1
|
Luo M. Social Isolation, Loneliness, and Depressive Symptoms: A Twelve-Year Population Study of Temporal Dynamics. J Gerontol B Psychol Sci Soc Sci 2023; 78:280-290. [PMID: 36315577 PMCID: PMC9938924 DOI: 10.1093/geronb/gbac174] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Social isolation and loneliness are two different aspects of social connections. Whether social isolation and loneliness precede depressive symptoms, or depressive symptoms precede feelings of loneliness and social isolation, or both, has not been fully established. This study aims to examine the possible reciprocity in the relationship between the two aspects of social connections and depressive symptoms among middle-aged and older adults. METHOD This study analyzed four waves of data (2008-2016) from the Health and Retirement Study (N = 5,393 individuals) and investigated within-person level cross-lagged associations of social isolation and loneliness with depressive symptoms using random intercept cross-lagged panel models. RESULTS This study revealed a unidirectional relationship between social isolation and depressive symptoms and a bidirectional relationship between loneliness and depressive symptoms at the within-person level. Specifically, net of trait levels and prior states, earlier state depressive symptoms predicted future state social isolation. That is, when adults feel depressed more frequently than they usually do, they are more likely to be socially disconnected than usual at a later time. In the reverse direction, earlier state social isolation did not predict future state depressive symptoms. Within-person deviation in prior expected depressive symptoms predicted deviation in expected loneliness 4 years later and vice versa. Moreover, the strength of the two cross-lagged effects did not differ. DISCUSSION Social isolation and loneliness are linked to depressive symptoms differently. Though depressive symptoms might be a potential antecedent of social isolation, they might be both a potential antecedent and an outcome of loneliness.
Collapse
Affiliation(s)
- Mengsha Luo
- Department of Sociology, Zhejiang University, Hangzhou, China
| |
Collapse
|
2
|
Rodriguez-Sanchez J, Lewis G, Solmi F, Bone JK, Moore M, Wiles N, Harmer CJ, Duffy L, Lewis G. Neuropsychological markers of antidepressant action: a secondary analysis of the ANTLER randomised controlled trial. Psychol Med 2023; 53:1-8. [PMID: 36727498 PMCID: PMC10600933 DOI: 10.1017/s0033291722003981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/17/2022] [Accepted: 12/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Antidepressants have been proposed to act via their influence on emotional processing. We investigated the effect of discontinuing maintenance antidepressant treatment on positive and negative self-referential recall and the association between self-referential recall and risk of relapse. METHODS The ANTLER trial was a large (N = 478) pragmatic double-blind trial investigating the clinical effectiveness of long-term antidepressant treatment for preventing relapse in primary care patients. Participants were randomised to continue their maintenance antidepressants or discontinue via a taper to placebo. We analysed memory for positive and negative personality descriptors, assessed at baseline, 12- and 52-week follow-up. RESULTS The recall task was completed by 437 participants. There was no evidence of an effect of discontinuation on self-referential recall at 12 [positive recall ratio 1.00, 95% CI (0.90-1.11), p = 0.93; negative recall ratio 1.00 (0.87-1.14), p = 0.87] or 52 weeks [positive recall ratio 1.03 (0.91-1.17), p = 0.62; negative recall ratio 1.00 (0.86-1.15), p = 0.96; ratios larger than one indicate higher recall in the discontinuation group], and no evidence of an association between recall at baseline or 12 weeks and later relapse [baseline, positive hazard ratio (HR) 1.02 (0.93-1.12), p = 0.74; negative HR 1.01 (0.90-1.13), p = 0.87; 12 weeks, positive HR 0.99 (0.89-1.09), p = 0.81; negative HR 0.98 (0.84-1.14), p = 0.78; ratios larger than one indicate a higher frequency of relapse in those with higher recall]. CONCLUSIONS We found no evidence that discontinuing long-term antidepressants altered self-referential recall or that self-referential recall was associated with risk of relapse. These findings suggest that self-referential recall is not a neuropsychological marker of antidepressant action.
Collapse
Affiliation(s)
| | | | | | - Jessica K. Bone
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL, London, UK
| | - Michael Moore
- Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Catherine J. Harmer
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | | |
Collapse
|
3
|
Lewis G, Srinivasan R, Roiser J, Blakemore SJ, Flouri E, Lewis G. Risk-taking to obtain reward: sex differences and associations with emotional and depressive symptoms in a nationally representative cohort of UK adolescents. Psychol Med 2022; 52:2805-2813. [PMID: 33431091 PMCID: PMC9647510 DOI: 10.1017/s0033291720005000] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/13/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cognitive mechanisms that characterize or precede depressive symptoms are poorly understood. We investigated cross-sectional and longitudinal associations between risk taking to obtain reward and adolescent depressive symptoms in a large prospective cohort, using the Cambridge Gambling Task (CGT). We also explored sex differences. METHODS The Millennium Cohort Study (MCS) is an ongoing UK study, following the lives of 19 000 individuals born 2000/02. The CGT was completed at ages 11 (n = 12 355) and 14 (n = 10 578). Our main exposure was the proportion of points gambled, when the odds of winning were above chance (risk-taking to obtain reward). Outcomes were emotional symptoms (Strengths and Difficulties Questionnaire, SDQ) at age 11 and depressive symptoms (short Mood and Feelings Questionnaire, sMFQ) at age 14. We calculated cross-sectional and longitudinal associations, using linear regressions. RESULTS In univariable models, there was evidence of cross-sectional associations between risk-taking and SDQ/sMFQ scores, but these associations disappeared after we adjusted for sex. Longitudinally, there was weak evidence of an association between risk-taking and depressive symptoms in females only [a 20-point increase in risk-taking at age 11 was associated with a reduction of 0.31 sMFQ points at age 14 (95% CI -0.60 to -0.02)]. At both time-points, females were less risk-taking than males. CONCLUSIONS We found no convincing evidence of a relationship between risk-taking to obtain reward and depressive symptoms. There were large sex differences in risk-taking, but these do not appear to contribute to the female preponderance of depressive symptoms in adolescence.
Collapse
Affiliation(s)
- Gemma Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Ramya Srinivasan
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Jonathan Roiser
- Division of Psychology & Language Sciences, Institute of Cognitive Neuroscience, University College London, London, UK
| | - Sarah-Jayne Blakemore
- Department of Psychology, Division of Psychology & Language Sciences, University of Cambridge; and Institute of Cognitive Neuroscience, University College London, London, UK
| | - Eirini Flouri
- IOE – Psychology & Human Development, UCL Institute of Education, London, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| |
Collapse
|
4
|
Ahmed N, Bone JK, Lewis G, Freemantle N, Harmer CJ, Duffy L, Lewis G. The effect of sertraline on emotional processing: secondary analyses of the PANDA randomised controlled trial. Psychol Med 2022; 52:2814-2821. [PMID: 33431087 PMCID: PMC9647512 DOI: 10.1017/s0033291720004985] [Citation(s) in RCA: 3] [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] [Received: 06/26/2020] [Revised: 10/29/2020] [Accepted: 11/30/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND According to the cognitive neuropsychological model, antidepressants reduce symptoms of depression and anxiety by increasing positive relative to negative information processing. Most studies of whether antidepressants alter emotional processing use small samples of healthy individuals, which lead to low statistical power and selection bias and are difficult to generalise to clinical practice. We tested whether the selective serotonin reuptake inhibitor (SSRI) sertraline altered recall of positive and negative information in a large randomised controlled trial (RCT) of patients with depressive symptoms recruited from primary care. METHODS The PANDA trial was a pragmatic multicentre double-blind RCT comparing sertraline with placebo. Memory for personality descriptors was tested at baseline and 2 and 6 weeks after randomisation using a computerised emotional categorisation task followed by a free recall. We measured the number of positive and negative words correctly recalled (hits). Poisson mixed models were used to analyse longitudinal associations between treatment allocation and hits. RESULTS A total of 576 participants (88% of those randomised) completed the recall task at 2 and 6 weeks. We found no evidence that positive or negative hits differed according to treatment allocation at 2 or 6 weeks (adjusted positive hits ratio = 0.97, 95% CI 0.90-1.05, p = 0.52; adjusted negative hits ratio = 0.99, 95% CI 0.90-1.08, p = 0.76). CONCLUSIONS In the largest individual placebo-controlled trial of an antidepressant not funded by the pharmaceutical industry, we found no evidence that sertraline altered positive or negative recall early in treatment. These findings challenge some assumptions of the cognitive neuropsychological model of antidepressant action.
Collapse
Affiliation(s)
- Norin Ahmed
- Division of Psychiatry, University College London, Faculty of Brain Sciences, London, UK
| | - Jessica K. Bone
- Division of Psychiatry, University College London, Faculty of Brain Sciences, London, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, Faculty of Brain Sciences, London, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Catherine J. Harmer
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Larisa Duffy
- Division of Psychiatry, University College London, Faculty of Brain Sciences, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, Faculty of Brain Sciences, London, UK
| |
Collapse
|
5
|
de Angel V, Lewis S, Munir S, Matcham F, Dobson R, Hotopf M. Using digital health tools for the Remote Assessment of Treatment Prognosis in Depression (RAPID): a study protocol for a feasibility study. BMJ Open 2022; 12:e059258. [PMID: 35523486 PMCID: PMC9083394 DOI: 10.1136/bmjopen-2021-059258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Digital health tools such as smartphones and wearable devices could improve psychological treatment outcomes in depression through more accurate and comprehensive measures of patient behaviour. However, in this emerging field, most studies are small and based on student populations outside of a clinical setting. The current study aims to determine the feasibility and acceptability of using smartphones and wearable devices to collect behavioural and clinical data in people undergoing therapy for depressive disorders and establish the extent to which they can be potentially useful biomarkers of depression and recovery after treatment. METHODS AND ANALYSIS This is an observational, prospective cohort study of 65 people attending psychological therapy for depression in multiple London-based sites. It will collect continuous passive data from smartphone sensors and a Fitbit fitness tracker, and deliver questionnaires, speech tasks and cognitive assessments through smartphone-based apps. Objective data on sleep, physical activity, location, Bluetooth contact, smartphone use and heart rate will be gathered for 7 months, and compared with clinical and contextual data. A mixed methods design, including a qualitative interview of patient experiences, will be used to evaluate key feasibility indicators, digital phenotypes of depression and therapy prognosis. Patient and public involvement was sought for participant-facing documents and the study design of the current research proposal. ETHICS AND DISSEMINATION Ethical approval has been obtained from the London Westminster Research Ethics Committee, and the Health Research Authority, Integrated Research Application System (project ID: 270918). Privacy and confidentiality will be guaranteed and the procedures for handling, processing, storage and destruction of the data will comply with the General Data Protection Regulation. Findings from this study will form part of a doctoral thesis, will be presented at national and international meetings or academic conferences and will generate manuscripts to be submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/PMYTA.
Collapse
Affiliation(s)
- Valeria de Angel
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Serena Lewis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Sara Munir
- Lewisham Talking Therapies, South London and Maudsley NHS Foundation Trust, London, UK
| | - Faith Matcham
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard Dobson
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Hobbs C, Vozarova P, Sabharwal A, Shah P, Button K. Is depression associated with reduced optimistic belief updating? ROYAL SOCIETY OPEN SCIENCE 2022; 9:190814. [PMID: 35127107 PMCID: PMC8808098 DOI: 10.1098/rsos.190814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/07/2022] [Indexed: 05/04/2023]
Abstract
When asked to evaluate their probability of experiencing a negative life event, healthy individuals update their beliefs more following good news than bad. This is referred to as optimistic belief updating. By contrast, individuals with depression update their beliefs by a similar amount, showing reduced optimism. We conducted the first independent replication of this effect and extended this work to examine whether reduced optimistic belief updating in depression also occurs for positive life events. Replicating previous research, healthy and depression groups differed in belief updating for negative events (β = 0.71, 95% CI: 0.24, 1.18). Whereas healthy participants updated their beliefs more following good news than bad, individuals experiencing depression lacked this bias. However, our findings for positive events were inconclusive. While we did not find statistical evidence that patterns of belief updating between groups varied by valence (β = -0.51, 95% CI: -1.16, 0.15), mean update scores suggested that both groups showed largely similar updating for positive life events. Our results add confidence to previous findings that depression is characterized by negative future expectations maintained by reduced updating in response to good news. However, further research is required to understand the specificity of this to negative events, and into refining methods for quantifying belief updating in clinical and non-clinical research.
Collapse
Affiliation(s)
- Catherine Hobbs
- Department of Psychology, University of Bath, 10 West, Bath BA2 7AY
| | - Petra Vozarova
- Department of Psychology, University of Bath, 10 West, Bath BA2 7AY
| | | | - Punit Shah
- Department of Psychology, University of Bath, 10 West, Bath BA2 7AY
| | - Katherine Button
- Department of Psychology, University of Bath, 10 West, Bath BA2 7AY
| |
Collapse
|
7
|
Hager NM, Judah MR, Rawls E. Win, lose, or draw: Examining salience, reward memory, and depression with the reward positivity. Psychophysiology 2022; 59:e13953. [PMID: 34637149 PMCID: PMC8633076 DOI: 10.1111/psyp.13953] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/03/2023]
Abstract
The reward positivity (RewP) is a putative biomarker of depression. Careful control of stimulus properties and manipulation of both stimulus valence and salience could facilitate interpretation of the RewP. RewP interpretation could further be improved by investigating functional outcomes of a blunted RewP in depression, such as reduced memory for rewarding outcomes. This study sought to advance RewP interpretation first by advancing task design through use of neutral (i.e., draw) control trials and counterbalanced feedback stimuli. Second, we examined the RewP's association with memory and the impact of depression. Undergraduates completed self-report measures of depression and anhedonia prior to a modified doors task in which words were displayed in colored fonts that indicated win, loss, or draw feedback. Memory of the feedback associated with each word (i.e., source memory) was tested. Results showed that RewP response to wins was more positive than to losses, which was more positive than to draws. The RewP was not associated with depression or anhedonia. The low depression group showed a source memory advantage for win words, but the high depression group did not. Source memory showed small relations to the RewP, but these did not survive Bonferroni correction. Results suggest the RewP is sensitive to salience and highlight challenges in detecting an association between the RewP and depression in modified doors tasks. Findings indicate that depression is related to dysfunctional source memory for reward but not loss and that future research should probe the possible associations between the RewP and memory in depression.
Collapse
Affiliation(s)
- Nathan M. Hager
- Old Dominion University
- Virginia Consortium Program in Clinical Psychology
| | | | | |
Collapse
|
8
|
Katyal J, Rashid H, Tripathi M, Sood M. Prevalence of depression and suicidal ideation in persons with epilepsy during the COVID-19 pandemic: A longitudinal study from India. Epilepsy Behav 2021; 124:108342. [PMID: 34627069 PMCID: PMC8450275 DOI: 10.1016/j.yebeh.2021.108342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES COVID-19 pandemic has disrupted healthcare services for chronic disorders such as epilepsy. In this study, the impact of COVID-19 pandemic on persons with epilepsy (PWE) with regard to their seizure control, depression status, and medication adherence was assessed. METHODS After ethical clearance, 449 PWE who had been previously evaluated for depression at All India Institute of Medical Sciences (AIIMS), New Delhi, India, were telephonically revaluated using Mini International Neuropsychiatric Interview and surveyed for source of medication and medication adherence over past 6 months. The prevalence and the association of depression, suicidality, and seizures during pandemic with different PWE variables were determined. RESULTS Out of 449 PWE, 70.6% responded. 19.9% were diagnosed positive for depression as per MINI while suicidal ideation was observed in 5.4%. Seventy six (23.9%) PWE reported seizures during pandemic. The incidence was greater in females, unemployed, previously uncontrolled epilepsy, polytherapy, altered use of medications, and depressed PWE. Seizure during pandemic, increased seizure frequency, previous history of depression, and altered use of medications were all significantly associated with depression during COVID-19 pandemic (2.6-95%CI, 1.45-4.73; 1.9-95%CI, 1.01-3.57; 8.8-95%CI, 4.54-17.21; 2.9-95%CI, 1.19-7.24), and polytherapy (2.9-95%CI, 0.92-9.04), seizures during pandemic (3.9-95%CI, 1.45-10.53) and previous history of depression and suicidality, were related with suicidal ideation. CONCLUSION COVID-19 pandemic-induced disruptions can be detrimental for PWE, and restoring services to the precovid levels as well as putting appropriate continuity plans in place for care of PWE should be a priority.
Collapse
Affiliation(s)
- Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
9
|
Woods A, Solomonov N, Liles B, Guillod A, Kales HC, Sirey JA. Perceived Social Support and Interpersonal Functioning as Predictors of Treatment Response Among Depressed Older Adults. Am J Geriatr Psychiatry 2021; 29:843-852. [PMID: 33419660 PMCID: PMC8255325 DOI: 10.1016/j.jagp.2020.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Social isolation is highly common in late life and is associated with devastating mental health and physical outcomes. This study investigated whether components of social isolation (marital status, perceived social support, and interpersonal problems) predict change in depression severity over the course of a brief adherence intervention delivered in a primary care setting. METHOD A sample of 189 older adults with major depressive disorder were randomized to either an adherence intervention, "Treatment Initiation Program," or treatment as usual. Marital status, perceived social support and interpersonal problems were assessed at baseline. A mixed-effects regression was used to test whether these factors predicted the change trajectory in depression severity over 24 weeks. RESULTS Being married (F(2,176) = 6.60; p = 0.001), reporting higher perceived social support (F(2,177) = 4.70; p = 0.01), and fewer interpersonal problems (F(2, 176) = 4.34; p = 0.01) predicted lower depression severity on average over the course of 24 weeks. CONCLUSION Social variables such as living in partnership, perceiving others as supportive, and reporting few interpersonal problems may reduce older adults' vulnerability to depression and enhance their ability to benefit from treatment. These findings can guide development of interventions that will target these social factors early in treatment to increase efficacy.
Collapse
|
10
|
Sommerlad A, Marston L, Huntley J, Livingston G, Lewis G, Steptoe A, Fancourt D. Social relationships and depression during the COVID-19 lockdown: longitudinal analysis of the COVID-19 Social Study. Psychol Med 2021; 52:1-10. [PMID: 33436126 PMCID: PMC7844174 DOI: 10.1017/s0033291721000039] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic led to measures that reduced social contact and support. We explored whether UK residents with more frequent or supportive social contact had fewer depressive symptoms during March-August 2020, and potential factors moderating the relationship. METHODS A convenience sample of UK dwelling participants aged ⩾18 in the internet-based longitudinal COVID-19 Social Study completed up to 22 weekly questionnaires about face-to-face and phone/video social contact frequency, perceived social support, and depressive symptoms using the PHQ-9. Mixed linear models examined associations between social contact and support, and depressive symptoms. We examined for interaction by empathic concern, perspective taking and pre-COVID social contact frequency. RESULTS In 71 117 people with mean age 49 years (standard deviation 15), those with high perceived social support scored 1.836 (1.801-1.871) points lower on PHQ-9 than those with low support. Daily face-to-face or phone/video contact was associated with lower depressive symptoms (0.258 (95% confidence interval 0.225-0.290) and 0.117 (0.080-0.154), respectively) compared to no contact. The negative association between social relationships and depressive symptoms was stronger for those with high empathic concern, perspective taking and usual sociability. CONCLUSIONS We found during lockdown that those with higher quality or more face-to-face or phone/video contact had fewer depressive symptoms. Contact quality was more strongly associated than quantity. People who were usually more sociable or had higher empathy had more depressive symptoms during enforced reduced contact. The results have implications for COVID-19 and potential future pandemic management, and for understanding the relationship between social factors and mental health.
Collapse
Affiliation(s)
- Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| |
Collapse
|
11
|
Lee SL, Pearce E, Ajnakina O, Johnson S, Lewis G, Mann F, Pitman A, Solmi F, Sommerlad A, Steptoe A, Tymoszuk U, Lewis G. The association between loneliness and depressive symptoms among adults aged 50 years and older: a 12-year population-based cohort study. Lancet Psychiatry 2021; 8:48-57. [PMID: 33181096 PMCID: PMC8009277 DOI: 10.1016/s2215-0366(20)30383-7] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Loneliness is experienced by a third of older adults in the UK and is a modifiable potential risk factor for depressive symptoms. It is unclear how the association between loneliness and depressive symptoms persists over time, and whether it is independent of related social constructs and genetic confounders. We aimed to investigate the association between loneliness and depressive symptoms, assessed on multiple occasions during 12 years of follow-up, in a large, nationally representative cohort of adults aged 50 years and older in England. METHODS We did a longitudinal study using seven waves of data that were collected once every 2 years between 2004 and 2017, from adults aged 50 years and older in the English Longitudinal Study of Ageing (ELSA). The exposure was loneliness at baseline (wave two), measured with the short 1980 revision of the University of California, Los Angeles Loneliness Scale (R-UCLA). The primary outcome was a score indicating severity of depression measured at six subsequent timepoints (waves three to eight), using the eight-item version of the Centre for Epidemiologic Studies Depression Scale (CES-D). Analyses were linear multilevel regressions, before and after adjusting for social isolation, social support, polygenic risk scores, and other sociodemographic and health-related confounders. The secondary outcome was depression diagnosis, measured using a binary version of the CES-D. FINDINGS 4211 (46%) of 9171 eligible participants had complete data on exposure, outcome, and confounders, and were included in our complete case sample. After all adjustments, a 1-point increase in loneliness score was associated with a 0·16 (95% CI 0·13-0·19) increase in depressive symptom severity score (averaged across all follow-ups). We estimated a population attributable fraction for depression associated with loneliness of 18% (95% CI 12-24) at 1 year of follow-up and 11% (3-19) at the final follow-up (wave eight), suggesting that 11-18% of cases of depression could potentially be prevented if loneliness were eliminated. Associations between loneliness and depressive symptoms remained after 12 years of follow-up, although effect sizes were smaller with longer follow-up. INTERPRETATION Irrespective of other social experiences, higher loneliness scores at baseline were associated with higher depression symptom severity scores during 12 years of follow-up among adults aged 50 years and older. Interventions that reduce loneliness could prevent or reduce depression in older adults, which presents a growing public health problem worldwide. FUNDING National Institute on Aging and a consortium of UK Government departments coordinated by the National Institute for Health Research.
Collapse
Affiliation(s)
- Siu Long Lee
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Eiluned Pearce
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Olesya Ajnakina
- Department of Behavioural Science and Health, University College London, London, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, London, UK
| | - Farhana Mann
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, London, UK
| | - Francesca Solmi
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Andrew Sommerlad
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Urszula Tymoszuk
- Centre for Performance Science, Royal College of Music, Imperial College London, London, UK
| | - Gemma Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
| |
Collapse
|
12
|
Influence of theta-burst transcranial magnetic stimulation over the dorsolateral prefrontal cortex on emotion processing in healthy volunteers. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 20:1278-1293. [PMID: 33000366 PMCID: PMC7716858 DOI: 10.3758/s13415-020-00834-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/13/2020] [Indexed: 02/07/2023]
Abstract
Repetitive transcranial magnetic stimulation is a potential treatment option for depression, with the newer intermittent theta-burst stimulation (iTBS) protocols providing brief intervention. However, their mechanism of action remains unclear. We investigated the hypothesis that iTBS influences brain circuits involved in emotion processing that are also affected by antidepressants. We predicted that iTBS would lead to changes in performance on emotion-processing tasks. We investigated the effects of intermittent TBS (iTBS) over the left dorsolateral prefrontal cortex (DLPFC) on the processing of emotional information (word recall and categorization, facial emotion recognition, and decision-making) in 28 healthy volunteers by contrasting these effects with those of sham stimulation. Each volunteer received iTBS and sham stimulation in a blinded crossover design and completed the emotion-processing tasks before and after stimulation. Compared to sham stimulation, iTBS increased positive affective processing for word recall, yet had an unexpected effect on facial emotion recognition for happy and sad faces. There was no evidence of an effect on decision-making or word categorization. We found support for our hypothesis that iTBS influences emotion processing, though some changes were not in the expected direction. These findings suggest a possible common mechanism of action between iTBS and antidepressants, and a complex neural circuitry involved in emotion processing that could potentially be tapped into via brain stimulation. Future research should investigate the neural correlates of emotion processing more closely to inform future iTBS protocols.
Collapse
|
13
|
The utility of smartphone-based, ecological momentary assessment for depressive symptoms. J Affect Disord 2020; 274:602-609. [PMID: 32663993 DOI: 10.1016/j.jad.2020.05.116] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/06/2020] [Accepted: 05/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a common and debilitating mood disorder. Individuals with MDD are often misdiagnosed or diagnosed in an untimely manner, exacerbating existing functional impairments. Ecological momentary assessment (EMA) involves the repeated sampling of an individual's symptoms within their natural environment and has been demonstrated to assist in illness assessment and characterization. Capturing data in this way would set the stage for improved treatment outcomes and serve as a complementary resource in the management and treatment of depressive symptoms. METHODS Online databases PubMed/MedLine and PsycINFO were searched using PRISMA guidelines and combinations of the following keywords: EMA, depression, smartphone app, diagnosing, symptoms, phone, app, ecological momentary assessment, momentary assessment, data mining, unobtrusive, passive data, GPS, sensor. RESULTS A total of nineteen original articles were identified using our search parameters and ten articles met the inclusion criteria for full-text review. Among the ten relevant studies, three studies evaluated feasibility, seven evaluated detection, and three evaluated treatment of MDD. LIMITATIONS Limitations include that the design of all of the studies included in this review are non-randomized. It should be noted that most of the studies included were pilot studies and/or exploratory trials lacking a control group. CONCLUSIONS Available evidence suggests that the use of passive smartphone-based applications may lead to improved management of depressive symptoms. This review aids the creation of new EMA applications, highlights the potential of EMA usage in clinical settings and drug development, emphasizes the importance for regulation of applications in the mental health field, and provides insight into future directions.
Collapse
|
14
|
Duffy L, Lewis G, Ades A, Araya R, Bone J, Brabyn S, Button K, Churchill R, Croudace T, Derrick C, Dixon P, Dowrick C, Fawsitt C, Fusco L, Gilbody S, Harmer C, Hobbs C, Hollingworth W, Jones V, Kendrick T, Kessler D, Khan N, Kounali D, Lanham P, Malpass A, Munafo M, Pervin J, Peters T, Riozzie D, Robinson J, Salaminios G, Sharp D, Thom H, Thomas L, Welton N, Wiles N, Woodhouse R, Lewis G. Antidepressant treatment with sertraline for adults with depressive symptoms in primary care: the PANDA research programme including RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Despite a growing number of prescriptions for antidepressants (over 70 million in 2018), there is uncertainty about when people with depression might benefit from antidepressant medication and concern that antidepressants are prescribed unnecessarily.
Objectives
The main objective of the PANDA (What are the indications for Prescribing ANtiDepressAnts that will lead to a clinical benefit?) research programme was to provide more guidance about when antidepressants are likely to benefit people with depression. We aimed to estimate the minimal clinically important difference for commonly used self-administered scales for depression and anxiety, and to understand more about how patients respond to such assessments. We carried out an observational study of patients with depressive symptoms and a placebo-controlled randomised controlled trial of sertraline versus placebo to estimate the treatment effect in UK primary care. The hypothesis was that the severity and duration of symptoms were related to treatment response.
Design
The programme consisted of three phases. The first phase relied on the secondary analysis of existing data extracted from published trials. The second phase was the PANDA cohort study of patients with depressive symptoms who presented to primary care and were followed up 2, 4 and 6 weeks after a baseline assessment. Both quantitative and qualitative methods were used in the analysis. The third phase was a multicentre randomised placebo-controlled double-blind trial of sertraline versus placebo in patients presenting to primary care with depressive symptoms.
Setting
UK primary care in Bristol, London, Liverpool and York.
Participants
Patients aged 18–74 years who were experiencing depressive symptoms in primary care. Eligibility for the PANDA randomised controlled trial included that there was uncertainty about the benefits about treatment with an antidepressant.
Interventions
In the PANDA randomised controlled trial, patients were individually randomised to 100 mg daily of sertraline or an identical placebo. The PANDA cohort study was an observational study.
Main outcome measures
Depressive symptoms measured using the Patient Health Questionnaire were the primary outcome for the randomised controlled trial. Other outcomes included anxiety symptoms using the Generalised Anxiety Disorder-7; depressive symptoms using the Beck Depression Inventory, version 2; health-related quality of life; self-reported improvement; and cost-effectiveness.
Results
The secondary analysis of existing randomised controlled trials [GENetic and clinical Predictors Of treatment response in Depression (GenPod), TREAting Depression with physical activity (TREAD) and Clinical effectiveness and cost-effectiveness of cognitive Behavioural Therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care (CoBalT)] found evidence that the minimal clinically important difference increased as the initial severity of depressive symptoms rose. Our estimates of minimal clinically important difference were a 17% and 18% reduction in Beck Depression Inventory scores for GenPod and TREAD, respectively. In CoBalT, a 32% reduction corresponded to the minimal clinically important difference but the participants in this study had depression that had not responded to antidepressants. In the PANDA study cohort, and from our analyses in existing data, we found that the minimal clinically important difference varies considerably with the initial severity of depressive and anxiety symptoms. Expressing the minimal clinically important difference as a percentage reduction reduces this variation at higher scores, but at low scores the percentage reduction increased substantially. The results from the qualitative studies pointed out many limitations of the Patient Health Questionnaire-9 items in assessing change and recovery from depression. In the PANDA randomised controlled trial, there was no evidence that sertraline resulted in a reduction in depressive symptoms within 6 weeks of randomisation, but there was some evidence of a reduction by 12 weeks. However, sertraline led to a reduction in anxiety symptoms, an improvement of mental health-related quality of life and an increased likelihood of reporting improvement. The mean Patient Health Questionnaire-9 items score at 6 weeks was 7.98 (standard deviation 5.63) in the sertraline group and 8.76 (standard deviation 5.86) in the placebo group (5% relative reduction, 95% confidence interval –7% to 15%; p = 0.41). Of the secondary outcomes, there was strong evidence that sertraline reduced anxiety symptoms (Generalised Anxiety Disorder-7 score reduced by 17% (95% confidence interval 9% to 25%; p = 0.00005). Sertraline had a high probability (> 90%) of being cost-effective at 12 weeks. The PANDA randomised controlled trial found no evidence that treatment response or cost-effectiveness was related to severity or duration of depressive symptoms. The minimal clinically important difference estimates suggested that sertraline’s effect on anxiety, but not on depression, was likely to be clinically important.
Limitations
The results from the randomised controlled trial and the estimates of minimal clinically important difference were not sufficiently precise to provide specific clinical guidance for individuals. We had low power in testing whether or not initial severity and duration of depressive symptoms are related to treatment response.
Conclusions
The results of the trial support the use of sertraline and probably other selective serotonin reuptake inhibitors because of their action in reducing anxiety symptoms and the likelihood of longer-term benefit on depressive symptoms. Sertraline could be prescribed for anxiety symptoms that commonly occur with depression and many patients will experience a clinical benefit. The Patient Health Questionnaire-9 items and similar self-administered scales should not be used on their own to assess clinical outcome, but should be supplemented with further clinical assessment.
Future work
We need to examine the longer-term effects of antidepressant treatment. We need more precise estimates of the treatment effects and minimal clinically important difference at different severities to provide more specific guidance for individuals. However, the methods we have developed provide an approach towards providing such detailed guidance.
Trial registration
Current Controlled Trials ISRCTN84544741 and EudraCT number 2013-003440-22.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 10. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Larisa Duffy
- Division of Psychiatry, University College London, London, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, UK
| | - Anthony Ades
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Ricardo Araya
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jessica Bone
- Division of Psychiatry, University College London, London, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York, UK
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Tim Croudace
- School of Nursing and Health Studies, University of Dundee, Dundee, UK
| | | | - Padraig Dixon
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | | | - Louise Fusco
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Vivien Jones
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Tony Kendrick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Kessler
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Naila Khan
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Daphne Kounali
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Lanham
- Patient and public involvement contributor, UK
| | - Alice Malpass
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus Munafo
- Department of Psychology and Integrated Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - Tim Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jude Robinson
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, UK
| | | | - Debbie Sharp
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Howard Thom
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura Thomas
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky Welton
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Wiles
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| |
Collapse
|
15
|
Evans IEM, Llewellyn DJ, Matthews FE, Woods RT, Brayne C, Clare L. Social isolation, cognitive reserve, and cognition in older people with depression and anxiety. Aging Ment Health 2019; 23:1691-1700. [PMID: 30518250 DOI: 10.1080/13607863.2018.1506742] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Poor social connections may be associated with poor cognition in older people who are not experiencing mental health problems, and the trajectory of this association may be moderated by cognitive reserve. However, it is unclear whether this relationship is the same for older people with symptoms of depression and anxiety. This paper aims to explore social relationships and cognitive function in older people with depression and anxiety. Method: Baseline and two-year follow-up data were analysed from the Cognitive Function and Ageing Study-Wales (CFAS-Wales). We compared levels of social isolation, loneliness, social contact, cognitive function, and cognitive reserve at baseline amongst older people with and without depression or anxiety. Linear regression was used to assess the relationship between isolation and cognition at baseline and two-year follow-up in a subgroup of older people meeting pre-defined criteria for depression or anxiety. A moderation analysis tested for the moderating effect of cognitive reserve. Results: Older people with depression or anxiety perceived themselves as more isolated and lonely than those without depression or anxiety, despite having an equivalent level of social contact with friends and family. In people with depression or anxiety, social isolation was associated with poor cognitive function at baseline, but not with cognitive change at two-year follow-up. Cognitive reserve did not moderate this association. Conclusion: Social isolation was associated with poor cognitive function at baseline, but not two-year follow-up. This may be attributed to a reduction in mood-related symptoms at follow-up, linked to improved cognitive function.
Collapse
Affiliation(s)
- Isobel E M Evans
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter , Exeter , United Kingdom
| | - David J Llewellyn
- Mental Health Research Group, Institute of Health Research, University of Exeter Medical School , Exeter , United Kingdom
| | - Fiona E Matthews
- Faculty of Medicine, Institute of Health and Society, Newcastle University , Newcastle , United Kingdom.,MRC Biostatistics Unit, Institute of Public Health, University of Cambridge , Cambridge , United Kingdom
| | - Robert T Woods
- Dementia Services Development Centre Wales, School of Healthcare Sciences, Bangor University , Bangor , United Kingdom
| | - Carol Brayne
- Institute of Public Health, University of Cambridge , Cambridge , United Kingdom
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter , Exeter , United Kingdom.,PenCLAHRC, Institute of Health Research, University of Exeter Medical School , Exeter , United Kingdom.,Centre for Research Excellence in Promoting Cognitive Health, Australian National University , Canberra , Australia
| |
Collapse
|
16
|
Bone JK, Lewis G, Button KS, Duffy L, Harmer CJ, Munafò MR, Penton-Voak IS, Wiles NJ, Lewis G. Variation in recognition of happy and sad facial expressions and self-reported depressive symptom severity: A prospective cohort study. J Affect Disord 2019; 257:461-469. [PMID: 31310908 DOI: 10.1016/j.jad.2019.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/31/2019] [Accepted: 06/21/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Cognitive theories suggest people with depression interpret self-referential social information negatively. However, it is unclear whether these biases precede or follow depression. We investigated whether facial expression recognition was associated with depressive symptoms cross-sectionally and longitudinally. METHODS Prospective cohort study of people who had visited UK primary care in the past year reporting depressive symptoms (n = 509). Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9) at four time-points, 2 weeks apart. A computerised task assessed happy and sad facial expression recognition at three time-points (n = 505 at time 1). The unbiased hit rate measured ability to recognise emotions accounting for any general tendency to identify the emotion when it was not present. RESULTS The sample included the full range of depressive symptom severity, with 45% meeting diagnostic criteria for depression. There was no evidence that happy or sad unbiased hit rates were associated with concurrent or subsequent depressive symptoms. There was weak evidence that, for every additional face incorrectly classified as happy, concurrent PHQ-9 scores reduced by 0.05 of a point (95% CI = -0.10 to 0.002, p = 0.06 after adjustment for confounders). This association was strongest for more ambiguous facial expressions (interaction term p<0.001). LIMITATIONS This was an observational study with relatively short follow-up (6 weeks) and small changes in depressive symptoms and emotion recognition. Only 7% of invited patients consented to participate. CONCLUSIONS Reduced misclassifications of ambiguous faces as happy could be a state marker of depression, but was not associated with subsequent depressive symptoms. Future research should focus on the interpretation of ambiguous social information.
Collapse
Affiliation(s)
- Jessica K Bone
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Gemma Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | | | - Larisa Duffy
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | | | - Marcus R Munafò
- School of Experimental Psychology, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Ian S Penton-Voak
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Nicola J Wiles
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| |
Collapse
|
17
|
Nord CL, Lawson RP, Huys QJM, Pilling S, Roiser JP. Depression is associated with enhanced aversive Pavlovian control over instrumental behaviour. Sci Rep 2018; 8:12582. [PMID: 30135491 PMCID: PMC6105578 DOI: 10.1038/s41598-018-30828-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 08/07/2018] [Indexed: 12/13/2022] Open
Abstract
The dynamic modulation of instrumental behaviour by conditioned Pavlovian cues is an important process in decision-making. Patients with major depressive disorder (MDD) are known to exhibit mood-congruent biases in information processing, which may occur due to Pavlovian influences, but this hypothesis has never been tested directly in an unmedicated sample. To address this we tested unmedicated MDD patients and healthy volunteers on a computerized Pavlovian-Instrumental Transfer (PIT) task designed to separately examine instrumental approach and withdrawal actions in the context of Pavlovian appetitive and aversive cues. This design allowed us to directly measure the degree to which Pavlovian cues influence instrumental responding. Depressed patients were profoundly influenced by aversive Pavlovian stimuli, to a significantly greater degree than healthy volunteers. This was the case for instrumental behaviour both in the approach condition (in which aversive Pavlovian cues inhibited ‘go’ responses), and in the withdrawal condition (in which aversive Pavlovian cues facilitated ‘go’ responses). Exaggerated aversive PIT provides a potential cognitive mechanism for biased emotion processing in major depression. This finding also has wider significance for the understanding of disrupted motivational processing in neuropsychiatric disorders.
Collapse
Affiliation(s)
- C L Nord
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, WC1N 3AZ, London, UK. .,Department of Psychiatry, University of Cambridge, Addenbrookes Hospital, Level E4, Box 189, Hills Road, CB2 0QQ, Cambridge, UK.
| | - R P Lawson
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, WC1N 3AZ, London, UK.,Wellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, WC1N 3BG, London, UK.,Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, UK
| | - Q J M Huys
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, ETH Zürich and University of Zürich, Wilfriedstrasse 6, 8032, Zürich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Lenggstasse 31, 8032, Zürich, Switzerland
| | - S Pilling
- Department of Clinical, Educational and Health Psychology, University College London, Gower Street, WC1E 6BT, London, UK
| | - J P Roiser
- Institute of Cognitive Neuroscience, University College London, 17 Queen Square, WC1N 3AZ, London, UK
| |
Collapse
|
18
|
Cooper CM, Godlewska B, Sharpley AL, Barnes E, Cowen PJ, Harmer CJ. Interferon-α induces negative biases in emotional processing in patients with hepatitis C virus infection: a preliminary study. Psychol Med 2018; 48:998-1007. [PMID: 28889805 PMCID: PMC5767463 DOI: 10.1017/s0033291717002379] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment of medical patients with the inflammatory cytokine, interferon-α (IFN-α), is frequently associated with the development of clinical depressive symptomatology. Several important biological correlates of the effect of IFN-α on mood have been described, but the neuropsychological changes associated with IFN-α treatment are largely unexplored. The aim of the present preliminary study was to assess the effect of IFN-α on measures of emotional processing. METHOD We measured changes in emotional processing over 6-8 weeks in 17 patients receiving IFN-α as part of their treatment for hepatitis C virus infection. Emotional processing tasks included those which have previously been shown to be sensitive to the effects of depression and antidepressant treatment, namely facial expression recognition, emotional categorisation and the dot probe attentional task. RESULTS Following IFN-α, patients were more accurate at detecting facial expressions of disgust; they also showed diminished attentional vigilance to happy faces. IFN-α produced the expected increases in scores on depression rating scales, but there was no correlation between these scores and the changes in emotional processing. CONCLUSIONS Our preliminary findings suggest that IFN-α treatment produces negative biases in emotional processing, and this effect is not simply a consequence of depression. It is possible that increased recognition of disgust may represent a neuropsychological marker of depressive disorders related to inflammation.
Collapse
Affiliation(s)
- C. M. Cooper
- University Department of Psychiatry, Warneford Hospital Oxford, Oxford, UK
| | - B. Godlewska
- University Department of Psychiatry, Warneford Hospital Oxford, Oxford, UK
| | - A. L. Sharpley
- University Department of Psychiatry, Warneford Hospital Oxford, Oxford, UK
| | - E. Barnes
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- The Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - P. J. Cowen
- University Department of Psychiatry, Warneford Hospital Oxford, Oxford, UK
| | - C. J. Harmer
- University Department of Psychiatry, Warneford Hospital Oxford, Oxford, UK
| |
Collapse
|
19
|
Harmer CJ, Duman RS, Cowen PJ. How do antidepressants work? New perspectives for refining future treatment approaches. Lancet Psychiatry 2017; 4:409-418. [PMID: 28153641 PMCID: PMC5410405 DOI: 10.1016/s2215-0366(17)30015-9] [Citation(s) in RCA: 317] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 12/30/2022]
Abstract
Most currently available antidepressants target monoamine neurotransmitter function. However, a purely neurotransmitter-based explanation for antidepressant drug action is challenged by the delayed clinical onset of most agents and the need to explain how neurochemical changes reverse the many different symptoms of depression. Novel approaches to understanding of antidepressant drug action include a focus on early changes in emotional and social processing and the role of neural plasticity. In this Review, we discuss the ways in which these two different theories reflect different or complementary approaches, and how they might be integrated to offer novel solutions for people with depression. We consider the predictions made by these mechanistic approaches for the stratification and development of new therapeutics for depression, and the next steps that need to be made to facilitate this translation of science to the clinic.
Collapse
Affiliation(s)
| | - Ronald S Duman
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
20
|
Lewis G, Kounali D, Button KS, Duffy L, Wiles NJ, Munafò MR, Harmer CJ, Lewis G. Variation in the recall of socially rewarding information and depressive symptom severity: a prospective cohort study. Acta Psychiatr Scand 2017; 135:489-498. [PMID: 28374430 PMCID: PMC5763395 DOI: 10.1111/acps.12729] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To test the association between recall for socially rewarding (positive) and/or socially critical (negative) information and depressive symptoms. METHOD Cohort study of people who had visited UK primary care in the past year reporting depressive symptoms (N = 558, 69% female). Positive and negative recall was assessed at three time-points, 2 weeks apart, using a computerised task. Depressive symptoms were assessed at four time-points using the Beck Depression Inventory (BDI). Analyses were conducted using multilevel models. RESULTS Concurrently we found evidence that, for every increase in two positive words recalled, depressive symptoms reduced by 0.6 (95% CI -1.0 to -0.2) BDI points. This association was not affected by adjustment for confounders. There was no evidence of an association between negative recall and depressive symptoms (-0.1, 95% CI -0.5 to 0.3). Longitudinally, we found more evidence that positive recall was associated with reduced depressive symptoms than vice versa. CONCLUSION People with more severe depressive symptoms recall less positive information, even if their recall of negative information is unaltered. Clinicians could put more emphasis on encouraging patients to recall positive, socially rewarding information, rather than trying to change negative interpretations of events that have already occurred.
Collapse
Affiliation(s)
- G. Lewis
- Division of PsychiatryFaculty of Brain SciencesUniversity College LondonLondonUK
| | - D.‐Z. Kounali
- School of Social and Community MedicineUniversity of BristolBristolUK
| | - K. S. Button
- Department of PsychologyUniversity of BathBathUK
| | - L. Duffy
- Division of PsychiatryFaculty of Brain SciencesUniversity College LondonLondonUK
| | - N. J. Wiles
- Centre for Academic Mental HealthSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - M. R. Munafò
- MRC Integrative Epidemiology Unit and School of Experimental PsychologyUniversity of BristolBristolUK
| | - C. J. Harmer
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - G. Lewis
- Division of PsychiatryFaculty of Brain SciencesUniversity College LondonLondonUK
| |
Collapse
|