Recent developments in understanding the psychosocial aspects of depression

Einfluss einer achtsamkeitsbasierten Depressionsbehandlung in einer Tagesklinik auf arbeitsbezogene Bewältigungsmuster bei depressiven Patientinnen und Patienten mit berufsbezogenen Konflikten

<b><i>Hintergrund:</i></b> Ziel der Studie war es, den Einfluss einer achtsamkeitsbasierten Depressionsbehandlung in einer Tagesklinik auf arbeitsbezogene Bewältigungsmuster bei Patientinnen und Patienten mit einer akuten depressiven Episode und berufsbezogenen Konflikten zu untersuchen. <b><i>Methode:</i></b> In einer Pilotstudie wurden 81 Patientinnen und Patienten mit einer mittelgradigen oder schweren depressiven Episode und berufsbezogenen Konflikten entweder einer tagesklinischen achtsamkeitsbasierten Depressionsbehandlung (mit psychopharmakologischer Medikation bei Bedarf, <i>N</i> = 47) oder einer Kontrollbedingung mit psychopharmakologischer Beratung (<i>N</i> = 34) zugeordnet. Arbeitsbezogene Bewältigungsstile und -muster wurden mit dem Fragebogen für arbeitsbezogenes Erlebens- und Verhaltensmuster (AVEM) zu drei Messzeitpunkten (Beginn, Ende und 8-Monats-Katamnese) untersucht, um gesundheitsgefährdende Risikomuster zu untersuchen. Zudem wurde die psychopathologische Symptombelastung anhand des Beck-Depressions-Inventars (BDI-II) und des Brief-Symptom-Inventory (BSI) gemessen. <b><i>Ergebnisse:</i></b> Die achtsamkeitsbasierte Depressionsbehandlung reduzierte die psychopathologische Symptombelastung signifikant und bewirkte eine positive Veränderung umschriebener gesundheitsgefährdender arbeitsbezogener Bewältigungsstile und Risikomuster hin zu gesundheitsförderlichen Bewältigungsstilen. <b><i>Diskussion:</i></b> Wenngleich Risikomuster durch die achtsamkeitsbasierte Depressionsbehandlung nur zum Teil abgebaut werden konnten, sind die Ergebnisse vielversprechend in Bezug auf gesundheitsförderliche Veränderungen einzelner arbeitsbezogener Bewältigungsstile wie “Verausgabungsbereitschaft”, “Perfektionsstreben”, “Distanzierungsfähigkeit” und “Innere Ruhe/Ausgeglichenheit”. <b><i>Schlussfolgerung:</i></b> Die psychiatrische Versorgung von Patientinnen und Patienten mit einer Depression sollte arbeitsbedingte Stressfaktoren und Konflikte und deren Bewältigung berücksichtigen. Das Behandlungskonzept schließt eine Lücke in der psychiatrischen Versorgung.

Association between Near Work Time and Depression among Workers in South Korea

BACKGROUND

The aim of this study was to evaluate the association between near work time and depression.

METHODS

Data of 1,551 workers aged 19-49 years from the sixth Korea National Health and Nutrition Examination Survey were examined. The Patient Health Questionaire-9 scores were used to screen for depression. Participants who scored a total of 10 or above, which is suggestive of the presence of depression, were classified as the depression group; the rest were classified as normal. The correlation between daily near work time and depression was analyzed using multivariate logistic analysis after adjusting for other sociodemographic and health behavior-related variables.

RESULTS

Multivariate logistic analysis found that workers with 3 or more hours of near work were more likely to report depression compared to the reference group who had 2 or fewer hours per day of near work (adjusted odds ratio, 2.471; 95% confidence interval, 1.062-5.747).

CONCLUSION

Longer near work time was associated with depression among South Korea's workers. Therefore, it is necessary to reduce near work time to prevent depression.

Neurocognitive Measures of Self-blame and Risk Prediction Models of Recurrence in Major Depressive Disorder

BACKGROUND

Overgeneralized self-blaming emotions, such as self-disgust, are core symptoms of major depressive disorder and prompt specific actions (i.e., action tendencies), which are more functionally relevant than the emotions themselves. We have recently shown, using a novel cognitive task, that when feeling self-blaming emotions, maladaptive action tendencies (feeling like hiding and feeling like creating a distance from oneself) and an overgeneralized perception of control are characteristic of major depressive disorder, even after remission of symptoms. Here, we probed the potential of this cognitive signature, and its combination with previously employed functional magnetic resonance imaging (fMRI) measures, to predict individual recurrence risk. For this purpose, we developed a user-friendly hybrid machine/statistical learning tool, which we make freely available.

METHODS

A total of 52 medication-free patients with remitted major depressive disorder, who had completed the action tendencies task and our self-blame fMRI task at baseline, were followed up clinically over 14 months to determine recurrence. Prospective prediction models included baseline maladaptive self-blame-related action tendencies and anterior temporal fMRI connectivity patterns across a set of frontolimbic a priori regions of interest, as well as including established clinical and standard psychological predictors. Prediction models used elastic net regularized logistic regression with nested 10-fold cross-validation.

RESULTS

Cross-validated discrimination was highly promising (area under the receiver-operating characteristic curve ≥ 0.86), and positive predictive values over 80% were achieved when including fMRI in multimodal models, but only up to 71% (area under the receiver-operating characteristic curve ≤ 0.74) when solely relying on cognitive and clinical measures.

CONCLUSIONS

This study shows the high potential of multimodal signatures of self-blaming biases to predict recurrence risk at an individual level and calls for external validation in an independent sample.

Prevalence of mental health problems and associated factors among front-line public health workers during the COVID-19 pandemic in China: an effort-reward imbalance model-informed study

BACKGROUND

Poor mental health status and associated risk factors of public health workers have been overlooked during the COVID-19 pandemic. This study used the effort-reward imbalance model to investigate the association between work-stress characteristics (effort, over-commitment, reward) and mental health problems (anxiety and depression) among front-line public health workers during the COVID-19 pandemic in China.

METHODS

A total of 4850 valid online questionnaires were collected through a self- constructed sociodemographic questionnaire, the adapted ERI questionnaire, the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item General Anxiety Disorder Scale (GAD-7). Hierarchical logistic regression analysis was conducted to investigate the association between ERI factors and mental health problems (i.e., depression and anxiety), with reward treated as a potential moderator in such associations.

RESULTS

The data showed that effort and over-commitment were positively associated with depression and anxiety, while reward was negatively associated with depression and anxiety. Development and job acceptance were the two dimensions of reward buffered the harmful effect of effort/over-commitment on depression and anxiety, whereas esteem was non-significant.

CONCLUSIONS

This study confirmed the harmful effects of effort and over-commitment on mental health among public health workers during the COVID-19 pandemic in China. Such effects could be alleviated through an appropriate reward system, especially the development and job acceptance dimensions of such a system. These findings highlight the importance of establishing an emergency reward system, comprising reasonable work-allocation mechanism, bonuses and honorary titles, a continuous education system and better career-development opportunities.

Gender Role, But Not Sex, Shapes Humans' Susceptibility to Emotion

It is unknown whether the famous sex-related difference in emotion processing is accounted for by biological sex, gender role, or their interaction. To clarify the issue, in Study 1 we recorded event-related potentials in response to negative and positive images of diverse intensities when 47 masculine (26 males) and 47 feminine (22 males) subjects performed a non-emotional task. The occipital P1 and N1 amplitudes were larger in women than in men, while feminine subjects showed larger N1 amplitudes than masculine subjects, regardless of sex. Moreover, feminine subjects showed enhanced frontocentral N2 (210-270 ms) amplitudes for highly and mildly negative than for neutral stimuli, while masculine subjects showed an emotion effect only for highly negative stimuli. The feminine-specific effect for mildly negative stimuli was positively correlated to the feminine score, and this correlation was located to the anterior cingulate and the superior and medial frontal gyri. Furthermore, feminine but not masculine subjects showed enhanced parietal P3 (330-560 ms) amplitudes for highly and mildly positive than for neutral stimuli, an effect positively related to the feminine score and localized to the precuneus, posterior cingulate, and superior temporal gyrus. Machine learning analyses verified that single-trial N2 and P3 amplitudes of feminine subjects reliably discriminated the intensity of negative and positive stimuli, respectively. For ecological considerations, in Study 2 we used an observational approach (n = 300) and confirmed that feminine gender role, rather than biological sex, predicted individual differences in daily experience of emotion-related psychopathological symptoms. These findings provide solid evidence for the critical impact of gender role rather than sex on emotional susceptibility.

The relationship between independent and dependent life events and depression symptoms in Sri Lanka: a twin and singleton study

PURPOSE

Life events have been associated with a variety of mental health conditions including depression. There is a scarcity of research in South Asia exploring the aetiology of independent and dependent life events and their relationship with depression symptoms. This study aimed, in a Sri Lankan population, to identify the socio-demographic correlates and genetic and environmental influences on independent and dependent life events and their relationship with depression.

METHODS

Questionnaire data came from the Colombo Twin and Singleton Follow-up Study, CoTaSS-2 (N = 3969), a population study of Sri Lankan twins and singletons. Lifetime-ever independent and dependent life events were measured using a questionnaire and depressive symptoms using the Revised Beck's Depression Inventory. Structural Equation Model-fitting analyses explored the genetic and environmental influences on life events and depression.

RESULTS

Living in a rural environment and financial hardship were associated with greater reporting of independent and dependent life events. Sex differences were evident in the aetiology of life events and depression symptoms. Independent and dependent life events, but not depression symptoms, were heritable in males. Independent life events and depression symptoms, but not dependent life events, were heritable in females. Non-shared environmental influences explained phenotypic associations between independent life events and depression symptoms in both males and females. Genetic and non-shared environmental influences explained the phenotypic associations between dependent life events and depression symptoms in males. Only non-shared environment explained the covariation between dependent life events and depression symptoms in females.

CONCLUSIONS

Socio-demographic correlates of independent and dependent life events were similar to those reported in Western populations. Life events were associated with increased depression symptoms. Contrary to research in Western populations, we found that non-shared environmental, rather than genetic, influences explained much of the covariation between life events and depression symptoms. This suggests that whilst independent LEs may be heritable, the relationship is unlikely to be confounded by genetic influences and has significant implications for possible interventions for depression.

Managerial Quality and Risk of Depressive Disorders Among Danish Eldercare Workers: A Multilevel Cohort Study

Objective:

To examine whether low managerial quality predicts risk of depressive disorders.

Methods:

Using multilevel mixed-effects logistic regression analyses we examined the prospective association of individual-level and workplace-mean managerial quality with onset of depressive disorders among 5244 eldercare workers from 274 workplaces during 20 months follow-up.

Results:

Low managerial quality predicted onset of depressive disorders in both the individual-level (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.25 to 2.76) and the workplace-mean analysis (OR = 1.48, 95% CI = 1.06 to 2.07). Low individual-level managerial quality predicted onset of depressive disorders when workplace-mean managerial quality was high (OR = 3.10, 95% CI = 1.71 to 5.62) but not when it was low (OR = 1.07, 95% CI = 0.61 to 1.87). This interaction was statistically significant (P = 0.03).

Conclusions:

Both low individual-level and low workplace-mean managerial quality predicted risk of depressive disorders. The association was strongest among individuals reporting low managerial quality at workplaces with high workplace-mean managerial quality.

Adverse childhood experiences leads to perceived negative attitude of others and the effect of adverse childhood experiences on depression in adulthood is mediated via negative attitude of others

Background:

The attachment theory suggests that adverse childhood experiences (ACEs) can have an effect on how individuals perceive other people's attitude towards them. ACEs have also been associated with adult depression. We hypothesised that ACEs associate with perceived negative attitude of others (AoO) and depressive symptoms (DEPS), and that these associations differ between the genders.

Methods:

Altogether, 692 participants drawn from the general population completed the Trauma and Distress Scale, as a measurement of ACE and its domains: emotional abuse (EmoAb), physical abuse (PhyAb), sexual abuse (SexAb), emotional neglect (EmoNeg) and physical neglect (PhyNeg); a visual analog scale with the question: “What kind of attitude do other people take towards you?”, and the self-report scale DEPS on depressive symptoms.

Results:

ACEs, AoO and DEPS correlated strongly with each other. In path analyses, ACE total and all its domains associated directly and indirectly, via DEPS, to negative AoO in the whole sample, and in females separately. ACE total, EmoAb, PhyAb, EmoNeg and PhyNeg associated directly and indirectly, via AoO, to DEPS in the whole sample and in both genders separately. EmoNeg, in all, and EmoAB, in males, had specific associations both with negative AoO and DEPS. Mediation effect via AoO was greater than via DEPS.

Conclusions:

ACEs have a direct and indirect, via depression, negative effect on how adult individuals perceive other people's attitude towards themselves. Additionally, negative AoO mediates the effects of ACEs on depression. Childhood EmoNeg associates specifically with negative AoO and DEPS in adulthood.

Direct to Public Peer Support and e-Therapy Program Versus Information to Aid Self-Management of Depression and Anxiety: Protocol for a Randomized Controlled Trial

Background

Regardless of geography or income, effective help for depression and anxiety only reaches a small proportion of those who might benefit from it. The scale of the problem suggests a role for effective, safe, anonymized public health–driven Web-based services such as Big White Wall (BWW), which offer immediate peer support at low cost.

Objective

Using Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) methodology, the aim of this study was to determine the population reach, effectiveness, cost-effectiveness, and barriers and drivers to implementation of BWW compared with Web-based information compiled by UK’s National Health Service (NHS, NHS Choices Moodzone) in people with probable mild to moderate depression and anxiety disorder.

Methods

A pragmatic, parallel-group, single-blind randomized controlled trial (RCT) is being conducted using a fully automated trial website in which eligible participants are randomized to receive either 6 months access to BWW or signposted to the NHS Moodzone site. The recruitment of 2200 people to the study will be facilitated by a public health engagement campaign involving general marketing and social media, primary care clinical champions, health care staff, large employers, and third sector groups. People will refer themselves to the study and will be eligible if they are older than 16 years, have probable mild to moderate depression or anxiety disorders, and have access to the Internet.

Results

The primary outcome will be the Warwick-Edinburgh Mental Well-Being Scale at 6 weeks. We will also explore the reach, maintenance, cost-effectiveness, and barriers and drivers to implementation and possible mechanisms of actions using a range of qualitative and quantitative methods.

Conclusions

This will be the first fully digital trial of a direct to public online peer support program for common mental disorders. The potential advantages of adding this to current NHS mental health services and the challenges of designing a public health campaign and RCT of two digital interventions using a fully automated digital enrollment and data collection process are considered for people with depression and anxiety.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 12673428; http://www.controlled-trials.com/ISRCTN12673428/12673428 (Archived by WebCite at http://www.webcitation.org/6uw6ZJk5a)

Chronic Vortioxetine Treatment Reduces Exaggerated Expression of Conditioned Fear Memory and Restores Active Coping Behavior in Chronically Stressed Rats

BACKGROUND

Stress is a risk factor for depression and anxiety disorders, disrupting neuronal processes leading to exaggerated fear and compromised coping behaviors. Current antidepressants are only partially effective. Vortioxetine, a novel multimodal antidepressant, is a serotonin transporter inhibitor; 5-HT3, 5-HT7, and 5-HT1D receptor antagonist; 5-HT1B partial agonist; and 5-HT1A agonist. We have shown that chronic dietary vortioxetine administration reversed stress-induced deficits in cognitive flexibility. In the present studies, we investigated the generality of vortioxetine's effects on other stress-related behavioral changes after different types of chronic stress.

METHODS

In experiment 1, rats were fear-conditioned by pairing a tone with footshock, then exposed to chronic plus acute prolonged stress. In experiment 2, rats were exposed to chronic unpredictable stress. In both experiments, beginning on day 4 of chronic stress, vortioxetine was given in the diet (24 mg/kg/d). In experiment 1, effects of vortioxetine were tested on stress-induced changes in retention and extinction of cue-conditioned fear, and in experiment 2, on coping behavior on the shock probe defensive burying test after chronic stress.

RESULTS

Chronic stress exaggerated the expression of conditioned fear memory. Vortioxetine restored fear memory to control levels and rendered extinction in stressed rats comparable with that in controls. In experiment 2, chronic unpredictable stress caused a shift from active to passive coping behavior, and vortioxetine restored active coping.

CONCLUSIONS

Vortioxetine reduced exaggerated expression of conditioned fear and restored adaptive coping behavior following 2 different types of chronic stress, adding to the evidence of its therapeutic potential in the management of depression and anxiety disorders.

Inpatients with major depressive disorder: Psychometric properties of the new Multidimensional Depression Scale

The New Multi-dimensional Depression Scale (NMDS) is one of the most comprehensive scales that measures depression symptoms in four domains, including emotional, cognitive, somatic, and interpersonal. This study aimed to evaluate the factor structure and psychometric properties of the NMDS in a group of Iranian inpatients with Major Depressive Disorder (MDD). At first, the scale was translated into Persian and used as part of a battery consisting of the Beck Depression Inventory-II (BDI-II), Oxford Happiness Inventory (OHI), Beck Anxiety Inventory (BAI), and Short Form Health Survey (SF-36). The battery was administered to 271 inpatients with MDD (90 men and 181 women) aged from 18 to 60 who had been referred to psychiatric hospitals in Tehran, Iran. Confirmatory factor analysis of the Persian version of the NMDS upheld its original four-factor structure. Moreover, the results showed its good internal consistency (Cronbach's alpha coefficient ranging from 0.70 for the emotional subscale to 0.83 for the interpersonal subscale). In addition, the NMDS scores were correlated with other constructs in empirically and theoretically expected ways, which provides evidence for the convergent (positive significant relationships with anxiety and cognitive and somatic-affective symptoms of depression) and divergent (negative significant relationships with happiness and mental health and physical health) validity of the scale. These findings supported the Persian version of the NMDS as a reliable and valid measure for the assessment of depression symptoms in patients with MDD.

A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

OBJECTIVES

Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare workers.

METHODS

Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work unit averaged working conditions with depressive symptoms in a sample of 95 individually observed eldercare workers. Further, we examined the association of work unit averaged working conditions with depressive symptoms in a sample of 205 care workers, including both observed and non-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events.

RESULTS

Higher levels of regulation requirements were associated with lower depressive symptoms at the individual level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model.

CONCLUSIONS

Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both individual and workplace levels of working conditions.

Antidepressant-like cognitive and behavioral effects of acute ketamine administration associated with plasticity in the ventral hippocampus to medial prefrontal cortex pathway

RATIONALE

Acute low-dose administration of the N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine, produces rapid and sustained antidepressant-like effects in humans and rodents. Recently, we found that the long-lasting effect of ketamine on the forced swim test requires ventral hippocampal (vHipp) activity at the time of drug administration. The medial prefrontal cortex (mPFC), a target of the vHipp dysregulated in depression, is important for cognitive flexibility and response strategy selection. Deficits in cognitive flexibility, the ability to modify thoughts and behaviors in response to changes in the environment, are associated with depression. We have shown that chronic stress impairs cognitive flexibility on the attentional set-shifting test (AST) and induces a shift from active to passive response strategies on the shock-probe defensive burying test (SPDB).

OBJECTIVE

In this study, we tested the effects of ketamine on chronic stress-induced changes in cognitive flexibility and coping behavior on the AST and SPDB, respectively. Subsequently, we investigated vHipp-mPFC plasticity as a potential mechanism of ketamine's therapeutic action.

RESULTS

Ketamine reversed deficits in cognitive flexibility and restored active coping behavior in chronically stressed rats. Further, high frequency stimulation in the vHipp replicated ketamine's antidepressant-like effects on the forced swim test and AST, but not on the SPDB.

CONCLUSION

These results show that ketamine restores cognitive flexibility and coping response strategy compromised by stress. Activity in the vHipp-mPFC pathway may represent a neural substrate for some of the antidepressant-like behavioral effects of ketamine, including cognitive flexibility, but other circuits may mediate the effects of ketamine on coping response strategy.

Predictors of depression among a sample of South African mortuary workers

Mortuary workers are at high risk of developing depression and other psychiatric disorders owing to the nature of their work and exposure to deceased victims of violent deaths. Few studies have investigated mental health among mortuary workers in low- and middle-income countries. Participants (N = 45) were recruited from mortuaries in South Africa and completed a battery of questionnaires measuring depression, physical health, perceived stress, fear of blood/injury/mutilation, and resilience. Participants with self-reported depression and posttraumatic stress disorder (PTSD) comprised 13.3% and 4.4% of the sample, respectively. Inexperienced mortuary workers had a higher prevalence rate of depression (16.7%) compared with experienced workers (9.5%). Prevalence of PTSD did not differ significantly between inexperienced (4.2%) and experienced (4.8%) workers. Physical health, perceived stress, fear of blood/injury/mutilation, and resilience were significant predictors of depression in the combined group (experienced and inexperienced). However, perceived stress was the only significant predictor of depression, in multiple regression, in the combined group. Inexperienced workers had significantly higher levels of blood/injury/mutation fear and depression. Mortuary workers seem to be at increased risk of depression, especially inexperienced workers. Perceived poor health, lower levels of resilience, and blood/injury/mutilation fears may lead to increased perceived stress among mortuary workers, which may, in turn, lead to depression. Interventions focused on promoting mental health may be beneficial to all mortuary workers, and preparatory training related to mental health may be beneficial to inexperienced mortuary workers before occupational uptake.

The influence of life events on first and recurrent admissions in bipolar disorder

Background

Life events play an important role in the onset and course of bipolar disorder. We will test the influence of life events on first and recurrent admissions in bipolar disorder and their interaction to test the kindling hypothesis.

Methods

We collected information about life events and admissions across the life span in 51 bipolar patients. We constructed four models to explore the decay of life event effects on admissions. To test their interaction, we used the Andersen-Gill model.

Results

The relationship between life events and admissions was best described with a model in which the effects of life events gradually decayed by 25% per year. Both life event load and recurrent admissions significantly increased the risk of both first and subsequent admissions. No significant interaction between life event load and number of admissions was found.

Conclusions

Life events increase the risk of both first and recurrent admissions in bipolar disorder. We found no significant interaction between life events and admissions, but the effect of life events on admissions decreases after the first admission which is in line with the kindling hypothesis.

Is the association between high strain work and depressive symptoms modified by private life social support: a cohort study of 1,074 Danish employees?

BACKGROUND

Previous studies have shown that psychosocial working conditions characterized by high psychological demands and low decision latitude (i.e., high strain work) are associated with increased risk of depressive symptoms. Little is known, however, concerning how this association may be modified by factors outside the working environment. This article examines the modifying role of private life social support in the relation between high strain work and the development of severe depressive symptoms.

METHODS

Data were questionnaire-based, collected from a cross-occupational sample of 1,074 Danish employees. At baseline, all participants were free of severe depressive symptoms, measured by the Mental Health Inventory. High strain work was defined by the combination of high psychological demands at work and low control, measured with multi-dimensional scales. Private life social support was operationalized as the number of life domains with confidants and dichotomized as low (0-1 domains) or high (2 or more domains). Using logistic regression we examined the risk of onset of severe depressive symptoms, adjusting for sex, age, occupational position, and prior depressive symptoms.

RESULTS

Separately, neither high strain work nor low private life social support statistically significantly predicted depressive symptoms. However, participants with joint exposure to high strain work and low private life social support had an Odds ratio (OR) for severe depressive symptoms of 3.41 (95% CI: 1.36-8.58), compared to participants with no work strain and high private life social support. There was no increased risk for participants with high strain work and high private life social support (OR = 1.32, 95% CI: 0.65-2.68). The interaction term for departure from additivity was, however, not statistically significant (p = 0.18).

CONCLUSIONS

Our findings suggest that high strain work may increase risk of depressive symptoms in individuals with low private life social support, although the effect-modification was statistically non-significant. Larger studies are needed to further establish the role of private life social support in the relation between high strain work and depression.

Trajectories of depressive symptoms in response to prolonged stress in medical interns

OBJECTIVE

The high degree of heterogeneity in the development of depression under stress is unaccounted for in traditional statistical modeling. We employ growth mixture modeling to identify classes of individuals at highest risk of depression under stress.

METHOD

Medical internship was used as a prospective stress model. Interns from US residency programs completed demographic, psychological, and depressive symptom assessments 2 months prior to internship and at 3-month intervals throughout internship year.

RESULTS

A total of 2278 (59%) of interns chose to take part in the study. Three classes of depressive symptoms were identified: i) Stress-resilient class: 62% of participants report low depressive symptoms before and throughout internship year; ii) Stress-neutral class: 22% of participants report mild depressive symptoms before and throughout internship year; and iii) Stress-sensitive class: 16% of participants report low depressive symptoms before internship stress, and high levels of depressive symptoms throughout internship year. Individuals in the Stress-sensitive class were more likely to be female, in a surgical specialty, and have a history of depression, difficulty early family environment and high-neuroticism scores compared with individuals in the Stress-resilient class.

CONCLUSION

Trajectory-based analysis allows for the identification of a high-risk group, within a heterogeneous population, that accounts for the link between stress and depression.

Does good leadership buffer effects of high emotional demands at work on risk of antidepressant treatment? A prospective study from two Nordic countries

PURPOSE

Emotionally demanding work has been associated with increased risk of common mental disorders. Because emotional demands may not be preventable in certain occupations, the identification of workplace factors that can modify this association is vital. This article examines whether effects of emotional demands on antidepressant treatment, as an indicator of common mental disorders, are buffered by good leadership.

METHODS

We used data from two nationally representative work environment studies, the Danish Work Environment Cohort Study (n = 6,096) and the Swedish Longitudinal Occupational Survey of Health (n = 3,411), which were merged with national registers on antidepressant purchases. All individuals with poor self-reported baseline mental health or antidepressant purchases within 8.7 months before baseline were excluded, and data analysed prospectively. Using Cox regression, we examined hazard ratios (HRs) for antidepressants in relation to the joint effects of emotional demands and leadership quality. Buffering was assessed with Rothman's synergy index. Cohort-specific risk estimates were pooled by random effects meta-analysis.

RESULTS

High emotional demands at work were associated with antidepressant treatment whether quality of leadership was poor (HR = 1.84, 95 % CI 1.32-2.57) or good (HR = 1.70, 95 % CI 1.25-2.31). The synergy index was 0.66 (95 % CI 0.34-1.28).

CONCLUSIONS

Our findings suggest that good leadership does not substantially ameliorate any effects of emotional demands at work on employee mental health. Further research is needed to identify possible preventive measures for this work environment exposure.

Study protocol for examining job strain as a risk factor for severe unipolar depression in an individual participant meta-analysis of 14 European cohorts

BACKGROUND

Previous studies have shown that gainfully employed individuals with high work demands and low control at work (denoted "job strain") are at increased risk of common mental disorders, including depression. Most existing studies have, however, measured depression using self-rated symptom scales that do not necessarily correspond to clinically diagnosed depression. In addition, a meta-analysis from 2008 indicated publication bias in the field.  

METHODS

This study protocol describes the planned design and analyses of an individual participant data meta-analysis, to examine whether job strain is associated with an increased risk of clinically diagnosed unipolar depression based on hospital treatment registers.  The study will be based on data from approximately 120,000 individuals who participated in 14 studies on work environment and health in 4 European countries. The self-reported working conditions data will be merged with national registers on psychiatric hospital treatment, primarily hospital admissions. Study-specific risk estimates for the association between job strain and depression will be calculated using Cox regressions. The study-specific risk estimates will be pooled using random effects meta-analysis.  

DISCUSSION

The planned analyses will help clarify whether job strain is associated with an increased risk of clinically diagnosed unipolar depression. As the analysis is based on pre-planned study protocols and an individual participant data meta-analysis, the pooled risk estimates will not be influenced by selective reporting and publication bias. However, the results of the planned study may only pertain to severe cases of unipolar depression, because of the outcome measure applied.

[Effort-reward imbalance at work and depression: current research evidence]

In view of highly prevalent stressful conditions in modern working life, in particular increasing work pressure and job insecurity, it is of interest to know whether specific constellations of an adverse psychosocial work environment increase the risk of depressive disorder among employed people. This contribution gives a short overview of current research evidence based on an internationally established work stress model of effort-reward imbalance. Taken together, results from seven prospective epidemiological investigations demonstrate a two-fold elevated relative risk of incident depressive disorder over a mean observation period of 2.7 years among exposed versus non-exposed employees. Additional findings from experimental and quasi-experimental studies point to robust associations of effort-reward imbalance at work with proinflammatory cytokines and markers of reduced immune competence. These latter markers may indicate potential psychobiological pathways. In conclusion, incorporating this new knowledge into medical treatment and preventive efforts seems well justified.

Psychosocial work factors, major depressive and generalised anxiety disorders: results from the French national SIP study

BACKGROUND

Anxiety and depression are prevalent mental disorders in working populations. The risk factors of these disorders are not completely well known. Developing knowledge on occupational risk factors for mental disorders appears crucial. This study investigates the association between various classical and emergent psychosocial work factors and major depressive and generalised anxiety disorders in the French working population.

METHODS

The study was based on a national random sample of 3765 men and 3944 women of the French working population (SIP 2006 survey). Major Depressive Disorder (MDD) and Generalised Anxiety Disorder (GAD) were measured using a standardised diagnostic interview (MINI). Occupational factors included psychosocial work factors as well as biomechanical, physical, and chemical exposures. Adjustment variables included age, occupation, marital status, social support, and life events. Multivariate analysis was performed using logistic regression analysis.

RESULTS

Low decision latitude, overcommitment, and emotional demands were found to be risk factors for both MDD-GAD among both genders. Other risk factors were observed: high psychological demands, low reward, ethical conflict, and job insecurity, but differences were found according to gender and outcome. Significant interaction terms were observed suggesting that low decision latitude, high psychological demands, and job insecurity had stronger effects on mental disorders for men than for women.

LIMITATIONS

Given the cross-sectional study design, no causal conclusion could be drawn.

CONCLUSIONS

This study showed significant associations between classical and emergent psychosocial work factors and MDD-GAD. Preventive actions targeting various psychosocial work factors, including emergent factors, may help to reduce mental disorders at the workplace.

Life-event specificity: bipolar disorder compared with unipolar depression

BACKGROUND

Little is known about the impact of different types of stressful events (for example divorce v. bereavement) on unipolar depression compared with bipolar disorder. Inconsistencies exist concerning the association between independent events (beyond an individual's control, such as bereavement) and bipolar disorder.

AIMS

To examine the role of specific, independent and dependent events in mood disorders.

METHOD

Life-event information was collected from 512 people with bipolar disorder, 1448 people with unipolar depression and over 600 controls.

RESULTS

Various events were associated with unipolar depression and bipolar disorder, but some event specificity was detected. For example, financial crisis was more strongly related to bipolar disorder rather than unipolar depression. Independent events were only related to unipolar depression and not bipolar disorder.

CONCLUSIONS

The events that were linked to bipolar disorder and unipolar depression were similar. Independent events were not associated with bipolar episodes, suggesting that life stress may be a consequence of, rather than a trigger for, bipolar episodes.

Development of mental disorders one year after exposure to psychosocial stressors; a cohort study in primary care patients with a physical complaint

BACKGROUND

Mental disorders, common in primary care, are often associated with physical complaints. While exposure to psychosocial stressors and development or presence of principal mental disorders (i.e. depression, anxiety and somatoform disorders defined as multisomatoforme disorders) is commonly correlated, temporal association remains unproven. The study explores the onset of such disorders after exposure to psychosocial stressors in a cohort of primary care patients with at least one physical symptom.

METHOD

The cohort study SODA (SOmatization, Depression and Anxiety) was conducted by 21 private-practice GPs and three fellow physicians in a Swiss academic primary care centre. GPs included patients via randomized daily identifiers. Depression, anxiety or somatoform disorders were identified by the full Patient Health Questionnaire (PHQ), a validated procedure to identify mental disorders based on DSM-IV criteria. The PHQ was also used to investigate exposure to psychosocial stressors (before the index consultation and during follow up) and the onset of principal mental disorders after one year of follow up.

RESULTS

From November 2004 to July 2005, 1020 patients were screened for inclusion. 627 were eligible and 482 completed the PHQ one year later and were included in the analysis (77%). At one year, prevalence of principal mental disorders was 30/153 (19.6% CI95% 13.6; 26.8) for those initially exposed to a major psychosocial stressor and 26/329 (7.9% CI95% 5.2; 11.4) for those not. Stronger association exists between psychosocial stressors and depression (RR = 2.4) or anxiety (RR = 3.5) than multisomatoforme disorders (RR = 1.8). Patients who are "bothered a lot" (subjective distress) by a stressor are therefore 2.5 times (CI95% 1.5; 4.0) more likely to experience a mental disorder at one year. A history of psychiatric comorbidities or psychological treatment was not a confounding factor for developing a principal mental disorder after exposure to psychosocial stressors.

CONCLUSION

This primary care study shows that patients with physical complaints exposed to psychosocial stressors had a higher risk for developing mental disorders one year later. This temporal association opens the field for further research in preventive care for mental diseases in primary care patients.

Psychosocial vulnerabilities to depression after acute coronary syndrome: the pivotal role of rumination in predicting and maintaining depression

Psychosocial vulnerabilities may predispose individuals to develop depression after a significant life stressor, such as an acute coronary syndrome (ACS). The aims are (1) to examine the interrelations among vulnerabilities, and their relation with changes in depressive symptoms 3 months after ACS, (2) to prospectively assess whether rumination interacts with other vulnerabilities as a predictor of later depressive symptoms, and (3) to examine how these relations differ between post-ACS patients who meet diagnostic criteria for depression at baseline versus patients who do not. Within 1 week after hospitalization for ACS, and again after 3 months, 387 patients (41% female, 79.6% white, mean age 61) completed the Beck Depression Inventory (BDI) and measures of vulnerabilities (lack of pleasant events, dysfunctional attitudes, role transitions, poor dyadic adjustment). Exclusion criteria were a BDI score of 5-9, terminal illness, active substance abuse, cognitive impairment, and unavailability for follow-up visits. We used hierarchical regression modeling cross-sectionally and longitudinally. Controlling for baseline (in-hospital) depression and cardiovascular disease severity, vulnerabilities significantly predicted 3 month depression severity. Rumination independently predicted increased depression severity, above other vulnerabilities (β = 0.75, p < 0.001), and also interacted with poor dyadic adjustment (β = 0.32, p < 0.001) to amplify depression severity. Among initially non-depressed patients, the effects of vulnerabilities were amplified by rumination. In contrast, in patients who were already depressed at baseline, there was a direct effect of rumination above vulnerabilities on depression severity. Although all vulnerabilities predict depression 3 months after an ACS event has occurred rumination plays a key role to amplify the impact of vulnerabilities on depression among the initially non-depressed, and maintains depression among those who are already depressed.

Sex differences on emotional processing are modulated by subclinical levels of alexithymia and depression: a preliminary assessment using event-related potentials

Several studies have suggested that women are more sensitive than men to emotions in general. Event-related potential (ERP) studies have demonstrated N2 and P3b modulations, suggesting that women allocate more attentional resources to emotions than men do. However, the exact origin of this emotional modulation by sex is still a matter of debate. We wondered whether these sex differences might be due to some specific personality traits of women and men. Thirty participants (15 males and 15 females) were selected so that there were no sex differences on alexithymia, or depression and anxiety scales. The participants were asked to complete a "modified emotional" oddball task, in which they had to detect deviant stimuli among frequent neutral ones as quickly as possible. Behavioral performance, N2 and P3b ERP data were analyzed. When personality factors were controlled for, the sex differences on N2 and P3b components of the ERPs disappeared. Moreover, linear regression analyses showed that alexithymia was much better than sex at predicting the N2 latencies, while depression was the best factor for predicting the P3b latency. These results suggest that personality factors should be taken into account when sex differences on emotional processing are investigated.

Overtime work as a predictor of major depressive episode: a 5-year follow-up of the Whitehall II study

Background

The association between overtime work and depression is still unclear. This study examined the association between overtime work and the onset of a major depressive episode (MDE).

Methodology/Principal Findings

Prospective cohort study with a baseline examination of working hours, psychological morbidity (an indicator of baseline depression) and depression risk factors in 1991–1993 and a follow-up of major depressive episode in 1997–1999 (mean follow-up 5.8 years) among British civil servants (the Whitehall II study; 1626 men, 497 women, mean age 47 years at baseline). Onset of 12-month MDE was assessed by the Composite International Diagnostic Interview (CIDI) at follow-up. In prospective analysis of participants with no psychological morbidity at baseline, the odds ratio for a subsequent major depressive episode was 2.43 (95% confidence interval 1.11 to 5.30) times higher for those working 11+ hours a day compared to employees working 7–8 hours a day, when adjusted for socio-demographic factors at baseline. Further adjustment for chronic physical disease, smoking, alcohol use, job strain and work-related social support had little effect on this association (odds ratio 2.52; 95% confidence interval 1.12 to 5.65).

Conclusions/Significance

Data from middle-aged civil servants suggest that working long hours of overtime may predispose to major depressive episodes.

Work-related violence and incident use of psychotropics

Although the mental health consequences of domestic violence are well documented, empirical evidence is scarce regarding the mental health effects of violence in the workplace. Most studies have used data from small occupation-specific samples, limiting their generalizability. This article examines whether direct exposure to work-related violence is associated with clinically pertinent mental health problems, measured by purchases of psychotropics (antidepressants, anxiolytics, hypnotics), in a cross-occupational sample of 15,246 Danish employees free from using psychotropics at baseline. Self-reported data on work-related violence were merged with other data on purchases of medications through a national registry to estimate cause-specific hazard ratios during 3.6 years (1,325 days) of follow-up in the years 1996-2008. Outcomes were examined as competing risks, and analyses were adjusted for gender, age, cohabitation, education, income, social support from colleagues, social support from supervisor, and influence and quantitative demands at work. Work-related violence was associated with purchasing antidepressants alone (hazard ratio = 1.38, 95% confidence interval: 1.09, 1.75) or in combination with anxiolytics (hazard ratio = 1.74, 95% confidence interval: 1.13, 2.70) but not with purchasing anxiolytics or hypnotics only. The frequency of violent episodes and risk of caseness were unrelated. Work-related violence is associated with increased risk of clinically pertinent mental health problems. Reducing levels of work-related violence may help to prevent mental disorders in the working population.

Evolutionary theories of depression: a critical review

We critically review evolutionary theories of major depressive disorder (MDD). Because most instances of MDD appear to be caused by adversity, evolutionary theories of MDD generally propose that sadness and low mood evolved as beneficial responses to adversity, and that MDD is dysfunctional sadness and low mood. If so, MDD research should focus much more heavily on understanding the healthy functions of sadness and low mood to better understand how they dysfunction. A debate about the boundary between healthy sadness and MDD is then reviewed. In part, this debate turns on whether MDD's costliest symptoms could provide unknown benefits. Therefore, the review concludes by discussing 2 theories that explore possible benefits of prolonged anhedonia and suicidality.

Can managed care networks improve perinatal mental healthcare for Black and minority ethnic (BME) women?

Purpose

Perinatal mental illness is an important public health issue. Conditions such as postnatal depression increase mothers' risk of suicide and can herald onset of recurrent and chronic mental health problems. Maternal mental illness can also adversely impact the cognitive, physical, and psychological health and development of children. In light of known psychosocial risks, there is concern that fewer than expected women from black and minority ethnic (BME) backgrounds access care and treatment. This paper aims to address this issue.

Design/methodology/approach

Responding to persistent reports of patchy service provision across the UK more generally and particular concerns about potentially unmet needs among BME women, mixed‐method research was undertaken between September 2009 and March 2010. Using survey questionnaires and telephone interviews, the study sought to explore professional stakeholders' perspectives on current perinatal mental health provision and the extent to which it meets the needs of BME women. Findings from the study were intended to inform policy and plans to improve provision by establishing managed care networks (MCNs) for perinatal mental healthcare.

Findings

In total, 45 questionnaires were returned from the national survey. One‐third of respondents (n=14) consented to follow‐up telephone interviews. There was evidence of multi‐agency working among the 27 professional groups which respondents reported as being directly involved in delivering perinatal mental healthcare across the country. However, there was also evidence of disjuncture and poor communication – particularly between statutory and voluntary sectors and NHS primary and secondary care. Some respondents had difficulty defining “BME” or identifying the women to whom the acronym might be applied. They also questioned the validity of providing “BME‐specific” services. Instead, they endorsed more ethnically “inclusive models” of provision and “signposting” women to appropriate “community” services.

Practical implications

Taken together, these findings suggests that whilst there might be a theoretical argument for perinatal mental health MCNs, considerable effort is required if policy‐makers' aspirations for more “joined‐up” services capable of meeting the needs of all women are to be fully realised. Furthermore, current proposals for public sector reform coupled with reduction in voluntary sector provision is likely to disproportionately affect women from BME and other marginalised communities as they provide significant amounts of “below the radar” care and support.

Originality/value

This paper is of particular relevance to policy makers and practitioners. Findings suggest that women from BME backgrounds might be particularly vulnerable to perinatal mental illness. Contraction of voluntary sector provision increases the likelihood that the needs of BME women will remain unmet with deleterious consequences for their health and wellbeing of their families. This has potentially serious public health implications. MCNs/clinical networks have the potential to reduce inequalities by providing more “joined up” care for all women. However, the evidence base for levels of need and appropriate service response to perinatal mental illness among BME women is weak. Further research is required to bridge the evidence gap and to evaluate the impact of health and social care reform on vulnerable groups.

Sex-related memory recall and talkativeness for emotional stimuli

Recent studies have evidenced an increasing interest in sex-related brain mechanisms and cerebral lateralization subserving emotional memory, language processing, and conversational behavior. We used event-related-potentials (ERP) to examine the influence of sex and hemisphere on brain responses to emotional stimuli. Given that the P300 component of ERP is considered a cognitive neuroelectric phenomenon, we compared left and right hemisphere P300 responses to emotional stimuli in men and women. As indexed by both amplitude and latency measures, emotional stimuli elicited more robust P300 effects in the left hemisphere in women than in men, while a stronger P300 component was elicited in the right hemisphere in men compared to women. Our findings show that the variables of sex and hemisphere interacted significantly to influence the strength of the P300 component to the emotional stimuli. Emotional stimuli were also best recalled when given a long-term, incidental memory test, a fact potentially related to the differential P300 waves at encoding. Moreover, taking into account the sex-related differences in language processing and conversational behavior, in the present study we evaluated possible talkativeness differences between the two genders in the recollection of emotional stimuli. Our data showed that women used a higher number of words, compared to men, to describe both arousal and neutral stories. Moreover, the present results support the view that sex differences in lateralization may not be a general feature of language processing but may be related to the specific condition, such as the emotional content of stimuli.

Depression and heavy drinking occasions: a cross-sectional general population study

The purpose of this study was to assess the association between depression and heavy drinking occasions in the Finnish general population. A subsample (2086/4020, response rate 51.9%) of the National FINRISK 2007 Study was used. Depression was assessed with a modified Beck Depression Inventory (short form) and alcohol problems with the Alcohol Use Disorders Identification Test. Total alcohol intake and number of heavy drinking occasions (≥7 drinks for men, ≥5 drinks for women) were evaluated using the Timeline Followback. Of the sample, 13.0% (123/946) of men and 17.4% (198/1140) of women were classified as being depressed. Further, 7.5% (71/946) of men and 3.5% (40/1140) of women reported having at least four heavy drinking occasions in the previous 28days. In an adjusted logistic regression model, these men had a 2.6-fold risk (95% C.I. 1.2-5.3) of depression, as compared to men with less than four heavy drinking occasions. The association was found irrespective of total alcohol consumption and alcohol problems. This association was not found in women.

Symptoms of depression and anxiety, and change in body mass index from adolescence to adulthood: results from a British birth cohort

BACKGROUND

Depression and anxiety have been shown to be associated with obesity and underweight, but little is known about how the relationship varies across the life course, from adolescence through adulthood. We aimed to investigate the association between adolescent- and adult-onset affective symptoms and body mass index (BMI) change from age 15 to 53 years.

METHOD

We used data from a British birth cohort born in 1946 and followed up ever since. The relationship between affective symptom profiles, distinguishing adolescent-onset and adult-onset symptoms, and BMI change from adolescence to age 53 years was investigated using multilevel models.

RESULTS

Women with adolescent-onset symptoms had lower mean BMI at age 15 years, faster rates of increase across adulthood, and higher BMI at age 53 years than those with no symptoms. Men with adolescent-onset symptoms had lower BMI at all ages from 15 to 53 years. The BMI trajectories of men and women with adult-onset symptoms did not differ from those with absence of symptoms at all ages.

CONCLUSIONS

The relationship between affective symptoms and change in BMI varies by sex and age at onset of symptoms. Adolescence may be an important period for the development of the association between affective symptoms and weight gain in girls. Intervention to prevent increases in BMI across adult life in women with adolescent-onset symptoms, even if they are not overweight at this age, should be considered.

Childhood adversities, adulthood life events and depression

BACKGROUND

The role of childhood adversities in predicting adulthood depression has been suggested to be complex and in need of additional comprehensive studies.

AIMS

This investigation set out to examine whether increased exposure to life events (LEs) in adulthood mediates the association between childhood adversities and adulthood depression.

METHODS

This study is based on a random health survey sample from the Finnish working-aged population (n=16,877) with a follow-up of up to 7 years. Depression was identified by Beck Depression Inventory, records of antidepressant prescriptions and hospitalization due to depression obtained from national health registers.

RESULTS

Childhood adversities were associated with an increased likelihood of experiencing a high number of LEs in adulthood and their perceived burdensomeness. The mean number of new LEs correlated significantly (P<0.001) in a dose-response relationship with the number of childhood adversities. Reporting childhood adversities was associated with a 1.28-2.70-fold increase in the odds of depression as indicated by BDI score, a 1.29-1.94-fold increase in the rate of antidepressant prescriptions and a 1.17-4.04-fold increase in the risk of hospitalization due to depression. Adjustment for new LE attenuated these associations by 21-24%, but did not render them insignificant.

CONCLUSIONS

Increased exposure to adult negative life events proximal to adult depression may partially explain the association between childhood adversities and adult depression.

Sensitivity to the depressogenic effect of stress and HPA-axis reactivity in adolescence: a review of gender differences

Adolescence is characterized by major biological, psychological, and social challenges, as well as by an increase in depression rates. This review focuses on the association between stressful experiences and depression in adolescence, and the possible role of the hypothalamus-pituitary-adrenal cortex (HPA-)axis in this link. Adolescent girls have a higher probability to develop depressive symptoms than adolescent boys and preadolescents. Increasing evidence indicates that girls' higher risk of depression is partly brought about by an increased sensitivity for stressful life events, particularly interpersonal stressors, which are highly prevalent in adolescent girls. Genetic risk factors for depression, as well as those for stress sensitivity, are often expressed differently in girls and boys. Also environmental adversity tends to affect girls' stress responses more than those of boys. These gender-specific association patterns have been reported for both sensitivity to stressful life events and HPA-axis responses to social stress. Together, the findings suggest that girls are more malleable than boys in response to internal and external influences. This postulated greater malleability may be adaptive in many circumstances, but also brings along risk, such as an increased probability of depression.

Major depression: the importance of clinical characteristics and treatment response to prognosis

BACKGROUND

This article analyzed data from the intervention arm of a large treatment trial to demonstrate the importance of clinical severity, course, comorbidity, and treatment response in patient prognosis.

METHODS

This is a secondary analysis of data from a large primary care-based geriatric depression treatment trial that analyzes outcomes from the measurement-based stepped-care intervention arm (N=871 patients) to determine: whether increasing severity levels of depression at baseline were linked with other factors associated with poor depression outcomes such as double depression, anxiety, medical disorders, and high levels of neuroticism and pain; and whether patients with increasing levels of depressive severity would have more intervention visits and treatment trials based on a stepped-care algorithm, but would be less likely to reach remission and have a greater likelihood of re-emerging depression in the year after intervention.

RESULTS

Increasing levels of depression severity were a robust predictor of lack of remission and were associated with other clinical variables that have been associated with lack of remission in earlier studies such as double depression, anxiety, medical comorbidity, high neuroticism levels, and chronic pain. Patients with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but had fewer depression-free days during the 12-month intervention and in the postintervention year.

CONCLUSION

Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience.

The early health consequences of smoking: relationship with psychosocial factors among treatment-seeking Black smokers

INTRODUCTION

Blacks suffer disproportionately from the long-term health effects of smoking. Little is known about the prevalence of the early health consequences of smoking in this population or whether psychosocial factors influence the frequency of symptoms. This study investigated the prevalence and psychosocial correlates of smoking-related physical symptoms in Black smokers.

METHODS

Adult smokers (N = 117, 58% female, M(age) = 43.0 years) who smoked at least 5 cigarettes/day completed self-administered assessments of cigarettes smoked per day, smoking duration, alcohol use, perceived stress, depressive symptoms, and smoking-related symptoms.

RESULTS

The most frequently occurring physical symptoms were shortness of breath (66%), coughing (50%), and headaches (49%). Multivariate analyses showed that smoking history, alcohol use, perceived stress, and depressive symptoms were independently related to smoking-related symptoms, even after controlling for sociodemographic variables and medical diagnoses.

DISCUSSION

The early health consequences of smoking appear to be common among Black smokers and can serve as a cue to action for cessation efforts. Alcohol use, stress, and depression appear to negatively influence the early health consequences of smoking and should be assessed routinely in treatment-seeking Black smokers.

'I'm not an outsider, I'm his mother!' A phenomenological enquiry into carer experiences of exclusion from acute psychiatric settings

Contemporary standards and policies advocate carer involvement in planning, implementing, and evaluating mental health services. Critics have questioned why such standards and policies fail to move from rhetoric to reality, this particularly being applicable to carer involvement within acute psychiatric settings. As there is only limited UK research on this topic, this interpretive phenomenological study was undertaken to explore the perceived level of involvement from the perspective of carers of service users who were admitted to acute inpatient settings within the previous 2 years. Interviews were conducted with four individuals who cared for a loved one with a mental illness. The interview analysis was influenced by Van Manen, whose interpretive approach seeks to generate a deeper understanding of the phenomenon under study. Four main themes emerged: powerlessness, feeling isolated, needing to be recognized and valued, and a desire for partnership. The findings reflect the views expressed by carers in other studies, identifying that while carers seek to work in partnership with health-care professionals, at a clinical level they often feel excluded. The study concludes by discussing ways of improving and promoting carer involvement and advocating a partnership in care approach within acute psychiatry.

Ethnic density, physical illness, social deprivation and antidepressant prescribing in primary care: ecological study

BACKGROUND

Antidepressant prescribing should reflect need. The Quality and Outcomes Framework has provided an opportunity to explore factors affecting antidepressant prescribing in UK general practice.

AIMS

To explore the relationship between physical illness, social deprivation, ethnicity, practice characteristics and the volume of antidepressants prescribed in primary care.

METHOD

This was an ecological study using data derived from the Quality and Outcomes Framework, the Informatics Collaboratory of the Social Sciences, and Prescribing Analyses and CosT data for 2004-2005. Associations were examined using linear regression modelling.

RESULTS

Socio-economic status, ethnic density, asthma, chronic obstructive pulmonary disease and epilepsy explained 44% of the variance in the volume of antidepressants prescribed.

CONCLUSIONS

Lower volumes of antidepressants are prescribed in areas with high densities of Black or Asian people. This may suggest disparities in provision of care. Chronic respiratory disease and epilepsy may have a more important association with depression in primary care than previously thought.

Impact of stressors in a natural context on release of cortisol in healthy adult humans: a meta-analysis

Increased hypothalamic-pituitary-adrenal (HPA) activation, culminating in elevated circulating cortisol levels is a fundamental response to stressors. In animals, this neuroendocrine change is highly reliable and marked (approximately 5-10-fold elevations), whereas in humans, the increase of cortisol release is less pronounced, and even some potent life-threatening events (anticipation of surgery) only elicit modest cortisol increases. Meta-analysis of factors that influenced the increase of cortisol release in a laboratory context pointed to the importance of social evaluative threats and stressor controllability in accounting for the cortisol rise. The present meta-analysis, covering the period from 1978 through March 2007, was undertaken to identify the factors most closely aligned with cortisol increases in natural settings. It appeared that stressor chronicity was fundamental in predicting cortisol changes; however, this variable is often confounded by the stressor type, the stressor's controllability, as well as contextual factors, making it difficult to disentangle their relative contributions to the cortisol response. Moreover, several experiential factors (e.g. previous stressor experiences) may influence the cortisol response to ongoing stressors, but these are not readily deduced through a meta-analysis. Nevertheless, there are ample data suggesting that stressful events, through their actions on cortisol levels and reactivity, may influence psychological and physical pathology.

Dying cancer patients' experiences of powerlessness and helplessness

GOALS OF WORK

Experiences of powerlessness and helplessness are closely linked to incurable diseases but seldom studied in patients with disseminated cancer. The aim is to explore the perception, experiences and significance of powerlessness and helplessness, to study triggering factors and to make quantifications.

MATERIALS AND METHODS

One hundred three patients, enrolled in four different palliative home-care settings, completed a questionnaire with both Likert-type questions and open-ended questions. The response rate was 58%, and background data was reported as frequencies, whereas the main material was analysed using a qualitative content analysis.

MAIN RESULTS

Impending death, symptoms, loss of control and autonomy, ignorance, isolation and uncertainty constituted the basis for powerlessness and helplessness, but each factor was reinforced by the occurrence of suddenness, high intensity and/or lengthiness. In total, 65% reported definite experiences of powerlessness and helplessness. These feelings also held a deeper meaning, involving aspects such as existential loneliness and hopelessness. They were ultimately caused by an incapacity to control feelings and cope with the situation related to the impending death. The results are discussed in relation to Cassel's theory of suffering and existential psychology.

A biopsychosocial approach to examining tobacco-related health disparities among racially classified social groups

AIMS

To articulate a broader, multi-causal model that incorporates psychosocial and environmental factors that can differ systematically across racially classified social groups (RCSGs) and impact biological pathways related to the development of tobacco-related diseases.

METHODS

This paper is built upon a review of the existing scientific literature on selected biopsychosocial factors (diet/nutrition, obesity, alcoholic intake, psychosocial stress, occupational/environmental exposures and exposure to other diseases and illnesses) and tobacco use in examining the biological contributions to differences in tobacco-related health outcomes among RCSGs.

FINDINGS

Recent work has focused on RCSG genetic variations as a possible explanation for differences in tobacco-related health disparities. It is argued in this paper that, given the genetic heterogeneity 'within' RCSGs, it is unlikely that across RCSG genetic variations are likely to be the major source of differences impacting biological pathways in tobacco-related health outcomes. The evidence shows that results, even at the level of within-population genetic variations, have been limited and often inconsistent. A conceptual framework is proposed to account for biological pathways related to the development of tobacco-related diseases.

CONCLUSIONS

Determinants of tobacco-related health disparities are not understood clearly. The contribution of biological factors may be important. Current efforts to determine biological differences in tobacco use and related diseases among RCSGs have focused primarily on genetic variations. However, this approach has limitations. An alternative biopsychosocial framework that examines the potential biological mechanisms through which life experiences and behavior might affect tobacco use and health outcomes in these population groups is needed, including those of life-style (e.g. diet/nutrition, obesity, physical exercise, alcohol consumption), psychosocial (e.g. stress and coping), occupational/environmental exposures and the presence of other diseases/illnesses.

Work related violence and threats and the risk of depression and stress disorders

OBJECTIVE

To examine the risk of depression and stress related disorders as a function of occupational exposure to violence and threats.

DESIGN

Population based nested case-control study.

SETTING

All gainfully employed Danes. Cases and controls: 14 166 hospital inpatients and outpatients, aged 18-65, treated for affective or stress related disorders during 1995-1998 selected from The Danish Psychiatric Central Research Register and 58 060 controls matched for age, sex, and time, drawn from Statistics Denmark's Integrated Database for Labour Market Research.

MAIN OUTCOME MEASURE

Clinical psychiatric diagnosis (WHO ICD-10) of affective (F30-39) or stress related (F40-48) disorders compared with controls by the occupation held the year before treatment. The occupation held the year before treatment was used as exposure proxy.

RESULTS

Potential exposure to occupational violence is associated with significantly increased relative risks of both disorders in either sex (women: depression RR 1.45 CI 1.27 to 1.65, stress RR 1.32 CI 1.19 to 1.46; men: depression RR 1.48 CI 1.18 to 1.86, stress RR 1.55 CI 1.29 to 1.84). Work related threats are associated with increase in the risk of depression in women (RR 1.48 CI 1.23 to 1.79) and the risk of stress related disorders in men (RR 1.59 CI 1.32 to 1.91). Risks rose with increasing prevalence of violence and threats. The results remain significant and only slightly attenuated after controlling for extent of professional contact with people other than colleagues.

CONCLUSIONS

Employment in occupations involving exposure to work related threats and violence is a risk factor for depression and stress related disorders in both sexes. These findings have implications for health and safety at work policies.

Is there an association between the use of oral contraception and depressive symptoms in young Australian women?

PURPOSE

The purpose of this study was to explore the relationship between oral contraceptive pill (OCP) use and the experience of depressive symptoms among a representative sample of young Australian women.

METHODS

The study sample comes from the Australian Longitudinal Study on Women's Health. Analysis was confined to women in the youngest cohort who responded to Survey 2, which was conducted in 2000 (n=9688) when they were aged between 22 and 27 years, and to Survey 3, which was conducted in 2003 (n=9081) when they were aged between 25 and 30 years.

RESULTS

After adjusting for potential confounders, the odds of a nonuser experiencing depressive symptoms is not significantly different from that of an OCP user [odds ratio=1.05; 95% confidence interval (95% CI)=0.90-1.21]. Women who used OCP for reasons other than contraception were 1.32 (95% CI=1.07-1.62) times as likely to be depressed than women who used OCP for contraception. The percentage of women who reported experiencing depressive symptoms declined as the number of years of OCP use increased (p=.009).

CONCLUSIONS

The results of this study suggest that, after adjusting for confounders, there is no independent effect of OCP use on depressive symptoms in young Australian women.