Is early-onset in major depression a predictor of specific clinical features with more impaired social function?

Effects of mind-body therapies on depression among adolescents: a systematic review and network meta-analysis

Background

Depression poses significant threats to adolescents' health globally. Research has shown the potential of mind-body therapies to alleviate depression, but limited studies have directly compared the therapeutic effects of different types of mind-body therapies on adolescent depression and the optimal therapy remain unclear. Therefore, we conducted a systematic review and network meta-analysis of randomized controlled trials that met the inclusion criteria to explore the effectiveness of different types of mind-body therapies as interventions to improve depression among adolescents, and to identify the most effective interventions.

Methods

A comprehensive search of databases including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus up to January 2024 was conducted to assess the impact of mind-body therapies on depression among adolescents. The risk of bias of the included studies was evaluated using Cochrane Review Manager 5.4. STATA 18.0 was used for network meta-analysis. The node-splitting method was used to test the local inconsistency of the network meta-analysis. Funnel plots and the Egger's test were utilized to assess the potential impact of bias in this study.

Result

This network meta-analysis included 9 randomized controlled trials involving a total of 955 subjects. The results indicated that yoga, dance therapy and Tai Chi were more effective than other mind-body therapies in reducing symptoms of depression among adolescents. Specifically, according to the SUCRA ranking, yoga was rated to be the optimal intervention for adolescents with depression (SCURA: 82.2%), followed by dance therapy (SCURA: 77.5%) and Tai Chi (SCURA: 64.9%).

Conclusion

This study revealed that mind-body therapies have positive effects on improving depression among adolescents. Yoga may be the most effective intervention among the different types of mind-body therapies. However, due to the small sample size of patients included, the certainty of the results was limited to some extent. Therefore, further investigation is necessary to strengthen the evidence base when more relevant studies become available.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024508774.

Global, regional, and national incidence trends of depressive disorder, 1990-2019: An age-period-cohort analysis based on the Global Burden of Disease 2019 study

BACKGROUND

Depressive disorder is a severe global public health problem. It is crucial to evaluate the global incidence trends of depressive disorder.

METHODS

The incidence data were drawn from the Global Burden of Disease Study (GBD) 2019. Estimates were presented by global and sociodemographic index (SDI) quintiles, and the age-period-cohort (APC) model was used to estimate the incidence trends.

RESULTS

APC analysis indicated a decline in depressive disorder incidence globally (net drift = -0.24%, 95%CI: -0.29, -0.18), except for an increase in SDI regions (net drift = 0.07, 95%CI:0, 0.14). In high SDI regions, depressive disorder incidence increased among the younger and declined among the elder population, whereas the opposite trend was observed in middle and low-middle SDI regions. The depressive disorder incidence increased significantly among people aged 15 to 24 years after adjusting for age effects, decreased since 2000 after adjusting for period effects and increased rapidly in the birth cohort after 1990 in high SDI by adjusting for cohort effects.

CONCLUSION

Globally, there was a declining trend of depressive disorder incidence in 1990-2019. Specifically, the incidence was declining globally in younger populations, while increasing in older populations. However, this trend differed depending on the SDI of the region.

Global, regional, and national burdens of depressive disorders in adolescents and young adults aged 10-24 years from 1990 to 2019: A trend analysis based on the Global Burden of Disease Study 2019

BACKGROUND

Depressive disorders (DD) including dysthymia and major depressive disorder (MDD) are common among adolescents and young adults. However, global trends in DD burden remain unclear.

METHODS

We analysed data from the Global Burden of Disease 2019 study on incidence, prevalence, disability-adjusted life years (DALYs), and mortality due to DD from 1990 to 2019 at global, regional and national levels.

RESULTS

Globally, dysthymia incidence increased notably in females, older age groups, and lower-middle income countries from 1990 to 2019. In contrast, MDD incidence decreased slightly over this period except in high-income North America. Females and middle-income countries had the highest dysthymia burden while North America had the highest MDD incidence and DALYs. Oman and Malaysia experienced largest increases in dysthymia and MDD burden respectively.

CONCLUSION

Despite certain global indicators suggesting a leveling off or decrease, it's clear that depressive disorders continue to be a significant and increasing issue, particularly among women, teenagers, and young adults. Differences between regions and countries indicate that specific interventions aimed at addressing economic inequalities, improving healthcare systems, and taking cultural factors into account could make a real difference in lessening the burden of depressive disorders. More research is needed to understand what's driving these trends so that we can develop better strategies for preventing and managing these conditions.

Biobehavioral mechanisms underlying testosterone and mood relationships in peripubertal female adolescents

The pubertal transition is characterized by pronounced sex hormone fluctuation, refinement of affective neural circuitry, and an increased risk of depression in female adolescents. Sex hormones, including testosterone, exert modulatory effects on frontal-limbic brain networks and are associated with emotion dysregulation and depressive symptoms. Weekly changes in hormones predict affective symptoms in peripubertal female adolescents, particularly in the context of stress; however, the biobehavioral mechanisms underlying hormone change and mood relationships during the pubertal transition have yet to be determined and was the objective of the present study. Forty-three peripubertal female adolescents (ages 11-14) collected 8-weekly salivary hormone (estrone, testosterone) samples and mood assessments to evaluate hormone-mood relationships, followed by a biobehavioral testing session with psychosocial stress and EEG. Within-person correlations between weekly hormone changes and corresponding mood were performed to determine individual differences in mood sensitivity to weekly hormone change. Increased frontal theta activity indexing emotion reactivity, reduced cortisol reactivity, and reduced vagal efficiency predicted the strength of the relationship between testosterone and mood. Further, testosterone-sensitivity strength was associated with the enhancement of negative affect following stress testing. Results identify divergent frontal theta and stress responses as potential biobehavioral mechanisms underlying mood sensitivity to peripubertal testosterone fluctuation.

Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan

INTRODUCTION

Globally, 80% of the burdenof major depressive disorder (MDD) pertains to low- and middle-income countries. Research into genetic and environmental risk factors has the potential to uncover disease mechanisms that may contribute to better diagnosis and treatment of mental illness, yet has so far been largely limited to participants with European ancestry from high-income countries. The DIVERGE study was established to help overcome this gap and investigate genetic and environmental risk factors for MDD in Pakistan.

METHODS

DIVERGE aims to enrol 9000 cases and 4000 controls in hospitals across the country. Here, we provide the rationale for DIVERGE, describe the study protocol and characterise the sample using data from the first 500 cases. Exploratory data analysis is performed to describe demographics, socioeconomic status, environmental risk factors, family history of mental illness and psychopathology.

RESULTS AND DISCUSSION

Many participants had severe depression with 74% of patients who experienced multiple depressive episodes. It was a common practice to seek help for mental health struggles from faith healers and religious leaders. Socioeconomic variables reflected the local context with a large proportion of women not having access to any education and the majority of participants reporting no savings.

CONCLUSION

DIVERGE is a carefully designed case-control study of MDD in Pakistan that captures diverse risk factors. As the largest genetic study in Pakistan, DIVERGE helps address the severe underrepresentation of people from South Asian countries in genetic as well as psychiatric research.

Earlier age of onset is associated with a pro-inflammatory state in major depressive disorder

Major depressive disorder (MDD) is a common condition that affects the general population over a wide range of ages, regardless of gender and social background. Early-onset of MDD in adulthood, between ages of 18 and 30 years, is associated with worse outcomes and increased years of disability. Stress load and physical health have been associated with age of onset in MDD. We aim to investigate whether early onset MDD might be associated with changes in systemic inflammatory markers. We examined levels of following cytokines: IL-1β, IL-6, IL-10 and TNFα in 234 patients with MDD. Higher serum levels of TNFα and IL-1β are associated with the early onset of the disorder in patients with MDD. IL-6 levels were also higher in the early onset group and IL-10 levels were higher in the late onset group, but with no significant difference. Changes in the anti-inflammatory/pro-inflammatory balance have been described in mood disorders and may be implicated in its severity and pattern of progression. Our findings reinforce that higher serum levels of IL-1β and TNFα may be associated with the earlier onset subgroup of MDD patients. Future research that target inflammatory markers of immune modulation may be, key in the search for novel preventative therapeutics.

Features of cognitive impairment and related risk factors in patients with major depressive disorder: A case-control study

BACKGROUND

Cognitive impairment (CI) is a common symptom contributing to functional loss in major depressive disorder (MDD). However, the features of CI and its related risk factors in young and middle-aged MDD patients remain unclear.

METHODS

In this case-control study, 18- to 55-year-old acute-onset MDD patients and healthy controls (HCs) were recruited from nine centers in China. MDD patients were diagnosed based on the DSM-IV, the Mini-International Neuropsychiatric Interview, and a 17-item Hamilton Rating Scale for Depression score ≥ 14. Cognitive function, including attention/vigilance, learning, memory, processing speed and executive function, was assessed with a neuropsychological battery and compared between MDD patients and HCs. MDD patients scoring 1.5 SDs below the mean HC score in at least 2 domains were defined as having CI. Logistic regression analysis was used to identify risk factors for CI in MDD patients.

RESULTS

Compared with HCs (n = 302), MDD patients (n = 631) showed significant impairment in all cognitive domains (P < 0.001); 168 MDD patients (26.6%) had CI. Male sex (OR: 1.712; 95% CI: 1.165-2.514; P < 0.01) was positively correlated with CI; age of first onset (OR: 0.974; 95% CI: 0.957-0.991; P < 0.05) and comorbid anxiety disorders (OR: 0.514; 95% CI: 0.332-0.797; P < 0.01) were negatively correlated with CI.

LIMITATIONS

Biomarkers and neuroimaging were not used to investigate the possible biological mechanism and neural basis of CI in MDD.

CONCLUSIONS

CI was prominent in adults with acute-onset MDD; male sex and younger age of first onset were independent risk factors, and comorbid anxiety disorders were a protective factor.

Factors associated with antipsychotic use in non-psychotic depressed patients: results from a clinical multicenter survey

BACKGROUND

The combination of antipsychotics is not well studied among non-psychotic major depressive disorder (MDD). This study aims to explore the antipsychotics use in this population and its associated factors.

METHODS

This cross-sectional and multi-site study was conducted in 11 sites of China. one Thousand five hundred three eligible MDD patients after 8-12 weeks of antidepressant treatment were included consecutively. A structured questionnaire was used to obtain socio-demographic data and medical histories. The Chinese version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR), the Patient Health Questionnaire-15 (PHQ-15) and the Sheehan Disability Scale (SDS) were used for patient self-rating. Logistic regression model was used to explore the associated factors that could potentially be influential for the use antipsychotic augmentation.

RESULTS

Overall, quetiapine (43.4%) was the most commonly used as an adjunct to antidepressants, followed by olanzapine (38.8%). And antipsychotics were commonly combined with escitalopram (23.1%), venlafaxine (21.7%), sertraline (14.8%). The factors influencing the combination of antipsychotics in non-psychotic depressed patients included service setting (OR = 0.444; p < 0.001; 95%CI = 0.338-0.583), comorbidity of physical illness (OR = 1.704; p < 0.001; 95%CI = 1.274-2.278), PHQ level (OR = 0.680; p < 0.001; 95%CI = 0.548-0.844), SDS level (OR = 1.627; p < 0.001; 95%CI = 1.371-1.930) and antidepressants co-treatment (OR = 2.606; p < 0.001; 95%CI = 1.949-3.485).

CONCLUSIONS

Antipsychotics use is common among non-psychotic MDD patient. Service setting, comorbidity of physical illness, somatic symptoms, social functioning and engagement, and antidepressants co-treatment could be the factors associated with the antipsychotics use in MDD patients.

Program for education and enrichment of relational skills (PEERS) training for social skills and depressed mood intervention in young adult with depression: Study protocol for a randomized controlled trial

INTRODUCTION

Depression is a common psychiatric disorder characterized by persistent low mood, reduced interest, and slowed thinking. Young adults are the main first-onset group for depression in all categories of the population. Program for education and enrichment of relational skills (PEERS) training, a program for the Education and Enrichment of Relational Skills, has been used in Europe and America for people with various types of social disorders with good results. A Chinese adaptation of the PEERS training program may be a new approach to help youth with depression return to society as soon as possible. This study aimed to construct and optimize a social skills training program for Chinese young adults with depression and to validate the impact of the program.

MATERIALS AND METHODS AND ANALYSIS

The aim of this trial protocol is to evaluate the efficacy of the localized PEERS training program on social competence, depressed mood in a Chinese young adult population with depression. The primary outcome will be a change in self-reported depressive symptoms from baseline to week 3 post-randomization to week 6 post-randomization measured using the Liebowitz social anxiety scale (LSAS). Secondary outcomes include the rate of decline in severe social anxiety, the Social Avoidance and Distress Scale (SAD), the Social Self-Efficacy Scale (PSSE), and the Hamilton Depression Scale (HAMD-17). Data for each assessment will be collected at baseline, week 3 of the trial, and week 6 of the trial.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Hospital Ethics Committee. Findings will be disseminated through scientific journals, conferences, and university courses.

TRIAL REGISTRATION NUMBER

[http://www.chictr.org.cn/], identifier [ChiCTR2100046050].

Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis

OBJECTIVE

Adolescence is a formative and turbulent phase where physiological, psychosocial, and cognitive changes leave adolescents vulnerable to psychological disorders. Given the lack of reviews that consolidate and compare worldwide prevalence of depression among adolescents, this review aims to examine the global prevalence of major depressive disorders, dysthymia, and elevated depressive symptoms among adolescents.

METHODS

A systematic review and meta-analysis was conducted. Six databases were searched for studies published from 2001 to December 2020. Seventy-two studies were included. Subgroup analysis were performed for year of publication, geographical region, gender, and assessment tools used.

RESULTS

The global point prevalence rate of elevated self-reported depressive symptoms from 2001 to 2020 was 34% (95% CI: 0.30-0.38). Point prevalence for major depressive disorder (MDD) and dysthymia was 8% (95% CI: 0.02-0.13) and 4% (95% CI: 0.01-0.07), respectively. The pooled one-year prevalence and lifetime prevalence for MDD were 8% (95% CI: 0.05-0.12) and 19% (95% CI: 0.12-0.26). Point prevalence of elevated depressive symptoms among adolescents increased from 24% (95% CI: 0.19-0.28) between 2001 and 2010 to 37% (95% CI: 0.32-0.42) between 2011 and 2020. The Middle East, Africa, and Asia have the highest prevalence of elevated depressive symptoms, and female adolescents were reported to have a higher prevalence of elevated depressive symptoms than male adolescents.

CONCLUSION

Besides targeting those with existing clinical depression, research and policies should also focus on educational and supportive mitigation efforts to curb depressive symptoms among adolescents before escalation. The findings encourage future research to develop more gender-specific and culturally relevant intervention programmes.

PRACTITIONER POINTS

34% of adolescents globally, aged 10-19 years, are at risk of developing clinical depression, which exceeds the reported estimates of individuals aged 18 to 25 years. Practitioners are highly encouraged to prioritize depression screening and intervention implementation for individuals in this age group. Female adolescents and adolescents from Middle East, Africa, and Asia have the highest risk of developing depression. This urges practitioners and researchers to develop more gender-specific and culturally relevant intervention programmes.

Early onset of depression and treatment outcome in patients with major depressive disorder

Major depressive disorder (MDD) is a highly heterogeneous disorder, which may partly explain why treatment outcome using antidepressants is unsatisfactory. We investigated the onset of depression as a possible clinical marker for therapy response prediction in the context of somatic biomarkers blood pressure and plasma electrolyte concentration. 889 MDD patients were divided into early (EO, n = 226), intermediate (IO, n = 493), and late onset (LO, n = 169) patients and were analyzed for differences in socio-demographic and clinical parameters, comorbidities and treatment outcome as well as systolic blood pressure and electrolytes. EO patients more often suffered from a recurrent depression, had more previous depressive episodes, a higher rate of comorbid axis I and II disorders, and more often reported of suicidality (p < 0.001) compared to IO and LO patients. Treatment outcome was not different from IO and LO patients, although LO patients responded faster. EO patients who showed an early non-improvement of depression after 2 weeks of therapy (<20% improvement) had a 4.3-fold higher likelihood to become non-remitter as compared to LO patients with an early improvement. EO patients had significantly lower systolic blood pressure than patients with IO or LO and electrolytes in EO patients were significantly correlated with depression severity. Our results confirm other studies showing an association of an early onset of depression with a slower treatment response. The worse treatment outcome in patients with an additional early non-improvement to antidepressant therapy opens perspectives to develop and test individualized treatment approaches for EO and LO patients in the future, which may be based on differences in autonomic regulation.

Gender differences in quality of life and functional disability for depression outpatients with or without residual symptoms after acute phase treatment in China

BACKGROUND

Depression is associated with substantial personal suffering and reduced quality of life and functioning. The aim of this study was to investigate gender differences on quality of life and functional impairment of outpatients with depression after acute phase treatment.

METHODS

1503 depression outpatients were recruited from eleven hospitals in China. Subjects were evaluated with sociodemographic characteristics, history and self-report instruments, related to severity of symptoms, function and quality of life. All data were analyzed to determine the gender differences.

RESULTS

Men had a younger age at onset and the first onset age, higher education compared to women in total patients and with or without residual symptoms group. Using regression analysis, it was found that gender was significantly statistically related to severity scores of SDS and had no correlation with Q-LES-Q-SF total scores. In the residual symptoms group, greater functional impairment was noted by men in the area of work and social life. Significant gender differences of mood, work and sexual life in quality of life were observed.

LIMITATIONS

This is a cross-sectional study of depressed outpatients and duration of acute phase treatment may not an adequate time to measure changes.

CONCLUSIONS

Depression appears to affect men more seriously than women after acute phase treatment. Men had a younger age at onset and the first onset age, higher education, more functional impairment and lower satisfaction of quality of life in mood, work and sexual life. Gender differences affect acute treatment, remission and recovery.