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Nunes A, Pavlova B, Cunningham JEA, Nuñez JJ, Quilty LC, Foster JA, Harkness KL, Ho K, Lam RW, Li QS, Milev R, Rotzinger S, Soares CN, Taylor VH, Turecki G, Kennedy SH, Frey BN, Rudzicz F, Uher R. Depression-Anxiety Coupling Strength as a predictor of relapse in major depressive disorder: A CAN-BIND wellness monitoring study report. J Affect Disord 2024; 361:189-197. [PMID: 38866253 DOI: 10.1016/j.jad.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND A critical challenge in the study and management of major depressive disorder (MDD) is predicting relapse. We examined the temporal correlation/coupling between depression and anxiety (called Depression-Anxiety Coupling Strength, DACS) as a predictor of relapse in patients with MDD. METHODS We followed 97 patients with remitted MDD for an average of 394 days. Patients completed weekly self-ratings of depression and anxiety symptoms using the Quick Inventory of Depressive Symptoms (QIDS-SR) and the Generalized Anxiety Disorder 7-item scale (GAD-7). Using these longitudinal ratings we computed DACS as random slopes in a linear mixed effects model reflecting individual-specific degree of correlation between depression and anxiety across time points. We then tested DACS as an independent variable in a Cox proportional hazards model to predict relapse. RESULTS A total of 28 patients (29 %) relapsed during the follow-up period. DACS significantly predicted confirmed relapse (hazard ratio [HR] 1.5, 95 % CI [1.01, 2.22], p = 0.043; Concordance 0.79 [SE 0.04]). This effect was independent of baseline depressive or anxiety symptoms or their average levels over the follow-up period, and was identifiable more than one month before relapse onset. LIMITATIONS Small sample size, in a single study. Narrow phenotype and comorbidity profiles. CONCLUSIONS DACS may offer opportunities for developing novel strategies for personalized monitoring, early detection, and intervention. Future studies should replicate our findings in larger, diverse patient populations, develop individual patient prediction models, and explore the underlying mechanisms that govern the relationship of DACS and relapse.
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Affiliation(s)
- Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada.
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - John-Jose Nuñez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Jane A Foster
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada; Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Keith Ho
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qingqin S Li
- Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Roumen Milev
- Department of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada
| | - Susan Rotzinger
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada
| | - Valerie H Taylor
- Cumming School of Medicine, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Gustavo Turecki
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Frank Rudzicz
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada; Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada
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Noda Y, Fujii K, Nakajima S, Kitahata R. Real-world case series of maintenance theta burst stimulation therapy following response to acute theta burst stimulation therapy for difficult-to-treat depression. CNS Spectr 2024:1-10. [PMID: 38769839 DOI: 10.1017/s109285292400035x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Treatment and management for difficult-to-treat depression are challenging, especially in a subset of patients who are at high risk for relapse and recurrence. The conditions that represent this subset are recurrent depressive disorder (RDD) and bipolar disorder (BD). In this context, we aimed to examine the effectiveness of maintenance transcranial magnetic stimulation (TMS) on a real-world clinical basis by retrospectively extracting data from the TMS registry data in Tokyo, Japan. METHODS Data on patients diagnosed with treatment-resistant RDD and BD who received maintenance intermittent theta burst stimulation (iTBS) weekly after successful treatment with acute iTBS between March 2020 and October 2023 were extracted from the registry. RESULTS All patients (21 cases: 10 cases with RDD and 11 cases with BD) could sustain response, and 19 of them further maintained remission. In this study, maintenance iTBS did not exacerbate depressive symptoms in any of the cases, but may rather have the effect of stabilizing the mental condition and preventing recurrence. CONCLUSIONS This case series is of great clinical significance because it is the first study to report on the effectiveness of maintenance iTBS for RDD and BD, with a follow-up of more than 2 years. Further validation with a randomized controlled trial design with a larger sample size is warranted.
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Affiliation(s)
- Yoshihiro Noda
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Shinichiro Nakajima
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Ghanbarian S, Wong GWK, Bunka M, Edwards L, Cressman S, Conte T, Peterson S, Vijh R, Price M, Schuetz C, Erickson D, Riches L, Landry G, McGrail K, Austin J, Bryan S. A Canadian Simulation Model for Major Depressive Disorder: Study Protocol. PHARMACOECONOMICS - OPEN 2024; 8:493-505. [PMID: 38528312 PMCID: PMC11058136 DOI: 10.1007/s41669-024-00481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is a common, often recurrent condition and a significant driver of healthcare costs. People with MDD often receive pharmacological therapy as the first-line treatment, but the majority of people require more than one medication trial to find one that relieves symptoms without causing intolerable side effects. There is an acute need for more effective interventions to improve patients' remission and quality of life and reduce the condition's economic burden on the healthcare system. Pharmacogenomic (PGx) testing could deliver these objectives, using genomic information to guide prescribing decisions. With an already complex and multifaceted care pathway for MDD, future evaluations of new treatment options require a flexible analytic infrastructure encompassing the entire care pathway. Individual-level simulation models are ideally suited for this purpose. We sought to develop an economic simulation model to assess the effectiveness and cost effectiveness of PGx testing for individuals with major depression. Additionally, the model serves as an analytic infrastructure, simulating the entire patient pathway for those with MDD. METHODS AND ANALYSIS Key stakeholders, including patient partners, clinical experts, researchers, and modelers, designed and developed a discrete-time microsimulation model of the clinical pathways of adults with MDD in British Columbia (BC), including all publicly-funded treatment options and multiple treatment steps. The Simulation Model of Major Depression (SiMMDep) was coded with a modular approach to enhance flexibility. The model was populated using multiple original data analyses conducted with BC administrative data, a systematic review, and an expert panel. The model accommodates newly diagnosed and prevalent adult patients with MDD in BC, with and without PGx-guided treatment. SiMMDep comprises over 1500 parameters in eight modules: entry cohort, demographics, disease progression, treatment, adverse events, hospitalization, costs and quality-adjusted life-years (payoff), and mortality. The model predicts health outcomes and estimates costs from a health system perspective. In addition, the model can incorporate interactive decision nodes to address different implementation strategies for PGx testing (or other interventions) along the clinical pathway. We conducted various forms of model validation (face, internal, and cross-validity) to ensure the correct functioning and expected results of SiMMDep. CONCLUSION SiMMDep is Canada's first medication-specific, discrete-time microsimulation model for the treatment of MDD. With patient partner collaboration guiding its development, it incorporates realistic care journeys. SiMMDep synthesizes existing information and incorporates provincially-specific data to predict the benefits and costs associated with PGx testing. These predictions estimate the effectiveness, cost-effectiveness, resource utilization, and health gains of PGx testing compared with the current standard of care. However, the flexible analytic infrastructure can be adapted to support other policy questions and facilitate the rapid synthesis of new data for a broader search for efficiency improvements in the clinical field of depression.
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Affiliation(s)
- Shahzad Ghanbarian
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Gavin W K Wong
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Mary Bunka
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Louisa Edwards
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Sonya Cressman
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Tania Conte
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Morgan Price
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Christian Schuetz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - David Erickson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Psychology Department, Fraser Health, Vancouver, BC, Canada
| | | | | | - Kim McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Stirling Bryan
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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Renneberg CK, Brund RBK, Heuckendorff S, Gunaseelan A, Kruse LV, Fonager K. Preschool children from lower household incomes experience inequality in asthma treatment: findings from a Danish nationwide cohort study. Eur J Public Health 2024; 34:85-90. [PMID: 37862429 PMCID: PMC10843934 DOI: 10.1093/eurpub/ckad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The obligation to pay for asthma medication in a country with universal healthcare might lead to increased asthma exacerbations and inequitable healthcare access for children from low-income households. Thus, the aim of this study was to examine the association between household income and childhood/preschool asthma regarding hospitalization and medication receipt. METHODS In this nationwide register-based cohort study, we encompassed all 3-year-old children residing in Denmark, born between 2000 and 2014, along with their linked parents and followed them until their sixth birthday. Household income was divided into quartiles. Asthma was categorized in two mutually exclusive groups as either the redemption of two prescriptions for asthma medication or receiving a hospital diagnosis. We utilized Poisson regression to estimate the risk ratio (RR). RESULTS The analysis included 834 422 preschool children. The prevalence of asthma dependent on medication alone was 7.3%, while 1.8% of children necessitated asthma-related hospitalization. Income inequality was evident across all income quartiles. Notably, children from the lowest income quartile had a RR of 0.95 (95% CI: 0.92-0.98) of redeeming asthma medication and conversely a RR of 1.18 (95% CI: 1.14-1.23) of asthma-related hospitalization. CONCLUSIONS Despite universal healthcare, income inequality has a dual impact on children from low-income households. They face a diminished risk of redeeming asthma medication and a higher susceptibility to asthma-related hospitalizations indicating an unequal access to healthcare. Prioritizing efforts to reduce childhood health inequalities is crucial. However, further research, particularly qualitative studies, is needed to better comprehend the underlying mechanisms to address the complexities of income inequality.
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Affiliation(s)
| | | | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Psychiatry Region North Jutland, Aalborg, Denmark
| | - Artika Gunaseelan
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbeth Venø Kruse
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Kato M, Shiosakai M, Kuwahara K, Iba K, Shimada Y, Saito M, Isogai Y, Sekine D, Aoki K, Koga N, Higuchi T. Adjunctive brexpiprazole 1 mg and 2 mg daily for Japanese patients with major depressive disorder following inadequate response to antidepressants: a phase 2/3, randomized, double-blind (BLESS) study. Psychiatry Clin Neurosci 2024; 78:113-122. [PMID: 37933521 DOI: 10.1111/pcn.13615] [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: 09/07/2023] [Revised: 10/27/2023] [Accepted: 11/04/2023] [Indexed: 11/08/2023]
Abstract
AIMS Inadequate antidepressant response interrupts effective treatment of major depressive disorder (MDD). The BLESS study evaluates the dosage, efficacy, and safety of brexpiprazole adjunctive therapy in Japanese patients with inadequate antidepressant therapy (ADT) response. METHODS This placebo-controlled, randomized, multicenter, parallel-group phase 2/3 study randomized Japanese MDD patients (Hamilton Rating Scale for Depression 17-item total score ≥ 14; historical inadequate response to 1-3 ADTs) with inadequate response to 8-week single-blind, prospective SSRI/SNRI treatment to 6-week adjunctive treatment with brexpiprazole 1 mg, 2 mg, or placebo. The primary endpoint was change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline. Secondary endpoints included MADRS response, remission rate, and Clinical Global Impression-Improvement score. Safety was comprehensively evaluated, especially regarding antipsychotic adverse events (AEs). RESULTS Of 1194 screened patients, 740 were randomized and 736 (1 mg, n = 248; 2 mg, n = 245; placebo, n = 243) had ≥1 baseline/post-baseline MADRS total score. The LSM (SE) change from baseline in MADRS total score at Week 6 by MMRM analysis was -8.5 (0.47) with brexpiprazole 1 mg, -8.2 (0.47) with brexpiprazole 2 mg, and -6.7 (0.47) with placebo (placebo-adjusted LSM difference [95% CI]: 1 mg, -1.7 [-3.0, -0.4]; P = 0.0089; 2 mg, -1.4 [-2.7, -0.1]; P = 0.0312). Secondary efficacy results supported the primary endpoint. Brexpiprazole was generally well tolerated. CONCLUSION Brexpiprazole 1 mg daily was an appropriate starting dose and both 1 mg and 2 mg daily were effective and well tolerated as adjunctive therapy for Japanese MDD patients not adequately responsive to ADT.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Masako Shiosakai
- Clinical Development, Headquarters of Clinical Development Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Kazuo Kuwahara
- Clinical Development, Headquarters of Clinical Development Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Katsuhiro Iba
- Clinical Development, Headquarters of Clinical Development Otsuka Pharmaceutical Co. Ltd., Osaka, Japan
| | - Yuki Shimada
- Clinical Development, Headquarters of Clinical Development Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Mizuki Saito
- Clinical Development, Headquarters of Clinical Development Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Yuki Isogai
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Daisuke Sekine
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Kazuo Aoki
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Nobuyuki Koga
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokushima, Japan
| | - Teruhiko Higuchi
- Japan Depression Center, Tokyo, Japan
- National Center of Neurology and Psychiatry, Tokyo, Japan
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6
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de Jonge M, Blankers M, Bockting CLH, van Dijk MK, Kikkert MJ, Dekker JJM. Economic evaluation of preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders. Front Psychiatry 2024; 14:1134071. [PMID: 38268558 PMCID: PMC10806131 DOI: 10.3389/fpsyt.2023.1134071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 12/11/2023] [Indexed: 01/26/2024] Open
Abstract
Background The highly recurrent nature of Major Depressive Disorder is a major contributor to disability and health care costs. Several studies indicate that recurrence may be prevented with Preventive Cognitive Therapy (PCT). This study is the first to perform an economic evaluation of PCT in comparison with care as usual for recurrently depressed patients who experienced two or more depressive episodes and remitted after receiving Cognitive Behavioural Therapy. Methods An economic evaluation from the societal perspective was performed alongside a randomized trial (N = 214). Health-related quality of life (QALYs), depression-free days, health care utilization, and productivity losses were measured between randomization and 15 months follow-up. The costs were indexed to the reference year 2014. Results QALY gains did not differ significantly between the groups (p = 0.69). Depression-free days were higher after PCT (p = 0.02). Societal costs of PCT were 10,417 euro and for care as usual 9,545 euro per person. We found a 47% likelihood that PCT led to additional QALYs at higher costs, and there was a 26% likelihood that PCT led to fewer QALYs at higher costs. When depression-free days was used as an outcome, we found PCT had a 72% likelihood of leading to more depression-free days at higher costs than care as usual and a 27% likelihood of leading to more depression-free days at lower societal costs. Limitations The 15-month follow-up might be too short to draw long-term conclusions about the cost-effectiveness of the PCT. The data collected for this study is part of an RCT to examine the effectiveness of adding PCT to care as usual. Therefore, the study was powered primarily to detect an effect in time to relapse/recurrences. Conclusion The economic evaluation is slightly in favour of the PCT condition when depression-free days is used as an outcome. PCT is not cost-effective given the high costs per additional QALYs from the societal perspective when QALYs are the effect measure. Clinical trial registration https://www.onderzoekmetmensen.nl/en, identifier NL2482.
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Affiliation(s)
- Margo de Jonge
- Department of Research, Arkin, Amsterdam, Netherlands
- Novarum, Amstelveen, Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin, Amsterdam, Netherlands
- Trimbos, Utrecht, Netherlands
| | | | | | | | - Jack J. M. Dekker
- Department of Research, Arkin, Amsterdam, Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
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7
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Dai P, Zhou Y, Shi Y, Lu D, Chen Z, Zou B, Liu K, Liao S. Classification of MDD using a Transformer classifier with large-scale multisite resting-state fMRI data. Hum Brain Mapp 2024; 45:e26542. [PMID: 38088473 PMCID: PMC10789197 DOI: 10.1002/hbm.26542] [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] [Received: 05/22/2023] [Revised: 10/27/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024] Open
Abstract
Major depressive disorder (MDD) is one of the most common psychiatric disorders worldwide with high recurrence rate. Identifying MDD patients, particularly those with recurrent episodes with resting-state fMRI, may reveal the relationship between MDD and brain function. We proposed a Transformer-Encoder model, which utilized functional connectivity extracted from large-scale multisite rs-fMRI datasets to classify MDD and HC. The model discarded the Transformer's Decoder part, reducing the model's complexity and decreasing the number of parameters to adapt to the limited sample size and it does not require a complex feature selection process and achieves end-to-end classification. Additionally, our model is suitable for classifying data combined from multiple brain atlases and has an optional unsupervised pre-training module to acquire optimal initial parameters and speed up the training process. The model's performance was tested on a large-scale multisite dataset and identified brain regions affected by MDD using the Grad-CAM method. After conducting five-fold cross-validation, our model achieved an average classification accuracy of 68.61% on a dataset consisting of 1611 samples. For the selected recurrent MDD dataset, the model reached an average classification accuracy of 78.11%. Abnormalities were detected in the frontal gyri and cerebral cortex of MDD patients in both datasets. Furthermore, the identified brain regions in the recurrent MDD dataset generally exhibited a higher contribution to the model's performance.
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Affiliation(s)
- Peishan Dai
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Ying Zhou
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Yun Shi
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Da Lu
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Zailiang Chen
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Beiji Zou
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Kun Liu
- Brain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaChina
| | - Shenghui Liao
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
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Rnic K, LeMoult J, Torres IJ, Chakrabarty T, Foster J, Frey BN, Harkness KL, Ho K, Li QS, Milev R, Quilty LC, Rotzinger S, Soares CN, Uher R, Kennedy SH, Lam RW. Predicting recurrence of major depressive episodes using the Depression Implicit Association Test: A Canadian biomarker integration network in depression (CAN-BIND) report. Psychiatry Res 2023; 330:115606. [PMID: 37979318 DOI: 10.1016/j.psychres.2023.115606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023]
Abstract
Identifying clinically relevant predictors of depressive recurrence following treatment for Major Depressive Disorder (MDD) is critical for relapse prevention. Implicit self-depressed associations (SDAs), defined as implicit cognitive associations between elements of depression (e.g., sad, miserable) and oneself, often persist following depressive episodes and may represent a cognitive biomarker for future recurrences. Thus, we examined whether SDAs, and changes in SDAs over time, prospectively predict depressive recurrence among treatment responders in the CAN-BIND Wellness Monitoring for MDD Study, a prospective cohort study conducted across 5 clinical centres. A total of 96 patients with MDD responding to various treatments were followed an average of 1.01 years. Participants completed the Depression Implicit Association Test (DIAT) - a computer-based measure of SDAs - every 8 weeks on a tablet device. Survival analyses indicated that greater SDAs at baseline and increases in SDAs over time predicted shorter time to MDD recurrence, even after accounting for depressive symptom severity. The findings show that SDAs are a robust prognostic indicator of risk for MDD recurrence, and that the DIAT may be a feasible and low-cost clinical screening tool. SDAs also represent a potential mechanism underlying the course of recurrent depression and are a promising target for relapse prevention interventions.
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Affiliation(s)
- Katerina Rnic
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
| | - Joelle LeMoult
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jane Foster
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada; Department of Psychiatry, Queen's University, Providence Care, Kingston, ON, Canada
| | - Keith Ho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Qingqin S Li
- Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Roumen Milev
- Department of Psychology, Queen's University, Kingston, ON, Canada; Department of Psychiatry, Queen's University, Providence Care, Kingston, ON, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Providence Care, Kingston, ON, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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9
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Noda Y, Miyashita C, Komatsu Y, Kito S, Mimura M. Cost-effectiveness analysis comparing repetitive transcranial magnetic stimulation therapy with antidepressant treatment in patients with treatment-resistant depression in Japan. Psychiatry Res 2023; 330:115573. [PMID: 37939593 DOI: 10.1016/j.psychres.2023.115573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/05/2023] [Accepted: 08/06/2023] [Indexed: 11/10/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) for patients with treatment-resistant depression (TRD) became covered by the National Health Insurance (NHI) in Japan since 2019. Although the evidence of rTMS for TRD is well established, the cost-effectiveness of rTMS versus antidepressants has not been thoroughly analyzed in Japan. Thus, we aimed to evaluate the cost-effectiveness of rTMS for TRD under the NHI system using a microsimulation model to compare the direct costs and quality-adjusted life years (QALYs). Model inputs of clinical parameters and the utility were derived from published literature. Cost parameters were estimated from the Japanese Claim Database. The robustness of the analyses was evaluated with sensitivity analysis and scenario analysis. The analysis estimated that rTMS increased effectiveness by 0.101QALYs and total cost by ¥94,370 ($689) compared with antidepressant medications. As a result, the incremental cost-effectiveness ratio (ICER) of rTMS was estimated to be ¥935,984 ($6,832)/QALY. In the sensitivity and scenario analyses, ICER did not exceed ¥5 million ($36,496)/QALY as the reference value of the Japanese public cost-effectiveness evaluation system. rTMS therapy for TRD can be a cost-effective treatment strategy compared to antidepressant medication under the NHI system in Japan.
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Affiliation(s)
- Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Chiaki Miyashita
- Department of Medical Science, Teijin Pharma Limited, Tokyo, Japan
| | - Yoko Komatsu
- Department of Medical Science, Teijin Pharma Limited, Tokyo, Japan
| | - Shinsuke Kito
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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10
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Dunlop BW, Cha J, Choi KS, Nemeroff CB, Craighead WE, Mayberg HS. Functional connectivity of salience and affective networks among remitted depressed patients predicts episode recurrence. Neuropsychopharmacology 2023; 48:1901-1909. [PMID: 37491672 PMCID: PMC10584833 DOI: 10.1038/s41386-023-01653-w] [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: 04/03/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
Recurrent episodes in major depressive disorder (MDD) are common but the neuroimaging features predictive of recurrence are not established. Participants in the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study who achieved remission after 12 weeks of treatment withcognitive behavior therapy, duloxetine, or escitalopram were prospectively monitored for up to 21 months for recurrence. Neuroimaging markers predictive of recurrence were identified from week 12 functional magnetic resonance imaging scans by analyzing whole-brain resting state functional connectivity (RSFC) using seeds for four brain networks that are altered in MDD. Neuroimaging correlates of established clinical predictors of recurrence, including the magnitude of depressive (Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale) symptom severity at time of remission, and a comorbid anxiety disorder were examined for their similarity to the neuroimaging predictors of recurrence. Of the 344 patients randomized in PReDICT, 61 achieved remission and had usable scans for analysis, 9 of whom experienced recurrence during follow-up. Recurrence was predicted by: 1) increased RSFC between subcallosal cingulate cortex (SCC) and right anterior insula, 2) decreased RSFC between SCC and bilateral primary visual cortex, and 3) decreased RSFC between insula and bilateral caudate. Week 12 depression and anxiety scores were negatively correlated with RSFC strength between executive control and default mode networks, but they were not correlated with the three RSFC patterns predicting recurrence. We conclude that altered RSFC in SCC and anterior insula networks are prospective risk factors associated with MDD recurrence, reflecting additional sources of risk beyond clinical measures.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA.
| | - Jungho Cha
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ki Sueng Choi
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Institute for Early Life Adversity Research, University of Texas at Austin Dell Medical School, Austin, USA
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
- Department of Psychology, Emory University, Atlanta, USA
| | - Helen S Mayberg
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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11
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Remmerswaal KCP, Ten Have M, de Graaf R, van Balkom AJLM, Penninx BWJH, Batelaan NM. Risk factors of chronic course of anxiety and depressive disorders: a 3-year longitudinal study in the general population. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02591-0. [PMID: 38015237 DOI: 10.1007/s00127-023-02591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Risk factors of a chronic course of anxiety and depressive disorders were previously studied using a limited definition of recovery, i.e. remission of the index disorder. However, frequently, other mental disorders are present at follow-up. Thus, the course of anxiety and depressive disorders was represented too rosy and the identified determinants may not apply when using a broader, more realistic definition. Additionally, physical health risk factors have often been ignored. METHODS Data were used from two waves of the Netherlands Mental Health Survey and Incidence Study-2 including 509 respondents with 12-month anxiety disorder (panic disorder, social phobia, agoraphobia or generalized anxiety disorder) or/and major depressive disorder at baseline. Chronic course was defined as (1) presence of index disorder; and (2) presence of any anxiety, mood or substance use disorder (overall course) during the subsequent three years. Regression models were built with sociodemographic, clinical, and lifestyle/physical health indicators. Predictive accuracy was evaluated with area under the curve (AUC). RESULTS Chronic course of the index disorder was present among 24.8% of cases, whereas 38.7% had a chronic overall course. The accuracy of prediction of chronic course of the index disorder was suboptimal (AUC = 0.68) compared to prediction of overall course (AUC = 0.75). The main risk factors were baseline number of mental disorders, neuroticism, childhood abuse, parental psychopathology and alcohol use. Lifestyle and physical health indicators were marginally relevant. CONCLUSION Transdiagnostic risk factors are important in predicting overall course of anxiety and depressive disorders but cannot accurately predict chronic course of the index disorder.
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Affiliation(s)
- Karin C P Remmerswaal
- Amsterdam UMC, location Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health, Mental Health program and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, location Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health, Mental Health program and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, location Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health, Mental Health program and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Neeltje M Batelaan
- Amsterdam UMC, location Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health, Mental Health program and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
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12
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Böttcher L, Breedvelt JJF, Warren FC, Segal Z, Kuyken W, Bockting CLH. Identifying relapse predictors in individual participant data with decision trees. BMC Psychiatry 2023; 23:835. [PMID: 37957596 PMCID: PMC10644580 DOI: 10.1186/s12888-023-05214-9] [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: 11/10/2022] [Accepted: 09/22/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Depression is a highly common and recurrent condition. Predicting who is at most risk of relapse or recurrence can inform clinical practice. Applying machine-learning methods to Individual Participant Data (IPD) can be promising to improve the accuracy of risk predictions. METHODS Individual data of four Randomized Controlled Trials (RCTs) evaluating antidepressant treatment compared to psychological interventions with tapering ([Formula: see text]) were used to identify predictors of relapse and/or recurrence. Ten baseline predictors were assessed. Decision trees with and without gradient boosting were applied. To study the robustness of decision-tree classifications, we also performed a complementary logistic regression analysis. RESULTS The combination of age, age of onset of depression, and depression severity significantly enhances the prediction of relapse risk when compared to classifiers solely based on depression severity. The studied decision trees can (i) identify relapse patients at intake with an accuracy, specificity, and sensitivity of about 55% (without gradient boosting) and 58% (with gradient boosting), and (ii) slightly outperform classifiers that are based on logistic regression. CONCLUSIONS Decision tree classifiers based on multiple-rather than single-risk indicators may be useful for developing treatment stratification strategies. These classification models have the potential to contribute to the development of methods aimed at effectively prioritizing treatment for those individuals who require it the most. Our results also underline the existing gaps in understanding how to accurately predict depressive relapse.
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Affiliation(s)
- Lucas Böttcher
- Frankfurt School of Finance and Management, Frankfurt am Main, Germany.
- Department of Medicine, University of Florida, Gainesville, FL, USA.
| | - Josefien J F Breedvelt
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- NatCen Social Research, London, UK
| | - Fiona C Warren
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Zindel Segal
- Department of Clinical Psychological Science, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Claudi L H Bockting
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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13
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van Kleef RS, Müller A, van Velzen LS, Marie Bas-Hoogendam J, van der Wee NJA, Schmaal L, Veltman DJ, Rive MM, Ruhé HG, Marsman JBC, van Tol MJ. Functional MRI correlates of emotion regulation in major depressive disorder related to depressive disease load measured over nine years. Neuroimage Clin 2023; 40:103535. [PMID: 37984226 PMCID: PMC10696117 DOI: 10.1016/j.nicl.2023.103535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
Major Depressive Disorder (MDD) often is a recurrent and chronic disorder. We investigated the neurocognitive underpinnings of the incremental risk for poor disease course by exploring relations between enduring depression and brain functioning during regulation of negative and positive emotions using cognitive reappraisal. We used fMRI-data from the longitudinal Netherlands Study of Depression and Anxiety acquired during an emotion regulation task in 77 individuals with MDD. Task-related brain activity was related to disease load, calculated from presence and severity of depression in the preceding nine years. Additionally, we explored task related brain-connectivity. Brain functioning in individuals with MDD was further compared to 35 controls to explore overlap between load-effects and general effects related to MDD history/presence. Disease load was not associated with changes in affect or with brain activity, but with connectivity between areas essential for processing, integrating and regulating emotional information during downregulation of negative emotions. Results did not overlap with general MDD-effects. Instead, MDD was generally associated with lower parietal activity during downregulation of negative emotions. During upregulation of positive emotions, disease load was related to connectivity between limbic regions (although driven by symptomatic state), and connectivity between frontal, insular and thalamic regions was lower in MDD (vs controls). Results suggest that previous depressive load relates to brain connectivity in relevant networks during downregulation of negative emotions. These abnormalities do not overlap with disease-general abnormalities and could foster an incremental vulnerability to recurrence or chronicity of MDD. Therefore, optimizing emotion regulation is a promising therapeutic target for improving long-term MDD course.
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Affiliation(s)
- Rozemarijn S van Kleef
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center Groningen, Groningen, the Netherlands.
| | - Amke Müller
- Department of Psychology, Helmut Schmidt University / University of the Federal Armed Forces Hamburg, Hamburg, Germany
| | - Laura S van Velzen
- Orygen Parkville, VIC, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Janna Marie Bas-Hoogendam
- Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University Medical Center, the Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute for Brain and Cognition, Leiden University Medical Center, the Netherlands
| | - Lianne Schmaal
- Orygen Parkville, VIC, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC location VUMC & Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Maria M Rive
- Department of Psychiatry, Amsterdam UMC location AMC, Amsterdam, the Netherlands; Triversum, Department of Child and Adolescent Psychiatry, GGZ Noord-Holland Noord, Hoorn, the Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Radboudumc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Jan-Bernard C Marsman
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center Groningen, Groningen, the Netherlands
| | - Marie-José van Tol
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center Groningen, Groningen, the Netherlands
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14
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van Reekum EA, Woo JJ, Petropoulos JA, Samaan Z, Mbuagbaw L. Association between the COVID-19 pandemic and psychiatric symptoms in people with preexisting obsessive-compulsive, eating, anxiety, and mood disorders: a systematic review and meta-analysis of before-after studies. Psychiatry Clin Neurosci 2023; 77:583-591. [PMID: 37565691 DOI: 10.1111/pcn.13582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
AIM To determine whether the coronavirus disease 2019 (COVID-19) pandemic was associated with a change in psychiatric symptoms in people with preexisting obsessive-compulsive, eating, anxiety, and mood disorders compared to their prepandemic levels. METHODS We searched MEDLINE, CINAHL, PsycINFO, and Embase from inception until February 16, 2022. Studies were included if they reported prepandemic and during-pandemic psychiatric symptoms, using validated scales, in people with preexisting mood, anxiety, eating, or obsessive-compulsive disorders. Two reviewers independently screened studies, extracted data, and assessed evidence certainty. Random-effects meta-analyses were conducted. Effect sizes were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS Eighteen studies from 10 countries were included. Of the 4465 included participants, 68% were female and the average age was 43 years. Mood and obsessive-compulsive disorders were the most studied disorders. During-pandemic psychiatric measurements were usually collected during nationwide lockdown. Obsessive-compulsive symptoms worsened among people with obsessive-compulsive and related disorders, with a moderate effect size (N = 474 [six studies], SMD = -0.45 [95% CI, -0.82 to -0.08], I2 = 83%; very low certainty). We found a small association between the COVID-19 pandemic and reduced anxiety symptoms in people with mood, anxiety, obsessive-compulsive, and eating disorders (N = 3738 [six studies], SMD = 0.11 [95% CI, 0.02-0.19], I2 = 63%; very low certainty). No change in loneliness, depressive, or problematic eating symptoms was found. CONCLUSION People with obsessive-compulsive and related disorders may benefit from additional monitoring during the COVID-19 pandemic and possibly future pandemics. Other psychiatric symptoms were stable in people with the specific disorders studied. Overall, evidence certainty was very low.
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Affiliation(s)
- Emma A van Reekum
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Julia J Woo
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jo-Anne Petropoulos
- Health Sciences Library, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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15
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Smit AC, Snippe E. Real-time monitoring of increases in restlessness to assess idiographic risk of recurrence of depressive symptoms. Psychol Med 2023; 53:5060-5069. [PMID: 35833374 PMCID: PMC10476069 DOI: 10.1017/s0033291722002069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 03/10/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND This confirmatory study aimed to examine whether we can foresee recurrence of depressive symptoms using personalized modeling of rises in restlessness. METHODS Participants were formerly depressed patients (N = 41) in remission who (gradually) discontinued antidepressants. Participants completed five smartphone-based Ecological Momentary Assessments (EMA) a day, for a period of 4 months, yielding a total of 21 180 observations. Statistical Process Control by means of Exponentially Weighted Moving Average (EWMA) control charts was used to detect rises in the EMA item 'I feel restless', for each individual separately. RESULTS An increase in restlessness was detected in 68.3% of the participants with recurring depressive symptoms, and in 26.3% of those who stayed in remission (Fisher's exact test p = 0.01, sensitivity was 68.3%, specificity was 73.7%). In the participants with a recurrence and an increase in restlessness, this increase could be detected in the prodromal phase of depression in 93.3% of the cases and at least a month before the onset of the core symptoms of depression in 66.7% of the cases. CONCLUSIONS Restlessness is a common prodromal symptom of depression. The sensitivity and specificity of the EWMA charts was at least as good as prognostic models based on cross-sectional patient characteristics. An advantage of the current idiographic method is that the EWMA charts provide real-time personalized insight in a within-person increase in early signs of depression, which is key to alert the right patient at the right time.
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Affiliation(s)
- Arnout C. Smit
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Behavioral and Movement Sciences, Clinical Psychology, VU Amsterdam, Amsterdam, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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16
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Yamazaki R, Matsuda Y, Oba M, Oi H, Kito S. Maintenance repetitive transcranial magnetic stimulation (rTMS) therapy for treatment-resistant depression: a study protocol of a multisite, prospective, non-randomized longitudinal study. BMC Psychiatry 2023; 23:437. [PMID: 37322460 PMCID: PMC10273734 DOI: 10.1186/s12888-023-04944-0] [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: 07/09/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a widely used treatment for major depressive disorder (MDD), and its effectiveness in preventing relapse/recurrence of MDD has been explored. Although few small sample controlled studies exist, the protocols of maintenance rTMS therapy were heterogeneous and evidence of its effectiveness is not sufficient. Thus, this study aims to evaluate whether maintenance rTMS is effective in maintaining the treatment response in patients with MDD with a large sample size and feasible study design. METHODS In this multicenter open-labelled parallel-group trial we plan to recruit 300 patients with MDD who have responded or remitted to acute rTMS therapy. Participants would be classified into two groups according to their preference; the maintenance rTMS and pharmacotherapy group, and the pharmacotherapy only group. The protocol of maintenance rTMS therapy is once a week for the first six months and once biweekly for the second six months. The primary outcome is the relapse/recurrence rates during 12 months following enrollment. Other measures of depressive symptoms and recurrence/relapse rates at different time points are the secondary outcomes. The primary analysis is the between-group comparison adjusted for background factors using a logistic regression model. We will perform the group comparison with inverse probability of treatment weighting as the sensitivity analysis to ensure the comparability of the two groups. DISCUSSION We hypothesize that maintenance rTMS therapy could be an effective and safe treatment for preventing depressive relapse/recurrence. Considering the limitation of potential bias owing to the study design, we plan to use statistical approaches and external data to avoid overestimation of the efficacy. TRIAL REGISTRATION Japan Registry of Clinical Trials, ID: jRCT1032220048 . Registered 1 May 2022.
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Affiliation(s)
- Ryuichi Yamazaki
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Matsuda
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Mari Oba
- Department of Clinical Data Science, Clinical Research and Education Premotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hideki Oi
- Department of Clinical Data Science, Clinical Research and Education Premotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shinsuke Kito
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-Machi, Kodaira-Shi, Tokyo, 1878551, Japan.
- Neuromodulation Therapy and Research Center, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
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17
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Shin J, Bae SM. A Systematic Review of Location Data for Depression Prediction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5984. [PMID: 37297588 PMCID: PMC10252667 DOI: 10.3390/ijerph20115984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
Depression contributes to a wide range of maladjustment problems. With the development of technology, objective measurement for behavior and functional indicators of depression has become possible through the passive sensing technology of digital devices. Focusing on location data, we systematically reviewed the relationship between depression and location data. We searched Scopus, PubMed, and Web of Science databases by combining terms related to passive sensing and location data with depression. Thirty-one studies were included in this review. Location data demonstrated promising predictive power for depression. Studies examining the relationship between individual location data variables and depression, homestay, entropy, and the normalized entropy variable of entropy dimension showed the most consistent and significant correlations. Furthermore, variables of distance, irregularity, and location showed significant associations in some studies. However, semantic location showed inconsistent results. This suggests that the process of geographical movement is more related to mood changes than to semantic location. Future research must converge across studies on location-data measurement methods.
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Affiliation(s)
- Jaeeun Shin
- Department of psychology, Chung-Ang University, Seoul 06974, Republic of Korea;
| | - Sung Man Bae
- Department of Psychology and Psychotherapy, Dankook University, Cheonan 31116, Republic of Korea
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18
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Gerber M, Cody R, Beck J, Brand S, Donath L, Eckert A, Faude O, Hatzinger M, Imboden C, Kreppke JN, Lang UE, Mans S, Mikoteit T, Oswald A, Schweinfurth-Keck N, Zahner L, Ludyga S. Differences in Selective Attention and Inhibitory Control in Patients with Major Depressive Disorder and Healthy Controls Who Do Not Engage in Sufficient Physical Activity. J Clin Med 2023; 12:jcm12103370. [PMID: 37240475 DOI: 10.3390/jcm12103370] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Patients with major depressive disorder (MDD) are characterized by neurocognitive impairments and show deficits in various cognitive performance indicators, including executive function. We examined whether sustained attention and inhibitory control differ between patients with MDD and healthy controls, and whether differences exist between patients with mild, moderate, and severe depression. METHODS Clinical in-patients (N = 212) aged 18-65 years with a current diagnosis of MDD and 128 healthy controls were recruited. Depression severity was assessed using the Beck Depression Inventory, and sustained attention and inhibitory control were assessed using the oddball and flanker tasks. The use of these tasks promises insights into executive function in depressive patients that are not biased by verbal skills. Group differences were tested via analyses of covariance. RESULTS Patients with MDD showed slower reaction times in both the oddball and flanker task, independent of the executive demands of the trial types. Younger participants achieved shorter reaction times in both inhibitory control tasks. After correcting for age, education, smoking, BMI, and nationality, only differences in reaction times in the oddball task were statistically significant. In contrast, reaction times were not sensitive to the symptom severity of depression. CONCLUSION Our results corroborate deficits in basic information processing and specific impairments in higher-order cognitive processes in MDD patients. As difficulties in executive function underlie problems in planning, initiating, and completing goal-directed activities, they may jeopardize in-patient treatment and contribute to the recurrent nature of depression.
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Affiliation(s)
- Markus Gerber
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Robyn Cody
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Johannes Beck
- Psychiatric Clinic Sonnenhalde, 4125 Riehen, Switzerland
| | - Serge Brand
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1419733141, Iran
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, 50933 Cologne, Germany
| | - Anne Eckert
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
| | - Oliver Faude
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services Solothurn, University of Basel, 4503 Solothurn, Switzerland
| | | | - Jan-Niklas Kreppke
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Undine E Lang
- Adult Psychiatric Clinics (UPKE), University of Basel, 4002 Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, 3053 Münchenbuchsee, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services Solothurn, University of Basel, 4503 Solothurn, Switzerland
| | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, 4125 Riehen, Switzerland
| | | | - Lukas Zahner
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Sebastian Ludyga
- Department for Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
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19
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Renneberg CK, Brund RBK, Heuckendorff S, Bech BH, Fonager K. Children of parents with different severities of mental health conditions have higher risk of somatic morbidity: a Danish nationwide register-based cohort study. BMC Public Health 2023; 23:810. [PMID: 37138276 PMCID: PMC10155386 DOI: 10.1186/s12889-023-15714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Children with the most severe parental mental health conditions have an elevated risk of numerous adversities including somatic morbidity. However, there is no knowledge concerning physical health in most children affected by parental mental health conditions. Therefore, the aim was to examine the association between different severities of parental mental health conditions and somatic morbidity in children of different age-groups and further explore the combinations of maternal and paternal mental health conditions on child somatic morbidity. METHODS In this register-based cohort study, we included all children born in Denmark between 2000-2016 and linked parents. Parental mental health conditions were categorised into four severity groups (no, minor, moderate, and severe). Somatic morbidity in offspring was categorised into broad disease categories corresponding to the International Classification of Diseases. We estimated the risk ratio (RR) using Poisson regression, of the first registered diagnosis in different age-groups. RESULTS Of the around 1 million children in the study > 14.5% were exposed to minor parental mental health conditions and < 2.3% were exposed to severe parental mental health conditions. Overall, the analyses revealed a higher risk of morbidity in exposed children across all disease categories. The strongest association was observed for digestive diseases in children aged < 1 year exposed to severe parental mental health conditions (RR: 1.87 (95% CI: 1.74-2.00). Generally, the risk of somatic morbidity increased the more severe the parental mental health conditions. Both paternal and especially maternal mental health conditions were associated with a higher risk of somatic morbidity. The associations were strongest if both parents had a mental health condition. CONCLUSION Children with different severities of parental mental health conditions experience a higher risk of somatic morbidity. Although children with severe parental mental health conditions had the highest risk, children with minor parental mental health conditions should not be neglected as more children are exposed. Children with both parents having a mental health condition were the most vulnerable to somatic morbidity and maternal mental health conditions were more strongly associated with somatic morbidity than paternal. More support and awareness of families with parental mental health conditions is highly needed.
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Affiliation(s)
- Camilla Klinge Renneberg
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.
| | | | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark
- Psychiatry Region North Jutland, Aalborg, Denmark
| | | | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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20
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Simon MS, Arteaga-Henríquez G, Fouad Algendy A, Siepmann T, Illigens BMW. Anti-Inflammatory Treatment Efficacy in Major Depressive Disorder: A Systematic Review of Meta-Analyses. Neuropsychiatr Dis Treat 2023; 19:1-25. [PMID: 36636142 PMCID: PMC9830720 DOI: 10.2147/ndt.s385117] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Immune imbalances in major depressive disorder (MDD) have been targeted by anti-inflammatory treatment approaches in clinical trials to increase responsiveness to therapy. However, even after several meta-analyses, no translation of evidence into clinical practice has taken place. We performed a systematic review to evaluate meta-analytic evidence of randomized controlled trials on the use of anti-inflammatory agents for MDD to summarize efficacy estimates and elucidate shortcomings. METHODS Pooled effect estimates and heterogeneity indices were primary outcomes. Characteristics of the included meta-analyses were extracted. Scientific quality of meta-analyses was assessed using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR). RESULTS N=20 meta-analyses met the eligibility criteria. Study characteristics like outcome scales, composition of patient populations, and add-on or monotherapy regimen varied very little for celecoxib studies, varied little for minocycline studies, and were rather variable for omega 3 fatty acids studies. R-AMSTAR scores ranged from 26 to 39 out of 44 points indicating variable quality, where a comprehensive literature search was the strongest and the consideration of scientific quality in the conclusions was the weakest domain across all meta-analyses. For minocycline and celecoxib, superiority was demonstrated with medium to large effect size with substantial heterogeneity and with large to very large effect size with negligible heterogeneity, respectively. For omega 3 fatty acids, superiority was also demonstrated with mainly small and medium effect sizes with substantial heterogeneity. However, for minocycline and omega 3 fatty acids, non-significant meta-analyses were found also. CONCLUSION Even in our synthesized approach, no clear recommendations could be derived on the use of anti-inflammatory treatment for MDD due to several critical aspects like heterogeneity, diversity of patient populations, treatment regimen, and outcomes, and limited scientific quality. However, we observed clear inter-substance differences with meta-analytic evidence being strongest for celecoxib and weakest for omega 3 fatty acids.
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Affiliation(s)
- Maria S Simon
- Division of Health Care Sciences, Dresden International University, Dresden, Saxony, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Bavaria, Germany
| | - Gara Arteaga-Henríquez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Ahmed Fouad Algendy
- Division of Health Care Sciences, Dresden International University, Dresden, Saxony, Germany.,Clinical Pharmacy, Geriatric Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, Dresden, Saxony, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Ben M W Illigens
- Division of Health Care Sciences, Dresden International University, Dresden, Saxony, Germany.,Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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21
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MacNeil A, Birk S, Villeneuve PJ, Jiang Y, de Groh M, Fuller-Thomson E. Incident and Recurrent Depression among Adults Aged 50 Years and Older during the COVID-19 Pandemic: A Longitudinal Analysis of the Canadian Longitudinal Study on Aging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15032. [PMID: 36429749 PMCID: PMC9690838 DOI: 10.3390/ijerph192215032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic and accompanying public health measures have exacerbated many risk factors for depression in older adulthood. The objectives of the current study are: (1) to determine the risk of incident and recurrent depression during the COVID-19 pandemic among those with, or without, a history of depression; and (2) to identify factors that were predictive of depression in these two groups. The study population included 22,622 participants of the Canadian Longitudinal Study on Aging who provided data at baseline (2011-2015), follow-up (2015-2018), and twice during the pandemic (April-May 2020, September-December 2020). The Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to classify individuals with depression. Logistic regression was used to estimate the odds of depression during COVID across a series of risk factors. Individuals with a history of depression had four times the risk of depression during the pandemic when compared to those without a history of depression, even after controlling for relevant covariates. Other factors associated with depression during the pandemic include being female, having fewer savings, and experiencing COVID-19 related stressors, such as health stressors, difficulties accessing resources, and family conflict. Clinicians working with older adults should consider interventions to support high-risk groups, such as those with recurrent depression.
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Affiliation(s)
- Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Sapriya Birk
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Paul J. Villeneuve
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
- CHAIM Research Centre, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Ying Jiang
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Margaret de Groh
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
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22
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Ten Have M, Tuithof M, van Dorsselaer S, de Beurs D, de Graaf R, Batelaan NM, Penninx BWJH. How chronic are depressive and anxiety disorders? 9-year general population study using narrow and broad course outcomes. J Affect Disord 2022; 317:149-155. [PMID: 36031004 DOI: 10.1016/j.jad.2022.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/24/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Existing studies on disease course usually apply relatively short follow-up periods and narrow definitions of disease course resulting in too optimistic views on disease prognosis. This study explores the relevance of using a longer and broader (cross-disorder) perspective. METHODS Respondents with a 12-month disorder at baseline and available at 3-, 6- and 9-year follow-up were selected (major depressive disorder, MDD: n = 208; anxiety disorder: n = 220) from a general population study (N = 6646). DSM-IV disorders were assessed with the Composite International Diagnostic Interview. Disease course was described using a short and narrow perspective (i.e., 3-year follow-up, and considering presence of the index disorder only) and a long and broad perspective (9-year follow-up, and considering presence of any mood, anxiety or substance use disorder as outcome). RESULTS The recovery rates of both MDD and anxiety disorder reduced by half when the perspective switched from short and narrow (MDD: 74.0 %; anxiety disorder: 79.5 %) to long and broad (35.6 % and 40.0 % respectively). At 9-year follow-up, the rates of a persistent disorder (a disorder at each follow-up assessment) tripled when the perspective switched from narrow to broad (MDD: from 4.8 % to 13.9 %; anxiety disorder: from 4.5 % to 15.5 %). LIMITATIONS The findings are not generalizable to the most severe depressed and anxious patients. CONCLUSIONS Most people with MDD or anxiety disorder in the general population have a rather favourable prognosis when a narrow perspective is applied, but an unfavourable prognosis when a long-term and broad perspective is applied. Consequently, MDD and anxiety disorder should not merely be perceived as episodic disorders, and require longer-term disease monitoring and management.
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Affiliation(s)
- Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
| | - Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | | | - Derek de Beurs
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Neeltje M Batelaan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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23
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Lloyd CEM, Mengistu BS, Reid G. "His Main Problem Was Not Being in a Relationship With God": Perceptions of Depression, Help-Seeking, and Treatment in Evangelical Christianity. Front Psychol 2022; 13:831534. [PMID: 35519648 PMCID: PMC9063734 DOI: 10.3389/fpsyg.2022.831534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
Some Christian communities may understand mental illness as the result of spiritual causes, such as sin, demons, or a lack of faith. Such perceptions are likely to influence how Christian individuals conceptualise and experience their mental health and enact help-seeking behaviours. This study explores perceptions of depression and mental health help-seeking in evangelical Christianity by using a novel qualitative story completion task. A convenience sample of 110 Christian participants from the United Kingdom completed a third-person, fictional story stem featuring a male with depression who entered his local church. A contextualist-informed thematic analysis illustrated how the disclosure of depression was represented as eliciting negative social reactions, potentially rendering individuals with depression as socially dislocated. Stories suggested that, increasingly, evangelical Christians may perceive a spiritualisation of mental illness, which negates reference to psychological, social, and biomedical representations, as unhelpful. Findings reveal the risks of a solely spiritual aetiology of depression and highlight how existing mental ill-health can be exacerbated if fundamentalist beliefs and approaches to therapeutic care are prioritised over holistic models of care. Methodologically, this study demonstrates the value of a rarely-used tool in psychology—the story completion task—for examining socio-cultural discourses and dominant meanings surrounding stigmatised topics or populations.
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Affiliation(s)
| | - Brittney S Mengistu
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Graham Reid
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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24
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Otto MW, Birk JL, Fitzgerald HE, Chauvin GV, Gold AK, Carl JR. Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition. Clin Psychol Rev 2022; 95:102172. [DOI: 10.1016/j.cpr.2022.102172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
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25
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 276] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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26
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Abstract
Major depression is one of the most prevalent and debilitating personal and public health conditions worldwide. Less appreciated is that depression's tremendous burdens are not shared equally among all who become depressed. Some will suffer recurrences over the rest of their lives, whereas half or more will never have a recurrence. Based on these two distinctive life course prototypes, we propose a subtype distinction for research on the origins and lifetime course of major depression. A pressing goal is to determine at the time of depression's first onset who will follow which clinical trajectory. The lack of recognition of this distinction has resulted in many obstacles, including conceptual biases, methodological oversights, and definitional dead ends. Current theories are reviewed and compared. The implications for contemporary diagnostic controversies, reevaluating research on treatment and prevention, and enhancing the predictive strength of traditionally weak indicators of recurrences and recurrent depression are discussed. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Scott M Monroe
- Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA;
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
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27
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Munkholm K, Jørgensen KJ, Paludan-Müller AS. Electroconvulsive therapy for preventing relapse and recurrence in people with depression. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [DOI: 10.1002/14651858.cd015164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Klaus Munkholm
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark; Department of Clinical Research, University of Southern Denmark; Odense Denmark
- Open Patient data Exploratory Network (OPEN); Odense University Hospital; Odense Denmark
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28
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Psychological risk factors and the course of depression and anxiety disorders: A review of 15 years NESDA research. J Affect Disord 2021; 295:1347-1359. [PMID: 34706448 DOI: 10.1016/j.jad.2021.08.086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Netherlands Study of Depression and Anxiety (NESDA; Nbaseline=2981) is an ongoing longitudinal, multi-site, naturalistic, cohort study examining the etiology, course, and consequences of depression and anxiety. In this article we synthesize and evaluate fifteen years of NESDA research on prominent psychological risk factors for the onset, persistence, recurrence, and comorbidity of affective disorders. METHODS A narrative review of 62 NESDA articles examining the specificity and predictive value of neuroticism, behavioral inhibition, repetitive negative thinking, experiential avoidance, cognitive reactivity, locus of control, (implicit) self-esteem, (implicit) disorder-specific self-associations, and attentional bias for the course of affective disorders. RESULTS All self-reported risk factors showed cross-sectional relationships with singular and comorbid affective disorders, and prospective relationships with the development and chronicity of depression and anxiety disorders. High neuroticism, low self-esteem, and negative repetitive thinking showed most prominent transdiagnostic relationships, whereas cognitive reactivity showed most pronounced depression-specific associations. Implicit self-esteem showed predictive validity for the persistence and recurrence of anxiety and depression over and above self-reported risk factors. Automatic approach-avoidance behavior and attentional bias for negative, positive, or threat words showed no relationship with affective disorders. CONCLUSION NESDA identified both (a) transdiagnostic factors (e.g., neuroticism, low implicit self-esteem, repetitive negative thinking) that may help explain the comorbidity between affective disorders and overlap in symptoms, and (b) indications for disorder-specific risk factors (e.g., cognitive responsivity) which support the relevance of distinct disorder categories and disorder-specific mechanisms. Thus, the results point to the relevance of both transdiagnostic and disorder-specific targets for therapeutic interventions.
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29
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Previous disorders and depression outcomes in individuals with 12-month major depressive disorder in the World Mental Health surveys. Epidemiol Psychiatr Sci 2021; 30:e70. [PMID: 34761736 PMCID: PMC8611932 DOI: 10.1017/s2045796021000573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcomes. METHODS Data came from 29 cross-sectional community epidemiological surveys of adults in 27 countries (n = 80 190). The Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent's age at interview. Disorders were grouped into depressive distress disorders, non-depressive distress disorders, fear disorders and externalising disorders. Depression outcomes included 12-month suicidality, days out of role and impairment in role functioning. RESULTS Among respondents with 12-month MDD, 94.9% (s.e. = 0.4) had at least one prior disorder (including previous MDD), and 64.6% (s.e. = 0.9) had at least one prior, non-MDD disorder. Previous non-depressive distress, fear and externalising disorders, but not depressive distress disorders, predicted higher impairment (OR = 1.4-1.6) and suicidality (OR = 1.5-2.5), after adjustment for sociodemographic variables. Further adjustment for MDD characteristics weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalising disorders predicted suicidality among respondents with 12-month MDD. CONCLUSIONS These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalising disorders in individuals with MDD.
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30
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Yang L, Yang X, Yang T, Wu X, Sun P, Zhu Y, Su Y, Gu W, Qiu H, Wang J, Chen J, Fang Y. The effect of thyroid function on the risk of psychiatric readmission after hospitalization for major depressive disorder. Psychiatry Res 2021; 305:114205. [PMID: 34551381 DOI: 10.1016/j.psychres.2021.114205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/28/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
The relationship between thyroid function and depression has long been recognized, but little is known about the effect of thyroid function on the risk of readmission after hospitalization for major depressive disorder (MDD). This retrospective cohort study was aimed to explore the effect of thyroid function on psychiatric readmission after hospitalization for MDD. Data was derived from electronic medical records (EMR) of the Shanghai Mental Health Center (SMHC), Shanghai, China. Univariate and multivariate logistic regression analyses were conducted in subjects aged ≥ 18 years who had been hospitalized for MDD between January 1, 2007, and May 31, 2019. Of the 1803 eligible patients, 85 and 132 patients experienced psychiatric readmission within 90 days and 180 days after discharge respectively. Multivariate analyses showed that serum FT3 level (aOR=1.271; 95%CI=1.051-1.537) and comorbidity of thyroid disease (aOR=2,179; 95%CI=1.136-4.179) was independently associated with the risk of 90-day and 180-day readmission respectively. These findings indicated that high serum FT3 levels and comorbidity of thyroid disease could increase the risk of readmission after hospitalization for MDD. It is warranted to provide routine assessment and intervention of the thyroid function during the treatment of depression so as to prevent re-hospitalization.
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Affiliation(s)
- Lu Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaorui Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Tao Yang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaohui Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Ping Sun
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yuncheng Zhu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yousong Su
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Wenjie Gu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Hong Qiu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jianli Wang
- School of Epidemiology and Public Health, Department of Psychiatry, Faculty of Medicine & Institute of Mental Health Research, University of Ottawa, Ontario K1N 6N5, Canada
| | - Jun Chen
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou 510515, China.
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai 201108, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou 510515, China.
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Knudsen CK, Christesen AMS, Heuckendorff S, Fonager K, Johansen MN, Overgaard C. The risk of preterm birth in combinations of socioeconomic position and mental health conditions in different age groups: a Danish nationwide register-based cohort study. BMC Pregnancy Childbirth 2021; 21:696. [PMID: 34649508 PMCID: PMC8515728 DOI: 10.1186/s12884-021-04138-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Inequality in preterm birth is a world-wide challenge that has proved difficult for maternity care services to meet. Reducing the inequality requires identification of pregnant women at particularly high risk of preterm birth in order to target interventions. Therefore, the aim was to estimate the risk of preterm birth in women with different combinations of socioeconomic position, mental health conditions, and age. Methods In this nationwide register-based cohort study, we included all first-time mothers that gave birth to a singleton liveborn infant in Denmark between 2000 and 2016. The absolute and relative risk of preterm birth (< 37 weeks of gestation) was examined in different combinations of educational level (high, intermediate, and low) and mental health conditions (no, minor, and moderate/severe) in three age strata (≤23, 24–30, and ≥ 31 years). We estimated the relative risk using Poisson regression with a robust error variance. As additive interaction can help identify subgroups where limited resources can be of best use, we measured the attributable proportion to assess the risk that is due to interaction of the different exposures. Results Of the 415,523 included first-time mothers, 6.3% gave birth prematurely. The risk of preterm birth increased with decreasing educational level and increasing severity of mental health conditions in all age strata, but most in women aged ≥31 years. The highest absolute risk was 12.9% [95% CI: 11.2;14.8%] in women aged ≥31 years with low education and moderate/severe mental health conditions resulting in a relative risk of 2.23 [95% CI: 1.93–2.58] compared to the unexposed reference group in that age strata. We found positive additive interaction between low education and mental health conditions in women aged 24–30 and ≥ 31 years and between age ≥ 31 years and combinations of mental health conditions and educational levels. Conclusion The inequality in preterm birth increased with increasing age. To reduce inequality in preterm birth focused attention on women with higher age further combined with lower educational levels and mental health conditions is essential. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04138-0.
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Affiliation(s)
- Camilla Klinge Knudsen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark. .,Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Amanda Marie Somer Christesen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Christesen AMS, Knudsen CK, Fonager K, Johansen MN, Heuckendorff S. Prevalence of parental mental health conditions among children aged 0-16 years in Denmark: A nationwide register-based cross-sectional study. Scand J Public Health 2021; 50:1124-1132. [PMID: 34609273 DOI: 10.1177/14034948211045462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: Parental mental health conditions adversely affect the children. Information on the prevalence of parental mental health conditions is needed to help policymakers allocate resources appropriately. Therefore, the aim of this study was to estimate the prevalence of children with parental mental health conditions in Denmark and further estimate the age-specific prevalence and geographical variation. Methods: In this nationwide register-based cross-sectional study, we included all children born between 2000 and 2016 if they resided in Denmark on 31 December 2016. Information on both maternal and paternal mental health conditions was retrieved from primary and secondary healthcare registers. Parental mental health conditions were categorised in three severity groups: minor, moderate, and severe. We estimated the proportion of children with parental mental health conditions on 31 December 2016. Results: Of the 1,106,459 children aged 0-16 years, 39.1% had at least one parent with a mental health condition. The prevalence increased with age of the children until the age of six years. Geographical variation in the prevalence ranged from 29.0% to 48.3% in the 98 municipalities. Minor parental mental health conditions (23.5%) were more common than moderate (13.5%) and severe parental mental health conditions (2.2%). Hospital-diagnosed parental mental health conditions were prevalent in 12.8% of the children. Conclusions: Two in five children aged 0-16 years in Denmark have parents with a mental health condition and geographical variation exists. The high prevalence of children with parental mental health conditions is an important public health challenge, which calls for attention.
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Affiliation(s)
| | | | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
| | - Martin N Johansen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Denmark
| | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Denmark.,Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Denmark
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33
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Jelovac A, Kolshus E, McLoughlin DM. Relapse following bitemporal and high-dose right unilateral electroconvulsive therapy for major depression. Acta Psychiatr Scand 2021; 144:218-229. [PMID: 34033117 DOI: 10.1111/acps.13331] [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: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is an effective acute treatment for severe and/or medication-resistant depression but maintaining remission following completion of a course remains a clinical challenge. METHODS EFFECT-Dep Trial (ISRCTN23577151) participants with a DSM-IV major depressive episode who met remission criteria after a randomly assigned course of twice-weekly brief-pulse bitemporal (1.5 × seizure threshold) or high-dose (6 × seizure threshold) right unilateral ECT were monitored for relapse for 12 months. In line with the pragmatic trial design, all patients received treatment-as-usual individualised pharmacotherapy during and after ECT; no remitter received continuation ECT. RESULTS Of 61 remitters, 24 (39.3%) relapsed, one (1.6%) withdrew from the study while in remission and the remaining 36 (59.0%) stayed well for a year. Most relapses occurred within the first six months, resulting in a cumulative six-month relapse rate of 31.1%. In a multivariable Cox proportional hazards regression model, older age (p = 0.039) and psychotic features at pre-ECT baseline (p = 0.037) were associated with a more favourable long-term prognosis while a greater number of previous depressive episodes (p = 0.028) and bipolar II (but not bipolar I) diagnosis (p = 0.030) were associated with a worse long-term outcome. Electrode placement and medication resistance prior to ECT had no effect on relapse. Adjusting for covariates, fewer patients treated with lithium relapsed in the overall group (p = 0.008) and in the unipolar depression subgroup (p = 0.027). CONCLUSION Long-term outcome following high-dose right unilateral ECT does not differ from bitemporal ECT. Prognosis is particularly favourable in older adults, psychotic depression and patients maintained on lithium.
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Affiliation(s)
- Ana Jelovac
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland
| | - Erik Kolshus
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin 8, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
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Li XM, Dobson KS. Cognitive Reactivity Related to Coping Behaviors: An Assessment of Explicit and Implicit Dimensions in Clinical Depression. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Moriarty AS, Meader N, Snell KI, Riley RD, Paton LW, Chew-Graham CA, Gilbody S, Churchill R, Phillips RS, Ali S, McMillan D. Prognostic models for predicting relapse or recurrence of major depressive disorder in adults. Cochrane Database Syst Rev 2021; 5:CD013491. [PMID: 33956992 PMCID: PMC8102018 DOI: 10.1002/14651858.cd013491.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depressive symptoms after some level of improvement but preceding recovery) and recurrence (onset of a new depressive episode after recovery) are common in depression, lead to worse outcomes and quality of life for patients and exert a high economic cost on society. Outcomes can be predicted by using multivariable prognostic models, which use information about several predictors to produce an individualised risk estimate. The ability to accurately predict relapse or recurrence while patients are well (in remission) would allow the identification of high-risk individuals and may improve overall treatment outcomes for patients by enabling more efficient allocation of interventions to prevent relapse and recurrence. OBJECTIVES To summarise the predictive performance of prognostic models developed to predict the risk of relapse, recurrence, sustained remission or recovery in adults with major depressive disorder who meet criteria for remission or recovery. SEARCH METHODS We searched the Cochrane Library (current issue); Ovid MEDLINE (1946 onwards); Ovid Embase (1980 onwards); Ovid PsycINFO (1806 onwards); and Web of Science (1900 onwards) up to May 2020. We also searched sources of grey literature, screened the reference lists of included studies and performed a forward citation search. There were no restrictions applied to the searches by date, language or publication status . SELECTION CRITERIA We included development and external validation (testing model performance in data separate from the development data) studies of any multivariable prognostic models (including two or more predictors) to predict relapse, recurrence, sustained remission, or recovery in adults (aged 18 years and over) with remitted depression, in any clinical setting. We included all study designs and accepted all definitions of relapse, recurrence and other related outcomes. We did not specify a comparator prognostic model. DATA COLLECTION AND ANALYSIS Two review authors independently screened references; extracted data (using a template based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS)); and assessed risks of bias of included studies (using the Prediction model Risk Of Bias ASsessment Tool (PROBAST)). We referred any disagreements to a third independent review author. Where we found sufficient (10 or more) external validation studies of an individual model, we planned to perform a meta-analysis of its predictive performance, specifically with respect to its calibration (how well the predicted probabilities match the observed proportions of individuals that experience the outcome) and discrimination (the ability of the model to differentiate between those with and without the outcome). Recommendations could not be qualified using the GRADE system, as guidance is not yet available for prognostic model reviews. MAIN RESULTS We identified 11 eligible prognostic model studies (10 unique prognostic models). Seven were model development studies; three were model development and external validation studies; and one was an external validation-only study. Multiple estimates of performance measures were not available for any of the models and, meta-analysis was therefore not possible. Ten out of the 11 included studies were assessed as being at high overall risk of bias. Common weaknesses included insufficient sample size, inappropriate handling of missing data and lack of information about discrimination and calibration. One paper (Klein 2018) was at low overall risk of bias and presented a prognostic model including the following predictors: number of previous depressive episodes, residual depressive symptoms and severity of the last depressive episode. The external predictive performance of this model was poor (C-statistic 0.59; calibration slope 0.56; confidence intervals not reported). None of the identified studies examined the clinical utility (net benefit) of the developed model. AUTHORS' CONCLUSIONS Of the 10 prognostic models identified (across 11 studies), only four underwent external validation. Most of the studies (n = 10) were assessed as being at high overall risk of bias, and the one study that was at low risk of bias presented a model with poor predictive performance. There is a need for improved prognostic research in this clinical area, with future studies conforming to current best practice recommendations for prognostic model development/validation and reporting findings in line with the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement.
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Affiliation(s)
- Andrew S Moriarty
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Nicholas Meader
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | - Kym Ie Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Lewis W Paton
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
- Cochrane Common Mental Disorders, University of York, York, UK
| | | | - Shehzad Ali
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
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36
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O'Driscoll C, Buckman JEJ, Fried EI, Saunders R, Cohen ZD, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Kessler D, Lewis G, Watkins E, Wiles N, Pilling S. The importance of transdiagnostic symptom level assessment to understanding prognosis for depressed adults: analysis of data from six randomised control trials. BMC Med 2021; 19:109. [PMID: 33952286 PMCID: PMC8101158 DOI: 10.1186/s12916-021-01971-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Depression is commonly perceived as a single underlying disease with a number of potential treatment options. However, patients with major depression differ dramatically in their symptom presentation and comorbidities, e.g. with anxiety disorders. There are also large variations in treatment outcomes and associations of some anxiety comorbidities with poorer prognoses, but limited understanding as to why, and little information to inform the clinical management of depression. There is a need to improve our understanding of depression, incorporating anxiety comorbidity, and consider the association of a wide range of symptoms with treatment outcomes. METHOD Individual patient data from six RCTs of depressed patients (total n = 2858) were used to estimate the differential impact symptoms have on outcomes at three post intervention time points using individual items and sum scores. Symptom networks (graphical Gaussian model) were estimated to explore the functional relations among symptoms of depression and anxiety and compare networks for treatment remitters and those with persistent symptoms to identify potential prognostic indicators. RESULTS Item-level prediction performed similarly to sum scores when predicting outcomes at 3 to 4 months and 6 to 8 months, but outperformed sum scores for 9 to 12 months. Pessimism emerged as the most important predictive symptom (relative to all other symptoms), across these time points. In the network structure at study entry, symptoms clustered into physical symptoms, cognitive symptoms, and anxiety symptoms. Sadness, pessimism, and indecision acted as bridges between communities, with sadness and failure/worthlessness being the most central (i.e. interconnected) symptoms. Connectivity of networks at study entry did not differ for future remitters vs. those with persistent symptoms. CONCLUSION The relative importance of specific symptoms in association with outcomes and the interactions within the network highlight the value of transdiagnostic assessment and formulation of symptoms to both treatment and prognosis. We discuss the potential for complementary statistical approaches to improve our understanding of psychopathology.
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Affiliation(s)
- C O'Driscoll
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. ciaran.o'
| | - J E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- iCope - Camden & Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK.
| | - E I Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - R Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Z D Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - G Ambler
- Statistical Science, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - R J DeRubeis
- School of Arts and Sciences, Department of Psychology, 425 S. University Avenue, Philadelphia, PA, 19104-60185, USA
| | - S Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - S D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - T Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - D Kessler
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - G Lewis
- Division of Psychiatry, University College London, Maple House, London, W1T 7NF, UK
| | - E Watkins
- Department of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter, EX4 4QG, UK
| | - N Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
| | - S Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
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Hou G, Lai W, Jiang W, Liu X, Qian L, Zhang Y, Zhou Z. Myelin deficits in patients with recurrent major depressive disorder: An inhomogeneous magnetization transfer study. Neurosci Lett 2021; 750:135768. [PMID: 33636288 DOI: 10.1016/j.neulet.2021.135768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/30/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023]
Abstract
PURPOSES The recently developed myelin imaging method, inhomogeneous magnetization transfer (ihMT), is a surrogate measure of myelin content. The goal of the current study was to investigate alterations in myelin integrity in patients with recurrent major depressive disorder (rMDD). METHODS Fifty-two patients with rMDD (36 female and 16 male) and 42 healthy controls (HC, 29 female and 13 male) were included. Two ihMT indices, quantitative ihMT (qihMT) and quantitative MT (qMT), were estimated from the ihMT data. A 50 white matter atlas was used to extract the regional quantitative values for each subject. The differences in qihMT and qMT values between the rMDD and HC groups were compared by a general linear model. Pearson correlation analyses were conducted to investigate associations between the significantly altered ihMT indices and clinical measures (Hamilton Depression Rating Scale scores and disease duration) in rMDD group. RESULTS The rMDD group showed significantly lower qihMT values in the fornix, left anterior limb of internal capsule, and left sagittal stratum, and lower qMT values in the fornix and left anterior limb of internal capsule than those of the HC group (p < 0.05, false discovery rate corrected). Both the qihMT and qMT values in the fornix of patients with rMDD were negatively correlated with disease duration (qihMT: r = -0.478, p < 0.001, Bonferroni corrected; qMT: r = -0.433, p = 0.001, Bonferroni corrected). CONCLUSION Our findings suggested that rMDD is associated with myelin impairment in the fornix, left anterior limb of internal capsule, and left sagittal stratum. In addition, this disruption of myelin integrity in the fornix could be cumulative as the disease progresses.
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Affiliation(s)
- Gangqiang Hou
- Department of Radiology, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, 518020, China
| | - Wentao Lai
- Department of Radiology, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, 518020, China
| | - Wentao Jiang
- Department of Radiology, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, 518020, China
| | - Xia Liu
- Department of Radiology, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, 518020, China
| | - Long Qian
- MR Research, GE Healthcare, Beijing, 100176, China
| | - Yingli Zhang
- Department of Psychology, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, 518020, China.
| | - Zhifeng Zhou
- Department of Radiology, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, 518020, China.
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Schmid M, Hammar Å. First-Episode Patients Report Cognitive Difficulties in Executive Functioning 1 Year After Initial Episode of Major Depressive Disorder. Front Psychiatry 2021; 12:667238. [PMID: 34135786 PMCID: PMC8200526 DOI: 10.3389/fpsyt.2021.667238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Major Depressive Disorder (MDD) is associated with cognitive impairment in general, and Executive Functioning (EF) in particular, even in remitted phase of the disorder, suggesting residual cognitive symptoms. The aim of the present study was to investigate self-reported EF 1 year after the first episode of MDD and to explore this in relation to depressive mood symptoms, remission and relapse. Method: The study included data from 24 patients and 23 healthy control subjects 1 year after the patients' initial first episode of MDD. All participants completed the Behavior Rating Inventory of Executive Functioning-Adult version (BRIEF-A), a standardized self-report measure of perceived EF in everyday life, measuring nine different EF. Total index scores for metacognitive functions, behavior/emotional regulation functions and a global EF score is also calculated. Results: The patient group in total, independent of symptom status, reported significantly lower EF in all indexes compared to the healthy controls 1 year after the initial episode. However, higher depressive mood symptom load correlated with self-reported difficulties in metacognitive functions and poor global EF scores. Regulatory control of behavior and emotional responses did not show such strong association with mood symptoms, but low self-report scores on this measure was associated with relapse during the first year after the initial episode. Conclusion: First-episode patients report significant lower executive functioning in everyday life compared to individually matched healthy controls, 1 year after onset, independent of symptom load. Residual cognitive symptoms seem to be evident and associated with risk of relapse and should be targeted in treatment and prevention of recurrence in MDD.
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Affiliation(s)
- Marit Schmid
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Ivanets NN, Kinkulkina MA, Tikhonova YG, Izumina TA, Lazareva AV. [Clinical and sociodemographic characteristics of patients with the first depressive episode and recurrent depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:33-39. [PMID: 33340295 DOI: 10.17116/jnevro202012011133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To comparare socio-demographic and clinical characteristics of patients with the first depressive episode and recurrent depression. MATERIAL AND METHODS Three hundred and twenty one patients with unipolar depression, including 96 patients with first depressive episode and 225 patients with recurrent depression, were examined using clinical and psychometric methods. RESULTS AND CONCLUSION There were differences in clinical characteristics between groups but such factors as gender, marital status, level of education, family history of mental disorders and personality were similar. With each new episode of recurrent depression, the next episode tends to be more severe with more intense pessimistic and suicidal thoughts but fewer anxiety and complaints of depressive mood that affects the differences and requires further research, especially considering the effect of therapy.
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Affiliation(s)
- N N Ivanets
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M A Kinkulkina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Y G Tikhonova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T A Izumina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A V Lazareva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Ronold EH, Schmid MT, Oedegaard KJ, Hammar Å. A Longitudinal 5-Year Follow-Up Study of Cognitive Function After First Episode Major Depressive Disorder: Exploring State, Scar and Trait Effects. Front Psychiatry 2020; 11:575867. [PMID: 33364989 PMCID: PMC7750430 DOI: 10.3389/fpsyt.2020.575867] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
Major depression (MDD) is associated with cognitive deficits in processing speed and executive function (EF) following first episode (FE). It is unclear whether deficits are state or trait related. Studies following FE MDD over longer periods are lacking, making it uncertain how cognition and symptoms develop after the initial episode. The present study assessed cognitive function and symptoms 5 years following FE MDD. In addition, the study explored relationships between MDD symptoms, rumination, and cognitive deficits with regards to the trait, state, and scar perspective. Twenty-three participants with previous FE MDD, and 20 matched control participants were compared on Delis-Kaplan Executive Function System measures of processing speed and EF, in a 5-year longitudinal follow-up study. Correlations between current symptoms- and history of MDD, rumination, cognition were investigated. Findings indicated that cognitive deficits persisted with no clear signs of exacerbation after initial episode. Inhibition appeared independent of current and previous symptoms of depression. Processing speed was related to depressive- symptoms and rumination. In conclusion, results indicated persisting, stable deficits in both EFs and processing speed. Findings further suggest that depressive symptoms could be related to deficits in processing speed, indicating state effects. There was limited support for worsening of cognition after initial episode. Some aspects of EF like Inhibition could show persistent deficits independent of depressive symptoms indicating trait effects.
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Affiliation(s)
- Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Marit Therese Schmid
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Ketil Joachim Oedegaard
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
- Department of Psychiatry, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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Outcome of First-admission Depression Treated in a Specialized Mood Disorders Service. J Psychiatr Pract 2020; 26:461-471. [PMID: 33275383 DOI: 10.1097/pra.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Few studies have described the treatment or outcome of depression in specialized mood disorders units (MDUs). Previous studies have focused on cohorts of patients with highly treatment-resistant illness who are likely to have a poor prognosis even with intensive treatment. This study describes the treatment and medium-term outcomes of a cohort of first-admission depressed patients with less treatment-resistant illness treated in a specialized MDU. METHODS A cohort of 137 consecutive first-admission depressed patients, referred to an MDU over 2 years, were interviewed using standardized schedules and followed up prospectively from admission for ∼18 months to describe baseline characteristics, treatment, outcome, and predictors of outcome. Times to recovery and recurrence were evaluated using survival analyses and predictors of outcome were examined using bivariate and multivariate regression analyses. RESULTS On admission, 75% of the 137 patients had depression that had been found to be resistant to pharmacological treatment, and 34% had been chronically depressed (>2 y). Over half of the patients had likely maladaptive personality traits and one third had at least 1 comorbid psychiatric disorder. By discharge, a significantly higher proportion of the patients were being prescribed very high (P<0.01) or high doses (P<0.05) of antidepressants, augmentation therapy (P<0.001), or a combination of antidepressants (P<0.001) or were engaged in individual psychotherapy (P<0.001), compared with baseline. With intensive treatment, 62% of the patients recovered by 6 months and 76% by 12 months, with 83% overall recovering and patients found to be asymptomatic during almost 60% of the follow-up period. However, 48% suffered a recurrence over the course of the follow-up. Chronicity of mood episodes (P<0.01) and the presence of psychiatric comorbidity (P<0.05) predicted recurrence. CONCLUSIONS This prospective, naturalistic, medium-term study describes better outcomes, in terms of recovery and symptomatology over time, in a cohort of first-admission depressed patients than previous first-admission studies after continuous, intensive treatment, although the proportion of patients who experienced recurrences remained high.
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van Loo HM, Bigdeli TB, Milaneschi Y, Aggen SH, Kendler KS. Data mining algorithm predicts a range of adverse outcomes in major depression. J Affect Disord 2020; 276:945-953. [PMID: 32745831 DOI: 10.1016/j.jad.2020.07.098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/15/2020] [Accepted: 07/05/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Course of illness in major depression (MD) is highly varied, which might lead to both under- and overtreatment if clinicians adhere to a 'one-size-fits-all' approach. Novel opportunities in data mining could lead to prediction models that can assist clinicians in treatment decisions tailored to the individual patient. This study assesses the performance of a previously developed data mining algorithm to predict future episodes of MD based on clinical information in new data. METHODS We applied a prediction model utilizing baseline clinical characteristics in subjects who reported lifetime MD to two independent test samples (total n = 4226). We assessed the model's performance to predict future episodes of MD, anxiety disorders, and disability during follow-up (1-9 years after baseline). In addition, we compared its prediction performance with well-known risk factors for a severe course of illness. RESULTS Our model consistently predicted future episodes of MD in both test samples (AUC 0.68-0.73, modest prediction). Equally accurately, it predicted episodes of generalized anxiety disorder, panic disorder and disability (AUC 0.65-0.78). Our model predicted these outcomes more accurately than risk factors for a severe course of illness such as family history of MD and lifetime traumas. LIMITATIONS Prediction accuracy might be different for specific subgroups, such as hospitalized patients or patients with a different cultural background. CONCLUSIONS Our prediction model consistently predicted a range of adverse outcomes in MD across two independent test samples derived from studies in different subpopulations, countries, using different measurement procedures. This replication study holds promise for application in clinical practice.
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Affiliation(s)
- Hanna M van Loo
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 (PO Box 30.001), 9700 RB Groningen, the Netherlands.
| | - Tim B Bigdeli
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States; Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health and Neuroscience Amsterdam research institutes, Amsterdam UMC and GGZ inGeest Amsterdam, Amsterdam, the Netherlands
| | - Steven H Aggen
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States; Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
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Smail MA, Smith BL, Nawreen N, Herman JP. Differential impact of stress and environmental enrichment on corticolimbic circuits. Pharmacol Biochem Behav 2020; 197:172993. [PMID: 32659243 DOI: 10.1016/j.pbb.2020.172993] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/27/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022]
Abstract
Stress exposure can produce profound changes in physiology and behavior that can impair health and well-being. Of note, stress exposure is linked to anxiety disorders and depression in humans. The widespread impact of these disorders warrants investigation into treatments to mitigate the harmful effects of stress. Pharmacological treatments fail to help many with these disorders, so recent work has focused on non-pharmacological alternatives. One of the most promising of these alternatives is environmental enrichment (EE). In rodents, EE includes social, physical, and cognitive stimulation for the animal, in the form of larger cages, running wheels, and toys. EE successfully reduces the maladaptive effects of various stressors, both as treatment and prophylaxis. While we know that EE can have beneficial effects under stress conditions, the morphological and molecular mechanisms underlying these behavioral effects are still not well understood. EE is known to alter neurogenesis, dendrite development, and expression of neurotrophic growth factors, effects that vary by type of enrichment, age, and sex. To add to this complexity, EE has differential effects in different brain regions. Understanding how EE exerts its protective effects on morphological and molecular levels could hold the key to developing more targeted pharmacological treatments. In this review, we summarize the literature on the morphological and molecular consequences of EE and stress in key emotional regulatory pathways in the brain, the hippocampus, prefrontal cortex, and amygdala. The similarities and differences among these regions provide some insight into stress-EE interaction that may be exploited in future efforts toward prevention of, and intervention in, stress-related diseases.
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Affiliation(s)
- Marissa A Smail
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States; Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH, United States.
| | - Brittany L Smith
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States
| | - Nawshaba Nawreen
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States; Neuroscience Graduate Program, University of Cincinnati, Cincinnati, OH, United States
| | - James P Herman
- Department of Pharmacology and Systems Physiology, University of Cincinnati, Cincinnati, OH, United States; Veterans Affairs Medical Center, Cincinnati, OH, United States; Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
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Bear HA, Edbrooke-Childs J, Norton S, Krause KR, Wolpert M. Systematic Review and Meta-analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety. J Am Acad Child Adolesc Psychiatry 2020; 59:810-841. [PMID: 31881268 DOI: 10.1016/j.jaac.2019.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/30/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Depression and anxiety are the most prevalent mental health problems in youth, yet almost nothing is known about what outcomes are to be expected at the individual level following routine treatment. This paper sets out to address this gap by undertaking a systematic review of outcomes following treatment as usual (TAU) with a particular focus on individual-level outcomes. METHOD MEDLINE, Embase and PsycInfo were searched for articles published between 1980 and January 2019 that assessed TAU outcomes for youth depression and anxiety accessing specialist mental health care. Meta-analysis considered change at both group-level pre-post effect size (ES) and individual-level recovery, reliable change, and reliable recovery. Temporal analysis considered stability of primary and secondary outcomes over time. Subgroup analysis considered the moderating effect of informant; presenting problem; study design; study year; mean age of youth; use of medication; intervention dosage and type of treatment offered on outcomes. A protocol was preregistered on PROSPERO (CRD42017063914). RESULTS Initial screening of 6,350 publications resulted in 38 that met the inclusion criteria, and that were subsequently included in meta-analyses. This resulted in a final full pooled sample of 11,739 young people (61% of whom were female, mean age 13.8 years). The pre-post ES (Hedges' g) at first/final outcome (13/26 weeks) was -0.74/-0.87. The individual-level change on measures of self-report was 38% reliable improvement, 44% no reliable change, and 6% reliable deterioration. Outcomes varied according to moderators, informant, problem type and dosage. CONCLUSION Poor data quantity and quality are limitations, but this is the first study that indicates likely rates of reliable improvement for those accessing TAU. We propose the need for improved reporting of both individual-level metrics and details of TAU to enable greater understanding of likely current outcomes from routine care for youths with depression and anxiety in order to allow the potential for further improvement of impact.
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Affiliation(s)
- Holly Alice Bear
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK.
| | - Julian Edbrooke-Childs
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
| | - Sam Norton
- Health Psychology Section at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, Guy's Hospital Campus, London Bridge, London, UK
| | - Karolin Rose Krause
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
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Brief Psychological Intervention Through Mobile App and Conference Calls for the Prevention of Depression in Non-Professional Caregivers: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124578. [PMID: 32630541 PMCID: PMC7345199 DOI: 10.3390/ijerph17124578] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 01/18/2023]
Abstract
Despite its potential, no intervention aimed at non-professional caregivers administered through a smartphone app has been proven to prevent depression. The objective of this pilot study was to evaluate the efficacy and feasibility of an indicated depression-prevention intervention for non-professional caregivers administered through an app with the addition of conference-call contact. The intervention was administered to 31 caregivers (Mean age = 54.0 years, 93.5% women). An independent evaluation determined the incidence of depression, depressive symptoms, risk of developing depression, and the variables in the theoretical model (positive environmental reinforcement, negative automatic thoughts) at the pre-intervention and post-intervention, as well as the one- and three-month follow-ups. The incidence of depression at 3 months of follow-up was 6.5%. There was a significant reduction in depressive symptoms (p < 0.001) and in the risk of developing depression (p < 0.001) at the post-intervention and at the one- and three-month follow-ups. The model’s variables improved significantly after the intervention and were associated with post-intervention depressive symptoms. The intervention was more effective in caregivers who had a lower level of depressive symptoms at the pre-intervention. Adherence and satisfaction with the intervention were high. The results encourage future research using a randomized controlled clinical trial.
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Nuggerud-Galeas S, Oliván Blázquez B, Perez Yus MC, Valle-Salazar B, Aguilar-Latorre A, Magallón Botaya R. Factors Associated With Depressive Episode Recurrences in Primary Care: A Retrospective, Descriptive Study. Front Psychol 2020; 11:1230. [PMID: 32581978 PMCID: PMC7290009 DOI: 10.3389/fpsyg.2020.01230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction and Objective The early identification of depressive patients having a poor evolution, with frequent relapses and/or recurrences, is one of the priority challenges in this study of high prevalence mental disorders, and specifically in depression. So, this study aims to analyze the factors that may be associated with an increased risk of recurrence of major depression episodes in patients treated in primary care. Methods A retrospective, descriptive study of cases-controls was proposed. The cases consisted of patients who had been diagnosed with major depression and who had presented recurrences (n = 101), in comparison with patients who had experienced a single major depression episode with no recurrence (n = 99). The variables of the study are age at first episode; number of episodes; perception of severity of the depression episode suffered prior to recurrence; number of residual symptoms; physical and psychiatric comorbidity; history of anxiety disorders; family psychiatric history; high incidence of stressful life events (SLEs); and experiences of physical, psychological, or sexual abuse in childhood. The differences of the variables were compared between the case subjects and the control subjects, using the Mann-Whitney, chi-square, and Fisher's U statistics. A multivariate analysis (ordinary logistic regression) was performed. Results The average age of those suffering more than one depressive episode is significantly older (5 years), and a higher percentage of subjects who have experienced more than one depressive episode have a history of anxiety disorders. In the multivariate analysis, the variables that obtained a significant value in the logistic regression analysis were age (OR: 1.03; value: 0.007) and having suffered sexual abuse during childhood (OR: 1.64; value: 0.072). Conclusion These indicators should be considered by primary care physicians when attending patients suffering from major depression.
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Affiliation(s)
- Shysset Nuggerud-Galeas
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván Blázquez
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - María Cruz Perez Yus
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Begoña Valle-Salazar
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Primary Health Care, Aragón Health Service, Zaragoza, Spain
| | | | - Rosa Magallón Botaya
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.,Primary Health Care, Aragón Health Service, Zaragoza, Spain
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The involvement of GABAergic system in the antidepressant-like effect of agmatine. Naunyn Schmiedebergs Arch Pharmacol 2020; 393:1931-1939. [DOI: 10.1007/s00210-020-01910-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
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Vázquez FL, López L, Torres ÁJ, Otero P, Blanco V, Díaz O, Páramo M. Analysis of the Components of a Cognitive-Behavioral Intervention for the prevention of Depression Administered via Conference Call to Nonprofessional Caregivers: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062067. [PMID: 32244970 PMCID: PMC7143258 DOI: 10.3390/ijerph17062067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/06/2020] [Accepted: 03/15/2020] [Indexed: 01/17/2023]
Abstract
Effective and accessible interventions for indicated prevention of depression are necessary and lacking, especially for informal caregivers. Although telephone-based interventions could increase the accessibility for caregivers, randomized controlled trials are scarce, with no examination of prevention to date. Moreover, the efficacy of specific therapeutic components in preventive cognitive-behavioral programs is unknown. The main objective of this study was to evaluate the efficacy of a telephone-administered psychological preventive intervention in informal caregivers with high depressive symptoms. A total of 219 caregivers were randomized to a cognitive-behavioral conference call intervention (CBCC, n = 69), a behavioral-activation conference call intervention (BACC, n = 70), or a usual care control group (CG, n = 80). Both interventions consisted of five 90-minute group sessions. At the post-intervention, incidence of depression was lower in CBCC and BACC compared to CG (1.5% and 1.4% vs. 8.8%). Relative risk was 0.17 for the CBCC and 0.16 for the BACC, and the number-needed-to-treat was 14 in both groups. Depressive symptoms were significantly lower in BACC and BACC groups compared to CG (d = 1.16 and 1.29), with no significant differences between CBCC and BACC groups. The conference call intervention was effective in preventing depression and the behavioral-activation component (BACC) was comparable to the CBCC intervention.
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Affiliation(s)
- Fernando L. Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (L.L.); (O.D.)
- Correspondence: ; Tel.: +34-881813705
| | - Lara López
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (L.L.); (O.D.)
| | - Ángela J. Torres
- Department of Psychiatry, Radiology and Public Health, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain (M.P.)
| | - Patricia Otero
- Department of Psychology, University of A Coruña, 15001 A Coruña, Spain;
| | - Vanessa Blanco
- Department of Evolutionary and Educational Psychology, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain;
| | - Olga Díaz
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain; (L.L.); (O.D.)
| | - Mario Páramo
- Department of Psychiatry, Radiology and Public Health, University of Santiago de Compostela, 15705 Santiago de Compostela, Spain (M.P.)
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Course of depressive symptoms in men and women: differential effects of social, psychological, behavioral and somatic predictors. Sci Rep 2019; 9:18929. [PMID: 31831794 PMCID: PMC6908702 DOI: 10.1038/s41598-019-55342-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/27/2019] [Indexed: 11/08/2022] Open
Abstract
In this study, we aimed to identify the most important and sex-specific social, psychological, behavioral and somatic predictors of recurrent depressive symptoms. Data was obtained at two measurement points within five years by the Gutenberg Health Study (GHS). Out of N = 12,061 individuals, a sample of 877 (age 52.3 ± 9.9) who reported clinically relevant depressive symptoms at baseline was analyzed. Univariate analyses and multiple logistic regression analyses were conducted. Almost half of participants depressed at baseline also reported depressive symptoms five years later. Sex-stratified multivariate analyses revealed that solely social support remained a significant protective predictor against recurrence of depression in men (OR = 0.93; CI95% = 0.87-0.99), whereas in women smoking (OR = 1.97; CI95% = 1.23-3.22), and Type D personality (OR = 1.65; CI95% = 1.10-2.49) were significant risk factors. However, when analyzing the entire sample, no interaction effect between sex and each predictor turned out to be significant. Only social support was retained as an overall predictive factor. As depressive symptoms recur, depressive vulnerability is established involving personality, health behavior and social factors. Although no significant sex-specific interactions were observed, sex-stratified analyses point out different patterns for relevant predictors of recurrent depressive symptoms in men and women.
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Visted E, Sørensen L, Vøllestad J, Osnes B, Svendsen JL, Jentschke S, Binder PE, Schanche E. The Association Between Juvenile Onset of Depression and Emotion Regulation Difficulties. Front Psychol 2019; 10:2262. [PMID: 31695636 PMCID: PMC6816416 DOI: 10.3389/fpsyg.2019.02262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/23/2019] [Indexed: 01/04/2023] Open
Abstract
Juvenile onset of Major Depressive Disorder (MDD) is associated with increased likelihood of recurrent episodes of depression and more detrimental clinical trajectories. The aim of the current study was to investigate the effect of juvenile onset of MDD on emotion regulation as measured by self-report and Heart Rate Variability (HRV). Furthermore, we wanted to assess whether juvenile onset impacted the association between rumination and depressive symptoms. Sixty-four individuals with at least three prior episodes of MDD were recruited and filled out self-report questionnaires measuring rumination and emotion regulation abilities. In addition, electrocardiographic assessments were used to calculate HRV. Based on self-reported age of MDD onset, individuals were divided in two groups: Juvenile onset of MDD (first MDD episode before the age of 18, n = 30) and adult onset of MDD (first MDD episode after the age of 18, n = 34). Results showed that individuals whose first depressive episode occurred in childhood and adolescence reported more rumination and less emotional clarity compared to individuals who had their first episode of MDD in adulthood. Moreover, the tendency to ruminate was strongly associated with depressive symptoms in the juvenile onset of MDD group, whereas no such association was found in the adult onset group. There was no significant group difference for HRV. The findings are discussed in light of existing literature, in addition to suggesting how our findings may inform clinical practice and future research. We conclude that juvenile onset of MDD may lead to difficulties in emotion regulation and that these difficulties may increase depressive symptoms and vulnerability for relapse in this particular subgroup.
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Affiliation(s)
- Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Solli District Psychiatric Center (DPS), Nesttun, Norway
| | - Berge Osnes
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Bjørgvin District Psychiatric Centre, Haukeland University Hospital, Bergen, Norway
| | - Julie Lillebostad Svendsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | | | - Per-Einar Binder
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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