The impact of childhood trauma on depression: does resilience matter? Population-based results from the Study of Health in Pomerania

Psychometric properties of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) in adolescent and young adult psychiatric outpatients in the Texas Youth Depression and Suicide Research Network (TX-YDSRN)

BACKGROUND

This study assessed the psychometric properties of the 10-item Connor Davidson Resilience Scale (CD-RISC-10), a self-report measure of resilience, in youth receiving treatment and/or screening positive for depression/suicidality in psychiatric outpatient settings.

METHODS

Data from 908 youth (age 12-20 years) were analyzed. A confirmatory factor analysis (CFA) model was fit to the data, and goodness-of-fit was assessed using indices such as the comparative fit index (CFI). Psychometric analyses were performed through the lenses of classical test theory (CTT) and item response theory (IRT). Measurement invariance of the scale was assessed by classifying the sample by depression severity. Finally, intraclass correlation coefficients (ICC) from test-retest were used to assess the reliability of the scale using data collected at baseline and one-month post-baseline.

RESULTS

The scale was unidimensional, representing a single latent trait. CFA demonstrated acceptable model fit (CFI = 0.94). CTT analyses showed good internal consistency (Cronbach's alpha 0.85) and good item discrimination (item-total correlations between 0.38 and 0.66). The scale demonstrated good test-retest reliability over a one-month period (ICC = 0.82). IRT analyses exhibited good item performance on all but the three items related to versatility, humor and persistence. These items were also deterrent to the scale having full scalar invariance.

LIMITATIONS

Limitations include questionable generalizability beyond the sample and biases inherent in self-report scales.

CONCLUSIONS

CD-RISC-10 has acceptable reliability and validity. However, depressive symptom severity affected selected item performance. If these findings are confirmed in other independent samples, a seven-item version of the scale may be investigated for depressed samples.

The prospective association of adolescent loneliness and low resilience with anxiety and depression in young adulthood: The HUNT study

BACKGROUND

Loneliness is a recognized risk factor for anxiety and depression, yet research on its interaction with low resilience remains sparse, particularly across the adolescent-to-adult transition. This study investigates how adolescent loneliness, both independently and in interaction with low resilience, influences anxiety and depression in young adulthood.

METHODS

This study utilized longitudinal data from The Trøndelag Health Study (HUNT) to track adolescents (13-19 years) from Young-HUNT3 (2006-08) through to HUNT4 (2017-19). Loneliness was assessed via a single-item measure, while resilience was estimated using the Resilience Scale for Adolescents. Anxiety and depression outcomes at the 11-year follow-up were measured using the Hospital Anxiety and Depression Scale. Multivariable logistic regression analyses were done to analyze the associations. Moreover, interaction effects were evaluated using relative excess risk due to interaction (RERI).

RESULTS

Loneliness during adolescence independently predicted anxiety and depression in young adulthood. Adolescents experiencing both loneliness and low resilience showed notably higher risks compared to other groups (highly resilient adolescents without loneliness [reference], highly resilient adolescents with loneliness, and adolescents with low resilience and low loneliness). The combined effect of loneliness and low resilience exhibited a synergistic interaction on the additive scale, although it was not statistically significant (RERI 0.13, 95% CI -2.39-2.65).

CONCLUSION

Adolescent loneliness and low resilience independently predict anxiety and depression in young adulthood. The interaction between loneliness and low resilience further heightens these risks. This underscores the importance of early interventions that focus on resilience-building during adolescence and reducing the impacts of loneliness on mental health.

Associations of Early-Life Deprivation and Threat with Exploratory Behavior: Moderated Mediation Models of Sensation Seeking and Executive Function

Exploratory behavior, as a crucial aspect of decision-making, plays an indispensable role in maximizing long-term benefits and is, therefore, essential in promoting adolescents' psychological well-being and social adaptation. Recent studies have shown that this adaptive behavior is influenced by previous early experiences. However, little was known about the associations between specific types of childhood maltreatment and exploratory behavior and the roles of individual motivational and cognitive factors in these relationships. The present study aimed to examine whether the subtypes of maltreatment, that is, threat and deprivation, would influence adolescents' exploratory behavior, the mediating role of sensation seeking, and the moderating role of executive function. Using a sample of 720 Chinese adolescents (Mage = 13.29, SDage = 0.82, 54.8% female), we found that sensation seeking fully mediated the relationship between threat and exploratory behavior. That is, adolescents who experienced threat were more likely to increase sensation seeking, which further promote exploratory activities. Moreover, executive function was a second-stage moderator of this full mediation pathway, with the mediating effect of sensation seeking between threat and exploratory behavior increasing with the enhancement of executive function. However, we did not observe the mediating effect of sensation seeking and the second-stage moderating effect of executive function on the relationship between deprivation and exploration. Considering the distinct impact mechanisms of threat and deprivation on exploratory behavior, our study provides empirical support for the Dimensional Model of Adversity and Psychopathology, and highlights the critical role of sensation seeking and the necessity of implementing executive function interventions for those experiencing threat experiences.

Psychological Resilience Mediates the Impact of Childhood Trauma on Depressive Symptoms in Major Depressive Disorder

Background: This research aimed to investigate the mediating and moderating effects of psychological resilience (PR) on the association between childhood trauma (CT) and the development of depression. Methods: This study included 94 cases who consecutively applied to the outpatient psychiatry clinic of Rize Recep Tayyip Erdoğan University Training and Research Hospital in Turkey between 1 June 2023 and 1 December 2023 and were diagnosed with Major Depressive Disorder (MDD). In addition, 83 healthy individuals (control group) were also included. Participants administered the Hamilton Depression Rating Scale (HDRS), the Resilience Scale for Adults (RSA), and the Childhood Trauma Questionnaire (CTQ). Results: In the context of this research, the mediating effect of PR between CT and depression development was investigated. When examining the mediating role of PR on the association between CT and depression, it was found that CT statistically significantly influenced disease severity directly (B = 0.158, SE = 0.0398, z = 3.98, p < 0.001, 95% CI [0.0759, 0.232]), while it also influenced disease severity indirectly through PR (B = 0.193, SE = 0.028, z = 6.88, p < 0.001, 95% CI [0.1343, 0.244]). It was revealed that PR mediated the association between CT and depressive symptoms partially. Conclusions: This study demonstrates that PR has a mediating effect on the relationship between CT and MDD. These results provide new contributions to the existing literature. Interventions that increase psychological resilience may positively contribute to the treatment of patients with MDD who have suffered from CT.

Developing a translational research framework for MDD: combining biomolecular mechanisms with a spiraling risk factor model

Objective

The global incidence and burden of Major Depressive Disorder (MDD) are increasing annually, with current antidepressant treatments proving ineffective for 30-40% of patients. Biomolecular mechanisms within the microbiota-gut-brain axis (MGBA) may significantly contribute to MDD, potentially paving the way for novel treatment approaches. However, integrating the MGBA with the psychological and environmental aspects of MDD remains challenging. This manuscript aims to: 1) investigate the underlying biomolecular mechanisms of MDD using a modeling approach, and 2) integrate this knowledge into a comprehensive 'spiraling risk factor model' to develop a biopsychosocial translational research framework for the prevention and treatment of MDD.

Methods

For the first aim, a systematic review (PROSPERO registration) was conducted using PubMed, Embase, and Scopus to query literature published between 2016-2020, with select additional sources. A narrative review was performed for the second aim.

Results

In addition to genetics and neurobiology, research consistently indicates that hyperactivation of the HPA axis and a pro-inflammatory state are interrelated components of the MGBA and likely underlying mechanisms of MDD. Dysregulation of the MGBA, along with imbalances in mental and physical conditions, lifestyle factors, and pre-existing treatments, can trigger a downward spiral of stress and anxiety, potentially leading to MDD.

Conclusions

MDD is not solely a brain disorder but a heterogeneous condition involving biomolecular, psychological, and environmental risk factors. Future interdisciplinary research can utilize the integrated biopsychosocial insights from this manuscript to develop more effective lifestyle-focused multimodal treatment interventions, enhance diagnosis, and stimulate early-stage prevention of MDD.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42020215412.

Psychometric properties of the German version of the brief resilience scale in persons with mental disorders

The Brief Resilience Scale (BRS) was developed to assess individual differences in the ability to recover from stress despite adversity and has been translated into several languages. This study aimed to examine the psychometric properties (i.e., item characteristics, reliability, factor structure, measurement invariance, and validity) of the German version of the BRS in persons with mental disorders. A total of N = 5,986 persons admitted to inpatient treatment completed the German version of the BRS and other questionnaires. The discriminating power of the items, the difficulty of the items, and the internal consistency were all sufficient. Moreover, confirmatory factor analysis supported the two-factor structure of the BRS, consistent with the findings of the German validation study in a non-clinical sample. The BRS also had strict measurement invariance across diagnostic groups for mental disorders according to ICD-10. Validity was examined using a network analysis, in which the BRS demonstrated positive correlations with life satisfaction, self-efficacy and optimism and negative correlations with somatic symptoms, anxiety, insomnia, and depression. The BRS can serve as a reliable and valid tool for assessing resilience in clinical settings, facilitating the identification of persons with potentially lower psychosocial resources.

The effect of childhood trauma on depression in college students: A moderated mediation model

OBJECTIVE

Childhood trauma is considered as a critical risk factor for depression. Although many studies have investigated the pathway of Childhood trauma to depression, especially the mediating or moderating effects of cognitive emotion regulation strategies or neuroticism or stress perception, the results were inconsistent and the underlying psychological mechanisms of depression remain unclear. This study aims to explore the influence and mechanism of childhood trauma on depression in college students, and establish a full model among these interactive factors.

METHODS

1272 college students were surveyed using the childhood trauma questionnaire (CTQ), short version of center for epidemiologic studies depression scale (CES-D), Chinese perceived stress scale (CPSS), neuroticism extraversion openness five-factor inventory (NEO-FFI), and the Cognitive Emotion Regulation Questionnaire (CERQ).

RESULTS

(1) Childhood trauma, neuroticism, stress perception, and maladaptive cognitive emotion regulation strategies were all significantly and positively correlated with depression among college students; (2) Stress perception and neuroticism act as a chain mediator between childhood trauma and depression in college students. (3) Maladaptive cognitive emotion regulation strategies play a moderating role in "childhood trauma-neuroticism-depression".

CONCLUSION

Childhood trauma increases the risk of depression in college students by affecting neuroticism and stress perception, and high levels of maladaptive cognitive emotion regulation strategies link neuroticism and enhance the effect of childhood trauma on depression in college students.

Global Prevalence of Childhood Exposure to Physical Violence within Domestic and Family Relationships in the General Population: A Systematic Review and Proportional Meta-Analysis

Efforts to identify and prevent childhood exposure to physical violence within domestic and family relationships must be underpinned by reliable prevalence estimates to ensure the appropriate allocation of resources and benchmarks for assessing intervention efficacy. We conducted a systematic review and meta-analysis of the global prevalence of childhood exposure to physical domestic and family violence separately as a victim or witness. Searches were conducted in Criminal Justice Abstracts, Embase, Scopus, PubMed, PsychInfo, and Google Scholar. Studies were included if they were peer-reviewed, published in English, had a representative sample, unweighted estimates, and were published between January 2010 and December 2022. One-hundred-and-sixteen studies comprising 56 independent samples were retained. Proportional meta-analysis was conducted to calculate the pooled prevalence for each exposure. Pooled prevalence estimates were also stratified by region and sex. The global pooled prevalence of childhood exposure to physical domestic and family violence as a victim or witness was 17.3% and 16.5%, respectively. Prevalence estimates were highest in West Asia and Africa (victim = 42.8%; witness = 38.3%) and lowest for the Developed Asia Pacific region (victim = 3.7%; witness = 5.4%). Males were 25% more likely than females to be the victim of physical domestic and family violence during childhood, while both were equally likely to have witnessed it. These findings suggest that childhood exposure to domestic and family violence is relatively common, affecting around one-in-six people by 18 years of age globally. Regional variations in prevalence estimates may reflect underlying economic conditions, cultural norms, and service availability.

Different adverse childhood experiences and adolescents' altruism: The mediating role of life history strategy

INTRODUCTION

The present study sought to investigate whether the relationship between childhood trauma, childhood socioeconomic (SES), and adolescents' altruism were mediated by their life history strategies and different adverse childhood experiences may function diversely on altruism, with two waves of data collected 6 months apart in a longitudinal design among Chinese adolescents.

METHODS

A total of 658 adolescents (Mage  = 13.51, SD = 0.73 at T1) were recruited and completed the online survey; their life history strategies were measured by the Mini-K, the Delayed of Gratification Questionnaire (DOG), and the Chinese version of the Adolescent Risk-Taking Questionnaire (ARQ-RB) together, and their altruism was collected again after six months.

RESULTS

After controlling for gender and their altruism at T1, the results showed that childhood trauma (i.e., emotional maltreatment, physical maltreatment), as well as low SES and fast life history strategy, were significantly negatively correlated with adolescents' altruism at T2. Importantly, life history strategy at T1 mediated the relationship between T1 emotional maltreatment, T1 low SES, and adolescents' altruism at T2. However, the effect of physical maltreatment on altruism was not mediated by life history strategy.

CONCLUSIONS

This study indicated that emotional maltreatment and low SES can affect adolescents' altruism by influencing the formation of adolescents' life history strategies. The findings revealed the different influences of adverse childhood experiences on adolescents' altruism, which supplied new empirical evidence for the life history theory and provided certain reference values for cultivating adolescents' altruism.

The association between childhood maltreatment and internet addiction among Chinese junior middle school students: prospective cohort study

BACKGROUND

Childhood maltreatment is associated with internet addiction, but most evidence is from retrospective studies.

AIMS

We aimed to investigate the relationship between childhood maltreatment and internet addiction through a prospective cohort design.

METHOD

In a prospective cohort study, self-reported data on childhood maltreatment (Childhood Trauma Questionnaire - Short Form) at baseline, and internet addiction (Revised Chinese Internet Addiction Scale) at baseline and 6-month follow-up, were collected online from 756 Chinese junior middle school students aged 11-15 years and residing in Changsha, Hunan Province. Demographic data and covariates such as depression, anxiety, stress (Depression, Anxiety, and Stress Scale 21) and insomnia (Athens Insomnia Scale) were also surveyed at baseline. Logistic regression analysis measured the association between childhood maltreatment and internet addiction, and gender-related differences.

RESULTS

Childhood maltreatment was prevalent in Chinese junior middle school students (37.83%), and the incidence rate of internet addiction was 9.26% at the 6-month follow-up. Emotional abuse was a significant risk factor for internet addiction (adjusted odds ratio 2.618, 95% CI 1.194-5.738; P = 0.016) in both males and females.

CONCLUSIONS

This study suggests a high prevalence of childhood maltreatment in Chinese junior middle school students, and that emotional abuse plays a significant role in internet addiction. More attention should be paid to parenting style and adolescents' mental health.

Pituitary gland volumes and stress: Results of a population-based adult sample

Early and chronic stress was reported to alter the hypothalamic-pituitary-adrenal axis functioning which regulates the secretion of cortisol. Nevertheless, few studies mainly focused on specific study populations (e.g. adolescents, pregnant women, and psychiatric patients), and researched interactive associations of pituitary volumes and single stress markers. The present study used pituitary volumes of two adult general-population cohorts of the Study of Health in Pomerania (SHIP-START-2: N = 1026, 54% Men, 30-90 years; SHIP-TREND-0: N = 1868, 53% Men, 21-82 years). In linear regression models, main effects of the pituitary volumes as well as interaction effects with childhood abuse and neglect (Childhood Trauma Questionnaire) were estimated using depressive symptoms (Beck Depression Inventory-II), and serum cortisol concentrations as outcome variables. The results of both cohorts were integrated via meta-analyses. No main effect between pituitary volumes and depressive symptoms was observed (START-2: β = -0.004 [-0.082; 0.075], p = .929; TREND-0: β = 0.020 [-0.033; 0.073], p = .466; Meta-analysis: β = 0.012 [-0.031; 0.056], p = .580). However, larger pituitary volumes were associated with more depressive symptoms in participants with more severe childhood neglect (START-2: β = 0.051 [-0.024; 0.126], p = .183; TREND-0: β = 0.083 [0.006; 0.159], p = .034; Meta-analysis: β = 0.066 [0.013; 0.120], p = .015). Further, larger pituitary volumes were associated with lower serum cortisol concentrations in participants with more severe depressive symptoms (START-2: β = -0.087 [-0.145; -0.030], p = .003; TREND-0: β = -0.053 [-0.091; -0.015], p = .006; Meta-analysis: β = -0.063 [-0.095; -0.032], p = 8.39e-05). Summarizing, larger pituitary volumes were associated with more severe psychopathological symptoms, particularly in participants reporting early life stress. This was supported by stronger associations between pituitary volumes and cortisol concentrations in participants with more severe depressive symptoms. Future studies are needed to transfer these results into developmental stages of high hormonal changes and patient samples.

Impact of childhood maltreatment on adult resilience

BACKGROUND

Previous studies suggested that childhood maltreatment is associated with poor health outcomes. While not everyone who experiences abuse as a child goes on to experience poor mental health, some traumatized people are grown to be more resilient than others. Few studies have examined the association between childhood maltreatment and adult resilience. This study aimed to determine different relationships between specific types and features of childhood maltreatment with adult resilience among Chinese with Major Depressive Disorder (MDD) and healthy controls (HCs).

METHODS

A total of 101 patients with MDD and 116 participants in the healthy control (HC) group from Zhumadian Psychiatric Hospital and its nearby communities were included in this analysis. Childhood maltreatment was assessed retrospectively using Childhood Trauma Questionnaire (CTQ). Adults' resilience was assessed by the Connor-Davidson Resilience Scale (CD-RISC). Generalized linear models were applied between childhood maltreatment (specific types and features) and resilience adjusting for covariates.

RESULTS

The total score of CD-RISC and factor scores of strength, optimism, and tenacity in the HC group were higher than those in the MDD group. CTQ total score had a negative association with optimism score among participants in MDD (β=-0.087, P < 0.001) and HC (β=-0.074, P = 0.023) groups. Higher emotional neglect (EN) score (β=-0.169, P = 0.001) and physical neglect (PN) score (β=-0.153, P = 0.043) were related to a worse optimism score in MDD group. Emotional abuse (EA) score was associated with a worse tenacity score (β=-0.674, P = 0.031) in MDD group. For participants in HC group, higher EN and PN scores were related to worse resilience scores (tenacity, strength, and optimism).

CONCLUSIONS

Patients with MDD showed lower optimism than HCs. Childhood maltreatment, especially childhood negect, independently contributed to optimism, with more severe childhood maltreatment predictive of worse performance of optimism. EA in childhood was also linked to worse tenacity in adult patients with MDD.

School-based Psychosocial interventions on mental health among Chinese rural children with traumatic experiences: a protocol using cluster randomized controlled trial

BACKGROUND

The first aim of this study is to test the effectiveness of school-based psychosocial interventions for improving mental health in rural Chinese children with traumatic experiences. The second aim is to examine which individual, family and school related factors could explain the effectiveness of school-based psychosocial interventions. Third, we will investigate whether individual, family, and school related conditions play a moderator role on the effectiveness of school-based psychosocial interventions.

METHODS

This study will conduct a cluster randomized controlled trial (RCT) in a large sample of Chinese rural children. Four rural counties in Shandong (Central China), Henan (Central China), Inner Mongolia (Northern China), and Xinjiang (Western China) will be selected as study settings from which schools will be sampled. Each sampled school will be randomly allocated either the intervention groups or a control group. Randomization will be performed by the research member who is not involved in the intervention stage. In each school students in grade 5 or higher will be recruited to ensure that approximately 50 children aged 10 to 18 years will be included. In each county, one high school, one middle school, and one primary school will be randomly chosen as the intervention group, and the other three similar schools will be chosen as control (waiting list) groups. A standardized and uniform research protocol will be applied in all intervention schools. All school social workers and psychological teachers would receive one week of in-person training following procedures. School-based psychosocial interventions included 14 group sessions for 14 consecutive weeks.

DISCUSSION

This study would develop school-based mental health promotion policy recommendations to improve Chinese rural children's mental health. This study can provide solid evidence for the promotion of school-based intervention in general.

TRIAL REGISTRATION

ChiCTR2300069405, Registered on 15 March 2023.

Associations between psychological resilience and metrics of white matter microstructure in pediatric concussion

This study investigated associations between psychological resilience and characteristics of white matter microstructure in pediatric concussion. This is a case control study and a planned substudy of a larger randomized controlled trial. Children with an acute concussion or orthopedic injury were recruited from the emergency department. Participants completed both the Connor-Davidson Resilience Scale 10 and an MRI at 72 h and 4-weeks post-injury. The association between resiliency and fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) at both timepoints were examined. We examined whether these associations were moderated by group. The association between resiliency captured at 72 h and diffusion tensor imaging metrics at 4 weeks was also investigated. Clusters were extracted using a significance threshold of threshold-free cluster enhancement corrected p < .05. A total of 66 children with concussion (median (IQR) age = 12.88 (IQR: 11.80-14.36); 47% female) and 29 children with orthopedic-injury (median (IQR) age = 12.49 (IQR: 11.18-14.01); 41% female) were included. A negative correlation was identified in the concussion group between 72 h resilience and 72 h FA. Meanwhile, positive correlations were identified in the concussion group with concussion between 72 h resilience and both 72 h MD and 72 h RD. These findings suggest that 72 h resilience is associated with white matter microstructure of the forceps minor, superior longitudinal fasciculus, and anterior thalamic radiation at 72 h post-concussion. Resilience seems to be associated with neural integrity only in the acute phase of concussion and thus may be considered when researching concussion recovery.

Worse psychological traits associated with higher probability of emotional problems during the Omicron pandemic in Tianjin, China

Background and Objectives

Individuals with specific psychological weaknesses are prone to mental problems during the coronavirus pandemic. This self-rating study assessed the combined effects of infection-related stress, resilience, worry, and loneliness on the likelihood of depression and anxiety among infected and non-infected individuals during the Tianjin Pandemic in 2022.

Methods

Individuals infected with Omicron (n = 249) and health residents (n = 415) were recruited from two hospitals and communities in Tianjin. Each respondent completed the following on-site assessment: Self-developed Scale of Demographics, Zung Self-Rating Depression Scale (SDS), Zung Self-Rating Anxiety Scale (SAS), the Connor-Davidson Resilience Scale (CD-RISC), De Jong Gierveld Scale (DJGLS), and the Penn State Worry Questionnaire (PSWQ). The respondents were categorized into depression or non-depression group by SDS scores, and anxiety or non-anxiety group by SAS scores.

Results

The overall scores of CD-RISC, DJGJLS, and PSWQ were significantly different both between the depression group and non-depression groups and between the anxiety group and non-anxiety groups. The greater likelihood of depression was associated with lower overall scores of CD-RISC and higher scores of PSWQ; the greater likelihood of anxiety was associated with higher scores of PSWQ. The likelihood of depression was also positively associated with having infection-related stress and three demographics.

Conclusions

This on-site study demonstrates the importance of specific traits in a small-scale pandemic: the worse resilience and the greater worry propensity related to the higher probability of depression, and the greater propensity of worry related to the higher probability of anxiety. Moreover, those experiencing infection-related stress, being male, living alone, and being unemployed are more likely to have depressive problems.

Relationship between childhood trauma and resilience in patients with mood disorders

BACKGROUND

Childhood trauma has lasting negative impacts on individuals' psychological functioning. However, there is limited empirical evidence on the association between childhood trauma and resilience and none examining such relationship among diverse clinical populations. This study aimed to investigate the relationship in patients with major depressive disorder, bipolar I disorder, bipolar II disorder, and a comparison group.

METHODS

In total, 787 psychiatric patients and 734 people from the general population participated in the study. The Childhood Trauma Questionnaire-Short Form and Connor-Davidson Resilience Scale were used to assess childhood trauma and resilience, respectively.

RESULTS

Individuals with childhood trauma showed lower levels of resilience in all subjects; among them, those who experienced emotional abuse and emotional neglect exhibited even stronger associations than other types of childhood trauma. There was a significant difference in the negative relationship between childhood trauma and resilience by group, where the association was more prominent in the comparison group than in MDD and BD II patient groups.

LIMITATIONS

The generalizability of our results may be limited due to unproportionate patient sample size. Also, we could not examine the causal relationship between childhood trauma and resilience.

CONCLUSION

Childhood trauma and resilience had a significantly negative association. Our results suggest that people who have experienced emotional abuse and emotional neglect should be closely assisted to develop resilience. Interventions that promote resilience should be provided to individuals predisposed to psychological risks as a result of childhood trauma.

Trajectory of suicidal ideation among medical students during the COVID-19 pandemic: the role of childhood trauma

BACKGROUND

The aim of this study was to understand the longitudinal trajectory of suicidal ideation (SI) among Chinese medical students and the role of childhood trauma (CT).

METHODS

Using a whole-group sampling method, we assessed SI in 2192 (male = 834, female = 1358) medical students on three occasions over a period of one year. The Suicidal Ideation Self-Assessment Scale (SISAS) and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess SI and CT. The growth mixture modeling (GMM) was used to classify the developmental trajectory of SI.

RESULTS

A greater number of medical students were experiencing suicidal ideation during the COVID-19 pandemic. The trajectory of SI among medical students was divided into two groups: a low risk, slowly rising group and a high risk, continuous group. The low risk, slowly rising group had a significant time effect (B = 1.57, p < 0.001) and showed a slowly increasing trend. Emotional neglect (EN), physical neglect (PN), emotional abuse (EA) and physical abuse (PA) all had significant positive predictive effects for the high risk, continuous group (B = 0.18-0.65, P < 0.01).

CONCLUSION

The trajectory of SI among medical students can be divided into a low risk, slowly rising group and a high risk, continuous group; the more EN, PN, EA and PA experienced during childhood, the more likely medical students are to develop a high risk, continuous state of SI.

The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: an emphasis on maternal mental health

BACKGROUND

Several factors can contribute to the development of postpartum depression (PPD) and negatively affect mothers' mental and physical well-being. The objective of this study was to determine the relationship between fatigue, sleep quality, resilience, and the risk of PPD development.

METHODS

A cross-sectional study was conducted using an online questionnaire distributed to mothers during their postpartum period. The risk of PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), postpartum fatigue (PPF) was assessed using the Fatigue Severity Scale (FSS), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and resilience was assessed using the Brief Resilience Scale (BRS). The Pearson correlation coefficient was calculated to determine the relationship between the study variables. Simple and multiple linear regression analyses were performed to explain the contributions of PPF, sleep quality, and resilience as independent predictors of PPD development.

RESULTS

A total of 1409 postpartum women were included in the analysis, with 75% of the participants reporting a risk of PPD, 61% reporting PPF, 97% reporting having sleep problems, and 36% being in the "low resilience level" category. In terms of correlations, the scores of FSS and the PSQI showed moderate positive relationships with the EPDS scores (r = 0.344 and r = 0.447, respectively, p = .000). The BRS scores were negatively associated with the EPDS scores (r = -0.530, p = 0.000). Fatigue, sleep quality, and resilience were predictors of depressive symptoms (β = 0.127, β = 0.262, and β = -0.393, respectively, R² = 0.37, p = 0.000). The association remained significant in the regression model after adjusting for mother's age, mother's BMI, child's age, smoking status, full-term pregnancy, having a chronic disease, and taking anti-depressant.

CONCLUSIONS

Mothers with higher levels of fatigue, poor sleep quality, and low resilience levels were at high risk of developing PPD. Healthcare providers should identify these factors and thus set better rehabilitation goals to improve overall maternal health.

Examining the Associations Between Childhood Trauma, Resilience, and Depression: A Multivariate Meta-Analysis

TOPIC OF REVIEW

Childhood trauma has been associated with increased depression; however, resilience has been found to reduce this association.

METHOD OF REVIEW

Present analyses were based on multivariate meta-analytical techniques, an extension of univariate meta-analysis. All computations were performed using the metafor package and the metaRmat package from R. Bivariate associations (r) between trauma, resilience, and depression were utilized as the pooled effect sizes.

CRITERIA FOR INCLUSION

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were coded based on the following inclusion criteria: (a) sample participants had a history of childhood trauma; (b) studies included one of the four instruments of trait resilience; (c) studies included measures of individual outcomes of depression; (d) studies were published in peer-reviewed journals, dissertations, book chapters since 2009, or provided by leading scholars who had yet to publish their data; (e) all manuscripts were written in English; and (f) studies included the Pearson Product Moment Correlation Coefficient (r) for the effect size.

CRITERIA FOR REVIEW

We systematically coded for the following items for each study: year of publication, type of report, peer-reviewed, funding, sampling strategy, sample size, gender, mean age, country of study, measure of resilience, measure depression, and measure of childhood trauma.

MAJOR FINDINGS

The pooled correlations indicate that trauma, resilience, and depression are significantly associated. There were no significant differences in symptoms of depression for high versus low reports of resilience for individuals with a history of trauma. Year of publication was a significant moderator for the associations between trauma, resilience, and depression. Resilience significantly mediated the association between trauma and depression.

Traumatic Experiences in Childhood and Maternal Depressive Symptomatology: Their Impact on Parenting in Preschool

The goal of this study is to describe and analyze the relationship between childhood trauma and depressive symptoms and its relation to the parental interactions of mothers (19-47 years) with their 3-4 year old preschool children. Parental interactions, traumatic experiences in mothers' childhood, and current depressive symptoms were measured using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO), the Childhood Trauma Questionnaire Short Form (CTQ), and the Beck Depression Inventory (BDI-I), respectively. A nonclinical sample of 81 Chilean mothers with their children was used. Results show that the presence of trauma in mothers' childhood has an impact on parenting; specifically, mothers with an emotional neglect experience showed greater difficulties in adequately promoting autonomy in their children.

The interplay between genetic variation and gene expression of the glucocorticoid receptor gene NR3C1 and blood cortisol levels on verbal memory and hippocampal volumes

The hypothalamus-pituitary-adrenal axis is the main physiological stress response system and regulating the release of cortisol. The two corticoid receptors encoded by the genes NR3C1 and NR3C2 are the main players in regulating the physiological response to cortisol. This biological system has been linked to neurocognitive processes and memory, yet the mechanisms remain largely unclear. In two independent general population studies (SHIP, total sample size > 5500), we aim to diseantangle the effects of genetic variation, gene expression and cortisol on verbal memory and memory associated brain volume. Especially for NR3C1 results exhibited a consistent pattern of direct an interactive effects. All three biological layers, genetic variation (rs56149945), gene expression for NR3C1 and cortisol levels, were directly associated with verbal memory. Interactions between these components showed significant effects on verbal memory as well as hippocampal volume. For NR3C2 such a complex association pattern could not be observed. Our analyses revealed that different components of the stress response system are acting together on different aspects of cognition. Complex phenotypes, such as cognition and memory function are regulated by a complex interplay between different genetic and epigenetic features. We promote the glucocorticoid receptor NR3C1 as a main target to focus in the context of verbal memory and provided a mechanistic concept of the interaction between various biological layers spanning NR3C1 function and its effects on memory. Especially the NR3C1 transcript seemed to be a key element in this complex system.

The Impact of School Education on Depressive Symptoms in Chinese Adolescents: a Prospective Longitudinal Study

There is a growing but limited literature on psychological distress among Chinese students, especially the impact of the COVID-19 pandemic, using a longitudinal comparison between in school and at home. This study aimed to assess the psychological status of adolescents in school and related risk and protective factors. We surveyed 13,637 adolescents before the COVID-19 outbreak (T1) and 10,216 after two months of home confinement (T2). The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms or the severity of depression among the adolescents. In addition, the Childhood Trauma Questionnaire and the Connor-Davidson Resilience Scales were also used to screen for experiences of abuse and neglect and to measure resilience in adolescents. At baseline, 22.34% reported depressive symptoms. At T2, this rate decreased to 14.86%. When adolescents were in school, age (P < .0001), gender (P < .0001), and experience of abuse (P < .0001) were risk factors, while parent-child relationship (P < .0001), and resilience (P < .0001) were protective factors for depressive symptoms. After leaving school, age and physical abuse were no longer risk factors for depression. The negative impact of school education on the mental health of adolescents in China exceeds even the impact of the pandemic and home isolation. The focus should be on those adolescents with abuse experience and poor parent-child relationships to prevent the onset of psychological and psychiatric disorders.

Mental health status of adolescents after family confinement during the COVID-19 outbreak in the general population: a longitudinal survey

Few studies have examined the psychological impact on adolescents of family confinement and infection exposure during the COVID-19 pandemic. However, these surveys lacked follow-up data to determine how the family confinement affects participants' depression and anxiety. The purpose of this study was to evaluate the psychological status and related risk and protective factors of adolescents after two months of family confinement for preventing COVID-19 in China, and compare them with baseline data. We surveyed teenagers in January 2020 before the COVID-19 outbreak (T1) and after home confinement (T2). We used the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorder (GAD) Scale and the Childhood Trauma Questionnaire (CTQ). 13,637 valid questionnaires were collected at T1, of which 22.34% reported depressive symptoms (PHQ-9 ≥ 10) and 14.42% reported anxiety symptoms (GAD-7 ≥ 10). At T2, the rates decreased to 14.86 and 7.44%, respectively (all P < 0.0001). Of the adolescents, 223 reported potential risk of exposure to COVID-19. We then compared them to the 9639 non-risk adolescents using a propensity score matching analysis. The adolescents with potential exposure risk had higher rates of depression (26.91 vs 15.32%, P = 0.0035) and anxiety (14.80 vs 7.21%, P = 0.01) than risk-free adolescents. Among adolescents with an exposure risk, psychological resilience was protective in preventing depression and anxiety symptoms, while emotional abuse, a poor parent-child relationship were risk factors. Long-term home confinement had minimal psychological impact on adolescents, but COVID-19 infection rates accounted for 50% of the variance in depression and anxiety among adolescents even with low community rates.

Abnormal brain gray matter volume in patients with major depressive disorder: Associated with childhood trauma?

BACKGROUND

Patients with major depressive disorders (MDD) have abnormalities in the frontal-limbic structures of the brain. Childhood trauma is a risk factor for both structural brain alterations and MDD. However, the relationships among the three have not been confirmed.

METHODS

Sixty-four patients with MDD and sixty-one healthy controls (HC) were checked by using MRI, the Hamilton Depression Scale (HAMD) and Childhood Trauma Questionnaire (CTQ). Voxel-based morphometry (VBM) was used to compare gray matter volume (GMV) differences between the two groups. Moreover, partial correlation and mediation analyses were conducted to test for potential associations between CTQ scores, different GMV, and clinical variables.

RESULTS

Compared to the HC group, the MDD patients showed decreased GMV in the right middle frontal gyrus (rMFG) and right precentral gyrus (rPreCG). In the patient group, reduced GMV in rMFG was associated with CTQ scores (r = -0.30, P = 0.019) and HAMD scores (r = -0.53, P < 0.001). Finally, in the patient group, mediation analysis revealed that the indirect effect of rMFG GMV in CTQ scores and HAMD scores was 0.115 and the proportion of indirect effect to total effect was 23.86%.

LIMITATIONS

This study used a cross-sectional collection, and it is unclear whether at the longitudinal level the brain GMV mediates the relationship between childhood trauma and depression.

CONCLUSIONS

Abnormalities in the frontal GMV were presented in the MDD patients. It is possible that childhood traumatic experiences cause inefficient GMV and ultimately lead to an increased susceptibility to depression.

APOE ε4 in Depression-Associated Memory Impairment-Evidence from Genetic and MicroRNA Analyses

(1) Background: The aim of this study was to replicate a reported interaction between APOE ε4 status and depression on memory function in two independent, nondemented samples from the general population and to examine the potential role of circulating plasma miRNAs. (2) Methods: The impact of the APOE ε4 allele on verbal memory and the interaction with depression is investigated in two large general-population cohorts from the Study of Health in Pomerania (SHIP, total n = 6286). Additionally, biological insights are gained by examining the potential role of circulating plasma miRNAs as potential epigenetic regulators. Analyses are performed using linear regression models adjusted for relevant biological and environmental covariates. (3) Results: Current depression as well as carrying the APOE ε4 allele were associated with impaired memory performance, with increasing effect for subjects with both risk factors. In a subcohort with available miRNA data subjects with current depressive symptoms and carrying APOE e4 revealed reduced levels of hsa-miR-107, a prominent risk marker for early Alzheimer's Disease. (4) Conclusions: Our results confirm the effect of depressive symptoms and APOE ε4 status on memory performance. Additionally, miRNA analysis identified hsa-miR-107 as a possible biological link between APOE ε4, depressive symptoms, and cognitive impairment.

Psychological resilience and daily stress mediate the effect of childhood trauma on depression

OBJECTIVE

Childhood trauma (CT) is a well-recognized distal risk factor for depression. Previous studies suggested that the psychological mechanism of the impact of childhood trauma on depression may be attributed to some mediators such as daily stress and psychological resilience. This study aimed to assess how daily stress and resilience affect the relationship between childhood trauma and depression in adult clinical context.

METHOD

In this cross-section survey, a total of 569 clinical patients with psychological disorders completed a series of psychological scales such as the Childhood Trauma Questionnaire (CTQ), the Center for Epidemiologic Studies Depression Scale (CESD), the Perceived Stress Scale (PSS) and Connor-Davidson Resilience Scale (CD-RISC). To show the relationship among childhood trauma, psychological resilience, daily stress and depression, structural equation modeling (SEM) was performed.

RESULTS

The results indicated that psychological resilience and daily stress partially mediated the relationship between childhood trauma and depressive symptoms. Childhood trauma not only exerted direct effect on depressive symptoms, but also had indirect effect through the mediation pathway (resilience → daily stress) on depressive symptoms. The chain mediation pathway through resilience and daily stress was weighted 43.31%.

CONCLUSIONS

The study provides novel evidence on the underlying process between childhood trauma and depression. The distal factor childhood trauma can influence the latter depression by the chain effect of psychological resilience and daily stress. Therefore, some clinical interventions to improve psychological resilience to carry off daily stress are the way to reduce the impact of childhood trauma on depression.

"Time Does Not Heal All Wounds": Sexual Victimisation Is Associated with Depression, Anxiety, and PTSD in Old Age

Sexual violence (SV) has an important impact on mental health. Childhood sexual abuse is linked to internalising disorders in later life. In older adults, SV occurs more often than previously believed. Moreover, health care workers lack the skills to address SV in later life. Studies researching the mental health impact of lifetime SV, i.e., SV during childhood, adulthood, and old age, are lacking. Between July 2019 and March 2020, 513 older adults living in Belgium participated in structured face-to-face-interviews. Selection occurred via a cluster random probability sampling with a random walk finding approach. Depression, anxiety, and posttraumatic stress syndrome (PTSD) were measured using validated scales. Participants were asked about suicide attempts and self-harm during their lifetime and in the past 12 months. SV was measured using behaviourally specific questions based on a broad SV definition. We found rates for depression, anxiety, and PTSD of 27%, 26%, and 6% respectively, while 2% had attempted suicide, and 1% reported self-harm in the past 12 months. Over 44% experienced lifetime SV and 8% in the past 12 months. Lifetime SV was linked to depression (p = 0.001), anxiety (p = 0.001), and PTSD in participants with a chronic illness/disability (p = 0.002) or no/lower education (p < 0.001). We found no link between lifetime SV and suicide attempts or self-harm in the past 12 months. In conclusion, lifetime SV is linked to mental health problems in late life. Tailored mental health care for older SV victims is necessary. Therefore, capacity building of professionals and development of clinical guidelines and care procedures are important.

The Impact of Resilience, Alexithymia and Subjectively Perceived Helplessness of Myocardial Infarction on the Risk of Posttraumatic Stress

The aim of this study was to investigate the impact of resilience, alexithymia and the subjectively perceived severity (fear of death, pain intensity, helplessness) of myocardial infarction (MI) on posttraumatic symptom severity (PTSS) after MI. Patients were assessed with the Posttraumatic Diagnostic Scale (PDS), Resilience Scale (RS-11) and Toronto Alexithymia Scale (TAS-20). Subjectively perceived severity of MI was measured with three items on a 10-point Likert scale. To test our hypothesis, we applied Pearson correlations as well as multiple hierarchical linear regression analyses. A higher resilience score was significantly associated with lower (r =  - .39, p < .001) PTSS. Higher scores of alexithymia (r = .38, p < .01) and subjectively perceived helplessness (r = .42, p < .001) were associated with higher PTSS. Multiple hierarchical linear regression analyses revealed that resilience, the TAS-20 subscale difficulty identifying feelings (DIF) and especially subjectively perceived helplessness were independent significant predictors for the PTSS, adjusted R² = .29, F(5, 102) = 9.57, p < .001. Our results suggest that resilience reduces the PTSS whereas alexithymia and subjectively perceived helplessness increase the risk. Especially the subjectively perceived helplessness explains a high degree of variance of PTSS and should be assessed to hindering further mental health burden.

Association of child maltreatment and bullying victimization among Chinese adolescents: The mediating role of family function, resilience, and anxiety

BACKGROUND

Among adolescents, child maltreatment is linked to being bullied at school. Nevertheless, little is known about the mediating mechanisms underlying this association. Therefore, our research aimed to explore and evaluate the potential mediators of the relationship between child maltreatment and bullying victimization among Chinese adolescents.

METHODS

From October to December 2020, a population-based cross-sectional survey was conducted among 6247 adolescents (3401 males, 2846 females) in Anhui Province, China. The subjects of the survey were elementary and middle school students from grades 4 to 9. The data were collected through self-report questionnaires. Pearson correlation and linear regression were used to examine the relationships among child maltreatment, bullying victimization, family function, resilience, and anxiety. Structural equation modeling (SEM) was employed to conduct mediation analyses.

RESULTS

The results indicated that child maltreatment positively predicted the later bullying victimization of adolescents. Resilience and anxiety were each shown to separately mediate this relationship. Moreover, the sequential mediating effects of family function, resilience, and anxiety also mediated the predictive effect of child maltreatment on bullying victimization.

CONCLUSIONS

Resilience and anxiety were both shown to be important independent mediators for the relationship between child maltreatment and bullying victimization. Furthermore, the combined mediating effects of family function, resilience, and anxiety were also of great significance. These findings provide additional evidence that family and individual factors are critical to understanding bullying victimization. Effective prevention and intervention strategies for school bullying should target family and individual vulnerabilities in adolescents.

Childhood trauma and personality explain more variance in depression scores than sociodemographic and lifestyle factors - Results from the BiDirect Study

OBJECTIVE

Sociodemographic and lifestyle factors, childhood adversities, and personality aspects have been identified as contributing to the onset and course of depression. However, only few studies examined all aspects concomitantly in different populations. This was the objective of the study presented here.

METHODS

The BiDirect Study includes three distinct cohorts: Cross-sectional data for 670 patients with depression (DEP), 283 patients with cardiovascular disease (CVD), and 787 population controls (POP) were available for the present analysis. Participants answered interviews and filled in questionnaires assessing depression details, childhood trauma, the Big Five personality traits, trait resilience as well as socioeconomic and lifestyle factors. Descriptive statistics and hierarchical linear regression analyses were employed to identify those factors, which contributed significantly to the explanation of depression severity scores (assessed by the Center for Epidemiologic Studies Depression Scale, CESD).

RESULTS

In all three cohorts, the psychological variables explained most variance in depression scores (35-44%), while sociodemographic and lifestyle factors explained only very little variance (1-2%). When all postulated predictors were entered in the same regression model, higher neuroticism and lower resilience scores were associated with higher depression severity levels in all three cohorts, while higher childhood trauma proved significant in the cardiovascular and population cohort.

CONCLUSION

Childhood trauma, neuroticism, and low resilience are significantly associated with depression in different populations. Although a considerable part of the variance in depression severity levels was explained by the variables studied here, more research on the impact of lifestyle and social factors on depression is needed.

Coping strategies, optimism, and resilience factors associated with mental health outcomes among medical residents exposed to coronavirus disease 2019 in Qatar

OBJECTIVE

The aim of this study is to examine the association between coping strategies, resilience, optimism and different mental health outcomes like stress, anxiety, and depression among the medical residents' during the COVID-19 pandemic, with consideration of different factors like seniority, frontliner, gender, and coping style.

METHODS

An electronic survey was sent to all medical residents in Qatar. Depression, anxiety, and stress were assessed by the DASS-21. Professional quality of life was measured by the ProQOL scale. The coping mechanisms were assessed with the Brief-COPE, and resilience was measured by the Brief Resilience Scale.

RESULTS

The most commonly used coping strategies were acceptance, religion, and active coping. The avoidant coping style scores were higher among junior residents (p = .032) and non-COVID-19 frontliners (p = .039). Optimism LOT-R score was higher in senior than in junior residents (p < .001). Lower avoidant coping scores, higher optimism, and higher resilience were associated with lower stress, anxiety, and depressive symptoms.

CONCLUSION

It seems that avoidant coping styles can exacerbate depressive, anxiety, and stress symptoms in medical residents amidst the COVID-19 pandemic. Strategies promoting optimism, resilience, and approach coping styles can decrease the mental health burden of the pandemic on medical residents.

The relation between childhood adversity and adult obesity in a population-based study in women and men

Childhood maltreatment has been shown to relate to adult obesity. In this epidemiological study, we investigate the association between childhood maltreatment and waist-to-height-ratio (WHtR) in a sample of the German adult population, comprising of N = 2936 participants. WHtR, an indicator for risk of obesity, was the primary outcome. Childhood maltreatment was assessed by the Childhood Trauma Screener (CTS), which assesses emotional and physical neglect, abuse as well as sexual abuse. Cohort-data were harmonized and analyzed within DataSHIELD. We used multivariable regression models to estimate the association of childhood maltreatment and WHtR at different levels of adjustments for potential confounders. Overall childhood maltreatment was associated with a higher WHtR in both sexes (women: p = 0.004, men: p < 0.001); associations were no longer significant in women after adding socioeconomic variables, but remained significant in men (p = 0.013). Additionally, we were able to identify sex specific patterns for childhood maltreatment predicting the WHtR. Emotional neglect and abuse had stronger impacts on the WHtR in women than in men, whereas physical neglect and abuse had stronger impacts in men. To our knowledge, this is the first comprehensive population-based study testing various types of childhood maltreatment with WHtR in sex-, region- and weight-stratified analyses. Future studies in clinical populations are warranted to examine U-shaped correlations between increased WHtR and childhood maltreatment.

Resilience Following Child Maltreatment: Definitional Considerations and Developmental Variations

Resilience following childhood maltreatment has received substantial empirical attention, with the number of studies on this construct growing exponentially in the past decade. While there is ample interest, inconsistencies remain about how to conceptualize and assess resilience. Further, there is a lack of consensus on how developmental stage influences resilience and how protective factors affect its expression. The current systematic review uses a developmental lens to synthesize findings on resilience following child maltreatment. Specifically, this article consolidates the body of empirical literature in a developmentally oriented review, with the intention of inclusively assessing three key areas-the conceptualization of resilience, assessment of resilience, and factors associated with resilience in maltreatment research. A total of 67 peer-reviewed, quantitative empirical articles that examined child maltreatment and resilience were included in this review. Results indicate that some inconsistencies in the literature may be addressed by utilizing a developmental lens and considering the individual's life stage when selecting a definition of resilience and associated measurement tool. The findings also support developmental variations in factors associated with resilience, with different individual, relational, and community protective factors emerging based on life stage. Implications for practice, policy, and research are incorporated throughout this review.

Gender differences in the relationships between different types of childhood trauma and resilience on depressive symptoms among Chinese adolescents

Growing studies have paid attention to the relationships between childhood trauma, resilience and depressive symptoms. Depression is more common in girls, while gender differences in these associations have been rarely studied. Yet the study will be beneficial for prevention and intervention of depression in adolescents. The aim of this study is to examine gender differences in the effects of different types of childhood trauma and resilience on depressive symptoms. Data was collected from 6510 students (3408 males, aged 10-17 years) in Wuhan, Hubei, China from 2015 to 2016. Participants completed a self-report questionnaire assessing childhood trauma, resilience, and depressive symptoms. Multiple regression analysis was used to determine gender differences in the relationships between childhood trauma, resilience and depressive symptoms. We found that childhood trauma was positively related to depressive symptoms for both genders, but the relationship in females was stronger than in males. No significant gender difference was found in the independent effect of resilience to depressive symptoms. Resilience moderated the effects of emotional abuse, physical abuse and sexual abuse on depressive symptoms in both males and females. However, the interaction effect of resilience with emotional abuse on depressive symptoms was stronger in females compared to males. Our findings revealed gender differences in the links between childhood trauma and depressive symptoms among adolescents, and the interaction effect of resilience and childhood emotional abuse on depressive symptoms was gender-specific. These provide the basis for gender-special prevention and intervention measures for depressive symptoms in adolescents.

Is there a diagnosis-specific influence of childhood trauma on later educational attainment? A machine learning analysis in a large help-seeking sample

BACKGROUND

Childhood adversities and trauma (CAT) are associated with poor functional outcome. However, the influence of the single CAT aspects on the risk of a poor functional outcome within different mental disorders has not been investigated so far. Our aims were (i) to predict individual functional outcome based on CAT (ii) to examine whether the prediction power differs within different diagnostic groups (clinical high-risk for psychosis (CHR), psychosis, affective disorders, anxiety disorders) (iii) to compare the specific patterns of CAT experiences, influencing functional outcomes in these groups.

METHOD

Clinical data of 707 patients (mean age: 25.09 years (SD = 5.6), 65.5% male) of the Cologne Early Recognition and Intervention Center were assessed with the Trauma And Distress Scale. Functional outcome was estimated by the Social and Occupational Functioning Assessment Scale and school educational attainment. Using machine learning, we generated individualized models to predict functional outcome and to identify specific CAT patterns.

RESULTS

Across the entire sample, the best prediction for the functional outcome achieved a balanced accuracy (BAC) of 0.6. After splitting into the single diagnostic groups, an improvement with best results in the psychosis group (BAC = 0.70) was observed. Considering specific CAT patterns, the most predictive items depicted a positive and caring environment - or the absence of these, a positive self-image and experiences of bullying.

CONCLUSIONS

Our results indicated that CAT was differentially associated with functional outcome in the various mental disorders. Thus, the importance of mediating variables, that might explain the interindividual differences in the vulnerability to CAT, like resilience factors, appeared to be crucial.

Patterns of Depression and Resilience in Children and Adolescents Exposed to an Earthquake: A Latent Profile Analysis

OBJECTIVE

Depression and resilience are different psychological outcomes caused by experiencing traumatic events. We aimed to 1) explore heterogeneity patterns of co-occurrence between depression symptoms and resilience among children and adolescents exposed to an earthquake and 2) assess covariates (trauma exposure, sex, age, ethnicity, and sleep quality) in identifying the best fitting solution.

METHODS

Latent profile analysis (LPA) was used to examine patterns of self-reported depression and resilience in an epidemiological sample of 2,887 Chinese youth survivors 1 year after the Lushan earthquake.

RESULTS

A suitable 3-class model were identified, which are mild depression/high resilience (65.0%), severe depression/high resilience (22.1%), and severe depression/low resilience (12.9%). Trauma exposure, demographic characteristics and sleep state can be used to identify the different latent classes.

CONCLUSION

Our results contribute to understanding the heterogeneous coexisting patterns of depression and resilience and provide suggestions for identifying high-risk youth survivors and offering effective interventions.

Association between Childhood Trauma and Suicidal Behavior in the General Population

This study aimed to investigate the associations between various types of childhood trauma and suicidal behavior in the general population in South Korea. This mental health survey included a total of 1,490 general citizens living in a metropolitan South Korean city who completed a questionnaire that assessed respondents' histories of childhood trauma before the age of 12 years, including bullying victimization, emotional abuse, sexual abuse, and physical abuse, as well as suicidal behavior, including current suicidal ideation and histories of suicide planning and attempts. The following psychiatric scales were administered: Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (R-SES), Connor-Davidson Resilience Scale (CD-RISC), Perceived Stress Scale (PSS), and visual analogue scale of EuroQol 5D (EQ-5D). Participants who experienced any childhood trauma had significantly higher HADS and PSS scores, and significantly lower EQ-5D scores. Additionally, participants with any type of childhood trauma were significantly more likely to have current suicidal ideation and histories of planned and attempted suicide. Multivariate analyses adjusted for confounding variables indicated that bullying victimization and sexual abuse were associated significantly with all types of suicidal behavior. Physical abuse was associated significantly with histories of suicide planning and attempts. The present findings showed that any type of childhood trauma was associated with higher levels of suicidality, anxiety, depression, and perceived stress, as well as lower health-related quality of life, in the general population. In particular, associations between childhood trauma and suicidality were identified after adjustment for confounding variables.

The Mediating Role of Resilience and Social Support on the Relationship Between Childhood Neglect and Adult Well-Being

Childhood neglect has a lifelong negative impact on the individual's physical health and well-being and is a risk for psychopathology. The main purpose of this study was to examine the relationship between child neglect, resilience, social support, and well-being. Data were collected from 450 women. A structural equation model was designed and tested to determine the correlations between the variables affecting well-being. The results revealed that the more women were neglected during childhood, the lower they perceived social support and the lower their resilience and well-being. Additionally, there was a significant relationship between resilience and well-being, whereas there was no significant relationship between social support and well-being. The findings show that neglect directly affects well-being in adulthood in the negative direction.

Depression in Children and Adolescents on the Qinghai-Tibet Plateau: Associations with Resilience and Prosocial Behavior

Depression in children and adolescents has become a serious public health problem worldwide. The objectives of this study were twofold: first, to investigate the status of depression among children and adolescents on the Qinghai-Tibet Plateau, the highest plateau in the world, with an average altitude of more than 4200 m (13,776 feet), and second, to examine the associations among prosocial behavior, resilience, and depression. A cross-sectional study was conducted among children and adolescents from Yushu Prefecture on the Qinghai-Tibet Plateau. A total of 11,160 participants aged 10–17 years (M_age = 14.34 years, SD = 1.77; 51.4% girls) were included. Self-reported depression, resilience, and prosocial behavior were assessed. The prevalence of depression was 29.2% in the current study. Higher levels of prosocial behavior were significantly associated with lower levels of depression (β = −0.25, p < 0.001). Furthermore, resilience significantly moderated the relationship between prosocial behavior and depression (β = −0.08, p < 0.001); that is, resilience enhanced the protective role of prosocial behavior in depression. These findings indicate that resilience may play an important role in the associations between prosocial behavior and depression, which suggests that improving resilience is essential for the prevention and intervention of depression among children and adolescents on the Qinghai-Tibet Plateau.

Vitamin D moderates the interaction between 5-HTTLPR and childhood abuse in depressive disorders

A complex interplay between genetic and environmental factors determines the individual risk of depressive disorders. Vitamin D has been shown to stimulate the expression of the tryptophan hydroxylase 2 (TPH2) gene, which is the rate-limiting enzyme for serotonin production in the brain. Therefore, we investigate the hypothesis that serum vitamin D levels moderate the interaction between the serotonin transporter promotor gene polymorphism (5-HTTLPR) and childhood abuse in depressive disorders. Two independent samples from the Study of Health in Pomerania (SHIP-LEGEND: n = 1 997; SHIP-TREND-0: n = 2 939) were used. Depressive disorders were assessed using questionnaires (BDI-II, PHQ-9) and interview procedures (DSM-IV). Besides serum vitamin D levels (25(OH)D), a functional polymorphism (rs4588) of the vitamin D-binding protein is used as a proxy for 25(OH)D. S-allele carriers with childhood abuse and low 25(OH)D levels have a higher mean BDI-II score (13.25) than those with a higher 25(OH)D level (9.56), which was not observed in abused LL-carriers. This significant three-way interaction was replicated in individuals with lifetime major depressive disorders when using the rs4588 instead of 25(OH)D (p = 0.0076 in the combined sample). We conclude that vitamin D relevantly moderates the interaction between childhood abuse and the serotonergic system, thereby impacting vulnerability to depressive disorders.

Prevalence and correlates of major depressive disorder: a systematic review

OBJECTIVES

Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD.

METHODS

A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018.

RESULTS

Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies.

CONCLUSIONS

MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder's prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.

Association between childhood trauma and depression: A moderated mediation analysis among normative Chinese college students

BACKGROUND

Childhood trauma is a critical risk factor for depression. Many studies have investigated the pathway between childhood trauma and depression, especially the mediating or moderating effects of neuroticism or resilience, but the results were inconsistent and there was no full model of these interactive factors. In addition, high prevalence of depression existed in normative college students, and few studies focused on their pathway between childhood trauma and depressive scores. Therefore, this study intended to examine the relationships among childhood trauma, resilience, neuroticism and depressive scores in normative college students.

METHODS

Normative college students (n = 404) aged 18-22 years were recruited as participants from universities in Guangzhou in 2019. The participants were asked to complete four self-report questionnaires, including the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Conner-Davidson Resilience Scale (CD-RISC), NEO-Five Factor Inventory (NEO-FFI) and the Beck Depression Inventory-II (BDI-II).

RESULTS

Results revealed that the effect of childhood trauma on depressive scores in normative college students was mediated by neuroticism. In addition, resilience moderated the association between childhood trauma and neuroticism.

CONCLUSIONS

This study helps to elucidate the mechanism that underlined the pathway between childhood trauma and depressive scores in normative college students. These findings may give indications of developing measures to strengthen resilience and lower neuroticism in normative college students with childhood traumatic experiences.

Childhood maltreatment and impact on clinical features of major depression in adults

OBJECTIVES

This study examined: 1) the prevalence of childhood maltreatment (CMT) in individuals with chronic and/or recurrent depression, 2) the association between CMT and depressive symptoms, 3) the link between CMT and worse clinical presentation of depression, 4) the effects of accumulation of different types of CMT, and 5) the relationship between the age at CMT and depression.

METHODS

We analyzed the baseline data of 663 individuals from the CO-MED study. CMT was determined by a brief self-reported questionnaire assessing sexual abuse, emotional abuse, physical abuse, and neglect. Correlational analyses were conducted.

RESULTS

Half of the sample (n = 331) reported CMT. Those with CMT had higher rates of panic/phobic, cognitive and anhedonic symptoms than those without CMT. All individual types of maltreatment were associated with a poorer clinical presentation including: 1) earlier MDD onset; 2) more severe MDD, 3) more suiccidality, 4) worse quality of life, and functioning, and 5) more psychiatric comorbidities. Clinical presentation was worse in participants who reported multiple types of CMT.

CONCLUSIONS

In chronic and/or recurrent depression, CMT is common, usually of multiple types and is associated with a worse clinical presentation in MDD. The combination of multiple types of CMT is associated with more impairment.

Animal models built for women's brain health: Progress and potential

Women and men have different levels of risk for a variety of brain disorders. Despite this well-known epidemiological finding, preclinical work utilizing animal models has historically only included male animals. The policies of funders to require consideration of sex as a biological variable has shifted the momentum to include female animals in preclinical neuroscience and to report findings by sex. However, there are many biological questions related to brain health that go beyond sex differences and are indeed specific to women. Here, the focus is on why animal models should be utilized in the pursuit of understanding women's brain health, a brief overview of what they have provided thus far, and why they still hold tremendous promise. This review concludes with a set of suggestions for how to begin to pursue translational animal models in a way that facilitates rapid success and harnesses the most powerful aspects of animal models.

Resilience as a mediator factor in the relationship between childhood trauma and mood disorder: A community sample of young adults

BACKGROUND

Studies on the field of mood disorders has mainly focusing on the risk factors associated to develop the illness or the clinical factors associated with the clinical progression. Less attention was given to factors such as resilience that may be associated with better outcomes in the course of mood disorders. In this study, we assessed the mediation effect of resilience on the relationship between childhood trauma and mood disorders, as well as the severity of depressive symptoms in a population-based sample.

METHODS

This is a cross-sectional study with a community sample of young adults with bipolar disorder (BD), major depressive disorder (MDD), and community controls without any mood disorder. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The severity of depressive symptoms was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and to assess the resilience was used the Resilience Scale (RS-25).

RESULTS

All subtypes of trauma were associated with both MDD and BD, however, only physical and emotional abuse differentiated BD from MDD subjects. Bootstrapping-enhanced mediation analyses indicated that resilience partly mediated the association of childhood trauma to both mood disorder and severity of depression.

LIMITATION

The employed mediation analyses are cross-sectional in nature, which limits any firm conclusions regarding causality.

CONCLUSIONS

The findings support the clinical assumption that resilient subjects may be partly protected against the detrimental long-term effects of childhood trauma. This study provides important information regarding the relationships among childhood trauma, resilience, and mood disorder.

Resilience and cortical thickness: a MRI study

Resilience is defined as the psychological resistance which enables the processing of stress and adverse life events and thus constitutes a key factor for the genesis of psychiatric illness. However, little is known about the morphological correlates of resilience in the human brain. Hence, the aim of this study is to examine the neuroanatomical expression of resilience in healthy individuals. 151 healthy subjects were recruited and had to complete a resilience-specific questionnaire (RS-11). All of them underwent a high-resolution T1-weighted MRI in a 3T scanner. Fine-grained cortical thickness was analyzed using FreeSurfer. We found a significant positive correlation between the individual extent of resilience and cortical thickness in a right hemispherical cluster incorporating the lateral occipital cortex, the fusiform gyrus, the inferior parietal cortex as well as the middle and inferior temporal cortex, i.e., a reduced resilience is associated with a decreased cortical thickness in these areas. We lend novel evidence for a direct linkage between psychometric resilience and local cortical thickness. Our findings in a sample of healthy individuals show that a lower resilience is associated with a lower cortical thickness in anatomical areas are known to be involved in the processing of emotional visual input. These regions have been demonstrated to play a role in the pathogenesis of stress and trauma-associated disorders. It can thus be assumed that neuroanatomical variations in these cortical regions might modulate the susceptibility for the development of stress-related disorders.

Psychological resilience, depression, anxiety, and somatization symptoms in response to COVID-19: A study of the general population in China at the peak of its epidemic

Rationale

Psychological resilience is characterized as the ability to respond to extreme stress or trauma or adverse experience successfully. While the relation between public emergencies and psychological distress is well known, research on therelationship between psychological resilience and mental health is very limited during the outbreak of public health emergencies.

Objective

This research investigated the relationship between psychological resilience and mental health (depression, anxiety, somatization symptoms) among the general population in China.

Method

Psychological resilience, depression, anxiety, and somatization symptoms of 1770 Chinese citizens were investigated during the epidemic peak of coronavirus disease 2019 (COVID-19) (23rd February 2020 to 2nd March 2020). The analyses were done through the Connor-Davidson Resilience Scale (CD-RISC), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) scale, and the Patient Health Questionnaire-15 (PHQ-15) scale.

Results

The prevalence of depression, anxiety, somatization symptoms was found to be 47.1%, 31.9%, 45.9%, respectively, among all participants. From them, 18.2% showed moderate to severe symptoms of depression, 8.8% showed moderate to severe symptoms of anxiety, and 16.6% showed moderate to severe symptoms of somatization. Psychological resilience was negatively correlated with depression (standardized β = −0.490, P < 0.001), anxiety (standardized β = −0.443, P < 0.001), and somatization symptom scores (standardized β = −0.358, P < 0.001), while controlling for confounding factors. Analysis of the three-factor resilience structure showed that strength and tenacity were correlated with depression (standardized β = −0.256, P < 0.001; standardized β = −0.217, P < 0.001), anxiety (standardized β = −0.268, P < 0.001; standardized β = −0.147, P < 0.001), and somatization symptoms (standardized β = −0.236, P < 0.001; standardized β = −0.126, P < 0.01).

Conclusions

Our results suggest that there is a high prevalence of psychological distresses among the general population at the peak of the COVID-19 epidemic in China, which is negatively correlated with resilience. Psychological resilience represents an essential target for psychological intervention in a public health emergency.

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Investigated mental health and resilience in response to COVID-19.

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The study took place at the peak of the COVID-19 epidemic in China.

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In total, 18.2% had depression, 8.8% had anxiety, and 16.6% had somatic symptoms.

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Resilience negatively correlated with depression, anxiety, and somatic symptoms.

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Resilience represents an essential target for psychological interventions.

Interaction between FKBP5 polymorphisms and childhood trauma on depressive symptoms in Chinese adolescents: The moderating role of resilience

BACKGROUND

Previous gene-environment studies on depression have examined the interaction between FKBP5 gene and childhood trauma, but the results are inconsistent and few studies have focused on Asian adolescents. Psychological resilience may explain for the inconsistency. We examined the interaction between FKBP5 gene and childhood trauma on depressive symptoms in Chinese adolescents, and firstly explored the moderating role of resilience in the relationship.

METHODS

This study comprised 942 participants (448 males, 47.6%) randomly recruited from four senior schools in Wuhan, Hubei of China. Depressive symptoms, childhood trauma, and resilience were respectively evaluated by the Center for Epidemiological Studies Depression Scale (CES-D), the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-RISC). Three potentially functional FKBP5 polymorphisms were selected for genotyping.

RESULTS

Participants carrying minor alleles of FKBP5 polymorphisms (rs3800373, rs1360780, and rs4713916) and a haplotype derived from these variants displayed higher CES-D scores when exposed to childhood physical abuse after adjusting for demographic characteristics and resilience (all P < 0.01). The three-way interactions of FKBP5 SNPs, physical abuse, and resilience on depressive symptoms all yielded statistical significance after adjusting for demographic characteristics (β = -0.282 to -0.236; all P < 0.001).

LIMITATIONS

Cross-sectional design, self- reported measurements and limited genotyped FKBP5 polymorphisms.

CONCLUSION

FKBP5 variants in combination with childhood physical abuse may increase more pronounced depressive symptoms among Chinese adolescents, while resilience plays a moderating role in the associations. Future research to examine the exact mechanism of resilience in these associations is needed.

Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire

BACKGROUND

Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.

OBJECTIVE

We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.

PARTICIPANTS AND SETTING

192 unique samples consisting of 68,830 individuals.

METHODS

We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.

RESULTS

We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.

CONCLUSIONS

These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.