Comorbid anxiety and depression: illumination of a controversy

The path of depression in rural children: A fuzzy-set qualitative comparative analysis across multiple provinces in China

OBJECTIVES

This study explores the combinations of conditional variables contributing to depressive symptoms in rural children.

METHODS

We analyzed data from 715 children from a rural mental health database, conducting detailed follow-up investigations on 129 children in Zhejiang and Henan provinces. We used fuzzy set Qualitative Comparative Analysis (fsQCA) and regression analysis to identify causal pathways leading to depression.

RESULTS

The results indicate that depression in rural children does not stem from a single, necessary condition but arises from multiple factors. Our findings highlight significant contributions from both maternal and paternal involvement. Specifically, maternal involvement, combined synergistically with peer support and problematic behaviors, as well as paternal involvement, together with peer support and anxiety, significantly affects depressive outcomes. Additionally, anxiety and strong peer relationships independently have a substantial impact on these outcomes. Effective mitigation strategies involve active parental engagement and robust peer support, reducing the influence of risk factors such as problematic behaviors and anxiety.

LIMITATIONS

The generalizability of the results is limited by cultural and geographical variations. The study also does not account for all potential factors influencing depression in rural children.

CONCLUSION

Depression in rural children results from multiple interacting factors. Tailored interventions addressing these specific combinations are recommended.

Depression and anxiety among Macau residents during the COVID-19 outbreak: A network analysis perspective

Background

The 2019 novel coronavirus disease (COVID-19) outbreak affected people's lifestyles and increased their risk for depressive and anxiety symptoms (depression and anxiety, respectively hereafter). We assessed depression and anxiety in residents of Macau during "the 6.18 COVID-19 outbreak" period and explored inter-connections of different symptoms from the perspective of network analysis.

Methods

In this cross-sectional study, 1,008 Macau residents completed an online survey comprising the nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder Scale (GAD-7) to measure depression and anxiety, respectively. Central and bridge symptoms of the depression-anxiety network model were evaluated based on Expected Influence (EI) statistics, while a bootstrap procedure was used to test the stability and accuracy of the network model.

Results

Descriptive analyses indicated the prevalence of depression was 62.5% [95% confidence interval (CI) = 59.47-65.44%], the prevalence of anxiety was 50.2% [95%CI = 47.12-53.28%], and 45.1% [95%CI = 42.09-48.22%] of participants experienced comorbid depression and anxiety. "Nervousness-Uncontrollable worry" (GADC) (EI = 1.15), "Irritability" (GAD6) (EI = 1.03), and "Excessive worry" (GAD3) (EI = 1.02) were the most central symptoms, while "Irritability" (GAD6) (bridge EI = 0.43), "restlessness" (GAD5) (bridge EI = 0.35), and "Sad Mood" (PHQ2) (bridge EI = 0.30) were key bridge symptoms that emerged in the network model.

Conclusion

Nearly half of residents in Macau experienced comorbid depression and anxiety during the 6.18 COVID-19 outbreak. Central and bridge symptoms identified in this network analysis are plausible, specific targets for treatment and prevention of comorbid depression and anxiety related to this outbreak.

Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials

LAY ABSTRACT

Nearly three out of four autistic people experience mental health problems such as stress, anxiety or depression. The research already done does not guide us on how best to prevent or treat mental health problems for autistic people. Our aim was to look at the benefits and harms of different interventions on mental health outcomes in autistic people. We searched all the published randomised controlled trials (RCTs) about interventions for mental health conditions in autistic people until 17 October 2020. We also searched for RCTs that were not published in peer-reviewed journals. These were obtained from registers of clinical trials online. We then combined the information from all these trials using advanced statistical methods to analyse how good the interventions are. Seventy-one studies (3630 participants) provided information for this research. The studies reported how participants were responding to the intervention for only a short period of time. The trials did not report which interventions worked for people with intellectual disability. In people without intellectual disability, some forms of cognitive behavioural therapy and mindfulness therapy may be helpful. However, further research is necessary. Many trials used medications to target core features of autism rather than targeting mental health conditions, but these medications did not help autistic people. Until we have more evidence, treatment of mental health conditions in autistic people should follow the evidence available for non-autistic people. We plan to widely disseminate the findings to healthcare professionals through medical journals and conferences and contact other groups representing autistic people.

Sex differences in amygdalohippocampal oscillations and neuronal activation in a rodent anxiety model and in response to infralimbic deep brain stimulation

Introduction

Depression and anxiety are highly comorbid mental disorders with marked sex differences. Both disorders show altered activity in the amygdala, hippocampus, and prefrontal cortex. Infralimbic deep brain stimulation (DBS-IL) has anxiolytic and antidepressant effects, but the underlying mechanisms remain unclear. We aimed to contribute to understanding sex differences in the neurobiology of these disorders.

Methods

In male and female rats, we recorded neural oscillations along the dorsoventral axis of the hippocampus and the amygdala in response to an anxiogenic drug, FG-7142. Following this, we applied DBS-IL.

Results

Surprisingly, in females, the anxiogenic drug failed to induce most of the changes observed in males. We found sex differences in slow, delta, theta, and beta oscillations, and the amygdalo-hippocampal communication in response to FG-7142, with modest changes in females. Females had a more prominent basal gamma, and the drug altered this band only in males. We also analyzed c-Fos expression in both sexes in stress-related structures in response to FG-7142, DBS-IL, and combined interventions. With the anxiogenic drug, females showed reduced expression in the nucleus incertus, amygdala, septohippocampal network, and neocortical levels. In both experiments, the DBS-IL reversed FG-7142-induced effects, with a more substantial effect in males than females.

Discussion

Here, we show a reduced response in female rats which contrasts with the higher prevalence of anxiety in women but is consistent with other studies in rodents. Our results open compelling questions about sex differences in the neurobiology of anxiety and depression and their study in animal models.

Clinical efficacy of Shugan granule in the treatment of mixed anxiety-depressive disorder: A multicenter, randomized, double-blind, placebo-controlled trial

ETHNOPHARMACOLOGICAL RELEVANCE

Shugan granule is derived from Xiaoyao powder, a traditional Chinese medicine that has been shown to be effective in treating emotional disorders. At present, there is no standard drug treatment for mixed anxiety-depressive disorder (MADD), and no evidence-based clinical trial has been performed for any drug, meaning MADD patients are unable to obtain standardized treatment.

AIM OF THE STUDY

The purpose of this clinical trial was to test the clinical efficacy and safety of Shugan granules in the treatment of MADD, and to provide clinical trial-based support along with drug recommendations for the treatment of MADD.

MATERIALS AND METHODS

A multicenter, randomized, double-blind, placebo-controlled study was conducted on 400 patients with MADD recruited from January 1, 2019 to December 31, 2020, and they were randomly divided into test and placebo groups with a 1:1 ratio. Subjects in the test group (n = 200) received oral administration of Shugan granules, while subjects in the placebo group (n = 200) received oral administration of a Shugan granule simulator. The treatment lasted for 8 weeks. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale-17 (HAMD-17), Clinical Global Impression Scale (CGIS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were used to evaluate efficacy. In addition, the traditional Chinese medicine (TCM) syndrome scale for MADD was developed to observe improvements of related symptoms in patients after treatment based on the disease guidelines of TCM and the clinical manifestations of depression. Furthermore, the safety of Shugan granules was evaluated during and after treatment.

RESULTS

After 8 weeks of treatment, the total scores for HAMA, HAMD, SAS, and SDS in the test group were significantly lower than those in the placebo group (P < 0.01). The proportion of patients with efficacy index (EI) > 1 for the CGIS score in the test group was significantly higher than that in the placebo group (P < 0.01). The efficacy of treatment in the test group based on the TCM syndrome scale was 70.16% and 88.27% after 4 weeks and 8 weeks, respectively, which was significantly higher than that in the placebo group (44.27% and 66.67% after 4 weeks and 8 weeks, respectively; P < 0.01). The disappearance rate of single symptoms in the test group was 20-30% higher than that in the placebo group, with a significant difference between groups (P < 0.05). During the treatment period, the incidence of adverse reactions was 2.05% in the test group and 2.06% in the placebo group, with no significant differences noted (P = 1.0000).

CONCLUSION

Shugan granule was more effective than placebo in the treatment of MADD. Moreover, there was no significant difference between the two groups in terms of safety. This paper provides a clinical therapeutic regime using Shugan granule for the treatment of MADD.

Assessment of Attentional Processes in Patients with Anxiety-Depressive Disorders Using Virtual Reality

To characterize the attention deficits in one-hundred-fifteen participants, comprising two types of clinical profiles (affective and anxiety disorder), through a test of continuous VR execution. Method: Three tests (i.e., Nesplora Aquarium, BDI, and STAI) were used to obtain a standardized measure of attention, as well as the existence and severity of depression and anxiety, respectively. Results: Significant differences (CI = 95%) were found between the control group and the group with depression, in variables related to the speed of visual processing (p = 0.008) in the absence of distractors (p = 0.041) and during the first dual execution task (p = 0.011). For scores related to sustained attention, patients with depression and those with anxiety did not differ from controls. Our results suggest attentional deficits in both clinical populations when performing a continuous performance test that involved the participation of the central executive system of working memory.

Comorbid Anxiety and Depression and Related Factors Among Pregnant and Postpartum Chinese Women During the Coronavirus Disease 2019 Pandemic

Objective: To identify the prevalence of comorbid anxiety and depression (CAD) and analyze the relationship between CAD and sociodemographic and obstetric-related variables in pregnant and postpartum Chinese women during the COVID-19 pandemic. Methods: Participants were 2,237 pregnant and postpartum women (aged 19-47 years) who visited various medical institutions in China between February 28, 2020, and April 26, 2020. They were asked to complete an online survey assessing the anxiety and depression, obstetric characteristics, and sociodemographic variables. The women were grouped into the following categories in accordance with the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9): (a) CAD, (b) "anxiety only," (c) "depression only," and (d) "no depression or anxiety." After estimating the prevalence of CAD, "anxiety only," and "depression only," we carried out chi-squared tests and multiple logistic regression analysis to examine the related factors between these groups of pregnant and postpartum Chinese women. Results: Comorbid anxiety and depression, "anxiety only," and "depression only," occurred in 6.3, 5.8, and 3.9% of participants, respectively. The prevalence rates of CAD during the first, second, and third trimesters of pregnancy and the postpartum period were found to be 7.4, 6.5, 5.7, and 8.2%, respectively. The factors that differed among the groups were age (p < 0.05), marital status (p < 0.001), level of education (p < 0.05), family support (p < 0.001), and total live births (p < 0.001). "Poor family support" (odds ratio (OR): 1.90; 95% confidence interval (CI): 1.30-2.78; p = 0.0009) and "no birth" (OR: 1.91; 95% CI: 1.32-2.75; p = 0.0006) remained significant factors for the CAD group, while "poor family support" (OR: 2.16; 95% CI: 1.34-3.47; p = 0.0015) remained a significant factor for the "depression only" group when their results were compared to those of the "no depression or anxiety" group in the multiple logistic regression analysis. Conclusion: Pregnant and postpartum Chinese women with poor family support and primipara are at high risk for CAD during the COVID-19 pandemic. These results support the need for targeted perinatal programs to address CAD in pregnant and postpartum women during the pandemic period.

Psychological distress after esophageal cancer surgery and the predictive effect of dispositional optimism: a nationwide population-based longitudinal study

Purpose

To examine the trajectory of psychological distress from 1 to 2 years after esophageal cancer surgery, and whether dispositional optimism could predict the risk of postoperative psychological distress.

Methods

This Swedish nationwide longitudinal study included 192 patients who had survived for 1 year after esophageal cancer surgery. We measured dispositional optimism with the Life Orientation Test-Revised (LOT-R) 1 year post-surgery and psychological distress with the Hospital Anxiety and Depression Scale 1, 1.5, and 2 years post-surgery. Latent growth curve models were used to assess the trajectory of postoperative psychological distress and to examine the predictive validity of dispositional optimism.

Results

One year after surgery, 11.5% (22 of 192) patients reported clinically significant psychological distress, and the proportion increased to 18.8% at 1.5 years and to 25.0% at 2 years post-surgery. Higher dispositional optimism predicted a lower probability of self-reported psychological distress at 1, 1.5, and 2 years after esophageal cancer surgery. For each point increase in the LOT-R sum score, the odds of psychological distress decreased by 44% (OR, 0.56; 95% CI, 0.40 to 0.79).

Conclusion

The high prevalence and longitudinal increase of self-reported psychological distress after esophageal cancer surgery indicate the unmet demands for timely psychological screening and interventions. Measuring dispositional optimism may help identify patients at higher risk of developing psychological distress, thereby contributing to the prevention of postoperative psychological distress.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06517-x.

Quetiapine in the Anxiety Dimension of Mood Disorders: A Systematic Review of the Literature to Support Clinical Practice

PURPOSE/BACKGROUND

Bipolar disorder and major depressive disorder are heterogeneous conditions characterized by marked variations in mood. High levels of anxiety are often present in these conditions and are associated with increased suicidal risk, increased disease duration, and treatment resistance. Mood stabilizers or antipsychotics are recommended for the treatment of bipolar disorder in comorbidity with anxiety disorders. This study examines current knowledge to evaluate the efficacy of quetiapine in the treatment of anxiety in mood disorders.

METHODS/PROCEDURES

A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting randomized control trials that evaluated the efficacy of quetiapine on anxiety symptoms in patients diagnosed with bipolar disorder or major depressive disorder and included anxiety evaluation scales.

FINDINGS/RESULTS

We collected 27 studies (19 with primary data analysis, 8 with secondary data analysis) regarding the use of quetiapine in mood disorders. Quetiapine was more effective than placebo and active comparators in reducing anxiety in unipolar and bipolar patients in 20 of these studies. In 7 studies, quetiapine was not superior to psychoactive comparators or placebo on the anxiety dimension.

IMPLICATIONS/CONCLUSIONS

Statistical power might be limited by small sample size in 5 of the studies included in our review. Moreover, data on anxiety were a secondary outcome in most studies. Nevertheless, the reported studies show with good levels of concordance that quetiapine is effective in controlling anxiety symptoms in patients with mood disorders. This evidence supports current guidelines and recommendations concerning the use of quetiapine in clinical practice.

[Comorbidity of depression and anxiety in clinical practice]

OBJECTIVE

The study was the comparative characterization of depressed patients depending on the presence of comorbid anxiety.

MATERIAL AND METHODS

Thirty patients of the Clinic of neuroses named after acad. I.P. Pavlov Clinic of Neuroses. Comparison groups included 15 patients with comorbid anxiety and depressive disorders and 15 patients with depressive disorder without comorbid anxiety. The groups were comparable by sex and age. Clinical-catamnestic, clinical-therapeutic, and clinical-scale methods, including the Hamilton Depression and Anxiety Scales, were used during the study.

RESULTS

The structure of clinically diagnosed comorbid anxiety and depressive disorders was shown to be characterized by high representation of somato-vegetative symptoms and higher level of depression in comparison to depressive disorder without comorbid anxiety. According to psychometric assessment results, the level of anxiety did not differ in comparison groups, while clinically, according to ICD-10 criteria, anxiety was not diagnosed, indicating a discrepancy between clinical and scale assessments of anxiety and depressive disorders and greater accuracy of clinical and scale assessment of the condition. The effectiveness of combined treatment, including psychotropic therapy and psychotherapy, was lower in patients with comorbidity of anxiety and depression according to parameters of the degree of reduction of psychopathological symptoms, duration of treatment, and quality of remission. The structure of incomplete remission was similar in patients with comorbid anxiety and depressive disorders and depression.

CONCLUSION

The obtained data suggest the expediency of continuous systematization of affective disorders and the need to improve the diagnostic criteria of comorbid anxiety and depressive disorders on the basis of combined clinical and scale assessment.

Comparing the EQ-5D-3L anxiety or depression domain to the Hospital Anxiety and Depression Scale to identify anxiety or depression after stroke

Background: Anxiety and depression are common post-stroke and impact quality-of-life (QoL). The EQ-5D three-level version (EQ-5D-3L) is increasingly used to routinely measure health-related QoL in stroke populations, but its potential value for detecting anxiety or depression is uncertain. We sought to examine the agreement and convergent validity of the EQ-5D-3L anxiety or depression domain in survivors of stroke.Methods: Cross-sectional survey data obtained from participants in the Australian Stroke Clinical Registry (AuSCR) between 90 and 180 days after stroke were used. Correlation, sensitivity, specificity, and the area under the curve were calculated for the EQ-5D-3L anxiety or depression domain against the Hospital Anxiety Depression Scale (HADS, reference standard), which has been validated as a screening measure following stroke.Results: Data were obtained from 245 respondents (median time post-stroke 143 days), median age 74 years; 42% female. Nearly 50% reported problems (43% moderate; 7% extreme) in the EQ-5D-3L anxiety or depression domain. The median HADS-Anxiety score was 6 (Q1:3, Q3:9), and the median HADS-Depression score was 5 (Q1:2, Q3:9). The EQ-5D-3L anxiety or depression scores were strongly correlated (r = 0.58) with scores of the HADS-Anxiety, but moderately correlated with HADS-Depression (r = 0.37), and combined HADS-Anxiety or HADS-Depression (r = 0.46). The EQ-5D-3L anxiety or depression domain had greater sensitivity and specificity in identifying cases with anxiety than in identifying depressive symptoms in survivors of stroke.Conclusions: The EQ-5D-3L appears to have value as a population level indicator of anxiety or depression following stroke. Further validation against "gold standard" clinical assessment is required for clinical applications.

Antepartum Depression and Preterm Birth: Pathophysiology, Epidemiology, and Disparities due to structural racism

PURPOSE OF REVIEW

Informed by the evidence of links between physiology of stress and parturition, we review recent epidemiologic evidence (2015-2020) of antenatal depression as a risk factor for preterm birth (PTB). We also explain racial/ethnic disparities in depression and preterm birth as a consequence of structural racism.

RECENT FINDINGS

Epidemiologic evidence is consistent in linking antepartum depression with an elevated risk of PTB. Antidepressant usage has been linked with an elevated risk of PTB. However, recent evidence suggests that severity of depression is the underlying driver of the elevated risk attributed to antidepressant usage. The number of depressive symptoms, as a proxy for severity of maternal stress, may be a more informative predictor of PTB than criterion based predictors. Across various study designs, measurement modalities, and populations, antenatal depression predicts an elevated risk of delivering preterm. The physiology of stress provides a plausible explanation for this observation. Excessive stress-induced elevations in maternal and then fetal HPA hormones can alter maternal and fetal homeostasis and hasten the timing of parturition. Antenatal depression and exposure to structural racism are two stressors that can trigger the maternal stress response. Chronically elevated levels of stress hormones among women of color in the USA provide a likely physiologic explanation for Black-White disparities in the risk of PTB. Focusing on the number of depressive symptoms as the more informative predictor of PTB raises several questions. We consider these questions as well as directions for future research in the context of recent advances in the field.

Psychological Profiles and Clinical Clusters of Patients Diagnosed With Functional Neurological Disorder

Our understanding about underlying mechanisms leading to Functional Neurological Disorders (FND) has changed in recent years. While in the past these disorders were presumed to be solely due to psychological issues we know now that their development is dependent on complex interactions between biological, psychological and social factors. We present an analysis of clinical presentations and psychological profiles of patients who were seen in our FND outpatient clinic over 3 years. We aim to review the prevalence of common symptoms in the patients seen within our clinic, and to identify any common psychological or psychiatric profiles that differentiated these symptom groups. This may help to elucidate underlying mechanisms leading to the development of functional symptoms and identify the predisposing, triggering and perpetuation factors.

Prenatal maternal depressive symptoms are associated with smaller amygdalar volumes of four-year-old children

Prenatal maternal depressive symptoms are related to an increased offspring susceptibility to psychiatric disorders over the life course. Alterations in fetal brain development might partly mediate this association. The relation of prenatal depressive symptoms with child's amygdalar volumes is still underexplored, and this study aimed to address this gap. We explored the association of prenatal maternal depressive symptoms with amygdalar volumes in 28 4-year-old children (14 female). Amygdalar volumes were assessed using the volBrain pipeline and manual segmentation. Prenatal depressive symptoms were self-reported by mothers at gestational weeks 14, 24 and 34 (Edinburgh Postnatal Depression Scale). Sex differences were probed, and possible pre- and postnatal confounders, such as maternal general anxiety, were controlled for. We observed that elevated depressive symptoms of the early second trimester, after controlling for prenatal maternal general anxiety, were significantly related to smaller right amygdalar volumes in the whole sample. Higher depressive symptoms of the third trimester were associated with significantly smaller right amygdalar volumes in boys compared to girls. Altogether, our data suggest that offspring limbic brain development might be affected by maternal depressive symptoms in early pregnancy, and might also be more vulnerable to depressive symptoms in late pregnancy in boys compared to girls.

Anxiolytic and antidepressant effects of Ziziphus mucronata hydromethanolic extract in male rats exposed to unpredictable chronic mild stress: Possible mechanisms of actions

ETHNOPHARMACOLOGICAL RELEVANCE

Ziziphus mucronata (ZM) is used traditionally in the treatment of mood and depression. However, no existing scientific data is confirming this traditional claim.

AIM OF THE STUDY

The present study was planned to investigate the anxiolytic and antidepressant-like effects of this plant in a stressed-induced depression model in rats.

MATERIALS AND METHODS

Depressive-like behaviors were induced by exposing rats to different stress paradigms daily for 30 days. A sucrose preference test was performed to assess anhedonia in rats. Anxiety and depression-related behavior were assessed. The oxidative parameters (lipid peroxidation, SOD and catalase activities) were evaluated. Pindolol and Flumazenil were also used to assess the mechanism of action of ZM extract.

RESULTS

The results showed that chronic administration of ZM (150, 300, and 600 mg/kg, p.o., 30 days) and imipramine treatment (20 mg/kg, p.o, 30 days) remarkably (P < 0.05) reversed the UCMS-induced behavioral changes observed in stress vehicle treated rats by reducing sucrose preference, decreased the immobility period in the FST and latency in NSF. Besides, ZM (300 and 600 mg/kg, p.o., 30 days) raised the percentages of time spent and number of open arms entries as well as the number of transitions. Also, ZM (300 mg/kg, (P < 0.05) decreased lipid peroxidation and increased both SOD and catalase activities (300 and 600 mg/kg, (P < 0.05)). These aforementioned behavioral indices were also completely nullified by pindolol a β-adrenoceptors blocker and 5-HT 1A/1B receptor antagonist but not by flumazenil, a benzodiazepine receptors antagonist.

CONCLUSION

ZM improved symptoms of anxiety and depression in behavioral despair paradigm in chronically stressed rats. The observed effects could be due to its capacities to restore the antioxidant status, and probably the modulation of monoamines transmissions.

Temperament and Sense of Coherence: Emotional Intelligence as a Mediator

Sense of coherence (SOC) reflects an individual’s capacity and available resources to deal with stressful situations. For some time now studies have revealed that people differ in their experience of SOC; yet, very little is known about how and through which mechanisms a high level of SOC is formed. In order to increase our understanding about the paths to a high SOC in the stage of adulthood, we focused on exploring the role both of temperament, as it has been confirmed as a potential component in the development of more complex traits that emerge later in life, and of emotional intelligence (EI) as it has been found to increase SOC. The sample consisted of 173 participants between 18 and 49. We used the Temperament Evaluation of Memphis, Pisa and San Diego Autoquestionnaire (TEMPS-A), Orientation to Life Questionnaire (OLQ), and Emotional Intelligence Questionnaire (INTE). Results showed a negative correlation between the depressive, cyclothymic, irritable, and anxious dimensions of temperament and SOC, and EI. There was also a positive correlation between hyperthymic temperament and SOC, and EI. EI correlated positively with a general sense of coherence and its three dimensions. The PROCESS macro for SPSS showed that emotional intelligence mediates the relationship between depressive, cyclothymic, hyperthymic, irritable and anxious temperament, comprehensibility, manageability, meaningfulness, and global orientation to life. On the basis of the obtained outcomes, it can be stated that emotional intelligence mediates the relationship between dimensions of temperament and dimensions of SOC.

Common and different neural markers in major depression and anxiety disorders: A pilot structural magnetic resonance imaging study

Although anxiety and depression often co-occur and share some clinical features, it is still unclear if they are neurobiologically distinct or similar processes. In this study, we explored common and specific cortical morphology alterations in depression and anxiety disorders. Magnetic Resonance Imaging data were acquired from 13 Major Depressive Disorder (MDD), 11 Generalized Anxiety Disorder (GAD), 11 Panic Disorder (PD) patients and 21 healthy controls (HC). Regional cortical thickness, surface area (SA), volume and gyrification were measured and compared among groups. We found left orbitofrontal thinning in all patient groups, as well as disease-specific alterations. MDD showed volume deficits in left precentral gyrus compared to all groups, volume and area deficits in right fusiform gyrus compared to GAD and HC. GAD showed lower SA than MDD and PD in right superior parietal cortex, higher gyrification than HC in right frontal gyrus. PD showed higher gyrification in left superior parietal cortex when compared to MDD and higher SA in left postcentral gyrus compared to all groups. Our results suggest that clinical phenotypic similarities between major depression and anxiety disorders might rely on common prefrontal alterations. Frontotemporal and parietal abnormalities may represent unique biological signatures of depression and anxiety.

Coping With Depressive Symptoms in Young Adults: Perceived Social Support Protects Against Depressive Symptoms Only Under Moderate Levels of Stress

Introduction: The interrelationship between social support, depressive symptoms, stress and self-esteem in young adults remains unclear. This study aims to test the mediating role of self-esteem in the relationship between social support and depressive symptoms and the moderating role of perceived stress in the relationship between the two. This is important to inform components of future intervention development targeting youth depression.

Methods: Three hundred forty-four (N = 344) young adults in Cyprus aged 17–26 (78% female) completed measures of self-esteem, social support, depressive symptoms, and perceived stress. Structural equation models were used to examine the interactions between social support and depressive psychopathology, whereas mediational analyses were run to examine the mediating role of self-esteem. Latent moderated mediation models were applied to examine the potentially moderating role of perceived stress.

Results: Perceived social support from family and friends were significantly related to lower depressive symptoms. Self-esteem fully mediated the relationship between perceived family support and depressive symptoms. Perceived stress moderated the model, and perceived social support was found to be more protective against depressive symptoms when moderate levels of stress were presented.

Conclusion: The study demonstrates that social support is protective against depressive symptoms. Self-esteem and perceived stress are important mechanisms that interact with this effect. Implications include the efforts to increase perceived family support during college years and management of stress levels before working with depressive symptoms.

Association of auditory hallucination and anxiety symptoms with depressive symptoms in patients with schizophrenia: A three-month follow-up

This study was to investigate the association of auditory hallucinations and anxiety symptoms with depressive symptoms in patients with schizophrenia for three months. The participants (N = 189) were evaluated using Characteristics of Auditory Hallucination Questionnaire (CAHQ), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II. Forty-two participants suffered from depressive symptoms at both baseline and 3-month follow-up. Higher CAHQ and BAI at both periods predicted depressive symptoms at three-month end. Being male, increased severity of CAHQ and BAI were risk factors of depressive symptoms. Psychiatric professionals must educate patients to manage auditory hallucinations and anxiety symptoms to decrease depressive symptoms.

Depressive and anxious symptoms and 20-year mortality: Evidence from the Stirling County study

BACKGROUND

Depression and anxiety disorders are highly comorbid, and share significant symptom overlap. Whereas depression has been consistently associated with excess mortality, the association between anxiety and mortality is less clear. Our aim was to identify constellations of anxious and depressive symptoms and examine their associations with mortality.

METHOD

This study considers respondents from the 1970 (n = 1203) and 1992 (n = 1402) cohorts of the Stirling County study. Symptoms of depression and anxiety were assessed using structured at-home interviews. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database.

RESULTS

Exploratory factor analysis yielded three correlated factors in each cohort. Items loading on each factor varied slightly between cohorts, but roughly corresponded to (1) depressive symptoms, (2) anxious symptoms, and (3) somatic symptoms. The depressive factor was associated with increased risk of mortality in both the 1970 (HR: 1.35, 95% CI: 1.12, 1.62) and 1992 (HR: 1.25, 95% CI: 1.05, 1.48) cohorts. Anxious symptoms were associated with a reduced risk of mortality in the 1992 sample (HR: 0.72; 95% CI: 0.53, 0.90). Somatic symptoms were associated with a reduced risk of mortality in the 1970 sample (HR: 0.83, 95% CI: 0.69, 0.99), but an elevated risk of mortality in the 1992 sample (HR: 1.29; 95% CI: 1.11, 1.51).

CONCLUSIONS

This study provides evidence that symptoms of depression and anxiety may have differential associations with early mortality. Somatic symptoms such as upset stomach and loss of appetite may be protective against mortality, perhaps through increased use of health care services. Conversely, symptoms such as weakness and cold sweats may be indicative of failing health.

Safety and effectiveness of escitalopram in an 8-week open study in Chinese patients with depression and anxiety

BACKGROUND

Anxiety symptoms usually worsen depression and functional impairment. The present study was aimed to evaluate the impact of escitalopram on social function and quality of life in major depressive disorder (MDD) patients with anxiety symptoms.

PATIENTS AND METHODS

Adult MDD patients with functional impairment (Sheehan Disability Scale [SDS] score ≥9) and anxiety symptoms (Hamilton Anxiety Rating Scale [HAM-A] score ≥14) received escitalopram (10-20 mg/day) for 8 weeks. Symptom status was assessed by SDS, Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, Montgomery-Åsberg Depression Rating Scale (MADRS), HAM-A, and Quick Inventory of Depressive Symptomatology-Self Report scales. Safety was evaluated by treatment-emergent adverse events (TEAEs).

RESULTS

Overall, 208 (79.7%) of 261 enrolled patients completed the 8-week treatment. Mean (SD) SDS and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form total scores were 17.4 (5.87) and 39.3 (14.43) at baseline, which improved to 7.6 (6.71) and 61.6 (15.80), respectively, at week 8. Totally, 59.2% of patients achieved functional remission (SDS≤6) and 61.7% of patients achieved depression remission (MADRS≤10) at week 8; 48.1% of patients achieved both functional and depression remission (SDS≤6 and MADRS≤10). The change in SDS total score was positively correlated with the change in MADRS and HAM-A total scores at each visit. Patient's baseline SDS score was related with depression score (regression coefficient=0.40582, p=0.0005); remission of SDS was statistically related to a reduction of week 2 and week 6 HAM-A score (p<0.0001) and reduction of MADRS score (p<0.0001). Overall, 25.7% of patients reported ≥1 TEAEs. Most frequently reported TEAEs were nausea (5.8%), diarrhea (2.3%), and dizziness (2.7%). Most TEAEs were mild to moderate in severity. Four patients reported serious TEAEs, two patients reported suicide attempts, and one patient completed suicide.

CONCLUSION

Escitalopram (10-20 mg/day) treatment was efficacious in reducing depression, improving social function, and quality of life in MDD patients with anxiety symptoms. No new safety signals were identified.

Dissociating the effects of alternative early-life feeding schedules on the development of adult depression-like phenotypes

Early-life adversity is associated with increased vulnerability to depression in humans, and depression-like phenotypes in animals. However, different types of adverse experience may leave different signatures in adulthood. We experimentally manipulated the Amount of food delivered to European starling nestlings and the begging Effort required to obtain food during early development. Here, we report behavioural data in adulthood from a task that assessed sensitivity to shifts in reward magnitude characteristic of depression-like low mood. Birds that had experienced Hard Effort were more food motivated than birds that had experienced Easy Effort. Both Effort and Amount affected sensitivity to shifts in reward magnitude: Hard Effort birds showed an enhanced negative contrast effect following loss of reward ('disappointment'), and Lean Amount birds failed to show a normal positive contrast effect following gain in reward (a lack of 'elation'). Therefore, the feeding schedule experienced for just 10 days in early life caused enduring effects on feeding motivation and sensitivity to reward loss/gain consistent with human depression. Furthermore, the contrast effects were specific to different types of adversity. These results highlight the importance of early-life feeding schedules in the development of depression-like phenotypes.

The relevance of 'mixed anxiety and depression' as a diagnostic category in clinical practice

According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.

Common Etiological Sources of Anxiety, Depression, and Somatic Complaints in Adolescents: A Multiple Rater twin Study

Somatic complaints in children and adolescents may be considered part of a broader spectrum of internalizing disorders that include anxiety and depression. Previous research on the topic has focused mainly on the relationship between anxiety and depression without investigating how common somatic symptoms relate to an underlying factor and its etiology. Based on the classical twin design with monozygotic and dizygotic twins reared together, our study aimed to explore the extent to which the covariation between three phenotypes in adolescent girls and boys can be represented by a latent internalizing factor, with a focus on both common and specific etiological sources. A population-based sample of twins aged 12-18 years and their mothers and fathers (N = 1394 families) responded to questionnaire items measuring the three phenotypes. Informants' ratings were collapsed using full information maximum likelihood estimated factor scores. Multivariate genetic analyses were conducted to examine the etiological structure of concurrent symptoms. The best fitting model was an ACE common pathway model without sex limitation and with one substantially heritable (44%) latent factor shared by the phenotypes. Concurrent symptoms also resulted from shared (25%) and non-shared (31%) environments. The factor loaded most on depression symptoms and least on somatic complaints. Trait-specific influences explained 44% of depression variance, 59% of anxiety variance, and 65% of somatic variance. Our results suggest the presence of a general internalizing factor along which somatic complaints and mental distress can be modeled. However, specific influences make the symptom types distinguishable.

Subjective cognitive decline in cognitively normal elders from the community or from a memory clinic: Differential affective and imaging correlates

INTRODUCTION

Subjective cognitive decline (SCD) could indicate preclinical Alzheimer's disease, but the existing literature is confounded by heterogeneous approaches to studying SCD. We assessed the differential cognitive, affective, and neuroimaging correlates of two aspects of SCD: reporting high cognitive difficulties on a self-rated questionnaire versus consulting at a memory clinic.

METHODS

We compared 28 patients from a memory clinic with isolated SCD, 35 community-recruited elders with similarly high levels of self-reported cognitive difficulties, and 35 community-recruited controls with low self-reported cognitive difficulties.

RESULTS

Increased anxiety and amyloid β deposition were observed in both groups with high self-reported difficulties, whereas subclinical depression and (hippocampal) atrophy were specifically associated with medical help seeking. Cognitive tests showed no group differences.

DISCUSSION

These results further validate the concept of SCD in both community- and clinic-based groups. Yet, recruitment methods influence associated biomarkers and affective symptomatology, highlighting the heterogeneous nature of SCD depending on study characteristics.

The Role of Neuroticism and Experiential Avoidance in Predicting Anxiety and Depression Symptoms: Mediating Effect of Emotion Regulation

Background

Preliminary evidence supports the role of neuroticism, experiential avoidance and emotion regulation in anxiety and depression; however, the mechanism of these relationships is not known well.

Objectives

The present study mainly aimed to assess the mediating role of emotion regulation in the relationship between neuroticism and experiential avoidance and anxiety and depression symptoms.

Materials and Methods

By convenient sampling, 316 students from Tehran University of Medical Sciences, Iran University of Social Welfare and Rehabilitation Sciences and University of Tehran were selected and measures of experiential avoidance, neuroticism, emotion regulation, worry, anxiety and depression were administered among them, 2014-2015. Path analysis via regression according to Baron and Kenny evaluative criteria was used for data analysis.

Results

Experiential avoidance and neuroticism predicted anxiety, and depression symptoms and the predictions were mediated by emotion regulation and worry.

Conclusions

Emotion regulation deficits have an outstanding role in the mechanism of anxiety and depression which are so comorbid and further studies are needed to evaluate emotion regulation with more advanced methods and along with other transdiagnostic components.

Fourteen-day administration of corticosterone may induce detrusor overactivity symptoms

Introduction and hypothesis

Epidemiological studies demonstrated that patients suffering from overactive bladder often present with different mental problems, amongst which depression is the most frequently observed. The main goal of our study was to check if the repeated administration of corticosterone (CORT) is able to evoke the depressive-like behaviour and detrusor overactivity (DO) symptoms in rats. Moreover, we investigated whether the acute administration of common antidepressants (imipramine, 30 mg/kg, and fluoxetine, 15 mg/kg), antimuscarinic (oxybutynin chloride, 0.5 mg/kg) or CRF₁ (SN 003, 1 mg/kg) antagonists has an impact on the cystometric parameters, behaviour in the Porsolt test, and overall locomotor activity of animals exposed to CORT.

Methods

The experiments were carried out on female Wistar rats. All applied surgical and histopathology procedures, cystometric investigations, locomotor activity and forced swim measurements have been fully described in the published literature.

Results

Fourteen-day administration of CORT may induce both depressive and DO symptoms in rats, which are reversed by the inhibition of CRF₁ receptors.

Conclusions

It seems that the CRF₁ receptor could be an interesting target for overactive bladder pharmacotherapy, particularly in patients with co-existing depression.

A systematic review of randomised control trials on the effects of yoga on stress measures and mood

Stress related disorders such as depression and anxiety are leading sources of disability worldwide, and current treatment methods such as conventional antidepressant medications are not beneficial for all individuals. There is evidence that yoga has mood-enhancing properties possibly related to its inhibitory effects on physiological stress and inflammation, which are frequently associated with affective disorders. However the biological mechanisms via which yoga exerts its therapeutic mood-modulating effects are largely unknown. This systematic review investigates the effects of yoga on sympathetic nervous system and hypothalamic pituitary adrenal axis regulation measures. It focuses on studies collecting physiological parameters such as blood pressure, heart rate, cortisol, peripheral cytokine expression and/or structural and functional brain measures in regions involved in stress and mood regulation. Overall the 25 randomised control studies discussed provide preliminary evidence to suggest that yoga practice leads to better regulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal system, as well as a decrease in depressive and anxious symptoms in a range of populations. Further research is warranted to confirm these preliminary findings and facilitate implementation in clinical settings.

Effects of social housing on hippocampal dendrites and behavior in ovariectomized rats

Social stress is both species and gender specific. For female rats, individual housing and social instability housing conditions are associated with behavioral indicators of stress and depression. The present study directly compared the effects of six weeks of individual housing, social instability and mixed sex, semi-crowded housing in a visible burrow system (VBS) on ovariectomized female rats. Paired, stable housing was used as the control. Behavioral tests were conducted two, four and six weeks into the housing manipulations and included sucrose consumption, social interest, and activity in the open field. Following a series of four behavioral tests, animals were sacrificed and brains were processed for Golgi impregnation. Basal dendrites of CA3 hippocampal neurons were measured. Results indicate that the individual housing and social instability groups were comparable to the control group for all measures. In contrast, the rats housed in the VBS exhibited reduced activity in open field testing, and alterations in social interest. Dendritic lengths were also reduced in those animals living in the VBS in comparison to the animals housed in pairs. To our knowledge, this is the first report of behavioral and neural effects of VBS housing on female rats. Further research is necessary to determine what facets of the VBS housing are responsible for the behavioral and neural changes. This article is part of a Special Issue entitled 'Animal Models'.

Can father inclusive practice reduce paternal postnatal anxiety? A repeated measures cohort study using the Hospital Anxiety and Depression Scale

Background

Perinatal research on anxiety and depression has primarily focused on mothers. We have limited knowledge of fathers’ anxiety during the perinatal period yet there is evidence that the parenting capacity of a person can be compromised by anxiety and depression. The purpose of this paper is to identify the impact of a father inclusive intervention on perinatal anxiety and depression. The prime focus of the intervention was to provide education and support to fathers of breastfeeding partners with the aim of increasing both initiation and duration of breastfeeding.

Methods

A repeated measures cohort study was conducted during a RCT that was implemented across eight public maternity hospitals in Perth, Western Australia between May 2008 and June 2009. A baseline questionnaire which included the Hospital Anxiety and Depression Scale (HADS) was administered to all participants on the first night of their hospital based antenatal education program and was repeated at six weeks postnatal. SPSS version 17 was used for reporting descriptive results.

Results

The mean anxiety levels at baseline for the fathers in the intervention group (n=289) and control group (n=244) were 4.58 and 4.22 respectively. At 6 weeks postnatal (only matched pairs), intervention and control group were 3.93 and 3.79. More intervention group fathers self-rated less anxiety compared to the fathers in the control group from baseline to post test (p=0.048). Depression scores for intervention fathers at baseline (mean =1.09) and at six weeks (mean=1.09) were very similar to fathers in the control group at baseline (mean=1.11) and at six weeks (mean =1.07) with no significant changes.

Conclusions

Both intervention and control group fathers experienced some anxiety prior to the birth of their baby, but this was rapidly reduced at six weeks. Paternal anxiety is common to new fathers and providing them with information and strategies for problem-solving can increase their knowledge and potentially lower the risk of postnatal anxiety.

Trial registration

(Australian New Zealand Clinical Trials Registry ACTRN12609000667213)

Anxiety disorders as a risk factor for subsequent depression

Abstract Introduction. Patients with comorbid depression and anxiety disorders have a higher suicide risk, increased social and vocational dysfunction and more severe and refractory illness. Methods. This paper reviews the studies examining the temporal relationship between onset of anxiety disorders and depression. Results. The highest rates of subsequent depression have been found in generalized anxiety disorder, followed by panic disorder and social anxiety disorder. The largest numbers of studies have been done on social anxiety disorder. Panic attacks, separation anxiety disorder and specific phobia also have an association with higher rates of subsequent depression in a limited number of studies. Conclusion. Further studies are needed to investigate whether treatment and treatment outcomes in anxiety disorders has an effect on the risk for developing subsequent depression.

Trajectories of maternal symptoms of anxiety and depression. A 13-year longitudinal study of a population-based sample

Background

There is a lack of population-based studies of developmental trajectories following mothers throughout the whole child-rearing phase and there are few longitudinal studies focusing on both symptoms of depression and anxiety. The aim of the current study is to identify latent trajectory groups based on counts of symptoms of anxiety and depression among mothers throughout the child-rearing phase and the relations of the latent groups to maternal socio-demographic variables.

Methods

Data is from a prospective, longitudinal study of nearly 1000 families in Norway followed from when the index children were 18 months until they were 14.5 years old (the TOPP study). The study used latent profile analysis (LPA) to identify latent groups of mothers with distinct trajectories across time of symptom counts. Latent group differences on socio-demographic variables were tested with one-way ANOVAs, chi-square tests and exact tests.

Results

Six trajectories based on maternal scores from six waves of data collection of symptoms of anxiety and depression were identified; a 'No symptoms' group with mothers without symptoms; a 'Low' group with mothers reporting low symptom levels; a 'Moderate-low' group with mothers reporting moderately low symptom levels; a 'Moderate' group with mothers with moderate symptoms; a 'High-chronic' group with mothers with overall high symptom levels; and a 'Low-rising' group with mothers starting with a low symptom level that increased over time. The mothers in the High-chronic symptom group differed from the other mothers on several socio-demographic variables. They were significantly younger than the mothers in the Low group comprising the oldest mothers. The mothers in the High-chronic group had significantly lower education, were less likely to have paid work and were less likely to be living with a partner than the mothers in the other groups.

Conclusions

The study shows socio-demographic differences between mothers classified into six trajectory groups based on symptoms of anxiety and depression covering 13 years of the child-rearing period. Specific socio-demographic risk factors characterised mothers in the High-chronic symptom group. Identifying subgroups with enduring problems might inform more targeted preventive efforts.

Life course perspectives on the epidemiology of depression

Life course epidemiology seeks to understand how determinants of health and disease interact across the span of a human life, and has made significant contributions to understanding etiological mechanisms in many chronic diseases, including schizophrenia. The life course approach is ideal for understanding depression: causation in depression appears to be multifactorial, including interactions between genes and stressful events, or between early life trauma and later stress in life; timing of onset and remission of depression varies widely, indicating differing trajectories of symptoms over long periods of time, with possible differing causes and differing outcomes; and early life events and development appear to be important risk factors for depression, including exposure to acute and chronic stress in the first years of life. To better understand etiology and outcome of depression, future research must move beyond basic epidemiologic techniques that link specific exposures to specific outcomes and embrace life course principles and methods. Time-sensitive modelling techniques that are able to incorporate multiple interacting factors across long periods of time, such as structural equation models, will be critical in understanding the complexity of causal and influencing factors from early development to the end stages of life. Using these models to identify key pathways that influence trajectories of depression across the life course will help guide prevention and intervention.

Neonatal lipopolysaccharide and adult stress exposure predisposes rats to anxiety-like behaviour and blunted corticosterone responses: implications for the double-hit hypothesis

The double-hit hypothesis posits that an early life genetic or environmental insult sets up a neural predisposition to psychopathology, which may emerge in the presence of a subsequent insult, or 'second hit' in later life. The current study assessed the effect of neonatal lipopolysaccharide (LPS) exposure on anxiety-like behaviours in the adult Wistar rat. Rats were administered either LPS (Salmonella enterica, serotype enteritidis, 0.05 mg/kg, i.p.) or saline (equivolume) on days 3 and 5 of life (birth=day 1). In adulthood (85 days), subjects were allocated to either "stress" or "no stress" treatment groups. For the "stress" group, subjects were exposed to a three-day stress protocol consisting of a 30 min period of restraint and isolation. The "no stress" group was left unperturbed but were handled during this period to control for handling effects between adult "stress" and "no stress" conditions. All animals then underwent behavioural testing using standardised tests of anxiety-like behaviour, including either the Hide Box/Open Field, Elevated Plus Maze (EPM) or Acoustic Startle Response (ASR). Time and event measures for restraint and isolation, the Hide Box/Open Field and EPM were recorded using automated tracking software. Startle amplitude and habituation across time was measured in the ASR test. Prior to and following behavioural test sessions, peripheral blood was collected to assess serum corticosterone and ACTH levels. Data analysis indicated that LPS-treated animals exposed to stress in adulthood exhibited increased anxiety-like behaviour across all behavioural tests compared to controls. Sexually dimorphic effects were observed with males exhibiting increased anxiety-related behaviours compared to females (p<.05). Neonatal LPS exposure induced a significant increase in corticosterone compared to controls (p<.05), whereas corticosterone responses to stress in adulthood were associated with a significantly blunted HPA axis response (p<.05). No differences in ACTH were observed. These results lend support to the double-hit hypothesis of anxiety-related behaviour, demonstrating that neonatal immune activation produces an enhanced propensity toward anxiety-related behaviour following stress in adulthood, and that this susceptibility is associated with alterations to HPA axis ontogeny.