Comparing cognitive and somatic symptoms of depression in myocardial infarction patients and depressed patients in primary and mental health care

Prevalence, correlates, and network analysis of depression and its association with quality of life in survivors with myocardial infarction during the COVID-19 pandemic

BACKGROUND

Depression is common among myocardial infarction (MI) survivors and is strongly associated with poor quality of life (QOL). The aim of this study was to examine the prevalence, correlates and the network structure of depression, and its association with QOL in MI survivors during the COVID-19 pandemic.

METHODS

This cross-sectional study evaluated depression and QOL in MI survivors with the Chinese version of the nine-item Patient Health Questionnaire (PHQ-9) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) respectively. Univariable analyses, multivariable analyses, and network analyses were performed.

RESULTS

The prevalence of depression (PHQ-9 total score ≥ 5) among 565 MI survivors during the COVID-19 pandemic was 38.1 % (95 % CI: 34.1-42.1 %), which was significantly associated with poor QOL. Patients with depression were less likely to consult a doctor regularly after discharge, and more likely to experience more severe anxiety symptoms and fatigue. Item PHQ4 "Fatigue" was the most central symptom in the network, followed by PHQ6 "Guilt" and PHQ2 "Sad mood". The flow network showed that PHQ4 "Fatigue" had the highest negative association with QOL.

CONCLUSION

Depression was prevalent among MI survivors during the COVID-19 pandemic and was significantly associated with poor QOL. Those who failed to consult a doctor regularly after discharge or reported severe anxiety symptoms and fatigue should be screened for depression. Effective interventions for MI survivors targeting central symptoms, especially fatigue, are needed to reduce the negative impact of depression and improve QOL.

Virtual Reality-Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task

BACKGROUND

Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder.

OBJECTIVE

We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment.

METHODS

We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality-based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them.

RESULTS

Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality-based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy.

CONCLUSIONS

These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation.

Secondary Prevention of Depressive Prodrome in Adolescents: Before and After Attending a Jogging Program on Campus

The adolescent depressive prodrome has been conceptualized as an early integrated sign of depressive symptoms, which may develop to a first episode of depression or return to normal for the adolescents. In this study, depressive prodrome presented the early self-rated depressive symptoms for the sample participants. By referring to the Kutcher Adolescent Depression Scale and the psychometric characteristics of the Adolescent Depression Scale (ADR), we proposed a self-rated questionnaire to assess the severity of the depressive symptoms in adolescents before and after attending the jogging program on a high school campus in Taiwan. With the parental co-signature and self-signed informed consent form, 284 high school students under the average age of 15 years, participated in this study in March 2019. Through the software of IBMSPSS 25, we used a binary logistic model, principal component analysis (PCA), multiple-dimensional analysis, and receiver operating characteristic curve (ROC) to analyze the severity of the depressive prodrome via the threshold severity score (SC) and false positive rate (FPR). Findings revealed that attending the 15-week jogging program (3 times a week, 45 min each) on campus can change the severity status and reduce the prevalence of moderate-severe depressive prodrome by 26%. The two-dimensional approach identified three symptoms, which were the crying spell, loss of pleasure doing daily activities, and feeling the decline in memory. They kept being invariant symptoms during the course of depressive prodrome assessment for sample participants. In this study, the campus jogging program appeared to be able to affect the FPR of the measure of depressive prodrome. Compared with the subthreshold depression, the depressive prodrome emphasized the assessment from the view of the secondary prevention by representing the change from a person's premorbid functioning up until the first onset of depression or returning to normal. However, the subthreshold depression is a form of minor depression according to DSM-5 criteria varying on the number of symptoms and duration required, highly prevalent in the concern of primary care.

Person-fit feedback on inconsistent symptom reports in clinical depression care

BACKGROUND

Depressive patients can present with complex and different symptom patterns in clinical care. Of these, some may report patterns that are inconsistent with typical patterns of depressive symptoms. This study aimed to evaluate the validity of person-fit statistics to identify inconsistent symptom reports and to assess the clinical usefulness of providing clinicians with person-fit score feedback during depression assessment.

METHODS

Inconsistent symptom reports on the Inventory of Depressive Symptomatology Self-Report (IDS-SR) were investigated quantitatively with person-fit statistics for both intake and follow-up measurements in the Groningen University Center of Psychiatry (n = 2036). Subsequently, to investigate the causes and clinical usefulness of on-the-fly person-fit alerts, qualitative follow-up assessments were conducted with three psychiatrists about 20 of their patients that were randomly selected.

RESULTS

Inconsistent symptom reports at intake (12.3%) were predominantly characterized by reporting of severe symptoms (e.g. psychomotor slowing) without mild symptoms (e.g. irritability). Person-fit scores at intake and follow-up were positively correlated (r = 0.45). Qualitative interviews with psychiatrists resulted in an explanation for the inconsistent response behavior (e.g. complex comorbidity, somatic complaints, and neurological abnormalities) for 19 of 20 patients. Psychiatrists indicated that if provided directly after the assessment, a person-fit alert would have led to new insights in 60%, and be reason for discussion with the patient in 75% of the cases.

CONCLUSIONS

Providing clinicians with automated feedback when inconsistent symptom reports occur is informative and can be used to support clinical decision-making.

Association Between Affective-Cognitive Symptoms of Depression and Exacerbation of Crohn's Disease

OBJECTIVES

The prevalence of depression is high in patients with Crohn's disease (CD). We examined the influence of affective-cognitive symptoms of depression on the risk of exacerbation of CD.

METHODS

We studied 2,144 adult volunteers with a self-reported diagnosis of CD who completed a baseline survey that included demographics, CD status, and an affective-cognitive index of depression. Linear and logistic regression analyses were used to determine whether CD status at 12 months was associated with the baseline measure of depression. Analyses were adjusted for confounders including age, gender, race, baseline disease activity, disease duration, prior hospitalization and surgery, corticosteroid and anti-TNF use, medication adherence, body mass index, current smoking, education, and sleep quality.

RESULTS

Depression was significantly associated with subsequent increases in SCDAI score in both unadjusted (P<0.001) and adjusted (P<0.001) analyses. This association was non-linear, with a shallower slope for lower levels of depression. A 10-point increase in depression t-scores from 55 to 65 was associated with a 18.6-point increase in SCDAI (95% CI 11.5-25.6) and an odds ratio of 1.27 for SCDAI>150 at follow-up (CI: 1.01-1.60). We also found a significant association between depressive symptoms and hospitalization.

CONCLUSIONS

Cognitive-affective depressive symptoms were significantly associated with a risk of exacerbation of CD and hospitalization.

Acute coronary syndrome-associated depression: the salience of a sickness response analogy?

Depression emerging in conjunction with acute coronary syndrome (ACS) is thought to constitute a distinct high-risk phenotype with inflammatory determinants. This review critically examines the notion put forward in the literature that ACS-associated depression constitutes a meaningful subtype that is qualitatively different from depressive syndromes observed in psychiatric patients; and evaluates the salience of an analogy to the acute sickness response to infection or injury as an explanatory model. Specific features differentiating ACS-associated depression from other phenotypes are discussed, including differences in depression symptom profiles, timing of the depressive episode in relation to ACS, severity of the cardiac event, and associated immune activation. While an acute sickness response analogy offers a plausible conceptual framework, concrete evidence is lacking for inflammatory activity as the triggering mechanism. It is likely that ACS-associated depression encompasses several causative scenarios.

Subtypes of depression in cancer patients: an empirically driven approach

Purpose

This study aimed to (1) identify subgroups of cancer patients with distinct subtypes of depression before the start of psychological care, (2) examine whether socio-demographic and medical characteristics distinguished these subtypes, and (3) examine whether people with distinct subtypes reported differential courses of depression during psychological care.

Method

This naturalistic, longitudinal study included cancer patients who sought psychological care at specialized psycho-oncology institutions in the Netherlands. Data were collected before psychological care (T1) and three (T2) and nine (T3) months thereafter. Latent class analysis was performed to identify depression subtypes in 243 patients at T1.

Results

Before starting psychological care, three depressive subtypes were identified, differing in severity and type of symptoms. Class 1 (47 %) with mild depression reported mostly concentration and sleep problems and fatigue. Class 2 (41 %), with slightly higher levels of depression, reported similar concentration and sleep problems and fatigue as class 1, and additionally depressed mood. Class 3 (12 %), with severe depression, reported mainly a depressed mood and, to a lesser extent but still elevated, fatigue and concentration problems. None of socio-demographic and medical characteristics significantly distinguished these subtypes. These subtypes significantly predicted the course of depression over time, with class 1 reporting moderate improvements, class 2 large improvements, and class 3 the largest improvements.

Conclusions

Results indicate the presence of three subtypes of depression in cancer patients before starting psychological care. Our findings suggest that psychological interventions could be tailored to respond to the specific subtype of depression experienced by each individual.

Symptom-specific course trajectories and their determinants in primary care patients with Major Depressive Disorder: Evidence for two etiologically distinct prototypes

BACKGROUND

The course-heterogeneity of Major Depressive Disorder (MDD) hampers development of better prognostic models. Although latent class growth analyses (LCGA) have been used to explain course-heterogeneity, such analyses have failed to also account for symptom-heterogeneity of depressive symptoms. Therefore, the aim was to identify more specific data-driven subgroups based on patterns of course-trajectories on different depressive symptom domains.

METHODS

In primary care MDD patients (n=205), the presence of the MDD criterion symptoms was determined for each week during a year. Weekly 'mood/cognition' (MC) and 'somatic' (SOM) scores were computed and parallel processes-LCGA (PP-LCGA) was used to identify subgroups based on the course on these domains. The classes׳ associations with baseline predictors and 2-/3-year outcomes were investigated.

RESULTS

PP-LCGA identified four classes: quick recovery, persisting SOM, persisting MC, and persisting SOM+MC (chronic). Persisting SOM was specifically predicted by higher baseline somatic symptomatology and somatization, and was associated with more somatic depressive symptomatology at long-term follow-up. Persisting MC was specifically predicted by higher depressive severity, thinking insufficiencies, neuroticism, loneliness and lower self-esteem, and was associated with lower mental health related quality of life and more mood/cognitive depressive symptomatology at follow-up.

LIMITATIONS

The sample was small and contained only primary care MDD patients. The weekly depression assessments were collected retrospectively at 3-month intervals.

CONCLUSIONS

The results indicate that there are two specific prototypes of depression, characterized by either persisting MC or persisting SOM, which have different sets of associated prognostic factors and long-term outcomes, and could have different etiological mechanisms.

Platelet activating factors are associated with depressive symptoms in coronary artery disease patients: a hypothesis-generating study

INTRODUCTION

Depression is a frequent complication of coronary artery disease (CAD) with an unknown etiology. Platelet activating factor (PAF) lipids, which are associated with CAD, have recently been linked with novel proposed etiopathological mechanisms for depression such as inflammation, oxidative/nitrosative stress, and vascular endothelial dysfunction.

METHODS AND RESULTS

This hypothesis-generating study investigated the relationships between various PAF species and depressive symptoms in 26 CAD patients (age: 60.6±9.2 years, 69% male, mean Hamilton Depression Rating Scale [HAM-D] score: 11.8±5.2, HAM-D range: 3-20). Plasma PAF analyses were performed using high performance liquid chromatography electrospray ionization mass spectrometry in precursor ion scan. Significant associations between depressive symptom severity (HAM-D score) and a greater plasma abundance of the PAFs phosphocholine (PC) PC(O-12:0/2:0) (r=0.49, P=0.01), PC(O-14:1/2:0) (r=0.43, P=0.03), PC(O-17:3/2:0) (r=0.44, P=0.04), and PC(O-18:3/2:0) (r=0.50, P=0.01) were observed. Associations between those PAFs and HAM-D score persisted after adjusting for age and sex.

CONCLUSION

These preliminary findings support the exploration of the PAF lipidome for depressive symptom biomarkers in CAD patients. Patients were recruited as part of the following clinical trial: NCT00981383.

Data-driven course trajectories in primary care patients with major depressive disorder

BACKGROUND

The chronic nature of MDD has been acknowledged as one of the key determinants of the burden associated with depression. Unfortunately, so far described prognostic factors have been inconsistent, possibly due to used course outcomes that are often based on arbitrary criteria/cut-offs. Therefore, the aim of the current study was to use data-driven trajectory groups based on closely spaced weekly severity ratings, as outcomes in prognostic research.

METHODS

The sample consisted of primary care patients with MDD (n = 153), who were followed up for a year with 52 consecutive weekly ratings of the nine DSM-IV MDD criterion symptoms. Growth Mixture Modeling (GMM) was used to reduce the interpersonal growth variation to an optimal set of clinically interpretable trajectory groups. Next, baseline course predictors were investigated and the prognostic (added) value of course-group membership was investigated for clinical outcomes after 1, 2, and 3 years.

RESULTS

GMM resulted in four trajectory groups: "early remission" (40.2%), "late remission" (9.8%), "remission and recurrence" (17.0%), and "chronic" (33.0%). Multivariate predictors of "chronic" group membership were a prior suicide attempt, comorbid dysthymia, and lower levels of somatic depressive symptoms. Group membership predicted differences in depression severity and/or quality of life after 1, 2, and 3 years.

CONCLUSIONS

The used data-driven approach provided a parsimonious and clinically informative way to describe course variation across MDD patients. Using the trajectory groups to investigate prognostic factors of MDD provided insight in potentially useful prognostic factors. Importantly, trajectory-group membership was itself a strong predictor of future mental well-being.