Bright Light Therapy as Add-On to Inpatient Treatment in Youth With Moderate to Severe Depression: A Randomized Clinical Trial

Importance

Major depressive disorder is one of the most common mental disorders among adolescents, entailing severe, long-term psychosocial impairment and a high risk of chronicity. In view of the large number of patients requiring treatment, along with insufficient treatment responses with small effect sizes, innovative adjunctive treatment strategies are urgently needed.

Objective

To investigate whether the effect of adolescent psychiatric inpatient treatment as usual for major depressive disorder can be enhanced by simultaneous use of morning bright light therapy.

Design, Setting, and Participants

This was a double-blind, placebo-controlled randomized parallel-group trial with enrollment between March 2018 and November 2020 and follow-up completed in May 2021. The study took place among inpatients at 4 university hospitals for child and adolescent psychiatry across Germany. Of 248 eligible youth aged 12 to 18 years fulfilling ICD-10 criteria for major depressive disorder, 227 were randomized to bright light therapy (n = 116) or placebo red light (n = 111); 151 participants completed the study.

Interventions

Up to 20 sessions of either morning bright light therapy with an intensity of 10 000 lux or placebo red light (100 lux) in addition to multimodal inpatient treatment as usual over 4 weeks.

Main Outcomes and Measures

The primary outcome was the change in Beck Depression Inventory-II (BDI-II) score from baseline to posttreatment in the intention-to-treat sample.

Results

Among the 224 patients included in the intention-to-treat analyses (192 girls and 32 boys; mean [SD] age, 15.5 [1.4] years), the mean (SD) BDI-II score at baseline was 37.3 (8.7). BDI-II scores were significantly reduced after 4 weeks (postassessment) by a mean of -7.5 (95% CI, -9.0 to -6.0; Hedges g = 0.71). Bright light therapy had no impact on this change (no significant group × time effect). Loss to follow-up was 31% (n = 69) at 16 weeks and 49% (n = 110) at 28 weeks. There were 10 serious adverse events throughout the whole trial, which were not considered related to study treatment.

Conclusions and Relevance

The findings in this study did not indicate superiority of bright light therapy over placebo red light therapy in a large sample of adolescent inpatients with moderate or severe major depressive disorder. Both groups benefited equally from treatment as usual, showing relevant symptom reduction.

Trial Registration

German Clinical Trials Register: DRKS00013188.

[Support for families with a mentally ill parent : Which forms of help do mentally ill parents utilize and which would they like to have?]

BACKGROUND

In Germany different offers of social support are available for families that are provided by different sectors, e.g., the youth welfare and the healthcare systems.

OBJECTIVE

Documentation of the utilized help, child-related factors that are associated with the utilization and the parental desires for support.

MATERIAL AND METHODS

Survey of 160 parents undergoing (partial) inpatient treatment in psychiatric hospitals via an oral interview using standardized and semi-standardized instruments.

RESULTS

The results show that nonprofessional help by family and friends as well as support offers provided by the healthcare system are used most frequently. Families that perceived their children as more burdened receive more help than families with children judged as being less burdened. There are regional differences especially in the utilization of high-threshold help by the healthcare system.

DISCUSSION

Support offers seem to reach families with mental illnesses, especially those that are particularly burdened; however, there are regional differences regarding the utilization of support as well as the wishes for specific support offers.

Cross-infections between fallow deer and domestic ruminants with large lungworms (Dictyocaulus spp.)

Groups of four deer each were experimentally infected with larvae of Dictyocaulus (D.) eckerti (from fallow deer) or D. viviparus (from cattle) or D. filaria (from sheep), groups of four cattle each with D. viviparus or D. eckerti and groups of 4 lambs each with D. filaria or D. eckerti. The animals were daily examined coprologically following the 16th day post infectionem. The animals were slaughtered at different times and the lungs were dissected. With the exception of the infection of the sheep with D. eckerti from fallow deer, the mutual infections of the different hosts with the lungworm species became patent. Lungworms could be isolated. Fallow deer proved to be more susceptible to an infection with D. viviparus than cattle to an infection with D. eckerti. The large lungworms which naturally infest fallow deer and cattle, D. eckerti and D. viviparus respectively, can be distinguished according to the morphology of their mouth capsules, especially in the structure of the buccal ring. These features were also present after infection of the heterologous hosts.

[The content of pepsinogen in the blood plasma of growing fallow deer (Dama dama L.) raised helminth free and under natural conditions in captivity]

Pepsinogen values were determined in helminth free (n = 12) and naturally raised farmed fallow deer (n = 10-12) from birth (June 1992) to 11 (May 1993) and 15 months (September 1993) of age respectively in 4 weekly intervals. At birth the plasma pepsinogen value was 0.708 +/- 0.197 U Tyrosin/l and decreased thereafter until 14 weeks of age to 0.139 +/- 0.061 U Tyrosin/l in both groups. From the 18th week of age the naturally raised fallow deer, infected with gastrointestinal nematodes, had significantly higher pepsinogen values than the helminth free kept animals. Maximum pepsinogen levels in the naturally raised fallow deer were determined in November 1992 (0.813 +/- 0.336 U Tyrosin/l) and in June 1993 (1.050 +/- 0.163 U Tyrosin/l). In helminth free animals no further decrease of plasma pepsinogen values was seen from 14th week of age onwards: it was 0.202 +/- 0.110 U Tyrosin/l. There was no influence of sex on the plasma pepsinogen values in both groups.

Comparative RAPD-PCR analysis of lungworms (Dictyocaulidae) from fallow deer, cattle, sheep, and horses

Genomic DNA isolated from the four Dictyocaulus species D. viviparus, D. eckerti, D. filaria and D. arnfieldi was compared by random amplified polymorphic DNA polymerase chain reaction (RAPD)-PCR to get additional information whether lungworms from fallow deer belong to a separate species (D. eckerti) or have to be regarded as an isolate of D. viviparus in wild ruminants. The resulting banding patterns of the electrophoresed PCR products were compared to assess the degree of genetic differences between the different lungworms. For the two D. viviparus isolates a similarity coefficient of 93.4% was calculated, whereas the similarity coefficient of D. viviparus, D. eckerti, D. filaria and D. arnfieldi ranged from 12% to 32%. The similarity coefficient of 32% between D. eckerti and D. viviparus compared with the intraspecies similarity of 93.4% indicates that D. eckerti most likely belongs to a separate species and is not a D. viviparus isolate of wild ruminants.