Some distance measures for pythagorean cubic fuzzy sets: Application selection in optimal treatment for depression and anxiety

Pythagorean cubic fuzzy sets represent an advancement beyond conventional interval-valued Pythagorean sets, integrating the principles of Pythagorean fuzzy sets and interval-valued Pythagorean fuzzy sets. Given the critical significance of distance measures in real-world decision-making and pattern recognition tasks, it is noteworthy that there exists a notable gap in the literature regarding distance measures specifically tailored for Pythagorean cubic fuzzy sets. The objectives of this paper are:•To define novel generalized distance measures between Pythagorean cubic fuzzy sets (PCFSs) to tackle intricate decision-making challenges.•These novel distance measures are undergoing testing on a real-world scenario concerning the management of anxiety and depression to evaluate their effectiveness and practical application.•We have illustrated the boundedness and nonlinear characteristics inherent in these distance measures. In addition, we conduct comparative analyses with existing approaches to validate the proposed methodology, thereby providing insights into its advantages and potential applications.

Health care needs, experiences, and satisfaction after terrorism: a longitudinal study of parents of survivors of the Utøya attack

BACKGROUND

There is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up.

METHODS

Interview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up.

RESULTS

Among the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported "very high/high" needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received.

CONCLUSIONS

Our findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.

Depression- and anxiety-associated disrupted brain structural networks revealed by probabilistic tractography in thyroid associated ophthalmopathy

BACKGROUND

Patients with thyroid-associated opthalmopathy (TAO) have widespread white matter (WM) abnormalities in the emotional and cognitive functional regions. However, the topological representation of these WM abnormalities and the network-level structural aberrations underlying TAO and concomitant affective disorders are still unclear.

METHODS

We used probabilistic diffusion tractography and graph theory to investigate brain network topology in 37 active, 35 inactive TAO patients and 23 healthy controls. Then, we evaluated the partial correlations between network topological metrics and clinical parameters.

RESULTS

For global topology, only active TAO patients exhibited significantly decreased global (Eglob) and local (Eloc) efficiency compared with controls, while no significant difference was observed between active and inactive TAO patients. For regional topology, we found a significantly decreased nodal efficiency in the left orbital superior frontal gyrus (ORBsup), medial orbital superior frontal gyrus (ORBsupmed), hippocampus and amygdala in active TAO patients compared with inactive ones. Intriguingly, Eglob, Eloc, and nodal efficiency of left ORBsup, ORBsupmed, olfactory cortex, gyrus rectus, hippocampus, right parahippocampal gyrus and amygdala had significantly positive correlations with anxiety/depression scores, bilateral exophthalmos and intraocular pressure in active TAO patients, while no significant correlation was observed in inactive TAO patients.

LIMITATIONS

No longitudinal follow-up.

CONCLUSIONS

WM networks of TAO are characterized by decreased local specialization and global integration in the active phase, and decreased nodal efficiency highly related to anxiety and depression in the emotional and cognitive regions. Our findings provide new insight regarding the neurobiological mechanisms of TAO and contribute to the treatment of concomitant affective disorders.

Multi-omics analysis of fecal microbiota transplantation's impact on functional constipation and comorbid depression and anxiety

BACKGROUND

Depression and anxiety are common comorbid diseases of constipation. Fecal microbiota transplantation (FMT) significantly relieves gastrointestinal-related symptoms, but its impact on psychiatric symptoms remains uncharted.

METHODS

We collected fecal and serum samples before and after FMT from 4 functional constipation patients with psychiatric symptoms and corresponding donor stool samples. We categorized the samples into two groups: before FMT (Fb) and after FMT (Fa). Parameters associated with constipation, depression, and anxiety symptoms were evaluated. Metagenomics and targeted neurotransmitter metabolomics were performed to investigate the gut microbiota and metabolites. 5-hydroxytryptamine (5-HT) biosynthesis was detected in patients' fecal supernatants exposed to the QGP-1 cell model in vitro.

RESULTS

Our study demonstrated that patient's constipation, depression, and anxiety were improved after FMT intervention. At the genus level, relative abundance of g_Bacteroides and g_Klebsiella decreased in the Fa group, while g_Lactobacillus, and g_Selenomonas content increased in the same group. These observations suggest a potential involvement of these genera in the pathogenesis of constipation with psychiatric symptoms. Metabolomics analysis showed that FMT intervention decreased serum 5-HT levels. Additionally, we found that species, including s_Klebsiella sp. 1_1_55, s_Odoribacter splanchnicus, and s_Ruminococcus gnavus CAG:126, were positively correlated with 5-HT levels. In contrast, s_Acetobacterium bakii, s_Enterococcus hermanniensis, s_Prevotella falsenii, s_Propionispira arboris, s_Schwartzia succinivorans, s_Selenomonas artemidis, and s_Selenomonas sp. FC4001 were negatively correlated with 5-HT levels. Furthermore, we observed that patients' fecal supernatants increased 5-HT biosynthesis in QGP-1 cells.

CONCLUSION

FMT can relieve patients' constipation, depression, and anxiety symptoms by reshaping gut microbiota. The 5-HT level was associated with an altered abundance of specific bacteria or metabolites. This study provides specific evidence for FMT intervention in constipation patients with psychiatric symptoms.

Understanding and Addressing Mental Health Disorders: a Workplace Imperative

PURPOSE OF REVIEW

This article seeks to provide a broad overview of the workplace mental health literature, highlight practical implications of current research, and formulate key recommendations for stakeholders. Various aspects of disability related to mental health disorders, their associated financial costs, and the impact of stigma are covered. This article also discusses key strategies for assessing mental health problems among employees and reviews different types of interventions in the workplace.

RECENT FINDINGS

Workplace mental health is an evolving area, particularly in the wake of the pandemic. While established national workplace mental health standards do not currently exist, mental illness continues to have a severe impact on the health of organizations, employees, and the economy. Additional research is needed to fully understand and address the diversity of mental health needs among the broad range of employees and organizations across the USA. Employers have a responsibility and an opportunity to create workplaces that support the whole person, not just the employee. While research in the area has increased in the last decade, there is still much to learn in terms of the most effective ways to support our workforce.

Worsened Ability to Engage in Social and Physical Activity During the COVID-19 Pandemic and Older Adults' Mental Health: Longitudinal Analysis From the Canadian Longitudinal Study on Aging

Background and Objectives

Restrictions implemented to mitigate the transmission of coronavirus disease 2019 (COVID-19) affected older adults' ability to engage in social and physical activities. We examined mental health outcomes of older adults reporting worsened ability to be socially and physically active during the pandemic.

Research Design and Methods

Using logistic regression, we examined the relationship between positive screen for depression (10-item Center for Epidemiological Studies-Depression Scale) or anxiety (7-item Generalized Anxiety Scale) at the end of 2020 and worsened ability to engage in social and physical activity during the first 6-9 months of the pandemic among older adults in Canada. Interactions between ability to participate in social and physical activity and social participation pre-COVID (2015-2018) and physical activity were also examined. We analyzed data collected before and during the COVID pandemic from the Canadian Longitudinal Study on Aging, a nationally representative longitudinal cohort: pre-pandemic (2015-2018), COVID-Baseline survey (April to May 2020), and COVID-Exit survey (September to December 2020).

Results

Of the 24,108 participants who completed the COVID-Exit survey, 21.96% (n = 5,219) screened positively for depression and 5.04% (n = 1,132) for anxiety. Worsened ability to participate in social and physical activity was associated with depression (odds ratio [OR] = 1.85 [95% confidence interval {CI} 1.67-2.04]; OR = 2.46 [95% CI 2.25-2.69]), respectively, and anxiety (OR = 1.66 [95% CI 1.37-2.02] and OR = 1.96 [95% CI 1.68-2.30]). Fully adjusted interaction models identified a buffering effect of social participation and the ability to participate in physical activity on depression (χ2 [1] = 8.86, p = .003 for interaction term).

Discussion and Implications

Older adults reporting worsened ability to participate in social and physical activities during the COVID-19 pandemic had poorer mental health outcomes than those whose ability remained the same or improved. These findings highlight the importance of fostering social and physical activity resources to mitigate the negative mental health impacts of future pandemics or other major life stressors that may affect the mental health of older adults.

Differential Associations Between Depressive Symptom-Domains With Anxiety, Loneliness, and Cognition in a Sample of Community Older Chinese Adults: A Multiple Indicators Multiple Causes Approach

Background and Objectives

Depressive symptoms are common in older adults, and often co-occur with other mental health problems. However, knowledge about depressive symptom-domains and their associations with other conditions is limited. This study examined depressive symptom-domains and associations with anxiety, cognition, and loneliness.

Research Design and Methods

A sample of 3,795 participants aged 60 years and older were recruited from the community in Hong Kong. They were assessed for depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder 7-item), loneliness (UCLA 3-item), and cognition (Montreal Cognitive Assessment 5-Minute Protocol). Summary descriptive statistics were calculated, followed by confirmatory factor analysis of PHQ-9. Multiple Indicators Multiple Causes analysis was used to examine the associations between mental health conditions in the general sample and subgroups based on depressive symptom severity.

Results

A 4-factor model based on the Research Domain Criteria showed the best model fit of PHQ-9 (χ2/df = 10.63, Root-Mean-Square Error of Approximation = 0.05, Comparative Fit Index = 0.96, Tucker-Lewis Index = 0.93). After adjusting for demographics, 4 depressive symptom-domains were differentially associated with anxiety, loneliness, and cognition across different depression severity groups. The Negative Valance Systems and Internalizing domain (NVS-I; guilt and self-harm) were consistently associated with anxiety (β = 0.45, 0.44) and loneliness (β = 0.11, 0.27) regardless of depression severity (at risk/mild vs moderate and more severe, respectively, all p < .001).

Discussion and Implications

The consistent associations between the NVS-I domain of depression with anxiety and loneliness warrant attention. Simultaneous considerations of depressive symptom-domains and symptom severity are needed for designing more personalized care.

Clinical Trials Registration Number

NCT03593889.

Cognitive impairment, depressive-like behaviors and hippocampal microglia activation following exposure to air pollution nanoparticles

Air pollution particulate matter (PM) is a world risk factor that the effects of long-term exposure to these factors in terms of damage to cardiovascular and pulmonary function are well known, but little is known comparatively about the effects of PM on emotional and cognitive processes. Exposure to PM can adversely affect the central nervous system (CNS) by inflammatory pathways and activation of reactive oxygen species (ROS) associated with urban air pollution PM. Therefore, we investigated whether prolonged exposure to diesel exhaust particles (DEPs) affects hippocampal inflammatory cytokines and emotional and cognition responses. Male mice were exposed to DEPs for 6 and 12 weeks. DEP-exposed mice indicated more disorders in depressive-like responses and spatial memory and learning than in control groups. Pro-inflammatory cytokine expression in tge hippocampus was increased among mice exposed to DEPs. The number of activated microglia increased in the dentate gyrus (DG) and CA1 regions of the hippocampus in DEP-exposed mice. These results show that chronic exposure to DEPs can alter neurobehavioral and impair cognition. Generally, these findings reaffirm the importance of protecting from exposure to ambient PM2.5 and also advance our understanding of the toxic actions of air pollution nanoparticles.

Long-term outcomes of COVID-19 convalescents: An 18.5-month longitudinal study in Wuhan

OBJECTIVES

This study aimed to describe the full scope of long-term outcomes and the ongoing pathophysiological alterations among COVID-19 survivors.

METHODS

We established a longitudinal cohort of 208 COVID-19 convalescents and followed them at 3.3 (interquartile range [IQR]: 1.3, 4.4, visit 1), 9.2 (IQR: 9.0, 9.6, visit 2), and 18.5 (IQR: 18.2, 19.1, visit 3) months after infection, respectively. Serial changes in multiple physical and psychological outcomes were comprehensively characterized. We, in addition, explored the potential risk factors of SARS-CoV-2 antibody response and sequelae symptoms.

RESULTS

We observed continuous improvement of sequelae symptoms, lung function, chest computed tomography (CT), 6-minute walk test, and the Borg dyspnea scale, whereas sequelae symptoms (at least one) and abnormal chest CT patterns still existed in 45.2% and about 30% of participants at 18.5 months, respectively. Anxiety and depression disorders were alleviated for the convalescents, although depression status was sustained for a longer duration.

CONCLUSIONS

Most COVID-19 convalescents had an overall improved physical and psychological health status, whereas sequelae symptoms, residual lesions on lung function, exercise impairment, and mental health disorders were still observed in a small proportion of participants at 18.5 months after infection. Implementing appropriate preventive and management strategies for the ever-growing COVID-19 population is warranted.

The effect of exposure and response prevention therapy on obsessive-compulsive disorder: A systematic review and meta-analysis

This meta-analysis mainly examined the effect size of exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) when compared with different control conditions, and the difference in the efficacy of different variants of ERP in the treatment of OCD. Thirty studies were included, involving 39 randomized controlled trials with 1793 participants, from 30 studies up to January 18, 2022. Hedge's g was calculated using random-effects models. The results showed that ERP had a definite effect on OCD (g = 0.37), and its effect was significant when the control condition was placebo (g = 0.97) or drug (g = 0.59). However, ERP did not show statistical differences with other therapies in improving OCD (g = -0.07). In addition, we found that both therapist and self-controlled exposure (at the same time as the therapist controls, self-control is exercised after the therapy session) and total response prevention can better improve OCD symptoms. In addition, compared with the control group, ERP reduced depression (g = 0.15) and anxiety symptoms (g = 0.23) in patients with OCD. Meta-regression results showed that the longer the length of sessions, the better the treatment effect (t = 2.41, p = 0.022).

Seafarers' mental health during the COVID-19 pandemic: An examination of current supportive measures and their perceived effectiveness

As the current COVID-19 pandemic and the resulting crew change crisis exacerbates the mental health problem faced by seafarers, various maritime stakeholders have mobilised their resources and strengths to provide a variety of supportive measures to address the issue. This paper aims to find out what measures have been adopted in the industry and how widely they have been experienced/received by seafarers and evaluate their effectiveness. To achieve this aim, this research employed a mixed methods design involving qualitative interviews with 26 stakeholders and a quantitative questionnaire survey of 817 seafarers. The research identified a total number of 22 mental health support measures, all of which were perceived to have contributed positively to seafarers' mental health. However, not all of them were widely available to or utilised by seafarers. The findings also highlighted the importance of family, colleagues, shipping companies, and government agencies, as they are associated with the most effective support measures, namely communication with family, timely crew changes, being prioritised for vaccination, being vaccinated, and a positive and collegial atmosphere on-board. Based on the findings, recommendations are provided.

An online parenting intervention to prevent affective disorders in high-risk adolescents: the PIPA trial protocol

BACKGROUND

Adolescent depression can place a young person at high risk of recurrence and a range of psychosocial and vocational impairments in adult life, highlighting the importance of early recognition and prevention. Parents/carers are well placed to notice changes in their child's emotional wellbeing which may indicate risk, and there is increasing evidence that modifiable factors exist within the family system that may help reduce the risk of depression and anxiety in an adolescent. A randomised controlled trial (RCT) of the online personalised 'Partners in Parenting' programme developed in Australia, focused on improving parenting skills, knowledge and awareness, showed that it helped reduce depressive symptoms in adolescents who had elevated symptom levels at baseline. We have adapted this programme and will conduct an RCT in a UK setting.

METHODS

In total, 433 family dyads (parents/carers and children aged 11-15) will be recruited through schools, social media and parenting/family groups in the UK. Following completion of screening measures of their adolescent's depressive symptoms, parents/carers of those with elevated scores will be randomised to receive either the online personalised parenting programme or a series of online factsheets about adolescent development and wellbeing. The primary objective will be to test whether the personalised parenting intervention reduces depressive symptoms in adolescents deemed at high risk, using the parent-reported Short Mood & Feelings Questionnaire. Follow-up assessments will be undertaken at 6 and 15 months and a process evaluation will examine context, implementation and impact of the intervention. An economic evaluation will also be incorporated with cost-effectiveness of the parenting intervention expressed in terms of incremental cost per quality-adjusted life year gained.

DISCUSSION

Half of mental health problems emerge before mid-adolescence and approximately three-quarters by mid-20s, highlighting the need for effective preventative strategies. However, few early interventions are family focused and delivered online. We aim to conduct a National Institute for Health and Care Research (NIHR) funded RCT of the online personalised 'Partners in Parenting' programme, proven effective in Australia, targeting adolescents at risk of depression to evaluate its effectiveness, cost-effectiveness and usability in a UK setting. TRIAL REGISTRATION {2A}: ISRCTN63358736 . Registered 18 September 2019.

In Their Own Words: Using Open-Ended Assessment to Identify Culturally Relevant Concerns among Kenyan Adolescents

Standardized assessment tools developed in western contexts may systematically miss certain problems that are considered important in non-western cultures. In this mixed-methods study, we used an open-ended assessment tool (the Top Problem Assessment; TPA) to identify culturally relevant concerns among low-income Kenyan youth. We then (a) applied thematic analysis to identify the most frequently reported problems and (b) examined the extent to which these problems were reflected in standardized mental health measures. Using the TPA, we identified common social, academic, and economic problems facing Kenyan youths. Specifically, 61% of the sample reported a social problem, 38% an academic problem, and 35% an economic problem. By contrast, the standardized assessments revealed that worrying and difficulty concentrating were the most commonly reported symptoms. However, the emotional and behavioral problems assessed via the standardized measures were only reported as top problems by 17% of the sample. Overall, our findings are consistent with the idea that standardized measures can miss certain culturally-salient concerns that can be acquired through open-ended assessments. We discuss how brief open-ended assessment tools could complement standardized measures, inform the development of culturally relevant standardized measures, and offer rich data about the experiences of people in understudied cultural contexts.

Prevalence and predictors of symptoms of Perinatal Mood and anxiety Disorders among a sample of Urban Black Women in the South

OBJECTIVES

Data are scarce regarding the prevalence and predictors of perinatal mood and anxiety disorders (PMADs) among Black women. The purpose of this study was to examine the prevalence and predictors of symptoms of PMADS among Black women.

METHODS

Black women completed a paper survey between August 2019 and October 2019. Binomial logistic regression was employed to examine predictors of PMAD symptoms.

RESULTS

The prevalence of symptoms of PMADs was 56%. A higher proportion of women with PMADs had experienced depression (16% vs. 32%, p = 0.006); physical (18% vs. 31%, p = 0.030), emotional (35% vs. 61%, p = 0.000), or sexual abuse (12% vs. 29%, p = 0.002); and symptoms of depression or anxiety before pregnancy (18% vs. 46%, p = 0.000). After adjusting for socio-demographics in multivariate analysis, experiencing symptoms of depression or anxiety before pregnancy (adjusted odds ratio [aOR] = 3.445, p = 0.001) was positively associated with experiencing symptoms of PMADs, whereas higher levels of self-esteem (aOR = 0.837, p = 0.000) were negatively associated with experiencing symptoms of perinatal mood and anxiety disorders.

CONCLUSIONS FOR PRACTICE

The prevalence of PMAD symptoms among this sample of Black women was alarmingly high. Women who experienced PMADs were more likely to report adverse childhood experiences (e.g., physical, emotional, and/or sexual abuse). By understanding the prevalence of PMADs and the factors associated with these disorders, healthcare professionals can improve diagnosis and treatment rates among this understudied and underserved population.

The Psychiatric Comorbidities of Migraine in Children and Adolescents

PURPOSE OF REVIEW

Understanding comorbidities in migraine is important because it can help us understand disease pathophysiology while also aiding the development of more effective treatment strategies. Additionally, it can provide greater awareness about appropriate diagnosis, the need for additional disease screening, and the natural history of migraine. Psychiatric comorbidities have been independently studied in both adults and children with migraine because their presentations can be distinct, and the physiology in these two groups can be different.

RECENT FINDINGS

While symptoms of anxiety and depression seem to be comorbid with migraine in children, clinically significant disease does not appear to be, though the clarity of these data is limited by overlap between migraine symptomatology and that assessed by many screening tools. Functional neurologic disorders like psychogenic non-epileptic episodes (PNEE) and other functional movement disorders are not common but can be comorbid with migraine in this population and tend to improve with migraine treatment. The number of adverse childhood experiences (ACEs) a child is exposed to seems to be near-linearly associated with risk of migraine, but not with tension-type headache (TTH). The findings from these studies underscore the importance of utilizing appropriate screening methodologies for identifying psychiatric disorders in children with migraine. Additionally, the role of the insula, the hypothalamic-pituitary-adrenal axis, the serotonergic system, and the instability of hyperactivated neural networks may underlie the pathophysiology of both migraine and its psychiatric comorbidities.

The longitudinal influences of adverse childhood experiences and positive childhood experiences at family, school, and neighborhood on adolescent depression and anxiety

BACKGROUND

Adolescent depression and anxiety are major mental health concerns. Adverse childhood experiences (ACEs) are risk factors for depression and anxiety in adolescence and positive childhood experiences at home, school, and neighborhood are protective factors. Few studies, however, have compared the longitudinal effects of these two sets of contextual risk and protective factors on depression and anxiety among adolescents by framing them together.

METHODS

This study used data on a subsample of 3426 socioeconomically disadvantaged adolescents collected at their birth, ages one, three, five, nine, and fifteen. Logistic regression was used to examine the longitudinal effects of ACEs, focusing on childhood maltreatment and family dysfunctions, and positive childhood experiences with family, school, and neighborhood on the risks of depression and anxiety. Adolescents' characteristics and their families' socioeconomic status were adjusted.

RESULTS

In the two ACEs subcategories, childhood maltreatment exposures increased the risks only for later anxiety; family dysfunction increased the risks for both later depression and anxiety. In the three contexts, positive childhood experiences at family and school protected at-risk adolescents against both mental health concerns, whereas neighborhood collective efficacy protected adolescents only against depression.

LIMITATIONS

Resilience was examined as an outcome only; it can also be examined as a process. Neither teachers' nor grandparents' supports were included.

CONCLUSIONS

ACEs maltreatment and family dysfunction are two different risk dimensions for adolescent depression and anxiety. Positive childhood experiences at family are the strongest protective factors for children exposed to ACEs, followed by these in school and neighborhood. Early interventions building positive relationships may benefit adolescent mental health.

Psychosocial factors, mental health, and coordination capacity in patients with heart failure with preserved ejection fraction compared with heart failure with reduced ejection fraction

Aims

Patients with heart failure (HF) suffer from reduced quality‐of‐life (QoL). We aimed to compare QoL, depression, and anxiety scores among outpatients with preserved (HFpEF) and reduced (HFrEF) ejection fraction and non‐HF controls and its relationship to coordination capacity.

Methods and results

Fifty‐five participants were recruited prospectively at the University Hospital Jena, Germany (17 HFpEF, 18 HFrEF, and 20 non‐HF controls). All participants underwent echocardiography, cardiopulmonary exercise testing (CPET), 10 m walking test (10‐MWT), isokinetic muscle function and coordination tests, and QoL assessments using the short form of health survey (SF‐36), and hospital anxiety and depression scale (HADS). Furthermore, inflammatory biomarkers such as growth differentiation factor‐15 (GDF‐15) were assessed. Patients with HFpEF showed compared with HFrEF and non‐HF controls reduced QoL [mental component score (MCS): 43.6 ± 7.1 vs. 50.2 ± 10.0 vs. 50.5 ± 5.0, P = 0.03), vitality (VT): 47.5 ± 8.4 vs. 53.6 ± 8.6 vs. 57.1 ± 5.2, P = 0.004), and elevated anxiety (6.5 ± 3.2 vs. 3.3 ± 2.8 vs. 3.8 ± 2. 8, P = 0.02) and depression scores (6.5 [3.5–10.0] vs. 3.0 [1.0–6.5] vs. 2.0 [0.75–3.0], P = 0.01)]. After adjusting to multiple comparisons, anxiety remained higher in HFpEF patients compared with HFrEF (p_post‐hoc = 0.009). HFpEF and HFrEF patients showed reduced coordination capacity compared with non‐HF controls (P < 0.05). In a logistic regression, the presence of depression score ≥8 remained an independent factor for predicting reduced coordination capacity after adjusting for peak VO₂, GDF‐15, 10‐MWT, physical component score (PCS), and peak torque of the leg [odds ratio (OR): 0.1, 95% confidence interval (CI): 0.004–0.626, P = 0.02].

Conclusion

Outpatients with HFpEF had worse QoL and higher anxiety and depression scores compared with HFrEF and non‐HF controls. Depression is associated with reduced QoL and is an independent predictor for reduced coordination capacity.

Illness perceptions predict distress in patients with chronic kidney disease

BACKGROUND

Patients diagnosed with chronic kidney disease (CKD) report increased distress associated with their clinical diagnosis. Distress in patients with predialysis CKD, has been linked to several adverse events; including increased risk of hospitalisation, early dialysis initiation and even death, suggesting that distress is a matter of great concern during routine care in predialysis CKD.

AIMS

The present study aimed to assess the nature of illness perceptions and the level of distress in a CKD cohort diagnosed with different stages of kidney disease. It also aimed to explore the correlates of distress and to create a model for distress and its associated predictors making use of hierarchical regression analysis.

METHODS

A sample of 200 patients diagnosed with Chronic Kidney Disease were recruited for this study from the nephrology outpatient clinics of Mater Dei Hospital, Malta. The participants were assessed for their; illness perceptions, treatment beliefs, level of depression and anxiety, coping style, as well as treatment adherence. Routine clinical information was also collected for participants, including a co-morbidity score.

RESULTS

A percentage of 33.5% of the participants reported moderate distress, whilst 9.5% reported severe distress. Stronger illness identity, a perception of timeline as being increasingly chronic or cyclical in nature, greater consequences and higher emotional representations were associated with more advanced stages of CKD. In contrast, lower personal and treatment control and poorer illness coherence were associated with more advanced stages of CKD. Results from the hierarchical regression analysis showed that illness perceptions contributed significantly to distress over and above the clinical kidney factors. Being female, having low haemoglobin and specific illness perceptions including; perceptions of greater symptomatology, longer timeline, low personal control and strong emotional representations, as well as resorting to maladaptive coping, were all significantly associated with distress symptoms. Nevertheless, illness perceptions accounted for the greatest variance in distress thus indicating that the contribution of illness perceptions is greater than that made by the other known covariates.

CONCLUSION

Illness perceptions hold a principal role in explaining distress in CKD, relative to other traditional covariates. For this reason, illness perceptions should be addressed as a primary modifiable component in the development of distress in CKD.

Is well-being prior to receiving rehabilitation services associated with postrehabilitation mental health and functioning?

OBJECTIVES

Millions of older adults receive rehabilitation services every year, which aim to restore, maintain, or limit decline in functioning. We examine whether lower reported well-being prior to receiving rehabilitation services is associated with increased odds of worsening anxiety symptoms, depressive symptoms, and impairment in self-care and household activities following rehabilitation.

METHODS

Data come from the National Health and Aging Trends Study (NHATS), an annual survey of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Our sample consists of 811 NHATS participants who, in the 2015 interview, had information on well-being and, in the 2016 interview, reported receiving rehabilitation services in the prior year.

RESULTS

In multivariable logistic regression analyses, compared to the highest quartile, those in the lowest quartile of well-being at baseline have increased odds of having worsening depressive symptoms (OR = 9.25, 95% CI: 3.78-22.63) and worsening impairments in self-care activities (OR = 2.39, 95% CI: 1.12-5.11).

CONCLUSION

Our findings suggest that older adults with the lowest levels of baseline well-being may be susceptible to having worsening depressive symptoms and impairment in self-care activities following rehabilitation services. Examination on whether consideration of well-being during the rehabilitation process could lead to better mental health and functional outcomes following rehabilitation is needed.

Emotion and mood disorders associated with epilepsy

Epilepsy is a disorder characterized by recurrent seizures. Epilepsy can alter mood and emotions. Treatments for epilepsy can also alter mood and emotions. This chapter reviews the emotional changes that can occur before, during, and after a seizure, such as fear and anger, the interictal mood disorders associated with epilepsy, such as depression and anxiety, as well as alterations of emotional processing including comprehending and expressing emotional prosody and faces. The possible treatments of these emotional and mood disorders are also reviewed.

Remediation of chronic immobilization stress-induced negative affective behaviors and altered metabolism of monoamines in the prefrontal cortex by inactivation of basolateral amygdala

Exposure to chronic stress precipitates depression and anxiety. Stress-induced responses are differentially regulated by the prefrontal cortex (PFC) and basolateral amygdala (BLA). For instance, repeated stress leads to hypertrophy of BLA, resulting in the emergence of affective symptoms. Chronic stress-induced changes in the metabolism of monoamines are central in the manifestation of affective symptoms. Interestingly, BLA via its reciprocal connections modulates prefrontal cortical monoaminergic responses to acute stress. However, the effects of BLA inactivation on chronic stress-induced affective behaviors and monoaminergic changes in the PFC are relatively unknown. Thus, we hypothesized that inactivation of BLA might prevent chronic immobilization stress (CIS)-induced depressive-, anxiety-like behaviors, and associated monoaminergic alterations in the prelimbic (PrL) and anterior cingulate cortex (ACC) subregions of PFC. We used two different BLA silencing strategies, namely ibotenic acid lesion and reversible temporary inactivation using lidocaine. We found that CIS precipitates depressive- and anxiety-like behaviors. Further, CIS-induced negative affective behaviors were associated with decreased levels of 5-HT, DA, and NE, and increased 5-HIAA/5-HT, DOPAC + HVA/DA, and MHPG/NE ratio in the PrL and ACC, suggesting enhanced metabolism. Interestingly, BLA lesion prior to CIS blocked the emergence of depressive- and anxiety-like behaviors. Moreover, the lesion of BLA prior to CIS was sufficient to prevent alterations in levels of monoamines and their metabolites in the PrL and ACC. Thereafter, we evaluated whether the effects of BLA lesion could be mirrored by temporary inactivation of BLA, specifically during stress. Remarkably, temporary inactivation of BLA during stress recapitulated the effects of lesion. Our results have implications for understanding the role of BLA in chronic stress-induced metabolic alterations in prefrontal cortical monoaminergic systems, and associated mood and anxiety disorders. The current study supports the hypothesis that combating amygdalar hyperactivity might be a viable strategy for the management of stress and associated affective disorders.

Effectiveness of mental health community training on depression and anxiety to the health care profession working in rural centers of eastern Nepal

Background:

Depression and anxiety is the leading cause of disease burden in low- and middle-income countries. It is associated with a worse clinical course over the lifespan. This study aims the post-effect on the approach of managing depression and anxiety after the training on diagnosis and management of depression and anxiety.

Methods:

This is a prospective observational study done in the health care professionals who had done training on diagnosis and management of depression and anxiety from me. The participants were evaluated with the questionnaire.

Results:

The training was given in three parts in three different places of eastern Nepal with the health care professionals working near to those centers. There were total of 49 participants from 17 different primary health care centers. The referral rate of patients with depression and anxiety was decreased by 27% as stated by the participants as they can give psychoeducation and counseling in a very well manner after training which was lacking before training.

Conclusions:

Overall, the findings from the current data suggest that there is merit in continuing to evaluate and deliver community health training programs for depression and anxiety. While prevention type and personnel delivering the intervention account for aspects of the heterogeneity observed, more research is needed to identify how program completion and fidelity impact outcomes.

The impact of financial hardship in childhood on depression and anxiety in adult life: Testing the accumulation, critical period and social mobility hypotheses

This paper examines the association between financial hardship in childhood and adulthood, and depression and anxiety in adulthood with reference to the accumulation, critical period and social mobility hypotheses in lifecourse epidemiology. Using the BBC Stress test, linear regression models were used to investigate the associations for the whole population and stratifying by gender and adjusting for age and highest education attainment. The critical period hypothesis was not confirmed. The accumulation hypothesis was confirmed and stratifying by gender women had a higher estimated mean GAD score if they were poor in both childhood and adulthood compared to men. Our findings do not support the social mobility hypothesis. However, stratifying by gender, a clear difference emerged with upward mobility having a favourable impact (lower) on women's mean GAD scores, while upward social mobility in adulthood did not attenuate the impact of financial hardship in childhood or men. The impact of financial hardship in childhood on later mental health outcomes is particularly concerning for future health outcomes as current levels of child poverty increases in the UK.

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The association between financial hardship in childhood and adulthood, and depression and anxiety in adulthood was tested.

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A lifecourse approach was used.

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Two episodes of financial hardship had a greater impact on women’s Goldberg Anxiety & Depression score compared to men.

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Upward mobility had a favourable impact on women's mean Goldberg Anxiety & Depression scores, but not for men.

The impact of childhood socioeconomic status on depression and anxiety in adult life: Testing the accumulation, critical period and social mobility hypotheses

This paper examines the association between financial hardship in childhood and adulthood, and depression and anxiety in adulthood with reference to the accumulation, critical period and social mobility hypotheses in lifecourse epidemiology. Using the BBC Stress test, linear regression models were used to investigate the associations for the whole population and stratifying by sex and adjusting for age and highest education attainment. The critical period hypothesis was not confirmed. The accumulation hypothesis was confirmed and stratifying by sex women had a higher estimated mean GAD score if they were poor in both childhood and adulthood compared to men. Our findings do not support the social mobility hypothesis. However, stratifying by sex, a clear difference emerged with upward mobility having a favourable impact (lower) on women's mean GAD scores, while upward social mobility in adulthood did not attenuate the impact of financial hardship in childhood or men. The impact of financial hardship in childhood on later mental health outcomes is particularly concerning for future health outcomes as current levels of child poverty increases in the UK.

•

The association between socioeconomic status in childhood and adulthood, and depression and anxiety in adulthood was tested.

•

A lifecourse approach was used.

•

Two episodes of financial hardship had a greater impact on women’s Goldberg Anxiety & Depression score compared to men.

•

Upward mobility had a favourable impact on women's mean Goldberg Anxiety & Depression scores, but not for men.

Association of sleep among 30 antidepressants: a population-wide adverse drug reaction study, 2004-2019

Background

Sleep is one of the most essential processes required to maintain a healthy human life, and patients experiencing psychiatric illness often experience an inability to sleep. The aim of this study is to test the hypothesis that antidepressant compounds with strong binding affinities for the serotonin 5-HT2C receptor, histamine H1 receptors, or norepinephrine transporter (NET) will be associated with the highest odds of somnolence.

Methods

Post-marketing cases of patient adverse drug reactions were obtained from the United States Food and Drug Administration Adverse Events Reporting System (FAERS) during the reporting window of January 2004 to September 2019. Disproportionality analyses of antidepressants reporting somnolence were calculated using the case/non-case method. The reporting odds-ratios (ROR) and corresponding 95% confidence interval (95% CI) were computed and all computations and graphing conducted in R.

Results

There were a total of 69,196 reported cases of somnolence out of a total of 7,366,864 cases reported from January 2004 to September 2019. Among the 30 antidepressants assessed, amoxapine (n = 16) reporting odds-ratio (ROR) = 7.1 (95% confidence interval [CI] [4.3–11.7]), atomoxetine (n = 1,079) ROR = 6.6 (95% CI [6.2–7.1]), a compound generally approved for attention deficit hyperactivity disorder (ADHD), and maprotiline (n = 18) ROR = 6.3 (95% CI, 3.9–10.1) were the top three compounds ranked with the highest reporting odds of somnolence. In contrast, vortioxetine (n = 52) ROR = 1.3 (95% CI [1.0–1.8]), milnacipran (n = 58) ROR = 2.1 (95% CI [1.7–2.8]), and bupropion (n = 1,048) ROR = 2.2 (95% CI [2.1–2.4]) are least significantly associated with somnolence. Moreover, levomilnacipran (n = 1) ROR = 0.4 (95% CI [0.1–2.9]) was not associated with somnolence.

Conclusion

Among the thirty tested antidepressants, consistent with the original hypothesis, amoxepine has strongest 5-HT2C receptor binding affinity and has the highest reporting odds of somnolence. Atomoxetine, ranked second in reporting odds of somnolence overall, binds to the NET with with the strongest binding affinity among the thirty compounds. Mirtazapine, a tetracyclic antidepressant, was ranked 11th in reporting odds of somnolence and had the strongest H1 receptor binding affinity. This study provides an informative ranking of somnolence among thirty antidepressant compounds with an already wide array of clinical indications as well as provides insight into potential drug repurposing in psychopharmacology.

Therapeutic patient education in Alzheimer's disease and related disorders: Clinical experience and perspectives

Therapeutic patient education (TPE) is the process by which health professionals impart information to help patients self-manage their chronic disease: it is an essential part of treatment of long-term diseases and conditions. Memory loss and other cognitive disorders are usually considered as obstacles to TPE for patients with Alzheimer's disease or related disorders (ADRD). Over 100 patients with different forms of ADRD and caregivers have benefited from TPE programs since 2011 at the Limoges University Clinical and Research Memory Center. Participants report better understanding of the disease and improved relationships. TPE may prevent anxiety and depression in patient and in caregivers, and reduce burden of caregivers. General guidelines and perspectives for TPE in ADRD are outlined.

The dynamics of adolescents' pornography use and psychological well-being: a six-wave latent growth and latent class modeling approach

Despite increasing concerns that pornography decreases adolescents' well-being, existing empirical support for this position is largely limited to cross-sectional studies. To explore possible links between adolescent pornography use and psychological well-being more systematically, this study focused on parallel dynamics in pornography use, self-esteem and symptoms of depression and anxiety. A sample of 775 female and 514 male Croatian high school students (M_{age at baseline} 15.9 years, SD 0.52) from 14 larger secondary schools, who were surveyed 6 times at approximately 5-month intervals, was used for the analyses. The longitudinal data were analyzed using latent growth curve and latent class growth modeling. We observed no significant correspondence between growth in pornography use and changes in the two indicators of psychological well-being over time in either female or male participants. However, a significant negative association was found between female adolescents' pornography use and psychological well-being at baseline. Controlling for group-specific trajectories of pornography use (i.e., latent classes) confirmed the robustness of findings in the both female and male samples. This study's findings do not corroborate the notion that pornography use in middle to late adolescence contributes to adverse psychological well-being, but do not rule out such a link during an earlier developmental phase-particularly in female adolescents. The findings have ramifications for educational and adolescent health specialists, but also for concerned parents.

Assessment of the Gail Model in Estimating the Risk of Breast Cancer: Effect of Cancer Worry and Risk in Healthy Women

Background: There has been substantial interest in developing methods to predict the risk of breast cancer. The Gail model is one the first model have been widely used to identify women at higher risk of breast cancer. Aim: This study aimed to determine the 5-year and the general life-time risk of breast cancer and also to determine breast cancer predictors in women using the Gail model. Methods: We used the Gail model to estimate the risk of breast cancer in female Turkish outpatients aged above 35 years in this cross-sectional study. Age, life-style habits, breast-feeding duration, family history of breast cancer, and body mass index were compared between high and low-risk subjects. We have performed the Patient Health Questionnaire 9-item (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7) tools on patients regarding depression and anxiety. We also assessed the association of these covariates with the estimated risk of breast cancer in multivariate linear regression analysis. Results: We enrolled 1065 subjects with a mean age of 52.9 ± 8.4 years. The mean of the five-year risk for breast cancer was 1.33%±0.6. Meanwhile, the mean of lifetime risks for breast cancer was 10.15%±3.18, respectively. Nearly one-third of the participants had one child, 55.9% had breast-fed their children more than six months. Meanwhile, 18.5% of the subjects had a high depression score, 15.2% had a high anxiety score. Higher age, age at first birth, and parity; lower age at menarche; presence of menopause and family history of breast cancer were higher in the high-risk group. Higher age, and age at first birth; lower age at menarche; family history of breast cancer, presence of menopause, and parity were independently associated with higher breast cancer risk. Conclusion: We identified certain risk factors for breast cancer in our study population and Gail model is a reliable and useful breast cancer risk prediction model for clinical decision-making. This study contributes to the body of evidence in order to facilitate early detection and better plan for possible malignancies in Turkish population.

Ovarian progesterone suppresses depression and anxiety-like behaviors by increasing the Lactobacillus population of gut microbiota in ovariectomized mice

Depression and anxiety, which are severe symptoms during menopause, are caused by ceased ovarian activity and declined serum progesterone levels. Studies have demonstrated that gut microbiota can regulate brain function and change the microbiota composition during the perimenopause period. This study investigated whether progesterone affects depressant and anxious behaviors via gut microbiota. In ovariectomized (OVX) mice, treatment with progesterone improved depressive and anxious behaviors, and gut microbiota composition was significantly changed. In particular, increased Lactobacillus spp. were observed in these mice. Reduction of microbiota by antibiotic treatment abolished the effect of progesterone on depression and anxiety. In addition, administration of Lactobacillus (L.) reuteri that was increased by progesterone also reduced the depressant behavior in OVX mice, and BDNF gene expression was elevated by progesterone treatment and L. reuteri administration in the hippocampus. Moreover, we found that progesterone stimulated the growth of L. reuteri in vitro. In summary, our findings indicate that progesterone reduces depression and anxiety through changes in gut microbiota composition, particularly by increasing the Lactobacillus spp. population.

A Social Relations and Networks Perspective of Depressive Symptoms in Older African Americans Relative to Two Other Ethno-racial Groups

Background and Objectives

Family ties and role relationships through their effects on exchanges of resources and social support are critical health contexts for older African Americans. We studied the influence of affect-based (positive or negative) social relations and respondent-role network centrality on depressive symptoms in older African Americans compared to two ethno-racial groups, Black Caribbeans and Non-Hispanic Whites.

Research Design and Methods

We used data from the multigenerational 2004 National Survey of American Life Family Connections across Generations and Nations Study (NSAL 3-Gen). For respondents aged 50 years or older, we used tie affect (positive or negative) to code family role relations and two-mode (where an entity or thing is connected to a different type of entity, here individuals are connected to role relations) family networks. We used survey linear regressions to probe the independent association of relations and networks on depressive symptoms among older African Americans as compared to Black Caribbeans and Non-Hispanic Whites.

Results

Negative and positive relations are significantly associated with depressive symptoms, but there were some ethno-racial differences. For example, the negative Father relation is significantly associated with greater depressive symptoms among African Americans, but not in Black Caribbeans and Non-Hispanic Whites. Negative two-mode networks (connections from individuals to role relations) are significantly associated with depressive symptoms among African Americans and in the two comparison ethno-racial groups, while there is no significant association between positive networks and depressive symptoms.

Discussion and Implications

We found that negative relations had larger effects on depressive symptoms than positive ones, and conversely that negative networks had larger effects than positive networks. Simultaneously modeling social relations and networks could potentially enhance our understanding of the links between social structure, and depressive symptoms among older adults in African American and other ethno-racial minorities.

Psychosocial factors associated with symptoms of depression, anxiety and stress among single mothers with young children: A population-based study

BACKGROUND

Abundant evidence highlights single parenthood as a common risk factor for depression, anxiety and stress but few studies have comprehensively examined psychosocial factors (adversities), particularly during early parenting. We investigated symptom prevalence and potential risk factors among mothers with very young children.

METHODS

Data stem from the 2015 National Psychosocial Burdens Prevalence Study (KiD 0-3). Mothers with children up to 3 years of age (n = 6925) were recruited from random probability-sampled paediatric clinics (n = 271) across Germany and reported on depression or anxiety, general and parenting stress using the Patient Health Questionnaire (PHQ-4), Perceived Stress Scale (PSS-4) and Parenting Stress Index (PSI). Multivariable logistic regression models determined risk factors and quantified potential mediation of psychosocial factors for all 3 outcomes.

RESULTS

Approximately 30% of single mothers (n = 517) reported depressive or anxiety symptoms and 37% general stress, twice as high compared to partnered mothers (n = 6408; p < 0.0001). Parenting stress was also elevated (p < 0.0001). Adjusted regression models confirm that single mothers are twice as likely to report symptoms of depression or anxiety (OR 1.9, CI_95% 1.4-2.5). Risk factors for stress correspond to those for depression and anxiety. Inadequate social support and history of partner or childhood maltreatment were also consistent risk factors across all outcomes.

LIMITATIONS

The study design and self-reported symptoms are limitations to consider.

CONCLUSIONS

Single mothers with young children are more predisposed to mental health disorders than partnered mothers, especially when facing financial, social or distal adversities. Appropriate social support programs and screening measures are necessary to reduce further disparities.

Sexual Orientation and Gender Differences in Aging Perceptions and Concerns Among Older Adults

Background and Objectives

Ageism (negative attitudes and behavior toward older adults) is a serious social issue and is of growing concern as the population of older adults continues to increase. Research demonstrates that negative aging perceptions and aging concerns are associated with poor health and well-being among older adults; yet, few studies have examined sexual orientation or gender differences in aging perceptions and concerns among older adults.

Research Design and Methods

The current online study examined aging perceptions and concerns among a national community sample of 821 (female = 464) participants (76 lesbian, 159 gay, 88 bisexual, 498 heterosexual participants) ranging from 45 to 80 years of age (M = 55.56).

Results and Discussion

Older women reported more aging anxiety and endorsement of aging stereotypes while older sexual minority individuals reported heightened general aging concerns compared to their heterosexual peers. Among sexual minority participants, discrimination based on age and sexual orientation predicted greater sexual minority-specific aging concerns, anxiety, and depression. Experiencing sexual orientation discrimination buffered age discrimination’s impact on sexual minority-specific aging concerns, suggesting that experiencing discrimination based on one stigmatized identity (sexual minority) may promote effective coping with discrimination based on another stigmatized identity (older adult). Conversely, age and sexual orientation discrimination had multiplicative effects on anxiety and depression.

Implications

Overall, findings point to the importance of examining sexual orientation and gender differences in aging perceptions and concerns to more fully understand the experiences, health, and well-being of the growing older population. Implications for future directions are discussed.

The Impacts of Childhood Trauma on Psychosocial Features in a Chinese Sample of Young Adults

OBJECTIVE

The aims of the present study were to explore the occurrence of childhood trauma and importantly to determine the impacts of childhood trauma on psychosocial features in a Chinese sample of young adults.

METHODS

A survey was carried out in a group of 555 university students by using Childhood Trauma Questionnaire (CTQ), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Dysfunctional Attitudes Questionnaire (DAS), Eysenck Personality Questionnaire (EPQ), and Social Support Rating Scale (SSRS). The moderate-severe cut-off scores for CTQ were used to calculate the prevalence of childhood trauma, and then psychosocial features were compared between individuals with and without childhood trauma.

RESULTS

A proportion of 18.6% of university students had self-reported childhood trauma exposures. Subjects with childhood trauma reported higher scores of SDS, SAS, DAS, and psychoticism and neuroticism dimensions of EPQ (t=4.311-5.551, p<0.001); while lower scores of SSRS and extraversion dimension of EPQ (t=-4.061- -3.039, p<0.01). Regression analyses further revealed that scores of SAS and DAS were positively (Adjusted B=0.211-0.230, p<0.05), while scores of SSRS were negatively (Adjusted B=-0.273- -0.240, p<0.05) associated with specific CTQ scores.

CONCLUSION

Childhood trauma is still a common social and psychological problem. Individuals with childhood trauma show much more depression, anxiety, distorted cognition, personality deficits, and lower levels of social support, which may represent the social and psychological vulnerability for developing psychiatric disorders after childhood trauma experiences.

Validity and Reliability of the Major Depression Inventory for Persons With Dual Sensory Loss

Background and Objectives

Research has shown that dual sensory loss is a risk factor for depression in older adults. However, validated measures of depression for people with dual sensory loss are lacking. The purpose of the present study was to investigate the construct validity and reliability of the Major Depression Inventory for use among elderly persons with acquired dual sensory loss.

Research Design and Methods

A cross-sectional questionnaire survey was conducted in a national sample of people ≥50 years of age with functional acquired dual sensory loss. Of the invited participants, 302 (66%) returned the questionnaire and 207 complete cases were included for analysis. Rasch models and graphical log-linear Rasch models were used for item analysis. Lack of differential item functioning was tested relative to severity of vision and hearing impairment, mode of questionnaire completion, age, sex, comorbidity, instrumental activities of daily living, social position, and cohabitation status.

Results

The 10-item Major Depression Inventory did not fit the Rasch model. An 8-item version, excluding the items “feeling sad” and “sleep problems,” fit a graphical log-linear Rasch model. No evidence of differential item functioning was discovered, thus the 8-item Major Depression Inventory was measurement invariant across severity of impairments and mode of completing the questionnaire. The overall reliability was 0.81 and ranged from acceptable to good for all subgroups of participants, except males with severe hearing impairment and low functional status. Consequently, the 8-item version of the Major Depression Inventory was considered construct valid and reliable within the frame of reference.

Discussion and Implications

An 8-item version of the Major Depression Inventory can be used to screen for depressive symptoms in elderly persons with acquired dual sensory loss.

Clinical and psychological outcome after surgery for lumbar spinal stenosis: A prospective observational study with analysis of prognostic factors

BACKGROUND

The identification of psychological risk factors is important for the selection of patients before spinal surgery. Moreover, the effect of surgical decompression in lumbar spinal stenosis (LSS) on psychological outcome is not previously well analyzed.

AIM OF PAPER

to investigate clinical and psychological outcome after surgery for LSS and the effect of depressive symptoms and anxiety on the clinical outcome.

MATERIALS AND METHODS

A total of 25 patients with symptomatic LSS underwent decompressive surgery with or without spinal stabilization were prospectively enrolled in this observational surgery. The Symptom Checklist-90-Revised (SCL-90-R) was used to assess global psychological distress with a summary score termed Global Severity Index (GSI) and single psychological disorders including depression (DEP) and anxiety (ANX). The clinical outcome of surgery was evaluated with the Oswestry Disability Index (ODI) and visual analogue scale (VAS) pain assessment.

RESULTS

Compared with baseline, there was a statistically significant improvement in VAS, ODI and GSI after surgery (p<0.05) in all patients. Univariate analysis revealed that patients with high GSI and anxiety and depression scores had significantly higher ODI and VAS scores in the follow-up with a bad outcome.

CONCLUSIONS

Surgery for spinal stenosis was effective to treat pain and disability. In this prospective study baseline global psychological distress, depression and anxiety were associated with poorer clinical outcome.

Prevalence of depression and anxiety in rheumatoid arthritis patients and their associations with serum vitamin D level

Vitamin D deficiency may be associated with depression in the general population. This study aimed to describe the prevalence of depression and anxiety in rheumatoid arthritis (RA) patients from Northwestern China and identify associations of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores with serum vitamin D level in these patients. We recruited 161 RA patients inform the First Affiliated Hospital of Xi'an Jiaotong University during Nov. 2016 to Feb. 2017. All patients completed a survey including HAMD and HAMA scales. RA activity (DAS28) was scored by a rheumatologist, and serum 25-OH-D3 levels were measured by electrochemiluminescence immunoassay. The data were analyzed using the SPSS16.0 based on "possible and probable" cut points for HAMD and HAMA. About 62 and 60% of patients had some degrees of depression and anxiety, respectively. The mean of serum 25-OH-D3 levels in RA patients with depression was 15.24 ± 8.78 ng/mL, which was significantly lower than those without depression (24.68 ± 10.98 ng/mL, p = 0.009). Despite negative correlations between serum 25-OH-D3 level and the score of HAMD (r = - 0.520, p < 0.001) or HAMA (r = - 0.469, p < 0.001), there was a positive correlations between DAS28and the score of HAMD (r = 0.459, p = 0.001) or HAMA (r = 0.486, p < 0.001). The multivariate logistic regression showed that disease duration, serum 25-OH-D3 level, and treatment of tumor necrosis factor inhibitor were associated with depression/anxiety in RA patients. Our study shows a high prevalence of depression and anxiety in RA patients from Northwestern China. Both disease activity of RA and low serum 25-OH-D3 level are associated with the severity of depression and anxiety. It is imperative for clinicians to screen hypovitaminosis of vitamin D and depression/anxiety in RA patients.

Measuring generalised expectancies for negative mood regulation in China: The Chinese language Negative Mood Regulation scale

Negative mood regulation expectancies (NMRE) represent people's confidence that they can alleviate their negative affect or induce a positive emotional state through thought or action. NMRE predict coping behaviour and mood outcomes for individuals under stress. Since 1990, much research documents the reliability and validity of the English language Negative Mood Regulation (NMR) scale as a measure of NMRE. The current research reports two studies developing a Chinese language translation of the NMR (NMR-C) scale that goes beyond literal translation to be a culturally sensitive measure of NMRE in China. In Study 1, 713 college students from both a major city and a rural setting in China were surveyed. Data support the resulting 32-item NMR-C's reliability (alpha = .88) and validity. The NMR-C showed both direct and indirect links to depression and anxiety; coping mediated the indirect effect. In Study 2, 331 prison police officers in three Chinese provinces participated. NMRE buffered the effect of high role pressure, moderating the relationship between prison police role stress and job engagement. Results of the two studies support the reliability and validity of the Chinese language NMR scale and parallel results found with measures of NMRE in the West and in other Asian countries.

Sex, Sexual Orientation, Gender Atypicality, and Indicators of Depression and Anxiety in Childhood and Adulthood

The current study evaluated the possibility that greater negative mental health outcomes reported among gay, lesbian, and gender-atypical individuals, compared to gender-typical individuals, are present in childhood and persist into adulthood. Sex and sexual orientation differences in self-reported adulthood and recalled childhood indicators of depression and anxiety and their association with current and retrospectively reported gender (a)typicality were examined in a non-clinically recruited community sample of Canadian heterosexual men (n = 98), heterosexual women (n = 142), gay men (n = 289), and lesbian women (n = 69). Indicators of depression and anxiety were constructed based on diagnostic criteria for generalized anxiety disorder, major depression, agoraphobia, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and specific phobias. Factor reduction analyses yielded three factors: (1) indicators of childhood separation anxiety, (2) indicators of childhood depression and anxiety, and (3) indicators of adulthood depression and anxiety. Lesbian women scored higher on childhood separation anxiety than all other groups. Heterosexual men scored lower on indicators of childhood separation anxiety than gay men and lower on indicators of childhood and adulthood depression and anxiety than all other groups. No other significant group differences were observed. Correlational analysis suggested that for men, but not for women, gender-atypical behavior was associated with negative mental health. The current study indicated that childhood should be considered a critical time period during which the noted sexual orientation-related mental health discrepancies manifest and that childhood gender atypicality is a key factor for understanding the emergence of such discrepancies.

Influence of prenatal maternal stress on umbilical cord blood cytokine levels

PURPOSE

Prenatal maternal stress (PNMS) is known to influence fetal programming and development. Thus far, the effects of PNMS on the developing immune system have mainly been documented in animal studies. This study aimed to examine the association between PNMS and immune cytokine profiles in the umbilical cord blood of newborn human infants.

METHODS

PNMS, including perceived stress, numbers of stressful life events experiences (both partner and health related), and state and trait anxiety, was assessed with five questionnaires and interviews from 43 pregnant women during the second trimester. Seven key cytokines important for immune function, i.e., IL-12, IL-1β, IL-4, IL-5, IL-6, IL-8, and TNF-α, were analyzed in cord blood by bead-based ELISA method (Luminex 200). Logistic regression was used to estimate the associations of PNMS scores and cytokine levels.

RESULTS

Increased levels of IL-1β, IL-4, IL-5, IL-6, and IL-8 were significantly associated with at least one of the maternal stress assessments, while the levels of IL-12 and TNF-α were not significantly associated with any of the PNMS measurements examined.

CONCLUSION

These preliminary findings suggest that PNMS may influence cytokine levels in newborn infants, in particular Th2-related cytokines. This report supports previous findings in animal studies and could suggest that newborns born to mothers with elevated PNMS have a predisposition to immune-related disorders.

Path analysis of relationship among personality, perceived stress, coping, social support, and psychological outcomes

AIM: To provide a structural model of the relationship between personality traits, perceived stress, coping strategies, social support, and psychological outcomes in the general population.

METHODS: This is a cross sectional study in which the study group was selected using multistage cluster and convenience sampling among a population of 4 million. For data collection, a total of 4763 individuals were asked to complete a questionnaire on demographics, personality traits, life events, coping with stress, social support, and psychological outcomes such as anxiety and depression. To evaluate the comprehensive relationship between the variables, a path model was fitted.

RESULTS: The standard electronic modules showed that personality traits and perceived stress are important determinants of psychological outcomes. Social support and coping strategies were demonstrated to reduce the increasing cumulative positive effects of neuroticism and perceived stress on the psychological outcomes and enhance the protective effect of extraversion through decreasing the positive effect of perceived stress on the psychological outcomes.

CONCLUSION: Personal resources play an important role in reduction and prevention of anxiety and depression. In order to improve the psychological health, it is necessary to train and reinforce the adaptive coping strategies and social support, and thus, to moderate negative personality traits.

Depression and anxiety before and after limb length discrepancy correction in patients with unilateral developmental dysplasia of the hip

OBJECTIVE

Limb length discrepancy (LLD) is common in patients with developmental dysplasia of the hip (DDH) and may influence the psychological status of these patients. The present study aims to investigate depression and anxiety in DDH patients with different extents of LLD and to assess the effect of LLD correction on these two psychological factors.

METHODS

161 patients with DDH were recruited and divided into two groups based on whether they could perceive LLD preoperatively. The patients who could not perceive LLD were assigned to group N, and those who could perceive LLD were assigned to group P. Depression/anxiety, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and LLD were assessed one week before, six months and two years after total hip arthroplasty (THA).

RESULTS

Depression and anxiety were significantly higher in group P patients compared to group N patients. The patients in group N presented significant improvement in depression and anxiety six months after arthroplasty, while DDH patients in group P did two years after arthroplasty. Correlation analyses revealed their improvement was associated with pain relief and improved hip function in both groups of patients and was also related to changes in the perception of LLD in group P patients.

CONCLUSIONS

Depression and anxiety levels were higher in DDH patients with perceived LLD. Their improvement was related to pain relief and improved hip function following THA. In DDH patients with perceived LLD, a change in the perception of LLD also played a part in their improvement.

Depressive symptoms, anxiety and academic motivation in youth: Do schools and families make a difference?

This longitudinal study aimed to examine the association between depressive and anxiety symptoms and academic motivation by gender, and whether positive school and family factors would be associated with academic motivation, in spite of the presence of such symptoms. Study participants were predominantly economically disadvantaged youths aged 13-15 years in a Northeastern US urban public school system. The Social and Health Assessment (SAHA) served as the basis for a survey undertaken in 2003 and 2004 with information being used from students who participated at both time points (N = 643). Multiple linear regression analyses showed that depressive symptoms were negatively associated with academic motivation, while anxiety was positively related to academic motivation in both genders. Teacher support, school attachment and parental control were positively related to academic motivation even in the presence of internalizing problems. The negative association of depressive symptoms with academic motivation may be potentially decreased by attachment to school.

Determinants of disease severity in adults with epilepsy: Results from the Neurological Diseases and Depression Study

BACKGROUND

Epilepsy severity has been recognized as a significant predictor of health-related quality of life in patients with epilepsy. However, clinical markers of epilepsy severity such as seizure frequency often fail to capture important aspects of the disease. This study investigates the factors associated with patient-reported severity of epilepsy, assessed by the Global Assessment of Severity of Epilepsy (GASE) scale in adults with epilepsy.

METHODS

Data from a cohort of 250 patients consecutively enrolled in the Neurological Diseases and Depression Study (NEEDS) were used to assess the determinants of epilepsy severity as measured by the GASE scale. Multiple linear regression analyses were used to examine the mediation effect of clinical and sociodemographic characteristics on patients' ratings on the GASE scale.

RESULTS

The mean age of the study participants was 39.8 (SD=14.9) years, of which 44.4% were male. About 66.8% of the participants reported "not at all severe" or "a little severe" epilepsy, while 0.4% reported "extremely severe" epilepsy. One-year seizure freedom, number of antiseizure medications, medication side effects, depression, anxiety, and seizure-related disability were identified as significant determinants of patients' ratings of epilepsy severity. Seizure-related disability mediated the effects of 1-year seizure freedom, number of antiseizure medications, and medication side effects on epilepsy severity.

CONCLUSION

Overall, patients with epilepsy who reported higher GASE scores were less likely to achieve 1-year seizure freedom and more likely to be on more antiseizure medications, experience more side effects from medication, endorse more depression and anxiety symptoms, and have increased self-reported seizure-related disability. The identified determinants of global, self-rated epilepsy severity can aid the design of appropriate interventions and support services for patients with severe epilepsy.

Prevention of anxiety and depression in Chinese: a randomized clinical trial testing the effectiveness of a stepped care program in primary care

BACKGROUND

Despite empirical evidence demonstrating the effectiveness of collaborative stepped care program (SCP) in Western countries, such programs have not been evaluated in the east, which has a different services system structure and cultural nuances in seeking help for mental illness. Furthermore, only a few studies have used SCP for depression and anxiety prevention. We conducted a trial to test its effectiveness in preventing major depressive disorder and generalized anxiety disorder among primary care patients with subthreshold depression and/or anxiety in Hong Kong.

METHODS

Subthreshold depression and/or anxiety patients were randomized into the SCP group (n=121) or care as usual (CAU) group (n=119). The SCP included watchful waiting, telephone counseling, problem solving therapy, and family doctor treatment within one year. The primary outcome was the onset of major depressive disorder or generalized anxiety disorder in 15 months. The secondary outcomes were depressive and anxiety symptoms, quality of life and time absent from work due to any illness.

RESULTS

Survival analysis showed no differences between the SCP and CAU groups (the cumulative probability of onset at 15 month was 23.1% in the SCP group and 20.5% in the CAU group; Hazard Ratio=1.62; 95% Confidence Interval: 0.82-3.18; p=0.16). No significant differences were found in secondary outcomes.

LIMITATIONS

Sample size might not have been large enough.

CONCLUSIONS

SCP did not show beneficial effect on depression/anxiety prevention compared with CAU in Hong Kong primary care. As a large majority of patients improved overtime without any intervention, we are not able to exclude the possibility that the intervention might be effective. Future studies would need to have a larger sample size and conduct on patients with more severe symptoms or perform a second screening.

Chronic Treatment with the 5-HT1A Receptor Partial Agonist Tandospirone Increases Hippocampal Neurogenesis

INTRODUCTION

A large-scale clinical trial, the Sequence Trial Alternatives to Relieve Depression (STAR*D) study, concluded that about one-third of the studied patients with major depressive disorder remitted during the initial treatment with selective serotonin reuptake inhibitors and that approximately half of the remitted subjects relapsed over a 1-year follow-up. The development of new therapeutic approaches with potent efficacy and good tolerability for the treatment of depressive disorders is of great importance. Adult hippocampal neurogenesis has been proposed to be important for understanding and treating depression and anxiety. The present study aimed to elucidate whether or not 5-hydroxytryptamine 1A (5-HT1A) receptor partial agonists have a potential therapeutic effect for the treatment of depressive and anxiety disorders, from the standpoint of neurogenesis.

METHODS

Male Sprague-Dawley rats were subcutaneously administered a vehicle or tandospirone (TDS) (1 or 10 mg/kg) once daily for 14 days. The effects of chronic TDS treatment on neurogenesis were evaluated on the day after the last injection. The quantification of hippocampal neurogenesis was estimated using immunostaining with doublecortin (DCX), a marker protein of newborn neurons.

RESULTS

Chronic TDS treatment resulted in a significant increase in the number of DCX-positive cells per volume of dentate gyrus in a dose-dependent manner.

CONCLUSION

The results strongly suggest that 5-HT1A receptor partial agonists would be useful and beneficial in the treatment of depressive and anxiety disorders through increased hippocampal neurogenesis.

Novel therapeutic targets in depression and anxiety: antioxidants as a candidate treatment

There is growing evidence that the imbalance between oxidative stress and the antioxidant defense system may be associated with the development neuropsychiatric disorders, such as depression and anxiety. Major depression and anxiety are presently correlated with a lowered total antioxidant state and by an activated oxidative stress (OS) pathway. The classical antidepressants may produce therapeutic effects other than regulation of monoamines by increasing the antioxidant levels and normalizing the damage caused by OS processes. This chapter provides an overview of recent work on oxidative stress markers in the animal models of depression and anxiety, as well as patients with the aforementioned mood disorders. It is well documented that antioxidants can remove the reactive oxygen species (ROS) and reactive nitrogen species (RNS) through scavenging radicals and suppressing the OS pathway, which further protect against neuronal damage caused oxidative or nitrosative stress sources in the brain, hopefully resulting in remission of depression or anxiety symptoms. The functional understanding of the relationship between oxidative stress and depression and anxiety may pave the way for discovery of novel targets for treatment of neuropsychiatric disorders.

Illness perceptions in IBD influence psychological status, sexual health and satisfaction, body image and relational functioning: A preliminary exploration using Structural Equation Modeling

BACKGROUND AND AIMS

This study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD.

METHODS

Seventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale.

RESULTS

Exploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ(2) (25)=27.84, p=.32, χ(2)/N=1.11, CFI>0.99, RMSEA<0.04, SRMR<0.07, GFI>0.93). Illness perceptions had a significant direct influence on depression (β=0.49, p<0.001), anxiety (β=0.55, p<0.001), and family functioning (β=-0.17, p<0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction.

CONCLUSIONS

The findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.

Sensitivity, specificity, and predictive power of the "Brief Risk-resilience Index for SCreening," a brief pan-diagnostic web screen for emotional health

Few standardized tools are available for time-efficient screening of emotional health status across diagnostic categories, especially in primary care. We evaluated the 45-question Brief Risk-resilience Index for SCreening (BRISC) and the 15-question mini-BRISC in identifying poor emotional health and coping capacity across a range of diagnostic groups - compared with a detailed clinical assessment - in a large sample of adult outpatients. Participants 18-60 years of age (n = 1079) recruited from 12 medical research and clinical sites completed the computerized assessments. Three index scores were derived from the full BRISC and the mini-BRISC: one for risk (negativity-positivity bias) and two for coping (resilience and social capacity). Summed answers were converted to standardized z-scores. BRISC scores were compared with detailed health assessment and diagnostic interview (for current psychiatric, psychological, and neurological conditions) by clinicians at each site according to diagnostic criteria. Clinicians were blinded to BRISC scores. Clinical assessment stratified participants as having "clinical" (n = 435) or "healthy" (n = 644) diagnostic status. Receiver operating characteristic analyses showed that a z-score threshold of -1.57 on the full BRISC index of emotional health provided an optimal classification of "clinical" versus "healthy" status (sensitivity: 81.2%, specificity: 92.7%, positive predictive power: 80.2%, and negative predictive power: 93.1%). Comparable findings were revealed for the mini-BRISC. Negativity-positivity bias index scores contributed the most to prediction. The negativity-positivity index of emotional health was most sensitive to classifying major depressive disorder (100%), posttraumatic stress disorder (95.8%), and panic disorder (88.7%). The BRISC and mini-BRISC both offer a brief, clinically useful screen to identify individuals at risk of disorders characterized by poor emotion regulation, from those with good emotional health and coping.

Influence of emotional factors on cerebral glucose metabolism in patients with functional dyspepsia

AIM: To observe the influence of depression and anxiety on cerebral glucose metabolism in patients with functional dyspepsia (FD).

METHODS: Seven FD patients with mild depression and anxiety (AD group) and eight patients without depression and anxiety (non-AD group) were enrolled in the study. All the patients were examined by positron emission tomography-computed tomography (PET-CT) with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) to detect glucose metabolism in different brain regions. The difference in cerebral glucose metabolism was compared between the two groups using a semiquantitative method.

RESULTS: Compared with patients in the non-AD group, those in the AD group showed decreased cerebral glucose metabolism mainly in the temporal and frontal lobes and the limbic system in the right cerebral hemisphere and the inferior frontal gyrus and precentral gyrus in the left cerebral hemisphere, and increased cerebral glucose metabolism mainly in the temporal and occipital lobes in the right cerebral hemisphere and the parietal and occipital lobes and limbic system in the left cerebral hemisphere.

CONCLUSION: The emotion processing and regulation in FD patients with depression and anxiety involve multiple cerebral regions in bilateral cerebral hemispheres, mainly including the frontal and temporal lobes, the limbic system, and the parietal and occipital lobes.