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Ban M, He J, Wang D, Cao Y, Kong L, Yuan F, Qian Z, Zhu X. Association between segmental alterations of white matter bundles and cognitive performance in first-episode, treatment-naïve young adults with major depressive disorder. J Affect Disord 2024; 358:309-317. [PMID: 38703905 DOI: 10.1016/j.jad.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Cumulative evidence has consistently shown that white matter (WM) disruption is associated with cognitive decline in geriatric depression. However, limited research has been conducted on the correlation between these lesions and cognitive performance in untreated young adults with major depressive disorder (MDD), particularly with the specific segmental alterations of the fibers. METHOD Diffusion tensor images were performed on 60 first-episode, treatment-naïve young adult patients with MDD and 54 matched healthy controls (HCs). Automated fiber quantification was applied to calculate the tract profiles of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) to evaluate the WM microstructural organization. Correlation analysis was performed to find the associations between the diffusion properties and cognitive performance. RESULTS Compared with HCs, patients with MDD exhibited predominantly different diffusion properties in bilateral uncinate fasciculus (UF), corticospinal tracts (CSTs), left superior longitudinal fasciculus and anterior thalamic radiation. The FA of the temporal cortex portion of right UF was positively correlated with working memory. The MD of the temporal component of left UF was negatively correlated with working memory and positively correlated with symptom severity. Additionally, a positive correlation between the MD of left CST and the psychomotor speed, negative correlation between the MD of left CST and the executive functions and complex attentional processes were observed. CONCLUSIONS Our study validated the alterations in spatial localization of WM microstructure and its correlations with cognitive performance in first-episode, treatment-naïve young adults with MDD. This study added to the knowledge of the neuropathological basis of MDD.
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Affiliation(s)
- Meiting Ban
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jincheng He
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Dongcui Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Yuegui Cao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Lingyu Kong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Fulai Yuan
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Zhaoxin Qian
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xueling Zhu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; Hunan Singhand Intelligent Data Technology Co., Ltd, China.
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2
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Love H, Ezemenaka C, Grammer A, Yoon Y, Lee H. Undergraduate class standing, perceived social support, and depressive symptoms. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-7. [PMID: 38917368 DOI: 10.1080/07448481.2024.2368009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 06/09/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE Investigate the association between perceived social support and depressive symptoms at different stages of academic progress. PARTICIPANTS Undergraduate students (n = 505) enrolled at a large southeastern university. METHODS Students completed a cross-sectional survey about their self-reported physical and mental health. Logistic regression was used to assess the relationship between depressive symptoms, perceived social support, and academic class standing. RESULTS Academic class standing and perceived social support were both significantly associated with depressive symptoms. Compared to freshman, odds of having depressive symptoms were 2.15 times higher for sophomores and 3.94 times higher for seniors. For every one unit increase in perceived social support, the odds of depressive symptoms decreased by 51%. CONCLUSIONS A significant association between depressive symptoms and social support was identified for all undergraduates in this sample. The differences identified between social support and depressive symptoms reveal the need to tailor support provided at different academic stages.
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Affiliation(s)
- Heather Love
- Department of Human Development and Family Studies, University of Alabama, Tuscaloosa, Alabama, USA
| | - Christina Ezemenaka
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Abby Grammer
- College of Nursing, University of Alabama, Tuscaloosa, Alabama, USA
| | - Young Yoon
- Department of Social Work, Colorado State University, Pueblo, Colorado, USA
| | - Hee Lee
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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3
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Huang L, Cao Y, Liu Y, Zhu W, Zhou M. Peer effects on rural children's depression: do online games matter? Eur Child Adolesc Psychiatry 2024; 33:1707-1720. [PMID: 37553541 DOI: 10.1007/s00787-023-02271-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023]
Abstract
With the increasing prevalence of depression among children and adolescents, understanding the role of peer contagion in the spread of emotional distress is a critical area of research. The aim of this study is to examine the effect of classmates' depression on a rural child's own depression in China (aged 9-17, N = 1777). The study controls for possible endogeneity of peer effects through the instrumental variable method (the Wald F statistic is significant at the 1% level) and random class assignment data (all students and teachers are randomly assigned to classes).The results indicate that when the average depression score of a rural child's classmates increases by 1 point, that child's own depression score is likely to increase by 0.345 points (p value < .01).This study further finds that the contagion of depression among classmates is more severe for girls and children who play online games, and less severe for children who are cheerful and good-humored. Online games may be an important mechanism through which peer effects operate. Children's classmates' negative emotions are found to increase the occurrence of the children's internalizing behavior in online games, in turn increasing the occurrence of negative emotions in these children themselves.
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Affiliation(s)
- Li Huang
- College of Economics and Management, Shenyang Agricultural University, Shenyang, 110866, Liaoning, China
| | - Yinchuan Cao
- College of Economics and Management, Shenyang Agricultural University, Shenyang, 110866, Liaoning, China
| | - Yuhai Liu
- College of Economics and Management, Shenyang Agricultural University, Shenyang, 110866, Liaoning, China
| | - Weiming Zhu
- College of Economics and Management, Shenyang Agricultural University, Shenyang, 110866, Liaoning, China
| | - Mi Zhou
- College of Economics and Management, Shenyang Agricultural University, Shenyang, 110866, Liaoning, China.
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4
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Stecher C, Cloonan S, Domino ME. The Economics of Treatment for Depression. Annu Rev Public Health 2024; 45:527-551. [PMID: 38100648 DOI: 10.1146/annurev-publhealth-061022-040533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12-17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments' relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
| | - Sara Cloonan
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Marisa Elena Domino
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA;
- The Center for Health Information and Research, Arizona State University, Phoenix, Arizona, USA
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5
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Solis EC, Carlier IVE, Kamminga NGA, Giltay EJ, van Hemert AM. The clinical effectiveness of a self-management intervention for patients with persistent depressive disorder and their partners/caregivers: results from a multicenter, pragmatic randomized controlled trial. Trials 2024; 25:187. [PMID: 38481289 PMCID: PMC10938802 DOI: 10.1186/s13063-024-08033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Persistent depressive disorder (PDD) is prevalent and debilitating. For patients with PDD, psychiatric rehabilitation using self-management interventions is advised as the next therapeutic step after multiple unsuccessful treatment attempts. The "Patient and Partner Education Program for All Chronic Diseases" (PPEP4All) is a brief, structured self-management program that focuses on functional recovery for patients and their partners/caregivers. In chronic somatic disorder populations, PPEP4All has already been shown to be clinically effective. We examined whether PPEP4All adapted for PDD (PPEP4All-PDD, nine weekly group or individual sessions) is also clinically effective for adults/elderly with PDD and their partners/caregivers compared to care-as-usual (CAU) in specialized mental healthcare. METHODS In this mixed-method multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were allocated to either PPEP4All-PDD (patients, n = 37; partners/caregivers, n = 14) or CAU (patients, n = 33; partners/caregivers, not included) and completed questionnaires at 0, 3, 6, and 12 months regarding depressive symptoms, psychopathology, psychosocial burden, mental resilience, and happiness/well-being. Qualitative data were collected regarding treatment satisfaction. Data were analyzed using mixed model analyses and an intention-to-treat (ITT) approach. RESULTS There was no statistically significant difference in any outcome regarding clinical effectiveness between PPEP4All-PDD and CAU. Subgroup analysis for depressive symptoms did not show any interaction effect for any subgroup. Although 78% of participants recommended PPEP4All-PDD, there was no difference in treatment satisfaction between PPEP4All-PDD (score = 6.6; SD = 1.7) and CAU (score = 7.6; SD = 1.2), p = 0.06. CONCLUSION Although depressive symptoms did not improve relative to CAU, this only confirmed that treatment for patients with treatment-resistant PDD should move from symptom reduction to functional recovery. Also, functional recovery may be reflected in other outcomes than psychosocial burden, such as self-empowerment, in patients with treatment-resistant PDD. Future research on PPEP4All-PDD could focus on a longer-term program and/or online program that may also be offered earlier in the treatment process as an empowerment intervention. TRIAL REGISTRATION: Netherlands Trial Register Identifier NL5818. Registered on 20 July 2016 https://clinicaltrialregister.nl/nl/trial/20302.
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Affiliation(s)
- Ericka C Solis
- Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, The Netherlands.
| | - Ingrid V E Carlier
- Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, The Netherlands
| | - Noëlle G A Kamminga
- Department of Psychiatry and Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, The Netherlands
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Wang B, Frank R, Glied S. Lasting scars: The impact of depression in early adulthood on subsequent labor market outcomes. HEALTH ECONOMICS 2023; 32:2694-2708. [PMID: 37528531 DOI: 10.1002/hec.4747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023]
Abstract
A growing body of evidence indicates that poor health early in life can leave lasting scars on adult health and economic outcomes. While much of this literature focuses on childhood experiences, mechanisms generating these lasting effects-recurrence of illness and interruption of human capital accumulation-are not limited to childhood. In this study, we examine how an episode of depression experienced in early adulthood affects subsequent labor market outcomes. We find that, at age 50, people who had met diagnostic criteria for depression when surveyed at ages 27-35 earn 10% lower hourly wages (conditional on occupation), work 120-180 fewer hours annually, and earn 24% lower annual wage incomes. A portion of this income penalty (21%-39%) occurs because depression is often a chronic condition, recurring later in life. But a substantial share (25%-55%) occurs because depression in early adulthood disrupts human capital accumulation, by reducing work experience and by influencing selection into occupations with skill distributions that offer lower potential for wage growth. These lingering effects of early depression reinforce the importance of early and multifaceted intervention to address depression and its follow-on effects in the workplace.
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Affiliation(s)
- Buyi Wang
- School of Social Work, Columbia University, New York, New York, USA
| | - Richard Frank
- Brookings Institution, Washington, District of Columbia, USA
| | - Sherry Glied
- Robert F. Wagner Graduate School of Public Service, New York University, New York, New York, USA
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7
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Gee KA, Asmundson V, Vang T. Educational impacts of the COVID-19 pandemic in the United States: Inequities by race, ethnicity, and socioeconomic status. Curr Opin Psychol 2023; 52:101643. [PMID: 37442079 DOI: 10.1016/j.copsyc.2023.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
The COVID-19 pandemic caused reverberations throughout the educational system that disproportionately impacted students of color and those from lower socioeconomic backgrounds. In this review, we examine recent research documenting the disparate educational impacts of the pandemic across racial, ethnic, and socioeconomic status groups that deepened existing educational inequities in the United States. Numerous systemic barriers underlie these disparities, including disproportionate access to in-person learning and technology alongside the intensification of racial discrimination. Amidst these disparities, we also highlight emerging evidence of similarities in the educational impacts. Finally, recent evidence reveals a more multifaceted view of how some students of color leveraged supplemental educational supports and their academic confidence to confront educational challenges during the pandemic despite experiencing more pandemic-related stressors.
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Affiliation(s)
- Kevin A Gee
- School of Education, University of California, Davis, USA.
| | | | - Tseng Vang
- Department of Human Ecology, University of California, Davis, USA
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8
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Carr CE, Millard E, Dilgul M, Bent C, Wetherick D, French J, Priebe S. Group music therapy with songwriting for adult patients with long-term depression (SYNCHRONY study): a feasibility and acceptability study of the intervention and parallel randomised controlled trial design with wait-list control and nested process evaluation. Pilot Feasibility Stud 2023; 9:75. [PMID: 37147699 PMCID: PMC10161457 DOI: 10.1186/s40814-023-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/30/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Despite effective treatments, one fifth of patients develop chronic depression. Music therapy may offer a different approach. This study aimed to assess feasibility and acceptability of a music therapy intervention and trial methodology. METHODS A parallel two-arm randomised controlled trial with wait-list control, mixed feasibility/acceptability measures and nested process evaluation. Adults with long-term depression (symptom duration > 1 year) were recruited from community mental health services and computer randomised to 42 sessions of group music therapy with songwriting three times per week or wait-list control. Depression, social functioning, distress, quality of life, satisfaction and service use were assessed by blinded researchers at enrolment, 1 week and 3 and 6 months post-therapy. Outcomes were analysed descriptively, controlling for baseline covariates. Recruitment (number eligible, participation and retention rates) and intervention (fidelity, adherence) feasibility were assessed using pre-defined stop-go criteria. Attendance, adverse events, mood, relationship satisfaction and semi-structured interviews were analysed in a nested process evaluation. RESULTS Recruitment processes were feasible with 421 eligible, 12.7% participation and 60% (18/30) retention. Thirty participants were randomised to intervention (N = 20) and control (N = 10). Session attendance was low (mean 10.5) with four withdrawals. Music therapist adherence was good but changes to session frequency were suggested. Outcomes were available for 10/20 treatment and 9/10 wait-list participants. Depression increased in both arms post-therapy. Treatment depression scores fell below baseline 3 and 6 months post-therapy indicating improvement. Wait-list depression scores increased from baseline 3 and 6 months post-therapy. At 3 months, the treatment arm improved from baseline on all measures except satisfaction and functioning. At 6 months, quality of life, distress and functioning improved with reduction in health service contacts. High-attending participants improved more than low-attending. Seven adverse events (one serious) were reported. LIMITATIONS As this was a feasibility study, clinical outcomes should be interpreted cautiously. CONCLUSION A randomised controlled trial of group music therapy using songwriting is feasible with inclusion criteria and session frequency modifications, but further intervention development is required. TRIAL REGISTRATION ISRCTN18164037 on 26.09.2016.
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Affiliation(s)
- Catherine Elizabeth Carr
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, Newham Centre for Mental Health, Glen Road, London, E13 8SP, UK.
- East London NHS Foundation Trust, Trust Headquarters, Robert Dolan House, 9 Alie Street, London, E1 8DE, UK.
| | - Emma Millard
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, Newham Centre for Mental Health, Glen Road, London, E13 8SP, UK
- East London NHS Foundation Trust, Trust Headquarters, Robert Dolan House, 9 Alie Street, London, E1 8DE, UK
| | - Merve Dilgul
- East London NHS Foundation Trust, Trust Headquarters, Robert Dolan House, 9 Alie Street, London, E1 8DE, UK
| | - Cornelia Bent
- East London NHS Foundation Trust, Trust Headquarters, Robert Dolan House, 9 Alie Street, London, E1 8DE, UK
| | - Donald Wetherick
- East London NHS Foundation Trust, Trust Headquarters, Robert Dolan House, 9 Alie Street, London, E1 8DE, UK
| | - Jennifer French
- East London NHS Foundation Trust, Trust Headquarters, Robert Dolan House, 9 Alie Street, London, E1 8DE, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, Newham Centre for Mental Health, Glen Road, London, E13 8SP, UK
- East London NHS Foundation Trust, Trust Headquarters, Robert Dolan House, 9 Alie Street, London, E1 8DE, UK
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Moulton V, Sullivan A, Goodman A, Parsons S, Ploubidis GB. Adult life-course trajectories of psychological distress and economic outcomes in midlife during the COVID-19 pandemic: evidence from the 1958 and 1970 British birth cohorts. Soc Psychiatry Psychiatr Epidemiol 2023; 58:779-794. [PMID: 36653540 PMCID: PMC9848711 DOI: 10.1007/s00127-022-02377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/28/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Financial adversity in times of economic recession have been shown to have an unequal effect on individuals with prior mental health problems. This study investigated the relationship between mental health groupings across the adult life-course and change in financial situation and employment status during the COVID-19 pandemic, as well as the use of financial measures to mitigate the economic shock. METHODS Using two nationally representative British birth cohorts, the National Child Development Study (1958) n = 17,415 and 1970 British Cohort Study n = 17,198, we identified 5 different life-course trajectories of psychological distress from adolescence to midlife which were similar but not identical across the two cohorts. We explored their relation to changes in financial and employment circumstances at different stages during the pandemic from May 2020 to March 2021, applying multinomial logistic regression and controlling for numerous early life covariates, including family socio-economic status (SES). In addition, we ran modified Poisson models with robust standard errors to identify whether different mental health trajectories were supported by government and used other methods to mitigate their financial situation. RESULTS We found that the financial circumstances of pre-pandemic trajectories of psychological distress with differential onset, severity, and chronicity across the life-course were exacerbated by the COVID-19 economic shock. The 'stable-high' (persistent severe symptoms) and 'adult-onset' (symptoms developing in 30s, but later decreasing) groups were vulnerable to job loss. Compared to pre-pandemic trajectory groupings with no, minor, or psychological distress symptoms in early adulthood, the 'stable-high', 'midlife-onset' (symptoms developing in midlife), and 'adult-onset' trajectory groups were more likely to seek support from the UK governments economic response package. However, trajectories with pre-pandemic psychological distress were also at greater risk of reducing consumption, dis-saving, relying on increased financial help from family and friends, and also taking payment holidays (agreements with lenders to pause mortgage, credit card or loan payments for a set period) and borrowing. CONCLUSION This work highlights different trajectories of pre-pandemic psychological distress, compared to groups with no symptoms were more vulnerable to pandemic-related economic shock and job loss. By adopting unsustainable mitigating measures (borrowing and payment holidays) to support their financial circumstances during COVID-19, these mental health trajectories are at even more risk of lasting adverse impacts and future economic difficulties.
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Affiliation(s)
- V. Moulton
- grid.83440.3b0000000121901201Centre for Longitudinal Studies, University College London, London, UK
| | - A. Sullivan
- grid.83440.3b0000000121901201Centre for Longitudinal Studies, University College London, London, UK
| | - A. Goodman
- grid.83440.3b0000000121901201Centre for Longitudinal Studies, University College London, London, UK
| | - S. Parsons
- grid.83440.3b0000000121901201Centre for Longitudinal Studies, University College London, London, UK
| | - G. B. Ploubidis
- grid.83440.3b0000000121901201Centre for Longitudinal Studies, University College London, London, UK
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10
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Minh A, McLeod CB, Reijneveld SA, Veldman K, van Zon SK, Bültmann U. The role of low educational attainment on the pathway from adolescent internalizing and externalizing problems to early adult labour market disconnection in the Dutch TRAILS cohort. SSM Popul Health 2022; 21:101300. [PMID: 36647514 PMCID: PMC9840178 DOI: 10.1016/j.ssmph.2022.101300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/25/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Mental health challenges in adolescence may affect labour market transitions in young adulthood. Policies addressing early labour market disconnection largely focus on early school-leaving and educational attainment; however, the role of low educational attainment on the path from adolescent mental health to labour market disconnection is unclear. Using the TRacking Adolescents' Individual Lives Survey from the Netherlands (n = 1,197), we examined the extent to which achieving a basic educational qualification (by age 22) in the contemporary Dutch education system, mediates the effect of adolescent mental health (age 11-19) on early adult labour market disconnection, defined as 'not in education, employment, or training' (NEET, age 26). We estimated the total effect, the natural direct and indirect effects, and the controlled direct effects of internalizing and externalizing symptoms on NEET by gender. Among young men, clinical levels of adolescent externalizing symptoms were associated with a 0.093 higher probability of NEET compared with no symptoms (95% confidence interval, CI: 0.001, 0.440). The indirect effect through educational attainment accounted for 15.1% of the total effect. No evidence of mediation was observed for the relationship between externalizing symptoms and NEET in young women. No evidence of mediation was observed for the relationship between adolescent internalizing symptoms and NEET in either gender. The findings imply that adolescent externalizing symptoms disrupts the achievement of a basic educational qualification, leading to a higher probability of NEET in young men. This mechanism may play a smaller role in the risk of NEET associated with internalizing symptoms and in young women.
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Affiliation(s)
- Anita Minh
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Netherlands
- Corresponding author. School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z9, Canada.
| | - Christopher B. McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Sijmen A. Reijneveld
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Netherlands
| | - Karin Veldman
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Netherlands
| | - Sander K.R. van Zon
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Netherlands
| | - Ute Bültmann
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Netherlands
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11
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Han X, Li C, Zhu Y, Ma Y, Hua R, Xie W, Xie L. Relationships of persistent depressive symptoms with subsequent lung function trajectory and respiratory disease mortality. J Affect Disord 2022; 309:404-410. [PMID: 35490885 DOI: 10.1016/j.jad.2022.04.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the longitudinal association between persistent depressive symptoms and future lung health in the general population. METHOD 4860 middle-aged and older participants with repeated measurements of depressive symptoms at wave 1 (2002-2003) and wave 2 (2004-2005) and at least two measurements of lung function (waves 2-6, 2004-2013) from the English Longitudinal Study of Ageing, were included in this study. The Center for Epidemiologic Studies Depression Scale (CESD) was used to evaluate depressive symptoms. Participants who had depressive symptoms in both waves 1 and 2 were considered to have persistent depressive symptoms. Linear mixed models were applied to assess longitudinal associations. Cox regression models were fitted to analyze respiratory disease mortality. RESULTS During an 8-year follow-up, we found that women with persistent depressive symptoms suffered accelerated declines in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), percentage of the FEV1 predicted, percentage of the FVC predicted, and peak expiratory flow, compared with women without depressive symptoms at baseline. Likewise, an elevated risk of respiratory disease mortality (HR: 6.02, 95% CI: 2.30 to 15.79) was observed in women with persistent depressive symptoms compared with women without depressive symptoms. We also observed a dose-response relationship between cumulative depressive symptom scores and subsequent lung health outcomes in women. However, no such association was observed in men. CONCLUSION Long-term depressive symptoms might predict an accelerated decline of lung function and higher mortality from respiratory disease among women but not among men over an 8-year follow-up. Further studies are needed to verify our findings.
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Affiliation(s)
- Xiaobo Han
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China
| | - Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Yidan Zhu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Rong Hua
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China.
| | - Lixin Xie
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China; Chinese PLA Medical School, Beijing, China.
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Zhou L, Wang L, Wang M, Dai G, Xiao Y, Feng Z, Wang S, Chen G. Alterations in white matter microarchitecture in adolescents and young adults with major depressive disorder: A voxel-based meta-analysis of diffusion tensor imaging. Psychiatry Res Neuroimaging 2022; 323:111482. [PMID: 35477111 DOI: 10.1016/j.pscychresns.2022.111482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/18/2022] [Accepted: 04/14/2022] [Indexed: 02/08/2023]
Abstract
Adolescents and young adults are at a critical stage of life development, and depression can have serious consequences. In recent decades, an increasing number of diffusion tensor imaging (DTI) studies of major depressive disorder (MDD) have reported inconsistent alterations in white matter (WM) microarchitecture. To rule out the confounding effects of age, we conducted a meta-analysis of fractional anisotropy (FA) in adolescents and young adults with MDD to identify abnormalities in WM involved in the pathogenesis of MDD using anisotropic effect-size signed differential mapping (AES-SDM). The pooled meta-analysis revealed significantly lower FA mainly in the corpus callosum (CC) extending to the left anterior thalamic projections (ATP) and left cortico-spinal projection (CSP) in depressed adolescents and young adults than that in healthy controls. A reduction in FA was also identified in the right frontal orbito-polar tract (FOPT) extending to the right inferior fronto-occipital fasciculus (IFOF). In the meta-regression analysis, the mean age of patients, percentage of female patients and duration of depression were not linearly associated with abnormalities in FA. These results constitute robust evidence that abnormalities in WM microarchitecture in the interhemispheric connections and frontal-subcortical neuronal circuits may contribute to the pathogenesis of MDD during adolescence and young adulthood.
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Affiliation(s)
- Li Zhou
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Li Wang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Maohua Wang
- Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Guidong Dai
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Yan Xiao
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Zhi Feng
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Guangxiang Chen
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
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Klimes-Dougan B, Başgöze Z, Mueller B, Wiglesworth A, Carosella KA, Westlund Schreiner M, Bortnova A, Reigstad K, Cullen KR, Gunlicks-Stoessel M. Structural and Functional Neural Correlates of Treatment Response for Interpersonal Psychotherapy for Depressed Adolescents. J Clin Med 2022; 11:jcm11071878. [PMID: 35407493 PMCID: PMC8999886 DOI: 10.3390/jcm11071878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Precision medicine approaches hold tremendous promise to advance current clinical practice by providing information about which individuals will benefit from which treatments. This pilot study evaluated if baseline structure and function of the salience and emotion brain regions implicated in adolescent depression, specifically the amygdala and anterior cingulate cortex (ACC), predict response to Interpersonal Psychotherapy for Depressed Adolescents (IPT-A). Adolescents (n = 15; mean age = 14.5 (1.6); 80.0% female) diagnosed with a depressive disorder completed brain scans before the start of a 16 week trial of IPT-A. Clinical measures assessing depressive symptoms were completed before, during, and after a trial of therapy. Results show that at baseline, greater ACC activation in the context of an emotion-matching task and greater amygdala-ACC resting-state functional connectivity was related to greater improvement in depression symptoms. There was minimal evidence that brain structure predicted changes in depressive symptoms. The present study is the first to evaluate neural predictors of IPT-A response. While the results are preliminary, these findings suggest some avenues for future research to pursue in the hopes that more will benefit from treatment.
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Affiliation(s)
- Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA; (A.W.); (K.A.C.)
- Correspondence: ; Tel.: +1-612-626-4347
| | - Zeynep Başgöze
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (Z.B.); (B.M.); (K.R.); (K.R.C.); (M.G.-S.)
| | - Bryon Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (Z.B.); (B.M.); (K.R.); (K.R.C.); (M.G.-S.)
| | - Andrea Wiglesworth
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA; (A.W.); (K.A.C.)
| | - Kathrine A. Carosella
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, USA; (A.W.); (K.A.C.)
| | | | - Ana Bortnova
- Minnesota Department of Health and Human Services, Saint Paul, MN 55101, USA;
| | - Kristina Reigstad
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (Z.B.); (B.M.); (K.R.); (K.R.C.); (M.G.-S.)
| | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (Z.B.); (B.M.); (K.R.); (K.R.C.); (M.G.-S.)
| | - Meredith Gunlicks-Stoessel
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (Z.B.); (B.M.); (K.R.); (K.R.C.); (M.G.-S.)
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Examining the Use of Antidepressants for Adolescents with Depression/Anxiety Who Regularly Use Cannabis: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010523. [PMID: 35010782 PMCID: PMC8744706 DOI: 10.3390/ijerph19010523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022]
Abstract
Depression and anxiety disorders are two of the most common and growing mental health concerns in adolescents. Consequently, antidepressant medication (AD) use has increased widely during the last decades. Several classes of antidepressants are used mainly to treat depression, anxiety, and obsessive-compulsive disorders by targeting relevant brain neurochemical pathways. Almost all randomized clinical trials of antidepressants examined patients with no concomitant medications or drugs. This does not address the expected course of therapy and outcome in cannabis users. Cannabis is the most commonly used illicit substance globally. Substantial changes in its regulation are recently taking place. Many countries and US states are becoming more permissive towards its medical and recreational use. The psychological and physiological effects of cannabis (mainly of its major components, tetrahydrocannabinol (THC) and cannabidiol (CBD)) have been extensively characterized. Cannabis use can be a risk factor for depressive and anxiety symptoms, but some constituents or mixtures may have antidepressant and/or anxiolytic potential. The aim of this literature review is to explore whether simultaneous use of AD and cannabis in adolescence can affect AD treatment outcomes. Based on the current literature, it is reasonable to assume that antidepressants are less effective for adolescents with depression/anxiety who frequently use cannabis. The mechanisms of action of antidepressants and cannabis point to several similarities and conjunctions that merit future investigation regarding the potential effectiveness of antidepressants among adolescents who consume cannabis regularly.
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Vaingankar JA, Chong SA, Abdin E, Shafie S, Chua BY, Shahwan S, Verma S, Subramaniam M. Early age of onset of mood, anxiety and alcohol use disorders is associated with sociodemographic characteristics and health outcomes in adults: results from a cross-sectional national survey. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1835-1846. [PMID: 33791821 DOI: 10.1007/s00127-021-02070-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This cross-sectional study investigated distribution, sociodemographic correlates, and health outcomes in early versus late age of onset (AOO) of mood, anxiety, and alcohol use disorders in Singapore. METHODS The Composite International Diagnostic Interview established lifetime diagnoses of major depressive, bipolar, generalized anxiety, obsessive compulsive and alcohol use disorders in a representative sample of residents aged 18 years and over (n = 6126). The AOO of the individual and any mental disorders were classified into early and late onset using median values as cut-offs. Data included socio-demographic and health background, health utility score, and productivity losses. Multivariable logistic regression analysis was conducted to assess sociodemographic correlates of early versus late AOO of any mental disorder while linear regression analysis investigated the associations between AOO of individual disorders with health utility score and productivity loss. RESULTS Respondents' mean (SD) age was 45.6 (16.5) years, comprising 50.5% women and majority of Chinese ethnicity (75.8%). The median AOO for any of the five studied disorders was 21 years (IQR: 15-29). Lowest AOO was observed for obsessive compulsive disorder (Median: 14, IQR: 11-26). Those aged 35 years and over (versus 18-34) were less likely to have earlier AOO [35-49 years (OR: 0.287; 95% CI: 0.154-0.534); 50-64 years (OR:0.156; 95% CI: 0.068-0.361) and 65 and over (OR:0.112; 95% CI:0.027-0.461)], while Malay ethnicity (versus Chinese) (OR: 2.319; 95% CI: 1.384-3.885) and being never married (versus married) (OR: 2.731; 95% CI: 1.493-4.993) were more likely to have early AOO for any mental disorder. Sample with early (versus late) AOO had a lower health utility score (β = - 0.06,95% CI: - 0.08 to - 0.03) and higher number of days cut down on the type of work (β = 1.61,95% CI: 0.12-3.10) in those with any mental disorders. CONCLUSION This study showed that half of the adults with mood, anxiety or alcohol use disorders in Singapore experienced their illness onset by 21 years of age. Early AOO is associated with sociodemographic background and poor health outcomes. Prevention, early detection, and interventions to improve health outcomes in mental disorders should consider the sociodemographic profile and age at first onset of symptoms in the population.
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Affiliation(s)
- Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Saleha Shafie
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
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16
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Early onset of depression and treatment outcome in patients with major depressive disorder. J Psychiatr Res 2021; 139:150-158. [PMID: 34058654 DOI: 10.1016/j.jpsychires.2021.05.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/22/2022]
Abstract
Major depressive disorder (MDD) is a highly heterogeneous disorder, which may partly explain why treatment outcome using antidepressants is unsatisfactory. We investigated the onset of depression as a possible clinical marker for therapy response prediction in the context of somatic biomarkers blood pressure and plasma electrolyte concentration. 889 MDD patients were divided into early (EO, n = 226), intermediate (IO, n = 493), and late onset (LO, n = 169) patients and were analyzed for differences in socio-demographic and clinical parameters, comorbidities and treatment outcome as well as systolic blood pressure and electrolytes. EO patients more often suffered from a recurrent depression, had more previous depressive episodes, a higher rate of comorbid axis I and II disorders, and more often reported of suicidality (p < 0.001) compared to IO and LO patients. Treatment outcome was not different from IO and LO patients, although LO patients responded faster. EO patients who showed an early non-improvement of depression after 2 weeks of therapy (<20% improvement) had a 4.3-fold higher likelihood to become non-remitter as compared to LO patients with an early improvement. EO patients had significantly lower systolic blood pressure than patients with IO or LO and electrolytes in EO patients were significantly correlated with depression severity. Our results confirm other studies showing an association of an early onset of depression with a slower treatment response. The worse treatment outcome in patients with an additional early non-improvement to antidepressant therapy opens perspectives to develop and test individualized treatment approaches for EO and LO patients in the future, which may be based on differences in autonomic regulation.
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17
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Dobson KG, Vigod SN, Mustard C, Smith PM. Major Depressive Episodes and Employment Earnings Trajectories over the Following Decade among Working-aged Canadian Men and Women. J Affect Disord 2021; 285:37-46. [PMID: 33626409 DOI: 10.1016/j.jad.2021.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Quantify the association between experiencing a major depressive episode (MDE) and employment earnings over the following decade among working-aged Canadian men and women. METHODS Ten national Canadian Community Health Survey (CCHS 2003-2014) cycles were linked to administrative tax records (1997-2016) for individuals 18-54 years old with information on past year MDE defined by the Composite International Diagnostic Interview Short Form (n=85,155) measured at baseline. Subsequent earnings were measured annually two to ten years post-MDE. MDE cases were matched with adult controls without MDE using 1:1 greedy nearest-neighbour without replacement propensity score matching for women and men. RESULTS Using random-effects longitudinal modelling, among women (n=6,974) in the matched cohort (average initial earnings ~$52,119/annum, 2016 Canadian real dollars), experiencing an MDE was associated with average earnings of $4,473 less in the year the MDE was reported (95%CI=-$3,215,-$5,731) and an additional $363 less/year over the following decade (95%CI=-$132,-$594). Among men (n=3,620, average initial earnings ~$76,110/annum), an MDE was associated with an initial reduction in earnings of $5,023 (95%CI=-$2,453,-$7,593) followed by an earnings decline starting with $730/year, increasing to ~$1,810/year at ten years post-MDE. LIMITATIONS Residual confounding by measures excluded from the propensity score. Only one MDE measurement limited exploring earnings trajectories of those with multiple episodes. CONCLUSIONS Consistently lower earnings were seen for ten years after experiencing one MDE. The magnitude of earnings difference immediately after the MDE was similar for men and women. Findings reveal the critical period surrounding an MDE where effective clinical treatment and labor policy may help buffer longstanding earnings loss.
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Affiliation(s)
- Kathleen G Dobson
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Work & Health, Toronto, ON, Canada.
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Women's College Hospital and Research Institute, Toronto, ON, Canada
| | - Cameron Mustard
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Work & Health, Toronto, ON, Canada
| | - Peter M Smith
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Work & Health, Toronto, ON, Canada; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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18
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Eigenhuis E, Waumans RC, Muntingh ADT, Westerman MJ, van Meijel M, Batelaan NM, van Balkom AJLM. Facilitating factors and barriers in help-seeking behaviour in adolescents and young adults with depressive symptoms: A qualitative study. PLoS One 2021; 16:e0247516. [PMID: 33684154 PMCID: PMC7939362 DOI: 10.1371/journal.pone.0247516] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Despite the availability of mental health care, only a minority of depressed adolescents and young adults receive treatment. This study aimed to investigate facilitating factors and barriers in help-seeking behaviour of adolescents and young adults with depressive symptoms, using qualitative research methods. METHODS In-depth, semi-structured interviews with 32 participants with current or previous depressive symptoms aged 16 to 24 years using thematic content analysis. FINDINGS Our sample consisted mainly of adolescents who eventually found their way to professional help. Five main themes in help-seeking by adolescents and young adults were identified: (I) Individual functioning and well-being, (II) Health literacy, (III) Attitudinal aspects, (IV) Surroundings, and (V) Accessibility. Prompts to seek treatment were disease burden and poor academic performance. Health illiteracy negatively influenced treatment-seeking behaviour. Attitudinal aspects either hampered (shame, wanting to handle the problem oneself, negative attitudes towards treatment) or facilitated (positive attitudes towards treatment) help-seeking. Furthermore, adolescents' surroundings (school, family, and peers) appeared to play a critical role in the recognition of depressive symptoms and encouragement to seek help. Barriers regarding accessibility of mental health care were found, whereas direct and easy access to treatment greatly improved mental health care use. CONCLUSION Facilitating factors can play a critical role in the help-seeking process of depressed adolescents and young adults, and may guide efforts to increase access to mental health care of this vulnerable age group. In particular, recognition and encouragement from school personnel and peers and easy access to care providers positively influenced help-seeking in our sample. Health illiteracy and attitudinal aspects appeared to be important barriers to seeking treatment and public/school campaigns aimed at reducing health illiteracy and stigma might be necessary to improve treatment-seeking and health care utilization in this age group.
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Affiliation(s)
- Eline Eigenhuis
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Ruth C. Waumans
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna D. T. Muntingh
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjan J. Westerman
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Location VUmc and Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Marlinde van Meijel
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | - Neeltje M. Batelaan
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anton J. L. M. van Balkom
- Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
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Serbanescu I, Backenstrass M, Drost S, Weber B, Walter H, Klein JP, Zobel I, Hautzinger M, Meister R, Härter M, Schramm E, Schoepf D. Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder. Front Psychiatry 2020; 11:607300. [PMID: 33408656 PMCID: PMC7779472 DOI: 10.3389/fpsyt.2020.607300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Abstract
Importance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and differentially from both psychotherapies. Objective: To identify those patient-level baseline characteristics that predict a comparable treatment effectiveness of CBASP and SP and those that moderate the differential effectiveness of CBASP compared to SP. Design, setting and participants: In this analysis of a 48-week multicenter randomized clinical trial comparing CBASP to SP in adult antidepressant-free outpatients with early-onset PDD, we evaluated baseline variables from the following domains as potential predictors and moderators of treatment effectiveness: socio-demography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy. Interventions: A 48-week treatment program with 32 sessions of either CBASP or SP. Main outcomes and measures: Depression severity measured by the 24-item Hamilton Rating Scale for Depression (HRSD-24) at week 48. Results: From N = 268 randomized outpatients, N = 209 completed the 48-week treatment program. CBASP completers had significantly lower post-treatment HRSD-24 scores than SP completers (meanCBASP=13.96, sdCBASP= 9.56; meanSP= 16.69, sdSP= 9.87; p = 0.04). A poor response to both therapies was predicted by higher baseline levels of clinician-rated depression, elevated suicidality, comorbid anxiety, lower social functioning, higher social inhibition, moderate-to-severe early emotional or sexual abuse, no preference for psychotherapy, and the history of at least one previous inpatient treatment. Moderator analyses revealed that patients with higher baseline levels of self-rated depression, comorbidity of at least one Axis-I disorder, self-reported moderate-to-severe early emotional or physical neglect, or at least one previous antidepressant treatment, had a significantly lower post-treatment depression severity with CBASP compared to SP (all p < 0.05). Conclusions and relevance: A complex multifactorial interaction between severe symptoms of depression, suicidality, and traumatic childhood experiences characterized by abuse, social inhibition, and anxiety may represent the basis of non-response to psychotherapy in patients with early onset PDD. Specific psychotherapy with CBASP might, however, be more effective and recommendable for a variety of particularly burdened patients compared to SP.
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Affiliation(s)
- Ilinca Serbanescu
- Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Matthias Backenstrass
- Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany
- Institute of Clinical Psychology, Hospital Stuttgart, Stuttgart, Germany
| | - Sarah Drost
- Department of Psychiatry and Psychotherapy, Cognitive Behavioral Analysis System of Psychotherapy Center of Competence, University of Bonn, Bonn, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Berlin, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Ingo Zobel
- Psychology School at the Fresenius University of Applied Sciences Berlin, Berlin, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dieter Schoepf
- Department of Psychiatry and Psychotherapy, Cognitive Behavioral Analysis System of Psychotherapy Center of Competence, University of Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, Vitos Weil-Lahn, Weilmünster, Germany
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20
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Tobon JI, Zipursky RB, Streiner DL, Colvin E, Bahl N, Ouimet AJ, Burckell L, Jeffs L, Bieling PJ. Motivational Enhancement as a Pretreatment to a Transdiagnostic Intervention for Emerging Adults with Emotion Dysregulation: A Pilot Randomized Controlled Trial. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2020; 29:132-148. [PMID: 32774397 PMCID: PMC7391867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE New approaches are needed to help the large number of emerging adults (EA) presenting with early-stage mental health problems. The goal of this pilot study was to carry out a randomized controlled trial to investigate whether motivational enhancement therapy (MET) improved the treatment effects of a 12-week psychological intervention, Dialectical Behaviour Therapy Skills Training (DBT-ST), for EA presenting in the early stages of mental health difficulties. Participants were recruited from the Youth Wellness Centre at St. Joseph's Healthcare Hamilton and McMaster University's Student Wellness Centre in Hamilton, Canada. METHODS Seventy-five participants were randomized to receive MET followed by DBT-ST or to DBT-ST alone. We assessed psychological distress, emotion dysregulation, and depression and anxiety symptoms as outcomes. RESULTS We found that both treatment groups had significant reductions in emotional dysregulation, psychological distress, depression, and anxiety at post-treatment and at the three-month follow-up. Participants assigned to MET pre-treatment experienced greater improvement in psychological distress at the end of treatment. CONCLUSION This pilot study provides preliminary evidence of the potential augmentation of DBT-ST using MET in a real-world setting. Future studies should examine whether MET uniquely augments DBT-ST through the use of a comparable pre-treatment control group.
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Affiliation(s)
- Juliana I Tobon
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - Robert B Zipursky
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Eamon Colvin
- School of Psychology, University of Ottawa, Ottawa, Ontario
| | - Nancy Bahl
- School of Psychology, University of Ottawa, Ottawa, Ontario
| | | | - Lisa Burckell
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Borderline Personality Disorder Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - Lisa Jeffs
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - Peter J Bieling
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
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Bessette KL, Jacobs RH, Heleniak C, Peters AT, Welsh RC, Watkins ER, Langenecker SA. Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial. PLoS One 2020; 15:e0233539. [PMID: 32555582 PMCID: PMC7299403 DOI: 10.1371/journal.pone.0233539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 05/06/2020] [Indexed: 11/29/2022] Open
Abstract
CLINICAL TRIALS REGISTRATION NCT01905267, https://clinicaltrials.gov/ct2/show/NCT01905267.
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Affiliation(s)
- Katie L. Bessette
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Charlotte Heleniak
- Department of Psychology, Columbia University, New York City, NY, United States of America
| | - Amy T. Peters
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Robert C. Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
| | | | - Scott A. Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States of America
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22
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Ueno K, Krause A. Occupational attainment and depressive symptoms in young adulthood. Stress Health 2020; 36:107-118. [PMID: 31612594 DOI: 10.1002/smi.2902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/07/2019] [Accepted: 09/27/2019] [Indexed: 11/07/2022]
Abstract
Past studies have shown that various aspects of occupational attainment (unemployment, job instability, low occupational status, and low earnings) are associated with poor mental health, but each of these studies focused on one or two aspects of occupational attainment. Consequently, it remains unclear whether their associations are independent of each other. Further, little is known about whether negative self-assessments of occupational attainment are linked to poor mental health. We sought to overcome these limitations of past research while focusing on depressive symptoms as a mental health outcome and young adulthood as a life stage context. The study analysed U.S. data from the National Longitudinal Study of Adolescent to Adult Health (n = 13,178) using ordinary least square models. The analysis showed that all aspects of occupational attainment were associated with depressive symptoms in the expected directions. Further, unemployment, job instability, and negative self-assessment of career progress showed stronger associations, and those associations were independent of other occupational attainment variables. Overall, the results suggested that understanding the association between occupational attainment and mental health requires close attention to the life stage context.
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Affiliation(s)
- Koji Ueno
- Department of Sociology, Florida State University, Tallahassee, Florida
| | - Alexandra Krause
- Department of Sociology, Florida State University, Tallahassee, Florida
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Parental Influences on University Students’ Mental Help‐Seeking Intentions. JOURNAL OF COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1002/jcad.12308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pan F, Xu Y, Zhou W, Chen J, Wei N, Lu S, Shang D, Wang J, Huang M. Disrupted intrinsic functional connectivity of the cognitive control network underlies disease severity and executive dysfunction in first-episode, treatment-naive adolescent depression. J Affect Disord 2020; 264:455-463. [PMID: 31780136 DOI: 10.1016/j.jad.2019.11.076] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/01/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous neuroimaging studies have showed that imbalanced functional integration of distributed large-scale brain networks is associated with pathophysiological characteristics of major depressive disorder (MDD). However, the association between network integrative disturbances and clinical features and cognitive functions remains largely unclear in adolescent MDD. This study investigated the neural correlates of abnormal functional connectivity networks with clinical and cognitive characteristics in adolescent MDD. METHODS Twenty-eight first-episode, treatment-naive adolescents with MDD and 24 well-matched healthy controls (HCs) underwent functional magnetic resonance imaging (fMRI) and a battery of cognitive tests. A seed-based functional connectivity (FC) approach was used to depict connectivity patterns of the cognitive control network (CCN), affective network (AN) and default mode network (DMN), whose between-group differences were correlated with clinical variables and cognitive functions in the patients. RESULTS Compared with the HCs, the MDD patients exhibited impaired executive functions. The FC analysis revealed lower CCN FC with the temporal, parietal and frontal regions and the limbic system, higher AN FC with the temporal and occipital regions and the cerebellum, and lower DMN FC with the cerebellum and insula. Interestingly, the decreased CCN FC was related to disease severity (with the inferior frontal gyrus) and executive dysfunctions (with the middle cingulate gyrus and supramarginal gyrus) in the patients. LIMITATIONS The main limitations were the relatively small sample size and suboptimal imaging parameters. CONCLUSION Functional alteration of CCN during the developmentally sensitive period may be important in the neurobiology of adolescent MDD.
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Affiliation(s)
- Fen Pan
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Weihua Zhou
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Jinkai Chen
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Ning Wei
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Shaojia Lu
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Desheng Shang
- Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China.
| | - Manli Huang
- Department of Psychiatry, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China.
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Windle E, Hickling LM, Jayacodi S, Carr C. The experiences of patients in the synchrony group music therapy trial for long-term depression. ARTS IN PSYCHOTHERAPY 2020. [DOI: 10.1016/j.aip.2019.101580] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Pelham WE, Page TF, Altszuler AR, Gnagy EM, Molina BSG, Pelham WE. The long-term financial outcome of children diagnosed with ADHD. J Consult Clin Psychol 2020; 88:160-171. [PMID: 31789549 PMCID: PMC6940517 DOI: 10.1037/ccp0000461] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Characterize the early trajectories of financial functioning in adults with history of childhood ADHD and use these trajectories to project earnings and savings over the lifetime. METHOD Data were drawn from a prospective case-control study (PALS) following participants with a rigorous diagnosis of ADHD during childhood (N = 364) and demographically matched controls (N = 240) for nearly 20 years. Participants and their parents reported on an array of financial outcomes when participants were 25 and 30 years old. RESULTS At age 30, adults with a history of ADHD exhibited substantially worse outcomes than controls on most financial indicators, even when they and their parents no longer endorsed any DSM symptoms of ADHD. Between ages 25 and 30, probands had exhibited considerably slower growth than controls in positive financial indicators (e.g., monthly income) and substantially less reduction than controls in indicators of financial dependence (e.g., living with parents), indicating worsening or sustained deficits on nearly all measures. When earnings trajectories from age 25 to age 30 were extrapolated using matched census data, male probands were projected to earn $1.27 million less than controls over their working lifetime, reaching retirement with up to 75% lower net worth. CONCLUSION The financial deficit of adults with history of childhood ADHD grows across early adulthood. Projections based on early financial trajectories suggest very large cumulative differences in earnings and savings. With or without persistence of the DSM symptoms, the adult sequela of childhood ADHD can be conceptualized as a chronic condition often requiring considerable support from others during adulthood. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Timothy F. Page
- Health Policy and Management, Florida International University, Miami, FL 33199
- Center for Children and Families, Florida International University, Miami, FL 33199
| | - Amy R. Altszuler
- Center for Children and Families, Florida International University, Miami, FL 33199
| | - Elizabeth M. Gnagy
- Center for Children and Families, Florida International University, Miami, FL 33199
| | | | - William E. Pelham
- Department of Psychology, Florida International University, Miami, FL 33199
- Center for Children and Families, Florida International University, Miami, FL 33199
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Shen W. A tangled web: The reciprocal relationship between depression and educational outcomes in China. SOCIAL SCIENCE RESEARCH 2020; 85:102353. [PMID: 31789192 PMCID: PMC6901113 DOI: 10.1016/j.ssresearch.2019.102353] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 05/05/2023]
Abstract
Research on depression and education usually focuses on a unidirectional relationship. This paper proposes a reciprocal relationship, simultaneously estimating the effects of depression on education and of education on depression. China, which has the world's largest education system, is used as a case study. This paper applies structural equation modeling to three datasets: the China Family Panel Studies, the China Education Panel Survey, and the Gansu Survey of Children and Families. Analyses reveal a reciprocal and negative relationship between depression and educational outcomes. Specifically, early depression reduces later educational achievement, and higher educational achievement also lowers the level of subsequent depression by resulting in less peers' unfriendliness, less pressure from parents' expectations, and less teachers' criticism. More time spent on studies is not associated with higher educational achievement but significantly increases the level of depression. Children from lower SES families bear more pressure and spend more time on studies, which does not correspond to higher educational achievement but rather to higher levels of depression. In the long term, prior depression lowers educational attainment and, after controlling for prior depression, lower educational attainment is also associated with higher levels of subsequent depression. This paper shows that the lower achievers, not the high achievers, bear the major psychological burden of the education system's quest to produce high achievement. This situation reinforces these students' educational disadvantage.
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Affiliation(s)
- Wensong Shen
- Department of Sociology, University of Pennsylvania, 3718 Locust Walk, McNeil Building, Ste. 353, Philadelphia, PA, 19104, USA.
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Serbanescu I, Walter H, Schnell K, Kessler H, Weber B, Drost S, Groß M, Neudeck P, Klein JP, Assmann N, Zobel I, Backenstrass M, Hautzinger M, Meister R, Härter M, Schramm E, Schoepf D. Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder. Behav Res Ther 2019; 124:103512. [PMID: 31734568 DOI: 10.1016/j.brat.2019.103512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/14/2019] [Accepted: 11/03/2019] [Indexed: 12/24/2022]
Abstract
Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65% of the patients had a better treatment outcome with CBASP, while the remaining 41.35% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.
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Affiliation(s)
- Ilinca Serbanescu
- Center for Economics and Neuroscience, University of Bonn, Nachtigallenweg 86, D-53127, Bonn, Germany; Institute of Experimental Epileptology and Cognition Research, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany.
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Charitéplatz 1, D-10117, Berlin, Germany
| | - Knut Schnell
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, vonsiebold Straße 5, D-37075, Göttingen, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Alexandrinenstrasse 1-3, D-44791, Bochum, Germany
| | - Bernd Weber
- Center for Economics and Neuroscience, University of Bonn, Nachtigallenweg 86, D-53127, Bonn, Germany; Institute of Experimental Epileptology and Cognition Research, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany
| | - Sarah Drost
- Department of Psychiatry and Psychotherapy, CBASP Center of Competence, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany
| | - Magdalena Groß
- Department of Psychiatry and Psychotherapy, CBASP Center of Competence, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany
| | - Peter Neudeck
- Department of Psychiatry and Psychotherapy, CBASP Center of Competence, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Nele Assmann
- Department of Psychiatry and Psychotherapy, Lübeck University, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Ingo Zobel
- Psychology School at the Fresenius University of Applied Sciences Berlin, Jägerstrasse 32, D-10117, Berlin, Germany
| | - Matthias Backenstrass
- Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Hauptstrasse 47-51, D-69117, Heidelberg, Germany; Institute of Clinical Psychology, Hospital Stuttgart, Prießnitzweg 24, D-70374, Stuttgart, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Schleichstrasse 4, D-72076, Tübingen, Germany
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Dieter Schoepf
- Department of Psychiatry and Psychotherapy, CBASP Center of Competence, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany; Department of Psychiatry and Psychotherapy, Vitos Weil-Lahn, Mönchberg 8, D-65589, Hadamar, Germany
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Joensuu M, Mattila-Holappa P, Ahola K, Kivimäki M, Tuisku K, Koskinen A, Vahtera J, Virtanen M. Predictors of employment in young adults with psychiatric work disability. Early Interv Psychiatry 2019; 13:1083-1089. [PMID: 30125468 DOI: 10.1111/eip.12730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/05/2018] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Abstract
AIM Mental disorders are the leading cause of work disability among young adults in the industrialized world. Factors predicting employment after long-term psychiatric work disability are largely unknown. METHODS We linked personal and clinical information from the benefit applications and medical certificates of 1163 young adults (18-34 years) with a new-onset fixed-term psychiatric disability pension in 2008 with employment records between 2005 and 2013. The outcomes were starting employment during and being employed at the end of follow-up. RESULTS Of the participants, 48% had been employed during and 22% were employed at the end of follow-up. Sustained employment history, university education (master's degree) and no recorded psychological symptoms in childhood were associated with both subsequent employment outcomes. Women and participants under 25 years were more likely to start employment. Depression and other mental disorders (vs psychotic diagnose) and having no comorbid mental disorders or substance abuse were associated with employment at the end of follow-up. CONCLUSIONS Sustained employment history, university education and no recorded psychological symptoms during childhood predict a return to employment among young adults after a fixed-term psychiatric work disability pension. Pro-active interventions in psychological problems during childhood could enhance employment after a period of work disability.
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Affiliation(s)
- Matti Joensuu
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Kirsi Ahola
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland.,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Katinka Tuisku
- Outpatient Clinic for Assessment of Ability to Work, Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
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Liu J, Xu P, Zhang J, Jiang N, Li X, Luo Y. Ventral attention-network effective connectivity predicts individual differences in adolescent depression. J Affect Disord 2019; 252:55-59. [PMID: 30978625 DOI: 10.1016/j.jad.2019.04.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 03/08/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stimulus-driven negative attention bias is a central deficit in depression and might play an important role in vulnerability to depression Adolescents are susceptible to depression. Thus, investigating the neural correlates of attention bias in adolescents is a critical step for identifying neural markers of early onset of depression. Previous studies have shown that the ventral attention network (VAN), which includes bilateral ventrolateral prefrontal cortex (VLPFC) and bilateral temporal-parietal junction (TPJ), is the key brain network for stimulus-driven attention. However, the relationship between depression and effective connectivity within the VAN in adolescents is poorly understood. METHOD We employed resting-state fMRI to assess the relationship between directional effective connectivity within the VAN and depression scores in 216 healthy adolescents. RESULTS Using stochastic dynamic modeling, we found that individuals who exhibited higher self-reported depression showed stronger effective connectivity between right VLPFC and left TPJ within the VAN. LIMITATION The level of depression in this study was assessed with self-reported questionnaire. This measure might be more influenced by current mood in adolescents than that in adults. Future studies should emplo more objective measures to index levels of depression. CONCLUSIONS Our findings indicate that effective connectivity between right VLPFC and left TPJ could at least partially serve as a biomarker for bottom-up processing of depression in adolescents.
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Affiliation(s)
- Jie Liu
- College of Psychology and Sociology, Shenzhen University, Shenzhen, China; Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Center for Brain Disorders and Cognitive Neuroscience, Shenzhen University, Shenzhen, China
| | - Pengfei Xu
- College of Psychology and Sociology, Shenzhen University, Shenzhen, China; Center for Brain Disorders and Cognitive Neuroscience, Shenzhen University, Shenzhen, China
| | - Jingyuan Zhang
- College of Psychology and Sociology, Shenzhen University, Shenzhen, China
| | - Nengzhi Jiang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xinying Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Yuejia Luo
- College of Psychology and Sociology, Shenzhen University, Shenzhen, China; Centre for Emotion and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China; Department of Psychology, Southern Medical University, Guangzhou, China.
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Machmutow K, Meister R, Jansen A, Kriston L, Watzke B, Härter MC, Liebherz S. Comparative effectiveness of continuation and maintenance treatments for persistent depressive disorder in adults. Cochrane Database Syst Rev 2019; 5:CD012855. [PMID: 31106850 PMCID: PMC6526465 DOI: 10.1002/14651858.cd012855.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Persistent depressive disorder (PDD) is defined as a depressive disorder with a minimum illness duration of two years, including four diagnostic subgroups (dysthymia, chronic major depression, recurrent major depression with incomplete remission between episodes, and double depression). Persistent forms of depression represent a substantial proportion of depressive disorders, with a lifetime prevalence ranging from 3% to 6% in the Western world. Growing evidence indicates that PDD responds well to several acute interventions, such as combined psychological and pharmacological treatments. Yet, given the high rates of relapse and recurrences of depression following response to acute treatment, long-term continuation and maintenance therapy are of great importance. To date, there has been no evidence synthesis available on continuation and maintenance treatments of PDDs. OBJECTIVES To assess the effects of pharmacological and psychological (either alone or combined) continuation and maintenance treatments for persistent depressive disorder, in comparison with each other, placebo (drug/attention placebo/non-specific treatment control), and treatment as usual (TAU). Continuation treatments are defined as treatments given to currently remitted people (remission is defined as depressive symptoms dropping below case level) or to people who previously responded to an antidepressant treatment. Maintenance therapy is given during recovery (which is defined as remission lasting longer than six months). SEARCH METHODS We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 28 September 2018. An earlier search of these databases was also conducted for RCTs via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to 11 Dec 2015). In addition we searched grey literature resources as well as the international trial registers ClinicalTrials.gov and ICTRP to 28 September 2018. We screened reference lists of included studies and contacted the first author of all included studies. SELECTION CRITERIA We included randomized (RCTs) and non-randomized controlled trials (NRCTs) in adults with formally diagnosed PDD, receiving pharmacological, psychological, or combined continuation and maintenance interventions. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted and analyzed data. The primary efficacy outcome was relapse/recurrence rate of depression. The primary acceptance outcome was dropout due to any reason other than relapse/recurrence. We performed random-effects meta-analyses using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS We included 10 studies (seven RCTs, three NRCTs) involving 840 participants in this review, from which five studies investigated continuation treatments and five studies investigated maintenance treatments. Overall, the included studies were at low-to-moderate risk of bias. For the three NRCTs, the most common source of risk of bias was selection of reported results. For the seven RCTs, the most common sources of risk of bias was non-blinding of outcome assessment and other bias (especially conflict of interest due to pharmaceutical sponsoring).Pharmacological continuation and maintenance therapiesThe most common comparison was antidepressant medication versus tablet placebo (five studies). Participants taking antidepressant medication were probably less likely to relapse or to experience a recurrent episode compared to participants in the placebo group at the end of the intervention (13.9% versus 33.8%, RR 0.41, 95% CI 0.21 to 0.79; participants = 383; studies = 4; I² = 54%, moderate quality evidence). Overall dropout rates may be similar between participants in the medication and placebo group (23.0% versus 25.5%, RR 0.90, 95% CI 0.39 to 2.11; RCTs = 4; participants = 386; I² = 64%, low quality evidence). However, sensitivity analyses showed that the primary outcome (rate of relapse/recurrence) showed no evidence of a difference between groups when only including studies with low risk of bias.None of the studies compared pharmacological or psychological treatments versus TAU.Psychological continuation and maintenance therapiesOne study compared psychological therapies versus attention placebo/non-specific control. One study compared psychotherapy with medication. The results of the studies including psychotherapy might indicate that continued or maintained psychotherapy could be a useful intervention compared to no treatment or antidepressant medication. However, the body of evidence for these comparisons was too small and uncertain to draw any high quality conclusions.Combined psychological and pharmacological continuation and maintenance therapiesThree studies compared combined psychological and pharmacological therapies with pharmacological therapies alone. One study compared combined psychological and pharmacological therapies with psychotherapeutic therapies alone. However, the body of evidence for these comparisons was too small and uncertain to draw any high quality conclusionsComparison of different antidepressant medications Two studies reported data on the direct comparison of two antidepressants. However, the body of evidence for this comparison was too small and uncertain to draw any high quality conclusions. AUTHORS' CONCLUSIONS Currently, it is uncertain whether continued or maintained pharmacotherapy (or both) with the reviewed antidepressant agents is a robust treatment for preventing relapse and recurrence in people with PDD, due to moderate or high risk of bias as well as clinical heterogeneity in the analyzed studies.For all other comparisons, the body of evidence was too small to draw any final conclusions, although continued or maintained psychotherapy might be effective compared to no treatment. There is need for more high quality trials of psychological interventions. Further studies should address health-related quality of life and adverse events more precisely, as well as assessing follow-up data.
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Affiliation(s)
- Katja Machmutow
- University of ZurichDepartment of Clinical Psychology and PsychotherapyZurichSwitzerland
- Psychiatrische Dienste Aargau AGWindischSwitzerland
| | - Ramona Meister
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyMartinistr. 52HamburgHamburgGermanyD‐20246
| | - Alessa Jansen
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyMartinistr. 52HamburgHamburgGermanyD‐20246
| | - Levente Kriston
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyMartinistr. 52HamburgHamburgGermanyD‐20246
| | - Birgit Watzke
- University of ZurichDepartment of Clinical Psychology and PsychotherapyZurichSwitzerland
| | - Martin Christian Härter
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyMartinistr. 52HamburgHamburgGermanyD‐20246
| | - Sarah Liebherz
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyMartinistr. 52HamburgHamburgGermanyD‐20246
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Xu F, Cui W, Xing T, Parkinson M. Family Socioeconomic Status and Adolescent Depressive Symptoms in a Chinese Low- and Middle- Income Sample: The Indirect Effects of Maternal Care and Adolescent Sense of Coherence. Front Psychol 2019; 10:819. [PMID: 31031681 PMCID: PMC6470245 DOI: 10.3389/fpsyg.2019.00819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/27/2019] [Indexed: 11/17/2022] Open
Abstract
The current study investigated whether socioeconomic status (SES) was associated with adolescent depressive symptoms through maternal parenting and adolescent sense of coherence (SOC). Using a sample of 1220 Chinese adolescents, it was found that SES, maternal care, and adolescent SOC were positively related to each other and negatively related to adolescent depressive symptoms, respectively. Maternal control was positively related to adolescent depressive symptoms and negatively related to their SOC, but not significantly to SES. By analysis of structural equation modeling, we found that SES was associated with adolescent depressive symptoms indirectly through maternal care separately, as well as through maternal care and adolescent SOC sequentially. This study extended our understanding by showing possible indirect pathways by which family contextual factors and individual internal resources for adolescent depressive symptoms may operate separately and sequentially. The overall results highlighted the need to study adolescent depressive symptoms to find external and internal positive factors for maintaining adolescent emotional health, especially in families with relatively lower income.
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Affiliation(s)
- Fuzhen Xu
- School of Psychology, Shandong Normal University, Jinan, China
| | - Wei Cui
- School of Psychology, Shandong Normal University, Jinan, China
| | - Tingting Xing
- School of Psychology, Shandong Normal University, Jinan, China
| | - Monika Parkinson
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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Lynch FL, Dickerson JF, Clarke GN, Beardslee WR, Weersing VR, Gladstone TRG, Porta G, Brent DA, Mark TL, DeBar LL, Hollon SD, Garber J. Cost-Effectiveness of Preventing Depression Among At-Risk Youths: Postintervention and 2-Year Follow-Up. Psychiatr Serv 2019; 70:279-286. [PMID: 30929618 PMCID: PMC6897501 DOI: 10.1176/appi.ps.201800144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Youth depression can be prevented, yet few programs are offered. Decision makers lack cost information. This study evaluated the cost-effectiveness of a cognitive-behavioral prevention program (CBP) versus usual care. METHODS A cost-effectiveness analysis was conducted with data from a randomized controlled trial of 316 youths, ages 13-17, randomly assigned to CBP or usual care. Youths were at risk of depression because of a prior depressive disorder or subthreshold depressive symptoms, or both, and had parents with a prior or current depressive disorder. Outcomes included depression-free days (DFDs), quality-adjusted life years (QALYs), and costs. RESULTS Nine months after baseline assessment, youths in CBP experienced 12 more DFDs (p=.020) and .018 more QALYs (p=.007), compared with youths in usual care, with an incremental cost-effectiveness ratio (ICER) of $24,558 per QALY. For youths whose parents were not depressed at baseline, CBP youths had 26 more DFDs (p=.001), compared with those in usual care (ICER=$10,498 per QALY). At 33 months postbaseline, youths in CBP had 40 more DFDs (p=.05) (ICER=$12,787 per QALY). At 33 months, CBP youths whose parents were not depressed at baseline had 91 more DFDs (p=.001) (ICER=$13,620 per QALY). For youths with a currently depressed parent at baseline, CBP was not significantly more effective than usual care at either 9 or 33 months, and costs were higher. CONCLUSIONS CBP produced significantly better outcomes than usual care and was particularly cost-effective for youths whose parents were not depressed at baseline. Depression prevention programs could improve youths' health at a reasonable cost; services to treat depressed parents may also be warranted.
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Affiliation(s)
- Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Gregory N Clarke
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - William R Beardslee
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - V Robin Weersing
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Tracy R G Gladstone
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Giovanna Porta
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - David A Brent
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Tami L Mark
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Lynn L DeBar
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Steven D Hollon
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Judy Garber
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
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Hellerstein DJ, Stewart JW, Chen Y, Arunagiri V, Peterson BS, McGrath PJ. Desvenlafaxine vs. placebo in the treatment of persistent depressive disorder. J Affect Disord 2019; 245:403-411. [PMID: 30423468 DOI: 10.1016/j.jad.2018.11.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 09/21/2018] [Accepted: 11/03/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pharmacotherapy of non-major persistent depressive disorder (PDD) is little studied. We report a study of the serotonin-norepinephrine reuptake inhibitor (SNRI) desvenlafaxine (DVLX) for PDD. METHOD Non-psychotic, non-bipolar outpatients aged 20-65 having PDD without concurrent major depression (MDD) were randomized double-blind to desvenlafaxine or placebo for 12 weeks. All had Hamilton Depression Rating Scale (HDRS-24) score ≥ 12. Open-label DVLX was offered for 12 weeks following the acute trial. RESULTS Seventy-one subjects having mean baseline HDRS-24 20.27 ± 4.77 were eligible, of whom post-RZ data was available for all 59 randomized. The primary 12 week analysis did not differentiate DVLX-treated subjects' mean HDRS scores from those on placebo (6.53 ± 3.98 vs. 8.24 ± 4.96, F = 3.33, df = 1, p = .07). Several secondary analyses yielded statistically significant results, including Responder, CGI and QIDS. DISCUSSION As the primary analysis did not reach statistical significance, this is a negative study which does not support the use of DVLX for non-major PDD. Nevertheless, statistically significant secondary analyses suggest the overall negative result could be due to sample size or sampling, suggesting further studies of this medication might be appropriate in this population.
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Affiliation(s)
- David J Hellerstein
- New York State Psychiatric Institute, New York, NY, United States; Columbia University College of Physicians and Surgeons, New York, NY, United States.
| | - Jonathan W Stewart
- New York State Psychiatric Institute, New York, NY, United States; Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Ying Chen
- New York State Psychiatric Institute, New York, NY, United States; Columbia University College of Physicians and Surgeons, New York, NY, United States
| | | | - Bradley S Peterson
- Institute for the Developing Mind at Children's Hospital Los Angeles, Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Patrick J McGrath
- New York State Psychiatric Institute, New York, NY, United States; Columbia University College of Physicians and Surgeons, New York, NY, United States
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Clayborne ZM, Varin M, Colman I. Systematic Review and Meta-Analysis: Adolescent Depression and Long-Term Psychosocial Outcomes. J Am Acad Child Adolesc Psychiatry 2019; 58:72-79. [PMID: 30577941 DOI: 10.1016/j.jaac.2018.07.896] [Citation(s) in RCA: 331] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/13/2018] [Accepted: 08/15/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Experiencing depression in adolescence can disrupt important developmental processes, which can have longstanding effects on socioeconomic status and relationships. The objective of this article was to systematically review the evidence examining associations between adolescent depression and adult psychosocial outcomes. METHOD Five databases (MEDLINE, Embase, PsycINFO, CINAHL, and ERIC) were searched for articles published from 1980 through March 2017. Eligible articles were peer reviewed, published in English, had prospective cohort study designs, and contrasted adult psychosocial outcomes in those with versus without adolescent depression. Outcomes with sufficient data were pooled using random-effects meta-analyses, with summary measures reported as odds ratios (ORs). A protocol for this review was registered on PROSPERO (CRD42017059662). RESULTS Of the 4,988 references screened for inclusion, 31 articles comprising 136 analyses were included for review. Twenty-four cohorts were represented. Seventy-seven analyses across 10 outcomes were meta-analyzed, with remaining analyses summarized narratively. Meta-analyses suggested that adolescent depression was associated with outcomes including, but not limited to, failure to complete secondary school (OR 1.76, 95% CI 1.29-2.39), unemployment (OR 1.66, 95% CI 1.29-2.14), and pregnancy/parenthood (OR 1.38, 95% CI 1.06-1.81). CONCLUSION This review demonstrates that adolescent depression is associated with a myriad of adult psychosocial outcomes. Many are linked and can lead to the propagation of difficulties across the lifespan. These findings can have important implications for encouraging the provision of targeted mental health care early in development to improve life chances.
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Affiliation(s)
- Zahra M Clayborne
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Melanie Varin
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada.
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Chen ZD, Chen WQ, Wang ZY, Cao DN, Wu N, Li J. Antidepressant-like action of agmatine in the acute and sub-acute mouse models of depression: a receptor mechanism study. Metab Brain Dis 2018; 33:1721-1731. [PMID: 30019267 DOI: 10.1007/s11011-018-0280-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/22/2018] [Indexed: 01/28/2023]
Abstract
Previous studies have shown that agmatine, a potential neuromodulator or co-transmitter, exhibited antidepressant-like action in animal models, yet its mechanism, especially the receptor mechanism, remains unclear. In the present study, using efaroxan, a preferential antagonist of I1 imidazoline receptor (I1R) and yohimbine, an antagonist of α2 adrenergic receptor (α2AR), we investigated the roles of I1R and α2AR in agmatine's antidepressant-like effect in acute and sub-acute depression models in mice. We found that in the tail-suspension test (TST) and the forced swimming test (FST), acute administration of agmatine (20 and 40 mg/kg, p.o.) significantly shortened the immobility time. Concurrent administration of efaroxan (1 mg/kg, i.p.) completely abolished the antidepressant-like effects of agmatine (40 mg/kg, p.o.) whereas yohimbine (5 mg/kg, i.p.) failed to exert similar effects, suggesting that the acute antidepressant-like effects of agmatine was mainly mediated by I1R but not α2AR. Additionally, in the learned helplessness (LH) test, repeated administration of agmatine (20 mg/kg, p.o., q.d.) for 5 days significantly decreased the escape latency and the number of escape failure, and these effects were respectively abolished by concurrent administration of efaroxan (0.5 mg/kg,i.p., q.d.) and yohimbine (3 mg/kg, i.p., q.d.) for 5 days, suggesting that the antidepressant-like action of agmatine in the LH test was achieved via the activation of both I1R and α2AR. In summary, we found that the antidepressant-like effects of agmatine in the TST and the FST were mediated by activating I1R and in the sub-acute LH test were mediated by activating both I1R and α2AR.
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Affiliation(s)
- Zhao-Di Chen
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China
| | - Wen-Qiang Chen
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Harvard Medical School, 200 Longwood Avenue, Boston, MA, 02115, USA
| | - Zhi-Yuan Wang
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China
| | - Dan-Ni Cao
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China
| | - Ning Wu
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China.
| | - Jin Li
- Beijing Key Laboratory of Neuropsychopharmacology, State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, 27th Taiping Road, Beijing, 100850, China.
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Zhang MX, Mou NL, Tong KK, Wu AMS. Investigation of the Effects of Purpose in Life, Grit, Gratitude, and School Belonging on Mental Distress among Chinese Emerging Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2147. [PMID: 30274292 PMCID: PMC6210347 DOI: 10.3390/ijerph15102147] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 11/16/2022]
Abstract
Given the high prevalence of mental distress indicators, such as depression, among emerging adults, it is imperative to identify not only factors that place them at risk for mental distress, but also those that protect against it. This study tested the direct and indirect effects (via purpose in life) of gratitude, two aspects of grit (i.e., consistency of interest and perseverance of effort), and school belonging on three indicators of mental distress (i.e., depression, anxiety, and stress). A total of 468 Chinese university students (58.3% female), aged 18 to 27, in Macao, China responded to an anonymous questionnaire between April to May, 2016. As expected, all psychosocial factors were negatively associated with all three indicators of mental distress (r = -0.15 to -0.42, p < 0.05), with the exception of perseverance of effort, which had a significant, negative association with depression only. The results of path analysis showed that purpose in life significantly mediated the effect of school belonging and perseverance of effort on depression, whereas school belonging, gratitude, and consistency of interest all had direct effects on all three indicators of mental distress (p < 0.05). Our results also suggested that the two components of grit may have differential effects on mental distress among Chinese emerging adults. School-based programs should consider positive psychology interventions in Chinese populations.
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Affiliation(s)
- Meng Xuan Zhang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Avenida da Universidade, Taipa, Macao, China.
| | - Ngai Lam Mou
- Department of Psychology, Faculty of Social Sciences, University of Macau, Avenida da Universidade, Taipa, Macao, China.
| | - Kwok Kit Tong
- Department of Psychology, Faculty of Social Sciences, University of Macau, Avenida da Universidade, Taipa, Macao, China.
| | - Anise M S Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Avenida da Universidade, Taipa, Macao, China.
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Johnson D, Dupuis G, Piche J, Clayborne Z, Colman I. Adult mental health outcomes of adolescent depression: A systematic review. Depress Anxiety 2018; 35:700-716. [PMID: 29878410 DOI: 10.1002/da.22777] [Citation(s) in RCA: 234] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 04/12/2018] [Accepted: 04/23/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adolescent depression may increase risk for poor mental health outcomes in adulthood. The objective of this study was to systematically review the literature on the association between adolescent depression and adult anxiety and depressive disorders as well as suicidality. METHODS EMBASE, MEDLINE, and PSYCinfo databases were searched and longitudinal cohort studies in which depression was measured in adolescence (age 10-19) and outcomes of depressive disorders, anxiety disorders, or suicidality were measured in adulthood (age 21+), were selected. Meta-analysis using inverse variance and random effects modeling, along with sensitivity analyses, were used to synthesize article estimates. RESULTS Twenty articles were identified, representing 15 unique cohorts. Seventeen of 18 articles showed adolescent depression increased risk for adult depression; eleven pooled cohorts estimated that adolescents with depression had 2.78 (1.97, 3.93) times increased odds of depression in adulthood. Seven of eight articles that investigated the association between adolescent depression and any adult anxiety found a significant association. Three of five articles showed a significant association between adolescent depression and adult suicidality. CONCLUSION This review shows that adolescent depression increases the risk for subsequent depression later in life. Articles consistently found that adolescent depression increases the risk for anxiety disorders in adulthood, but evidence was mixed on whether or not a significant association existed between adolescent depression and suicidality in adulthood. Early intervention in adolescent depression may reduce long-term burden of disease.
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Affiliation(s)
- Dylan Johnson
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabrielle Dupuis
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Piche
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Zahra Clayborne
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Depressive Symptoms of Chinese Children: Prevalence and Correlated Factors among Subgroups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020283. [PMID: 29414881 PMCID: PMC5858352 DOI: 10.3390/ijerph15020283] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 01/27/2018] [Accepted: 02/04/2018] [Indexed: 11/17/2022]
Abstract
Economic growth and socioeconomic changes have transformed nearly every aspect of childhood in China, and many are worried by the increasing prevalence of mental health issues among children, particularly depression. To provide insight into the distribution of depressive symptoms among children in China and identify vulnerable groups, we use data from the 2012 China Family Panel Survey (CFPS), a survey that collected data from a large, nationally representative sample of the Chinese population. Using the CFPS data, we construct a sample of 2679 children aged 10–15 years old from 25 provinces in China. According to our results, the incidence of depression varies by geographic area. Specifically, we find that rates of depressive symptoms are significantly lower in urban areas (14% of sample children) than in rural areas (23% of sample children). Our results also show that children from ethnic minorities, from poorer families, and whose parents are depressed are more likely to be depressed than other children. In contrast, we find that depressive symptoms do not vary by gender.
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Klimes-Dougan B, Westlund Schreiner M, Thai M, Gunlicks-Stoessel M, Reigstad K, Cullen KR. Neural and neuroendocrine predictors of pharmacological treatment response in adolescents with depression: A preliminary study. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:194-202. [PMID: 29100972 DOI: 10.1016/j.pnpbp.2017.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/09/2017] [Accepted: 10/24/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Typically, about 30 to 50% of adolescents with depression fail to respond to evidence-based treatments, including antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). Efforts for identifying predictors and moderators of treatment response are needed to begin to address critical questions relevant to personalized care in adolescent depression. In this pilot study, we aim to identify biological predictors of response to antidepressant treatment. METHOD We used a multiple levels of analysis approach to evaluate threat system functioning (fronto-limbic system and the associated hormonal cascade) to determine if key biological indexes at baseline could predict improvement in depressive symptoms after eight weeks of antidepressant treatment in adolescents with depression. RESULTS Neural predictors of favorable treatment response included lower amygdala connectivity with left supplementary motor area and with right precentral gyrus, and greater amygdala connectivity with right central opercular cortex and Heschl's gyrus connectivity during rest. During an emotion task, neural predictors of treatment response were greater activation of the bilateral anterior cingulate cortex and left medial frontal gyrus. Additionally, different patterns of salivary cortisol obtained in the context of a modified Trier Social Stress Test were associated with those whose depressive symptoms remitted as compared to those whose symptoms persisted. CONCLUSIONS This approach shows significant promise for identifying predictors of treatment response in adolescents with depression. Future work is needed that incorporates sufficiently powered, randomized control trials to provide the basis by which both predictors and moderators of treatment response are identified. The hope is that this work will inform the development of methods that can guide clinician decision-making in assigning beneficial treatments for adolescents who are suffering from depression.
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Affiliation(s)
- Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States.
| | - Melinda Westlund Schreiner
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States; Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Michelle Thai
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | | | - Kristina Reigstad
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
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Dickerson JF, Lynch FL, Leo MC, DeBar LL, Pearson J, Clarke GN. Cost-effectiveness of Cognitive Behavioral Therapy for Depressed Youth Declining Antidepressants. Pediatrics 2018; 141:peds.2017-1969. [PMID: 29351965 PMCID: PMC5810604 DOI: 10.1542/peds.2017-1969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescents with depression identified in primary care settings often have limited treatment options beyond antidepressant (AD) therapy. We assessed the cost-effectiveness of a brief cognitive behavioral therapy (CBT) program among depressed adolescents who declined or quickly stopped using ADs. METHODS A total of 212 youth with depression were randomly assigned to treatment as usual (TAU) or TAU plus brief individual CBT. Clinical outcomes included depression-free days (DFDs) and estimated quality-adjusted life-years (QALYs). Costs were adjusted to 2008 US dollars. Incremental cost-effectiveness ratios (ICERs) comparing CBT to TAU were calculated over 12- and 24-month follow-up periods. RESULTS Youth randomly assigned to CBT had 26.8 more DFDs (P = .044) and 0.067 more QALYs (P = .044) on average compared with TAU over 12 months. Total costs were $4976 less (P = .025) by the end of the 24-month follow-up among youth randomly assigned to CBT. Total costs per DFD were -$51 (ICER = -$51; 95% confidence interval [CI]: -$394 to $9) at 12 months and -$115 (ICER = -$115; 95% CI: -$1090 to -$6) at 24 months. Total costs per QALY were -$20 282 (ICER = -$20 282; 95% CI: -$156 741 to $3617) at 12 months and -$45 792 (ICER = -$45 792; 95% CI: -$440 991 to -$2731) at 24 months. CONCLUSIONS Brief primary care CBT among youth declining AD therapy is cost-effective by widely accepted standards in depression treatment. CBT becomes dominant over TAU over time, as revealed by a statistically significant cost offset at the end of the 2-year follow-up.
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Affiliation(s)
| | - Frances L. Lynch
- Kaiser Permanente Center for Health Research, Portland, Oregon; and
| | - Michael C. Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon; and
| | - Lynn L. DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - John Pearson
- Kaiser Permanente Center for Health Research, Portland, Oregon; and
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Carr CE, O’Kelly J, Sandford S, Priebe S. Feasibility and acceptability of group music therapy vs wait-list control for treatment of patients with long-term depression (the SYNCHRONY trial): study protocol for a randomised controlled trial. Trials 2017; 18:149. [PMID: 28356125 PMCID: PMC5372335 DOI: 10.1186/s13063-017-1893-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/10/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Depression is of significant global concern. Despite a range of effective treatment options it is estimated that around one in five diagnosed with an acute depressive episode continue to experience enduring symptoms for more than 2 years. There is evidence for effectiveness of individual music therapy for depression. However, no studies have as yet looked at a group intervention within an NHS context. This study aims to assess the feasibility of conducting a randomised controlled trial of group music therapy for patients with long-term depression (symptom durations of 1 year or longer) within the community. METHODS This is a single-centre randomised controlled feasibility trial of group music therapy versus wait-list control with a nested process evaluation. Thirty participants will be randomised with unbalanced allocation (20 to receive the intervention immediately, 10 as wait-list controls). Group music therapy will be offered three times per week in a community centre with a focus on songwriting. Data will be collected post-intervention, 3 and 6 months after the intervention finishes. We will examine the feasibility of recruitment processes including identifying the number of eligible participants, participation and retention rates and the intervention in terms of testing components, measuring adherence and estimation of the likely intervention effect. A nested process evaluation will consist of treatment fidelity analysis, exploratory analysis of process measures and end-of-participation interviews with participants and referring staff. DISCUSSION Whilst group music therapy is an option in some community mental health settings, this will be the first study to examine group music therapy for this particular patient group. We will assess symptoms of depression, acceptability of the intervention and quality of life. We anticipate potential challenges in the recruitment and retention of participants. It is unclear whether offering the intervention three times per week will be acceptable to participants, particularly given participants' enduring symptoms and impact upon motivation. This study will provide data to inform both development of the intervention and to assess and inform the design of a full trial. TRIAL REGISTRATION ISRCTN.com, ISRCTN18164037 . Registered on 26 September 2016.
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Affiliation(s)
- Catherine Elizabeth Carr
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, Newham Centre for Mental Health, Glen Road, London, E13 8SP UK
- East London NHS Foundation Trust, 9 Alie Street, Tower Hamlets, London, E1 8DE UK
| | - Julian O’Kelly
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, Newham Centre for Mental Health, Glen Road, London, E13 8SP UK
- East London NHS Foundation Trust, 9 Alie Street, Tower Hamlets, London, E1 8DE UK
| | - Stephen Sandford
- East London NHS Foundation Trust, 9 Alie Street, Tower Hamlets, London, E1 8DE UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, Newham Centre for Mental Health, Glen Road, London, E13 8SP UK
- East London NHS Foundation Trust, 9 Alie Street, Tower Hamlets, London, E1 8DE UK
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Hellerstein DJ, Hunnicutt-Ferguson K, Stewart JW, McGrath PJ, Keller S, Peterson BS, Chen Y. Do social functioning and symptoms improve with continuation antidepressant treatment of persistent depressive disorder? An observational study. J Affect Disord 2017; 210:258-264. [PMID: 28064115 DOI: 10.1016/j.jad.2016.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/28/2016] [Accepted: 12/17/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine efficacy of continued treatment with the serotonin norepinephrine reuptake inhibitor duloxetine on symptom reduction and functional improvement in outpatients with dysthymia. METHOD Fifty outpatients with DSM-IV-TR diagnosed dysthymia who had participated in a 10 week double-blind, placebo-controlled study of duloxetine received open treatment for three months. Nineteen duloxetine responders continued duloxetine, 24 patients initially treated with placebo started open duloxetine treatment, and 7 duloxetine non-responders were treated with desvenlafaxine or bupropion, selected by clinician choice. RESULTS Patients continuing duloxetine maintained symptom improvement, 84% meeting response and 63% remission criteria at week 22. Patients initially treated with placebo showed similarly high levels of response (83%) and remission (62%) at week 22, and most duloxetine non-responders subsequently responded to other antidepressants. Duloxetine-continuation patients improved modestly between weeks 10 and 22 on measures of social and cognitive functioning and temperament. Despite this improvement concurrently across several functional domains, 66.7% of patients continuing duloxetine remained in the impaired range of functioning according to the Social Adjustment Scale (SAS). CONCLUSIONS Continued duloxetine treatment appears to be effective in maintaining symptom response in dysthymic disorder, and has positive effects on social functioning. However, the majority of patients do not show normalization of functioning, even when controlling for remission status. Additional treatments should be considered to target residual impairments in social functioning in mood remitted patients with persistent depressive disorder.
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Affiliation(s)
- David J Hellerstein
- New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | | | - Jonathan W Stewart
- New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Patrick J McGrath
- New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles; and the Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ying Chen
- New York State Psychiatric Institute, New York, NY, USA; Columbia University College of Physicians and Surgeons, New York, NY, USA
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Bauriedl-Schmidt C, Jobst A, Gander M, Seidl E, Sabaß L, Sarubin N, Mauer C, Padberg F, Buchheim A. Attachment representations, patterns of emotion regulation, and social exclusion in patients with chronic and episodic depression and healthy controls. J Affect Disord 2017; 210:130-138. [PMID: 28033520 DOI: 10.1016/j.jad.2016.12.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/29/2016] [Accepted: 12/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The experience of social exclusion (ostracism) is linked to the etiology and maintenance of depression. Most individuals experience emotional stress in states of social exclusion. Insecurely attached individuals, especially with an unresolved trauma, show maladaptive coping in response to social stress. The present study examines (a) the differences with regards to attachment representations in episodic (ED) and chronic depressive (CD) inpatients and (b) how ostracism affects their emotional reactions. METHODS Patients with CD (n=29) and ED (n=23) and healthy control subjects (n=29) were interviewed using the Adult Attachment Projective Picture System (AAP), a valid measure to assess attachment representation; and played a virtual ball tossing game simulating social exclusion (Cyberball). Multiple depression-related risk and protective factors were considered. We hypothesized that CD patients show the most severe attachment disorganization and are emotionally most affected by the social exclusion situation. Moreover, we explored the interaction between ostracism and attachment. RESULTS Contradicting our hypotheses, ED and CD individuals were almost akin with regards to their attachment insecurity/disorganization and reactions to Cyberball. An emotionally altered reaction to social exclusion was identified in the insecure-disorganized depressive subgroup. LIMITATIONS Small sample size hampering further subgroup analyses. The ED sample may include single CD subjects with recent manifestation. CONCLUSIONS The pattern of emotion regulation in the depressive groups matches with findings from clinical studies, including attachment research. The relationship between attachment representations and ostracism should be further investigated in larger samples of depressive individuals.
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Affiliation(s)
- C Bauriedl-Schmidt
- Department of Psychiatry und Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
| | - A Jobst
- Department of Psychiatry und Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - M Gander
- Department of Psychology, Clinical Psychology, University of Innsbruck, Austria
| | - E Seidl
- Department of Psychiatry und Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - L Sabaß
- Department of Psychiatry und Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - N Sarubin
- Department of Psychiatry und Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - C Mauer
- Department of Psychiatry und Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - F Padberg
- Department of Psychiatry und Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - A Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Austria
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45
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Katon WJ, Ludman EJ. Improving Services for Women with Depression in Primary Care Settings. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1111/1471-6402.00091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Women have a higher prevalence of depressive disorders compared to men. The current system of care for women with depressive disorders provides significant financial barriers for patients with lower incomes to access mental health services. Primary care systems are used extensively by women and have the potential to diagnose patients at early stages of mental illness and to provide evidence-based treatments, but this potential is largely unfulfilled because of significant system-level barriers inherent in primary care. Recent effectiveness research provides an excellent framework for cost-effectively improving care of depression using stepped care principles and strategies effective for improving care of other chronic conditions. Psychologists have the potential to help implement stepped care models by providing training, consultation and ongoing quality assurance, as well as by delivering collaborative care models of acute-phase treatment and relapse prevention interventions.
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Affiliation(s)
- Wayne J. Katon
- Dept. of Psychiatry and Behavioral Sciences, Box 356560, University of Washington Medical School, 1959 NE Pacific, Seattle, WA 98195
| | - Evette J. Ludman
- Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101
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46
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Jacobs RH, Watkins ER, Peters AT, Feldhaus CG, Barba A, Carbray J, Langenecker SA. Targeting Ruminative Thinking in Adolescents at Risk for Depressive Relapse: Rumination-Focused Cognitive Behavior Therapy in a Pilot Randomized Controlled Trial with Resting State fMRI. PLoS One 2016; 11:e0163952. [PMID: 27880789 PMCID: PMC5120778 DOI: 10.1371/journal.pone.0163952] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/13/2016] [Indexed: 01/17/2023] Open
Abstract
This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder (MDD) who are at risk for relapse. We also examined whether these changes in symptoms were associated with changes in functional connectivity of the posterior cingulate cortex (PCC), a key node in the default mode network (DMN). Thirty-three adolescents (ages 12–18) were randomized to eight weeks of RFCBT or an assessment only (AO) control. Twenty two adolescents successfully completed fMRI scans pre- and post-intervention. Adolescents were recruited from the clinic and community and met criteria for at least one previous episode of MDD and were currently in full or partial remission. An Independent Evaluator interviewed parent and child before and after the eight-week intervention. The left PCC (-5, -50, 36) seed was used to probe resting state functional connectivity of the DMN. Adolescents who received RFCBT demonstrated reduced rumination (F = -2.76, df = 112, p < .01, 95% CI [-4.72,-0.80]) and self-report depression across eight weeks (F = -2.58, df = 113, p < .01, 95% CI [-4.21, -0.94]). Youth who received RFCBT also demonstrated significant decreases in connectivity between the left PCC and the right inferior frontal gyrus (IFG) and bilateral inferior temporal gyri (ITG). Degree of change in connectivity was correlated with changes in self-report depression and rumination. These data suggest that rumination can be reduced over eight weeks and that this reduction is associated with parallel decreases in residual depressive symptoms and decreased functional connectivity of the left PCC with cognitive control nodes. These changes may enhance the ability of vulnerable youth to stay well during the transition to adulthood. Trial Registration: ClinicalTrials.gov NCT01905267
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Affiliation(s)
- Rachel H. Jacobs
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
- * E-mail:
| | | | - Amy T. Peters
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Claudia G. Feldhaus
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Alyssa Barba
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Julie Carbray
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Scott A. Langenecker
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America
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Jaschek G, Carter-Pokras O, He X, Lee S, Canino G. Association of child maltreatment and depressive symptoms among Puerto Rican youth. CHILD ABUSE & NEGLECT 2016; 58:63-71. [PMID: 27344268 DOI: 10.1016/j.chiabu.2016.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/06/2016] [Accepted: 06/11/2016] [Indexed: 06/06/2023]
Abstract
This article compares multiple types of child maltreatment among Puerto Rican youth. We seek to expand the limited knowledge of the effects of multiple types of maltreatment on depressive symptoms in a specific Latino population as emerging studies indicate that children who are exposed to one type of maltreatment are often exposed to other types. This study examines the predictive strength of different and multiple types of lifetime child maltreatment (i.e., physical, sexual, and emotional abuse; and neglect), and the effect of youth support from parents, youth coping, youth self-esteem, and place of residence on depressive symptoms among Puerto Rican youth. Secondary data analyses were performed using three annual waves (2000-2004) of data from the Boricua Youth Study. The analytic sample consists of 1041 10-13 year old Puerto Rican youth living in New York and Puerto Rico. Results indicate that: (1) youth who experienced 'sexual abuse only', 'multiple maltreatment' (2 or more types of maltreatment), 'physical abuse only' have a significant increase in depressive symptoms (75.1%, 61.6%, and 40.5% respectively) compared to those without maltreatment; and (2) place of residence, exposure to violence, and mental disorders were significant risk factors. When developing psychosocial interventions, professionals should particularly focus on youth who report past lifetime experience with child maltreatment. Particular attention should be given to children living in the Bronx, New York and similar urban low-income areas who report past lifetime experience with multiple types of child maltreatment and who present symptoms or a diagnosis of co-occurring mental health problems.
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Affiliation(s)
- Graciela Jaschek
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, Building 255, 2242 Valley Drive, College Park, MD 20742, USA.
| | - Olivia Carter-Pokras
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, Building 255, 2242 Valley Drive, College Park, MD 20742, USA.
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, Building 255, 2242 Valley Drive, College Park, MD 20742, USA.
| | - Sunmin Lee
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, Building 255, 2242 Valley Drive, College Park, MD 20742, USA.
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, USA.
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Cuijpers P, Cristea IA, Ebert DD, Koot HM, Auerbach RP, Bruffaerts R, Kessler RC. PSYCHOLOGICAL TREATMENT OF DEPRESSION IN COLLEGE STUDENTS: A METAANALYSIS. Depress Anxiety 2016; 33:400-14. [PMID: 26682536 PMCID: PMC4846553 DOI: 10.1002/da.22461] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Expanded efforts to detect and treat depression among college students, a peak period of onset, have the potential to bear high human capital value from a societal perspective because depression increases college withdrawal rates. However, it is not clear whether evidence-based depression therapies are as effective in college students as in other adult populations. The higher levels of cognitive functioning and IQ and higher proportions of first-onset cases might lead to treatment effects being different among college students relative to the larger adult population. METHODS We conducted a metaanalysis of randomized trials comparing psychological treatments of depressed college students relative to control groups and compared effect sizes in these studies to those in trials carried out in unselected populations of depressed adults. RESULTS The 15 trials on college students satisfying study inclusion criteria included 997 participants. The pooled effect size of therapy versus control was g = 0.89 (95% CI: 0.66∼1.11; NNT = 2.13) with moderate heterogeneity (I(2) = 57; 95% CI: 23∼72). None of these trials had low risk of bias. Effect sizes were significantly larger when students were not remunerated (e.g. money, credit), received individual versus group therapy, and were in trials that included a waiting list control group. No significant difference emerged in comparing effect sizes among college students versus adults either in simple mean comparisons or in multivariate metaregression analyses. CONCLUSIONS This metaanalysis of trials examining psychological treatments of depression in college students suggests that these therapies are effective and have effect sizes comparable to trials carried out among depressed adults.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
,Correspondence to: Professor Pim Cuijpers, Clinical Psychology, Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | - Ioana A. Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
,Clinical Psychology Branch, Department of Surgical, Medical, Molecular, and Critical Pathology, University of Pisa, Pisa, Italy
| | - David D. Ebert
- Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Nuremberg-Erlangen, Erlangen, Germany
| | - Hans M. Koot
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
,EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Randy P. Auerbach
- Department of Psychiatry, Harvard Medical School, Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum – KU Leuven, Kortenberg, Belgium
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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van Randenborgh A, Pawelzik M, Quirin M, Kuhl J. Bad Roots to Grow: Deficient Implicit Self-Evaluations in Chronic Depression With an Early Onset. J Clin Psychol 2016; 72:580-90. [PMID: 26990418 DOI: 10.1002/jclp.22275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Implicit self-esteem, which is based on associative learning processes, is considered to be constituted earlier in life than explicit, verbalized self-esteem. While depressed individuals report negative explicit self-esteem, research has predominantly demonstrated equivalent levels of implicit self-esteem of depressed and healthy individuals. We further illuminate this finding by theorizing and empirically demonstrating that chronically depressed individuals show particularly low levels of implicit self-esteem when depression had an early onset. METHOD We applied measures of implicit (name-letter test) and explicit (Rosenberg Self-Esteem Scale) self-esteem in chronically depressed patients with an early onset (N = 17), a late onset (N = 13), and an episodic depression (N = 29). RESULTS As expected, patients with an early onset showed lower implicit self-esteem than the 2 other groups. CONCLUSION Implicit self-esteem may function as a marker of how deeply negative self-views are internalized. Furthermore, the distinction between early and late onset of chronic depression seems to be valuable for classification and potentially treatment of unipolar depression.
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50
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Sommerfeldt SL, Cullen KR, Han G, Fryza BJ, Houri AK, Klimes-Dougan B. Executive Attention Impairment in Adolescents With Major Depressive Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 45:69-83. [PMID: 26566871 DOI: 10.1080/15374416.2015.1072823] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Neural network models that guide neuropsychological assessment practices are increasingly used to explicate depression, though a paucity of work has focused on regulatory systems that are under development in adolescence. The purpose of this study was to evaluate subsystems of attention related to executive functioning including alerting, orienting, and executive attention networks, as well as sustained attention with varying working memory load, in a sample of depressed and well adolescents. Neuropsychological functioning in 99 adolescents diagnosed with major depressive disorder (MDD) and 63 adolescent healthy controls (M = 16.6 years old) was assessed on the Attention Network Test (ANT) and the Continuous Performance Test, Identical Pairs. Adolescents with MDD, particularly those who were not medicated, were slower to process conflict (slower reaction time on the Executive Attention scale of the ANT) compared to controls, particularly for those who were not undergoing psychopharmacological treatment. Tentative evidence also suggests that within the MDD group, orienting performance was more impaired in those with a history of comorbid substance use disorder, and alerting was more impaired in those with a history of a suicide attempt. Adolescents with depression showed impaired executive attention, although cognitive performance varied across subgroups of patients. These findings highlight the importance of examining neurocognitive correlates associated with features of depression and suggest an avenue for future research to help guide the development of interventions.
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Affiliation(s)
- Sasha L Sommerfeldt
- a Department of Psychology , University of Minnesota.,b Center for Investigating Healthy Minds at the Waisman Center , University of Wisconsin-Madison
| | | | - Georges Han
- d Center for Mind and Brain , University of California , Davis
| | | | - Alaa K Houri
- f Department of Educational Psychology , University of Minnesota
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