Adverse Life Events Research Articles

Poor psychosocial status and cardiovascular risk factors are associated with depression or anxiety

Abstract Background Depression and anxiety are rising in South Africa but their associations with psychosocial and cardiovascular risk factors (CVRFs) remain under explored. This study determined the associations of depression and anxiety traits with poor psychosocial wellbeing, risky lifestyle behaviours and cardiometabolic diseases. Methods In a population-based cross-sectional study, data were collected via administered questionnaires, clinical examinations and biochemical assessments. Depression and anxiety traits were ascertained via the Patient Health Questionnaire-9 and Generalised Anxiety Disorder screening questions. Multivariable logistic regressions determined the associations with depression and anxiety traits; the basic model comprised sociodemographic factors, physical inactivity, tobacco smoking and alcohol misuse (CAGE ≥2). Psychosocial and cardiometabolic variables were entered individually in separate models. Results Among 678 participants, median age 52 years and mainly women (81%), prevalence of depression scores ≥10 were 14.2% (men:12.7%, women:14.6%, p = 0.498) and anxiety scores ≥10 were 10.2% (men:10.3%, women:10.2%). In the basic regression models, depression, but not anxiety, was associated with being separated, living as married/widowed vs. single (OR:2.01, 95%CI:1.02-3.94), and alcohol misuse (2.07, 1.13-3.78). Depression and anxiety were associated with decreasing social support (depression: 1.09, 1.04-1.12; anxiety: 1.09, 1.04-1.14), and increasing number of adverse life events. Hypertension (1.76, 1.07-2.90, p = 0.025), diabetes (1.98, 1.03-3.82, p = 0.041) and dyslipidaemia (1.97, 1.01-3.85, p = 0.048) were associated with depression but not anxiety. Conclusions The high burden and associations of depression and anxiety traits with poor psychosocial wellbeing suggest a need for holistic care approaches. The associations of depression traits with CVRFs warrant screening and care of depression in the presence of cardiometabolic diseases and alcohol misuse. Key messages • The high burden of depression and anxiety traits in South Africa is associated with poor social support and quality of life, and increasing adverse life events experienced. • The associations of depression traits with hypertension, diabetes, dyslipidaemia, and alcohol misuse highlight the need for integrated management strategies.

Exploring the effect of family function on non-suicidal self-injury among Chinese adolescents in different family socioeconomic status.

Non-suicidal self-injury (NSSI) among adolescents represents an alarming public health concern worldwide. Both family function and family socioeconomic status (SES) were found to play important roles in adolescent NSSI engagement. However, the effects of family function on NSSI among adolescents in different family SES are not well evidenced. This study aimed to explore how family functions (adaptation, partnership, growth, affection, and resolve) affect NSSI among adolescents in different family SES levels. Data used in this study was derived from the Students' Mental Health Network Project (SMHN), a survey conducted among 8,872 pairs of adolescent-caregivers in a city in central China. Socio-demographic characteristics, family function, NSSI, adverse life events, and depressive symptoms were measured among adolescents. Family SES were generated from caregivers self-reported information using principal component analysis. Chi-square test and multivariate binary logistic regression analyses were adopted to analyze the effects of family function on NSSI. It revealed that 10.2% of adolescents reported engaging in NSSI in the past 12 months. Poor family function and high family SES were positively associated with NSSI. Partnership, both adaptation and affection, resolve were NSSI-protective factors for adolescents in low, middle, high family SES, respectively. Efforts to address NSSI should acknowledge the association between family function and NSSI among adolescents in different family SES levels.

Suicidal behavior among Turkish physicians: Associations with negative life-events, psychological distress, and attitudes towards suicide

BackgroundSuicidal behavior among physicians is a significant concern globally, with various factors contributing to increased risk. Physicians in Türkiye are a group facing significant psychological distress due to challenging work conditions, economic instability, and violence in the healthcare system. Understanding the specific risk factors and attitudes contributing to this elevated suicidal behavior can inform the development of targeted interventions and support mechanisms for improving the well-being of physicians in Türkiye. This study aims to investigate suicidal behavior among Turkish physicians and its associations with adverse life events, psychological distress, and attitudes toward suicide. MethodIn the present study, 512 Turkish physicians from diverse demographics and professional backgrounds participated. Suicidal behavior, psychological distress, stressful life events, and attitudes toward suicide were explored through tailored instruments. Logistic regression analysis was conducted to identify independent risk factors for suicidal behavior. ResultsThe results demonstrated that among Turkish physicians, psychological distress and suicidal behavior were frequent. One in five individuals (22.3%) reported experiencing one of the suicidal behaviors within the past month. Nearly one in ten (8.6%) have attempted suicide at some point in their lives. The average number of suicidal behaviors reported was .48 (SD = 1.1), and the average severity score for suicidal ideation was .51 (SD = 1.2). Young age, single marital status, low social support, psychological distress, the number of stressful life events, and the acceptability of suicide were identified as independent risk factors for suicidal behavior. Having a diagnosis of a psychiatric disorder and the number of stressful life events were factors associated with suicide attempts. ConclusionThe intricate associations between several factors that influence suicidal behavior among Turkish physicians are elucidated by this study. The results highlight the critical need for focused interventions and systems of support within the Turkish healthcare system to deal with this serious public health concern. Future studies and therapeutic practices can better meet the mental health requirements of this vulnerable demographic by considering the complex nature of suicidal behavior among physicians.

The association between patterns of exposure to adverse life events and the risk of chronic kidney disease: a prospective cohort study of 140,997 individuals

Exposure to adverse life events is linked to somatic disorders. The study aims to evaluate the association between adverse events at varying life stages and the risk of chronic kidney disease (CKD), a condition affecting about 10% population worldwide. This prospective cohort study included 140,997 participants from the UK Biobank. Using survey items related to childhood maltreatment, adulthood adversity and catastrophic trauma, we performed latent class analysis to summarize five distinct patterns of exposure to adverse life events, namely “low-level exposure”, “childhood exposure”, “adulthood exposure”, “sexual abuse” and “child-to-adulthood exposure”. We used Cox proportional hazard regression to evaluate the association of patterns of exposure to adverse life events with CKD, regression-based mediation analysis to decompose the total effect, and gene-environment-wide interaction study (GEWIS) to identify interactions between genetic loci and adverse life events. During a median follow-up of 5.98 years, 2734 cases of incident CKD were identified. Compared with the “low-level exposure” pattern, “child-to-adulthood exposure” was associated with increased risk of CKD (hazard ratio 1.37, 95% CI 1.14 to 1.65). BMI, smoking and hypertension mediated 11.45%, 9.79%, and 4.50% of this total effect, respectively. Other patterns did not show significant results. GEWIS and subsequent analyses indicated that the magnitude of the association between adverse life events and CKD differed according to genetic polymorphisms, and identified potential underlying pathways (e.g., interleukin 1 receptor activity). These findings underscore the importance of incorporating an individual’s psychological encounters and genetic profiles into the precision prevention of CKD.

The impact of trauma core dimensions on anxiety and depression: a latent regression model through the Post-Traumatic Symptom Questionnaire (PTSQ)

Adverse life events (e.g., severe accidents, violence/abuse, organic disorders) can elicit traumatic responses characterized by intrusive thoughts, hyperarousal, and avoidance—highlighting the need for sound assessment tools. Also, these traumatic components could heighten anxiety and depression symptoms. This study aims included to: (1) assessing the psychometric properties of the Post-Traumatic Symptom Questionnaire (PTSQ) and delineating clinical cut-offs; (2) investigating how distinct trauma components contribute to anxiety and depression symptoms. Involving 761 participants who experienced a traumatic event, Part I tested the PTSQ psychometric properties, defining clinical cut-offs. Part II tested the impact of traumatic components on anxiety and depression symptoms, using a multiple multivariate latent regression model. PTSQ exhibited exemplary fit indices and robust psychometric properties. Clinically relevant cut-offs were identified. The differential contributions of intrusion, avoidance, and hyperarousal to anxiety and depression symptoms were evaluated, elucidating the strength and nature of these relationships. This study reaffirms the PTSQ as a psychometrically sound and reliable instrument. It underscores the effects of intrusion, avoidance, and hyperarousal on anxiety and depression symptoms in individuals with traumatic experiences. These insights advocate for evidence-based interventions aimed at alleviating the psychological suffering associated with trauma components, fostering adaptation and supporting psychological health.

High rates of probable PTSD among Ukrainian war refugees: the role of intolerance of uncertainty, loss of control and subsequent discrimination

ABSTRACT Background: Intolerance of uncertainty is a well-known predictor of post-traumatic stress symptoms following a traumatic event. At the same time, it is relatively unknown whether intolerance of uncertainty amplifies the effects of other adverse life events on PTSD symptoms among traumatized individuals. Objective: This article addresses this problem in a study of Ukrainian war refugees’ experiences with post-migration discrimination and powerlessness (loss of control). Method: 4972 forced immigrants from Ukraine took part in the study (90.2% women, Mage = 40.4, SD = 12.5) completing the PTSD-8 scale, measures of post-migration discrimination and loss of control experiences, and intolerance of uncertainty. Results: Almost half of respondents (47.5%) have probable PTSD. Regression analysis confirmed that war-related experiences, as well as intolerance of uncertainty, post-migration loss of control and experiences of discrimination were significant predictors of self-reported PTSD symptoms. Also, intolerance of uncertainty weakly moderated the effects of experienced discrimination and control deprivation on self-reported PTSD symptoms, so that the effects of adverse post-migration experiences were more pronounced among individuals high in intolerance of uncertainty. Conclusions: Understanding the effect of post-migration experiences on war refugees’ mental health is crucial for developing improved acculturation policies and fostering a supportive environment for forced migrants.

USING (GEN)OMICS TO DISENTANGLE DEPRESSION'S HETEROGENEITY

Psychiatric disorders are heterogeneous conditions with diverse symptom and course profiles. This complicates pathophysiology studies as different biological and environmental mechanisms could lead to the same disorders. Unravelling this heterogeneity is important to be able to provide precision medicine. Penninx focuses on further unravelling the heterogeneity of depression using genomics (DNA, RNA, epigenetics) as well as other ‘-omics’ (metabolomics, proteomics). In her Netherlands Study of Depression and Anxiety, detailed phenotyping is combined with biobanking in seven waves covering 15 years of data collection. Using these rich resources, it has been shown that about one-third of all depressed patients illustrates an immunometabolic depression profile, where atypical, energy-related symptoms (fatigue, hypersomnia, weight increase, leaden paralysis) are predominant and co-occur with higher (genetic vulnerabilities for) immunometabolic dysregulations. The other two-thirds of all depressed patients can be characterized by a more typical depression profile, with e.g. melancholia, and pathophysiology that is more characterized by HPA-axis dysregulations, adverse life events and a genetic vulnerability that is more overlapping with e.g. schizophrenia. Penninx's work illustrates that genomics in combination with other detailed phenotyping contributes to further disentangle the heterogeneity of mental disorders, paving the way towards personalized medicine.

Characteristics and factors associated with psychotic-like experiences in remission: a cross-sectional study of 4208 college students in China

ObjectivesPrevious research has extensively explored the factors associated with psychotic-like experiences (PLEs). However, the characteristics and associated factors of remitted PLEs, which refer to the absence of current PLEs following...

Childhood adversity, stress reactivity, and structural brain measures in stress-related/neurodevelopmental disorders, and their comorbidity: A large transdiagnostic cross-sectional study.

Childhood adversity (CA), including childhood adverse life events, increases the risk for development of psychiatric disorders later in life. Both CA and psychiatric disorders are associated with structural brain changes and dysfunctional hypothalamic-pituitary-adrenal-axis. However, many studies investigated single diagnostic and single regions of interest of the brain, and did not take stress reactivity into account. We investigated associations of CA and cortisol levels with gray matter volume and cortical thickness, in a whole-brain manner. Primary analysis constituted of a transdiagnostic approach, followed by a moderation analysis to investigate the influence of diagnosis. Patients with stress-related and/or neurodevelopmental disorders and matched healthy controls underwent an magnetic resonance imaging scan, next to assessing hair cortisol levels and CA/life events. CA was reported by 62-72% of the patients versus 33% of the controls. Primary transdiagnostic linear regression analyses revealed that CA was not associated with gray matter volume, while childhood life events were associated with lower right thalamic volume. Hair cortisol was not associated with any lobe volume. None of the associations were moderated by diagnosis. In conclusion, CA is a risk factor that needs to be taken into account when investigating psychiatric disorders. Yet the relationship with structural brain changes and stress reactivity is less clear than postulated on the basis of more seed-based studies.

The impact of life events on child and adolescent psychiatry consultations

Purpose: Children are exposed to many adverse life events, and this may cause psychiatric disorders. In this study, we aimed to investigate the effects of two different life events, the COVID-19 pandemic and the earthquake, on the consultations requested. Materials and Methods: 1268 consultations requested from the child and adolescent psychiatry department between March 2019 and March 2023 were reviewed from hospital records. The specified period was divided into four distinct parts with one-year intervals: pre-pandemic, the first year of the pandemic, the second year of the pandemic, and post-pandemic. The age, gender, diagnoses of the cases, the department requesting consultation and the reason for consultation were recorded. Results: There were statistically significant differences between periods in terms of departments requested consultation, consultation reasons, and diagnoses. Compared to previous periods, a decrease was found in pediatric emergency and general pediatric clinic consultations in the post-pandemic period. In contrast, an increase was seen in nephrology and intensive care unit department consultations because of earthquakes. In the first year of the pandemic, more consultations were requested from the hematology & oncology department compared to other years. While the rate of consultations requested for suicide attempts decreased in the post-pandemic period, consultations for psychiatric assessment increased. Conclusion: Consultation-liaison psychiatry, which is at the center of interdisciplinary interaction, maintains its importance in the prevention and early diagnosis of psychological symptoms that can develop due to both organic events and the effect of trauma itself after the life events.

Young People Transitioning From Child and Adolescent to Adult Mental Health Services: A Qualitative Systematic Review.

To critically synthesise the literature on the lived experience of young adults about their transition to adult mental health services including the perspectives of key people in their world: parents, carers and clinicians. Young people within child and adolescent mental health services are usually required to transition to adult mental health services at the age of 18, despite evidence showing cognitive and emotional development impacted by childhood trauma, illness and adverse life events. This qualitative systematic review searched relevant electronic databases, policy documents, grey literature and theses examining original qualitative peer-reviewed studies published from 2009 to 2022 in English. The process utilised the PRISMA guidelines and the quality of papers assessed by the JBI critical appraisal tool. Nine papers met the criteria for inclusion in the review. The results indicate that qualitative research listening to the voices of young people transitioning to adult mental health services is a rarity. Even fewer papers examine the perspectives of key people in their lives: this review has critically synthesised the literature on the lived experience of young adults about their transition to adult mental health services including the perspectives of key people in their world: parents, carers and clinicians. The main themes identified include: age 18 is not a helpful trigger to transition; young people want more individualised planning; parents want more involvement and clinicians open up about a challenging nexus with adult mental health services.

The Effects of Adverse Life Events on Brain Development in the ABCD Study®: A Propensity-weighted Analysis.

Longitudinal studies of the effects of adversity on human brain development are complicated by the association of stressful events with confounding variables. To counter this bias, we apply a propensity-weighted analysis of the first two years of The Adolescent Brain Cognitive DevelopmentSM (ABCD) Study® data, employing a machine learning analysis weighted by individuals' propensity to experience adversity. Data included 338 resting-state functional connections from 7190 youth (46% female), divided into a training group (80%) and an independent testing group (20%). Propensity scores were computed using 390 variables to balance across two-year adverse life event exposures. Using elastic net regularization with and without inverse propensity weighting, we developed linear models in which changes in functional connectivity of brain connections during the two-year period served as predictors of the number of adverse events experienced during that same period. Haufe's method was applied to forward-transform the backward prediction models. We also tested whether brain changes associated with adverse events correlated with concomitant changes in internalizing or externalizing behaviors or to academic achievement. In the propensity-weighted analysis, brain development significantly predicted the number of adverse events experienced during that period in both the training group (ρ=0.14, p<0.001) and the independent testing group (ρ=0.10, p<0.001). The predictor indicated a general pattern of decreased functional connectivity between large-scale networks and subcortical brain regions, particularly for cingulo-opercular and sensorimotor networks. These network-to-subcortical functional connectivity decreases inversely associated with the development of internalizing symptoms, suggesting adverse events promoted adaptive brain changes that may buffer against stress-related psychopathology. However, these same functional connections were also associated with poorer grades at the two-year follow-up. Although cortical-subcortical brain developmental responses to adversity potentially shield against stress-induced mood and anxiety disorders, they may be detrimental to other domains such as academic success.

Evidence for the Contribution of the miR-206/BDNF Pathway in the Pathophysiology of Depression.

Depression is a complex disorder with substantial impacts on individual health and has major public health implications. Depression results from complex interactions between genetic and environmental factors. Epigenetic mechanisms, including DNA methylation, microRNAs (miRNAs), and histone modifications, can produce heritable phenotypic changes without a change in DNA sequence and recently were proven to mediate lasting increases in the risk of depression following exposure to adverse life events. Of these, miRNAs are gaining attention for their role in the pathogenesis of many stress-associated mental disorders, including depression. One such miRNA is microRNA-206 (miR-206), which is a critical candidate for increasing the susceptibility to stress. Although miR-206 is thought to be a typical muscle-specific miRNA, it is expressed throughout the brain, particularly in the hippocampus and prefrontal cortex. Until now, only a few studies have been conducted on rodents to understand the role of miR-206 in stress-related abnormalities in neurogenesis. However, the precise underlying molecular mechanism of miR-206-mediated depression-like behaviors remains largely unknown. Here, we reviewed recent advances in the field of biomedical and clinical research on the role of miR-206 in the pathogenesis of depression from studies using different tissues and various experimental designs and described how abnormalities in miR-206 expression in these tissues can affect neuronal functions. Moreover, we focused on studies investigating the brain-derived neurotrophic factor (BDNF) as a functional target of miR-206, where miR-206 has been implicated in the pathogenesis of depression by suppressing the expression of the BDNF. In summary, these studies confirm the existence of a tight correlation between the pathogenesis of depression and the miR-206/BDNF pathway.

Identity Distress, Confusion, Synthesis, and Social Media Use for Coping: Implications for Identity Development

ABSTRACT How do emerging adults undergoing identity distress during an adverse collective life event such as the COVID-19 pandemic use social media for coping? This study addressed this question by examining the associations of identity distress, confusion, and synthesis with social media use for coping with a national, multisite undergraduate sample of university students (N = 1257; M age = 20; 908 women) in the United States. Results indicated that emerging adult college students undergoing increased identity distress during the pandemic reported utilizing social media frequently for coping, such as socially connecting with others and alleviating negative emotions. Similarly, emerging adult college students experiencing increased identity uncertainty (marked by greater identity confusion and lower identity synthesis) during the pandemic reported using social media frequently for coping. Moreover, findings implied that emerging adult college students experiencing high identity distress severity, interference, and duration were almost two times more likely than their peers undergoing a lesser degree of distress to use social media to alleviate negative emotions. Implications for mental health practitioners working with emerging adults during an adverse collective life event are discussed.

Factors associated with nursing students' mental health-related stigma: A multisite cross-sectional study

BackgroundMental health-related stigma remains a complex and pervasive issue globally. It not only inhibits individuals from seeking help but also influences the quality of healthcare they receive. Despite extensive research on mental health-related stigma, there is still limited understanding of factors influencing mental health-related stigma among nursing students. ObjectivesThis study aimed to assess the level of mental health-related stigma among Chinese nursing students and investigate possible associated factors. MethodsData were collected from the 2023 Psychology and Behavior Investigation of Chinese Residents (PBICR) survey. A total of 967 nursing students were included in the study. Multivariate stepwise linear regression analysis was conducted to examine the influencing factors of mental health stigma. ResultsThe mean mental health-related stigma score among nursing students was 15.31 ± 5.23 (range = 0–27). Perceived stress (β = 0.14, P = 0.001), self-efficacy (β = 0.22, P < 0.001), academic stage (β = 0.17, P < 0.001), depression (β = 0.15, P < 0.001), and adverse life events (β = 0.06, P = 0.044) were significantly associated with mental health-related stigma among nursing students (R2 = 0.147, adjusted R2 = 0.143, F = 33.214, P < 0.001). ConclusionsNursing students in China exhibit a moderate level of mental health-related stigma, suggesting room for improvement. Perceived stress, self-efficacy, academic stage, depression, and adverse life events emerged as significant influencing factors for mental health-related stigma. These findings provide valuable insights for developing interventions to reduce mental health-related stigma among nursing students, ultimately enhancing their well-being and preparing them for becoming competent healthcare professionals in the future.

Adverse life events among bedouin and jewish women and the risk for postpartum depressive symptoms.

Postpartum depression (PPD) affects 10-15% of postpartum women with increased risk among women with trauma history. The purpose of this study was to investigate the relationship between adverse life events and postpartum depressive symptoms among Bedouin and Jewish women. A cross-sectional study was performed in a tertiary hospital in the southern district of Israel on women with singleton deliveries between November 2021 and March 2022. Eligible women completed two questionnaires to determine exposure to childhood trauma (CT) and other potentially traumatic events (PTE), including the Childhood Trauma Questionnaire (CTQ), and Lifetime Events Checklist questionnaire (LEC). To measure risk for PPD we used the Edinburgh Postnatal Depression Scale (EPDS). The associations between CT, PTE, and risk for PPD were analyzed and multivariable logistic regression models were constructed to control for potential confounders. A total of 201 women were included, 120 Bedouin (59.7%) and 81 Jewish (40.2%). In the entire study population, both CT and PTE were independently associated with risk for PPD (adjusted OR = 2.13, 95% CI 1.02-4.44, p = 0.043 and adjusted OR = 3.42, 95%, CI 1.46-8.00, p = 0.004, respectively). While among Bedouin women, PTE was independently associated with PPD risk (adjusted OR = 4.83, 95% CI 1.66-14.05, p = 0.004), no significant association was found among Jewish women. Both CT and PTE were associated with increased PPD risk in Bedouin and Jewish women. Only PTE, and not CT, was associated with PPD among Bedouin women. Understanding risk factors for PPD, and differences among minority groups, could promote prevention efforts for PPD.

Internal Strengths for Adverse Life Events.

In this study, a brief measure of four internal attributes found to protect against the impact of adverse life events on mental health was developed and validated. In addition, profiles of internal strengths that significantly predict mental health outcomes in young Chinese adults were identified. The results of exploratory and confirmatory factor analyses on data from 831 Chinese university students supported the proposed four-factor model of the ISALES. Participants in the current study fell into two clusters, with one cluster being higher than the other in all four internal strengths, with the former cluster demonstrating better overall mental health than those in the latter cluster. The ISALES is a promising instrument for use in clinical settings and may be used to identify individuals who are more 'at risk' of developing poor mental health in the aftermath of a negative life event. The use of the ISALES may permit tailored interventions and timely support to be provided to individuals within clinical settings.

Longitudinal variation in resilient psychosocial functioning is associated with ongoing cortical myelination and functional reorganization during adolescence

Adolescence is a period of dynamic brain remodeling and susceptibility to psychiatric risk factors, mediated by the protracted consolidation of association cortices. Here, we investigated whether longitudinal variation in adolescents’ resilience to psychosocial stressors during this vulnerable period is associated with ongoing myeloarchitectural maturation and consolidation of functional networks. We used repeated myelin-sensitive Magnetic Transfer (MT) and resting-state functional neuroimaging (n = 141), and captured adversity exposure by adverse life events, dysfunctional family settings, and socio-economic status at two timepoints, one to two years apart. Development toward more resilient psychosocial functioning was associated with increasing myelination in the anterolateral prefrontal cortex, which showed stabilized functional connectivity. Studying depth-specific intracortical MT profiles and the cortex-wide synchronization of myeloarchitectural maturation, we further observed wide-spread myeloarchitectural reconfiguration of association cortices paralleled by attenuated functional reorganization with increasingly resilient outcomes. Together, resilient/susceptible psychosocial functioning showed considerable intra-individual change associated with multi-modal cortical refinement processes at the local and system-level.

Exploring depressive symptoms and coping strategies in Chinese women facing infertility: A cross-sectional observational study.

Infertility can lead to significant psychological distress among women, yet the roles of hope and resilience in mitigating depressive symptoms remain inadequately explored, particularly within the Chinese context. We performed a cross-sectional observational study to investigate the psychological impacts of infertility among Chinese women as well as to discern whether hope and resilience can influence their depressive symptoms. We recruited 364 Chinese women seeking infertility treatment in the Shandong region. Participants completed validated assessments including the Hospital Anxiety and Depression Scale, Connor-Davidson Resilience Scale, and Herth Hope Index. Demographic and clinical data were also collected. We observed elevated levels of depressive symptoms and anxiety among women with infertility. Particularly, demographic factors such as an older age, rural residence, lower income, lower education, adverse life events, and longer infertility duration were associated with increased depressive symptoms. Individuals who experienced adverse life events were at a 2.42-fold increased risk of developing depressive symptoms (P = .04). Depressive symptoms were inversely correlated with both hope levels (r = -0.25; P < .05) and resilience levels (r = -0.32; P < .05). Hope levels were positively correlated with resilience (R = 0.67; P < .05). After controlling for the interaction of hope and resilience, we found that only depressive symptoms and resilience were negatively correlated. The psychological burden of infertility among Chinese women is widespread and affects many individuals from different demographic backgrounds. Interventions aimed at increasing resilience may be helpful to mitigate depressive symptoms.

Stress and depression-aneurobiological perspective

Depression is acommon and often very debilitating disease causing ahigh number of years lost to disability worldwide. Mortality rates are high due to suicide and depression-associated somatic disorders, which seem to have abidirectional connection. Depression is considered to be stress associated. Adverse life events such as losses, interpersonal conflicts, financial issues, unemployment, and loneliness are often found in the patient history. Also childhood maltreatment is aknown risk factor. Chronic stress can cause maladaptive changes in different neurobiological systems and may contribute to the development of depression. Relevant changes have been described in the stress-response and immune systems of persons with depression and those with childhood trauma or abuse. Psychotherapy and antidepressants are both effective, and current treatment guidelines recommend their combination in severe depressive episodes.