Risk Factors for Adult Depression: Adverse Childhood Experiences and Personality Functioning

Unravelling inter-relations within and between psychodynamic constructs and psychopathology using network analysis

Psychodynamic constructs and psychopathology are closely inter-related, but more detailed insight is needed. We investigated these complex inter-relations using network analysis. A Gaussian graphical model in a sample of N = 2232 psychotherapeutic inpatients was estimated. Self-administered questionnaires to assess interpersonal relations (Inventory of Interpersonal Problems-32), psychodynamic conflicts (Operationalized Psychodynamic Diagnosis-Conflict Questionnaire), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire-Short Form, Inventory of Personality Organization-Short Form), and psychopathology (Brief Symptom Inventory) were utilized. We investigated the network structure, identified the most inter-related psychodynamic constructs and the psychodynamic constructs with the strongest inter-relations to psychopathology, and explored the clustering of all included constructs. Active and passive conflict processing modes were negatively inter-related in most conflicts. Passive conflict processing modes were more strongly related to psychopathology than active ones in all conflicts, apart from the care versus autarky conflict. Identity diffusion shared the strongest inter-relations within psychodynamic constructs. The psychodynamic constructs that were most strongly related to psychopathology were impairments in self-perception and the passive self-worth conflict. Psychopathology and psychodynamic constructs formed distinct clusters. Our results emphasize the relevance of personality functioning within psychodynamic constructs and in relation to psychopathology.

Progress in understanding personality functioning in light of the DSM-5 and ICD-11

Updates regarding the dimensional model of personality disorder in the DSM-5 and ICD-11 have stimulated interest in the concept of personality functioning (PF). A growing number of literature has demonstrated the extensive empirical basis, validated evaluation tools, and clinical utility of the concept of PF. The concept of PF provides a construct for the diagnosis and evaluation of personality disorders. As a trans-diagnostic factor, PF is of great significance in the etiology and development of many mental and physical conditions. PF can be improved per se, primarily through psychotherapy. The evaluation and treatment of low PF should be considered in all relevant cases. The current study aims to provide a comprehensive review of the concept, pathogenesis, measurement, prevalence, psychopathological significance, as well as intervention for disordered PF.

Early Childhood Adversity Predicts Risk of Family Caregiver Suicidal Ideation:Roles of Neuroticism and Self-Compassion

Background

Despite high rates of family caregiver suicidal ideation (SI), little is known about its relationship with childhood adversity. Those with a history of adverse childhood experiences (ACEs) have been shown to have higher neuroticism, lower self-compassion, and higher rates of late life mental health disorders. Caregiving for a family member with dementia may pose a particular challenge for those with ACEs.

Methods

In a secondary analysis of 81 family caregivers of people living with dementia enrolled in clinical trials, we undertook a cross-sectional baseline analysis of the association between childhood adversity, measured with the ACE questionnaire, and self-reported suicidal ideation (SI). We further assessed whether the relationship between ACE and SI was mediated by neuroticism and self-compassion.

Results

18 caregivers self-reported SI (22%). 89% of caregivers with SI reported childhood adversity (ACE > 0), versus 63% of those without SI (p=.04). The relative risk of SI was 3.6x higher in those with childhood adversity than in those without (p=.04), and for those with a specific history childhood abuse, the relative risk of SI was 3.4x higher (p=.005). Neuroticism and self-compassion mediated the relationship between ACE and SI (p<.05), with neuroticism strengthening the association and self-compassion weakening it.

Conclusions

The association of SI with history of childhood adversity is high in family caregivers. Whereas elevated neuroticism might be one mechanism linking ACEs and SI, training self-compassion is a promising target for reducing SI. The phenotypic relationship between childhood adversity and SI in family caregivers should be further explored in larger samples, and could represent a new treatment target to improve the efficacy of therapies on caregiver emotional symptoms.

The relationship between night sleep duration, sleep quality and depressive symptoms in Chinese elderly couples

Although there are many studies analysing the relationship between sleep and depression in individuals, there is currently no bi-directional causal relationship between sleep and depression between older couples analysed from a binary perspective.Thus, this study used the CHARLS database to analyse the relationship between sleep and depression among older couples. A binary cross-lagged model was used to analyse the data.The study found an interaction between nighttime sleep duration and depression among older couples. Wife's depressive symptoms were significant predictors of husband's nocturnal sleep duration. Husband's depression and sleep quality predicted wife's sleep quality and depression, respectively. Therefore, when screening community-dwelling older adults for depressive symptoms, we need to be aware of the impact of different sleep profiles of older adults of different genders on spousal depressive symptoms. In addition, when dealing with patients with depressive symptoms, we need to consider not only the patient but also the impact of their depressive symptoms on their spouse.

Longitudinal association of exposure to work-related stress with major depressive disorder and the role of occupational burnout in this association in the general population

PURPOSE

To prospectively assess (1) the associations of Effort-Reward Imbalance (ERI), its individual components, and over-commitment with (a) the onset of a Major Depressive Episode (MDE) during a 3.6-year follow-up in a population-based cohort in participants with no current Major Depressive Disorder (MDD) in the beginning of the follow-up (n = 959), (b) incidence of MDD in the subsample of participants exempt from lifetime MDD (n = 490), and (c) the onset of a new MDE (i.e. recurrence) in the subsample of participants with remitted but no current MDD (n = 485), and (2) potential effect modification of burnout on these associations.

METHODS

DSM-IV Axis-I disorders were elicited using the semi-structured Diagnostic Instrument for Genetic Studies at each investigation. The ERI Questionnaire was used to measure ERI and overcommitment. Burnout was measured with the Maslach Burnout Inventory General Survey. Serially adjusted logistic regression models were used. The effect of burnout dimensions on these associations was assessed by testing interactions between the ERI and burnout dimensions.

RESULTS

(1) ERI was prospectively associated with the onset of MDE, even after adjustment for burnout [OR (95CI) = 1.22 (1.003-1.49)]. (2) The association between ERI and MDD incidence became non-significant after adjusting for burnout. (3) ERI was not associated with recurrence of pre-existing MDD. (4) burnout did not interact with ERI.

CONCLUSIONS

Our results support a longitudinal association between ERI and the risk of onset of MDE in the community. Burnout did not modify this effect, but it may partially account for the association between ERI and MDD incidence.

Adverse childhood experiences, marital status and depressive symptoms in later life among the Chinese middle-aged and older adults : the mediating role of marital status

BACKGROUND

Many studies have shown that adverse childhood experiences (ACEs) lead to adverse social relations in middle-aged and older adults and harm physical and mental health, but few studies have focused on the impact of ACEs on marital status in middle-aged and older adults and the potential influence of marital status between ACEs and depressive symptoms.

PURPOSE

This study aimed to analyze the effect of ACEs on marital status and depressive symptoms in the Chinese middle-aged and older adults, and to explore the mediating role of marital status in the association between ACEs and depressive symptoms in middle-aged and older adults.

METHOD

This study used the China Health and Retirement Longitudinal Study (CHARLS) 2014 life history survey and 2015 and 2018 follow-up data to analyze, ten ACEs conditions and marital status were collected by questionnaire, using the Center for Epidemiological Studies Depression Scale (CESD-10) 10-item short form to assess depressive symptoms. The association between cumulative ACEs and marital status was assessed by constructing a multinomial logistic regression (MLR) model, as well as a binary logistic regression model to assess the association between ACEs and depressive symptoms. The mediating role of marital status in the association between ACEs and depressive symptoms was also assessed.

RESULTS

A total of 10,246 individuals aged 45 years or older were included in the analysis. Compared to individuals who did not experience ACEs, those who experienced two or more ACEs had a higher risk of being unmarried (seperated/divorced/never married) (OR = 1.67, 95% CI=[1.10,2.51]) and a higher risk of depressive symptoms (OR = 1.66, 95% CI=[1.49,1.84]) in middle and old age. Unmarried status partially mediated the association of ACEs with depressive symptoms.

CONCLUSION

Chinese middle-aged and older people who experienced two or more ACEs have higher risks of unmarried status and depressive symptoms, and unmarried status partially mediated the ACEs-depressive symptom association. These findings reveal the fact that we need to develop life-cycle public health strategies to reduce exposure to ACEs and society should give more attention to the marital status of older people, thereby reducing the risk of depression among middle-aged and older adults in China.

Atypical Brain Aging and Its Association With Working Memory Performance in Major Depressive Disorder

BACKGROUND

Patients with major depressive disorder (MDD) can present with altered brain structure and deficits in cognitive function similar to those seen in aging. However, the interaction between age-related brain changes and brain development in MDD remains understudied. In a cohort of adolescents and adults with and without MDD, we assessed brain aging differences and associations through a newly developed tool that quantifies normative neurodevelopmental trajectories.

METHODS

A total of 304 participants with MDD and 236 control participants without depression were recruited and scanned from 3 studies under the Canadian Biomarker Integration Network for Depression. Volumetric data were used to generate brain centile scores, which were examined for 1) differences between participants with MDD and control participants; 2) differences between individuals with versus without severe childhood maltreatment; and 3) correlations with depressive symptom severity, neurocognitive assessment domains, and escitalopram treatment response.

RESULTS

Brain centiles were significantly lower in the MDD group than in the control group. Brain centile was also significantly correlated with working memory in the control group but not the MDD group. No significant associations were observed between depression severity or antidepressant treatment response and brain centiles. Likewise, childhood maltreatment history did not significantly affect brain centiles.

CONCLUSIONS

Consistent with previous work on machine learning models that predict brain age, brain centile scores differed in people diagnosed with MDD, and MDD was associated with differential relationships between centile scores and working memory. The results support the notion of atypical development and aging in MDD, with implications for neurocognitive deficits associated with aging-related cognitive function.

Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy

To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy.

We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor.

The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate.

Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.

Adverse childhood experiences, symptoms of anxiety and depression in adulthood: Mediation role of life history strategy

Life history theory has considered the effects of childhood experiences. The present study aimed to investigate the mediating role of life history strategy and the moderating role of gender in the relationship between childhood experiences and symptoms of anxiety and depression in adulthood. In this study, 248 Iranians (including 162 females and 86 males) between 18 and 53 voluntarily participated and responded to all online questionnaires regarding the COVID-19 pandemic. The data were analyzed with SPSS and macro PROCESS. The mediation analysis results demonstrated that the life history strategy mediates the relationship between childhood experiences and symptoms of anxiety and depression. The moderated mediation analysis revealed that there were no gender differences in the moderated mediation. The results have highlighted the importance of life history strategies in the association between childhood experiences and depression and anxiety symptoms and can be considered in the design of interventions based on the prevention of people's vulnerability to mental disorders.

Association between short- and medium-term exposure to air pollutants and depressive episode using comprehensive air quality index among the population in South Korea

BACKGROUND

Currently, air pollution is suggested as a risk factor for depressive episodes. Our study aimed to consider multiple air pollutants simultaneously, and continuously evaluate air pollutants using comprehensive air quality index (CAI) with depressive episode risk.

METHODS

Using a nationally representative sample survey from South Korea between 2014 and 2020, 20,796 participants who underwent health examination and Patient Depression Questionnaire-9 were included in the study. Six air pollutants (PM10, PM2.5, O3, CO, SO2, NO2) were measured for the analysis. Every air pollutant was standardized by air quality index (AQI) and CAI was calculated for universal representation. Using logistic regression, short- and medium-term exposure by AQI and CAI with the risk of depressive episode was calculated by odds ratio and 95 % confidence interval (CI). Furthermore, consecutive measurements of CAI over 1-month time intervals were evaluated with the risk of depressive episodes. Every analysis was conducted seasonally.

RESULTS

There were 950 depressive episodes occurred during the survey. An increase in AQI for short-term exposure (0-30 days) showed higher risk of depressive episode in CO, while medium-term exposure (0-120 days) showed higher risk of depressive episode in CO, SO2, PM2.5, and PM10. During the cold season, the exposure to at least one abnormal CAI within 1-month intervals over 120 days was associated with a 68 % (95 % CI 1.11-2.54) increase in the risk of depressive episode.

CONCLUSIONS

Short- and medium-term exposure of air pollution may be associated with an increased risk of depressive episodes, especially for cold season.

Examining childhood experiences and personality functioning as potential predictors for the speed of recovery during psychotherapy of patients with anxiety disorders

Background

Adverse childhood experiences were previously identified as relevant risk factors for the development of anxiety disorders. Furthermore, anxiety disorders were shown to be associated with impairments of personality functioning. The objective of this study was to investigate adverse and protective childhood experiences as well as personality functioning, as defined by the Operationalized Psychodynamic Diagnosis system, as potential predictors for the speed of recovery during psychotherapy for patients with anxiety disorders.

Methods

The sample consisted of n = 312 completed psychotherapies. The speed of recovery, defined as symptom abatement over time, was calculated using a two-stage hierarchical linear model. The effects of adverse and protective childhood experiences as well as personality functioning on the speed of recovery during psychotherapy were then examined using a structural equation model.

Results

The presence of adverse childhood experiences predicted a lower speed of recovery during psychotherapy. In addition, a higher number of adverse childhood experiences was associated with greater impairments in the abilities of perception and regulation as dimensions of personality functioning. A higher number of protective childhood experiences was associated with fewer impairments in the communication and attachment dimensions. Impairments in personality functioning in patients with anxiety disorders did not predict the speed of recovery during psychotherapy.

Conclusions

Among patients with anxiety disorders, adverse childhood experiences lead to a lower speed of recovery during psychotherapy. Therefore, childhood adversity should be routinely assessed before and thoroughly addressed during psychotherapy in patients with anxiety disorders.

All the Same? Different Measures of Personality Functioning Are Similar but Distinct. A Comparative Study from a Psychodynamic Perspective Using Exploratory Graph Analysis

Personality functioning (PF) is a central construct in many theories of personality pathology. Based on psychodynamic theories, two screening questionnaires to assess PF are widely used: The Inventory of Personality Organization-16 item version and the Operationalized Psychodynamic Diagnosis-Structure Questionnaire Short Form. This study aimed to explore the similarities and differences of the two questionnaires in a large clinical sample of N = 1636 psychotherapeutic inpatients. Correlation analyses were conducted to examine the associations between the global scores and between the subscales. The study further used Exploratory Graph Analysis (EGA) to explore the dimensionality of the items. The stability of estimates was evaluated using a bootstrap version of EGA (bootEGA). The results indicated that the two questionnaires are highly correlated, yet not multicollinear, and moderate to large correlations were found between their subscales. EGA revealed six dimensions that fairly represented the original subscales. BootEGA showed that the dimensions and items were stable, except for one item that did not load sufficiently on any dimension. The findings suggest that although the questionnaires are highly correlated, their subscales tap into distinct domains of PF. We discuss implications stemming from these findings for clinical and scientific practice.

Influencing Factors on the Efficacy of Aerobic Exercise Therapy in Depression: A Single-Centre Cross-Sectional Study

BACKGROUND

Aerobic exercise therapy can improve brain function and promote positive emotions in patients with depression. This study aims to improve the efficacy of aerobic exercise therapy in depression by investigating the influencing factors therein.

METHODS

This study conducted a single-centre cross-sectional analysis of clinical data from 211 depression patients who received aerobic exercise therapy at Heze Mudan People's Hospital from May 2021 to May 2023. After excluding 10 patients who did not meet the inclusion criteria, the final cohort included 201 patients. The clinical data of patients with effective treatment and patients with ineffective treatment were collected, such as socio-demographic characteristics, disease status, depression degree, treatment compliance, and social support. Binary Logistic regression was used to analyze the factors affecting the clinical efficacy of aerobic exercise therapy in patients.

RESULTS

Among the 201 patients, the effective and ineffective rates of aerobic exercise therapy were 80.10% (161/201) and 19.90% (40/201), respectively. When analysed as groups, no significant differences were observed between the effective group (EG) and ineffective group (IG) regarding gender, body mass index, course of depression, age of first onset, mental symptoms, years of education, personal income, or marital status (p > 0.05). However, the EG exhibited a reduced probability of family history of mental illness, smoking history, and severity of depression (p < 0.05), along with higher treatment compliance and Social Support Rating Scale (SSRS) scores compared to the IG (p < 0.05). Binary logistic regression analysis revealed that smoking history, family history of mental illness, treatment compliance, depression, and SSRS score were the primary influencing factors on the efficacy of aerobic exercise therapy (p < 0.05).

CONCLUSION

Smoking history, family history of mental illness, treatment compliance, severity of depression, and social support are the primary influencing factors on the efficacy of aerobic exercise therapy in patients with depression. These factors should be emphasized during follow-up treatment to optimize the clinical treatment effect.

Suicidal ideation in patients with diabetes and childhood abuse - The mediating role of personality functioning: Results of a German representative population-based study

AIMS

Suicidal ideation (SID) in patients with diabetes mellitus is increasingly acknowledged. Still, the underlying mechanisms are unclear. We examined SID prevalences in patients with diabetes, its association with different types of abuse, and a mediating effect of personality functioning.

METHODS

In a representative population sample (N = 2,515), diabetes, SID, abuse (ICAST-R), personality functioning (OPD-SQS), and depression/anxiety (PHQ-4) were assessed by self-report. Statistical analyses comprised Chi2-Tests, logistic regression and mediation analyses.

RESULTS

The prevalence of SID (21.8 %) was three fold higher in patients with diabetes compared to the general population. Abuse further increased the likelihood to report SID in diabetes patients (sexual: 48.1 % vs. 18.2 %; χ2(1) = 12.233, p <.001; emotional: 35.7 % vs. 15.7 %; χ2(1) = 10.892, p <.001). A dose-response relationship between the number of abuse experiences and SID was observed (one abuse experience: OR = 1.138, 95 %-CI [0.433, 2.990], p =.793, >2 abuse experiences: OR = 2.693, 95 %-CI [1.278, 5.675], p =.009). Impaired personality functioning had an indirect effect on the association between emotional abuse and SID (b = 0.25, 95 %-CI [0.037, 0.551]).

CONCLUSIONS

Diabetes patients experience increased SID prevalences, especially those with emotional or sexual abuse. In individuals with a history of emotional abuse, impaired personality functioning partly explained SID and should therefore be considered and addressed in this patient group.

Psychosocial adaptation under adverse experiences: A study on the role of empathy with adolescents from vulnerable contexts in Brazil

BACKGROUND

Adverse Childhood Experiences (ACEs) are potentially traumatic events that affect children and adolescents, increasing the risk for negative outcomes in several developmental domains. The literature suggests that ACEs affect boys and girls differently, and that protective factors such as social and emotional skills may favor resilience processes and promote Psychosocial Adjustment.

OBJECTIVE

The present study aimed to verify gender differences in relation to ACEs and Empathy, and to identify whether the effect of ACEs on Psychosocial Adjustment is moderated by Empathy.

PARTICIPANTS AND SETTING

A total of 1229 boys and girls aged 14 to 17 years from public schools in regions considered to be of high social vulnerability in two cities of Brazil participated in this study.

METHODS

Comparisons between genders were carried out using a logistic regression model. We then fitted multiple regression models predicting Psychosocial Adjustment, where ACEs, Empathy, and an interaction term between ACEs and Empathy were employed as independent variables, controlled by gender.

RESULTS

Logistic regression analysis showed that girls experience ACEs more often than boys (d = 0.26, p = 0.02; d = 0.36; p < 0.001), and score higher on the Empathy scale (d = 0.43, p < 0.001). The genders do not differ in Community Violence Exposure nor Psychosocial Adjustment levels. Interaction analysis showed that Empathy moderates the effect of ACEs on adolescents' level of Psychosocial Adjustment. In the context of close relationships, Empathy may counteract the effect of ACEs, while in cases involving domestic violence and/or psychological abuse, it may amplify the impact of ACEs.

CONCLUSIONS

The results show the relevance of considering gender specificities and that the role played by Empathy is more complex and needs further investigation. We emphasize that programs and policies aiming to prevent ACEs and their harmful effects should consider its types, in addition to the diversity and the specificities of the target population.

LGBTQ+ identity-related abuse during childhood and associations with depression and suicide behavior: Role of adulthood cisheterosexism and expressive suppression

BACKGROUND

Exposure to minority stressors specific to LGBTQ+ individuals, such as heterosexism and cissexism (or cisheterosexism) is not covered under the traditional adverse childhood experiences framework. This is important because childhood identity-related abuse by a parent/caregiver can lead to mental health challenges in later life through the adoption of maladaptive coping mechanisms.

OBJECTIVE

The present study aimed to examine the role of cisheterosexism and expressive suppression as serial mediators in the associations between identity-related abuse and depressive symptoms and suicide behavior.

PARTICIPANTS AND SETTING

Participants included 563 LGBTQ+ identifying adults between 18 and 64 years (M = 30.02, SD = 9.05) from different regions of Spain and were recruited through social media (e.g., Twitter, Facebook, and Instagram).

METHOD

A serial mediation model was conducted with cisheterosexism and expressive suppression as the mediators in the associations between LGBTQ+ identity-related childhood abuse and depressive symptoms and suicide behavior.

RESULTS

Findings indicated a positive indirect effect of identity-related abuse on depressive symptoms through cumulative cisheterosexism (B = 0.628, p < .01), and via cumulative cisheterosexism and suppression (B = 0.146, p < .05). No significant indirect effect was found for identity-related abuse on depressive symptoms via suppression (B = 0.086). An indirect effect was found for identity-related abuse on suicide behavior via cumulative cisheterosexism (B = 0.250, p < .01).

CONCLUSIONS

Findings reveal that LGBTQ+ identity-related cisheterosexist experiences perpetrated by parents or caregivers are associated with harmful, long-term impacts on symptoms of depression and suicide behavior via experiences of cisheterosexism and expressive suppression.

The mediating role of personality traits in the association between childhood trauma and depressive symptoms in young adulthood

BACKGROUND

The aim of this study was to investigate the mediating role of the Big 5 personality traits (extraversion, neuroticism, openness, agreeableness, conscientiousness) in the association between early traumatization and depressive symptoms in early adulthood (20-25-year-olds) in a German population-based sample.

METHODS

A total of 3176 participants from the German National Cohort (NAKO) baseline with an age between 20 and 25 years were included in this investigation. The sum score of the 9-item-version of the Patient Health Questionnaire was used for assessment of depressive symptoms. A structural equation model was built to test the paths between childhood trauma, Big 5 personality traits and depressive symptoms.

RESULTS

Overall, 10.7 % of the young adult sample had a PHQ-9 sum score of ten or higher. The final mediation model fitted well for young adults. We found evidence for a partial mediating effect of Big 5 personality traits.

LIMITATIONS

We only adjusted for age, sex, and year of data collection and did not include biological factors in the model.

CONCLUSION

Young adults with early trauma experiences have a risk for developing depressive symptoms in young adulthood. Personality traits, especially neuroticism, partially mediated the association between early trauma and depressive symptoms for young adults and should be recognized in preventive strategies.

Measuring personality functioning with the 12-item version of the OPD-Structure Questionnaire (OPD-SQS): reliability, factor structure, validity, and measurement invariance in the general population

Background

The assessment of personality functioning is at the core of current dimensional models of personality disorders. A variety of measures from different clinical and research traditions aim to assess basic psychological capacities regarding the self and others. While some instruments have shown reliability and validity in clinical or other selected samples, much less is known about their performance in the general population.

Methods

In three samples representative of the German adult population with a total of 7,256 participants, levels of personality functioning were measured with the short 12-item version of the Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQS). We addressed questions of factor structure, reliability, validity, factorial invariance, and provide norm values.

Results

Confirmatory factor analysis indicated a satisfactory to good model fit. OPD-SQS models were mostly unaffected by variables such as gender, age, or measurement time. As expected, personality functioning was associated with general psychopathology as well as indices of occupational functioning.

Conclusion

The OPD-SQS is a viable measure to assess personality functioning in the general population.

Adverse childhood experiences and personality functioning interact substantially in predicting depression, anxiety, and somatization

Etiological theories on the development of psychopathology often incorporate adverse childhood experiences (ACE) as an important contributing factor. Recent studies suggest personality functioning (PF; i.e., stability of the self and interpersonal relationships) as an important transdiagnostic construct that could be useful in better understanding when persons with ACE do (not) develop psychopathological symptoms. A representative sample of N = 2363 was assessed by questionnaires on ACE, PF (Level of Personality Functioning Scale-Brief Form 2.0), and current symptoms of depression, anxiety, and somatization (Brief Symptom Inventory 18). The interaction between ACE and PF on symptoms was investigated using multiple group models and Bayesian structural equation modeling. ACE were positively associated with psychopathology and PF impairments. The interaction effect between ACE and PF explained incremental variance in current symptoms, ranging from 26% for somatization to 49% for depression with the complete model explaining up to 91% of the latent variance in psychopathology. Our findings indicate a diathesis-stress model with PF as a resource or resilience that may buffer against the development of symptoms in the face of adversity. Treatments of depression and anxiety targeting self and interpersonal functioning therefore may lead to improvements in resilience and relapse prevention. [Correction added on 15 March 2023, after first online publication: Level of Personality Functioning Scale-Brief Form has been replaced to Level of Personality Functioning Scale-Brief Form 2.0 ].

The relationship between personality traits and individual factors with perinatal depressive symptoms: a cross-sectional study

BACKGROUND

Pregnancy is a crucial transition moment exposing women to potential mental health problems, especially depressive disturbances. Sociodemographic, pregnancy-related, and psychological factors have been related to depressive symptoms in the perinatal period. This study aims at (1) exploring personality and individual factors related with perinatal depressive symptoms, and (2) testing the mediating role of personality in the relation between characteristics of the woman's family of origin and depressive symptoms.

METHODS

Women in the perinatal period admitted to the gynecology unit for motherhood-related routine assessments (n = 241) were included in the study. A survey on individual sociodemographic, clinical, and pregnancy-related factors was administered, also including the Edinburgh Postnatal Depression Scale (EPDS) and the BIG-5 personality test.

RESULTS

Couple conflict and neuroticism were independent and directly correlated with EPDS total score (respectively: B = 2.337; p = .017; B = 0.303; p < .001). Neuroticism was a significant mediator of the relation between the presence of a psychiatric disorder diagnosis in participant's parents and the EPDS total score (indirect b = 0.969; BCCI95%=0.366-1.607).

CONCLUSIONS

Couple relation and neuroticism traits are individual factors related to depressive symptoms in the perinatal period. The family of origin also plays an indirect role on perinatal depressive symptoms. Screening of these factors could lead to early recognition and more tailored treatments, ultimately leading to better outcome for the entire family.

Association of changes in sleep duration and quality with incidence of depression: A cohort study

BACKGROUND

The longitudinal relationship between sleep duration, sleep quality, and their changes with the risk of depressive symptoms is unclear. We examined the association between sleep duration, sleep quality, and their changes with incident depressive symptoms.

METHODS

A total of 225,915 Korean adults without depression at baseline with a mean age of 38.5 years were followed for an average of 4.0 years. Sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index. The presence of depressive symptoms was assessed using the Center for Epidemiologic Studies Depression scale. Flexible parametric proportional hazard models were used to determine hazard ratios (HRs) and 95 % confidence intervals (CIs).

RESULTS

In total, 30,104 participants with incident depressive symptoms were identified. Multivariable-adjusted HRs (95 % CIs) for incident depression comparing sleep durations of ≤5, 6, 8, and ≥9 h with 7 h were 1.15 (1.11-1.20), 1.06 (1.03-1.09), 0.99 (0.95-1.03), and 1.06 (0.98-1.14), respectively. A similar trend was observed in patients with poor sleep quality. Compared with participants with persistently good sleep quality, participants with persistently poor sleep quality or who developed poor sleep quality were associated with the risk of incident depressive symptoms [HRs (95 % CIs) of 2.13 (2.01-2.25) and 1.67 (1.58-1.77), respectively].

LIMITATIONS

Sleep duration was assessed using self-reported questionnaire and the study population may not reflect general population.

CONCLUSIONS

Sleep duration, sleep quality and their changes were independently associated with incident depressive symptoms in young adults, suggesting that inadequate sleep quantity and quality play a role in depression risk.

A Cross-Sectional Study: Structural and Related Functional Connectivity Changes in the Brain: Stigmata of Adverse Parenting in Patients with Major Depressive Disorder?

Background: There is a high correlation between the risk of major depressive disorder (MDD) and adverse childhood experiences (ACEs) such as adverse parenting (AP). While there appears to be an association between ACEs and changes in brain structure and function, there have yet to be multimodal neuroimaging studies of associations between parenting style and brain developmental changes in MDD patients. To explore the effect of AP on brain structure and function. Methods: In this cross-sectional study, 125 MDD outpatients were included in the study and divided into the AP group and the optimal parenting (OP) group. Participants completed self-rating scales to assess depressive severity, symptoms, and their parents' styles. They also completed magnetic resonance imaging within one week of filling out the instruments. The differences between groups of gender, educational level, and medications were analyzed using the chi-squared test and those of age, duration of illness, and scores on scales using the independent samples t-test. Differences in gray matter volume (GMV) and resting-state functional connectivity (RS-FC) were assessed between groups. Results: AP was associated with a significant increase in GMV in the right superior parietal lobule (SPL) and FC between the right SPL and the bilateral medial superior frontal cortex in MDD patients. Limitations: The cross-cultural characteristics of AP will result in the lack of generalizability of the findings. Conclusions: The results support the hypothesis that AP during childhood may imprint the brain and affect depressive symptoms in adulthood. Parents should pay attention to the parenting style and avoid a style that lacks warmth.

Depressive personality traits and temperament and character personality traits in a clinical sample: Results from regression and network analyses

Personality and psychopathology are highly relevant and easily relatable constructs. The current study investigated the relationships between dependency and self-criticism, sociotropy and autonomy depressive personality traits, and Cloninger's temperament and character personality traits postulated as vulnerability factors for depression, in relation to depressive and general psychopathology symptoms in a clinical sample of 100 patients diagnosed with major depressive disorder. The results showed that self-directedness, a character trait of the temperament and character model, was positively associated with dependency, self-criticism, sociotropy, and autonomy. Applying more in-depth analyses with regression models revealed associations between self-directedness and depressive personality styles dependency and sociotropy, and general psychopathology symptoms was a significant clinical indicator in these relationships. Going beyond the regression models, network analysis showed that self-directedness is associated with self-criticism, sociotropy, autonomy, and general psychopathology symptoms. The relationship between self-directedness and sociotropy, self-criticism and autonomy suggests that these depressive personality traits may be attributable to aspects of self-determination, maturity, responsibility, discipline, and self-acceptance. General psychopathology research informed by literature incorporating personality traits has far-reaching implications for understanding individual differences as well as increasing efforts to contribute to the amelioration of disabling psychological disorders like major depressive disorders.

Mediating role of personality traits in the association between multi-dimensional adverse childhood experiences and depressive symptoms among older adults: A 9-year prospective cohort study

BACKGROUND

To explore the mediating role of personality traits in the correlation between multi-dimensional adverse childhood experiences (ACEs) and depressive symptoms in older adults.

METHODS

This cohort study used data from the English Longitudinal Study of Ageing, and included 4050 older adults without depressive symptoms in 2010-2011. Multi-dimensional ACEs were evaluated in 2006-2007. Personality traits were assessed using the Midlife Development Inventory in 2010-2011. Depressive symptoms were measured using the 8-item version of the Center for Epidemiologic Studies Depression Scale during 2012-2019. Cox proportional hazard model was used to explore the associations between ACEs and depressive symptoms. The package named "mediation" in R was used to test mediating role of personality traits.

RESULTS

ACEs in each dimension significantly increased the risk of depressive symptoms (all P-values < 0.05). The association of maltreatment (18.18 %) and household dysfunction (19.69 %) with depressive symptoms was significantly mediated by neuroticism. The correlation between poor parent-child bonding and depressive symptoms was significantly mediated by neuroticism (19.43 %), conscientiousness (4.84 %), and extroversion (8.02 %).

LIMITATIONS

ACEs were retrospectively assessed based on participants' memories, which may induce recall bias.

CONCLUSIONS

Maltreatment and household dysfunction may induce depressive symptoms by increasing neuroticism. Poor parent-child bonding may induce depressive symptoms by increasing neuroticism and reducing conscientiousness and extraversion. In addition to reducing the occurrence of ACEs, reducing neuroticism of individuals with maltreatment and household dysfunction in childhood, and reducing neuroticism, and increasing conscientiousness and extraversion of individuals with poor parent-child bonding in childhood might help to decrease their risk of depressive symptoms.

Exploring the associations between psychodynamic constructs and psychopathology: A network approach

Psychodynamic therapy effectively reduces symptomatology by focusing on underlying (unconscious) processes instead of symptoms. Nevertheless, the exact interrelationship between psychodynamic constructs and psychopathology remains unclear. This study uses network analysis to explore these associations. We computed a cross-sectional partial correlation network between psychodynamic constructs (i.e., personality functioning, interpersonal relations, and active and passive modes of intrapsychic conflicts according to the Operationalized Psychodynamic Diagnostics [OPD] system) and psychopathology (i.e., depression and somatization) in a naturalistic sample of 341 adults registering for psychodynamic outpatient therapy. We estimated node centrality, node predictability, and bridge symptoms and used community detection analysis. Bootstrap methods were applied to assess network stability. Psychodynamic constructs and psychopathology resulted in separate but connected clusters. Personality functioning emerged as the most influential node in the network and was bridging the clusters. The network was found to be highly stable, allowing reliable interpretations. The results offer important insights on how psychodynamic constructs relate to psychopathology, which can be used to inform treatment approaches. The findings suggest that personality functioning may be an important intervention target. However, future research is needed to include a broader range of diagnoses. In addition, longitudinal studies may clarify the direction of causality.

Personality functioning and the pathogenic effect of childhood maltreatment in a high-risk sample

BACKGROUND

While the psychopathological sequalae of childhood maltreatment are widely acknowledged, less is known about the underlying pathways by which childhood maltreatment might lead to an increased risk for mental health problems. Recent studies indicated that impaired personality functioning might mediate this relationship. The aim of the present paper was to extend the current literature by investigating the mediating effect of impaired personality functioning between different types of childhood maltreatment and self-reported mental health problems in a high-risk sample.

METHODS

Overall, 173 young adults (mean age = of 26.61 years; SD = 3.27) with a history of residential child welfare and juvenile justice placements in Switzerland were included in the current study. The Childhood Trauma Questionnaire (CTQ-SF), Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1) and the self-report questionnaires of the Achenbach System of Empirically Based Assessment scales (ASEBA) were used. Mediation analyses were conducted through structural equation modeling.

RESULTS

Overall, 76.3% (N = 132) participants indicated at least one type of childhood maltreatment, with emotional neglect being most commonly reported (60.7%). A total of 30.6% (N = 53) participants self-reported mental health problems. Emotional abuse (r = 0.34; p < .001) and neglect (r = 0.28; p < .001) were found to be most strongly associated with mental health problems. In addition, impaired personality functioning was fond to be a significant mediator for overall childhood maltreatment (β = 0.089; p = 0.008) and emotional neglect (β = 0.077; p = 0.016). Finally, impaired self-functioning was found to be a significant mediator when both self-functioning and interpersonal functioning were included as potential mediators in the relationship between overall childhood maltreatment (β1 = 0.177, p1 = 0.007) and emotional neglect (β1 = 0.173, p1 = 0.003).

CONCLUSION

Emotional neglect may be particularly important in the context of childhood maltreatment, personality functioning, and mental health problems and, therefore, should not be overlooked next to the more "obvious" forms of childhood maltreatment. Combining interventions designed for personality functioning with trauma-informed practices in standard mental health services might counteract the psychopathological outcomes of maltreated children and adolescents.

The interplay of Criterion A of the Alternative Model for Personality Disorders, mentalization and resilience during the COVID-19 pandemic

Background and aims

The COVID-19 pandemic has been accompanied by a worsening of mental health levels in some, while others manage to adapt or recover relatively quickly. Transdiagnostic factors such as personality functioning are thought to be involved in determining mental health outcomes. The present study focused on two constructs of personality functioning, Criterion A of the Alternative Model for Personality Disorders (AMPD, DSM-5) and mentalization, as predictors of depressive symptoms and life satisfaction during the COVID-19 pandemic. A second focus of the study was to examine whether this relationship was mediated by resilience.

Methods

Linear regression analyses were used to examine the relationship between personality functioning measured by Criterion A (AMPD, DSM-5) and mentalizing abilities as predictors, and depression and life satisfaction as mental health outcomes. To assess the hypothesis that this relationship is mediated by resilience a structural equation modeling approach was conducted. Data from N = 316 individuals from the general population were collected.

Results

Linear regression models revealed highly significant associations between Criterion A/mentalization and both outcome measures. Structural equation models showed a significant partial mediation by resilience of these relationships.

Conclusion

Our results support the hypothesis that mentalizing serves as a protective function by promoting resilience to the impact of stress and threats. Criterion A and mentalization performed similarly as predictors of mental health outcomes, providing empirically overlapping operationalizations of personality functioning. This finding emphasizes the importance of personality functioning in positive and negative mental health outcomes. Furthermore, our results are consistent with a mediating role of resilience.

Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study

Objective

Although treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence.

Methods

194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale.

Results

Non-adherence correlated significant with personality functioning (r = 0.325), childhood trauma (r = 0.204) and depressiveness (r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R2 = 0.149, F(3,190) = 12.225, p &lt; 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model.

Conclusion

In cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.

Early Life Adversity and Neuropsychiatric Disease: Differential Outcomes and Translational Relevance of Rodent Models

It is now well-established that early life adversity (ELA) predisposes individuals to develop several neuropsychiatric conditions, including anxiety disorders, and major depressive disorder. However, ELA is a very broad term, encompassing multiple types of negative childhood experiences, including physical, sexual and emotional abuse, physical and emotional neglect, as well as trauma associated with chronic illness, family separation, natural disasters, accidents, and witnessing a violent crime. Emerging literature suggests that in humans, different types of adverse experiences are more or less likely to produce susceptibilities to certain conditions that involve affective dysfunction. To investigate the driving mechanisms underlying the connection between experience and subsequent disease, neuroscientists have developed several rodent models of ELA, including pain exposure, maternal deprivation, and limited resources. These studies have also shown that different types of ELA paradigms produce different but somewhat overlapping behavioral phenotypes. In this review, we first investigate the types of ELA that may be driving different neuropsychiatric outcomes and brain changes in humans. We next evaluate whether rodent models of ELA can provide translationally relevant information regarding links between specific types of experience and changes in neural circuits underlying dysfunction.

Mechanisms linking physical activity with psychiatric symptoms across the lifespan: a protocol for a systematic review

INTRODUCTION

Persistent psychiatric symptomatology during childhood and adolescence predicts vulnerability to experience mental illness in adulthood. Physical activity is well-known to provide mental health benefits across the lifespan. However, the underlying mechanisms linking physical activity and psychiatric symptoms remain underexplored. In this context, we aim to systematically synthesise evidence focused on the mechanisms through which physical activity might reduce psychiatric symptoms across all ages.

METHODS AND ANALYSIS

With the aid of a biomedical information specialist, we will develop a systematic search strategy based on the predetermined research question in the following electronic databases: MEDLINE, Embase, Web of Science, Cochrane and PsycINFO. Two independent reviewers will screen and select studies, extract data and assess the risk of bias. In case of inability to reach a consensus, a third person will be consulted. We will not apply any language restriction, and we will perform a qualitative synthesis of our findings as we anticipate that studies are scarce and heterogeneous.

ETHICS AND DISSEMINATION

Only data that have already been published will be included. Then, ethical approval is not required. Findings will be published in a peer-reviewed journal and presented at conferences. Additionally, we will communicate our findings to healthcare providers and other sections of society (eg, through regular channels, including social media).

PROSPERO REGISTRATION NUMBER

CRD42021239440.

The mediation effect of personality functioning between different types of child maltreatment and the development of depression/anxiety symptoms - A German representative study

BACKGROUND

Child maltreatment (CM) is associated with an increased risk to develop symptoms of depression/anxiety across an individual's lifespan. Recent studies indicated that impairments in personality functioning might mediate this association. The purpose of this study is to add evidence of this mediating effect by regarding different types of CM (emotional, physical and sexual abuse as well as emotional and physical neglect) in the general population.

METHODS

A representative sample of the German population (N = 2,354) completed a set of standardized measures (OPD-SQS: Operationalized Psychodynamic Diagnosis - Structure Questionnaire Short, PHQ-4: Patient Health Questionnaire, CTQ: Childhood Trauma Questionnaire). Mediation analyses were carried out to examine the association between CM types, symptoms of depression/anxiety, and personality functioning.

RESULTS

Up to two-thirds of the associations between CM types and symptoms of depression/anxiety are mediated by personality functioning [indirect effect: emotional abuse (β = 0.219, 95%-CI: 0.187-0.251, p < .001), physical abuse (β = 0.151, 95%-CI: 0.123-0.178, p < .001), sexual abuse (β = 0.163, 95%-CI: 0.138-0.188, p < .001), emotional neglect (β = 0.131, 95%-CI: 0.104-0.159, p < .001) and physical neglect (β = 0.102, 95%-CI: 0.078-0.127, p < .001)].

LIMITATIONS

Symptoms of depression/anxiety were measured with screening instruments and results are based on cross-sectional data.

CONCLUSIONS

The present investigation expands the evidence on the mediating effect of personality functioning in the association between CM and depression/anxiety symptoms based on data of the general population. Our results show the relevance of types, as the mediating effects are slightly stronger in CM abuse types than in CM neglect types. Knowledge about impaired personality might be an angle for clinical interventions and inspire future research.

Patterns of adverse childhood experiences and depressive symptom trajectories in young adults: A longitudinal study of college students in China

BACKGROUND

Adverse childhood experiences (ACEs) tend to cluster together in daily life, and most studies focus on the level of depression at certain points, but the dynamic process of depression is often neglected. Thus, research is urgently needed to explore the relationship between ACEs pattern and trajectory of depressive symptom levels at multiple time points in order to provides early targeted interventions to those who are most at risk.

OBJECTIVE

We aimed to explore patterns of ACEs, including types and timing, associated with depression trajectories in college students.

METHODS

A school-based health survey was used to collect data as part of a longitudinal study in two medical college in Anhui province, China. Questionnaires were issued to 3,662 participants aged 17-22 and recorded details of ACEs (types and timing) and depression. Latent class analysis (LCA) was used to identify "patterns" of ACEs type and timing. Depressive symptom trajectories employed latent class growth analysis (LCGA). Multiple logistic regressions were employed to evaluate the relationships between ACEs patterns and depressive symptom trajectories.

RESULTS

We identified five ACEs patterns: "High neglect/emotional abuse/community violence," "High neglect/emotional abuse," "High neglect/family dysfunction," "High neglect," "Low ACEs." We traced three depression trajectories: "High depressive symptom" "Moderate depressive symptom," "Low depressive symptom." "High neglect/emotional abuse/community violence," "High neglect/emotional abuse" and "High neglect/family dysfunction" demonstrated a high risk for "High depressive symptom" and "Moderate depressive symptom." "High neglect" showed a high risk for "Moderate depressive symptom" but not for "High depressive symptom" (P < 0.05).

CONCLUSIONS

The findings address the need for a comprehensive consideration of exposure to childhood adversity associated with the risk of depression in young adults through identifying more problematic ACEs patterns amongst exposed children.

Adverse Childhood Experiences and Subjective Cognitive Decline in the US

OBJECTIVE

The aim of this study was to determine the association between adverse childhood experiences (ACEs) and subjective cognitive decline (SCD) among a representative sample of the adult US population.

METHODS

Data were obtained from the 2019 Behavioral Risk Factor Surveillance System (N = 82,688, ≥45 years). Adverse childhood experiences included sexual, physical/psychological and environmental ACEs, and a score. Multivariable logistic regression was used to determine the association between ACEs and SCD, and SCD-related outcomes.

RESULTS

Sexual (adjusted OR (aOR: 2.83; 95% CI: 2.42-3.31)), physical/psychological (aOR: 2.05; 95% CI: 1.83-2.29), and environmental (aOR: 1.94; 95% CI: 1.74-2.16) ACEs were associated with SCD in the past year. There was also a dose-response relationship between ACE score and SCD.

CONCLUSION

ACEs were associated with SCD. Interventions to maximize cognitive health in aging and prevent future cognitive impairment should consider the potential role of ACEs among affected populations.

Universal depression prevention: An umbrella review of meta-analyses

Depression is a disabling, highly prevalent, frequently chronic, and difficult-to-treat disorder with an immense cognitive, social, and economic burden. Given that many of the advances in other non-communicable disorders like cancer have been in prevention rather than treatment, the prevention of depression is currently an unmet public health priority. We sought to provide an overview of the meta-analytic literature through conducting a systematic umbrella review of universally delivered preventive interventions for depression. The search was conducted on March 18, 2021 utilising the following databases (all accessed through EBSCOHost); Allied and Complementary Medicine Database, CINAHL Complete, Global Health, Health Source: Nursing/Academic Edition, MEDLINE Complete and APA PsychArticles. The following search terms related to depression, prevention, and trial study design. Two authors independently screened articles and a third resolved discrepancies. Eligibility criteria sought to identify meta-analyses that investigated the prevention of depression (i.e., reduced incidence) through intervention studies that were universal, in that they were designed to be delivered to entire populations Six meta-analyses on psychological interventions, two school-based meta-analyses, and one eHealth meta-analysis were included in this umbrella review. Findings indicated that all identified studies were of good quality and one was of fair quality. One previous meta-review that examined physical activity to prevent depression was included in results, comprising eight meta-analyses. Preventive interventions have primarily and successfully utilized psychological therapeutic components, delivered at the school, community, and workplace settings. Both school- and eHealth-based interventions hold some utility for depression prevention. There is meta-analytic evidence that physical activity is efficacious for depression prevention. However, universal prevention is inconsistently defined. There is a pressing need for well-designed randomized controlled preventative interventions for depression before recommendations can be universally accepted with convincing level of evidence.

Mothers susceptible to child maltreatment and requiring public health nurses' continuous support

OBJECTIVE

This study aimed to identify the characteristics of mothers who are at a high risk for future child maltreatment and therefore, require continuous support from public health nurses (PHNs) to prevent child maltreatment and those who do not require it.

DESIGN AND SAMPLES

This retrospective cross-sectional study included women who were registered in 2018 for being at risk for future child maltreatment and required help with childrearing in City A within the Tokyo metropolis.

MEASUREMENTS

Public health nurses registered data pertaining to each mother, including demographic data, family-related variables, assessment by PHNs, use of maternal and child healthcare services, and continuity of support from PHNs.

RESULTS

Of the 206 cases, the discontinued group-comprising those who no longer needed PHNs' support-included 83 cases (40.3%) and the continuing group-comprising those needed continuing support-included 123 cases (59.7%). Logistic regression analysis showed that those with marital conflicts, maternal mental instability, lack of parenting skills, and not moving out of the city were more likely to require continuous PHNs' support.

CONCLUSIONS

By identifying these factors, PHNs can identify new mothers who need continuous support and provide more concentrated care for them. Thus, support from PHNs can help prevent child maltreatment.

Personality functioning as a mediator of adult mental health following child maltreatment

BACKGROUND

The broad range of adverse health outcomes following child maltreatment (child maltreatment) underscores the need to investigate shared trajectories that contribute to associated physical and mental health problems. Previous research focused on different mechanisms, such as emotion regulation or attachment. In the present study, we propose personality functioning, comprising self- and interpersonal regulation and perception, to mediate between child maltreatment and mental and physical health.

METHODS

In a German representative sample (N = 2,508), we assessed remembered child maltreatment, levels of personality functioning, and different health outcomes in adulthood, namely somatic symptoms, general mental distress, and body dysmorphic concern. We conducted path analyses to investigate mediation effects in the total sample as well as in female and male subsamples.

RESULTS

Child maltreatment significantly predicted the assessed health outcomes and showed significant associations with lower levels of personality functioning. Personality functioning partially mediated all health outcomes assessed by significant indirect effects and lowered direct effects of child maltreatment on health outcomes. An exploratory analysis of different facets of personality functioning revealed a pronounced impact of identity perception and self-reflective capacities in mediating between child maltreatment and physical and mental health. Comparable results were found in female and male participants.

LIMITATIONS

Major limitations of the study are the reliance on cross-sectional data and the use of a screening measure to assess experienced child maltreatment.

CONCLUSION

Personality functioning may represent a transdiagnostic link to different somatic and psychological symptoms in the aftermath of child maltreatment.

Associations Between Adverse Childhood Experiences and Adult Health Outcomes: Exploring Gender Differences

Objectives: This study aimed to (1) understand the associations between Adverse Childhood Experiences (ACEs) and poor adult health outcomes, specifically looking at both physical and mental health indicators, and (2) examine gender differences in ACEs’ impact on adult health outcomes.Methods: Data were obtained from the 2012 Korean General Social Survey. The study sample comprised 1,396 individuals aged ≥ 18 years who answered the ACE questionnaire. Controlling for sociodemographic factors, linear regression models were run to estimate the relationships between ACEs and adult physical (self-rated poor physical health status) and mental health indicators (depressive symptoms). Furthermore, the Chow test was carried out to ascertain whether there were any gender differences in ACEs’ impact on both adult physical and mental health outcomes.Results: Higher numbers of ACEs were significantly and positively associated with worse adult physical and mental health outcomes, such as poorer physical health status and higher levels of depressive symptoms compared with individuals who reported no adversities during childhood. In addition, gender differences were identified in ACEs’ impact on both health indicators, suggesting that females were at a higher risk of depression, while males were more likely to experience poor physical health.Conclusion: Adults reporting multiple adversities during childhood are more likely to experience poorer physical and mental health, demonstrating a strong, graded dose-response relationship between the number of ACEs and a range of negative adult health outcomes. Gender differences also exist in ACEs’ impact on adult physical and mental health, thus suggesting the need for gender-based intervention strategies to address ACEs in the adult population.

Relationship between childhood physical abuse and clinical severity of treatment-resistant depression in a geriatric population

Introduction

We assessed the correlation between childhood maltreatment (CM) and severity of depression in an elderly unipolar Treatment-Resistant Depression (TRD) sample.

Methods

Patients were enrolled from a longitudinal cohort (FACE-DR) of the French Network of Expert TRD Centres.

Results

Our sample included 96 patients (33% of the overall cohort) aged 60 years or above, with a mean age of 67.2 (SD = 5.7). The majority of the patients were female (62.5%). The Montgomery and Asberg Depression Rating Scale (MADRS) and Quick Inventory Depression Scale-Self Report (QIDS-SR) mean scores were high, 28.2 (SD = 7.49) [MADRS score range: 0–60; moderate severity≥20, high severity≥35] and 16.5 (SD = 4.94) [IDS-SR score range: 0–27; moderate severity≥11, high severity≥16], respectively. Mean self-esteem scores were 22.47 (SD = 6.26) [range 0–30]. In an age- and sex-adjusted model, we found a positive correlation between childhood trauma (CTQ scores) and depressive symptom severity [MADRS (β = 0.274; p = 0.07) and QIDS-SR (β = 0.302; p = 0.005) scores]. We detected a statistically significant correlation between physical abuse and depressive symptom severity [MADRS (β = 0.304; p = 0.03) and QIDS-SR (β = 0.362; p = 0.005) scores]. We did not observe any significant correlation between other types of trauma and depressive symptom severity. We showed that self-esteem (Rosenberg scale) mediated the effect of physical abuse (PA) on the intensity of depressive symptoms [MADRS: b = 0.318, 95% BCa C.I. [0.07, 0.62]; QIDS-SR: b = 0.177, 95% BCa C.I. [0.04, 0.37]]. Preacher & Kelly’s Kappa Squared values of 19.1% (k² = 0.191) and 16% (k² = 0.16), respectively for the two scales, indicate a moderate effect.

Conclusion

To our knowledge, this is the first study conducted in a geriatric TRD population documenting an association between childhood trauma (mainly relating to PA) and the intensity of depressive symptoms.

Influence of Pathogenic and Metabolic Genes on the Pharmacogenetics of Mood Disorders in Alzheimer's Disease

Background: Mood disorders represent a risk factor for dementia and are present in over 60% of cases with Alzheimer’s disease (AD). More than 80% variability in drug pharmacokinetics and pharmacodynamics is associated with pharmacogenetics. Methods: Anxiety and depression symptoms were assessed in 1006 patients with dementia (591 females, 415 males) and the influence of pathogenic (APOE) and metabolic (CYP2D6, CYP2C19, and CYP2C9) gene variants on the therapeutic outcome were analyzed after treatment with a multifactorial regime in a natural setting. Results and Conclusions: (i) Biochemical, hematological, and metabolic differences may contribute to changes in drug efficacy and safety; (ii) anxiety and depression are more frequent and severe in females than males; (iii) both females and males respond similarly to treatment, showing significant improvements in anxiety and depression; (iv) APOE-3 carriers are the best responders and APOE-4 carriers tend to be the worst responders to conventional treatments; and (v) among CYP2D6, CYP2C19, and CYP2C9 genophenotypes, normal metabolizers (NMs) and intermediate metabolizers (IMs) are significantly better responders than poor metabolizers (PMs) and ultra-rapid metabolizers (UMs) to therapeutic interventions that modify anxiety and depression phenotypes in dementia. APOE-4 carriers and CYP-related PMs and UMs deserve special attention for their vulnerability and poor response to current treatments.