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Riera-Serra P, Navarra-Ventura G, Castro A, Gili M, Salazar-Cedillo A, Ricci-Cabello I, Roldán-Espínola L, Coronado-Simsic V, García-Toro M, Gómez-Juanes R, Roca M. Clinical predictors of suicidal ideation, suicide attempts and suicide death in depressive disorder: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2024; 274:1543-1563. [PMID: 38015265 PMCID: PMC11422269 DOI: 10.1007/s00406-023-01716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
Patients with depressive disorders are especially prone to suicide risk. Among the clinical predictors of suicidality, those specifically related to depressive disorders have not been accurately detailed. Our aim was to conduct a systematic review and meta-analysis of studies reporting longitudinal predictors of suicidal ideation, suicide attempts and suicide death within depression, including diagnostic subtypes, symptoms, clinical course, and assessment scales. A systematic search of the literature between 2001 and 2022 identified 4422 references, among which 19 studies providing 45 different predictors of suicidality met the inclusion criteria. Random effects meta-analyses were performed for 22 predictors, three for suicidal ideation, eleven for suicide attempts and eight for suicide death. Heterogeneity and publication bias were inspected through I2 tests and Egger's tests respectively. Meta-analysis results showed that severity of hopelessness predicted suicidal ideation and suicide attempts. History of suicide attempts, suicidal ideation, severe depression, and psychotic symptoms predicted subsequent suicide attempts and suicide death. Time to full remission and sleep disturbances were also found as relevant predictors of future suicide behaviours. This review specifies which predictors of suicidality within the clinical features of depression will help clinicians and policy makers to better prevent suicide risk in patients with depressive disorders. Further longitudinal studies are needed to reliably assess the predictive ability of our results and to analyse other possible clinical predictors to prevent suicidality, especially with regard to suicidal ideation.
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Affiliation(s)
- Pau Riera-Serra
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Guillem Navarra-Ventura
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Adoración Castro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Margalida Gili
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Angie Salazar-Cedillo
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Balearic Islands Health Services (IB-SALUT), Primary Care Research Unit of Mallorca, Palma, Balearic Islands, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Lorenzo Roldán-Espínola
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Mauro García-Toro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Rocío Gómez-Juanes
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Miquel Roca
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma, Balearic Islands, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Son Espases University Hospital, Palma, Balearic Islands, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Balearic Islands, Spain
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2
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Schlechter P, Rohde P, Seeley JR, Klein DN, Olino TM. Examining the influence of episode number and age of onset on individual depressive symptoms across episodes of major depression. J Psychiatr Res 2024; 175:405-410. [PMID: 38776861 DOI: 10.1016/j.jpsychires.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
Major depression is characterized by an episodic course with symptom manifestations differing across episodes. Previous work has found that symptom presentation differs across age. However, studies of symptom presentation have largely focused on symptoms in individual episodes, requiring further investigation of longitudinal symptom change. This study explored the impact of the initial age of onset, the number of episodes, and age of onset of each episode on individual depressive symptoms, while accounting for episode severity. We used data from the Oregon Adolescent Depression Project (N = 629) examining participants with at least one major depressive episode, assessed by diagnostic interview, across a 15-year follow-up. Multilevel logistic regression models revealed that approximately 20-25% of the main effects were significant and some were qualified by cross-level interactions. However, only a few associations remained robust after correcting for multiple comparisons. Specifically, older initial age of onset was associated with fatigue, younger initial age of onset for the first episode was associated with suicidal ideation, and a lower episode number was associated with weight loss. These findings highlight potential initial age of onset and scar effects influencing symptom manifestation, but require replication.
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Affiliation(s)
| | | | | | | | - Thomas M Olino
- Department of Psychology & Neuroscience, Temple University, USA
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3
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Berny LM, Tanner-Smith EE. Interpersonal violence and suicide risk: Examining buffering effects of school and community connectedness. CHILDREN AND YOUTH SERVICES REVIEW 2024; 157:107405. [PMID: 38371909 PMCID: PMC10871710 DOI: 10.1016/j.childyouth.2023.107405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Exposure to interpersonal violence is associated with elevated suicide risk. Preventing suicide among high-risk adolescents is most often discussed from a clinical treatment perspective, resulting in a gap in research examining whether school and community connectedness can buffer the relationships between forms of interpersonal violence and suicide risk in clinical samples of adolescents. Methods Baseline data from 294 adolescents who received substance use treatment were analyzed to help fill this gap in research. Adolescents in this sample were at greater risk for suicidal thoughts and behaviors given their histories of substance use disorders and high rates of interpersonal violence, with 57% reporting experiencing at least one form of abuse/violence. Independent variables included lifetime exposure to physical abuse, sexual abuse, and weapon violence; moderators included various measures of school and community connectedness. Multinomial logistic regression models were estimated to examine the main and interaction effects predicting a three-category measure of suicide risk: non-suicidal, suicidal ideation only, and prior suicide attempts. Results Sexual abuse survivors had the highest predicted probability of a prior suicide attempt when reporting lower levels of teacher support, school-based positive peer interactions, or neighborhood social connection, but at higher levels of these protective factors, their predicted probability was similar to those not exposed to sexual abuse. The same protective pattern was observed for physical abuse survivors with high neighborhood social connection. Conclusion The buffering effects observed in this study identified dimensions of school and community social connectedness as protective factors for youth exposed to abuse. Although promoting social connectedness is often cited as a universal suicide prevention approach, tailored efforts to enhance connectedness within this population may also be a promising secondary prevention strategy. Thus, in addition to clinical treatment, more emphasis should be placed on systems-level approaches to reducing risk among youth most vulnerable to suicide.
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Affiliation(s)
- Lauren M. Berny
- University of Oregon, Department of Counseling Psychology and Human Services, USA
- University of Oregon, Prevention Science Institute, USA
| | - Emily E. Tanner-Smith
- University of Oregon, Department of Counseling Psychology and Human Services, USA
- University of Oregon, Prevention Science Institute, USA
- University of Oregon, HEDCO Institute for Evidence-Based Educational Practice, USA
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4
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Gülpen J, Brouwer ME, Geurtsen GJ, van Dis EAM, Denys DAJP, Bockting CL. Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis. BMJ MENTAL HEALTH 2023; 26:1-9. [PMID: 37914347 PMCID: PMC10626872 DOI: 10.1136/bmjment-2023-300827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
QUESTION Partial remission of major depressive disorder (MDD) is a debilitating and distressing clinical state related to chronicity, morbidity and relapse. Although one-third of patients remit partially, evidence for treatment efficacy is unclear. We provide an overview of treatment options and their efficacy. STUDY SELECTION AND ANALYSIS Embase, PsycINFO, Medline and SCOPUS were systematically searched through February 2023. Included were randomised controlled trials (RCTs) examining any treatment in patients with partially remitted MDD aged 13-65 years, reporting data on severity, remission or relapse. FINDINGS Seven RCTs examining psychotherapy including 1024 patients were eligible. There were not enough RCTs to examine effects of pharmacotherapy. Psychotherapy was associated with lower depressive symptom severity at post-treatment (Hedges' g=0.50; 95% CI 0.23 to 0.76), but not at follow-up up to 1 year (Hedges' g=0.36; 95% CI -0.30 to 1.02) or longer (Hedges' g=0.02; 95% CI -0.09 to 0.12). Psychotherapy was associated with superior remission rates at post-treatment (OR 2.57; 95% CI 1.71 to 3.87) and follow-up 6 months or longer (OR 1.75; 95% CI 1.21 to 2.53), although not with improved relapse rates at post-treatment (OR 0.17; 95% CI 0.01 to 4.83) or follow-up 6 months or longer (OR 0.46; 95% CI 0.21 to 1.03). Overall methodological quality was poor. CONCLUSIONS Psychotherapy targeting partial remission may be effective in lowering depressive symptom severity and patients may potentially achieve full remission twice as likely. Yet, long-term and prophylactic effects are lacking. Given the risk of chronicity, more high-quality RCTs are needed. PROSPERO REGISTRATION NUMBER CRD42020188451.
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Affiliation(s)
- Joost Gülpen
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies E Brouwer
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Eva A M van Dis
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Claudi L Bockting
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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5
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Torres Soler C, Kanders SH, Rehn M, Olofsdotter S, Åslund C, Nilsson KW. A Three-Way Interaction of Sex, PER2 rs56013859 Polymorphism, and Family Maltreatment in Depressive Symptoms in Adolescents. Genes (Basel) 2023; 14:1723. [PMID: 37761863 PMCID: PMC10531402 DOI: 10.3390/genes14091723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
The prevalence of depressive symptoms in adolescents is 12-18% and is twice as frequent in females. Sleep problems and thoughts of death are depressive symptoms or co-occurrent phenomena. Family maltreatment is a risk factor for later depressive symptoms and the period circadian regulator (PER) has been studied in relation to neurotransmitters, adaptation to stress, and winter depression. The purpose of this work was to study the relation of the three-way interactions of sex, PER2 rs56013859, and family maltreatment in relation to core depressive symptoms, sleep complaints, and thoughts of death and suicide in self-reports from a cohort of Swedish adolescents in 2012, 2015, and 2018. Cross-sectional and longitudinal analyses with linear and logistic regressions were used to study the relationships to the three outcomes. The three-way interaction was related to core depressive symptoms at both baseline and six years later. In contrast, the model did not show any relation to the other dependent variables. At 13-15 years, a sex-related differential expression was observed: females with the minor allele C:C/C:T exposed to family maltreatment showed higher levels of core depressive symptoms. Six years later, the trend was inverted among carriers of minor alleles.
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Affiliation(s)
- Catalina Torres Soler
- Centre for Clinical Research, Region Västmanland, Uppsala University, 721 89 Västerås, Sweden
| | - Sofia H. Kanders
- Centre for Clinical Research, Region Västmanland, Uppsala University, 721 89 Västerås, Sweden
| | - Mattias Rehn
- Centre for Clinical Research, Region Västmanland, Uppsala University, 721 89 Västerås, Sweden
| | - Susanne Olofsdotter
- Centre for Clinical Research, Region Västmanland, Uppsala University, 721 89 Västerås, Sweden
- Department of Psychology, Uppsala University, 751 05 Uppsala, Sweden
| | - Cecilia Åslund
- Centre for Clinical Research, Region Västmanland, Uppsala University, 721 89 Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, 751 05 Uppsala, Sweden
| | - Kent W. Nilsson
- Centre for Clinical Research, Region Västmanland, Uppsala University, 721 89 Västerås, Sweden
- Department of Neuroscience, Uppsala University, 751 05 Uppsala, Sweden
- The School of Health, Care and Social Welfare, Mälardalen University, 721 23 Västerås, Sweden
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6
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Bockting C, Legemaat AM, van der Stappen JGJ, Geurtsen GJ, Semkovska M, Burger H, Bergfeld IO, Lous N, Denys DAJP, Brouwer M. Augmenting neurocognitive remediation therapy to Preventive Cognitive Therapy for partially remitted depressed patients: protocol of a pragmatic multicentre randomised controlled trial. BMJ Open 2022; 12:e063407. [PMID: 35738653 PMCID: PMC9226921 DOI: 10.1136/bmjopen-2022-063407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) affects 163 million people globally every year. Individuals who experience subsyndromal depressive symptoms during remission (ie, partial remission of MDD) are especially at risk for a return to a depressive episode within an average of 4 months. Simultaneously, partial remission of MDD is associated with work and (psycho)social impairment and a lower quality of life. Brief psychological interventions such as preventive cognitive therapy (PCT) can reduce depressive symptoms or relapse for patients in partial remission, although achieving full remission with treatment is still a clinical challenge. Treatment might be more effective if cognitive functioning of patients is targeted as well since cognitive problems are the most persisting symptom in partial remission and predict poor treatment response and worse functioning. Studies show that cognitive functioning of patients with (remitted) MDD can be improved by online neurocognitive remediation therapy (oNCRT). Augmenting oNCRT to PCT might improve treatment effects for these patients by strengthening their cognitive functioning alongside a psychological intervention. METHODS AND ANALYSIS This study will examine the effectiveness of augmenting oNCRT to PCT in a pragmatic national multicentre superiority randomised controlled trial. We will include 115 adults partially remitted from MDD with subsyndromal depressive symptoms defined as a Hamilton Depression Rating Scale score between 8 and 15. Participants will be randomly allocated to PCT with oNCRT, or PCT only. Primary outcome measure is the effect on depressive symptomatology over 1 year. Secondary outcomes include time to relapse, cognitive functioning, quality of life and healthcare costs. This first dual approach study of augmenting oNCRT to PCT might facilitate full remission in partially remitted individuals as well as prevent relapse over time. ETHICS AND DISSEMINATION Ethical approval was obtained by Academic Medical Center, Amsterdam. Outcomes will be made publicly available. TRIAL REGISTRATION NUMBER NL9582.
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Affiliation(s)
- Claudi Bockting
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda M Legemaat
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies Brouwer
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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7
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Gao J, Li Y, Wei Q, Li X, Wang K, Tian Y, Wang J. Habenula and left angular gyrus circuit contributes to response of electroconvulsive therapy in major depressive disorder. Brain Imaging Behav 2020; 15:2246-2253. [PMID: 33244628 DOI: 10.1007/s11682-020-00418-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
The habenula (Hb), one of the hottest structures in depression, has been widely demonstrated to be involved in the neurobiology of depression. Although the structural and functional abnormalities of Hb have been reported in major depressive disorders (MDD) patients, the role of Hb in treatment response in MDD remains unclear. In this study, resting-state functional connectivity (RSFC) and Granger causality analysis (GCA) were performed to investigate the intrinsic and causal changes of Hb in MDD after ECT. Moreover, support vector classification was applied to find out whether the changed functional and causal connections of Hb can effectively distinguish the MDD patients from healthy controls. The RSFC and GCA identified increased RSFC strength between bilateral Hb and left angular gyrus (AG), decreased causal connectivity strength from left AG to left Hb, from right Hb to left AG, and bidirectional interactions between left and right Hb in MDD patients after ECT. The changed causal connectivities from left AG to left Hb, and from right Hb to left AG were correlated with the changed depression symptoms and impaired delay memory recall performances. Furthermore, the functional and causal connectivities between left AG and bilateral Hb could serve as a biomarker to differentiate MDD from HCs. These results provided new evidence for the importance of Hb in depression and revealed that the interactions between Hb and left AG contribute to ECT response in MDD. Our findings will facilitate the future treatment of depression with the target of Hb in MDD and other brain disorders.
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Affiliation(s)
- Jingjing Gao
- School of Information and Communication Engineer, University of Electronic Science and Technology of China, Chengdu, 625014, China
| | - Yuanyuan Li
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 625014, China
| | - Qiang Wei
- Department of Neurology, The First Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xuemei Li
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 625014, China
| | - Kai Wang
- Department of Neurology, The First Hospital of Anhui Medical University, Hefei, 230022, China.,Department of Medical Psychology, Anhui Medical University, 230022, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, 230022, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, 230022, Hefei, China
| | - Yanghua Tian
- Department of Neurology, The First Hospital of Anhui Medical University, Hefei, 230022, China.
| | - Jiaojian Wang
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 625014, China. .,Center for Language and Brain, Shenzhen Institute of Neuroscience, Shenzhen, 518060, China.
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8
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Ahmadabadi Z, Najman JM, Williams GM, Clavarino AM, d'Abbs P, Tran N. Intimate partner violence and subsequent depression and anxiety disorders. Soc Psychiatry Psychiatr Epidemiol 2020; 55:611-620. [PMID: 31912167 DOI: 10.1007/s00127-019-01828-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/24/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The current longitudinal study examines the temporal association between different types of intimate partner violence (IPV) at early adulthood (21 years) and subsequent depression and anxiety disorders in young adulthood (30 years). METHODS Participants were from the Mater-University of Queensland Study of Pregnancy. A cohort of 1529 was available for analysis. IPV was measured using the Composite Abuse Scale at 21 years. At the 21 and 30-year follow-ups, major depression disorder and anxiety disorders were measured using the Composite International Diagnostic Interview. RESULTS We found a temporal relationship between almost all forms of IPV at 21 years and females' new cases of major depression disorder at 30 years. This association was not found for females who had previously been diagnosed with depression disorder. IPV did not predict the onset of new anxiety disorders, but it had a robust association with anxiety disorders in females with a previous anxiety diagnosis. We observed no significant link between IPV and males' subsequent major depression disorder. Interestingly, the experience of emotional abuse was a robust predictor of new cases of anxiety disorders but only for males. CONCLUSION Our results suggest the need for sex-specific and integrated interventions addressing both IPV and mental health problems simultaneously. IPV interventions should be informed by the extend to which pre-existing anxiety and depression may lead to different psychological responses to the IPV experience. Increased risk of anxiety disorders predicted by emotional abuse experienced by males challenges beliefs about invulnerability of men in the abusive relationships and demands further attention.
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Affiliation(s)
- Zohre Ahmadabadi
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
| | - Jackob M Najman
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.,School of Social Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Gail M Williams
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
| | - Alexandra M Clavarino
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Peter d'Abbs
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.,Menzies School of Health Research, Spring Hill, QLD, 4000, Australia
| | - Nam Tran
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia
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9
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Makhubela M. The relation between low self-esteem and depressive mood in a non-clinical sample: The role of gender and negative life events. JOURNAL OF PSYCHOLOGY IN AFRICA 2019. [DOI: 10.1080/14330237.2019.1568067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Malose Makhubela
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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10
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van Eeden WA, van Hemert AM, Carlier IVE, Penninx BW, Giltay EJ. Severity, course trajectory, and within-person variability of individual symptoms in patients with major depressive disorder. Acta Psychiatr Scand 2019; 139:194-205. [PMID: 30447008 PMCID: PMC6587785 DOI: 10.1111/acps.12987] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression shows a large heterogeneity of symptoms between and within persons over time. However, most outcome studies have assessed depression as a single underlying latent construct, using the sum score on psychometric scales as an indicator for severity. This study assesses longitudinal symptom-specific trajectories and within-person variability of major depressive disorder over a 9-year period. METHODS Data were derived from the Netherlands Study of Depression and Anxiety (NESDA). This study included 783 participants with a current major depressive disorder at baseline. The Inventory Depressive Symptomatology-Self-Report (IDS-SR) was used to analyze 28 depressive symptoms at up to six time points during the 9-year follow-up. RESULTS The highest baseline severity scores were found for the items regarding energy and mood states. The core symptoms depressed mood and anhedonia had the most favorable course, whereas sleeping problems and (psycho-)somatic symptoms were more persistent over 9-year follow-up. Within-person variability was highest for symptoms related to energy and lowest for suicidal ideation. CONCLUSIONS The severity, course, and within-person variability differed markedly between depressive symptoms. Our findings strengthen the idea that employing a symptom-focused approach in both clinical care and research is of value.
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Affiliation(s)
- W. A. van Eeden
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - A. M. van Hemert
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - I. V. E. Carlier
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - B. W. Penninx
- Department of PsychiatryAmsterdam Public Health Research Institute and Amsterdam NeuroscienceVU University Medical CenterGGZ inGeestAmsterdamThe Netherlands
| | - E. J. Giltay
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
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11
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Unique Relationships Between Self-Related Constructs, Social Anxiety, and Depression in a Non-Clinical Sample. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Self-related constructs feature prominently in cognitive models of both social anxiety and depression. However, few studies have simultaneously investigated the unique relationship between self-related constructs and social anxiety and depression, while also controlling for the association between the two variables. In the present study, 522 undergraduate students completed measures of maladaptive self-beliefs, self-esteem, self-criticism, self-focused attention, self-concept clarity, social comparison, and social anxiety and depression. Bivariate correlations demonstrated that self-related constructs not only significantly correlated with social anxiety but also with depression and other self-variables. When entered simultaneously, multiple regression analyses indicated that maladaptive self-beliefs were uniquely and positively associated with social anxiety and depression, while self-esteem and self-concept clarity were uniquely and negatively associated with social anxiety and depression. A unique positive association between private self-consciousness and depression was also found. Maladaptive self-beliefs and self-esteem were the constructs most strongly associated with social anxiety and depression respectively. These findings underscore the importance of a negative self-concept even in subclinical presentations and suggest that several key self-related constructs may represent transdiagnostic vulnerability factors linking social anxiety and depression. Future research should continue to uncover unique relationships between self-related variables and social anxiety and depression in both clinical and non-clinical samples.
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Park SC, Kim JM, Jun TY, Lee MS, Kim JB, Yim HW, Park YC. How many different symptom combinations fulfil the diagnostic criteria for major depressive disorder? Results from the CRESCEND study. Nord J Psychiatry 2017; 71:217-222. [PMID: 27981876 DOI: 10.1080/08039488.2016.1265584] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The polythetic nature of major depressive disorder (MDD) in DSM- IV and DSM-5 inevitably leads to diagnostic heterogeneity. AIMS This study aimed to identify the number of depressive symptom combinations actually fulfilling the DSM-IV diagnostic criteria that can be found in Korean MDD patients and the relative frequencies of each combination. METHODS Using the data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, we enrolled 853 MDD patients diagnosed using DSM-IV and scored as 8 or more on the Hamilton Depression Rating Scale (HAMD). Descriptive statistical analyses were performed to reveal the degree of diagnostic heterogeneity of the MDD. RESULTS This study identified 119 different depressive symptom combinations. The most common combination consisted of all nine depressive symptom profiles, and nine different combinations were each present in more than 3% of the patients. CONCLUSION The findings support the criticism that the diagnosis of MDD is not based on a single mental process, but on a set of 'family resemblances'.
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Affiliation(s)
- Seon-Cheol Park
- a Department of Psychiatry , Inje University Haeundae Paik Hospital , Busan , Republic of Korea
| | - Jae-Min Kim
- b Department of Psychiatry , Chonnam National University School of Medicine , Gwangju , Republic of Korea
| | - Tae-Youn Jun
- c Department of Psychiatry , Catholic University of Korea College of Medicine , Seoul , Republic of Korea
| | - Min-Soo Lee
- d Department of Psychiatry , Korea University College of Medicine , Seoul , Republic of Korea
| | - Jung-Bum Kim
- e Department of Psychiatry , Keimyung University School of Medicine , Daegu , Republic of Korea
| | - Hyeon-Woo Yim
- f Department of Preventive Medicine , Catholic University of Korea College of Medicine , Seoul , Republic of Korea
| | - Yong Chon Park
- g Department of Psychiatry , Hanyang University Guri Hospital , Guri , Republic of Korea
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He Z, Cui Q, Zheng J, Duan X, Pang Y, Gao Q, Han S, Long Z, Wang Y, Li J, Wang X, Zhao J, Chen H. Frequency-specific alterations in functional connectivity in treatment-resistant and -sensitive major depressive disorder. J Psychiatr Res 2016; 82:30-9. [PMID: 27459030 DOI: 10.1016/j.jpsychires.2016.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 01/06/2023]
Abstract
Major depressive disorder (MDD) may involve alterations in brain functional connectivity in multiple neural circuits and present large-scale network dysfunction. Patients with treatment-resistant depression (TRD) and treatment-sensitive depression (TSD) show different responses to antidepressants and aberrant brain functions. This study aims to investigate functional connectivity patterns of TRD and TSD at the whole brain resting state. Seventeen patients with TRD, 17 patients with TSD, and 17 healthy controls matched with age, gender, and years of education were recruited in this study. The brain was divided using an automated anatomical labeling atlas into 90 regions of interest, which were used to construct the entire brain functional networks. An analysis method called network-based statistic was used to explore the dysconnected subnetworks of TRD and TSD at different frequency bands. At resting state, TSD and TRD present characteristic patterns of network dysfunction at special frequency bands. The dysconnected subnetwork of TSD mainly lies in the fronto-parietal top-down control network. Moreover, the abnormal neural circuits of TRD are extensive and complex. These circuits not only depend on the abnormal affective network but also involve other networks, including salience network, auditory network, visual network, and language processing cortex. Our findings reflect that the pathological mechanism of TSD may refer to impairment in cognitive control, whereas TRD mainly triggers the dysfunction of emotion processing and affective cognition. This study reveals that differences in brain functional connectivity at resting state reflect distinct pathophysiological mechanisms in TSD and TRD. These findings may be helpful in differentiating two types of MDD and predicting treatment responses.
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Affiliation(s)
- Zongling He
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China; Mental Health Center, The Fourth People's Hospital of Chengdu, Sichuan 610000, China
| | - Qian Cui
- School of Political Science and Public Administration, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Junjie Zheng
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Xujun Duan
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Yajing Pang
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Qing Gao
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Shaoqiang Han
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Zhiliang Long
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Yifeng Wang
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Jiao Li
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Xiao Wang
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Jingping Zhao
- Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Huafu Chen
- Center for Information in BioMedicine, Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China.
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Kouros CD, Garber J. Trajectories of individual depressive symptoms in adolescents: gender and family relationships as predictors. Dev Psychol 2014; 50:2633-43. [PMID: 25329553 PMCID: PMC4591045 DOI: 10.1037/a0038190] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Depressive syndrome and disorders increase substantially during adolescence. Little is known, however, about how individual symptoms of depression change over the course of this developmental period. The present study examined within-person changes in symptom severity of each individual symptom of depression, utilizing longitudinal data collected across 6 years of adolescence. Adolescent gender and family relationship variables were tested as predictors of the symptom trajectories (i.e., intercept and slope). Adolescents and their mothers (N = 240) were first evaluated when youth were in Grade 6 (M = 11.86 years old, SD = 0.56, 54% female) and then annually through Grade 12. Individual symptoms of depression were assessed by a clinical interviewer using the Children's Depression Rating Scale-Revised (CDRS-R). Mothers and youth also completed measures about their relationship on the Children's Report of Parent Behavior Inventory and the Family Environment Scale. Results showed that all depressive symptoms increased linearly over time except psychomotor disturbances and problems with concentration and decision making, which were best represented by a quadratic growth model. Sex differences were found such that significantly more rapid increases in worthlessness/guilt were found for girls than boys, and concentration/decision making problems significantly changed for boys, but not girls. Poor family relationship quality (mother-reported) predicted a significantly faster rate of increase in adolescents' symptoms of anhedonia, appetite/weight changes, and fatigue. High maternal psychological control (youth-reported) also predicted a faster rate of increase in anhedonia. Study limitations, future research directions, and clinical implications of the findings are discussed.
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Affiliation(s)
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University
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Lamers F, Rhebergen D, Merikangas KR, de Jonge P, Beekman ATF, Penninx BWJH. Stability and transitions of depressive subtypes over a 2-year follow-up. Psychol Med 2012; 42:2083-2093. [PMID: 22340131 DOI: 10.1017/s0033291712000141] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Identifying depressive subtypes is an important tool in reducing the heterogeneity of major depressive disorder. However, few studies have examined the stability of putative subtypes of depression over time. METHOD The sample included 488 persons from the Netherlands Study of Depression and Anxiety (NESDA) who had major depressive disorder at baseline and at the 2-year follow-up assessment. A latent transition analysis (LTA) was applied to examine the stability of depressive subtypes across time-points. Differences in demographic, clinical, psychosocial and health correlates between subtypes were evaluated in a subsample of persons with stable subtypes. RESULTS Three subtypes were identified at each time-point: a moderate subtype (prevalence T0 39%, T1 42%), a severe typical subtype (T0 30%, T1 25%), and a severe atypical subtype (T0 31%, T1 34%). The LTA showed 76% stability across the 2-year follow-up, with the greatest stability in the severe atypical class (79%). Analyses of correlates in the stable subtypes showed a predominance of women and more overweight and obesity in the severe atypical subtype, and a greater number of negative life events and higher neuroticism and functioning scores in the severe typical subtype. CONCLUSIONS Subtypes of major depressive disorder were found to be stable across a 2-year follow-up and to have distinct determinants, supporting the notion that the identified subtypes are clinically meaningful.
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Affiliation(s)
- F Lamers
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-3720, USA.
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Lee JY, Insel P, Mackin RS, Schuff N, Chui H, DeCarli C, Park KH, Mueller SG, Weiner MW. Different associations of white matter lesions with depression and cognition. BMC Neurol 2012; 12:83. [PMID: 22920586 PMCID: PMC3482604 DOI: 10.1186/1471-2377-12-83] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/20/2012] [Indexed: 11/24/2022] Open
Abstract
Background To test the hypothesis that white matter lesions (WML) are primarily associated with regional frontal cortical volumes, and to determine the mediating effects of these regional frontal cortices on the associations of WML with depressive symptoms and cognitive dysfunction. Methods Structural brains MRIs were performed on 161 participants: cognitively normal, cognitive impaired but not demented, and demented participants. Lobar WML volumes, regional frontal cortical volumes, depressive symptom severity, and cognitive abilities were measured. Multiple linear regression analyses were used to identify WML volume effects on frontal cortical volume. Structural equation modeling was used to determine the MRI-depression and the MRI-cognition path relationships. Results WML predicted frontal cortical volume, particularly in medial orbirtofrontal cortex, irrespective of age, gender, education, and group status. WML directly predicted depressive score, and this relationship was not mediated by regional frontal cortices. In contrast, the association between WML and cognitive function was indirect and mediated by regional frontal cortices. Conclusions These findings suggest that the neurobiological mechanisms underpinning depressive symptoms and cognitive dysfunction in older adults may differ.
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Affiliation(s)
- Jun-Young Lee
- Center for Imaging of Neurodegenerative Diseases, Veterans Affairs Medical Center, San Francisco, CA 94121, USA
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Kim W, Woo YS, Chae JH, Bahk WM. The Diagnostic Stability of DSM-IV Diagnoses: An Examination of Major Depressive Disorder, Bipolar I Disorder, and Schizophrenia in Korean Patients. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2011; 9:117-21. [PMID: 23430042 PMCID: PMC3569115 DOI: 10.9758/cpn.2011.9.3.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/19/2011] [Accepted: 10/03/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We examined the stability of diagnoses defined by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) (major depressive disorder [MDD], bipolar I disorder [BID], and schizophrenia [SPR]) by means of retrospective reviews of medical records. METHODS Data from patients who met the DSM-IV criteria for the aforementioned disorders according to two psychiatrists and who were followed for at least 2 years were included in this study. We reviewed the medical records and compared the diagnosis given at the index admission with assessments made every 6 months for 2 years after discharge to determine diagnostic stability. RESULTS A total of 138 patients with MDD, 56 patients with BID, and 107 patients with SPR who were followed for 2 years were included in the final analyses. The data showed that 84.8% of the sample retained their initial diagnosis of MDD during the first year; this figure decreased to 79.0% during the second year. During the first year, 93.5% retained their initial diagnosis of BID, and this figure decreased to 89.3% during the second year; 86.8% and 86.9% retained their diagnosis of SPR during the first and second years, respectively. CONCLUSION This study showed the instability of three major DSM-IV diagnoses among Korean patients. Additionally, the results demonstrated that accurate diagnosis using the current diagnostic system requires longitudinal observation.
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Affiliation(s)
- Won Kim
- Department of Psychiatry and Stress Research Institute, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Sup Woo
- Department of Psychiatry, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, The Catholic University of Korea, School of Medicine, Seoul, Korea
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La Flair LN, Bradshaw CP, Campbell JC. Intimate partner violence/abuse and depressive symptoms among female health care workers: longitudinal findings. Womens Health Issues 2011; 22:e53-9. [PMID: 21868248 DOI: 10.1016/j.whi.2011.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 07/02/2011] [Accepted: 07/04/2011] [Indexed: 10/17/2022]
Abstract
Intimate partner violence and abuse (IPV/A) have been shown to have a major impact on mental health functioning. This study assessed the longitudinal association between recent IPV/A and depressive symptoms to identify potential targets for preventive interventions for women. Random effects models were used to examine four waves of data collected at 6-month intervals from a cohort of 1,438 female health care workers. IPV/A (e.g., sexual and physical violence, psychological abuse) in the past 5 years was associated with higher Center for Epidemiologic Studies Depression Scale (CES-D) 10 scores across four waves after adjustment for age, time, marital status, and childhood trauma. Women who reported IPV/A in the past 5 years had higher CES-D 10 scores (β, 1.31; 95% confidence interval, 0.79-1.82; p < .0001) than nonabused women. This association was generally constant with time, suggestive of a cross-sectional association across all four waves of data. Additionally, recent IPV/A was associated with change in depressive symptoms over time among the full cohort and those with CES-D 10 scores below 10 (the threshold for likely depression) at baseline. Recent IPV/A was independently associated with depressive symptoms both cross-sectionally and longitudinally. The longitudinal association was stronger among those not depressed at baseline. Implications for health care settings and workplace policies addressing IPV/A are discussed.
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Affiliation(s)
- Lareina N La Flair
- Department of Mental Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Conradi HJ, Ormel J, de Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med 2011; 41:1165-1174. [PMID: 20932356 DOI: 10.1017/s0033291710001911] [Citation(s) in RCA: 309] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Residual depressive symptomatology constitutes a substantial risk for relapse in depression. Treatment until full remission is achieved is therefore implicated. However, there is a lack of knowledge about the prevalence of (1) residual symptoms in general and (2) the individual residual symptoms in particular. METHOD In a 3-year prospective study of 267 initially depressed primary care patients we established per week the presence/absence of the individual DSM-IV depressive symptoms during subsequent major depressive episodes (MDEs) and episodes of (partial) remission. This was accomplished by means of 12 assessments at 3-monthly intervals with the Composite International Diagnostic Interview (CIDI). RESULTS In general, residual depressive symptomatology was substantial, with on average two symptoms present during remissions. Three individual symptoms (cognitive problems, lack of energy and sleeping problems) dominated the course of depression and were present 85-94% of the time during depressive episodes and 39-44% of the time during remissions. CONCLUSIONS Residual symptoms are prevalent, with some symptoms being present for almost half of the time during periods of remission. Treatment until full remission is achieved is not common practice, yet there is a clear need to do so to prevent relapse. Several treatment suggestions are made.
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Affiliation(s)
- H J Conradi
- Department of Psychiatry, University of Groningen, The Netherlands.
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Abstract
INTRODUCTION Major depressive disorder (MDD) is thought to negatively impact cognitive function; however, the relationship has not been well explored. OBJECTIVE This study examined the association between depression severity and global cognitive function and memory in subjects with severe, treatment-resistant MDD. METHODS We enrolled 66 subjects with Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosed unipolar MDD in a multicenter trial to assess the efficacy and neurocognitive effects of electroconvulsive therapy (ECT). We measured depression severity with the 24 item Hamilton Rating Scale for Depression (HRSD(24)). Neuropsychologic measures included the Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT), and the Complex Figure Test (CFT). Correlational and regression analyses were conducted to explore associations between depression severity and cognitive function. RESULTS The mean age of the subjects was 53.6 years (SD=15.8), 65% were female, and mean HRSD(24) was 33.9 (SD=6.7). Mean demographic-corrected T-scores for each neurocognitive measure were in the average to borderline range, and HRSD(24) values were unrelated to performance on the MMSE, RAVLT immediate and delayed recall, and CFT immediate and delayed recall. CONCLUSION In this sample of severely depressed subjects referred for ECT, depression severity was unrelated to global cognitive function or memory. Future research should examine the interactions between other depressive characteristics and neurocognitive function.
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Theodore WH, Hasler G, Giovacchini G, Kelley K, Reeves-Tyer P, Herscovitch P, Drevets W. Reduced Hippocampal 5HT1A PET Receptor Binding and Depression in Temporal Lobe Epilepsy. Epilepsia 2007; 48:1526-30. [PMID: 17442003 DOI: 10.1111/j.1528-1167.2007.01089.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the relation of hippocampal 5HT1A receptor binding to symptoms of depression in patients with temporal lobe epilepsy. Depression is common in people with epilepsy, and reduced 5HT1A binding has been reported in patients with primary depressive disorders. METHODS We studied 45 patients with temporal lobe epilepsy confirmed by ictal video-EEG recording. Mood was assessed with the Beck Depression Inventory (BDI). Positron emission tomographic measurement of 5HT1A receptors was performed with 18F-FCWAY, a highly specific silent antagonist. 3D-T1-weighted MRI was used to correct for structural atrophy. Receptor distribution volume (V) was corrected for plasma tracer free fraction (f1). RESULTS There was a significant inverse relation between ipsilateral hippocampal v/f1 and the BDI. For contralateral hippocampus, there was a nonsignificant trend. Patients with BDI > 20 had significantly lower ipsilateral hippocampal V/f1 than patients in the low and medium groups. There was no significant effect of the presence of mesial temporal sclerosis, focus laterality, or gender on the BDI. CONCLUSIONS Our study shows a relationship between hippocampal 5HT1A binding and depressive symptoms measured by the BDI in patients with epilepsy. The findings parallel results in patients with MDD.
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Affiliation(s)
- William H Theodore
- Clinical Epilepsy Section, National Institute of Neurological Diseases and Stroke/NIH, Bethesda, MD 20892, USA.
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