Functional near-infrared spectroscopy during a decision-making task in patients with major depressive disorder

Shared and distinct prefrontal cortex alterations of implicit emotion regulation in depression and anxiety: An fNIRS investigation

BACKGROUND

Emotion regulation deficits, particularly in cognitive reappraisal, are crucial in depression and anxiety. However, research on the neural mechanisms of implicit emotion regulation is lacking, and it remains unclear whether these mechanisms are shared or distinct between the two disorders.

METHODS

We investigated the neural mechanisms of implicit cognitive reappraisal in 28 individuals with major depressive disorder (MDD), 25 with generalized anxiety disorder (GAD), and 30 healthy controls (HC) using functional near-infrared spectroscopy (fNIRS). Participants completed an implicit cognitive reappraisal task and underwent neuropsychological and clinical assessments.

RESULTS

We found that MDD patients reported higher levels of rumination and lower utilization of cognitive reappraisal, while GAD patients reported reduced use of perspective-taking. Notably, both MDD and GAD patients exhibited decreased activation in the dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) compared to HC participants during implicit cognitive reappraisal. Specifically, inadequate OFC activation was observed in MDD patients, while GAD patients demonstrated OFC deactivation during the task. Furthermore, DLPFC activation showed a negative correlation with depression severity in MDD patients, while OFC activation was positively correlated with perspective-taking in GAD patients.

LIMITATIONS

fNIRS has limited depth and spatial resolution.

CONCLUSION

Our fNIRS study is the first to reveal shared and distinct neurobiological profiles of depression and anxiety in implicit emotion regulation. These findings underscore the significance of reduced DLPFC/OFC activation in emotion regulation impairment and highlight unique OFC activation patterns in these disorders. These insights have potential implications for developing cognitive-behavioral therapy and transcranial magnetic stimulation as treatment approaches.

Risky decision-making in major depressive disorder: A three-level meta-analysis

Background

Individuals with major depressive disorder (MDD) are usually observed making inappropriate risky decisions. However, whether and to what extent MDD is associated with impairments in risky decision-making remains unclear. We performed a three-level meta-analysis to explore the relationship between risky decision-making and MDD.

Method

We searched the Web of Science, PubMed, Scopus, and PsycINFO databases up to February 7, 2023, and calculated Hedges' g to demonstrate the difference in risky decision-making between MDD patients and healthy controls (HCs). The moderating effect of sample and task characteristics were also revealed.

Results

Across 73 effect sizes in 39 cross-sectional studies, MDD patients exhibited greater risk-seeking than HCs (Hedges' g = 0.187, p = .030). Furthermore, age (p = .068), region (p = .005), and task type (p < .001) were found to have moderating effects. Specifically, patients preferred risk-seeking over HCs as age increased. European patients showed significantly increased risk-seeking compared to American and Asian patients. Patients in the Iowa Gambling Task (IGT) exhibited a notable rise in risk-seeking compared to other tasks, along with an increased risk aversion in the Balloon Analogue Risk Task (BART). The multiple-moderator analysis showed that only task type had significant effects, which may be explained by a tentative framework of "operationalization-mechanism-measure" specificity.

Conclusions

MDD patients generally exhibit higher risk-seeking than HCs. It implies that impaired risky decision-making might be a noteworthy symptom of depression, which should be placed more emphasis for clinical management and psycho-education.

Anxiety, depression and coping strategies among chronic medical patients with coronavirus disease-2019: a multicenter follow-up cohort study

BACKGROUND

Studies have shown that COVID-19 patients experience high levels of anxiety, depression, and stress during the pandemic. Patients adopt different coping strategies to reduce their psychological distress.

AIM

To compare the immediate and long-term psychological impact of COVID-19 disease on patients with and without chronic medical illnesses (CMI) and identify coping styles of both groups during the peak of COVID-19 disease in Egypt.

METHODS

This is a cohort follow-up study, that included an online survey consisting of General Health Questionnaire-12, Taylor Manifest Anxiety Scale, Beck Depression Inventory and Brief-COPE scale. The Post-Traumatic Stress Disorder (PTSD) Checklist was completed after 6 months. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt.

RESULTS

There was no significant difference between the two groups regarding anxiety and depression during the acute infection. Patients without CMI relied significantly on the use of informational support to cope with COVID-19 disease. Patients with CMI continued to show significant depressive symptoms after 6 months without significant PTSD symptoms.

CONCLUSIONS

COVID-19 has similar immediate psychological impact on patients with and without CMI. However, patients with CMI continue to show depression on long-term follow-up.

Engineered Enzyme-Loaded Erythrocyte Vesicles Precisely Deprive Tumoral Nutrients to Induce Synergistic Near-Infrared-II Photothermal Therapy and Immune Activation

Starvation therapy has been considered a promising strategy in cancer treatment for altering the tumor microenvironment (TME) and causing a cascade of therapeutic effects. However, it is still highly challenging to establish a therapeutic strategy for precisely and potently depriving tumoral nutrition. In this study, a glucose oxidase (GOx) and thrombin-incorporated erythrocyte vesicle (EV) with cyclic (Arg-Gly-Asp) (cRGD) peptide modification, denoted as EV@RGT, were synthesized for precisely depriving tumoral nutrition and sequentially inducing second near-infrared region (NIR-II) photothermal therapy (PTT) and immune activation. The EV@RGT could specifically accumulate at the tumor site and release the enzymes at the acidic TME. The combination of GOx and thrombin exhausts tumoral glucose and blocks the nutrition supply at the same time, resulting in severe energy deficiency and reactive oxygen species (ROS) enrichment within tumor cells. Subsequently, the abundant clotted erythrocytes in tumor vessels present outstanding localized NIR-II PTT for cancer eradication owing to the hemoglobin. Furthermore, the abundant ROS generated by enhanced starvation therapy repolarizes resident macrophages into the antitumor M1 phenotype via a DNA damage-induced STING/NF-κB pathway, ultimately contributing to tumor elimination. Consequently, the engineered EV@RGT demonstrates powerful antitumor efficiency based on precise nutrition deprivation, sequential NIR-II PTT, and immune activation effect. This work provides an effective strategy for the antitumor application of enzyme-based reinforced starvation therapy.

Functional near-infrared spectroscopy of medical students answering various item types

Background

Traditionally, the effect of assessment item types including true/false questions (TFQs), multiple-choice questions (MCQs), short answer questions (SAQs), and case scenario questions (CSQs) is examined through psychometric qualities or student interviews. However, brain activity while answering such questions or items remains unknown. Functional near-infrared spectroscopy (fNIRS) can be used to safely measure cerebral cortex hemodynamic response during various tasks. Hence, this fNIRS study aimed to determine differences in frontotemporal cortex activity as medical students answered TFQs, MCQs, SAQs, and CSQs.

Methods

In total, 24 medical students (13 males and 11 females) were recruited in this study during their mid-psychiatry posting. Oxy-hemoglobin and deoxy-hemoglobin levels in the frontal and temporal regions were measured with a 52-channel fNIRS system. Participants answered 9-18 trials under each of the four types of tasks that were based on their psychiatry curriculum during fNIRS measurements. The area under the oxy-hemoglobin curve (AUC) for each participant and each item type was derived. Repeated measures ANOVA with post-hoc Bonferroni-corrected pairwise comparisons were used to determine differences in oxy-hemoglobin AUC between TFQs, MCQs, SAQs, and CSQs.

Results

Oxy-hemoglobin AUC was highest during the CSQs, followed by SAQs, MCQs, and TFQs in both the frontal and temporal regions. Statistically significant differences between different types of items were observed in oxy-hemoglobin AUC of the frontal region (p ≤ 0.001). Oxy-hemoglobin AUC in the frontal region was significantly higher during the CSQs than TFQ (p = 0.005) and during the SAQ than TFQ (p = 0.025). Although the percentage of correct responses was significantly lower in MCQ than in the other item types, there was no correlation between the percentage of correct response and oxy-hemoglobin AUC in both regions for all four item types (p > 0.05).

Conclusion

CSQs and SAQs elicited greater hemodynamic response than MCQs and TFQs in the prefrontal cortex of medical students. This suggests that more cognitive skills may be required to answer CSQs and SAQs.

Differentiating people with schizophrenia from healthy controls in a developing Country: An evaluation of portable functional near infrared spectroscopy (fNIRS) as an adjunct diagnostic tool

INTRODUCTION

This study aimed to evaluate portable functional near-infrared spectroscopy (fNIRS) device as an adjunct diagnostic tool in Vietnam to assess hemodynamics when people with schizophrenia and healthy controls performed cognitive tasks.

METHODS

One hundred fifty-seven participants were divided into schizophrenia (n = 110) and healthy controls group (n = 47), which were recruited by match of age, and gender. Hemodynamic responses in the frontal cortex were monitored with a 48-channel portable device during the Stroop Color-Word Test (SCWT) and Verbal Fluency Test (VFT). General linear model compared the differences in oxyhemoglobin (HbO₂) levels between the two groups. The Receiver Operating Characteristic (ROC) graph was generated for each neuroanatomical area.

RESULTS

People with schizophrenia did not show significant activation in the frontal lobe during the SCWT and VFT as compared to pre-task. During the VFT, the area under the ROC curve of the bilateral dorsolateral prefrontal cortex, bilateral orbitofrontal cortex, bilateral frontopolar prefrontal cortex, and bilateral ventrolateral prefrontal cortex were greater than 0.7 (p < 0.001). The area under the ROC curve (AUC) for the right orbitofrontal cortex was maximal during the VFT (AUC = 0.802, 95%CI = 0.731-0.872). The Youden's index reached a peak (0.57) at the optimal cut-point value (HbO₂ cutoff <0.209 μmol/ml for schizophrenia) in which the sensitivity was 85%; specificity was 72%; positive predictive value (PPV) was 0.88; negative predictive value (NPV) was 0.68 and correct classification rate was 76%.

DISCUSSION

Assessing hemodynamics during VFT by portable fNIRS offers the potential as an adjunct diagnostic tool for schizophrenia in developing countries.

Hemodynamic analysis of the frontal cortex using multi-task fNIRS in major depressive disorder

BACKGROUND

Appropriate task selection is the key to fNIRS-based major depressive disorder (MDD) diagnosis and treatment; however, there exists no unified rule for task selection, which limits its clinical application.

METHODS

Four tasks were employed to investigate the hemodynamic characteristics of MDD during motor, emotional, cognitive, and combinational tasks. A total of 69 subjects were studied: 50 with MDD and 19 healthy controls. The integral value of oxy-hemoglobin and the asymmetric characteristics of the bilateral frontal lobe were used to demonstrate the hemodynamic changes in MDD during different tasks. A detailed analysis and comparison among different tasks were conducted.

RESULTS

Compared with deoxy-hemoglobin (deoxy-Hb), oxy-Hb was more significant to differentiate between MDD subjects and healthy controls. In subjects with MDD, lower activation of the frontal lobe and smaller integral values of oxy-Hb were observed. In most task paradigms, MDD subjects and healthy controls exhibited diametrically opposite left-right frontal asymmetry. For the integral value of oxy-Hb and the asymmetric characteristics of the bilateral frontal lobe, the differences between MDD subjects and healthy controls under the combinational task were more significant than that under the single tasks.

LIMITATIONS

Brain fatigue patterns over time and their effect on the hemodynamic analysis of MDD should be studied further.

CONCLUSIONS

The difference in hemodynamic characteristics between MDD subjects and healthy controls is closely related to the choice of task, and the combinational task showed better discrimination than the single tasks. It provides guidance for the appropriate task design for MDD in clinics.

Prevalence, Risk Factors and Intervention for Depression and Anxiety in Pulmonary Hypertension: A Systematic Review and Meta-analysis

Background

Current guidelines recommend psychological support for patients with pulmonary hypertension suffering from psychological adversity. However, little is known about the prevalence and risk factors of depression and anxiety in patients with pulmonary hypertension (PH).

Methods

Medline and Embase were searched from inception to 6 May 2021. Meta-analysis of proportions using the generalized linear mixed model was conducted to analyze the pooled prevalence rates of depression and anxiety in PH patients. Risk factors for depression and anxiety in PH patients were evaluated using meta regression.

Results

A total of 24 studies involving 2,161 PH patients were included. The pooled prevalence of depression in PH was 28.0% (95% CI: 20.5–36.8) and pooled prevalence of anxiety was 37.1% (95% CI: 28.7–46.4). There was a significantly higher prevalence of anxiety (p = 0.0013) amongst PH patients in Asia (61.1%) compared to Europe (40.3%) and North America (22.9%). In terms of risk factors, congenital heart disease-related pulmonary arterial hypertension (PAH-CHD) were significantly associated with both depression (OR: 1.68, 95% CI: 1.27–2.23, p = 0.024) and anxiety (OR: 1.63, 95% CI: 1.45–1.83, p = 0.002). On the other hand, chronic thromboembolic pulmonary hypertension (CTEPH, OR: 1.18, 95% CI: 1.10–1.26, p = 0.004) was significantly associated with depression, whereas worse pulmonary vascular resistance (β: 0.30, 95% CI: 0.09–0.52, p = 0.005) and cardiac index (β: −0.96, 95% CI: −1.58 to −0.35, p = 0.002) were significantly correlated with anxiety.

Conclusion

The prevalence of anxiety and depression in PH patients is alarmingly high, with an increased prevalence of anxiety in Asia compared to Europe or North America. Psychological support is warranted for patients with PH, particularly those with underlying congenital heart disease, CTEPH, and severe disease.

Systematic Review Registration

CRD42021251733.

Psychological problems among the university students in Saudi Arabia during the COVID-19 pandemic

BACKGROUND

The 2019 coronavirus disease (COVID-19) pandemic is a public health emergency that represents a challenge to psychological health. This study aimed to assess the psychological conditions among university students in Saudi Arabia during the COVID-19 pandemic.

METHODS

During the period between the 4th and 18th of June 2020, the students of Umm AlQura University in Saudi Arabia were invited to complete an online survey. The survey assessed their sociodemographic characteristics, educational disciplines, and manifestations of psychological health problems including depression, anxiety, and stress as determined by the Arabic version of the Depression Anxiety Stress Scale-21 (DASS-21).

RESULTS

The study included 936 university students (56.4% women and 43.6% men). Of them, 41.1% had depressive symptoms (31.7% mild to moderate and 9.4% severe to very severe), 26.9% had anxiety symptoms (15.8% mild to moderate and 11.1% severe to very severe), and 22.4% had stress symptoms (15.2% mild to moderate and 7.2% severe to very severe). Students who reported having a friend or relative infected with or died of COVID-19, watching or reading news about the pandemic ≥2 hours/day, and not getting emotional support from family, university, and society were more likely to show psychological problems.

CONCLUSION

Symptoms of depression, anxiety, and stress were common among Saudi university students during the COVID-19 pandemic. Psychological counselling and support should be provided to university students in Saudi Arabia.

Eating habits and mental health among rugby players of the Peruvian pre-selection during the second quarantine due to the COVID-19 pandemic

Objectives:

Social isolation during the COVID-19 pandemic impacts the mental health and diet of populations.

Aim:

The aim of the study was to evaluate whether the eating habits and mental health status of the rugby players of the Peruvian pre-selection were affected by the second quarantine of the COVID-19 pandemic.

Methods:

A cross-sectional study was carried out through a pre-structured online survey in 74 players, 42 men (56.8%) and 32 women (43.2%). The mean age was 20.5 ± 4.4 years. Participants completed a validated food frequency questionnaire and depression, anxiety, and stress scale-21 (DASS-21).

Results:

58.1% of the respondents reported that their dietary intake remained the same or increased. 58.3% of the players experienced anxiety, among which 26.4% reported moderate and severe symptoms. A greater proportion of participants <20 years old reported depression compared to those ⩾20 years (68.6% vs 31.4%, p = 0.010). Those who reported inadequate food intake were more likely to report depressive symptoms (p = 0.006).

Conclusion:

These findings reaffirm the need to implement programs of psychological support and nutritional counseling among athletes to reduce negative symptoms and better face mental health and dietary challenges in these times of crisis.

Mental health outcomes among health-care workers in Oman during COVID-19: A cluster analysis

Aim

Despite the much heralded epidemic of adjustment difficulties, health‐care workers (HCW), who are likely to be at risk and impacted with mental health issues, have received scant attention. This study aimed to determine whether definable profiles exist in a cohort of HCWs associated with demographic and mental health problems.

Methods

An online cross‐sectional survey was conducted in Oman. Demographic and mental health data were collected from 8 to 17 April 2020. A total of 1132 participants returned their completed questionnaire. A two‐step cluster analysis was used to split the sample into three clusters.

Results

Cluster A (n = 416) was from HCW in non‐frontline roles, and constituted “low‐risk and least‐impacted”. Cluster B (n = 412) and Cluster C (n = 304) were from frontline HCW and constituted ‘high‐risk and moderate‐impacted’ and ‘high‐risk and high‐impacted’ groups, respectively. HCWs in Cluster C reported more depression (P < 0.001), anxiety (P < 0.001), stress (P < 0.001) and clinical insomnia (P < 0.001) compared with those in the other clusters. HCWs in Cluster C were at the highest risk for mental health problems during the pandemic.

Conclusions

Early psychological interventions targeting this vulnerable group may be beneficial. Management should develop different tailor‐made strategic plans to address different mental health needs for each profile group.

What is already known about this topic?

Nurses, physicians and allied health‐care workers (HCWs) experienced many kinds of psychological problems, including depression, anxiety, stress and insomnia during the COVID‐19 outbreak.

What this paper adds?

The HCWs in Cluster A were more experienced, did not work in the frontline and reported a lower prevalence of depression, anxiety, stress and insomnia. This group was labelled as the ‘low risk and least impacts’ group.

The HCWs in Cluster B were predominantly nurses and doctors working in the frontline and reported a higher prevalence of anxiety and stress. This cluster was labelled as the ‘high risk but moderate impacts’ group.

The HCWs in Cluster C were predominantly nurses who were younger, with less working experience and work in the frontline but reporting a higher prevalence of depression, anxiety, stress and insomnia. This cluster was labelled as the ‘high risk and high impacts’ group.

The implications of this paper:

Management should develop different tailor‐made strategic plans to address different mental health needs for each profile group.

Online cognitive behaviour therapy targeting this vulnerable group may be beneficial during the COVID‐19 pandemic.

Depression, anxiety and stress among undergraduate students during COVID-19 outbreak and "home-quarantine"

Aim

Many people including students affected physically and psychologically by coronavirus disease (COVID‐19) outbreak and "home‐quarantine." This study aimed at assessing the prevalence and predictors of depression, anxiety and stress among university students in Jordan during "home‐quarantine" due to the outbreak of COVID‐19.

Design

This is a cross‐sectional descriptive study.

Methods

Data were collected from a convenience sample of 1,380 Jordanian university students. A web‐based survey was used to collect data from the participants using the DASS‐21.

Results

The prevalence of depression, anxiety and stress in different levels was 78.7%, 67.9% and 58.7%, respectively, which are higher during “home‐quarantine.” The mean scores of depression, anxiety and stress were at moderate levels. Strong correlations were found between depression, stress and anxiety, with demographic, health‐related, lifestyle variables. Several variables also predicted depression, stress and anxiety.

Depression, anxiety and stress during the COVID-19 pandemic: results from a New Zealand cohort study on mental well-being

OBJECTIVES

The COVID-19 pandemic has caused unprecedented disruption to daily life. This study investigated depression, anxiety and stress in New Zealand (NZ) during the first 10 weeks of the COVID-19 pandemic, and associated psychological and behavioural factors. It also compares the results with a similar cross-sectional study in the UK.

DESIGN

Cross-sectional study.

SETTING

NZ community cohort.

PARTICIPANTS

N=681 adults (≥18 years) in NZ. The cohort was predominantly female (89%) with a mean age of 42 years (range 18-87). Most (74%) identified as NZ European and almost half (46%) were keyworkers. Most were non-smokers (95%) and 20% identified themselves as having clinical risk factors which would put them at increased or greatest risk of COVID-19.

MAIN OUTCOME MEASURES

Depression, anxiety, stress, positive mood and engagement in health behaviours (smoking, exercise, alcohol consumption).

RESULTS

Depression and anxiety significantly exceeded population norms (p<0.0001). Being younger (p<0.0001) and most at risk of COVID-19 (p<0.05) were associated with greater depression, anxiety and stress. Greater positive mood, lower loneliness and greater exercise were protective factors for all outcomes (p<0.0001). Smoking (p=0.037) and alcohol consumption (p<0.05) were associated with increased anxiety. Pet ownership was associated with lower depression (p=0.006) and anxiety (p=0.008). When adjusting for age and gender differences, anxiety (p=0.002) and stress (p=0.007) were significantly lower in NZ than in the UK. The NZ sample reported lower perceived risk (p<0.0001) and worry about COVID-19 (p<0.0001) than the UK sample.

CONCLUSIONS

The NZ population had higher depression and anxiety compared with population norms. Younger people and those most at risk of COVID-19 reported poorer mental health. Interventions should promote frequent exercise, and reduce loneliness and unhealthy behaviours.