The effects of depression on the emotional responses of Spanish-speaking Latinas

The Measurement of Acculturation in Neuropsychological Evaluations of Hispanic/Latino Individuals across the Lifespan: A Scoping Review of the Literature

OBJECTIVE

Acculturation has been linked to health outcomes in Hispanics/Latinos (H/Ls). However, there is equivocal evidence of a relationship between acculturation and neuropsychological outcomes. Various factors limit the ability to subject the evidence to systematic/meta-analytic review. We sought to examine the current state of the literature in the context of H/Ls and neuropsychology and describe the various limitations of measuring acculturation across the lifespan.

METHOD

Applying a scoping review approach, we identified unique stand-alone (e.g., questionnaires) measures of acculturation. We focused on psychometric (e.g., internal consistency) and other characteristics (e.g., language, structure/format) and description of the validation samples (e.g., cultural background/country of origin).

RESULTS

A total of 40 unique acculturation measures were identified. Measures spanned various domains (e.g., language proficiency, food preference, music choice), and relied heavily on linguistic behavioral characteristics. Internal consistency varied from unacceptable to clinically acceptable ranges. Variable approaches to development and validation were reported. Validation samples varied from 22 to 2,048 respondents (median = 380), most of which represented a general adult population. Only eight measures were validated for use in pediatric populations; none were developed specifically for use with older adults.

CONCLUSIONS

Published measures are outdated, evidence highly variable psychometric and methodological weaknesses, and lack a lifespan perspective. Several themes in the types of items considered elemental to the acculturative process are revealed and findings are summarized via an "ABC" framework, categorizing items as antecedents, behaviors, and consequent acculturative changes, that lends itself to clinical and research settings.

Addressing social stressors in a brief motivational interview improve mental health symptoms for Latinx heavy drinkers

OBJECTIVE

Depressive and anxiety symptoms co-occur with hazardous drinking among Latinxs. This secondary analysis of a clinical trial to reduce hazardous drinking (motivational interviewing adapted to address social stressors [CAMI] vs. motivational interviewing [MI]) examined effects on anxiety/depressive symptoms. Discrimination and acculturation were examined as moderators.

METHODS

Latinx (n = 296) hazardous drinkers (2+ occasions/month of heavy drinking; 4/5 drinks/occasion, females/males) were randomized to CAMI/MI. Generalized estimating equations analyzed how treatment conditions and interactions were related to depressive and anxiety symptoms after controlling for covariates.

RESULTS

Baseline symptoms (anxiety, depression) exceeded clinical thresholds (Anxiety ≥8, M = 14.62, SD = 13.52; Depression ≥ 12, M = 18.78, SD = 12.57). Cultural adaptation of motivational interviewing (CAMI) showed significantly lower anxiety and depressive symptoms (6/12 months, respectively) than MI. CAMI with high baseline discrimination reported significantly less depression than MI (12 months).

CONCLUSIONS

Explicitly addressing social stressors may be a beneficial adjunct to treatment for Latinx drinkers.

Depression Severity Assessment for Adolescents at High Risk of Mental Disorders

Recent progress in artificial intelligence has led to the development of automatic behavioral marker recognition, such as facial and vocal expressions. Those automatic tools have enormous potential to support mental health assessment, clinical decision making, and treatment planning. In this paper, we investigate nonverbal behavioral markers of depression severity assessed during semi-structured medical interviews of adolescent patients. The main goal of our research is two-fold: studying a unique population of adolescents at high risk of mental disorders and differentiating mild depression from moderate or severe depression. We aim to explore computationally inferred facial and vocal behavioral responses elicited by three segments of the semi-structured medical interviews: Distress Assessment Questions, Ubiquitous Questions, and Concept Questions. Our experimental methodology reflects best practise used for analyzing small sample size and unbalanced datasets of unique patients. Our results show a very interesting trend with strongly discriminative behavioral markers from both acoustic and visual modalities. These promising results are likely due to the unique classification task (mild depression vs. moderate and severe depression) and three types of probing questions.

Sympathetic arousal during the processing of dysphoric affect by youths at high and low familial risk for depression

Youths at high risk for depression have been shown to have problems in repairing their own sad mood. Given that sympathetic arousal has been implicated both in the experience and regulation of affect, an atypical pattern of arousal may be one of the factors that contribute to mood repair problems. In the current study, we measured sympathetic arousal of never-depressed youths at high (n = 56) and low (n = 67) familial risk for depression during sad mood induction and instructed mood repair. Sympathetic arousal was indexed by skin conductance level (SCL) and cardiac pre-ejection period (PEP); mood repair outcome was indexed by self-rated affect. High-risk youths demonstrated increased SCL during sadness induction, which persisted during mood repair; low-risk youths evidenced increased SCL only during mood repair. Shortened PEP was evident only among high-risk youths and only during mood repair. Furthermore, shortened PEP during mood induction predicted less successful mood repair in the low-risk but not in the high-risk group. The findings suggest that: (a) depression-prone youths differ from control peers in patterns of sympathetic responses to emotional stimuli, which may impair their ability to relieve sadness, and (b) activation patterns differ across subsystems (SCL vs. PEP) of sympathetic activity, in conjunction with depression risk status.

The association between electrodermal activity (EDA), depression and suicidal behaviour: A systematic review and narrative synthesis

BACKGROUND

Electrodermal activity (EDA) and other peripheral autonomic electrical parameters have been used as indicators of emotional states, including depressive states and suicidal state. We aimed to review EDA research systematically, focusing on EDA's usefulness as a biomarker for depression and suicidal behaviour.

METHODS

We searched MEDLINE, Scopus, Cochrane Library, and Web of Science databases, following PRISMA guidelines. The initial screening of articles was based on titles and abstracts; then the full text was reviewed. A preliminary synthesis of findings was developed using tables, thematic analysis and quality ratings.

RESULTS

1287 articles were screened and 77 relevant studies were identified and included in the systematic review. The studies were fairly consistent in maintaining that hypoactive electrodermal response is an established feature of patients affected by depression. There is also preliminary evidence that monitoring EDA may help to differentiate the phases of mood disorders. A few studies provided evidence that EDA can be used to differentiate acutely suicidal subjects from depressed patients who are not severely suicidal. Although EDA has been shown to be a valid, sensitive marker of suicidal ideation, suicide attempts and violent suicidal behaviour, it also seems to be influenced to some extent by antidepressant treatment.

CONCLUSIONS

Most of the studies summarised in this review are quite outdated and employed a variety of designs and methods to evaluate EDA. This limits the generalisability of the results and makes it difficult to draw clear conclusions about the role of EDA in real-world settings. Electrodermal hypoactivity seems to be a reliable feature of depression and a valid marker of suicidal risk. Nevertheless, the potential utility of EDA in diagnosis, prevention, and treatment planning for depression and suicidal behaviour, should be thoroughly studied.

No praise, please: Depressive symptoms, reactivity to positive social interaction, and fear of positive evaluation

BACKGROUND

Depression is characterized by depressed mood and loss of interest or pleasure. Resulting alterations in emotional reactivity have been explained by three different accounts: 'positive attenuation', 'negative potentiation', and 'emotion context insensitivity'. Despite the importance of depression-related emotional alteration in social interactions, research with naturalistic interpersonal stimuli is scarce and underlying mechanisms largely unknown.

METHODS

Hence, the present study examined subjective emotional reactivity to brief negative, positive, and neutral social-evaluative videos as a function of depressive symptoms in an adult sample (N = 84). Fear of positive evaluation (FPE) and fear of negative evaluation (FNE), often conceptualized as cognitive components of social anxiety, were examined as possible mediators.

RESULTS

Results revealed that more depression symptoms were related to diminished pleasantness responses to both positive and neutral videos. When considering all three video conditions simultaneously, only responses to positive videos remained significantly related to depression scores, supporting the 'positive attenuation' account. Moreover, FPE was found to uniquely mediate the relationship between depressive symptoms and pleasantness responses to positive videos.

CONCLUSIONS

Results indicate that emotional reactivity to positive interpersonal stimuli is relevant for theoretical and clinical considerations of depression. This research underlines the importance of FPE not only for understanding social anxiety but also depression.

Facial expression to emotional stimuli in non-psychotic disorders: A systematic review and meta-analysis

Facial expression of emotion is crucial to social interaction and emotion regulation; therefore, altered facial expressivity can be a contributing factor in social isolation, difficulties with emotion regulation and a target for therapy. This article provides a systematic review and meta-analysis of the literature on automatic emotional facial expression in people with non-psychotic disorders compared to healthy comparison groups. Studies in the review used an emotionally salient visual induction method, and reported on automatic facial expression in response to congruent stimuli. A total of 39 studies show alterations in emotional facial expression across all included disorders, except anxiety disorders. In depression, decreases in facial expression are mainly evident for positive affect. In eating disorders, a meta-analysis showed decreased facial expressivity in response to positive and negative stimuli. Studies in autism partially support generally decreased facial expressivity in this group. The data included in this review point towards decreased facial emotional expressivity in individuals with different non-psychotic disorders. This is the first review to synthesise facial expression studies across clinical disorders.

Acculturation, hazardous drinking and depressive symptomatology among Hispanics enrolled in a clinical trial

BACKGROUND

Among Hispanics in the U.S., lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrollment, all participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms.

METHODS

Participants (N = 100) completed measures at baseline.

RESULTS

Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (n=49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men.

DISCUSSION

Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.

Nonverbal Social Withdrawal in Depression: Evidence from manual and automatic analysis

The relationship between nonverbal behavior and severity of depression was investigated by following depressed participants over the course of treatment and video recording a series of clinical interviews. Facial expressions and head pose were analyzed from video using manual and automatic systems. Both systems were highly consistent for FACS action units (AUs) and showed similar effects for change over time in depression severity. When symptom severity was high, participants made fewer affiliative facial expressions (AUs 12 and 15) and more non-affiliative facial expressions (AU 14). Participants also exhibited diminished head motion (i.e., amplitude and velocity) when symptom severity was high. These results are consistent with the Social Withdrawal hypothesis: that depressed individuals use nonverbal behavior to maintain or increase interpersonal distance. As individuals recover, they send more signals indicating a willingness to affiliate. The finding that automatic facial expression analysis was both consistent with manual coding and revealed the same pattern of findings suggests that automatic facial expression analysis may be ready to relieve the burden of manual coding in behavioral and clinical science.

Social Risk and Depression: Evidence from Manual and Automatic Facial Expression Analysis

Investigated the relationship between change over time in severity of depression symptoms and facial expression. Depressed participants were followed over the course of treatment and video recorded during a series of clinical interviews. Facial expressions were analyzed from the video using both manual and automatic systems. Automatic and manual coding were highly consistent for FACS action units, and showed similar effects for change over time in depression severity. For both systems, when symptom severity was high, participants made more facial expressions associated with contempt, smiled less, and those smiles that occurred were more likely to be accompanied by facial actions associated with contempt. These results are consistent with the "social risk hypothesis" of depression. According to this hypothesis, when symptoms are severe, depressed participants withdraw from other people in order to protect themselves from anticipated rejection, scorn, and social exclusion. As their symptoms fade, participants send more signals indicating a willingness to affiliate. The finding that automatic facial expression analysis was both consistent with manual coding and produced the same pattern of depression effects suggests that automatic facial expression analysis may be ready for use in behavioral and clinical science.

Empathic behavioral and physiological responses to dynamic stimuli in depression

Major depressive disorder (MDD) is strongly linked to social withdrawal and interpersonal problems which characterize the disorder and further aggravate symptoms. Investigating the nature of impaired emotional-social functioning as a basis of interpersonal functioning in MDD has been widely restricted to static stimuli and behavioral emotion recognition accuracy. The present study aimed at examining higher order emotional processes, namely empathic responses and its components, emotion recognition accuracy and affective responses in 28 MDD patients and 28 healthy control participants. The dynamic stimulus material included 96 short video clips depicting actors expressing basic emotions by face, voice prosody, and sentence content. Galvanic skin conductance measurements revealed implicit processes in the multimethod assessment of empathy. Overall, patients displayed lower empathy, emotion accuracy, and affective response rates than controls. Autonomous arousal was higher in patients. A generalized emotion processing deficit is in line with the "emotional context insensitivity" (ECI) theory which proposes decreased overall responsiveness to emotional stimuli. The dissociation between hypo-reactivity in explicit and hyper-reactivity in implicit measures of emotion processing can be related to the "limbic-cortical dysregulation" model of depression. Our findings support the dissociation of autonomic and subjective emotional responses which may account for interpersonal as well as emotional deficits in depression.

Emotion in psychogenic nonepileptic seizures: responses to affective pictures

We examined emotional responses to standard affective pictures in 18 psychogenic nonepileptic seizure (PNES) patients. Given reports of trauma and posttraumatic stress symptoms (PTS) in many PNES patients, comparison groups were seizure-free individuals high and low in PTS (PTS-high, PTS-low; n=18 per group). Patients with psychogenic nonepileptic seizures (1) reported more emotional intensity to neutral and pleasant pictures than PTS-low and more intensity to neutral pictures than PTS-high, and (2) showed less positive emotional behavior to pleasant pictures than PTS-high. Groups did not differ in pleasantness/unpleasantness ratings, negative emotional behavior, cardiac interbeat interval, or respiratory sinus arrhythmia (RSA) reactivity to the pictures. Patients with psychogenic nonepileptic seizures reported more general emotion regulation difficulties and showed lower baseline RSA than PTS-low but not PTS-high. In sum, intense emotional experience and diminished positive emotional behavior characterized PNES patients' emotional responses.

Reconsidering anhedonia in depression: lessons from translational neuroscience

Anhedonia is a core symptom of major depressive disorder (MDD), the neurobiological mechanisms of which remain poorly understood. Despite decades of speculation regarding the role of dopamine (DA) in anhedonic symptoms, empirical evidence has remained elusive, with frequent reports of contradictory findings. In the present review, we argue that this has resulted from an underspecified definition of anhedonia, which has failed to dissociate between consummatory and motivational aspects of reward behavior. Given substantial preclinical evidence that DA is involved primarily in motivational aspects of reward, we suggest that a refined definition of anhedonia that distinguishes between deficits in pleasure and motivation is essential for the purposes of identifying its neurobiological substrates. Moreover, bridging the gap between preclinical and clinical models of anhedonia may require moving away from the conceptualization of anhedonia as a steady-state, mood-like phenomena. Consequently, we introduce the term "decisional anhedonia" to address the influence of anhedonia on reward decision-making. These proposed modifications to the theoretical definition of anhedonia have implications for research, assessment and treatment of MDD.

Autonomic nervous system activity in emotion: a review

Autonomic nervous system (ANS) activity is viewed as a major component of the emotion response in many recent theories of emotion. Positions on the degree of specificity of ANS activation in emotion, however, greatly diverge, ranging from undifferentiated arousal, over acknowledgment of strong response idiosyncrasies, to highly specific predictions of autonomic response patterns for certain emotions. A review of 134 publications that report experimental investigations of emotional effects on peripheral physiological responding in healthy individuals suggests considerable ANS response specificity in emotion when considering subtypes of distinct emotions. The importance of sound terminology of investigated affective states as well as of choice of physiological measures in assessing ANS reactivity is discussed.

Viewing injustice: greater emotion heterogeneity with age

The present study examined age differences in emotion heterogeneity, defined as the experience of co-occurring negative emotions. Younger and older European American and Mexican American participants (N=183) viewed film clips depicting scenes of injustice. Younger adults were more likely to report a single primary negative emotion, whereas older adults reported greater emotion heterogeneity, a finding consistent across gender and ethnicity. In addition, greater emotion heterogeneity was related to a greater number of life experiences. Future directions concerning the meaning of and possible implications for this age difference are discussed.

Electrodermal dissociation of chronic fatigue and depression: evidence for distinct physiological mechanisms

Chronic fatigue syndrome (CFS) has an estimated prevalence between 0.5% and 3%, yet its diagnosis remains contentious. CFS is characterized by subjective symptoms that can be difficult to verify; moreover, depression is a commonly reported CFS complaint, whereas fatigue is a common symptom of depression. Our primary goal was dissociation of these disorders using psychophysiological methods. As previous research has implicated the autonomic nervous system in CFS, we conducted what we believe to be the first analysis of bilateral electrodermal and skin temperature responses of dextral females in a cross-modal orienting task, to investigate differences between these two patient groups and controls. A multivariate analysis of variance (MANOVA) examining three measures of electrodermal activity revealed prestimulus tonic skin conductance levels (SCLs) were markedly lower for the CFS group, with no difference between controls and depressives. Concurrent skin temperature levels were higher for the CFS group than the other two groups. These findings indicate that, despite overtly similar cognitive and symptom profiles, depression and CFS patients can be differentiated with psychophysiological measures. This study adds to the growing body of evidence demonstrating that CFS and depression have distinct neurobiological profiles, consistent with unique aetiologies.