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González-García I, Visser M. A Semantic Cognition Contribution to Mood and Anxiety Disorder Pathophysiology. Healthcare (Basel) 2023; 11:healthcare11060821. [PMID: 36981478 PMCID: PMC10047953 DOI: 10.3390/healthcare11060821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
Over the last two decades, the functional role of the bilateral anterior temporal lobes (bATLs) has been receiving more attention. They have been associated with semantics and social concept processing, and are regarded as a core region for depression. In the past, the role of the ATL has often been overlooked in semantic models based on functional magnetic resonance imaging (fMRI) due to geometric distortions in the BOLD signal. However, previous work has unequivocally associated the bATLs with these higher-order cognitive functions following advances in neuroimaging techniques to overcome the geometric distortions. At the same time, the importance of the neural basis of conceptual knowledge in understanding mood disorders became apparent. Theoretical models of the neural basis of mood and anxiety disorders have been classically studied from the emotion perspective, without concentrating on conceptual processing. However, recent work suggests that the ATL, a brain region underlying conceptual knowledge, plays an essential role in mood and anxiety disorders. Patients with anxiety and depression often cope with self-blaming biases and guilt. The theory is that in order to experience guilt, the brain needs to access the related conceptual information via the ATL. This narrative review describes how aberrant interactions of the ATL with the fronto–limbic emotional system could underlie mood and anxiety disorders.
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Sooner is Better: Longitudinal Relations Between Delay Discounting, and Depression and Anxiety Symptoms among Vietnamese Adolescents. Res Child Adolesc Psychopathol 2023; 51:133-147. [PMID: 35920957 DOI: 10.1007/s10802-022-00959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
Delay discounting refers to the decline in the present value of an outcome as a function of the delay to its receipt. Research on delay discounting initially focused on substance abuse, generally finding that greater delay discounting is associated with increased risk for and severity of substance abuse. More recently, delay discounting has been linked theoretically and empirically to affective psychopathology, potentially suggesting novel intervention targets for mental health problems such as depression and anxiety. Longitudinal research consequently is critical to determine direction of causality and rule out possible third variable explanations. Only a small number of longitudinal studies have been conducted in this area, however. Furthermore, socio-economic and socio-cultural factors may influence delay discounting and its effects, but thus far the literature is relatively limited in this regard. The present study focused on adolescence, a key time-period for development of delay discounting and emotional problems. Longitudinal relations between delay discounting, and depression and anxiety symptoms were assessed among 414 adolescents in Vietnam, a lower-middle-income Southeast Asian nation with significant cultural divergence from Western countries. In contrast to most cross-sectional studies that have found positive or non-significant correlations, in the present study delay discounting at Time 1 had a negative beta with anxiety and depression symptoms at Time 1, with preference for immediate but smaller rewards (higher discounting) at Time 1 associated with lower anxiety and depression symptoms at Time 2. These results suggest that under certain circumstances, steeper delay discounting may be adaptive and supportive of emotional mental health.
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Volz HP, Bartečků E, Bartova L, Bessa J, De Berardis D, Dragasek J, Kozhuharov H, Ladea M, Lazáry J, Roca M, Usov G, Wichniak A, Godman B, Kasper S. Sick leave duration as a potential marker of functionality and disease severity in depression. Int J Psychiatry Clin Pract 2022; 26:406-416. [PMID: 35373692 DOI: 10.1080/13651501.2022.2054350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression.Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic.Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity.Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key pointsDepression in the working population and depression-related sick leave have a profound economic impact on societyDepression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditionsA wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to workIn terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapyAlthough depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measuresDepression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.
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Affiliation(s)
- Hans-Peter Volz
- Department of Psychotherapy and Psychosomatic Medicine, Hospital for Psychiatry, Werneck, Germany
| | - Elis Bartečků
- Department of Psychiatry, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy (Division of General Psychiatry), Medical University of Vienna, Vienna, Austria
| | - João Bessa
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital "G. Mazzini", Teramo, Italy
| | - Jozef Dragasek
- First Department of Psychiatry, Pavol Jozef Šafárik University and University Hospital, Košice, Slovakia
| | - Hristo Kozhuharov
- Department of Psychiatry, University Hospital, "St. Marina", Varna, Bulgaria
| | - Maria Ladea
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Judit Lazáry
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Miquel Roca
- School of Medicine, Son Espases University Hospital, IUNICS/IDISBA, University of Balearic Islands, Palma de Mallorca, Spain
| | | | - Adam Wichniak
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy (Division of General Psychiatry), Medical University of Vienna, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Carlson DS, Thompson MJ, Hackney KJ, Crawford WS. With a little help from my (her) friends: The role of friend support on the negative effects of work engagement for married couples. JOURNAL OF VOCATIONAL BEHAVIOR 2021. [DOI: 10.1016/j.jvb.2021.103539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee Y, Rosenblat JD, Lee J, Carmona NE, Subramaniapillai M, Shekotikhina M, Mansur RB, Brietzke E, Lee JH, Ho RC, Yim SJ, McIntyre RS. Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review. J Affect Disord 2018; 227:406-415. [PMID: 29154157 DOI: 10.1016/j.jad.2017.11.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/11/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Work-related disability and productivity loss in Major Depressive Disorder (MDD) are critical determinants of patient quality of life and contribute significantly to the human and economic costs of MDD. Notwithstanding the return to work and pre-morbid levels of functioning as a critical therapeutic objective among individuals with MDD, it is unclear whether antidepressant treatment significantly and reliably improves measures of workplace functioning. Herein, we investigate to what extent antidepressant treatment improves workplace functioning among adults with MDD. METHODS We conducted a systematic review of randomized, double-blind, placebo-controlled or active comparator clinical trials primarily or secondarily investigating the efficacy of antidepressant agents on subjective ratings of workplace functioning and/or measures of work absence. RESULTS Thirteen placebo-controlled and four active comparator clinical trials reported on the efficacy of agomelatine, bupropion, desvenlafaxine, duloxetine, fluoxetine, levomilnacipran, paroxetine, sertraline, venlafaxine, or vortioxetine on subjective measures of workplace impairment. Overall, antidepressant treatment improved standardized measures of workplace functioning (e.g., Sheehan Disability Scale-work item). One placebo-controlled trial of agomelatine and one clinical trial comparing the efficacy of vortioxetine to that of venlafaxine had mixed results on measures of work absence. LIMITATIONS Included interventional trials evaluated work-related disability as a secondary outcome using subjective rating scales. CONCLUSION Extant data suggest that antidepressant treatment improves workplace outcomes in MDD. The capability of antidepressants in improving measures of workplace functioning should be considered in cost-benefit analyses to better inform cost-modelling studies pertaining to antidepressant therapy.
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Affiliation(s)
- Yena Lee
- Institute of Medical Science, University of Toronto, Toronto, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - JungGoo Lee
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea; Department of Health Science and Technology, Graduate School, Inje University, Busan, Republic of Korea; Department of Psychiatry, School of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Nicole E Carmona
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | | | - Margarita Shekotikhina
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Elisa Brietzke
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Jae-Hon Lee
- Department of Psychiatry, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Samantha J Yim
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Roger S McIntyre
- Institute of Medical Science, University of Toronto, Toronto, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada.
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Szigethy E, Solano F, Wallace M, Perry DL, Morrell L, Scott K, Bell MJ, Oser M. A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive-behavioural programme with integrated coaching for anxious adults in primary care. BMJ Open 2018; 8:e019108. [PMID: 29331971 PMCID: PMC5781102 DOI: 10.1136/bmjopen-2017-019108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Generalised anxiety disorder (GAD) and subclinical GAD are highly prevalent in primary care. Unmanaged anxiety worsens quality of life in patients seen in primary care practices and leads to increased medical utilisation and costs. Programmes that teach patients cognitive-behavioural therapy (CBT) techniques have been shown to improve anxiety and to prevent the evolution of anxiety symptoms to disorders, but access and engagement have hampered integration of CBT into medical settings. METHODS AND ANALYSIS This pragmatic study takes place in University of Pittsburgh Medical Center primary care practices to evaluate a coach-supported mobile cognitive- behavioural programme (Lantern) on anxiety symptoms and quality of life. Clinics were non-randomly assigned to either enhanced treatment as usual or Lantern. All clinics provide electronic screening for anxiety and, within clinics assigned to Lantern, patients meeting a threshold level of mild anxiety (ie, >5 on Generalised Anxiety Disorder 7-Item Questionnaire (GAD-7)) are referred to Lantern. The first study phase is aimed at establishing feasibility, acceptability and effectiveness. The second phase focuses on long-term impact on psychosocial outcomes, healthcare utilisation and clinic/provider adoption/sustainable implementation using a propensity score matched parallel group study design. Primary outcomes are changes in anxiety symptoms (GAD-7) and quality of life (Short-Form Health Survey) between baseline and 6-month follow-ups, comparing control and intervention. Secondary outcomes include provider and patient satisfaction, patient engagement, durability of changes in anxiety symptoms and quality of life over 12 months and the impact of Lantern on healthcare utilisation over 12 months. Patients from control sites will be matched to the patients who use the mobile app. ETHICS AND DISSEMINATION Ethics and human subject research approval were obtained. A data safety monitoring board is overseeing trial data and ethics. Results will be communicated to participating primary care practices, published and presented at clinical and scientific conferences. TRIAL REGISTRATION NUMBER NCT03035019.
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Affiliation(s)
- Eva Szigethy
- Department of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Francis Solano
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meredith Wallace
- Department of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dina L Perry
- UPMC Health Services Division, UPMC Community Medicine Inc, Renaissance Family Practice UPMC, Pittsburgh, Pennsylvania, USA
| | | | - Kathryn Scott
- Consumer Health UPMC Enterprises, Pittsburgh, Pennsylvania, USA
| | - Megan Jones Bell
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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Jha MK, Minhajuddin A, Greer TL, Carmody T, Rush AJ, Trivedi MH. Early Improvement in Work Productivity Predicts Future Clinical Course in Depressed Outpatients: Findings From the CO-MED Trial. Am J Psychiatry 2016; 173:1196-1204. [PMID: 27523501 PMCID: PMC5895453 DOI: 10.1176/appi.ajp.2016.16020176] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Depression symptom severity, the most commonly studied outcome in antidepressant treatment trials, accounts for only a small portion of burden related to major depression. While lost work productivity is the biggest contributor to depression's economic burden, few studies have systematically evaluated the independent effect of treatment on work productivity and the relationship between changes in work productivity and longer-term clinical course. METHOD Work productivity was measured repeatedly by the Work Productivity and Activity Impairment self-report questionnaire in 331 employed participants with major depression enrolled in the Combining Medications to Enhance Depression Outcomes trial. Trajectories of change in work productivity during the first 6 weeks of treatment were identified and used to predict remission at 3 and 7 months. RESULTS Participants reported reduced absence from work and increased work productivity with antidepressant treatment even after controlling for changes in depression severity. Three distinct trajectories of changes in work productivity were identified: 1) robust early improvement (24%), 2) minimal change (49%), and 3) high-impairment slight reduction (27%). Compared with other participants, those with robust improvement had 3-5 times higher remission rates at 3 months and 2-5 times higher remission rates at 7 months, even after controlling for select baseline variables and remission status at week 6. CONCLUSIONS In this secondary analysis, self-reported work productivity improved in depressed patients with antidepressant treatment even after accounting for depressive symptom reduction. Early improvement in work productivity is associated with much higher remission rates after 3 and 7 months of treatment.
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Affiliation(s)
- Manish K Jha
- From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore
| | - Abu Minhajuddin
- From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore
| | - Tracy L Greer
- From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore
| | - Thomas Carmody
- From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore
| | - A John Rush
- From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore
| | - Madhukar H Trivedi
- From the Departments of Psychiatry and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas; and the National University of Singapore, Singapore
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Onukwugha E, Qi R, Jayasekera J, Zhou S. Cost Prediction Using a Survival Grouping Algorithm: An Application to Incident Prostate Cancer Cases. PHARMACOECONOMICS 2016; 34:207-16. [PMID: 26714688 DOI: 10.1007/s40273-015-0368-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Prognostic classification approaches are commonly used in clinical practice to predict health outcomes. However, there has been limited focus on use of the general approach for predicting costs. We applied a grouping algorithm designed for large-scale data sets and multiple prognostic factors to investigate whether it improves cost prediction among older Medicare beneficiaries diagnosed with prostate cancer. METHODS We analysed the linked Surveillance, Epidemiology and End Results (SEER)-Medicare data, which included data from 2000 through 2009 for men diagnosed with incident prostate cancer between 2000 and 2007. We split the survival data into two data sets (D0 and D1) of equal size. We trained the classifier of the Grouping Algorithm for Cancer Data (GACD) on D0 and tested it on D1. The prognostic factors included cancer stage, age, race and performance status proxies. We calculated the average difference between observed D1 costs and predicted D1 costs at 5 years post-diagnosis with and without the GACD. RESULTS The sample included 110,843 men with prostate cancer. The median age of the sample was 74 years, and 10% were African American. The average difference (mean absolute error [MAE]) per person between the real and predicted total 5-year cost was US$41,525 (MAE US$41,790; 95% confidence interval [CI] US$41,421-42,158) with the GACD and US$43,113 (MAE US$43,639; 95% CI US$43,062-44,217) without the GACD. The 5-year cost prediction without grouping resulted in a sample overestimate of US$79,544,508. CONCLUSION The grouping algorithm developed for complex, large-scale data improves the prediction of 5-year costs. The prediction accuracy could be improved by utilization of a richer set of prognostic factors and refinement of categorical specifications.
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Affiliation(s)
- Eberechukwu Onukwugha
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA.
| | - Ran Qi
- Department of Computer Science and Electrical Engineering, University of Maryland Baltimore County, Catonsville, MD, USA
| | - Jinani Jayasekera
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Baltimore, MD, 21201, USA
| | - Shujia Zhou
- Department of Computer Science and Electrical Engineering, University of Maryland Baltimore County, Catonsville, MD, USA
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