Family functioning and 1-year prognosis of first-episode major depressive disorder

The mediation and interaction effects of Internet addiction in the association between family functioning and depressive symptoms among adolescents: A four-way decomposition

INTRODUCTION

Previous studies have demonstrated that both family dysfunction and internet addiction (IA) are associated with a higher risk of adolescent depression. However, no study has yet investigated the mechanisms involved. This study aims to explore the mediation and interaction roles of internet addiction (IA) between family functioning and depressive symptoms among adolescents in rural China.

METHODS

A multi-stage, stratified cluster, and random sampling was conducted among 3343 adolescents in rural China from October 27 to November 6, 2020. Depressive symptoms, IA, and family functioning were assessed using the Epidemiologic Studies Depression Scale (CESD), the Internet Addiction Test (IAT), and the Family Adaptation Partnership Growth Affection and Resolve Index (APGAR), respectively. Correlation analysis was performed by binary logistic regression. The study employed a four-way decomposition method to explore the potential mechanisms of family functioning on depressive symptoms.

RESULTS

The results indicated that family functioning and IA were associated with adolescents' depressive symptoms. The interaction between family functioning and IA accounted for 74 % of the association between family functioning and depression symptoms, while direct effects accounted for 24 %. The "proportion eliminated" (76.11 %) was substantially larger than "proportion mediated" (7.36 %).

LIMITATIONS

The cross-sectional design limited to identify the causal relationship among the variables.

CONCLUSIONS

We found that family dysfunction synergizes with IA to contribute to the high risk of adolescent depression. Prioritizing at preventing IA in adolescence could be an effective way to mitigate the adverse effects of family dysfunction on depression.

Associations of recent stressful life events with anxiety symptoms among Chinese adolescents with a consideration of family functioning

Background: The association between stressful life events (SLEs) and adolescent anxiety symptoms has been extensively studied, but the specific impacts of different SLEs domains remain inconclusive. Moreover, limited research has examined the role of family functioning in these associations.Objective: This study aimed to investigate the associations between various recent SLEs and adolescent anxiety symptoms and explore the role of family functioning.Methods: Data were obtained from the second phase of the Longitudinal Study of Adolescents' Mental and Behavioral Well-being Research in Guangzhou, China. A total of 10,985 students (51.9% boys; mean [SD] age, 15.3 [1.5] years) from forty middle schools participated in the study in 2022 and completed a self-report questionnaire assessing anxiety symptoms, SLEs, and family functioning using the Generalized Anxiety Disorder-7 (GAD-7), Adolescent Self-rating Life Events Checklist (ASLEC; including five subscales: interpersonal stress, academic stress, punishment-related stress, loss-related stress, and adaptation-related stress), and the adapted Chinese version of the Family Assessment Device (FAD), respectively. Linear mixed-effects models were performed and the moderation role of family functioning was also examined.Results: The fully adjusted model revealed that a 1-SD increase in the overall ASLEC score was associated with higher levels of anxiety symptoms (β = 2.23, 95%CI: 2.15-2.32). Among various SLEs domains, the academic domain shows the most significant association (β = 2.25, 95%CI: 2.17-2.33). Family functioning exerted an independent protective influence on anxiety symptoms, with each 1-SD increase in FAD scores negatively associated with anxiety symptoms (β = -2.11, 95%CI: - 2.29 to - 1.93) in the adjusted model. Moreover, family functioning significantly buffered the impacts of overall SLEs and each domain, except for adaptation-related SLEs, on anxiety symptoms.Conclusion: Higher recent SLEs levels were associated with increased anxiety symptoms among adolescents, with academic SLEs showing the greatest association. Positive family functioning had both direct and buffering influences on anxiety symptoms.

Relationship between family function, self-perceived burden and loneliness in patients with type 2 diabetes mellitus: a cross-lagged analysis

AIMS

To explore the inter-predictive role and causal relationship between family functioning, self-perceived burden and loneliness in people with type 2 diabetes.

METHODS

In this study, patients with type 2 diabetes admitted to two tertiary care hospitals in China were selected for an 8-month follow-up, and the patients' scores on the Family Functioning, Self-perceived Burden, and Loneliness scales were measured repeatedly at three time periods: during hospitalisation (T1), 1 month after discharge (T2), and 3 months after discharge (T3).

RESULTS

The results showed that family function at the T1 time point had a negative predictive effect on self-perceived burden at the T2 time point, β = - 0.43, P = 0.005. Loneliness at the T1 time point had a positive predictive effect on self-perceived burden at the T2 time point, β = 0.08, P = 0.021. Unlike the pathway at time point T1, family functioning at time point T2 negatively predicted loneliness at time point T3, β = - 0.32, P = 0.013. Loneliness at time point T2 positively predicted family functioning at time point T3, β = 0.025, P = 0.013. Loneliness at time point T2 negatively predicted self-perceived burden at time point T3 (P = 0.011).

CONCLUSIONS

The results of the cross-lagged analysis show that there is a mutually predictive and moderating relationship between family functioning and loneliness in patients with type 2 diabetes. Loneliness can predict the level of self-perceived burden at the next time point.

The risk of suicidal intention in severe mental illness: An ecological perspective

OBJECTIVE

Guided by the ecosystem theory model framework, we aimed to explore the influence of three ecological dimensions (social, family and psychological factors) on suicidal intention in people with severe mental illness (SMI). We hypothesized that three factors influence suicidal intention, and that psychological factors may play a mediating role in the influence of social and family factors on suicidal intention.

METHODS

We collected 994 patients with SMI aged 18 and above from May 2021 to March 2022 in the Fourth Hospital of Fuzhou City. We used logistic regression to analyse the association between social, family, psychological factors and suicidal intention. Furthermore, we explored the mediating effects among the influencing factors.

RESULTS

Younger male patients with schizophrenia were more likely to have suicidal intention due to psychosocial family factors (p < .05). Social factors (poor interpersonal relations, social retreat, social activities outside the home), family factors (parental functions, activities within the family, family functions), psychological factors (anxiety, depression, interest in the outside world, overt aggression, lack of accountability and planning) were all independent risk factors for suicidal intention in patients. Mediation analysis showed anxiety and depression mediated the role of social and family factors on suicidal intention (p < .05).

CONCLUSION

Social, family and psychological factors were important risk factors for suicidal intention, with anxiety and depression being partial mediators for suicidal intention. Therefore, interventions that enhance family and social functioning and reduce anxiety and depression may be effective in reducing suicidal intention in SMI.

Family Functioning, Illness-Related Self-Regulation Processes, and Clinical Outcomes in Major Depression: A Prospective Study in Greece

Major depressive disorder (MDD) is a common, seriously impairing, and often recurrent mental disorder. Based on the predictions of the Circumplex Model of Marital and Family Systems and the Common-Sense Self-Regulation Model, the aim of the present prospective study is to examine the predictive value of clinical outcomes of a process model in which associations between perceived family functioning and patient's clinical outcomes (i.e., symptom severity and suicide risk) are mediated by illness representations and coping strategies. A total of 113 patients with a clinical diagnosis of MDD (16.8% males and 83.2% females) aged 47.25 ± 13.98 years and recruited from the outpatient department and the mobile mental health unit of the Psychiatric Clinic of the University Hospital of Heraklion in Crete, Greece, and from a Greek online depression peer-support group participated in the study. Family functioning was assessed in terms of cohesion and flexibility (Family Adaptability and Cohesion Evaluation Scales IV) at baseline. Illness representations (Illness Perception Questionnaire-Mental Health) and coping strategies (Brief Cope Orientation to Problems Experienced) were measured about five months later (5.04 ± 1.16 months). Symptom severity (Beck Depression Inventory) and suicidality (Risk Assessment Suicidality Scale) were measured about 10 months after the baseline assessment (9.56 ± 2.52 months). The results indicated that representations about MDD impact and symptom severity serially mediated the association between family cohesion and suicide risk in MDD. Furthermore, family cohesion was found to be linked with maladaptive coping through MDD impact representations. Family-based psychotherapeutic interventions specifically designed to target unhealthy family functioning, along with negative illness perceptions and dysfunctional coping, could be further developed and explored as adjunctive therapy to standard treatment in MDD.

Association between family functioning and psychotic transition in ultra-high risk adolescents and young adults

Background

Psychotic transition (PT) is a crucial stage in schizophrenia. The Comprehensive Assessment of At-Risk Mental States (CAARMS) scale can be used to identify individuals at ultra-high risk (UHR) for psychosis and to evaluate their risk of PT. Many environmental and genetic factors have been identified as contributing to the development and decompensation of schizophrenia. This study aimed to determine if the quality of family functioning is associated with PT risk in UHR individuals aged between 11 and 25 years after 1 year of follow-up.

Methods

From January to November 2017, 45 patients aged 12 to 25 consulting for psychiatric reasons were included. Twenty-six were classified as UHR of PT at the CAARMS. Family functioning was assessed by the Family Assessment Device-Global Functioning (FAD-GF). Thirty-seven of these patients (30% men, mean age 16 ± 2.5) were reassessed at 8-14 months of recruitment. Survival analysis was used to examine the impact of family functioning on PT risk.

Results

A total of 40% of UHR patients were classified as psychotic at reassessment. Survival analysis showed that better family functioning is a significant protective factor for PT in this population.

Discussion

This result suggests that the global family functioning has an impact at 1 year on the risk of PT in the population of adolescents and young adults who consult the hospital for psychiatric reasons. A family intervention may be effective in reducing PT risk in this population and should be considered as a potential therapeutic option.

Prevalence and risk factors of anxious and depressive symptoms in first-trimester females and their partners: a study during the pandemic era of COVID-19 in China

BACKGROUND

The pandemic of coronavirus disease 2019 lastingly affects public mental health. Many studies have described symptoms of anxiety and depression in pregnant women before the pandemic. However, the limited study focuses on the prevalence and risk factors of mood symptoms among first-trimester females and their partners during the pandemic in China, which was the aim of the study.

METHODS

One hundred and sixty-nine first-trimester couples were enrolled. The Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, Family Assessment Device-General Functioning (FAD-GF), and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF) were applied. Data were mainly analyzed through logistic regression analysis.

RESULTS

17.75% and 5.92% of first-trimester females had depressive and anxious symptoms, respectively. Among partners, 11.83% and 9.47% had depressive and anxious symptoms, respectively. In females, higher scores of FAD-GF (OR = 5.46 and 13.09; P < 0.05) and lower scores of Q-LES-Q-SF (OR = 0.83 and 0.70; P < 0.01) were related to the risk of depressive and anxious symptoms. Higher scores of FAD-GF were associated with the risk of depressive and anxious symptoms in partners (OR = 3.95 and 6.89; P < 0.05). A history of smoking was also related to males' depressive symptoms (OR = 4.49; P < 0.05).

CONCLUSION

This study prompted prominent mood symptoms during the pandemic. Family functioning, quality of life, and smoking history increased risks of mood symptoms among early pregnant families, which facilitated the updating of medical intervention. However, the current study did not explore interventions based on these findings.

Psychosocial factors associated with anxious depression

BACKGROUND

Anxious depression is a common subtype of major depressive disorder (MDD) associated with adverse outcomes and severely impaired social function. The aim of this study was to explore the relationships between child maltreatment, family functioning, social support, interpersonal problems, dysfunctional attitudes, and anxious depression.

METHODS

Data were collected from 809 MDD patients. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale-17 (HAMD-17), Family Assessment Device (FAD), Childhood Trauma Questionnaire (CTQ), Social Support Rating Scale (SSRS), Interpersonal Relationship Integrative Diagnostic Scale (IRIDS), and Dysfunctional Attitudes Scale (DAS) were administered and recorded. Anxious depression was defined as an anxiety/somatization factor score ≥ 7 on the HAMD-17. Chi-squared tests, Mann-Whitney U tests, distance correlations, and structural equation models were used for data analysis.

RESULTS

Two-fifths of MDD patients had comorbid anxiety, and there were significant differences in child maltreatment, family functioning, social support, interpersonal problems, and dysfunctional attitudes between groups. Of these factors, interpersonal relationships were most related to anxiety in MDD patients, and dysfunctional attitudes mediated the relationship between interpersonal relationships and anxiety in MDD patients.

LIMITATIONS

This study used cross-sectional data with no further follow-up to assess patient outcomes. This study did not include information about pharmacological treatments. A larger sample size is needed to validate the results.

CONCLUSIONS

Psychosocial factors were significantly associated with anxious depression. Interpersonal relationships and dysfunctional attitudes have a direct effect on anxious depression, and interpersonal relationships also mediate the effects of anxious depression via dysfunctional attitudes.

Differences in associations between family functioning and anxious and depressive symptoms in Chinese women and their partners in early pregnancy

BACKGROUND

Family functioning is associated with anxiety and depression. Perinatal depression and anxiety are common and influence the well-being of women, partners and their offspring. However, little is known about differences in associations between family functioning and mood symptoms in women and their partners in early pregnancy.

AIMS

Investigating differences in associations between family functioning and anxious and depressive symptoms in women and their partners in early pregnancy.

METHOD

In total, 171 woman-partner pairs were enrolled. The Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item scale (GAD-7) and Family Assessment Device (FAD) were performed. Correlation analysis and multiple linear regression analysis were applied to investigate the associations.

RESULTS

In pregnant women, all the subscale scores on the FAD were correlated with total scores on the EPDS and GAD-7 (all P < 0.05), whereas only the Roles subscale showed a predicting effect in regression models (P < 0.01). In partners, all the subscale scores on the FAD were related to total scores on the PHQ-9 (all P < 0.05), whereas only the Problem Solving subscale showed a predicting effect (P = 0.029).

CONCLUSIONS

Our findings indicate that family functioning in the domain of roles is associated with anxious and depressive symptoms in pregnant women and functioning in the domain of problem solving is associated with depressive symptoms in partners. Clinicians should pay special attention to roles and problem solving when assessing mood symptoms in pregnant women and their partners. This study also provides a basis for family health education in early pregnancy.

Improved Safety of Hybrid Electroconvulsive Therapy Compared With Standard Electroconvulsive Therapy in Patients With Major Depressive Disorder: A Randomized, Double-Blind, Parallel-Group Pilot Trial

Objectives

ECT is a rapid and effective treatment for depression. While efficacy is often remarkable over the initial 3-4 sessions, the efficacy of later sessions is less rapid, and the side-effects, especially cognitive impairment limit its use. To preliminarily compare the efficacy and acceptability of a novel hybrid-ECT (HECT) protocol for patients with major depressive disorder (MDD) with standard ECT, we conducted this pilot trial.

Methods

Thirty patients were randomly assigned to ECT or HECT. Both arms received three ECT sessions (phase 1) but, in phase 2, the HECT arm received low-charge electrotherapy instead of ECT. The primary outcome was the change in 24-item Hamilton depression rating scale (HAMD-24) scores between baseline and the end of treatment. Cognitive function was assessed by repeatable battery for the assessment of neuropsychological status (RBANS), Stroop color word, and orientation recovery tests (ORT). Safety was measured by the drop-out rate and adverse events (AEs). Four visits were conducted at baseline, post-phase 1, post-phase 2, and at 1-month follow-up. Trial registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/), identifier: ChiCTR1900027701.

Results

Patients in both arms showed significant within-group improvements in HAMD-24, but the between-group differences were non-significant. Participants in the HECT arm outperformed ECT patients for most cognitive tests at the end of treatment or at follow-up. There was a significantly lower AE rate and shorter ORT in phase 2 of the HECT ar.

Conclusion

In this pilot trial, HECT was associated with fewer AEs and better cognitive function including executive and memory function, but its possible similar antidepressive efficacy needs to be further investigated in future.

Family Functioning and Optimism as Protective Factors of Life Satisfaction Among Stroke Patients During the COVID-19 Epidemic in Shenyang, China

The coronavirus disease-19 (COVID-19) pandemic may result in detrimental consequences for stroke patient's wellbeing. Family functioning and optimism could help stroke patients cope with crises leading to possible improvements in life satisfaction. This study aims to explore the protective effects of family functioning and optimism on life satisfaction among stroke patients during the COVID-19 pandemic in China. This study was designed as a cross-sectional survey. A total of 207 stroke inpatients who were receiving pharmacotherapy and rehabilitation in general public hospital of Liaoning province during the COVID-19 pandemic in China were consecutive selected and interviewed by online questionnaires via the WeChat platform effectively from April 8 to 30, 2020. The scales included: Satisfaction with Life Scale (SWLS), Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Scale and Revised Life Orientation Test (LOT-R). Hierarchical multiple regression (HMR) analysis was conducted to test the associated factors of life satisfaction. Stroke patient's life satisfaction was at a high level (Mean = 26.46, SD = 6.23) during the pandemic. Stroke patient's residence, duration of stroke, stroke type, and community shut down measures were the strong predictors of life satisfaction. Family functioning and optimism increased life satisfaction among stroke patients. This study contributes to the research on the association between family functioning and optimism on life satisfaction among stroke patients during the COVID-19 pandemic. Interventions that improve family functioning and enhance optimism should be provided in order to elevate life satisfaction for stroke patients.

Family Functioning is Associated with Post-Stroke Depression in First-Ever Stroke Survivors: A Longitudinal Study

BACKGROUND

Post-stroke depression (PSD) can aggravate the mortality and recurrence rate in stroke patients. The relationship between family functioning and PSD at different phases after a first-ever stroke is unclear. The purpose of this longitudinal study was to investigate the patterns and relationship of family functioning and PSD at acute hospitalization and 6 months post-discharge in first-ever stroke survivors.

METHODS

This is a longitudinal study conducted in Guangzhou, China. Family functioning and depression were measured by the Short Form Family Assessment Device (SF-FAD) and Self-Rating Depression Scale (SDS) at baseline and 6 months post-discharge. Multiple linear regression analysis was used to explore the relationship between family functioning and PSD.

RESULTS

The prevalence of PSD at acute hospitalization and 6 months post-discharge was 32.9% and 20.0%, respectively. SDS scores decreased significantly from baseline to 6 months post-discharge, while SF-FAD scores did not change significantly during this period. The Pearson correlation coefficient showed that SF-FAD scores were positively associated with SDS scores at the two time points (r ₁ = 0.341, r ₂ = 0.510, P < 0.05). Multiple linear regression analyses indicated that SF-FAD scores could predict PSD at baseline (unstandardized coefficient: 7.010, P < 0.05) and 6 months post-discharge (unstandardized coefficient: 9.672, P < 0.001).

CONCLUSION

This study found that first-ever stroke survivors had good family functioning at baseline and 6 months post-discharge. The findings in this study verified that poor family functioning is positively associated with PSD at different phases post-stroke. Good family functioning is an important protective factor against PSD.

Sexuality is associated with the quality of life of the elderly!

OBJECTIVE

to analyze the association between sexuality and quality of life of Brazilian elderly residents in the community.

METHODS

a cross-sectional study conducted with 477 Brazilian elderly. The data were collected between August and October 2020. We used the EVASI and WHOQOL-OLD (World Health Organization Quality of Life). Data analysis was performed with Mann-Whitney, Spearman and Kruskal-Wallis correlation tests, with Bonferroni post-hoc application when necessary, considering a 95% confidence interval.

RESULTS

there was a statistical association between all dimensions of sexuality and the general quality of life of the elderly (p<0.05).

CONCLUSION

the stimulation of sexuality can be configured as an innovative and holistic strategy focused on the promotion of health and active aging, since this study found the association between sexuality and the general quality of life of elderly people.