were used. The cohort studied 3,189 multimorbid general practice patients aged 65-85. Data were collected during personal interviews. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Predictors of change in depressive symptoms were determined using multivariate linear regression, while multivariate logistic regression was used to analyze predictors of remission and incident depression. Models included depressive symptoms at baseline and follow-up, socio-demographics and data on health status and social support.

RESULTS

Overall, 2,746 participants with complete follow-up data were analyzed. Mean age was 74.2 years, 59.2% were female, and 11.3% were classified as depressed at baseline. Burden of multimorbidity and social support were statistically significant predictors in all regression analyses. Further predictors of change in depressive symptoms were: income, pain, nursing grade, self-rated health and self-efficacy.

LIMITATIONS

The sample size for prediction of remission limited statistical certainty. Assessment of depressive symptoms using GDS-15 differs from routine clinical diagnoses of depression.

CONCLUSIONS

Predictors of change in depressive symptoms in older multimorbid patients are similar to those predicting remission and incident depression, and do not seem to differ significantly from other older patient populations with depressive symptoms.

Is perceived control of depression related to therapy outcome for depression? A longitudinal study

BACKGROUND

The present study followed a group of patients over a two-year period after they had received a cognitive behavioral psychoeducational intervention targeting patients' ability to cope with depression. The main aims were to examine whether a change in both depressive symptoms and in the perceived control of depression occurred and the relationship between depressive symptoms and perceived control.

METHODS

Using a prospective longitudinal design, a sample of 183 patients was assessed at four time points during a two-year period.

RESULTS

The patients showed a large reduction in depressive symptoms over the two-year period after the course ended. During the same time period, perceived controllability of depression increased. A parallel latent growth curve model showed that increased control beliefs were related to reduced depressive symptoms. The decrease in depressive symptoms over time was not dependent on the patients' initial level of depression or initial control of depression, use of medication, duration of previous depressive episodes, alcohol use or sociodemographic variables.

CONCLUSION

Group interventions aimed at increasing coping skills for preventing and mastering of depression may lead to a large and stable reduction in depressive symptoms. A key factor in prevention may be to strengthen patients' perceived ability to cope with the different symptoms of depression.

Prevalence and Associated Factors for Depressive Symptomatology in Chinese Adults During COVID-19 Epidemic

Background: The coronavirus disease 2019 (COVID-19) has been rapidly transmitted worldwide, which contributed to various psychological problems (such as fear, depression, and anxiety) among the general population in China. The purpose of this study is to investigate the prevalence and associated factors of depressive symptoms among Chinese adults.

Methods: A cross-sectional study of Chinese adults was conducted during 17–29 February 2020. Symptoms of depression were assessed using the Center for Epidemiologic Studies Depression scale (CES-D).

Results: A total of 3,399 respondents were included in the analysis. It was observed that 14.2% (481/3,399) of the participants were screened positive for depressive symptoms. In a multivariate logistic regression analysis, older age (OR = 0.98; 95% CI, 0.97–0.99), smoking (OR = 1.57; 95% CI, 1.10–2.26), self-rated health (good: OR = 0.49; 95% CI, 0.37–0.66; fairly: OR = 0.60; 95% CI, 0.45–0.80), having greater support scores (OR = 0.95; 95% CI, 0.94–0.96), knowledge about the main symptom of COVID-19 (very clearly: OR = 0.58; 95% CI, 0.42–0.79; relatively clearly: OR = 0.59; 95% CI, 0.44–0.79), and staying in Wuhan within 3 months before the outbreak of epidemic (OR = 1.78; 95% CI, 1.34–2.38) were associated with depressive symptoms.

Conclusion: A considerable proportion of the general population in China had depressive symptoms during the COVID-19 epidemic. Routine screening and targeted interventions for depression are needed among high-risk depressed individuals during the COVID-19 epidemic.

Social inequalities in antidepressant treatment outcomes: a systematic review

PURPOSE

To identify, review and synthesize evidence on whether social disadvantage moderates antidepressant treatment outcomes, even when access to treatment is not a consideration.

METHODS

The systematic review was done in accordance with PRIMSA guidelines. An a priori systematic search strategy was used to search databases (MEDLINE, PsychINFO, EMBASE, Global Health and Cochrane Trials Library) from their earliest entries through December 31, 2018. A two-step screening procedure was followed, and all experimental studies of antidepressant treatment in ICD/DSM diagnosed cases of depression were included. Studies with subjects < 18 years or investigating other modalities of treatment were excluded.

RESULTS

Thirteen papers reporting analyses from nine studies met inclusion criteria. There was heterogeneity in sample sizes, target populations, treatment settings, clinical outcomes and definition of SES indices. The primary outcome was the relative effect of socioeconomic status (SES) (as measured by income, employment status and level of education)-on antidepressant treatment outcomes.

CONCLUSIONS

The evidence from this review suggests that lower SES may lead to social inequalities in antidepressant treatment outcomes even in the context of clinical trials in which all participants have equal access to the same high-quality, standardized care. The review calls for more careful consideration of the choice and operationalization of SES indicators, and the need to "employ sampling methods that ensure ample representation of individuals from a wide range of social worlds". The review concludes with tentative suggestions about how to reduce social inequalities in antidepressant treatment outcomes at the level of individuals and populations.