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Barkley SB, Hajcak G, Klein DN, Nelson BD. Electrocortical Reactivity During Self-Referential Processing Predicts the Development of Depression Across Adolescence. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00118-6. [PMID: 38710386 DOI: 10.1016/j.bpsc.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/24/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Negative attentional biases and self-schemas have been implicated in the development of depression. Research has indicated that a larger late positive potential (LPP) to negative self-referential words is associated with depression-as well as a maternal history of depression, an indicator of risk. However, it is unclear whether the LPP to self-referential words predicts the actual development of depression. In the current study, we examined whether electrocortical reactivity during self-referential processing predicted the development of depression across adolescence. METHODS The sample consisted of 165 8- to 14-year-old girls with no lifetime history of a depressive disorder who completed the self-referential encoding task while electroencephalography was recorded at a baseline assessment. Participants and their parent completed the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children at the baseline and 2-, 4-, and 6-year follow-up assessments. RESULTS Results indicated that a larger LPP to negative self-referential words at baseline predicted an increased likelihood of developing chronic-intermittent depression (i.e., persistent and/or recurrent), but not nonchronic, single-episode depression, across adolescence. In contrast, neither self-referential encoding task recall biases nor the LPP to positive self-referential words predicted the development of either type of depression. CONCLUSIONS The results of the current study suggest that electrocortical reactivity associated with a negative self-schema in late childhood predicts the development of a more pernicious subtype of depression across adolescence. Moreover, the current study highlights the importance of considering clinical course in the examination of biomarkers of risk for depression.
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Affiliation(s)
- Sarah B Barkley
- Department of Psychology, Stony Brook University, Stony Brook, New York.
| | - Greg Hajcak
- Santa Clara University, School of Education and Counseling Psychology, Santa Clara, California
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, New York
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2
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Hopwood CJ, Morey LC, Markon KE. What is a psychopathology dimension? Clin Psychol Rev 2023; 106:102356. [PMID: 37926058 DOI: 10.1016/j.cpr.2023.102356] [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: 07/05/2023] [Revised: 09/06/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Coherence in the science and practice of mental health assessment depends upon a tight connection between psychopathology concepts that are used and the way those concepts are operationalized and defined. In contrast, the use of the same word to mean more than one thing contributes to incoherence, inefficiency, and confusion. In this paper, we review three possible meanings of the word "dimension" as it relates to the assessment of psychopathology and describe how the indiscriminate use of this word has caused confusion in the general context of the transition to a more evidence-based approach to mental health diagnosis. We attempt to disambiguate the term "dimension" by demarcating three concepts that can be distinguished based on different empirical standards: continuous variables, unidimensional dimensions, and distinct dimensions.
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3
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Klein DN, Perlman G, Feltman SM, Kotov R. Preonset predictors of chronic-intermittent depression from early adolescence to early adulthood. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:694-703. [PMID: 37276087 PMCID: PMC10524144 DOI: 10.1037/abn0000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Individuals with prolonged or frequent episodes account for a disproportionate share of the burden of depression. However, there are surprisingly few data on whether individuals at risk for developing chronic-intermittent depression (CID) as opposed to briefer, infrequent depressive episodes (time-limited depression [TLD]) can be distinguished before their first depressive episode. We followed a community sample of 465 never-depressed females on five occasions from age 14 to 20 years and examined whether 18 preonset clinical and psychosocial variables prospectively predicted CID. The CID group accounted for 40% of depressed cases but 84% of the cumulative time depressed in the sample. Participants with CID (n = 60) exhibited significantly higher preonset levels of 16 of the 18 risk factors than the never-depressed group (n = 315). The TLD group (n = 90) had significantly higher preonset levels of nine risk factors than never-depressed participants. Finally, the CID group had significantly higher levels of nine risk factors than the TLD group, five of which were similar in TLD and never-depressed participants. These findings indicate that differences between CID and TLD are evident before onset and suggest that the liability to CID may be both greater than, and somewhat different from, the liability to TLD. Moreover, they suggest that individuals at risk for a malignant course of depression can be targeted for prevention and early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Greg Perlman
- Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Scott M. Feltman
- Department of Psychiatry and Behavioral Health, Stony Brook University
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health, Stony Brook University
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Barczyk ZA, Foulds JA, Porter RJ, Douglas KM. Childhood trauma and cognitive functioning in mood disorders: A systematic review. Bipolar Disord 2023; 25:263-277. [PMID: 36949602 DOI: 10.1111/bdi.13321] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Cognitive impairment is a core feature of mood disorders and has been identified as an important treatment target. A better understanding of the factors contributing to cognitive impairment in mood disorders would be beneficial in developing interventions to address cognitive impairment. One key factor is childhood trauma. The aim of this review was to systematically synthesise and review research examining associations between reported childhood trauma and cognitive functioning in mood disorders. METHODS Studies in adult samples examining the relationship between objective cognitive function and reported childhood trauma in major depressive disorder and/or bipolar disorder (in-episode or euthymia) were identified. Searches were conducted on PubMed, Embase and PsycINFO until January 2022. A narrative review technique was used due to the heterogeneity of group comparisons, cognitive tests and data analysis across studies. RESULTS Seventeen studies met the criteria for inclusion (mood disorders N = 1723, healthy controls N = 797). Evidence for childhood trauma being related to poorer cognitive functioning was consistent across global cognitive functioning and executive function domains for euthymic patients and psychomotor speed for in-episode patients. There was mixed evidence for verbal learning and memory and executive function for in-episode patients. Identification of patterns within other domains was difficult due to limited number of studies. CONCLUSION Findings from this review suggest childhood trauma is associated with poorer cognitive functioning in people with mood disorders. Targeted interventions to improve cognition may be warranted for this group.
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Affiliation(s)
- Zoe A Barczyk
- Department of Psychological Medicine, University of Otago, Christchurch, 8011, New Zealand
| | - James A Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, 8011, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, 8011, New Zealand
- Specialist Mental Health Services, Canterbury District Health Board, Christchurch, 8024, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, 8011, New Zealand
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5
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de Vocht AMR, Witteman CLM, de Vocht F, Spijker J. Second Opinions for Patients With a Persistent Depressive Disorder: Effects on Severity of Depression and Quality of Life. J Psychiatr Pract 2023; 29:104-112. [PMID: 36928197 DOI: 10.1097/pra.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND A persistent depressive disorder has a major impact on both patients and health care systems. Despite the advice in guidelines to seek a second opinion if there is insufficient evidence of recovery after treatment, and the great number of second opinions in psychiatric care for patients with persistent depression, only a few studies have been published about their effects. METHODS Multilevel analyses were conducted to compare the mean test scores of a group of patients with a persistent depressive disorder who received the intervention of a second opinion with scores from a matched control group, at 3 time points: baseline, intervention, and follow-up. RESULTS A significant decrease in the severity of depression 3 months after the second opinion was found. No effects on quality of life or treatment satisfaction were found. LIMITATIONS The study sample was a convenience sample without randomization, and many values were missing in the data. In addition, a 3-month follow-up may have been too short to expect effects of the recommendations from the second opinion. The instructions concerning how to rate treatment satisfaction were also ambiguous. CONCLUSIONS A second opinion can be of value for persistent depression. Further research should address the question of whether the effect that was found is caused by the second opinion itself or is the result of subsequent changes in treatment.
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Affiliation(s)
- Anneke M R de Vocht
- DE VOCHT AMR: Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, The Netherlands; WITTEMAN: Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; DE VOCHT F: Population Health Sciences, Bristol Medical School, University of Bristol. Bristol, United Kingdom, and NIHR Applied Research Collaboration West (NIHR ARC West); SPIJKER: Depression Expertise Center, Pro Persona Mental Health Care, and Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Schirmer ST, Beckmann FE, Gruber H, Schlaaff K, Scheermann D, Seidenbecher S, Metzger CD, Tempelmann C, Frodl T. Decreased functional connectivity in patients with major depressive disorder and a history of childhood traumatization through experiences of abuse. Behav Brain Res 2023; 437:114098. [PMID: 36067949 DOI: 10.1016/j.bbr.2022.114098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Childhood trauma (CT) increases vulnerability for the development of major depressive disorder (MDD). Alterations in resting-state functional connectivity (RSFC) have frequently been reported for MDD. These alterations may be much more prominent in depressive patients with a history of CT. The present study aims to compare RSFC in different brain networks of patients with MDD and CT (MDD+CT) vs. MDD and no CT compared to healthy controls. METHODS 45 patients (22 with CT) were compared to 23 age-and-gender-matched healthy control subjects. Demographic parameters, severity of MDD, severity of CT and comorbid anxiety disorders were assessed. For assessment of RSFC alterations, a seed-based approach within five well-established RSFC networks was used. RESULTS CT in MDD patients predicts severity of comorbid anxiety. A significant decrease in in-between network RSFC-values of MDD patients compared to controls was found in the network pairs of default mode network (DMN) - dorsal attention network (DAN), ventral attention network (VAN) - DMN and DAN - affective network (AN). MDD+CT patients presented more aberrant RSFC than MDD-CT patients. MDD scores predicted the decrease in RSFC for MDD patients. Higher Childhood Trauma Questionnaire (CTQ) scores are linked to reduced functional connectivity (FC) between DMN - DAN. CONCLUSIONS Our study shows reduced RSFC in MDD patients for DMN - DAN, VAN - DMN, DAN - AN and MDD+CT patients presented more aberrant RSFC so that we suspect CT to be a considerable factor in the etiology of MDD. Through dysregulated neural circuits, CT is likely to contribute to a distinct MDD pathophysiology.
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Affiliation(s)
- Saskia Thérèse Schirmer
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Fienne-Elisa Beckmann
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Hanna Gruber
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Konstantin Schlaaff
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Denise Scheermann
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Stephanie Seidenbecher
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Coraline Danielle Metzger
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Claus Tempelmann
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Department of Psychiatry and Psychotherapy, RWTH University of Aachen, Aachen, Germany.
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Hung CI, Wu CT, Chao YP. Differences in gray matter volumes of subcortical nuclei between major depressive disorder with and without persistent depressive disorder. J Affect Disord 2023; 321:161-166. [PMID: 36272460 DOI: 10.1016/j.jad.2022.10.021] [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: 04/09/2022] [Revised: 10/01/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to compare the differences in gray matter volumes (GMVs) of subcortical nuclei between major depressive disorder (MDD) patients with and without persistent depressive disorder (PDD) at long-term follow-up. METHODS 114 and 94 subjects with MDD, including 48 and 41 with comorbid PDD, were enrolled to undergo high-resolution T1-weighted imaging at first (FIP) and second (three years later, SIP) investigation points, respectively. FreeSurfer was used to extract the GMVs of seven subcortical nuclei, and Generalized Estimating Equation models were employed to estimate the differences in GMVs of subcortical nuclei between the two subgroups. RESULTS The PDD subgroup had a significantly greater depressive severity and a higher percentage of patients undergoing pharmacotherapy at the FIP as compared with the non-PDD subgroup. These differences became insignificant at the SIP. The PDD subgroup had a significantly (p < 0.003) smaller GMV in the right putamen at the SIP and in the right nucleus accumbens (NAc) at the FIP and SIP as compared with the non-PDD subgroup. After controlling for clinical variables, PDD was independently associated with smaller GMVs in the right putamen and NAc. LIMITATIONS Imaging was not performed at baseline and pharmacotherapy was not controlled at the FIP and SIP. CONCLUSIONS MDD with PDD was associated with smaller GMVs in the right putamen and NAc as compared with MDD without PDD. Whether the two regions are biomarkers related to a poor prognosis and the chronicity of depression requires further study.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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8
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Longstanding health risk across the life course: The influence of early-life experience on health status throughout the life span. J Biosoc Sci 2022:1-27. [PMID: 36120813 DOI: 10.1017/s002193202200027x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study tracked the longstanding effect of childhood adversities on health status over the course of a life. This study used the data from China Health and Retirement Longitudinal Study which was a nationally representative survey and documented the generation who had arrived in the middle- and old-age phase and experienced the difficult time in the early founding of PR China in their childhood. Results shown the significant associations between multiple forms of children adversities (economic distress, child neglect, child abuse, lack of friends, parental mental health problems) and health status in adolescence (from 0.068 to 0.102, p<0.01), and health status in mid and late adulthood, including self-rated general health problems (from 0.039 to 0.061, p<0.01), chronic conditions (from 0.014 to 0.120, p<0.01 except for lack of friends), body aches (from 0.016 to 0.062, p<0.01 except for child neglect), and depression (from 0.047 to 0.112, p<0.01). Meanwhile, results also shown an underlying pathway (i.e., health status in adolescence) linking childhood adversities and health status in mid and late adulthood. Results suggested that the experience of multiple forms of adversities in childhood represented a substantial source of health risk throughout life.
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Altmeyer S, Wollersheim L, Kilian-Hütten N, Behnke A, Hofmann A, Tumani V. Effectiveness of treating depression with eye movement desensitization and reprocessing among inpatients–A follow-up study over 12 months. Front Psychol 2022; 13:937204. [PMID: 36033012 PMCID: PMC9402253 DOI: 10.3389/fpsyg.2022.937204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Increasing prevalence of depression poses a huge challenge to the healthcare systems, and the success rates of current standard therapies are limited. While 30% of treated patients do not experience a full remission after treatment, more than 75% of patients suffer from recurrent depressive episodes. Eye Movement Desensitization and Reprocessing (EMDR) therapy represents an emerging treatment option of depression, and preliminary studies show promising effects with a probably higher remission rate when compared to control-therapies such as cognitive behavioral therapy. In the present study, 49 patients with severe depression were treated with an integrated systemic treatment approach including EMDR therapy that followed a specific protocol with a treatment algorithm for depression in a naturalistic hospital setting. Following their discharge from the hospital, the patients were followed up by a structured telephone interview after 3 and 12 months. 27 of the 49 (55%) patients fulfilled the Beck’s depression criteria of a full remission when they were discharged. At the follow-up interview, 12 months after discharge, 7 of the 27 patients (26%) reported a relapse, while the remaining 20 patients (74%) had stayed relapse-free. The findings of our observational study confirm reports of earlier studies in patients with depression, showing that EMDR therapy leads to a high rate of remission, and is associated with a decreased number of relapses. Patients with depression receiving EMDR treatment may be more resilient to stressors.
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Affiliation(s)
- Susanne Altmeyer
- Gezeitenhaus Traumahospital Schloss Eichholz, Wesseling, Germany
- *Correspondence: Susanne Altmeyer,
| | - Leonie Wollersheim
- Gezeitenhaus Traumahospital Schloss Eichholz, Wesseling, Germany
- Leonie Wollersheim,
| | - Niclas Kilian-Hütten
- Gezeitenhaus Traumahospital Schloss Eichholz, Wesseling, Germany
- Niclas Kilian-Hütten,
| | - Alexander Behnke
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
- Alexander Behnke,
| | - Arne Hofmann
- EMDR-Institute Germany, Gezeitenhaus Traumahospital Schloss Eichholz, Wesseling, Germany
- Arne Hofmann,
| | - Visal Tumani
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
- Visal Tumani,
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Chu Q, Wang X, Yao R, Fan J, Li Y, Nie F, Wang L, Tang Q. Childhood trauma and current depression among Chinese university students: a moderated mediation model of cognitive emotion regulation strategies and neuroticism. BMC Psychiatry 2022; 22:90. [PMID: 35130873 PMCID: PMC8819909 DOI: 10.1186/s12888-021-03673-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Childhood trauma (CT) is considered as a highly risk factor for depression. Although the pathway of CT to depression, especially the mediating or moderating effects of cognitive emotion regulation strategies (CERS) or neuroticism, have investigated by several studies, the results were inconsistent and there is a paucity of full models among these interactive factors. This study aims to examine the relationships among CT, adaptive / maladaptive CERS, neuroticism, and current depression symptoms in university students. METHODS We recruited 3009 freshman of 2019, aged averagely 18.00 (SD = 0.772) years, from universities in Hunan province in 2019. A moderated mediation model was built to examine the relationships among CT, CERS, neuroticism, and current depression using the SPSS PROCESS 3.5 macro. We conducted bootstrapping of regression estimates with 5000 samples and 95% confidence interval. RESULTS Results revealed that the significant mediating effects of adaptive CERS (β = 0.012; 95% CI: 0.006 to 0.018) and maladaptive CERS (β = 0.028; 95% CI: 0.016 to 0.040) between CT and depression were observed, accounting for 5.69% and 13.52% of the total effect respectively. Then, moderated mediation analyses results showed that neuroticism simultaneously moderated the direct effect of CT on current depression (β = 0.035; 95% CI: 0.001 to 0.009), and the indirect effects of CT on current depression through adaptive CERS (adaptive CERS - current depression: β = - 0.034; 95% CI: - 0.007 to - 0.001) and maladaptive CERS (maladaptive CERS - current depression: β = 0.157; 95% CI: 0.017 to 0.025). However, the moderating effects of neuroticism in the indirect paths from CT to adaptive CERS (β = 0.037; 95% CI: 0.000 to 0.014) and maladaptive CERS (β = - 0.001; 95% CI: - 0.006 to 0.005) were not significant. CONCLUSIONS This study provides powerful evidences through a large university students sample for the mediating role of adaptive / maladaptive CERS and the moderating role of neuroticism between CT and current depression. This manifests that cognitive emotion regulation may be a vital factor for people who suffered from CT and current depression. Furthermore, the influence of neuroticism in this process cannot be ignored.
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Affiliation(s)
- Qianqian Chu
- grid.431010.7Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013 China
| | - Xiang Wang
- grid.452708.c0000 0004 1803 0208Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan 41000 China
| | - Rui Yao
- grid.488482.a0000 0004 1765 5169Center for Psychological Development and Service, Hunan University of Chinese Medicine, Hunan 410208 Changsha, China
| | - Jie Fan
- grid.452708.c0000 0004 1803 0208Medical Psychological Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan 41000 China
| | - Ya Li
- grid.488482.a0000 0004 1765 5169School of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan 410208 China
| | - Fei Nie
- grid.431010.7Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013 China
| | - Lifeng Wang
- grid.431010.7Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013 China
| | - Qiuping Tang
- Department of Clinical Psychology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
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Luo B, Yang Y, Zhang D, Zhang Q, Liu Z, Wang S, Shi Y, Xia L, Wang J, Liu Z, Geng F, Chen C, Wen X, Luo X, Zhang K, Liu H. Sleep disorders mediate the link between childhood trauma and depression severity in children and adolescents with depression. Front Psychiatry 2022; 13:993284. [PMID: 36386989 PMCID: PMC9664693 DOI: 10.3389/fpsyt.2022.993284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood trauma is closely related to the onset of depression and more severe depressive symptoms; however, the specific mechanisms are unclear. We aimed to examine the relationship between childhood trauma and sleep disorders in children and adolescents with depression and to explore further the role of sleep disorders in the relationship between childhood trauma and depression severity. METHODS A total of 285 children and adolescents with depression completed all scale assessments, including the Childhood Trauma Questionnaire, Self-Reported Insomnia Severity Index and Epworth Sleepiness Scale, and the Center for Epidemiologic Studies Depression Scale. A simple mediation model was used as a theoretical model to examine whether sleep disorders could mediate the relationship between childhood trauma and depression severity. RESULTS Among children and adolescents with depression, childhood trauma is about 78.9%. Compared with patients without childhood trauma, patients with childhood trauma had a higher incidence of sleep disorders (Z = 17.59, P < 0.001), which were characterized by insomnia (Z = 14.45, P < 0.001), not hypersomnia (Z = 2.77, P = 0.096). Different childhood trauma subtypes significantly affected sleep disorders and insomnia (all P < 0.05). Insomnia partially mediated the relationship between childhood trauma and depression severity, and the mediating effect accounted for 35.90%. CONCLUSION This study found a high rate of concurrent childhood trauma and insomnia among children and adolescents with depression. Insomnia, as a mediator between childhood trauma and depression severity, partially mediates the relationship.
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Affiliation(s)
- Bei Luo
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
| | - Yingying Yang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
| | - Dapeng Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, Fuyang Third People's Hospital, Fuyang, China
| | - Qing Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
| | - Zhichun Liu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
| | - Song Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
| | - Yudong Shi
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
| | - Lei Xia
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
| | - Jiawei Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, Bozhou People's Hospital, Bozhou, China
| | - Zhiwei Liu
- Department of Psychiatry, Fuyang Third People's Hospital, Fuyang, China
| | - Feng Geng
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, China
| | - Changhao Chen
- Department of Psychiatry, Suzhou Second People's Hospital, Suzhou, China
| | - Xiangwang Wen
- Department of Psychiatry, Ma'anshan Fourth People's Hospital, Maanshan, China
| | - Xiangfen Luo
- Department of Psychiatry, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Kai Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Hefei, China
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12
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Lee JY, Stewart R, Kang HJ, Kim JW, Jhon M, Kim SW, Shin IS, Kim JM. Childhood Abuse, Social Support, and Long-Term Pharmacological Treatment Outcomes in Patients With Depressive Disorders. Front Psychiatry 2022; 13:803639. [PMID: 35185652 PMCID: PMC8847738 DOI: 10.3389/fpsyt.2022.803639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study was performed to investigate the roles of childhood abuse and social support in predicting short- and long-term pharmacological treatment outcomes in outpatients with depressive disorders in a naturalistic 1-year prospective design. METHODS Patients were recruited at a university hospital in South Korea between March 2012 and April 2017. Subjects with stepwise pharmacotherapy (switching, augmentation, combination, and mixture of these approaches) included 1246 patients at 12-week points in the acute treatment response and 1,015 patients at 12-months in the long-term treatment response. Remission was defined as Hamilton Depression Rating Scale score ≤ 7. Exposure to three types of childhood abuse (physical, emotional, and sexual) before the age of 16 and perceived social support were assessed at baseline. RESULTS Individual associations of childhood abuse were associated with poorer treatment outcomes in the 12-month long-term phase, and no significant individual associations were found for social support level with any period outcome. In combination, any child abuse, emotional abuse, and physical abuse were significantly associated with long-term 12-month remission rate in the presence of higher level of social support after adjustment with significant interaction terms. However, no significant interactions were found with sexual abuse. CONCLUSION Synergistic interactive effects of child abuse and social support levels on treatment outcomes in depressive patients were found during long-term pharmacotherapy. Thus, depressed patients with a history of childhood abuse may require specialized clinical approaches, including social support, to enhance the long-term treatment outcomes.
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Affiliation(s)
- Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
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13
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Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR, Ruggero CJ, Simms LJ, Widiger TA, Achenbach TM, Bach B, Bagby RM, Bornovalova MA, Carpenter WT, Chmielewski M, Cicero DC, Clark LA, Conway C, DeClercq B, DeYoung CG, Docherty AR, Drislane LE, First MB, Forbush KT, Hallquist M, Haltigan JD, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Miller JD, Morey LC, Mullins-Sweatt SN, Ormel J, Patalay P, Patrick CJ, Pincus AL, Regier DA, Reininghaus U, Rescorla LA, Samuel DB, Sellbom M, Shackman AJ, Skodol A, Slade T, South SC, Sunderland M, Tackett JL, Venables NC, Waldman ID, Waszczuk MA, Waugh MH, Wright AG, Zald DH, Zimmermann J. Les progrès dans la réalisation de la classification quantitative de la psychopathologie ☆. ANNALES MEDICO-PSYCHOLOGIQUES 2021; 179:95-106. [PMID: 34305151 PMCID: PMC8309948 DOI: 10.1016/j.amp.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
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Affiliation(s)
- Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Miriam K. Forbes
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nicholas R. Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Camilo J. Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Leonard J. Simms
- Department of Psychology, University at Buffalo, State University of New York, New York, NY, USA
| | - Thomas A. Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - R. Michael Bagby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | | | - David C. Cicero
- Department of Psychology, University of Hawaii, Honolulu, HI, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Christopher Conway
- Department of Psychology, College of William and Mary, Williamsburg, VA, USA
| | - Barbara DeClercq
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Colin G. DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Anna R. Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Laura E. Drislane
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Michael B. First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Michael Hallquist
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - John D. Haltigan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Masha Y. Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Robert D. Latzman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Joshua D. Miller
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Leslie C. Morey
- Department of Psychology, Texas A&M University, College Station, TX, USA
| | | | - Johan Ormel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | | | - Aaron L. Pincus
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Darrel A. Regier
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Ulrich Reininghaus
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Douglas B. Samuel
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Andrew Skodol
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Susan C. South
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | | | - Noah C. Venables
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Mark H. Waugh
- Oak Ridge National Laboratory, University of Tennessee, Oak Ridge, TN, USA
| | - Aidan G.C. Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David H. Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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14
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Silver J, Olino TM, Carlson GA, Klein DN. Offspring of Mothers With Histories of Chronic and Non-chronic Depression: Symptom Trajectories From Ages 6 to 15. Front Psychiatry 2020; 11:601779. [PMID: 33329155 PMCID: PMC7710605 DOI: 10.3389/fpsyt.2020.601779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022] Open
Abstract
Several studies have reported that individuals with chronic depression have higher rates of depressive disorders, and particularly chronic depression, in their first-degree relatives, compared to those with non-chronic (episodic) major depression. In addition, a few studies have suggested that offspring of parents with chronic depression have elevated rates of depression and other psychopathology. Most of this work uses the Diagnostic and Statistical Manual of Mental Disorders (DSM), which defines chronicity as persistence for at least 2 years. An alternative is a life-course, approach, which evaluates overall course since first onset. We examined the trajectories of depressive, anxiety, and externalizing symptoms in a community sample of 577 offspring of mothers with histories of chronic depression, non-chronic (or episodic) major depression, and no depression using prospective, multi-informant assessments from age 6 to age 15. Offspring of mothers with a history of depression exhibited higher levels of depression, anxiety, and externalizing symptoms than offspring of mothers who were never depressed. Moreover, the effects of maternal depression on offspring depression, anxiety, and externalizing symptoms were more pronounced for mothers with histories of chronic than non-chronic depression, particularly when the life-course approach to classifying chronicity was used. These data suggest that research that combines chronic and non-chronic depressions includes significant heterogeneity that may hinder understanding of etiology and reduce the likelihood of developing a cumulative and replicable literature. In addition, these findings have significant implications for prevention and treatment.
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Affiliation(s)
- Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Thomas M. Olino
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Gabrielle A. Carlson
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, United States
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
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15
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Miller KJ, Areerob P, Hennessy D, Gonçalves-Bradley DC, Mesagno C, Grace F. Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. F1000Res 2020; 9:1325. [PMID: 34158928 PMCID: PMC8191520 DOI: 10.12688/f1000research.27123.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12
th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis (
n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’
g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’
g = -0.06,
PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’
g = -0.12,
PrI = -0.95, 0.72), mind-body versus resistance (Hedges’
g = -0.06,
PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO
CRD42018115866 (23/11/2018).
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Affiliation(s)
- Kyle J Miller
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Pinyadapat Areerob
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Declan Hennessy
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | | | - Christopher Mesagno
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Fergal Grace
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
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16
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Miller KJ, Areerob P, Hennessy D, Gonçalves-Bradley DC, Mesagno C, Grace F. Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. F1000Res 2020; 9:1325. [PMID: 34158928 PMCID: PMC8191520 DOI: 10.12688/f1000research.27123.1] [Citation(s) in RCA: 12] [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] [Accepted: 07/08/2021] [Indexed: 08/29/2023] Open
Abstract
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges' g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges' g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges' g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges' g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO CRD42018115866 (23/11/2018).
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Affiliation(s)
- Kyle J. Miller
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Pinyadapat Areerob
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Declan Hennessy
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | | | - Christopher Mesagno
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Fergal Grace
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
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17
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Schramm E, Klein DN, Elsaesser M, Furukawa TA, Domschke K. Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. Lancet Psychiatry 2020; 7:801-812. [PMID: 32828168 DOI: 10.1016/s2215-0366(20)30099-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/11/2020] [Accepted: 02/26/2020] [Indexed: 01/04/2023]
Abstract
Persistent depressive disorder is a chronic mood disorder that is common and often more disabling than episodic major depression. In DSM-5, the term subsumes several chronic depressive presentations, including dysthymia with or without superimposed major depressive episodes, chronic major depression, and recurrent major depression without recovery between episodes. Dysthymia can be difficult to detect in psychiatric and primary care settings until it intensifies in the form of a superimposed major depressive episode. Although information is scarce concerning the cause of persistent depressive disorder including dysthymia, the causation is likely to be multifactorial. In this narrative Review, we discuss current knowledge about the nosology and neurobiological basis of dysthymia and persistent depressive disorder, emphasising a dimensional perspective based on course for further research. We also review new developments in psychotherapy and pharmacotherapy for persistent depressive disorder, and propose a tailored, modular approach to accommodate its multifaceted nature.
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Affiliation(s)
- Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Daniel N Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Moritz Elsaesser
- Department of Psychiatry and Psychotherapy, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Woodhead E, Cronkite R, Finlay A, Wong J, Haverfield M, Timko C. The role of depression course on life functioning and coping outcomes from baseline through 23-year follow-up. J Ment Health 2020; 31:348-356. [PMID: 32667276 DOI: 10.1080/09638237.2020.1793127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although studies have examined how depressed patients' baseline characteristics predict depression course, still needed are studies of how depression course is associated with modifiable long-term outcomes. AIMS This study examined six outcomes of three groups representing distinct depression courses (low baseline severity, rapid decline; moderate baseline severity, rapid decline; and high baseline severity, slow decline): medical functioning, coping patterns, family functioning, social functioning, employment, and work functioning. METHOD Adults with depression at baseline (N = 382; 56% women) were followed for 23 years on self-reported outcomes (79% response rate). Data from the baseline assessment and follow-ups (1, 4, 10, and 23 years) were used in a longitudinal analysis to examine associations between depression course and outcomes. RESULTS All depression course groups declined on medical and social functioning and employment over follow-up. The high- and moderate-severity depression course groups reported poorer coping patterns than the low-severity group. The high-severity depression course group reported poorer family functioning than the moderate-severity group, and had the poorest work functioning outcome, followed by the moderate-severity and then the low-severity groups. CONCLUSIONS Patients with a high- or moderate-severity depression course may benefit from treatment that manages coping patterns and improves family and work functioning.
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Affiliation(s)
- Erin Woodhead
- Psychology Department, San José State University, San Jose, CA, USA
| | - Ruth Cronkite
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.,Department of Sociology, Stanford University, Stanford, CA, USA
| | - Andrea Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, USA
| | - Jessie Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Marie Haverfield
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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19
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Humphreys KL, LeMoult J, Wear JG, Piersiak HA, Lee A, Gotlib IH. Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. CHILD ABUSE & NEGLECT 2020; 102:104361. [PMID: 32062423 PMCID: PMC7081433 DOI: 10.1016/j.chiabu.2020.104361] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature. OBJECTIVE We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores. PARTICIPANTS AND SETTING 192 unique samples consisting of 68,830 individuals. METHODS We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis. RESULTS We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations. CONCLUSIONS These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.
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Affiliation(s)
| | | | - John G Wear
- Western University of Health Sciences, United States
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20
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Waszczuk MA, Eaton NR, Krueger RF, Shackman AJ, Waldman ID, Zald DH, Lahey BB, Patrick CJ, Conway CC, Ormel J, Hyman SE, Fried EI, Forbes MK, Docherty AR, Althoff RR, Bach B, Chmielewski M, DeYoung CG, Forbush KT, Hallquist M, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Mullins-Sweatt SN, Pincus AL, Reininghaus U, South SC, Tackett JL, Watson D, Wright AGC, Kotov R. Redefining phenotypes to advance psychiatric genetics: Implications from hierarchical taxonomy of psychopathology. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:143-161. [PMID: 31804095 PMCID: PMC6980897 DOI: 10.1037/abn0000486] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Genetic discovery in psychiatry and clinical psychology is hindered by suboptimal phenotypic definitions. We argue that the hierarchical, dimensional, and data-driven classification system proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium provides a more effective approach to identifying genes that underlie mental disorders, and to studying psychiatric etiology, than current diagnostic categories. Specifically, genes are expected to operate at different levels of the HiTOP hierarchy, with some highly pleiotropic genes influencing higher order psychopathology (e.g., the general factor), whereas other genes conferring more specific risk for individual spectra (e.g., internalizing), subfactors (e.g., fear disorders), or narrow symptoms (e.g., mood instability). We propose that the HiTOP model aligns well with the current understanding of the higher order genetic structure of psychopathology that has emerged from a large body of family and twin studies. We also discuss the convergence between the HiTOP model and findings from recent molecular studies of psychopathology indicating broad genetic pleiotropy, such as cross-disorder SNP-based shared genetic covariance and polygenic risk scores, and we highlight molecular genetic studies that have successfully redefined phenotypes to enhance precision and statistical power. Finally, we suggest how to integrate a HiTOP approach into future molecular genetic research, including quantitative and hierarchical assessment tools for future data-collection and recommendations concerning phenotypic analyses. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bo Bach
- Centre of Excellence on Personality Disorder
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21
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Abstract
Childhood trauma has been shown to have detrimental consequences on mental health. It is unknown what impact childhood trauma may have on the early trajectory of serious mental illness (SMI). The purpose of this article is to estimate the baseline prevalence, perceived impact, and duration of trauma that occurred before the age of 18 years in youth at risk for SMI using a transdiagnostic approach. This study included 243 youths, ages 12 to 25 years (42 healthy controls, 43 non-help-seeking individuals [stage 0], 52 help-seeking youth experiencing distress and possibly mild symptoms of anxiety or depression [stage1a], and 108 youth demonstrating attenuated symptoms of an SMI such as bipolar disorder or psychosis [stage 1b]). Participants completed an adapted version of the Childhood Trauma and Abuse scale. There were high frequencies of reported trauma across all stages. Symptomatic individuals experienced more trauma and bullying. Stage 1b individuals reported more physical abuse. Stage 1b also indicated psychological bullying to have a longer duration and impact on their lives. Future work should aim to clarify the complex interrelations between trauma and risk of SMI.
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22
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Zagorscak P, Heinrich M, Bohn J, Stein J, Knaevelsrud C. How individuals change during internet-based interventions for depression: A randomized controlled trial comparing standardized and individualized feedback. Brain Behav 2020; 10:e01484. [PMID: 31777204 PMCID: PMC6955845 DOI: 10.1002/brb3.1484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/26/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Standardized and individualized Internet-based interventions (IBI) for depression yield significant symptom improvements. However, change patterns during standardized or individualized IBI are unknown. Identifying subgroups that experience different symptom courses during IBI and their characteristics is vital for improving response. METHODS Mildly to moderately depressed individuals according to self-report (N = 1,089) were randomized to receive module-wise feedback that was either standardized or individualized by a counselor within an otherwise identical cognitive-behavioral IBI for depression (seven modules over six weeks). Depressive symptoms were assessed at baseline and before each module (Patient Health Questionnaire; PHQ-9). Other individual characteristics (self-report) and the presence of an affective disorder (structured clinical interview) were assessed at baseline. Growth mixture modeling was used to identify and compare subgroups with discernable change patterns and associated client variables across conditions. RESULTS Model comparisons suggest equal change patterns in both conditions. Across conditions, a group of immediate (62.5%) and a group of delayed improvers (37.5%) were identified. Immediate improvers decreased their PHQ-9 score by 5.5 points from pre to post, with 33% of improvement occurring before treatment commenced. Delayed improvers were characterized by stable symptom severity during the first two modules and smaller overall symptom decrease (3.4 points). Higher treatment expectations, a current major depressive disorder (interview), and lower social support were associated with delayed improvement. CONCLUSION Internet-based interventions for depression with individualized and with standardized feedback lead to comparable patterns of change. Expectation management and bolstering of social support are promising strategies for individuals that are at risk for delayed improvement.
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Affiliation(s)
- Pavle Zagorscak
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Manuel Heinrich
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Johannes Bohn
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Jana Stein
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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23
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Klein DN. Persistent Depressive Disorder: Commentary on Parker and Malhi. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:16-18. [PMID: 31242755 PMCID: PMC6966258 DOI: 10.1177/0706743719860823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Daniel N Klein
- Departments of Psychology and Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, New York, USA
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24
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Simon M, Németh N, Gálber M, Lakner E, Csernela E, Tényi T, Czéh B. Childhood Adversity Impairs Theory of Mind Abilities in Adult Patients With Major Depressive Disorder. Front Psychiatry 2019; 10:867. [PMID: 31920739 PMCID: PMC6928114 DOI: 10.3389/fpsyt.2019.00867] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/04/2019] [Indexed: 02/01/2023] Open
Abstract
Background: Patients with major depressive disorder (MDD) have various theory of mind (ToM) impairments which often predict a poor outcome. However, findings on ToM deficits in MDD are inconsistent and suggest the role of moderating factors. Child abuse and neglect are strong predictors of adult MDD and are often associated with a poorer clinical course trajectory. Objective: Because early-life adversities result in various forms of ToM deficits in clinical and nonclinical samples, our aim was to investigate if they are significant confounding factors of ToM impairments in MDD. Methods: We investigated 60 mildly or moderately depressed, nonpsychotic adult patients with MDD during an acute episode, and 32 matched healthy controls. The mental state decoding subdomain of ToM was examined with the Reading the Mind in the Eyes Test (RMET). Childhood adversities were assessed with the childhood trauma questionnaire (CTQ) and the early trauma inventory. Results: There was no difference between the control and MDD groups in RMET performance. However, when we divided the MDD group into two subgroups, one (N = 30) with high and the other (N = 30) with low levels of childhood adversities, a significant difference emerged between the controls and the highly maltreated MDD subgroup in RMET performance. A series of 3 (group) × 3 (valence) mixed-model analyses of covariance (ANCOVAs) revealed that childhood emotional and physical neglect had a significant negative impact on the response accuracy in RMET in general, whereas emotional abuse specifically interfered with the accuracy in the positive and negative valences if it co-occurred with early-life neglect. To test the dose-response relationship between the number of childhood adversities and RMET capacities, we subjected RMET data of the MDD group to multiple hierarchical regressions: the number of childhood adversities was a significant predictor of RMET total scores and RMET scores in the negative valence after controlling for age, sex, years of education, and the severity of current depression. Conclusion: Childhood adversities impair ToM capacities in MDD. Exposure to early-life emotional abuse and neglect have a negative impact on the performance in the emotional valences of RMET. Multiple early-life adversities have a dose-dependent association with mental state decoding deficits.
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Affiliation(s)
- Maria Simon
- Neurobiology of Stress Research Group, János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Nándor Németh
- Neurobiology of Stress Research Group, János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Mónika Gálber
- Neurobiology of Stress Research Group, János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Elza Lakner
- Neurobiology of Stress Research Group, János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Eszter Csernela
- Neurobiology of Stress Research Group, János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Tamás Tényi
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- Department of Laboratory Medicine, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
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25
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Fleury MJ, Delorme A, Benigeri M, Vanasse A. Utilisation et enjeux des données clinico-administratives dans le domaine de la santé
mentale et de la dépendance. SANTE MENTALE AU QUEBEC 2019. [DOI: 10.7202/1058608ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Les banques de données clinico-administratives sont des outils clés pour la prise
de décision publique en santé. Pour soutenir la gestion des services, plusieurs banques sont
disponibles s’intéressant aux besoins des populations et aux ressources disponibles, tout en
intégrant des indicateurs de performance. Depuis les années 2000, des efforts considérables
ont été menés afin de consolider les données et développer des outils visant à mieux
surveiller l’état de santé des populations ou la performance du système sociosanitaire. Dans
le cadre du congrès annuel de l’Association francophone pour le savoir (ACFAS), qui s’est
tenu à l’Université McGill en 2017, un colloque a été organisé pour débattre de leur
exploitation en santé mentale et en dépendance. Le colloque a intégré une discussion
d’experts qui se sont entretenus afin d’identifier les principales banques
clinico-administratives, l’ampleur de leur utilisation, leurs limites et les solutions à
développer pour les optimiser afin de mieux soutenir la gestion des services. Cet article
vise à résumer le contenu de ces discussions. Bien que les banques comportent des forces
importantes, dont un potentiel élevé de généralisation de l’information, elles présentent
des limites se rapportant surtout à leur capacité à répondre aux besoins, à des enjeux de
qualité et de validation, ainsi que d’accessibilité. Diverses recommandations ont été émises
pour améliorer leur gestion et optimiser leur impact, dont leur conservation et traitement
dans un organisme autonome et hautement accessible, et un changement sociétal de culture
favorisant l’évaluation de la performance afin d’améliorer les pratiques et de mieux
monitorer les résultats de santé.
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Affiliation(s)
- Marie-Josée Fleury
- Département de psychiatrie, Université McGill, QC, Canada
- Institut universitaire en santé mentale Douglas, QC, Canada
| | - André Delorme
- Direction générale des services de santé mentale et de psychiatrie légale,
ministère de la Santé et des Services sociaux (MSSS), QC, Canada
| | - Mike Benigeri
- Organisations publiques, consultations : gestion et exploitation des données
clinico-administratives, QC, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d’urgence, Université de
Sherbrooke, QC, Canada
- Direction scientifique, Unité de soutien à la stratégie de recherche axée sur le
patient (SRAP) du Québec, QC, Canada
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26
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Bowyer CB, Joyner KJ, Yancey JR, Venables NC, Hajcak G, Patrick CJ. Toward a neurobehavioral trait conceptualization of depression proneness. Psychophysiology 2019; 56:e13367. [DOI: 10.1111/psyp.13367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 01/22/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Colin B. Bowyer
- Department of Psychology Florida State University Tallahassee Florida
| | - Keanan J. Joyner
- Department of Psychology Florida State University Tallahassee Florida
| | - James R. Yancey
- Department of Psychology Florida State University Tallahassee Florida
| | - Noah C. Venables
- Department of Psychiatry University of Minnesota Minneapolis Minnesota
| | - Greg Hajcak
- Department of Psychology Florida State University Tallahassee Florida
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27
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Fisher SD, Sit DK, Yang A, Ciolino JD, Gollan JK, Wisner KL. Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms. Depress Anxiety 2019; 36:375-383. [PMID: 30645006 PMCID: PMC6494079 DOI: 10.1002/da.22879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Postpartum depression is a heterogeneous disorder in phenotype and etiology. Characterizing the longitudinal course of depressive symptoms over the first year after birth and identifying variables that predict distinct symptom trajectories will expedite efficient mental health treatment planning. The purpose was to determine 12-month trajectories of postpartum depressive symptoms, identify characteristics that predict the trajectories, and provide a computational algorithm that predicts trajectory membership. METHODS A prospective cohort of women delivering at an academic medical center (2006-2011) was recruited from an urban women's hospital in Pittsburgh, PA. Women with a postpartum depressive disorder (n = 507) participated and completed symptom severity assessments at 4-8 weeks (intake), 3 months, 6 months, and 12 months. Women were predominantly Caucasian (71.8%), married (53.3%), and college educated (38.7%). Clinician interviews of depressive symptom severity, medical and psychiatric history, assessment of function, obstetric experience, and infant status were conducted. RESULTS Analyses resulted in identification of three distinct trajectories of depressive symptoms: (1) gradual remission (50.4%), (2) partial improvement (41.8%), and (3) chronic severe (7.8%). Key predictive characteristics of the chronic severe versus gradual remission and partial improvement trajectories included parity, education, and baseline global functioning and depression severity. We were able to predict trajectory membership with 72.8% accuracy from these characteristics. CONCLUSIONS Four maternal characteristics predicted membership in the chronic severe versus gradual remission and partial improvement trajectories with 72.8% accuracy. The trajectory groups comprise clinically relevant subgroups with the potential for tailored treatments to reduce the disease burden of postpartum depression.
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Affiliation(s)
- Sheehan D. Fisher
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine, 676 North St Clair Street,
Suite 1000, Chicago, IL, 60611 USA
| | - Dorothy K. Sit
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine, 676 North St Clair Street,
Suite 1000, Chicago, IL, 60611 USA
| | - Amy Yang
- Department of Preventive Medicine-Biostatistics,
Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite
1400, Chicago IL 60611, USA
| | - Jody D. Ciolino
- Department of Preventive Medicine-Biostatistics,
Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite
1400, Chicago IL 60611, USA
| | - Jackie K. Gollan
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine, 676 North St Clair Street,
Suite 1000, Chicago, IL, 60611 USA
| | - Katherine L. Wisner
- Department of Psychiatry and Behavioral Sciences,
Northwestern University Feinberg School of Medicine, 676 North St Clair Street,
Suite 1000, Chicago, IL, 60611 USA
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28
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Fleury MJ, Fortin M, Rochette L, Grenier G, Huỳnh C, Pelletier É, Vasiliadis HM. Assessing quality indicators related to mental health emergency room utilization. BMC Emerg Med 2019; 19:8. [PMID: 30646847 PMCID: PMC6332534 DOI: 10.1186/s12873-019-0223-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/04/2019] [Indexed: 01/13/2023] Open
Abstract
Background This descriptive study compared 2014–15 to 2005–06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI). Methods Data emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014–15; 817,395 for 2005–06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization. Variables included: access (ER use/frequency, hospitalization rates, outpatient consultations preceding an ER visit), care continuity (outpatient consultations following an ER visit/hospitalization, consecutive returns to the ERs), and care appropriateness (high ER use, recurrence of yearly ER visits, length of hospitalization). Frequency distributions were calculated on sex, age and geographic area for ER visits/hospitalizations in 2014–15, and between 2014 and 15 and 2005–06. Results PMI accounted for 12 % of the Quebec population in 2014–15 (n = 865,255), of whom 39% visited an ER for any reason. Amount and frequency of ER use and number/length of hospitalizations were almost twice as high for PMI versus patients without MI; 17% of PMI were also high/very high ER users and were frequently hospitalized. Among PMI, ER users were also frequent users of outpatient services despite a lack of follow-up appointments after ER visits or hospitalizations. Findings revealed some positive changes over time, such as decreased ER and hospitalization rates; yet overall access, continuity and appropriateness of care, as measured in this study, remained low. Conclusions This study demonstrated that the Quebec reform did not produce a substantial impact on ER use or substantially improved care, as hypothesized. Better access and continuity of care should be promoted to reduce the high prevalence of ER use among PMI. Quality improvement in MHS may be realized if ERs are supported by substantial and well-integrated community MH networks.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Marilyn Fortin
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Louis Rochette
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Christophe Huỳnh
- Centre de recherche et d'expertise en dépendance, Montréal, QC, Canada.,Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
| | - Éric Pelletier
- Quebec National Institute of Public Health, Quebec, QC, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaires, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche de l'hôpital Charles LeMoyne, Longueuil, QC, Canada
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29
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Hung CI, Liu CY, Yang CH. Persistent depressive disorder has long-term negative impacts on depression, anxiety, and somatic symptoms at 10-year follow-up among patients with major depressive disorder. J Affect Disord 2019; 243:255-261. [PMID: 30248637 DOI: 10.1016/j.jad.2018.09.068] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/09/2018] [Accepted: 09/16/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The study aimed to investigate the impacts of persistent depressive disorder (PDD) and pharmacotherapy on depression, anxiety, and somatic symptoms among patients with major depressive disorder (MDD) over a ten-year period. METHODS 290 outpatients with MDD were enrolled, including 117 with PDD, at baseline. Subjects were followed-up at six-month, two-year, and 10-year points. MDD and dysthymic disorder were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The Hamilton Depression Rating Scale, the Hospital Anxiety and Depression Scale, and the Depression and Somatic Symptoms Scale were used. Generalized Estimating Equation models were used to investigate the impacts. RESULTS MDD patients with PDD had greater severities of depression, anxiety, and somatic symptoms at the three follow-up points as compared with those without; however, these results were of statistical significance only in patients without pharmacotherapy. MDD patients with PDD had a longer duration of pharmacotherapy and a lower remission rate as compared with those without. After controlling for depression and anxiety at baseline, PDD was independently associated with more severe depression, anxiety, and somatic symptoms. LIMITATION At the ten-year follow-up, approximately half of the subjects were lost to follow-up; this, in addition to the unequal follow-up intervals, might have caused bias. CONCLUSIONS Among the patients, PDD continued to have negative impacts on depression, anxiety, and somatic symptoms over the subsequent ten years. Differences in symptomatology between the patients with and without PDD were statistically insignificant when pharmacotherapy was utilized; however, pharmacotherapy did not fully compensate for the negative impacts of PDD.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, Tao-Yuan, Taiwan.
| | - Chia-Yih Liu
- Department of Psychiatry, Chang-Gung Memorial Hospital at Linkou and Chang-Gung University College of Medicine, Tao-Yuan, Taiwan
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30
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Rief W, Bleichhardt G, Dannehl K, Euteneuer F, Wambach K. Comparing the Efficacy of CBASP with Two Versions of CBT for Depression in a Routine Care Center: A Randomized Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:164-178. [PMID: 29649805 DOI: 10.1159/000487893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/20/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The cognitive-behavioral analysis system of psychotherapy (CBASP) was developed for the treatment of chronic, early-onset depression. However, it is unclear whether this approach can be recommended for depression in general (episodic and chronic), and no direct comparisons between CBASP with different versions of cognitive-behavioral therapy (CBT) exist. METHODS A randomized controlled trial compared 3 treatment conditions (all lasting 16 sessions) with a waiting list group (WL): CBASP, CBT with a focus on physical exercise (CBT-E), and CBT with a focus on pleasurable, low-energy and mindful activities (CBT-M). We included 173 patients and involved 41 therapists. Assessments were at baseline, after session 8, and at the end of treatment. RESULTS Our primary outcome Beck Depression Inventory-II indicated a general advantage of the CBT arms compared to CBASP [F(6, 154.5) = 4.2, p = 0.001], with significant contrasts in particular in favor of CBT-E. Effect sizes against WL were d = 0.91 (CBT-E), 0.87 (CBT-M), and 0.47 (CBASP). A triple interaction with an additional factor "chronic versus episodic depression" [F(6, 142.7) = 2.2, p = 0.048] indicated that the treatments resulted in different outcomes, with best results again for CBT-E in particular in episodic depression. Responder rates indicated significant improvements (56% in both CBT arms, 34% in the CBASP arm, 3.4% in WL; intention-to-treat samples). As compared to CBASP, response rates were significantly higher for CBT-E (OR = 2.48; 95% CI = 1.02-6.00) and CBT-M (OR = 2.46; 95% CI = 1.01-6.01). CONCLUSIONS CBASP was more effective than WL, but less effective than the 2 CBT arms. This was mainly caused by an advantage of CBT interventions in episodic depression.
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31
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Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR, Ruggero CJ, Simms LJ, Widiger TA, Achenbach TM, Bach B, Bagby RM, Bornovalova MA, Carpenter WT, Chmielewski M, Cicero DC, Clark LA, Conway C, DeClercq B, DeYoung CG, Docherty AR, Drislane LE, First MB, Forbush KT, Hallquist M, Haltigan JD, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Miller JD, Morey LC, Mullins-Sweatt SN, Ormel J, Patalay P, Patrick CJ, Pincus AL, Regier DA, Reininghaus U, Rescorla LA, Samuel DB, Sellbom M, Shackman AJ, Skodol A, Slade T, South SC, Sunderland M, Tackett JL, Venables NC, Waldman ID, Waszczuk MA, Waugh MH, Wright AGC, Zald DH, Zimmermann J. Progress in achieving quantitative classification of psychopathology. World Psychiatry 2018; 17:282-293. [PMID: 30229571 PMCID: PMC6172695 DOI: 10.1002/wps.20566] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022] Open
Abstract
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
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Affiliation(s)
- Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Miriam K Forbes
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, State University of New York, New York, NY, USA
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - R Michael Bagby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | | | - David C Cicero
- Department of Psychology, University of Hawaii, Honolulu, HI, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Christopher Conway
- Department of Psychology, College of William and Mary, Williamsburg, VA, USA
| | - Barbara DeClercq
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Anna R Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Laura E Drislane
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Michael Hallquist
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - John D Haltigan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Masha Y Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Katherine G Jonas
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Robert D Latzman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Joshua D Miller
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Leslie C Morey
- Department of Psychology, Texas A&M University, College Station, TX, USA
| | | | - Johan Ormel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Aaron L Pincus
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Darrel A Regier
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Ulrich Reininghaus
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Douglas B Samuel
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Andrew Skodol
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Susan C South
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | | | - Noah C Venables
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Irwin D Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Mark H Waugh
- Oak Ridge National Laboratory, University of Tennessee, Oak Ridge, TN, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David H Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Verduijn J, Verhoeven JE, Milaneschi Y, Schoevers RA, van Hemert AM, Beekman ATF, Penninx BWJH. Reconsidering the prognosis of major depressive disorder across diagnostic boundaries: full recovery is the exception rather than the rule. BMC Med 2017; 15:215. [PMID: 29228943 PMCID: PMC5725897 DOI: 10.1186/s12916-017-0972-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/08/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is often handled as an episodic and isolated disorder, resulting in an optimistic view about its prognosis. Herein, we test the idea that the prognosis of MDD changes if we vary the perspective in terms of (1) a longer time frame and (2) a broader diagnostic conceptualisation including dysthymia, (hypo)mania and anxiety disorders as relevant outcomes. METHODS Patients with current MDD at baseline (n = 903) and available 2-, 4-, and/or 6-year follow-up assessments were selected from the Netherlands Study of Depression and Anxiety, a psychiatric cohort study. Combining psychiatric DSM-IV-based diagnoses and life-chart data, patient course trajectories were classified as (1) recovered (no diagnoses at 2-year follow-up or thereafter), (2) recurrent without chronic episodes, (3) recurrent with chronic episodes or (4) consistently chronic since baseline. A chronic episode was defined as having a current diagnosis at the follow-up assessment and consistent symptoms over 2 years. Proportions of course trajectories were provided moving from a short, narrow perspective (2-year follow-up, considering only MDD diagnosis) to a long, broad perspective (6-year follow-up, including MDD, dysthymia, (hypo)mania and anxiety diagnoses). RESULTS With the short, narrow perspective, the recovery rate was 58% and 21% had a chronic episode. However, in the long, broad perspective the recovery rate was reduced to 17%, while 55% of the patients experienced chronic episodes. CONCLUSIONS Results from a long and rigorous follow-up in a large cohort suggests that most MDD patients have an unfavourable prognosis. Longer follow-up and broader diagnostic conceptualisation show that the majority of patients have a disabling and chronic disorder. Conceptualising and handling MDD as a narrowly defined and episodic disorder may underestimate the prognosis of the majority of depressed patients and, consequently, the type of care that is appropriate.
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Affiliation(s)
- Judith Verduijn
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 74077, 1070 BB, Amsterdam, The Netherlands
| | - Josine E Verhoeven
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 74077, 1070 BB, Amsterdam, The Netherlands.
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 74077, 1070 BB, Amsterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 74077, 1070 BB, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 74077, 1070 BB, Amsterdam, The Netherlands
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Kotov R, Fochtmann L, Li K, Tanenberg-Karant M, Constantino EA, Rubinstein J, Perlman G, Velthorst E, Fett AKJ, Carlson G, Bromet EJ. Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project. Am J Psychiatry 2017; 174:1064-1074. [PMID: 28774193 PMCID: PMC5767161 DOI: 10.1176/appi.ajp.2017.16101191] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Kraepelin considered declining course a hallmark of schizophrenia, but others have suggested that outcomes usually stabilize or improve after treatment initiation. The authors investigated this question in an epidemiologically defined cohort with psychotic disorders followed for 20 years after first hospitalization. METHOD The Suffolk County Mental Health Project recruited first-admission patients with psychosis from all inpatient units of Suffolk County, New York (response rate, 72%). Participants were assessed in person six times over two decades; 373 completed the 20-year follow-up (68% of survivors); 175 had schizophrenia/schizoaffective disorder. Global Assessment of Functioning (GAF), psychotic symptoms, and mood symptoms were rated at each assessment. Month 6, when nearly all participants were discharged from the index hospitalization, was used as a reference. RESULTS In the schizophrenia group, mean GAF scores declined from 49 at month 6 to 36 at year 20. Negative and positive symptoms also worsened (Cohen's d values, 0.45-0.73). Among participants without schizophrenia, GAF scores were higher initially (a mean of approximately 64) but declined by 9 points over the follow-up period. Worsening began between years 5 and 8. Neither aging nor changes in antipsychotic treatment accounted for the declines. In all disorders, depression improved and manic symptoms remained low across the 20 years. CONCLUSIONS The authors found substantial symptom burden across disorders that increased with time and ultimately may undo initial treatment gains. Previous studies have suggested that better health care delivery models may preempt this decline. In the United States, these care needs are often not met, and addressing them is an urgent priority.
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Affiliation(s)
- Roman Kotov
- Department of Psychiatry, Stony Brook University
| | | | - Kaiqiao Li
- Department of Psychiatry, Stony Brook University
| | | | | | | | - Greg Perlman
- Department of Psychiatry, Stony Brook University
| | - Eva Velthorst
- Departments of Psychiatry and Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Anne-Kathrin J. Fett
- Department of Educational Neuroscience & Research Institute LEARN!, Faculty of Psychology and Education, VU University, Amsterdam, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
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Dogan E, Sander C, Wagner X, Hegerl U, Kohls E. Smartphone-Based Monitoring of Objective and Subjective Data in Affective Disorders: Where Are We and Where Are We Going? Systematic Review. J Med Internet Res 2017; 19:e262. [PMID: 28739561 PMCID: PMC5547249 DOI: 10.2196/jmir.7006] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/31/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Background Electronic mental health interventions for mood disorders have increased rapidly over the past decade, most recently in the form of various systems and apps that are delivered via smartphones. Objective We aim to provide an overview of studies on smartphone-based systems that combine subjective ratings with objectively measured data for longitudinal monitoring of patients with affective disorders. Specifically, we aim to examine current knowledge on: (1) the feasibility of, and adherence to, such systems; (2) the association of monitored data with mood status; and (3) the effects of monitoring on clinical outcomes. Methods We systematically searched PubMed, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials for relevant articles published in the last ten years (2007-2017) by applying Boolean search operators with an iterative combination of search terms, which was conducted in February 2017. Additional articles were identified via pearling, author correspondence, selected reference lists, and trial protocols. Results A total of 3463 unique records were identified. Twenty-nine studies met the inclusion criteria and were included in the review. The majority of articles represented feasibility studies (n=27); two articles reported results from one randomized controlled trial (RCT). In total, six different self-monitoring systems for affective disorders that used subjective mood ratings and objective measurements were included. These objective parameters included physiological data (heart rate variability), behavioral data (phone usage, physical activity, voice features), and context/environmental information (light exposure and location). The included articles contained results regarding feasibility of such systems in affective disorders, showed reasonable accuracy in predicting mood status and mood fluctuations based on the objectively monitored data, and reported observations about the impact of monitoring on clinical state and adherence of patients to the system usage. Conclusions The included observational studies and RCT substantiate the value of smartphone-based approaches for gathering long-term objective data (aside from self-ratings to monitor clinical symptoms) to predict changes in clinical states, and to investigate causal inferences about state changes in patients with affective disorders. Although promising, a much larger evidence-base is necessary to fully assess the potential and the risks of these approaches. Methodological limitations of the available studies (eg, small sample sizes, variations in the number of observations or monitoring duration, lack of RCT, and heterogeneity of methods) restrict the interpretability of the results. However, a number of study protocols stated ambitions to expand and intensify research in this emerging and promising field.
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Affiliation(s)
- Ezgi Dogan
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
| | - Christian Sander
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany.,Depression Research Centre, German Depression Foundation, Leipzig, Germany
| | - Xenija Wagner
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany.,Depression Research Centre, German Depression Foundation, Leipzig, Germany
| | - Elisabeth Kohls
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
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35
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Liu RT. Childhood Adversities and Depression in Adulthood: Current Findings and Future Directions. ACTA ACUST UNITED AC 2017; 24:140-153. [PMID: 28924333 DOI: 10.1111/cpsp.12190] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Considerable support exists supporting a relationship between childhood adversities and adult depression. Consistent evidence has emerged linking early life adversities with a more chronic course for depression, as well as to poorer treatment outcomes. What remain decidedly less clear, however, are the moderators and mediating mechanisms underlying this association. This article provides a review of the existing research relating early adversities to adult depression, as well as recent studies suggestive of potential mediators and moderators of this relation. Advances in these areas are important for their potential to lead to the identification of new targets for clinical intervention for adults with a history of childhood adversities, as well as to the development of individually tailored prevention and treatment strategies.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior Alpert Medical School of Brown University
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