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Shu Y, Ao N, Wen X, Cui Z, Qu D, Chen R. The p factor outweighs the specific internalizing factor in predicting recurrences of adolescent depression. Eur Psychiatry 2024; 67:e28. [PMID: 38425212 PMCID: PMC10988157 DOI: 10.1192/j.eurpsy.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The early prediction of adolescent depression recurrence poses a significant challenge in the field. This study aims to investigate and compare the abilities of the general psychopathology factor (p) and the specific internalizing factor, in predicting depression recurrence over a 2-year course, as well as identifying remitted depressed adolescents from healthy adolescents. Longitudinal changes of these two factors in different trajectory groups were also tracked to examine their sensitivity to sustained remission and relapse. METHODS We included 255 baseline-remitted depressed adolescents and a healthy control group (n = 255) matched in age, sex, and race, sourced from the Adolescent Brain Cognitive Development Study. The linear mixed model was employed for the statistical analysis. RESULTS The p factor not only effectively discriminated between remitted depressed adolescents and healthy controls but also robustly predicted the depression recurrence over a subsequent 2-year course. The specific internalizing factor could only differentiate remitted depressed adolescents from healthy controls. Additionally, a noteworthy longitudinal decline of the p factor in the sustained-remission group was observed. CONCLUSIONS Psychopathology factors serve as the inherent and enduring measurement of long-term mental health aberrations. Longitudinal results indicate that the p factor is more sensitive to respond to sustained remission than the internalizing factor. The ability of the overall p factor to anticipate depression relapse, unlike the specific internalizing factor, suggests the clinical interventions should monitor and mitigate the coincident symptoms across all dimensions to preempt relapse of adolescent depression, rather than an exclusive focus on internalizing symptoms.
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Affiliation(s)
- Yinuo Shu
- Chinese Institute for Brain Research, Beijing, China
| | - Na Ao
- Chinese Institute for Brain Research, Beijing, China
| | - Xue Wen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zaixu Cui
- Chinese Institute for Brain Research, Beijing, China
| | - Diyang Qu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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2
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Klein DN. Assessment of Depression in Adults and Youth. Assessment 2024; 31:110-125. [PMID: 37081793 DOI: 10.1177/10731911231167446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the article addresses the nature and conceptualization of depression and some key issues that must be considered in its assessment. Next, the diagnostic interview and clinician- and self-administered rating scales that are most widely used to diagnose, screen for, and assess the severity of depression in adults and youth are selectively reviewed. In addition, the assessment of three transdiagnostic clinical features (anhedonia, irritability, and suicidality) that are frequently associated with both depression and other forms of psychopathology is discussed. The article concludes with some broad recommendations for assessing depression in research and clinical practice and suggestions for future research.
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Habets PC, Thomas RM, Milaneschi Y, Jansen R, Pool R, Peyrot WJ, Penninx BWJH, Meijer OC, van Wingen GA, Vinkers CH. Multimodal Data Integration Advances Longitudinal Prediction of the Naturalistic Course of Depression and Reveals a Multimodal Signature of Remission During 2-Year Follow-up. Biol Psychiatry 2023; 94:948-958. [PMID: 37330166 DOI: 10.1016/j.biopsych.2023.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The ability to predict the disease course of individuals with major depressive disorder (MDD) is essential for optimal treatment planning. Here, we used a data-driven machine learning approach to assess the predictive value of different sets of biological data (whole-blood proteomics, lipid metabolomics, transcriptomics, genetics), both separately and added to clinical baseline variables, for the longitudinal prediction of 2-year remission status in MDD at the individual-subject level. METHODS Prediction models were trained and cross-validated in a sample of 643 patients with current MDD (2-year remission n = 325) and subsequently tested for performance in 161 individuals with MDD (2-year remission n = 82). RESULTS Proteomics data showed the best unimodal data predictions (area under the receiver operating characteristic curve = 0.68). Adding proteomic to clinical data at baseline significantly improved 2-year MDD remission predictions (area under the receiver operating characteristic curve = 0.63 vs. 0.78, p = .013), while the addition of other omics data to clinical data did not yield significantly improved model performance. Feature importance and enrichment analysis revealed that proteomic analytes were involved in inflammatory response and lipid metabolism, with fibrinogen levels showing the highest variable importance, followed by symptom severity. Machine learning models outperformed psychiatrists' ability to predict 2-year remission status (balanced accuracy = 71% vs. 55%). CONCLUSIONS This study showed the added predictive value of combining proteomic data, but not other omics data, with clinical data for the prediction of 2-year remission status in MDD. Our results reveal a novel multimodal signature of 2-year MDD remission status that shows clinical potential for individual MDD disease course predictions from baseline measurements.
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Affiliation(s)
- Philippe C Habets
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; Department of Internal Medicine, section Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Rajat M Thomas
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
| | - Yuri Milaneschi
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
| | - Rick Jansen
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
| | - Rene Pool
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Wouter J Peyrot
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; Department of Complex Traits Genetics, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
| | - Onno C Meijer
- Department of Internal Medicine, section Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Guido A van Wingen
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
| | - Christiaan H Vinkers
- Department of Anatomy & Neurosciences, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
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4
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von Knorring J, Baryshnikov I, Jylhä P, Talaslahti T, Heikkinen M, Isometsä E. Prospective study of antidepressant treatment of psychiatric patients with depressive disorders: treatment adequacy and outcomes. BMC Psychiatry 2023; 23:888. [PMID: 38017416 PMCID: PMC10683284 DOI: 10.1186/s12888-023-05390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Despite numerous national depression care guidelines (DCGs), suboptimal antidepressant treatment may occur. We examined DCG concordance and depression treatment outcomes in psychiatric settings. METHODS We evaluated treatment received and outcomes of 128 psychiatric out- and inpatients participating in the PEGAD (Pharmacoepidemiology and Pharmacogenetics of Antidepressant Treatment for Depressive Disorders) study at baseline, two weeks, and eight weeks using interviews and questionnaires. Inclusion criteria were ICD-10 diagnosis of a depressive disorder, a Patient Health Questionnaire-9 symptom (PHQ-9) score ≥ 10, and a new antidepressant prescribed. The primary outcome of the study was within-individual change in PHQ-9 scores. RESULTS At baseline, patients had predominately recurrent (83%) and in 19% treatment-resistant depression (TRD). The median preceding duration of the current episode was 6.5 months. At eight weeks, 85% of the patients (n = 107) used a DCG-concordant antidepressant dose. However, due to the scarcity of antidepressant combinations and augmentations, fewer TRD than non-TRD patients (25% vs. 84%, p < 0.005) received adequate antidepressant treatment. Additionally, one-third of the patients received inadequate follow-up. Overall, only 53% received treatment compatible with DCG recommendations for adequate pharmacotherapy and follow-up. The mean decline in PHQ-9 scores (-3.8 ± SD 5.7) was significant (p < 0.0005). Nearly 40% of the patients reached a subthreshold level of depression (PHQ-9 < 10), predicted by a lower baseline PHQ-9 score, recurrent depression, and female sex. However, 45% experienced no significant clinical improvement (PHQ-9 score reduction < 20%). CONCLUSIONS Our findings suggest that inadequate treatment continues to occur in psychiatric care settings, particularly for TRD patients.
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Affiliation(s)
- Johanna von Knorring
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Ilya Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Pekka Jylhä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Tiina Talaslahti
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Martti Heikkinen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22, Helsinki, FI-00014, Finland.
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Klein DN, Perlman G, Feltman SM, Kotov R. Preonset predictors of chronic-intermittent depression from early adolescence to early adulthood. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:694-703. [PMID: 37276087 PMCID: PMC10524144 DOI: 10.1037/abn0000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Individuals with prolonged or frequent episodes account for a disproportionate share of the burden of depression. However, there are surprisingly few data on whether individuals at risk for developing chronic-intermittent depression (CID) as opposed to briefer, infrequent depressive episodes (time-limited depression [TLD]) can be distinguished before their first depressive episode. We followed a community sample of 465 never-depressed females on five occasions from age 14 to 20 years and examined whether 18 preonset clinical and psychosocial variables prospectively predicted CID. The CID group accounted for 40% of depressed cases but 84% of the cumulative time depressed in the sample. Participants with CID (n = 60) exhibited significantly higher preonset levels of 16 of the 18 risk factors than the never-depressed group (n = 315). The TLD group (n = 90) had significantly higher preonset levels of nine risk factors than never-depressed participants. Finally, the CID group had significantly higher levels of nine risk factors than the TLD group, five of which were similar in TLD and never-depressed participants. These findings indicate that differences between CID and TLD are evident before onset and suggest that the liability to CID may be both greater than, and somewhat different from, the liability to TLD. Moreover, they suggest that individuals at risk for a malignant course of depression can be targeted for prevention and early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Scott M. Feltman
- Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health, Stony Brook University
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Roberts H, Ford TJ, Karl A, Reynolds S, Limond J, Adlam ALR. Mood Disorders in Young People With Acquired Brain Injury: An Integrated Model. Front Hum Neurosci 2022; 16:835897. [PMID: 35754774 PMCID: PMC9218558 DOI: 10.3389/fnhum.2022.835897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose/Objective Young people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population. Method We review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation. Results and Implications We present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.
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Affiliation(s)
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Anke Karl
- Psychology, University of Exeter, Exeter, United Kingdom
| | - Shirley Reynolds
- Department of Psychology, University of Reading, Reading, United Kingdom
| | - Jenny Limond
- Psychology, University of Exeter, Exeter, United Kingdom
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Eilert N, Wogan R, Leen A, Richards D. Internet-Delivered Interventions for Depression and Anxiety Symptoms in Children and Young People: Systematic Review and Meta-analysis. JMIR Pediatr Parent 2022; 5:e33551. [PMID: 35551071 PMCID: PMC9136650 DOI: 10.2196/33551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/23/2022] [Accepted: 02/07/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mental health difficulties in children and adolescents are highly prevalent; however, only a minority receive adequate mental health care. Internet-delivered interventions offer a promising opportunity to increase access to mental health treatment. Research has demonstrated their effectiveness as a treatment for depression and anxiety in adults. This work provides an up-to-date examination of the available intervention options and their effectiveness for children and young people (CYP). OBJECTIVE In this systematic review and meta-analysis, we aimed to determine the evidence available for the effectiveness of internet-delivered interventions for treating anxiety and depression in CYP. METHODS Systematic literature searches were conducted throughout November 2020 using PubMed, PsycINFO, and EBSCO academic search complete electronic databases to find outcome trials of internet-delivered interventions treating symptoms of anxiety and/or depression in CYP by being either directly delivered to the CYP or delivered via their parents. Studies were eligible for meta-analysis if they were randomized controlled trials. Risk of bias and publication biases were evaluated, and Hedges g between group effect sizes evaluating intervention effects after treatment were calculated. Meta-analyses used random-effects models as per protocol. RESULTS A total of 23 studies met the eligibility criteria for the systematic review, of which 16 were included in the meta-analyses, including 977 participants in internet-delivered treatment conditions and 1008 participants in control conditions across 21 comparisons. Random-effects models detected a significant small effect for anxiety symptoms (across 20 comparisons; Hedges g=-0.25, 95% CI -0.38 to -0.12; P<.001) and a small but not significant effect for depression (across 13 comparisons; Hedges g=-0.27, 95% CI -0.55 to 0.01; P=.06) in favor of internet-delivered interventions compared with control groups. Regarding secondary outcomes, there was a small effect of treatment across 9 comparisons for impaired functioning (Hedges g=0.52, 95% CI 0.24-0.80; P<.001), and 5 comparisons of quality of life showed no effect (Hedges g=-0.01, 95% CI -0.23 to 0.21; P=.94). CONCLUSIONS The results show that the potential of internet-delivered interventions for young people with symptoms of anxiety or depression has not been tapped into to date. This review highlights an opportunity for the development of population-specific interventions and their research to expand our current knowledge and build an empirical base for digital interventions for CYP. TRIAL REGISTRATION PROSPERO CRD42020220171; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220171.
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Affiliation(s)
- Nora Eilert
- e-Mental Health Group, School of Psychology, University of Dublin Trinity College, Dublin, Ireland.,SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Rebecca Wogan
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Aisling Leen
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Derek Richards
- e-Mental Health Group, School of Psychology, University of Dublin Trinity College, Dublin, Ireland.,SilverCloud Science, SilverCloud Health, Dublin, Ireland
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Suor JH, Calentino AE, Granros M, Burkhouse KL. Maternal Error-Related Negativity Relationship With Offspring Error-Related Negativity and Negative Parenting Styles: A Novel Model of Internalizing Psychopathology Risk. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:435-442. [PMID: 34688921 PMCID: PMC8995320 DOI: 10.1016/j.bpsc.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Enhanced error-related negativity (ERN), an event-related potential component reflecting neural sensitivity to errors and threat, has been theorized to represent an endophenotype of internalizing psychopathologies (IPs). We tested whether intergenerational transmission of ERN patterns may confer risk for internalizing symptoms. We examined associations among maternal and offspring ERN and offspring internalizing symptoms. Given the role of parenting in IP risk, we also explored how maternal negative parenting styles related to maternal ERN and offspring internalizing symptoms. METHODS Participants included 117 biological mother-child dyads (ages 9-16 years, 70.9% female). Of these, 72 mothers had a history of major depression (32 with lifetime anxiety), and 45 had no history of psychiatric illness. Dyads completed psychiatric interviews, parenting questionnaires, and a flanker task to elicit the ERN while an electroencephalogram was recorded. RESULTS Path analyses revealed that maternal ERN was significantly associated with enhanced offspring ERN and greater negative parenting styles. Enhanced offspring ERN and maternal negative parenting styles were significantly related to greater internalizing symptoms in offspring. Maternal ERN had a significant indirect effect on offspring internalizing symptoms through offspring ERN and maternal negative parenting styles, above the effects of self-reported maternal internalizing symptoms. Maternal IP history did not moderate pathways. CONCLUSIONS Study findings suggest that enhanced maternal ERN is indirectly associated with greater offspring internalizing symptoms through its relationship to offspring ERN and negative parenting styles. Future longitudinal work is needed to evaluate the temporal timing and directionality of these tested pathways and their clinical implications for the prevention of IPs.
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Affiliation(s)
- Jennifer H Suor
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.
| | - Alison E Calentino
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois; Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Maria Granros
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois; Department of Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
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Wardenaar KJ, Riese H, Giltay EJ, Eikelenboom M, van Hemert AJ, Beekman AF, Penninx BWJH, Schoevers RA. Common and specific determinants of 9-year depression and anxiety course-trajectories: A machine-learning investigation in the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 2021; 293:295-304. [PMID: 34225209 DOI: 10.1016/j.jad.2021.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Given the strong relationship between depression and anxiety, there is an urge to investigate their shared and specific long-term course determinants. The current study aimed to identify and compare the main determinants of the 9-year trajectories of combined and pure depression and anxiety symptom severity. METHODS Respondents with a 6-month depression and/or anxiety diagnosis (n=1,701) provided baseline data on 152 sociodemographic, clinical and biological variables. Depression and anxiety symptom severity assessed at baseline, 2-, 4-, 6- and 9-year follow-up, were used to identify data-driven course-trajectory subgroups for general psychological distress, pure depression, and pure anxiety severity scores. For each outcome (class-probability), a Superlearner (SL) algorithm identified an optimally weighted (minimum mean squared error) combination of machine-learning prediction algorithms. For each outcome, the top determinants in the SL were identified by determining variable-importance and correlations between each SL-predicted and observed outcome (ρpred) were calculated. RESULTS Low to high prediction correlations (ρpred: 0.41-0.91, median=0.73) were found. In the SL, important determinants of psychological distress were age, young age of onset, respiratory rate, participation disability, somatic disease, low income, minor depressive disorder and mastery score. For course of pure depression and anxiety symptom severity, similar determinants were found. Specific determinants of pure depression included several types of healthcare-use, and of pure-anxiety course included somatic arousal and psychological distress. LIMITATIONS Limited sample size for machine learning. CONCLUSIONS The determinants of depression- and anxiety-severity course are mostly shared. Domain-specific exceptions are healthcare use for depression and somatic arousal and distress for anxiety-severity course.
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Affiliation(s)
- Klaas J Wardenaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands.
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Merijn Eikelenboom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Albert J van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Aartjan F Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
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Jiang X, Wang X, Jia L, Sun T, Kang J, Zhou Y, Wei S, Wu F, Kong L, Wang F, Tang Y. Structural and functional alterations in untreated patients with major depressive disorder and bipolar disorder experiencing first depressive episode: A magnetic resonance imaging study combined with follow-up. J Affect Disord 2021; 279:324-333. [PMID: 33096331 DOI: 10.1016/j.jad.2020.09.133] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) could assist in identifying objective biomarkers and follow-up study could effectively improve subjective diagnostic accuracy. By combining MRI with follow-up, this study aims to determine the shared and distinct alterations between major depressive disorder (MDD) and bipolar disorder (BD). METHODS Untreated patients with MDD experiencing the first episode were subjected to MRI and subsequent follow-up. Fifteen patients with mania or hypomania were regrouped into BD group. Twenty patients were still grouped as MDD after an average of 37.95 months follow-up. Thirty healthy controls (HCs) were recruited to match the patients. Gray matter volume (GMV) and amygdala-seed functional connectivity (FC) in the whole brain were detected and compared among the three groups. RESULTS GMV analysis revealed that the MDD and BD groups presented reduced GMV predominantly in the parietal, occipital, and frontal regions in the bilateral cerebrum compared with the HCs. The BD group had reduced GMV predominantly in the parietal, temporal, insular regions and the Rolandic operculum in the right-side cerebrum compared with MDD and HC groups. FC analysis revealed that the MDD and BD patients displayed increased FC values mainly in the bilateral parietal, and left occipital regions. Only the BD group displayed increased FC values in the temporal, occipital, parietal and limbic regions in the right-side cerebrum relative to HCs. LIMITATIONS The main limitation is the relatively small sample size. CONCLUSIONS Alterations in the cortical regions and cortico-limbic neural system may provide the scientific basis for differential diagnosis in affective disorders.
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Affiliation(s)
- Xiaowei Jiang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Xinrui Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Linna Jia
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Ting Sun
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Jiahui Kang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Yifang Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Shengnan Wei
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Feng Wu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Lingtao Kong
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China
| | - Fei Wang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, PR China.
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Rengasamy M, Marsland A, McClain L, Kovats T, Walko T, Pan L, Price RB. Longitudinal relationships of cytokines, depression and anhedonia in depressed adolescents. Brain Behav Immun 2021; 91:74-80. [PMID: 32919038 PMCID: PMC7952030 DOI: 10.1016/j.bbi.2020.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Depression has been associated with low-grade elevation of plasma cytokines (e.g. interleukin-6, IL-6; tumor necrosis factor alpha, TNFα) in both cross-sectional and longitudinal studies in adults. Preclinical and clinical studies also suggest that IL-6 and TNFα elevation are associated with anhedonia. However, few studies have examined longitudinal relationships between cytokines and depression/anhedonia in clinically depressed samples, particularly adolescents. METHODS Thirty-six adolescents with a depressive disorder receiving standard-of-care community treatment were assessed at a baseline and a follow-up timepoint. Self-report and clinical measures of depression and anhedonia, along with plasma IL-6 and TNFα levels, were obtained at both timepoints. Baseline cytokine measures were examined in association with baseline and follow-up clinical measures. On an exploratory basis, change in clinical measures over time was examined in relation to change in cytokine levels over time. RESULTS Higher baseline TNFα levels predicted higher follow-up depression severity after approximately four months (controlling for baseline depression). Higher baseline TNFα levels also associated positively with baseline anhedonia and predicted higher anhedonia at follow-up (controlling for baseline anhedonia). No association was found between change in clinical measures and change in cytokine levels over time. CONCLUSIONS Among adolescents receiving standard-of-care community treatment for depression, higher levels of TNFα predicted greater depressive symptoms at 4-month follow-up, suggesting this cytokine may be used to help identify patients in need of more intensive treatment. Elevated TNFα levels were also associated with concurrent and future anhedonia symptoms, suggesting a specific mechanism in which TNFα affects depression trajectories. Future studies should examine the relationships between cytokine levels and depression/anhedonia symptoms at multiple timepoints in larger cohorts of depressed adolescents.
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Affiliation(s)
- Manivel Rengasamy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Lora McClain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tessa Kovats
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas Walko
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Lisa Pan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca B Price
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, USA
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12
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Bulhões C, Ramos E, Severo M, Dias S, Barros H. Trajectories of depressive symptoms through adolescence and young adulthood: social and health outcomes. Eur Child Adolesc Psychiatry 2021; 30:65-74. [PMID: 32065326 DOI: 10.1007/s00787-020-01493-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
Depressive symptoms display heterogeneous trajectories across adolescence, which can lead to different consequences. This study aimed to identify trajectories of depressive symptoms from adolescence to young adulthood, assessing the association with social and health outcomes at young adulthood. Adolescents born in 1990, enrolled in schools of Porto, Portugal, in 2003-2004 (EPITeen study) completed the Beck Depression Inventory II (BDI-II) at 13, 17 and 21 years. Mixed models and model-based clustering were used to describe the trajectories in the BDI-II score (n = 2010). Outcomes were assessed at age 21 years with self-administered questionnaires and face-to-face interviews (n = 1594). Odds ratios or regression coefficients, with 95% confidence intervals, were estimated using logistic and linear regression. Three trajectory classes of depressive symptoms were identified, similar in shape in both sexes: High (8.4%), Moderate (31.3%) and Low (60.2%). Participants in High or Moderate classes were more likely to describe lower scores of community involvement, more medical appointments during the last year, higher levels of pain and had higher probability of self-rating health as "good" or "fair or poor". Females in the High and Moderate classes were more likely to be current smokers, to describe ever using drugs and to report more sexual partners, emergency room visits and the use of antidepressants. The risk of depressive symptoms in adulthood is likely to be early determined in adolescence. The trajectory classes with higher levels of symptoms were associated with worse social and health outcomes.
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Affiliation(s)
- C Bulhões
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.
| | - E Ramos
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
| | - M Severo
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
| | - S Dias
- Escola Nacional de Saúde Pública, Centro de Investigação Em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - H Barros
- EPIUnit, Instituto de Saúde Pública, Universidade Do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade Do Porto, Porto, Portugal
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13
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Hamlat EJ, McCormick KC, Young JF, Hankin BL. Early pubertal timing predicts onset and recurrence of depressive episodes in boys and girls. J Child Psychol Psychiatry 2020; 61:1266-1274. [PMID: 32017111 PMCID: PMC7396277 DOI: 10.1111/jcpp.13198] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/24/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recurrent depressive episodes during adolescence result in significant impairment and increased risk for subsequent adverse outcomes throughout the life span. Evidence suggests that early pubertal timing predicts the onset of depressive episodes (particularly for girls); however, it is not known if pubertal timing prospectively predicts recurrent depressive episodes in youth. METHODS At baseline, 603 youth (56% female, at baseline: Mage = 12.09, SD = 2.35) reported on their pubertal development. Youth and their parents completed a semistructured diagnostic interview to assess depressive episodes at baseline and then evaluated for onset repeatedly every 6 months for a period of 36 months. RESULTS Controlling for past history of depression, Cox proportional hazards models examined whether earlier pubertal timing predicted (a) days to first depressive episode from baseline and (b) days to a second (recurrent) depressive episode from the end of the first episode. Early pubertal timing predicted the onset of the first depressive episode after baseline (b = .19, Wald = 5.36, p = .02, HR = 1.21), as well as a recurrent episode during course of study follow-up episode (b = .32, Wald = 6.16, p = .01, HR = 1.38). CONCLUSIONS Findings reinforce the importance of considering the impact of early pubertal timing on depression risk. Investigation on how pubertal timing interacts with other risk factors to predict depression recurrence is needed.
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Affiliation(s)
| | | | - Jami F. Young
- Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
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14
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Van Voorhees B, Gladstone TRG, Sobowale K, Brown CH, Aaby DA, Terrizzi DA, Canel J, Ching E, Berry AD, Cantorna J, Eder M, Beardslee W, Fitzgibbon M, Marko-Holguin M, Schiffer L, Lee M, de Forest SA, Sykes EE, Suor JH, Crawford TJ, Burkhouse KL, Goodwin BC, Bell C. 24-Month Outcomes of Primary Care Web-Based Depression Prevention Intervention in Adolescents: Randomized Clinical Trial. J Med Internet Res 2020; 22:e16802. [PMID: 33112254 PMCID: PMC7657722 DOI: 10.2196/16802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/28/2020] [Accepted: 08/16/2020] [Indexed: 12/30/2022] Open
Abstract
Background Adolescent depression carries a high burden of disease worldwide, but access to care for this population is limited. Prevention is one solution to curtail the negative consequences of adolescent depression. Internet interventions to prevent adolescent depression can overcome barriers to access, but few studies examine long-term outcomes. Objective This study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education active control for depression onset at 12 and 24 months in adolescents presenting to primary care settings. Methods A 2-site randomized trial, blinded to the principal investigators and assessors, was conducted comparing Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training to health education to prevent depressive episodes in 369 adolescents (193 youths were randomly assigned to Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training and 176 to health education) with subthreshold depressive symptoms or prior depressive episodes. Participants were recruited from primary care settings in the United States. The primary outcome was the occurrence of a depressive episode, determined by the Depression Symptom Rating. The secondary outcome was functioning, measured by the Global Assessment Scale. Results In intention-to-treat analyses, the adjusted hazard ratio favoring Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training for first depressive episode was not statistically significant at 12 months (hazard ratio 0.77, 95% CI 0.42-1.40, P=.39) and 24 months (hazard ratio 0.87, 95% CI 0.52-1.47, P=.61). Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training provided preventive benefit for first depressive episode for those with mild hopelessness or at least moderate paternal monitoring at baseline. Global Assessment Scale scores improved comparably in both groups (intention-to-treat). Conclusions A technology-based intervention for adolescent depression prevention implemented in primary care did not have additional benefit at 12 or 24 months. Further research is necessary to determine whether internet interventions have long-term benefit. Trial Registration ClinicalTrials.gov NCT01893749; http://clinicaltrials.gov/ct2/show/NCT01893749.
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Affiliation(s)
- Benjamin Van Voorhees
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Tracy R G Gladstone
- The Robert S and Grace W Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College, Boston, MA, United States
| | - Kunmi Sobowale
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David A Aaby
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniela A Terrizzi
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Jason Canel
- NorthShore University Health System, Evanston, IL, United States
| | | | - Anita D Berry
- Almost Home Kids, Ann & Robert H Lurie Children's Hospital, Chicago, IL, United States
| | - James Cantorna
- Franciscan Medical Specialists, Munster, IN, United States
| | - Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - William Beardslee
- Judge Baker Center, Harvard Medical School, Roxbury Crossing, MA, United States
| | - Marian Fitzgibbon
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States.,Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States.,University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Monika Marko-Holguin
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Linda Schiffer
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Miae Lee
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Sarah A de Forest
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Emily E Sykes
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Jennifer H Suor
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | | | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Brady C Goodwin
- Department of General Pediatrics, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Carl Bell
- Department of Psychiatry, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States.,Department of Psychiatry, Windsor University, School of Medicine, Cayon St Kitts, Saint Kitts and Nevis
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15
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Kiviruusu O, Strandholm T, Karlsson L, Marttunen M. Outcome of depressive mood disorder among adolescent outpatients in an eight-year follow-up. J Affect Disord 2020; 266:520-527. [PMID: 32056921 DOI: 10.1016/j.jad.2020.01.174] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 01/28/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study investigated the eight-year course and outcomes of depressive mood disorders and the key outcome predictors among adolescent outpatients. METHODS Depressive adolescent outpatients (N = 148) in a naturalistic clinical setting were assessed at baseline, six months, 12 months and eight years using diagnostic and self-report instruments. Baseline predictors covered selected sociodemographic, clinical and treatment-related characteristics. The outcomes were time to recovery, recurrence, time spent being ill and longitudinal latent profiles of depressive symptoms. RESULTS The recovery rate from any depressive mood disorder was 73% at two years, 91% at five years and 94% by the end of the eight-year follow-up. Two thirds (67%) of the subjects presented at least one recurrence and 57% of them were depressed for 25% or more of the follow-up period. At the eight-year follow-up, 36% had a mood disorder, 48% suffered from anxiety and 26% had a personality disorder. Less severe depression at baseline predicted a shorter time to recovery, whereas recurrence was predicted by a younger age. A latent profile with initially moderate-level depressive symptoms but a poor distal outcome was associated with being female and borderline personality disorder. LIMITATIONS The female preponderance in the sample warrants caution when interpreting sex differences in the findings. CONCLUSIONS Although the depression outcome for some adolescents making the transition to young adulthood is promising, many of them experience long, even chronic episodes, and recurrences are common. Personality-disorder characteristics appeared to be significant outcome predictors in this adolescent population.
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Affiliation(s)
- Olli Kiviruusu
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Thea Strandholm
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Mauri Marttunen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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16
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Kang SG, Cho SE. Neuroimaging Biomarkers for Predicting Treatment Response and Recurrence of Major Depressive Disorder. Int J Mol Sci 2020; 21:ijms21062148. [PMID: 32245086 PMCID: PMC7139562 DOI: 10.3390/ijms21062148] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022] Open
Abstract
The acute treatment duration for major depressive disorder (MDD) is 8 weeks or more. Treatment of patients with MDD without predictors of treatment response and future recurrence presents challenges and clinical problems to patients and physicians. Recently, many neuroimaging studies have been published on biomarkers for treatment response and recurrence of MDD using various methods such as brain volumetric magnetic resonance imaging (MRI), functional MRI (resting-state and affective tasks), diffusion tensor imaging, magnetic resonance spectroscopy, near-infrared spectroscopy, and molecular imaging (i.e., positron emission tomography and single photon emission computed tomography). The results have been inconsistent, and we hypothesize that this could be due to small sample size; different study design, including eligibility criteria; and differences in the imaging and analysis techniques. In the future, we suggest a more sophisticated research design, larger sample size, and a more comprehensive integration including genetics to establish biomarkers for the prediction of treatment response and recurrence of MDD.
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17
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Pizzo A, Drobinin V, Sandstrom A, Zwicker A, Howes Vallis E, Fine A, Rempel S, Stephens M, Howard C, Villars K, MacKenzie LE, Propper L, Abidi S, Lovas D, Bagnell A, Cumby J, Alda M, Uher R, Pavlova B. Active behaviors and screen time in offspring of parents with major depressive disorder, bipolar disorder and schizophrenia. Psychiatry Res 2020; 285:112709. [PMID: 31813597 DOI: 10.1016/j.psychres.2019.112709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/07/2019] [Accepted: 11/26/2019] [Indexed: 11/29/2022]
Abstract
Activities may be modifiable factors that moderate the risk and resilience in the development of mental health and illness. Youth who spend more time using screens are more likely to have poor mental health. Conversely, time spent engaged in active behaviors (i.e., physical activity, socializing and reading) is associated with better mental health. The choice of activities may be important in offspring of parents with mental illness, who are at increased risk for developing mental disorders. Among 357 youth of the FORBOW (Families Overcoming Risks and Building Opportunities for Well-being) cohort aged 6-21, we examined whether parental diagnosis of mental illness (i.e., major depressive disorder, schizophrenia and bipolar disorder) and current levels of depression influenced the amount of time their offspring spent using screens and engaging in active behaviors. Parental history of mental illness and higher levels of current depression in mothers were associated with less time spent engaged in active behaviors and more time spent using screens. Creating opportunities and incentives for active behaviors may redress the balance between youth with and without a familial history of mental illness.
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Affiliation(s)
- Alex Pizzo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Vlad Drobinin
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Dalhousie University, Department of Medical Neuroscience, Halifax, Nova Scotia, Canada
| | - Andrea Sandstrom
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Alyson Zwicker
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Dalhousie University, Department of Pathology, Halifax, Nova Scotia, Canada
| | - Emily Howes Vallis
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Alexa Fine
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sheri Rempel
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Meg Stephens
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Cynthia Howard
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kelsey Villars
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Lynn E MacKenzie
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Dalhousie University, Department of Psychology, Halifax, Nova Scotia, Canada
| | - Lukas Propper
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sabina Abidi
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health Centre, Halifax, Nova Scotia, Canada
| | - David Lovas
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jill Cumby
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
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18
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Nübel J, Guhn A, Müllender S, Le HD, Cohrdes C, Köhler S. Persistent depressive disorder across the adult lifespan: results from clinical and population-based surveys in Germany. BMC Psychiatry 2020; 20:58. [PMID: 32041560 PMCID: PMC7011512 DOI: 10.1186/s12888-020-2460-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/23/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although the individual and economic disease burden of depression is particularly high for long-term symptoms, little is known of the lifetime course of chronic depression. Most evidence derives from clinical samples, and the diagnostic distinction between persistent depressive disorder (PDD) and non-chronic major depression (NCMDD) is still debated. Thus, we examined characteristics of PDD among clinical vs. non-clinical cases, and the associated disease burden at a population level. METHODS Data were drawn from the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, n = 4483) and a clinical sample of PDD inpatients at Charité - Universitätsmedizin Berlin (2018-2019, n = 45). The DSM-5 definition of PDD was operationalized a priori to the study using interview-based DSM-IV diagnoses of dysthymia and major depression lasting at least 2 years in both surveys. Additional depression characteristics (depression onset, self-classified course, suicidality, comorbid mental disorders, treatment history and current depressive symptoms [Patient Health Questionnaire-9]) were assessed. In the DEGS1-MH, health-related quality of life (Short Form Health Survey-36, SF-36), chronic somatic conditions, number of sick days (past 12 months) or days with limitations in normal daily life activities (past 4 weeks), and health service utilization (past 12 months) were compared for PDD vs. NCMDD. RESULTS PDD cases from the clinical sample had a significantly earlier depression onset, a higher proportion of self-classification as persistent course, and treatment resistance than PDD and NCMDD cases in DEGS1-MH. At a population level, PDD cases showed worse outcomes compared with NCMDD cases in terms of somatic comorbidity, SF-36 mental component score, and activity limitations owing to mental health problems, as well as a higher risk for outpatient mental health care contact. CONCLUSIONS The distinction between PDD and NCMDD proposed for DSM-5 seems warranted. Early onset depression, self-classification as persistent depressive course, and treatment resistance are suggested as markers of more severe and chronic depression courses. At a population level, PDD is associated with remarkably higher individual and economic disease burden than NCMDD, highlighting the need to improve medical recognition of chronic courses and establish specific treatment concepts for chronic depression.
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Affiliation(s)
- Julia Nübel
- Department of Epidemiology and Health Monitoring, Unit 26 Mental Health, Robert Koch Institute, PO Box 650261, 13302 Berlin, Germany
| | - Anne Guhn
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Susanne Müllender
- Department of Epidemiology and Health Monitoring, Unit 26 Mental Health, Robert Koch Institute, PO Box 650261, 13302 Berlin, Germany
| | - Hong Duyen Le
- Department of Epidemiology and Health Monitoring, Unit 26 Mental Health, Robert Koch Institute, PO Box 650261, 13302 Berlin, Germany
| | - Caroline Cohrdes
- Department of Epidemiology and Health Monitoring, Unit 26 Mental Health, Robert Koch Institute, PO Box 650261, 13302 Berlin, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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19
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Jiang X, Fu S, Yin Z, Kang J, Wang X, Zhou Y, Wei S, Wu F, Kong L, Wang F, Tang Y. Common and distinct neural activities in frontoparietal network in first-episode bipolar disorder and major depressive disorder: Preliminary findings from a follow-up resting state fMRI study. J Affect Disord 2020; 260:653-659. [PMID: 31542559 DOI: 10.1016/j.jad.2019.09.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND It is difficult to distinguish bipolar disorder (BD) from major depressive disorder (MDD), especially with the initial depressive episode. In this study, we compared neural activities of BD and MDD patients during the first-episode (FE) to investigate common and distinct neural activities and further explore predictive indicators in the two diseases. METHODS FE-MDD patients were performed resting state functional magnetic resonance imaging and followed up after scanning. After follow-up, FE-MDD patients were regrouped into FE-BD and FE-MDD patients. The study included 24 FE-BD patients, 28 FE-MDD patients, and 30 age- and sex-matched healthy controls (HC) to investigate neural activities with regional homogeneity (ReHo) analysis among the 3 groups. RESULTS Compared to HC, FE-BD patients displayed significantly higher ReHo values in the superior frontal gyrus, the medial superior frontal gyrus within right-side cerebral hemisphere than FE-MDD patients and HC. Compared to HC, FE-BD and FE-MDD patients displayed significant decreased ReHo values in the paracentral lobule, the precuneus and the median cingulate and paracingulate gyrus within bilateral cerebral hemisphere, and the postcentral gyrus and the precentral gyrus within the right-side. FE-BD displayed significant lower ReHo values than FE-MDD patients in these regions. LIMITATIONS The potential effects of medicine, age, course of disease and handedness on results could not be ignored. CONCLUSIONS Abnormal neural activities of frontoparietal network may provide common and distinct markers to affective disorders and scientific basis for further prediction researches of affective disorders.
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Affiliation(s)
- Xiaowei Jiang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Shinan Fu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Zhiyang Yin
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Jiahui Kang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Xinrui Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Yifang Zhou
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Shengnan Wei
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Feng Wu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Lingtao Kong
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China
| | - Fei Wang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China.
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China; Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, 110001, China.
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Garman EC, Cois A, Tomlinson M, Rotheram-Borus MJ, Lund C. Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36 months. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1111-1123. [PMID: 30805694 DOI: 10.1007/s00127-019-01665-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/21/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE Latent modelling was used to identify trajectories of depressive symptoms among low-income perinatal women in South Africa. Predictors of trajectories and the association of trajectories with child outcomes were assessed. METHODS This is a secondary analysis of data collected among women living in Cape Town settlements (N = 446). Participants were eligible if pregnant and 18 years or older, and included in the analysis if allocated to the control arm (routine perinatal care). Participants were excluded in case of non-singleton birth and baby death. Follow-up assessments were at 2 weeks, 6-, 18-, and 36-month postpartum. Trajectories of depressive symptoms were based on the Edinburgh Postnatal Depression Scale scores until 18-month postpartum, using latent class growth analysis. Child physical, cognitive, socio-emotional, and behavioural outcomes were assessed at 18 and/or 36 months. Univariate and multivariate regressions were used to identify predictors of trajectories and differences in child outcomes. RESULTS Four trajectories were identified: chronic low (71.1%), late postpartum (10.1%), early postpartum (14.4%), and chronic high (4.5%). Low social support, unwanted pregnancy, and risky drinking were associated with the chronic high trajectory; unemployment and HIV-positive status with the early postpartum trajectory; and intimate partner violence with the late postpartum trajectory. Weight-to-length and weight-for-age z-scores at 18 months, and weight-for-age z-scores, length-for-age z-scores, emotional symptom, and peer problem scores at 36 months differed across trajectories. CONCLUSIONS Severe depressive symptoms in postpartum period have a lasting effect on child physical and socio-emotional outcomes. Multiple screening throughout pregnancy and 1-year postpartum is essential.
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Affiliation(s)
- Emily Claire Garman
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, Western Cape, 7700, South Africa.
| | - Annibale Cois
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- Burden of Disease Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, PO Box 19070, Tygerberg, 7505, South Africa
| | - Mark Tomlinson
- Department of Psychology, Institute for Child and Adolescent Health Research, Stellenbosch University, Maitland, Private Bag X1, Stellenbosch, Western Cape, 7602, South Africa
| | - Mary Jane Rotheram-Borus
- University of California, UCLA Psychiatry and Behavioral Sciences, 10920 Wilshire Blvd, Suite 350, Box 957051, Los Angeles, CA, 90024, USA
| | - Crick Lund
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Building B, 46 Sawkins Road, Rondebosch, Cape Town, Western Cape, 7700, South Africa
- Population Research Department, Centre for Global Mental Health, Health Service, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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21
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Depression and Depressive Symptoms in Pediatric Traumatic Brain Injury: A Scoping Review. J Head Trauma Rehabil 2019; 33:E18-E30. [PMID: 28926485 DOI: 10.1097/htr.0000000000000343] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This scoping review aimed to summarize the existing knowledge base regarding depression and depressive symptoms in pediatric traumatic brain injury (TBI) and to identify gaps in the literature in an effort to guide future research. METHODS MEDLINE Ovid and PsycINFO Ovid databases were each searched by the authors using search terms intended to identify any original research study that examined depressive symptoms in children (ie, aged 0-18 years) with TBI. RESULTS A total of 14 published studies were included in the review. The studies included examined the prevalence of depression, risk factors associated with depression, and depression as a predictor of other TBI-related outcomes. CONCLUSION Existing research suggests that depressive symptoms are more common in a TBI population than in a healthy or orthopedically injured population. Injury-related factors such as lesions in the brain and the presence of pain, as well as noninjury factors such as older age at injury and low socioeconomic status, may be predictive of depressive symptoms. Depression is likely a secondary outcome of pediatric TBI rather than a direct result of the injury itself. Overall, a relative dearth of research exists on this topic; thus, the review concludes by proposing future research directions.
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22
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Dinga R, Marquand AF, Veltman DJ, Beekman ATF, Schoevers RA, van Hemert AM, Penninx BWJH, Schmaal L. Predicting the naturalistic course of depression from a wide range of clinical, psychological, and biological data: a machine learning approach. Transl Psychiatry 2018; 8:241. [PMID: 30397196 PMCID: PMC6218451 DOI: 10.1038/s41398-018-0289-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 12/20/2022] Open
Abstract
Many variables have been linked to different course trajectories of depression. These findings, however, are based on group comparisons with unknown translational value. This study evaluated the prognostic value of a wide range of clinical, psychological, and biological characteristics for predicting the course of depression and aimed to identify the best set of predictors. Eight hundred four unipolar depressed patients (major depressive disorder or dysthymia) patients were assessed on a set involving 81 demographic, clinical, psychological, and biological measures and were clinically followed-up for 2 years. Subjects were grouped according to (i) the presence of a depression diagnosis at 2-year follow-up (yes n = 397, no n = 407), and (ii) three disease course trajectory groups (rapid remission, n = 356, gradual improvement n = 273, and chronic n = 175) identified by a latent class growth analysis. A penalized logistic regression, followed by tight control over type I error, was used to predict depression course and to evaluate the prognostic value of individual variables. Based on the inventory of depressive symptomatology (IDS), we could predict a rapid remission course of depression with an AUROC of 0.69 and 62% accuracy, and the presence of an MDD diagnosis at follow-up with an AUROC of 0.66 and 66% accuracy. Other clinical, psychological, or biological variables did not significantly improve the prediction. Among the large set of variables considered, only the IDS provided predictive value for course prediction on an individual level, although this analysis represents only one possible methodological approach. However, accuracy of course prediction was moderate at best and further improvement is required for these findings to be clinically useful.
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Affiliation(s)
- Richard Dinga
- 0000 0004 1754 9227grid.12380.38Department of Psychiatry and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Andre F. Marquand
- 0000000122931605grid.5590.9Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands ,0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Dick J. Veltman
- 0000 0004 1754 9227grid.12380.38Department of Psychiatry and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- 0000 0004 1754 9227grid.12380.38Department of Psychiatry and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Robert A. Schoevers
- 0000 0004 0407 1981grid.4830.fUniversity Medical Center Groningen, Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), University of Groningen, Groningen, The Netherlands
| | - Albert M. van Hemert
- 0000000089452978grid.10419.3dDepartment of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Brenda W. J. H. Penninx
- 0000 0004 1754 9227grid.12380.38Department of Psychiatry and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lianne Schmaal
- Department of Psychiatry and Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands. .,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
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Nakabayashi T, Hara A, Minami H. Impact of demographic factors on the antidepressant effect: A patient-level data analysis from depression trials submitted to the Pharmaceuticals and Medical Devices Agency in Japan. J Psychiatr Res 2018; 98:116-123. [PMID: 29334636 DOI: 10.1016/j.jpsychires.2017.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/18/2017] [Accepted: 12/31/2017] [Indexed: 12/28/2022]
Abstract
A substantial and variable placebo response can cause unreliable findings in clinical trials designed to demonstrate the efficacy of antidepressants, and the high rate of failed trials represents a major obstacle in the development of new drugs for major depressive disorder (MDD). However, the influence of demographic and symptom factors on the antidepressant effect remains to be established. The purpose of this study was to estimate the magnitude of this influence. A patient-level meta-analysis of data from double-blind, randomized, placebo-controlled trials involving the use of antidepressants for adults with MDD was performed. Data from five confirmatory trials evaluating the efficacy of four antidepressants that were submitted to the Pharmaceuticals and Medical Devices Agency (PMDA) to support new drug applications were pooled (n = 1898). The change in the total score of 17-item Hamilton Depression Rating Scale (HDRS17) was the primary outcome of interest in our analysis. The changes in the total HDRS17 score in both the antidepressant medication group (ADM) and the placebo group (PBO) increased in relation to baseline symptom severity. Among older patients and those with a history of prior treatment with antidepressants, the changes in the total HDRS17 score decreased in ADM and remained static in PBO. There were no notable clinical symptoms that influenced the change in the total HDRS17 score. Baseline symptom severity, participant age and a history of previous treatment with antidepressants were suggested as moderators of the antidepressant effect. The drug-placebo difference in the estimated changes as a function of baseline symptom severity varied depending on the regression models used, and further studies are required to investigate appropriate models.
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Affiliation(s)
| | - Ayako Hara
- Biostatistics Group, Center for Product Evaluation, Pharmaceuticals and Medical Devices Agency, Japan
| | - Hirofumi Minami
- Office of New Drug IV, Pharmaceuticals and Medical Devices Agency, Japan
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Pereira-Morales AJ, Adan A, Forero DA. Network analysis of multiple risk factors for mental health in young Colombian adults. J Ment Health 2017; 28:153-160. [PMID: 29265896 DOI: 10.1080/09638237.2017.1417568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND A considerable proportion of young adults are affected by psychological distress at any time and an important fraction of them may develop mental disorders. Use of novel approaches for the analysis of data from multiple psychological scales might facilitate the identification of key indicators of mental health. AIMS The aim of current study was to examine the relationship between multiple risk factors for mental illness, using a network analysis perspective. METHODS A sample of 334 young Colombian adults (mean age = 21.7) were evaluated with validated scales measuring several psychosocial factors previously associated with mental health (e.g. worry, sleep problems, suicidal ideation, childhood abuse, alcohol related-problems and personality traits). A total of 24 nodes were included in the network analysis and topology, centrality, and stability of the networks were studied. RESULTS Specific nodes that occupied critical positions in the network were identified, with worry, perceived distress and low energy being the most central nodes. CONCLUSIONS Our explorative findings suggest that a network analysis might identify risk factors that have a central role in the multiple dimensions of emotional health in young adults. These novel analyses could have important applications for the understanding of the psychological functioning affecting mental health.
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Affiliation(s)
- Angela J Pereira-Morales
- a Laboratory of Neuropsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño , Bogotá , Colombia
| | - Ana Adan
- b Department of Clinical Psychology and Psychobiology , School of Psychology, University of Barcelona , Barcelona , Spain , and.,c Institute of Neurosciences, University of Barcelona , Barcelona , Spain
| | - Diego A Forero
- a Laboratory of Neuropsychiatric Genetics, Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño , Bogotá , Colombia
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Long-term function and psychosocial outcomes with venlafaxine extended release 75-225 mg/day versus placebo in the PREVENT study. Int Clin Psychopharmacol 2017; 32:271-280. [PMID: 28598899 DOI: 10.1097/yic.0000000000000183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This post-hoc analysis evaluated long-term psychosocial outcomes in patients with recurrent major depressive disorder treated with venlafaxine extended release (ER) 75-225 mg/day or placebo. Patients who responded to 10-week venlafaxine ER 75-300 mg/day treatment and maintained response through a 6-month continuation treatment were assigned randomly to venlafaxine ER or placebo maintenance-phase treatment. Data from responders to acute and continuation venlafaxine ER 75-225 mg/day treatment were analyzed during 12-month maintenance treatment while receiving venlafaxine ER of up to 225 mg/day. Failure to maintain improvement in psychosocial functioning, on the basis of the Social Adjustment Scale-Self-Report, Life Enjoyment Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and Short-Form Health Survey, was defined as loss of at least 50% of the improvement from acute-phase baseline achieved during acute and continuation treatment or dose escalation of more than 225 mg/day. The probability of remaining well (no failure to maintain improvement in functioning) was significantly higher through 12-month maintenance treatment for patients treated with venlafaxine ER 75-225 mg/day versus placebo Social Adjustment Scale-Self-Report, Life Enjoyment Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and Short-Form Health Survey component summary scores (all P≤0.0351). Effects of up to 20 months of treatment with venlafaxine ER 75-225 mg/day on psychosocial functioning were consistent with the results for venlafaxine ER 75-300 mg/day.
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Mahoney N, Gladstone T, DeFrino D, Stinson A, Nidetz J, Canel J, Ching E, Berry A, Cantorna J, Fogel J, Eder M, Bolotin M, Van Voorhees BW. Prevention of Adolescent Depression in Primary Care: Barriers and Relational Work Solutions. CALIFORNIAN JOURNAL OF HEALTH PROMOTION 2017; 15:1-12. [PMID: 30393470 PMCID: PMC6214481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Depression affects millions of adolescents in the United States each year. This population may benefit from targeted preventive interventions. We sought to understand the internal factors that affect the ability of healthcare organizations to implement an intervention that involves mental health screening and depression prevention treatment of at-risk adolescents in primary care settings. METHODS From November 2011 to July 2016 we conducted a study of the implementation of a multisite (N=30) phase 3 randomized clinical trial of an Internet-based depression prevention intervention program (CATCH-IT). We describe the prevalence of internal barriers on the screening and enrollment process by reporting REACH (the proportion of target audience exposed to the intervention). RESULTS A total of 369 adolescents were randomized into the intervention or control program. Mean REACH values for the study clinics were 0.216 for screening and 0.181 for enrollment to CATCH-IT. Mean REACH enrollment lost due to internal barriers was 0.233. This translated to 4,691 adolescents lost at screening and 2,443 adolescents lost at enrollment due to internal barriers. CONCLUSION We propose a model of the implementation process that emphasizes the importance of positive relational work that assists in overcoming internal barriers to REACH. We also provide implications for policy and practice.
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Affiliation(s)
- Nicholas Mahoney
- Department of Psychiatry, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Tracy Gladstone
- The Robert S. and Grace W. Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College
| | - Daniela DeFrino
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Allison Stinson
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Jennifer Nidetz
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Jason Canel
- Northshore University Health Systems, Evanston, Illinois
| | | | - Anita Berry
- Advocate Children's Hospital, Downers Grove, Illinois
| | | | - Joshua Fogel
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
- Department of Business Management, Brooklyn College, New York
| | - Milton Eder
- Access Community Health Network, Chicago, Illinois
| | - Megan Bolotin
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
| | - Benjamin W Van Voorhees
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Illinois
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Abstract
The present paper reports in parallel the findings of the two phase III trials that evaluated the efficacy of agomelatine in older depressed patients. It describes how the particular methodological innovations (particularly in relation to patient selection, design and accuracy of diagnosis of depression) introduced in study 2 have improved the quality of recruitment of patients and the assay sensitivity. Study 1 lacked assay sensitivity, and among the many differences with study 2, the inclusion of unexpected mildly ill patients could have inflated the placebo response. The increased demands on investigators in study 2 appear to have reduced the placebo effect and showed a robust benefit of agomelatine. The two agomelatine studies offer the opportunity to discuss hypotheses that have been raised to explain the low level of response of older patients to available antidepressants.
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28
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Pereverseff RS, Beshai S, Dimova M. First episode indices associated with lifetime chronicity of depression among formerly depressed participants: an exploratory study. J Ment Health 2017; 29:677-683. [PMID: 28488909 DOI: 10.1080/09638237.2017.1322181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Researchers have found that an earlier age of disorder onset and the severity of the first depressive episode are associated with recurrence in depression. Additionally, neuroticism has been shown to be an important factor in the recurrence of the disorder.Aims: This exploratory study aimed to replicate and extend previous research by examining the relationships between features of the first experienced depressive episode (age of onset, severity), the five factors of personality, and lifetime chronicity of depression.Method: Forty-three previously depressed participants completed measures of personality, current depression, hopelessness, and perfectionism. Previous depressive episodes were assessed using a semi-structured interview, and features of these episodes experienced by participants were recorded.Results: Pearson correlations showed that depression chronicity, measured in the number of weeks depressed in a lifetime, was significantly correlated with age of onset and number of symptoms experienced in the first episode. Personality measures were not significantly associated with depression chronicity.Conclusion: Earlier and more severe first episodes of depression may play an important role in the recurrence of the disorder. Future research should focus on replication and determining the causal role of these features.
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Affiliation(s)
| | - Shadi Beshai
- Department of Psychology, University of Regina, Saskatchewan, Canada, and
| | - Marina Dimova
- Department of Psychology, University of Exeter, England, UK
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McFarlane AC, Lawrence-Wood E, Van Hooff M, Malhi GS, Yehuda R. The Need to Take a Staging Approach to the Biological Mechanisms of PTSD and its Treatment. Curr Psychiatry Rep 2017; 19:10. [PMID: 28168596 DOI: 10.1007/s11920-017-0761-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite the substantial body of neurobiological research, no specific drug target has been developed to treat PTSD and there are substantial limitations with the available interventions. We propose that advances are likely to depend on the development of better classification of the heterogeneity of PTSD using a staging approach of disease. A primary rationale for staging is to highlight the probability that distinct therapeutic approaches need to be utilised according to the degree of biological progression of the disorder. Prospective studies, particularly of military populations, provide substantial evidence about the emerging biological abnormalities that precede the full-blown disorder. These need to be targeted with tailored interventions to prevent disease progression. Equally, the neurobiology of chronic unremitting PTSD needs to be differentiated from the acute disorder which emerges across a spectrum of severity, and this range of presentations correspondingly needs to be addressed with differing therapeutic strategies. The staging approach also needs to take account of the range of somatic pathological outcomes that are being identified as a consequence of traumatic stress exposure. PTSD should be conceptualised as a systemic disorder underpinned a range of biological dysregulation, including metabolic and altered immune function, reflected in the increased rates of cardiovascular and autoimmune disease. The effectiveness of novel treatments needs to be judged across their effectiveness in addressing the spectrum of trauma-related pathology.
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Affiliation(s)
- Alexander Cowell McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Level 2, 122 Frome Street, Adelaide, 5000, South Australia.
| | - Eleanor Lawrence-Wood
- Centre for Traumatic Stress Studies, The University of Adelaide, Level 2, 122 Frome Street, Adelaide, 5000, South Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, The University of Adelaide, Level 2, 122 Frome Street, Adelaide, 5000, South Australia
| | - Gin S Malhi
- Department of Psychiatry, Sydney Medical School, The University of Sydney, Edward Ford Building (A27), Fisher Road, University of Sydney, New South Wales, 2006, Australia
| | - Rachel Yehuda
- Traumatic Stress Studies Division, Mount Sinai School of Medicine, James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 110468, USA
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30
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Abstract
The present study was aimed at exploring the prevalence and factors associated with depressive symptoms among left-behind women in China. A sample of 938 participants (439 left-behind women and 499 non-left-behind women) was surveyed with self-rating questionnaire. The scores of depressive symptoms were higher in the left-behind women; and the overall prevalence of depressive symptoms was 34.54% for all participants and 46.69% for the left-behind women (mild, 40.77%; moderate/major, 5.92%). The status of left-behind is an independent risk factor of depressive symptoms in rural women. The multinomial logistic regression in the left-behind women indicated age, religious belief, annual individual income, impulsiveness, and active coping were associated with mild depressive symptoms; whereas age, religious belief, domestic violence, and active coping were associated with moderate/major depressive symptoms. Results suggest that depressive symptoms were prevalent among the left-behind women. The findings should be considered for the psychological intervention in the left-behind women.
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Brent DA, Brunwasser SM, Hollon SD, Weersing VR, Clarke GN, Dickerson JF, Beardslee WR, Gladstone TRG, Porta G, Lynch FL, Iyengar S, Garber J. Effect of a Cognitive-Behavioral Prevention Program on Depression 6 Years After Implementation Among At-Risk Adolescents: A Randomized Clinical Trial. JAMA Psychiatry 2015; 72:1110-8. [PMID: 26421861 PMCID: PMC4635056 DOI: 10.1001/jamapsychiatry.2015.1559] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Adolescents whose parents have a history of depression are at risk for developing depression and functional impairment. The long-term effects of prevention programs on adolescent depression and functioning are not known. OBJECTIVE To determine whether a cognitive-behavioral prevention (CBP) program reduced the incidence of depressive episodes, increased depression-free days, and improved developmental competence 6 years after implementation. DESIGN, SETTING, AND PARTICIPANTS A 4-site randomized clinical trial compared the effect of CBP plus usual care vs usual care, through follow-up 75 months after the intervention (88% retention), with recruitment from August 2003 through February 2006 at a health maintenance organization, university medical centers, and a community mental health center. A total of 316 participants were 13 to 17 years of age at enrollment and had at least 1 parent with current or prior depressive episodes. Participants could not be in a current depressive episode but had to have subsyndromal depressive symptoms or a prior depressive episode currently in remission. Analysis was conducted between August 2014 and June 2015. INTERVENTIONS The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Usual care consisted of any family-initiated mental health treatment. MAIN OUTCOMES AND MEASURES The Depression Symptoms Rating scale was used to assess the primary outcome, new onsets of depressive episodes, and to calculate depression-free days. A modified Status Questionnaire assessed developmental competence (eg, academic or interpersonal) in young adulthood. RESULTS Over the 75-month follow-up, youths assigned to CBP had a lower incidence of depression, adjusting for current parental depression at enrollment, site, and all interactions (hazard ratio, 0.71 [95% CI, 0.53-0.96]). The CBP program's overall significant effect was driven by a lower incidence of depressive episodes during the first 9 months after enrollment. The CBP program's benefit was seen in youths whose index parent was not depressed at enrollment, on depression incidence (hazard ratio, 0.54 [95% CI, 0.36-0.81]), depression-free days (d = 0.34, P = .01), and developmental competence (d = 0.36, P = .04); these effects on developmental competence were mediated via the CBP program's effect on depression-free days. CONCLUSIONS AND RELEVANCE The effect of CBP on new onsets of depression was strongest early and was maintained throughout the follow-up period; developmental competence was positively affected 6 years later. The effectiveness of CBP may be enhanced by additional booster sessions and concomitant treatment of parental depression. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT00073671.
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Affiliation(s)
- David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Steven M. Brunwasser
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - V. Robin Weersing
- Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, California, and University of California, San Diego, San Diego
| | - Gregory N. Clarke
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | | | - Giovanna Porta
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
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Schmaal L, Marquand AF, Rhebergen D, van Tol MJ, Ruhé HG, van der Wee NJA, Veltman DJ, Penninx BWJH. Predicting the Naturalistic Course of Major Depressive Disorder Using Clinical and Multimodal Neuroimaging Information: A Multivariate Pattern Recognition Study. Biol Psychiatry 2015; 78:278-86. [PMID: 25702259 PMCID: PMC4449319 DOI: 10.1016/j.biopsych.2014.11.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND A chronic course of major depressive disorder (MDD) is associated with profound alterations in brain volumes and emotional and cognitive processing. However, no neurobiological markers have been identified that prospectively predict MDD course trajectories. This study evaluated the prognostic value of different neuroimaging modalities, clinical characteristics, and their combination to classify MDD course trajectories. METHODS One hundred eighteen MDD patients underwent structural and functional magnetic resonance imaging (MRI) (emotional facial expressions and executive functioning) and were clinically followed-up at 2 years. Three MDD trajectories (chronic n = 23, gradual improving n = 36, and fast remission n = 59) were identified based on Life Chart Interview measuring the presence of symptoms each month. Gaussian process classifiers were employed to evaluate prognostic value of neuroimaging data and clinical characteristics (including baseline severity, duration, and comorbidity). RESULTS Chronic patients could be discriminated from patients with more favorable trajectories from neural responses to various emotional faces (up to 73% accuracy) but not from structural MRI and functional MRI related to executive functioning. Chronic patients could also be discriminated from remitted patients based on clinical characteristics (accuracy 69%) but not when age differences between the groups were taken into account. Combining different task contrasts or data sources increased prediction accuracies in some but not all cases. CONCLUSIONS Our findings provide evidence that the prediction of naturalistic course of depression over 2 years is improved by considering neuroimaging data especially derived from neural responses to emotional facial expressions. Neural responses to emotional salient faces more accurately predicted outcome than clinical data.
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Affiliation(s)
- Lianne Schmaal
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - Andre F Marquand
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Department of Neuroimaging, Institute of Psychiatry, King's College London, United Kingdom
| | - Didi Rhebergen
- Department of Psychiatry and the EMGO(+) Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Marie-José van Tol
- Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henricus G Ruhé
- Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Psychiatry, Mood and Anxiety Disorders, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry (NJvdW), Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry and Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry and the EMGO(+) Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Premorbid risk factors for major depressive disorder: are they associated with early onset and recurrent course? Dev Psychopathol 2015; 26:1477-93. [PMID: 25422974 DOI: 10.1017/s0954579414001151] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Premorbid risk for major depressive disorder (MDD) and predictors of an earlier onset and recurrent course were examined in two studies in a large, community-based sample of parents and offspring, prospectively assessed from late childhood into adulthood. In Study 1 (N = 2,764 offspring and their parents), parental psychiatric status, offspring personality at age 11, and age 11 offspring internalizing and externalizing symptoms predicted the subsequent development of MDD, as did poor quality parent-child relationships, poor academic functioning, early pubertal development, and childhood maltreatment by age 11. Parental MDD and adult antisocial behavior, offspring negative emotionality and disconstraint, externalizing symptoms, and childhood maltreatment predicted an earlier onset of MDD, after accounting for course; lower positive emotionality, trait anxiety, and childhood maltreatment predicted recurrent MDD, after accounting for age of onset. In Study 2 (N = 7,146), we examined molecular genetic risk for MDD by extending recent reports of associations with glutamatergic system genes. We failed to confirm associations with MDD using either individual single nucleotide polymorphism based tests or gene-based analyses. Overall, results speak to the pervasiveness of risk for MDD, as well as specific risk for early onset MDD; risk for recurrent MDD appears to be largely a function of its often earlier onset.
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Kaur J, Cheong SM, Mahadir Naidu B, Kaur G, Manickam MA, Mat Noor M, Ibrahim N, Rosman A. Prevalence and correlates of depression among adolescents in Malaysia. Asia Pac J Public Health 2014; 26:53S-62S. [PMID: 25070697 DOI: 10.1177/1010539514544356] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Depression among adolescents has been recognized as a major public health issue. The objective of this study was to determine the prevalence and correlates of depression among school-going adolescents in Malaysia. Data from the Malaysia Global School-based Health Survey (GSHS) 2012 were analyzed with additional data from the validated DASS21 (Depression, Anxiety, and Stress) questionnaire. The study revealed that 17.7% of respondents had depressive symptoms. Multivariate analysis further showed that feeling lonely (adjusted odds ratio [aOR] = 2.99; 95% CI = 2.57-3.47), Indian ethnicity (aOR = 2.00; 95% CI = 1.63-2.44), using drugs (aOR = 1.85; 95% CI = 1.21-2.82), and being bullied (aOR = 1.79; 95% CI = 1.60-1.99) were significantly associated with depressive symptoms. Lack of parental supervision, alcohol use, and tobacco use were also significant risk factors. Addressing depressive symptoms among adolescents may have implications for managing their risks of being bullied and substance use. This study also highlights the need to further investigate depressive symptoms among adolescents of Indian ethnicity.
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Affiliation(s)
- Jasvindar Kaur
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Siew Man Cheong
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Gurpreet Kaur
- National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Mala A Manickam
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Malisa Mat Noor
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia Ministry of Health, Putrajaya, Malaysia
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35
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Persistence of chronic major depression: a national prospective study. J Affect Disord 2013; 151:306-12. [PMID: 23866303 DOI: 10.1016/j.jad.2013.06.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/07/2013] [Accepted: 06/08/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic major depressive disorder (CMDD) is highly prevalent and associated with high personal and societal cost. Identifying risk factors for persistence and remission of CMDD may help in developing more effective treatment and prevention interventions. METHODS Prospective cohort study of individuals participating in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1; n=43,093) and its 3-year follow-up (Wave 2; n=34,653) who met a diagnosis of CMDD at the Wave 1 assessment. RESULTS Among the 504 respondents who met criteria for present CMDD at Wave 1, only 63 (11.52%) of them continued to meet criteria of CMDD. A history of childhood sexual abuse, earlier onset of MDD, presence of comorbidity and a history of treatment-seeking for depression predicted persistence of CMDD three years after the baseline evaluation. LIMITATIONS Our sample is limited to adults, our follow-up period was only three-years and the diagnosis of CMDD at baseline was retrospective. CONCLUSIONS CMDD shows high rates of remission within three years of baseline assessment, although some specific risk factors predict a persistent course. Given the high personal and societal cost associated with CMDD, there is a need to develop and disseminate effective interventions for CMDD.
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Cronkite RC, Woodhead EL, Finlay A, Timko C, Unger Hu K, Moos RH. Life stressors and resources and the 23-year course of depression. J Affect Disord 2013; 150:370-7. [PMID: 23688913 DOI: 10.1016/j.jad.2013.04.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/19/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Life stressors and personal and social resources are associated with depression in the short-term, but little is known about their associations with the long-term course of depression. The current paper presents results of a 23-year study of community adults who were receiving treatment for depression at baseline (N=382). METHODS Semi-parametric group-based modeling was used to identify depression trajectories and determine baseline predictors of belonging to each trajectory group. RESULTS There were three distinct courses of depression: high severity at baseline with slow decline, moderate severity at baseline with rapid decline, and low severity at baseline with rapid decline. At baseline, individuals in the high-severity group had less education than those in the moderate-severity group, and more medical conditions than those in the moderate- and low-severity groups. Individuals in the high- and moderate-severity groups evidenced less psychological flexibility, and relied more on avoidance coping than individuals in the low-severity group. LIMITATIONS Results are limited by use of self-report and lack of information about depression status and life events in the periods between follow-ups. CONCLUSIONS These results assist in identifying groups at high risk for a long-term course of depression, and will help in selecting appropriate interventions that target depression severity, coping skills and management of stressors.
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Affiliation(s)
- Ruth C Cronkite
- VA Palo Alto Center for Health Care Evaluation, Menlo Park, CA, United States
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Pan YJ, Liu SK, Yeh LL. Factors affecting early attrition and later treatment course of antidepressant treatment of depression in naturalistic settings: an 18-month nationwide population-based study. J Psychiatr Res 2013; 47:916-25. [PMID: 23566422 DOI: 10.1016/j.jpsychires.2013.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Early attrition can impede treatment success of depression; its contributing factors and impacts on subsequent treatment course need further clarification. METHODS All Taiwanese adult patients prescribed with antidepressants for depression (n=216,557) in 2003 were identified through a total population health insurance claims database; their initial contact patterns could be classified into three types of attrition: non-attrition, returning attrition and non-returning attrition. Demographic and clinical characteristics associated with each attrition type were described and relationships between attrition type and subsequent treatment course over an 18-month follow-up period were examined with these demographic/clinical confounders being controlled for. RESULTS 41.6% of Study subjects had early attrition; among them, 35.3% returned to treatment later. Type of depression, medical/psychiatric comorbidities, painful physical symptoms and past treatment history, as well as prescribing physician specialty and choice of antidepressants, were associated with early attrition. Three types of follow-up pattern over the 18-month follow-up period were identified: sustained treatment-free, continuous treatment and late re-contacts. Patients remaining engaged with treatment within the first three months had higher odds of achieving sustained treatment-free (OR=1.21; 99% CI: 1.16, 1.27) and lower odds of having late re-contacts (OR=0.20; 99% CI: 0.19, 0.21) over the 18-month period, compared to those who returned after early attrition. CONCLUSIONS Early attrition is a significant barrier for depression treatment in daily clinical practice and has negative impacts on later treatment course and/or outcome. Early attrition needs to be minimized through shared decision-making, exchange of treatment preferences and proper patient-physician communication.
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Affiliation(s)
- Yi-Ju Pan
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, United Kingdom
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Kraus M, Karaman T. Parameters of education and the course of depression: an analysis in the Turkish sociocultural context. Int J Soc Psychiatry 2013; 59:318-31. [PMID: 22408117 DOI: 10.1177/0020764012437122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Major depression (MD) is often marked by an unfavourable course. Education repeatedly was found to be associated with better mental health variables, but longitudinal data are scarce. This evaluation seeks to identify the predictive role of specific aspects of education on the course of depression in a socioculturally defined setting. METHODS A sample of 69 unipolar MD outpatients in university and primary health care in Antalya, Turkey were observed naturalistically for a mean 11-month period. The baseline examination included several psychosocial variables, among them the highest attained schooling degree (DEG), possible further but unfulfilled educational aspirations (UEA), and the participants' parental educational level (PEL). The depressive symptomatology was assessed with the HAM-D-17 at baseline and at four-monthly follow-ups. A binary variable differentiated 'non-remissive' from 'remissive' courses, the latter displaying at least temporal partial remissions. RESULTS Forty-two per cent of the sample displayed a non-remissive one-year course of MD. Half of the participants reported UEA. This was more prevalent among women, and qualitative information added causal gender-specific perceptions. In logistic regression, DEG proved prognostic impact, but was exceeded by the combination of UEA and PEL as the strongest predictor model (Cox & Snell R(2) = 0.217). This remained when controlled for place of examination, gender and initial severity of depression. As risk factors for low education, a pattern of female gender and large family size (itself predicted by rural descent) emerged. CONCLUSIONS Low education proved to be a risk factor for an unfavourable course of MD. Not only actual experienced schooling, but also unfulfilled academic aspirations and a low parental educational level appear to be of crucial impact.
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Affiliation(s)
- Michael Kraus
- Department of Psychiatry, Akdeniz Üniversitesi, Antalya, Turkey.
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39
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Yaroslavsky I, Pettit JW, Lewinsohn PM, Seeley JR, Roberts RE. Heterogeneous trajectories of depressive symptoms: adolescent predictors and adult outcomes. J Affect Disord 2013; 148:391-9. [PMID: 22963892 PMCID: PMC3654021 DOI: 10.1016/j.jad.2012.06.028] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depressive symptoms display heterogeneous trajectories across adolescence and early adulthood. Identifying risk and protective factors for distinct trajectory groups, and their respective outcomes, may provide insight into the etiological underpinnings of different symptom courses and inform the targets and timing of intervention. METHODS A school-based sample of 719 adolescents completed four diagnostic evaluations and up to 7 annually mailed questionnaires assessing psychiatric symptoms and psychosocial risk and protective factors. Parental history of psychiatric disorder was assessed. Growth mixture modeling (GMM) was used to identify latent depressive symptom trajectories from mid-adolescence through age 30, as well as their predictors in mid-adolescence and adult outcomes. RESULTS A three class model consisting of high stable (32%), moderate decreasing (44%), and low decreasing (24%) depressive symptom trajectories emerged as the preferred solution. Demographic, psychosocial, and psychiatric characteristics differentiated the low and high symptom classes, and provided support for interpersonal models of depression chronicity. Members of the moderate and high symptom classes evidenced the worst psychosocial and psychiatric outcomes by age 30, with members of the high symptom class showing the greatest levels of impairment. LIMITATIONS Cross-sectional measurement and floor effects of several predictor variables may have obscured the relations between those predictors and trajectory class membership. CONCLUSION These findings suggest that prevention and intervention strategies may specifically target young women and those who experience poor interpersonal functioning in an effort to alter the course of depressive symptoms through early adulthood.
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Affiliation(s)
| | - Jeremy W. Pettit
- Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL 33199, USA,Corresponding author. (J.W. Pettit)
| | | | | | - Robert E. Roberts
- University of Texas Health Science Center at Houston, Houston, TX, USA
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40
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Changes in the Beck Depression Inventory-II's underlying symptom structure over 1 month of inpatient treatment. J Nerv Ment Dis 2013; 201:371-6. [PMID: 23588226 DOI: 10.1097/nmd.0b013e31828e1004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research has not investigated changes in the symptom structure of depression over the course of mental health treatment. In the present study, 1025 psychiatric inpatients were recruited and assessed for depression symptom severity using the Beck Depression Inventory-II (BDI-II) at admission and after 1 month of treatment. A three-factor BDI-II model was tested using confirmatory factor analysis and fit reasonably well at both time points. Measurement invariance testing results demonstrated that factor loadings increased, indicating that the meaning of the three underlying depression dimensions changed through treatment. However, observed variable intercepts and residual error variances decreased significantly after 1 month of treatment, reflecting decreases in symptom severity as well as measurement error. Thus, depressive symptom severity decreased over the course of treatment, and the underlying factor structure of depression improved in fit after treatment. Implications for changes to the structure of depression symptoms and in the clinical practice of tracking depression over time are discussed.
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41
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Pettit JW, Hartley C, Lewinsohn PM, Seeley JR, Klein DN. Is liability to recurrent major depressive disorder present before first episode onset in adolescence or acquired after the initial episode? JOURNAL OF ABNORMAL PSYCHOLOGY 2013; 122:353-8. [PMID: 23713498 PMCID: PMC3777803 DOI: 10.1037/a0032655] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many individuals who experience a major depressive episode will subsequently develop recurrent episodes. Although numerous studies have investigated predictors of recurrent episodes, methodological limitations have made it difficult to determine the extent to which liability to recurrent major depressive disorder (rMDD) exists prior to first onset or develops after first onset. This study used a prospective design in a community sample of adolescents to examine variables before and after first onset MDD as predictors of rMDD over a 12-year follow-up. Among 59 adolescents who experienced first onset MDD, 72.88% developed rMDD during the follow-up period. Parental history of rMDD and lifetime history of minor depression prior to MDD onset significantly predicted rMDD. These two effects replicated in ancillary analyses in an expanded sample of N = 205. Following MDD onset, a higher number of major life events significantly predicted rMDD. Liability to rMDD exists prior to MDD onset in the form of familial risk and less severe mood disturbances, whereas liability to rMDD in the form of elevated stress may develop following a first onset in adolescence.
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Affiliation(s)
- Jeremy W Pettit
- Department of Psychology, Florida International University, Miami, FL 33199, USA.
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42
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Cents RAM, Diamantopoulou S, Hudziak JJ, Jaddoe VWV, Hofman A, Verhulst FC, Lambregtse-van den Berg MP, Tiemeier H. Trajectories of maternal depressive symptoms predict child problem behaviour: the Generation R study. Psychol Med 2013; 43:13-25. [PMID: 22490169 DOI: 10.1017/s0033291712000657] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is unclear how the course of maternal depressive symptoms affects child development. We modelled trajectories of maternal depressive symptoms from mid-pregnancy to 3 years after childbirth to better determine their associations with child problem behaviour. METHOD Mother-child dyads (n = 4167) participated in a population-based prospective cohort in The Netherlands. Depressive symptoms were assessed with the Brief Symptom Inventory during pregnancy and at 2, 6 and 36 months postnatally. When children were 3 years old, problem behaviour was assessed with the Child Behaviour Checklist completed by each parent. A group-based modelling technique was used to model trajectories of maternal depressive symptoms and to examine their association with child problem behaviour. The added value of trajectory modelling was determined with successive linear regressions. RESULTS We identified four trajectories of maternal depressive symptoms; 'no' (34%), 'low' (54%), 'moderate' (11%) and 'high' (1.5%). Child problem behaviour varied as a function of maternal trajectory membership. Whether rated by mother or father, children of mothers assigned to higher trajectories had significantly more problem behaviours than children of mothers assigned to lower trajectories. The model including trajectories had additive predictive value over a model relying only on a summed repeated measure of severity and a predefined chronicity variable. CONCLUSIONS Depending on their course, maternal depressive symptoms have different effects on child problem behaviour. More information is gained by studying trajectories of symptoms, than only predefined measures of severity and chronicity. Moreover, trajectories can help identifying clinically depressed mothers who are possible candidates for early interventions.
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Affiliation(s)
- R A M Cents
- The Generation R Study Group, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
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Crona L, Brådvik L. Long-term course of severe depression: late remission and recurrence may be found in a follow-up after 38-53 years. Ment Illn 2012; 4:e17. [PMID: 25478118 PMCID: PMC4253380 DOI: 10.4081/mi.2012.e17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/22/2012] [Accepted: 08/07/2012] [Indexed: 11/23/2022] Open
Abstract
This study is a follow-up of inpatients diagnosed with severe depression/melancholia between 1956 and 1969. During this period, all inpatients at the Department of Psychiatry, University Hospital, Lund, were rated on a multidimensional diagnostic schedule on discharge. There were 471 patients born from 1920 onward. In the present follow-up, 2006 to 2010, 169 survivors could be traced. They were asked to participate in the study involving a telephone interview, in which a structured life chart was used. Of the patients contacted, 16 were ill or confused and 3 did not remember ever being depressed, leaving 150 who could participate. Seventy-five of these agreed to participate in the study. Long-term course of depression was evaluated by cluster analysis and compared to background variables, such as heredity for depression, perceived parental rearing behaviour, and treatment of index depressive episode. Using a cluster analysis the patients could be separated into six clusters describing the course: i) single or few episodes followed by long-lasting remission; ii) single or few episodes followed by long-lasting remission, although shorter; iii) single or few episodes followed by late recurrence; iv) single or few episodes, but more frequently ill, followed by late recurrence; v) several episodes followed by lasting remission; vi) chronic course of episodes. Remission or recurrence could therefore occur even after more than a decade. In summary, there was a short-term course with or without recurrence or a chronic course with or without late remission. Heredity for depression was significantly related to a chronic course with or without late remission.
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Affiliation(s)
- Lisa Crona
- Department of Clinical Sciences, Division of Psychiatry, Lund University, Sweden
| | - Louise Brådvik
- Department of Clinical Sciences, Division of Psychiatry, Lund University, Sweden
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Rush AJ, Wisniewski SR, Zisook S, Fava M, Sung SC, Haley CL, Chan HN, Gilmer WS, Warden D, Nierenberg AA, Balasubramani GK, Gaynes BN, Trivedi MH, Hollon SD. Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report. Psychol Med 2012; 42:1131-1149. [PMID: 22008447 DOI: 10.1017/s0033291711002170] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is commonly chronic and/or recurrent. We aimed to determine whether a chronic and/or recurrent course of MDD is associated with acute and longer-term MDD treatment outcomes. METHOD This cohort study recruited out-patients aged 18-75 years with non-psychotic MDD from 18 primary and 23 psychiatric care clinics across the USA. Participants were grouped as: chronic (index episode >2 years) and recurrent (n = 398); chronic non-recurrent (n=257); non-chronic recurrent (n=1614); and non-chronic non-recurrent (n = 387). Acute treatment was up to 14 weeks of citalopram (≤ 60 mg/day) with up to 12 months of follow-up treatment. The primary outcomes for this report were remission [16-item Quick Inventory of Depressive Symptomatology - Self-Rated (QIDS-SR(16)) ≤ 5] or response (≥ 50% reduction from baseline in QIDS-SR(16)) and time to first relapse [first QIDS-SR16 by Interactive Voice Response (IVR) ≥ 11]. RESULTS Most participants (85%) had a chronic and/or recurrent course; 15% had both. Chronic index episode was associated with greater sociodemographic disadvantage. Recurrent course was associated with earlier age of onset and greater family histories of depression and substance abuse. Remission rates were lowest and slowest for those with chronic index episodes. For participants in remission entering follow-up, relapse was most likely for the chronic and recurrent group, and least likely for the non-chronic, non-recurrent group. For participants not in remission when entering follow-up, prior course was unrelated to relapse. CONCLUSIONS Recurrent MDD is the norm for out-patients, of whom 15% also have a chronic index episode. Chronic and recurrent course of MDD may be useful in predicting acute and long-term MDD treatment outcomes.
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Affiliation(s)
- A J Rush
- Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore
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Rubio JM, Markowitz JC, Alegría A, Pérez-Fuentes G, Liu SM, Lin KH, Blanco C. Epidemiology of chronic and nonchronic major depressive disorder: results from the national epidemiologic survey on alcohol and related conditions. Depress Anxiety 2011; 28:622-31. [PMID: 21796739 PMCID: PMC3212845 DOI: 10.1002/da.20864] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Burden related to major depressive disorder (MDD) derives mostly from long-term occurrence of symptoms. This study aims to examine the prevalence, sociodemographic correlates, patterns of 12-month and lifetime psychiatric comorbidity, lifetime risk factors, psychosocial functioning, and mental health service utilization of chronic major depressive disorder (CMDD) compared to nonchronic major depressive disorder. METHODS Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). RESULTS The 12-month and lifetime prevalence of CMDD within the population meeting criteria for MDD was 26.5% and 24.0%, respectively. Individuals reporting a chronic course of MDD were socioeconomically and educationally disadvantaged, tended to be older, report loss of spouse or history of divorce, live in rural areas, have public assistance, low self-esteem, worse overall health and more likely to report comorbidities, most importantly dysthymia, generalized anxiety disorder, avoidant, and dependant personality disorder. Individuals with chronic MDD were more likely to report familial but not childhood onset risk factors for MDD. Those suffering CMDD were more likely to seek and receive mental health care than other forms of MDD, even though it took longer to start treatment. CONCLUSION Chronic course of MDD is related to still worse socioeconomic conditions, educational achievement, more comorbidities, and family risk factors, although other courses of MDD carried greater risk of unmet treatment.
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Affiliation(s)
- Jose M. Rubio
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - John C. Markowitz
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032,Weill Medical College of Cornell University New York, NY 10065
| | - Analucía Alegría
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Gabriela Pérez-Fuentes
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Shang-Min Liu
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Keng-Han Lin
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
| | - Carlos Blanco
- Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, New York, NY 10032,New York State Psychiatric Institute, New York, NY 10032
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Trivedi MH, Dunner DL, Kornstein SG, Thase ME, Zajecka JM, Rothschild AJ, Friedman ES, Shelton RC, Keller MB, Kocsis JH, Gelenberg A. Psychosocial outcomes in patients with recurrent major depressive disorder during 2 years of maintenance treatment with venlafaxine extended release. J Affect Disord 2010; 126:420-9. [PMID: 20510459 PMCID: PMC3705737 DOI: 10.1016/j.jad.2010.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/23/2010] [Accepted: 04/19/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychosocial outcomes from the Prevention of Recurrent Episodes of Depression with Venlafaxine ER for Two Years (PREVENT) study were evaluated. METHODS Adult outpatients with recurrent major depressive disorder (MDD) and response or remission following 6-month continuation treatment with venlafaxine extended release (ER) were randomized to receive venlafaxine ER or placebo for 1 year. Patients without recurrence on venlafaxine ER during year 1 were randomized to venlafaxine ER or placebo for year 2. Psychosocial functioning was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q), Life Enjoyment Scale-Short Version (LES-S), Social Adjustment Scale-Self-Report (SAS-SR) total and individual factors, Short Form Health Survey (SF-36) (vitality, social functioning, and role function-emotional items), and Longitudinal Interval Follow-up Evaluation (LIFE). RESULTS At year 1 end, better overall psychosocial functioning was seen among patients randomly assigned to venlafaxine ER (n=129) vs placebo (n=129), with significant differences at end point on SF-36 role function-emotional, Q-LES-Q, and SAS-SR total, and work, house work, social/leisure, and extended-family factor scores (p≤0.05). At year 2 end, significant differences favored venlafaxine ER (n=43) vs placebo (n=40) on SF-36 vitality and role function-emotional, Q-LES-Q, LES-S, LIFE, and SAS-SR total, social/leisure, and extended-family factor scores (p≤0.05). LIMITATIONS Patients with chronic MDD or treatment resistance were excluded and long-term specialist care was a financial incentive for treatment compliance. Discontinuation-related adverse events may have compromised the integrity of the treatment blind. CONCLUSIONS For patients with recurrent MDD, 2 years' maintenance therapy with venlafaxine ER may improve psychosocial functioning vs placebo.
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Affiliation(s)
- Madhukar H. Trivedi
- University of Texas Southwestern Medical School, Dallas, Texas, United States,Corresponding author. University of Texas Southwestern Medical Center at Dallas, Bass Center, 6363 Forest Park Road, 13.354, Dallas, Texas 75235, United States. Tel.: +1 214 648 0188; fax: +1 214 648 0167. (M.H. Trivedi)
| | - David L. Dunner
- Center for Anxiety and Depression, Mercer Island, Washington, United States
| | | | - Michael E. Thase
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
| | - John M. Zajecka
- Rush University Medical Center, Chicago, Illinois, United States
| | - Anthony J. Rothschild
- University of Massachusetts Medical School, Worcester, Massachusetts, United States,UMass Memorial Health Care, Worcester, Massachusetts, United States
| | - Edward S. Friedman
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | | | | | - James H. Kocsis
- Weill Cornell Medical College, New York, New York, United States
| | - Alan Gelenberg
- Healthcare Technology Systems, Madison, Wisconsin, United States
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Abstract
BACKGROUND Severity is an important characteristic of major depression (MD) and an 'episode specifier' in DSM-IV classifying depressive episodes as 'mild', 'moderate' or 'severe'. These severity subtypes rely on three different measures of severity: number of criteria symptoms, severity of the symptoms and degree of functional disability. No prior empirical study has evaluated the coherence and validity of the DSM-IV definition of severity of MD. METHOD In a sample of 1015 (518 males, 497 females) Caucasian twins from a population-based registry who met criteria for MD in the year prior to interview, factor analysis and logistic regression were conducted to examine the inter-relationships of the three severity measures and their associations with a wide range of potential validators including demographic factors, risk for future episodes, risk of MD in the co-twin, characteristics of the depressive episode, the pattern of co-morbidity, and personality traits. RESULTS Correlations between the three severity measures were significant but moderate. Factor analysis indicated the existence of a general severity factor, but the factor was not highly coherent. The three severity measures showed differential predictive ability for most of the validators. CONCLUSIONS Severity of MD as defined by the DSM-IV is a multifaceted and heterogeneous construct. The three proposed severity measures reflect partly overlapping but partly independent domains with differential validity as assessed by a wide range of clinical characteristics. Clinicians should probably use a combination of severity measures as proposed in DSM-IV rather than privileging one.
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Affiliation(s)
- V. Lux
- Department of Psychology, Free University Berlin, Germany
| | - S. H. Aggen
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - K. S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
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48
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Glozier N, Martiniuk A, Patton G, Ivers R, Li Q, Hickie I, Senserrick T, Woodward M, Norton R, Stevenson M. Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study. Sleep 2010; 33:1139-45. [PMID: 20857859 PMCID: PMC2938854 DOI: 10.1093/sleep/33.9.1139] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Young people are sleeping less. Short sleep duration has a range of negative consequences including a hypothesized link with psychological distress, which has yet to be studied DESIGN Prospective cohort study SETTING Community-based sample from Australia PARTICIPANTS Twenty thousand (20,822) young adults (aged 17-24) identified through the state vehicle licensing authority. A random sample (n = 5000) was approached for follow-up 12-18 months later, with 2837 providing full data. MAIN OUTCOME MEASURE Psychological distress, determined by a Kessler 10 score > 21, at baseline; and as both onset and persistence of distress at follow-up. RESULTS Shorter sleep duration was linearly associated with prevalent psychological distress: relative risk (RR) 1.14 (95% CI 1.12 to 1.15). Only the very short (< 5 h) sleepers among those not distressed at baseline had an increased risk for onset of psychological distress (RR 3.25 [95% CI 1.84, 5.75]). Of 945 cohort participants reporting psychological distress at baseline, 419 (44%) were distressed at follow-up. Each hour less of sleep increased the risk of psychological distress persisting after adjustment for potential confounding variables: RR 1.05 (95% CI 1.01 to 1.10). Long sleep duration showed no association with distress at any time point. CONCLUSIONS Self-reported shorter sleep duration is linearly associated with prevalent and persistent psychological distress in young adults. In contrast, only the very short sleepers had a raised risk of new onset of distress. Different approaches to sleep duration measurement yield different results and should guide any interventions to improve subjective sleep duration in young adults.
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Affiliation(s)
- Nicholas Glozier
- Disciplines of Psychiatry and Sleep Medicine, University of Sydney, Sydney Australia
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49
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Mann JJ, Arango VA, Avenevoli S, Brent DA, Champagne FA, Clayton P, Currier D, Dougherty DM, Haghighi F, Hodge SE, Kleinman J, Lehner T, McMahon F, Mościcki EK, Oquendo MA, Pandey GN, Pearson J, Stanley B, Terwilliger J, Wenzel A. Candidate endophenotypes for genetic studies of suicidal behavior. Biol Psychiatry 2009; 65:556-63. [PMID: 19201395 PMCID: PMC3271953 DOI: 10.1016/j.biopsych.2008.11.021] [Citation(s) in RCA: 263] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 10/21/2008] [Accepted: 11/12/2008] [Indexed: 12/12/2022]
Abstract
Twin, adoption, and family studies have established the heritability of suicide attempts and suicide. Identifying specific suicide diathesis-related genes has proven more difficult. As with psychiatric disorders in general, methodological difficulties include complexity of the phenotype for suicidal behavior and distinguishing suicide diathesis-related genes from genes associated with mood disorders and other suicide-associated psychiatric illness. Adopting an endophenotype approach involving identification of genes associated with heritable intermediate phenotypes, including biological and/or behavioral markers more proximal to genes, is an approach being used for other psychiatric disorders. Therefore, a workshop convened by the American Foundation for Suicide Prevention, the Department of Psychiatry at Columbia University, and the National Institute of Mental Health sought to identify potential target endophenotypes for genetic studies of suicidal behavior. The most promising endophenotypes were trait aggression/impulsivity, early-onset major depression, neurocognitive function, and cortisol social stress response. Other candidate endophenotypes requiring further investigation include serotonergic neurotransmission, second messenger systems, and borderline personality disorder traits.
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Affiliation(s)
- J John Mann
- Department of Psychiatry, NewYork State Psychiatric Institute/ColumbiaUniversity, 1051 Riverside Drive, New York, NY 10032, USA.
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