Co-occurring Depression Research Articles

Innovation in addressing depression and anxiety symptoms in rural Honduran communities: a cross-sectional pilot study

Introduction. Due to limited information on mental health in rural areas, this study innovates by applying validated tools previously unused in rural Honduras to assess levels of anxiety and depression among rural residents of Ojojona, Honduras. Methods. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder Scale-7 (GAD-7) were used to assess depression and anxiety, respectively. Twenty-one participants were obtained through convenience sampling and door-to-door surveys. Results. The prevalence of depression and anxiety was 47.7% and 47.6%, respectively. 29% have co-occurring depression and anxiety. Conclusion. Additional research is needed to effectively understand the high prevalence of mental health disorders in rural Honduran communities and improve access to healthcare and health research technology in rural areas.

Exploring the associations between the presence, characteristics, and biopsychosocial covariates of pain and lifetime depression in adolescents: A cross-sectional ABCD study analysis

IntroductionDepression and pain co-occur, even during adolescence. However, there is limited knowledge on the association between pain and lifetime depression, and which biopsychosocial measures are associated with this co-occurrence. MethodsCross-sectional analysis of the Adolescent Brain and Cognitive Development (ABCD) two-year follow-up. We explored associations between the presence and characteristics of past month pain (intensity, duration, activity limitations, and number of pain sites) and lifetime depression using logistic regression. We explored associations of brain structure, physical, behavioural, emotional, social, and cognitive measures with lifetime depression and past month pain compared to having had one or neither condition using multinomial logistic regression. ResultsA total of 5211 adolescents (mean age = 12.0 years) who had: (1) no lifetime mental ill-health and no pain (n = 3327); (2) pain only (n = 1407); (3) lifetime depressive disorder but no pain (n = 272); and (4) lifetime depressive disorder and pain (n = 205) were included. Pain presence was associated with lifetime depression (OR[95%CI]: 1.76 [1.45, 2.13], p < 0.001). Pain-related activity limitations (1.13 [1.06, 1.21], p < 0.001) and the number of pain sites (1.06 [1.02, 1.09], p < 0.001) were associated with lifetime depression. Various behavioural, emotional, social, and cognitive, but not brain structure or physical measures, were associated with lifetime depression and past month pain. LimitationsLongitudinal analyses should validate prognostic markers on predicting co-occurring depression and pain. ConclusionsResults support an association between the presence and characteristics of pain and lifetime depression during adolescence and could indicate the need for more integrated recognition and clinical care of youth experiencing both depression and pain.

Anxiety and depression in Chinese cataract patients: a network analysis

BackgroundPrior research has demonstrated that people with cataracts are more likely to experience anxiety and depression co-occurring when the condition advances to a degree that impairs vision beyond its physiological effects. According to network theory, there is a connection between the interplay of anxiety and depression and the genesis of comorbidity. Using a network viewpoint, our study examined the network properties of anxiety-depression in cataract patients to pinpoint central and bridge symptoms as well as possible intervention targets for more focused and successful therapies.MethodA total of 1,254 cataract patients were enrolled in our study. The Nine-item Patient Health Questionnaire (PHQ-9) and the Seven-item Generalized Anxiety Disorder scale (GAD-7) were used to measure depression and anxiety symptoms, respectively. The R 4.3.3 software was utilized for network model building and descriptive statistics. Furthermore, we displayed a “Thoughts of death” flow network.ResultIn the network, A5 “Restlessness”- D7 “Concentration difficulties” showed the strongest edge. A2 “Uncontrollable worry” and D2 “Depressed or sad mood” could be identified as the central symptoms. A7 “Afraid something will happen” and D7 “Concentration difficulties” could be identified as bridge symptoms. The strongest edge in the flow network was D9 “Thoughts of death”-D6 “Feeling of worthlessness”.Conclusion“Uncontrollable worry”, “Depressed or sad mood”, “Afraid something will happen” and “Concentration difficulties” could be potential targets for the prevention of anxiety and depression in cataract patients. Furthermore, this study emphasizes how important it is to prevent suicide in cataract patients, and the symptom “Feeling of worthlessness” can be used as an effective target.

Effects of Integrated Care Approaches to Address Co-occurring Depression and Diabetes: A Systematic Review and Meta-analysis.

Depressive symptoms frequently co-occur with diabetes and, when unaddressed, can function to worsen diabetes control and increase the risk of diabetes-related morbidity. Integrated care (IC) approaches aim to improve outcomes among people with diabetes and depression, but there are no current meta-analyses examining their effects. In our study we summarize the effects of IC approaches to address depression and diabetes and examine moderating effects of IC approaches (e.g., behavioral intervention used; type of IC approach). A systematic search was conducted of PubMed, PsycInfo, CINAHL, and ProQuest. Two reviewers triaged abstracts and full-text articles to identify relevant articles. Randomized controlled trials with enrollment of participants with diabetes and depressive symptoms and with provision of sufficient data on depression scores and hemoglobin A1c were included. Two reviewers extracted demographic information, depression scores, diabetes outcomes, intervention details, and the risk of bias for each study. From 517 abstracts, 75 full-text reports were reviewed and 31 studies with 8,843 participants were analyzed. Among 26 studies with reporting of HbA1c, IC approaches were associated with a significant between-group difference regarding the percent decrease of HbA1c (d = -0.36, 95% CI -0.52 to -0.21). Studies that included a combination of behavioral interventions (behavioral activation with cognitive behavioral therapy) showed greater reductions in HbA1c. Among 23 studies with reporting of depressive symptoms, the pooled effect of IC approaches lowered depressive scores by 0.72 points (95% CI -1.15 to -0.28). The inclusion of a wide range of IC approaches increased study heterogeneity. A random effects model and sensitivity analyses mitigated this limitation. IC approaches are associated with improved glycemia and depressive symptoms in comparison with treatment as usual.

Understanding Community-Specific Health Behaviors to Prevent Type 2 Diabetes and Depression in Rural Adolescents: A Qualitative Study.

Type 2 diabetes (T2D) and depression co-occur, and rates are on the rise in adolescents, disproportionately affecting teenagers in rural communities and those who identify as members of historically disadvantaged racial/ethnic groups. Addressing the promotion of health behaviors is important for prevention of these comorbid health concerns; however, disparities in their prevalence highlight that a healthy lifestyle is not equally accessible for all individuals. Thus, holistic and multi-level approaches that address structural inequities, leverage cultural and family assets, and are effectively integrated into the community are critically needed. This project is an initial phase of a broader community-academic collaboration that aims to address preventable chronic diseases and mental health in adolescents living in the rural Mountain West by tailoring an evidence-based health behavior and lifestyle intervention for these communities. Interviewers conducted semi-structured interviews with N = 19 individuals (n = 11 adolescents, 11-17years, n = 8 mothers) who lived in neighboring counties in the rural Mountain Western USA and had a family history of T2D. Interview schedules were developed by an interdisciplinary team, with community input, and covered topics such as food and staying active, stress, T2D risk, and community and culture. Using thematic analysis, data were reduced through coding, categorization, and development of themes. Data revealed three major themes: "Families Face Systemic Barriers to Health," "Family Routines Support Health," and "Connection is Crucial to Holistic Health." Findings reveal opportunities for addressing health inequities and developing effective, integrated T2D and depression prevention strategies within this specific community. They also potentially contain insights that may be applicable to others interested in adapting interventions for diverse groups.

Gray Matter Volume Correlates of Co-Occurring Depression in Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) involves neurodevelopmental syndromes with significant deficits in communication, motor behaviors, emotional and social comprehension. Often, individuals with ASD exhibit co-occurring depression characterized by a change in mood and diminished interest in previously enjoyable activities. Due to communicative challenges and a lack of appropriate assessments in this cohort, co-occurring depression can often go undiagnosed during routine clinical examinations and, thus, its management neglected. The literature on co-occurring depression in adults with ASD is limited. Therefore, understanding the neural basis of the co-occurring psychopathology of depression in ASD is crucial for identifying brain-based markers for its timely and effective management.Using structural MRI and phenotypic data from the Autism Brain Imaging Data Exchange (ABIDE II) repository, we examined the pattern of relationship regional grey matter volume (rGMV) has with co-occurring depression and autism severity within regions of a priori interest in adults with ASD (n = 44; age = 17-28 years). Further, we performed an exploratory analysis of the rGMV differences between ASD and matched typically developed (TD, n = 39; age = 18-31 years) samples. The severity of co-occurring depression correlated negatively with the rGMV of the right thalamus. Additionally, a significant interaction was evident between the severity of co-occurring depression and core ASD symptoms towards explaining the rGMV in the left cerebellum crus II. The results further the understanding of the neurobiological underpinnings of co-occurring depression in adults with ASD towards exploring neuroimaging-based biomarkers in the same cohort.

Inclusion of Individuals With Lived Experiences in the Development of a Digital Intervention for Co-Occurring Depression and Cannabis Use: Mixed Methods Investigation.

Existing interventions for co-occurring depression and cannabis use often do not treat both disorders simultaneously and can result in higher rates of symptom relapse. Traditional in-person interventions are often difficult to obtain due to financial and time limitations, which may further prevent individuals with co-occurring depression and cannabis use from receiving adequate treatment. Digital interventions can increase the scalability and accessibility for these individuals, but few digital interventions exist to treat both disorders simultaneously. Targeting transdiagnostic processes of these disorders with a digital intervention-specifically positive valence system dysfunction-may yield improved access and outcomes. Recent research has highlighted a need for the inclusion of individuals with lived experiences to assist in the co-design of interventions to enhance scalability and relevance of an intervention. Thus, the purpose of this study is to describe the process of eliciting feedback from individuals with elevated depressed symptoms and cannabis use and co-designing a digital intervention, Amplification of Positivity-Cannabis Use Disorder (AMP-C), focused on improving positive valence system dysfunction in these disorders. Ten individuals who endorsed moderate to severe depressive symptoms and regular cannabis use (2-3×/week) were recruited online via Meta ads. Using a mixed methods approach, participants completed a 1-hour mixed methods interview over Zoom (Zoom Technologies Inc) where they gave their feedback and suggestions for the development of a mental health app, based on an existing treatment targeting positive valence system dysfunction, for depressive symptoms and cannabis use. The qualitative approach allowed for a broader investigation of participants' wants and needs regarding the engagement and scalability of AMP-C, and the quantitative approach allowed for specific ratings of intervention components to be potentially included. Participants perceived the 13 different components of AMP-C as overall helpful (mean 3.9-4.4, SD 0.5-1.1) and interesting (mean 4.0-4.9, SD 0.3-1.1) on a scale from 1 (not at all) to 5 (extremely). They gave qualitative feedback for increasing engagement in the app, including adding a social component, using notifications, and being able to track their symptoms and progress over time. This study highlights the importance of including individuals with lived experiences in the development of interventions, including digital interventions. This inclusion resulted in valuable feedback and suggestions for improving the proposed digital intervention targeting the positive valence system, AMP-C, to better match the wants and needs of individuals with depressive symptoms and cannabis use.

Understanding Depression in Autism: The Role of Subjective Perception and Anterior Cingulate Cortex Volume.

The prevalence of depression is elevated in individuals with autism spectrum disorder (ASD) compared to the general population, yet the reasons for this disparity remain unclear. While social deficits central to ASD may contribute to depression, it is uncertain whether social interaction behavior themselves or individuals' introspection about their social behaviors are more impactful. Although the anterior cingulate cortex (ACC) and amygdala are frequently implicated in ASD, depression, and social functioning, it is unknown if these regions explain differences between ASD adults with and without co-occurring depression. The present study contrasted observed vs. subjective perception of autism symptoms and social performances assessed with both standardized measures and a lab task, in 65 sex-balanced (52.24% male) autistic young adults. We also quantified ACC and amygdala volume with 7-Tesla structural neuroimaging to examine correlations with depression and social functioning. We found that ASD individuals with depression exhibited differences in subjective evaluations including heightened self-awareness of ASD symptoms, lower subjective satisfaction with social relations, and less perceived affiliation during the social interaction task, yet no differences in corresponding observed measures, compared to those without depression. Larger ACC volume was related to depression, greater self-awareness of ASD symptoms, and worse subjective satisfaction with social interactions. In contrast, amygdala volume, despite its association with clinician-rated ASD symptoms, was not related to depression. Due to the cross-sectional nature of our study, we cannot determine the directionality of the observed relationships. Additionally, we included only individuals with an IQ over 60 to ensure participants could complete the social task, which excluded many on the autism spectrum. We also utilized self-reported depression indices instead of clinically diagnosed depression, which may limit the comprehensiveness of the findings. Our approach highlights the unique role of subjective perception of autism symptoms and social interactions, beyond the observable manifestation of social interaction in ASD, in contributing to depression, with the ACC playing a crucial role. These findings imply possible heterogeneity of ASD concerning co-occurring depression. Using neuroimaging, we were able to demarcate depressive phenotypes co-occurring alongside autistic phenotypes.

Acceptance and Commitment Therapy (ACT) and Self-Compassion for Generalized Anxiety Disorder and Comorbid Major Depressive Disorder: A Case Study

The current case describes the implementation of Acceptance and Commitment Therapy (ACT) and self-compassion interventions with a 37-year-old Queer Hispanic woman “Cynthia” (pseudonym). Cynthia presented to a university training clinic, reporting pervasive difficulties with anxiety, an associated pattern of depressive episodes, and a trauma history. The therapist conceptualized Cynthia’s presenting problems through an ACT-based psychological flexibility framework. Functional analysis indicated intolerance of uncertainty, fusion to self-critical thoughts, and experientially avoidant behaviors (e.g., pervasive worry) contributed to Cynthia’s anxiety. Values clarification, as well as mindfulness- and acceptance-based interventions, were met with gains in quality-of-life scores and decreases in worry scores as treatment progressed. Additionally, self-compassion interventions were implemented to address pervasive self-criticism and feelings of low self-worth. Across 37 sessions, from pre-to-post treatment, Cynthia’s quality of life scores increased by 62.5%, and worry decreased by 52.8%. These results provide support for using ACT and self-compassion interventions for anxiety and co-occurring depression with a Queer, Hispanic woman.

Effect of a prescription digital therapeutic for chronic insomnia on post-treatment insomnia severity, depression, and anxiety symptoms: results from the real-world DREAM study.

Chronic insomnia is a substantial public health burden that often presents with co-occurring depression and anxiety. Randomized clinical trials and preliminary real-world evidence have shown that digitally delivered cognitive-behavioral therapy for insomnia (dCBT-I) is associated with improvements in insomnia, but real-world evidence is needed to determine the true impact of digital CBT-I. This pragmatic study aimed to evaluate the benefits of treating chronic insomnia with a tailored prescription digital therapeutic in a real-world population. This prospective, single-arm clinical study involved adults aged 22-75 with chronic insomnia living in the US who had access to a mobile device. Participants accessed the FDA-cleared prescription digital therapeutic (PDT; Somryst®) over a 9-week intervention period. The PDT delivers cognitive-behavioral therapy for insomnia via six interactive treatment cores and daily sleep diaries used for tailoring treatment. Participants completed validated patient-reported instruments at baseline, before completing treatment cores, immediately post-intervention, and at 6-month and 1-year follow-ups. The Insomnia Severity Index [ISI], the 8-item Patient Health Questionnaire [PHQ-8], and the Generalized Anxiety Disorder-7 scale [GAD-7] were used to determine the effect of the PDT on insomnia, depression, and anxiety. After screening, 1565 adults accessed the PDT. 58% of those who began the program completed Core 4, established as exposure to all mechanisms of action in the digital therapeutic. For those who completed assessments for all 6 cores (48.4%), the ISI was lowered from 18.8 to a mean of 9.9 (P <.001). These scores continued to be lower than baseline at immediate post (11.0), 6-month (11.6), and 1-year follow-ups (12.2) (P <.001). The results of the PHQ-8 and GAD-7 also show significant decreases at all measured timepoints from baseline (P <.001). Of the patients that began the program, 908 (58.0%) were considered adherent and 733 (46.8%) completed all 6 cores. Data from the DREAM study contributes to the growing body of clinical evidence of how patients are utilizing a PDT in the real world, outside of controlled settings, offering insights for clinicians who use these therapeutics in practice. ClinicalTrials.gov, identifier NCT04325464.

Understanding the Bidirectional Relationship between Alzheimer's and Depression

Abstract: With an ageing global population, understanding the potential links between mental health and neurodegenerative disorders has become increasingly crucial for comprehensive patient care. A comprehensive search of electronic databases yielded a selection of studies encompassing clinical trials, longitudinal cohorts, and cross-sectional analyses, published between 2000 and 2023. Key inclusion criteria focused on investigations involving both Alzheimer's disease and depression, encompassing a range of methodologies, including neuroimaging, epidemiological surveys, and clinical assessments. The analysis reveals compelling evidence of a bidirectional relationship, where depression serves as a potential precursor to Alzheimer's disease, and vice versa. Neurobiological mechanisms, including neuroinflammation, neurotransmitter imbalances, and genetic predispositions, emerge as significant contributors to this complex association. Furthermore, psychosocial factors, such as chronic stress and social isolation, are identified as potential accelerators of cognitive decline in individuals with co-occurring depression and Alzheimer's. Additionally, therapeutic interventions targeting both conditions concurrently exhibit promising outcomes in mitigating cognitive decline and ameliorating depressive symptoms. Approaches encompassing cognitive behavioural therapy, pharmacological interventions, and lifestyle modifications demonstrate potential avenues for integrated treatment strategies. This review underscores the imperative for a multidisciplinary approach to patient care, emphasizing the importance of early detection and intervention for individuals presenting with symptoms of depression and cognitive impairment. Future research avenues should prioritize longitudinal studies with larger cohorts to delineate the causal pathways and further elucidate effective treatment modalities for this intricate comorbidity. By unravelling the complexities of the Alzheimer's-depression nexus, we pave the way for more targeted and comprehensive interventions to improve the lives of those affected by these debilitating conditions.

Association between depression severity and trouble sleeping: A population-based study.

This study investigates the association between insomnia and depression severity, exploring sleep disturbances in individuals with depression. The aim is to establish a new foundation for managing patients with co-occurring depression and insomnia, using 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) data. We employed a cross-sectional design, using NHANES data from 2015 to 2018. The study included 11,261 participants after excluding incomplete data. Depression severity, assessed using Patient Health Questionnaire-9 (PHQ-9) scores, served as the exposure variable. We considered various demographic and lifestyle factors as covariates in the multivariate adjustment model. Statistical analyses adhered to CDC recommendations, with sample weights incorporated to account for NHANES' complex sample design. Our study, encompassing 19,225 participants, revealed that higher PHQ-9 scores correlated with an increased likelihood of sleep disorders. In the fully adjusted model, a positive association emerged between PHQ-9 scores and trouble sleeping (OR = 3.95, 95% CI: 3.35-4.66, P < .0001). This relationship displayed an inverted U-shaped curve, with an inflection point at 28. Subgroup analysis and interaction tests indicated no reliance on factors such as gender, age, marital status, or BMI for the connection between depression severity and trouble sleeping (all P for interaction > .05). We identified a significant inverted U-shaped correlation between sleep disturbances and depression severity. This underscores the crucial importance of assessing sleep disorder risks in individuals with varying degrees of depression severity, facilitating personalized therapeutic interventions.

Co-occurring Depression and Substance Use Disorders in Young People

Depression and substance use disorders frequently co-occur in young people, which leads to poor mood- and substance-related outcomes. This cooccurrence may be caused by depressive symptoms leading to problematic substance use, substance use leading to depressive symptoms, and/or common vulnerability factors that put individuals at risk for development of psychopathology. While treatments exist to address co-occurring depression and substance use disorders in young people, multiple barriers exist that inhibit treatment accessibility and effectiveness, such as differential diagnosis difficulties, siloing of treatment modalities, and shame and stigma surrounding substance use. Despite these barriers, some young people receive treatment for one or both of their co-occurring disorders. This review describes four different treatment avenues: substance use disorder focused, depression focused, integrated, and transdiagnostic treatments. We conclude with clinical recommendations for providers who work with young people with co-occurring depression and substance use disorders. [ Psychiatr Ann . 2024;54(9):e253–e257.]

Mental health in mothers of children with autism spectrum disorder: a cross-sectional study.

The increased prevalence of autism spectrum disorder (ASD) has placed a significant emotional and psychological burden on mothers. We explored the association between the severity of ASD symptoms in children and the mental health of their mothers during the COVID-19 pandemic. Our study included 1,924 mothers of children with ASD, enrolled in a web-based cross-sectional survey over 85 consecutive days to gather clinical and sociodemographic data. The severity of ASD symptoms was obtained according to the children's age. Using the Depression, Anxiety, and Stress Scales (DASS-21) scale, we found that 35.8 percent of mothers experienced both anxiety and depression. A high education level and a high family income reduced the chance of concurrent anxiety and depression. Conversely, unemployment, a child using psychiatric medication, and higher severity of ASD symptoms increased the chance. Notably, the severity of the ASD symptom was the sole predictor of maternal co-occurring anxiety and depression across all age groups (<3 years aOR = 2.04, 95%CI 1.07-3.89; 3-5 years aOR = 2.76, 95%CI 1.67-4.56; ≥ 6 years aOR = 1.61, 95%CI 1.04-2.50). Recognizing the challenges associated with ASD leads to greater acceptance and tailored interventions, ultimately improving the overall well-being of both individuals with ASD and their mothers.

Curcumin Reduces Depression in Obese Patients with Type 2 Diabetes: A Randomized Controlled Trial.

Type 2 diabetes and depression co-occur in a bidirectional manner. Curcumin supplements exhibit antidepressant effects that may mitigate depression by modulating neurotransmitters and reducing inflammatory and oxidative stress pathways. This study aimed to evaluate the efficacy of curcumin in improving depression severity in obese type 2 diabetes patients. The study employed a randomized, double-blind, placebo-controlled trial design with 227 participants. The primary end-point was depression severity assessed using the Patient Health Questionnaire-9. Biomarkers were measured at baseline and at 3-, 6-, 9-, and 12-month intervals. The biomarkers assessed were serotonin levels, pro-inflammatory cytokines (interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha), antioxidant activities (total antioxidant status, glutathione peroxidase, and superoxide dismutase), and malondialdehyde. After 12 months, the curcumin group exhibited significantly improved depression severity (p = 0.000001). The curcumin group had higher levels of serotonin (p < 0.0001) but lower levels of interleukin-1 beta, interleukin-6, and tumor necrosis factor-alpha (p < 0.001 for all) than the placebo group. Total antioxidant status, glutathione peroxidase activity, and superoxide dismutase activity were elevated in the curcumin group, whereas malondialdehyde levels were greater in the placebo group (p < 0.001 for all). These findings suggest curcumin may have antidepressant effects on obese type 2 diabetes patients.

Depression Is Associated with a Higher Risk of Mortality among Breast Cancer Survivors: Results from the National Health and Nutrition Examination Survey-National Death Index Linked Study.

Breast cancer (BC) and depression are globally prevalent problems. Numerous reviews have indicated the high prevalence of depression among BC survivors. However, the long-term impact of depression on survival among BC survivors has not been well explored. For this investigation, we aimed to explore the relationship between BC, depression, and mortality from a national random sample of adult American women. Data from the U.S. National Health and Nutrition Examination Survey (years 2005-2010) were linked with mortality data from the National Death Index up to December 31st, 2019. A total of 4719 adult women (ages 45 years and older) were included in the study sample with 5.1% having breast cancer and more than a tenth (12.7%) having depression. The adjusted hazard ratio (HR) for all-cause mortality risk among those with BC was 1.50 (95% CI = 1.05-2.13) compared to those without BC. In the adjusted analysis, the risk of all-cause mortality was highest among women with both depression and BC (HR = 3.04; 95% CI = 1.15-8.05) compared to those without BC or depression. The relationship between BC and mortality was moderated by cardiovascular diseases, anemia, smoking, age, PIR, and marital status. Our analysis provides vital information on factors that could be helpful for interventions to reduce mortality risk among those with BC and depression. In addition, given the higher risk of mortality with co-occurring BC and depression, collaborative healthcare practices should help with widespread screening for and treatment of depression among BC survivors.

The Contribution of Shame to Eating Disorder Treatment Outcomes in a Community Mental Health Clinic.

Shame is a powerful self-conscious emotion that is often experienced by individuals with eating disorders (EDs). While the association between EDs and shame is well-established, there is limited research investigating the contribution of pre-treatment shame to clinical outcomes. Participants (N = 273) received outpatient cognitive-behavioral therapy for eating disorders (CBT-ED). We investigated pre-treatment shame as a predictor of dropout and as a moderator of change in ED psychopathology and clinical impairment from pre-treatment to post-treatment. We also explored the potentially moderating roles of body mass index, ED diagnostic category, and co-occurring anxiety and depression diagnoses. Shame improved substantially (d = 1.28) despite not being explicitly targeted in treatment. Pre-treatment shame did not predict treatment dropout. Individuals high in shame started and ended treatment with higher ED symptoms and impairment than those with low shame. The contribution of pre-treatment shame on the degree of change in symptoms/impairment depended critically on whether analyses controlled for pre-treatment symptoms/impairment. When those were controlled, high pre-treatment shame was associated with substantially less improvement in ED symptoms and impairment. There was some evidence that ED diagnosis and co-occurring depressive diagnoses may moderate the relationship between shame and treatment outcome. Changes in shame were positively associated with changes in ED symptoms and clinical impairment. A high level of shame at pre-treatment is not a contraindication for CBT-ED as good therapeutic outcomes can be achieved. However, outcomes may be enhanced among individuals high in shame by offering adjunctive interventions that explicitly target shame.

Emotion dysregulation and coping motives as mediators of change in cognitive behavioral therapy-based treatments for depression and heavy episodic drinking among college students

BackgroundBoth cognitive behavioral therapy (CBT) alone and combined with brief motivational interviewing (CBT + BMI) are associated with reductions in depression, alcohol-related problems (ARP), and heavy alcohol use among college students with co-occurring depression and heavy episodic drinking (HED). Little is known regarding how these interventions facilitate change and the temporal ordering of reductions. This study examined mediators of CBT alone versus CBT + BMI, including (1) emotion regulation constructs (cognitive reappraisal, expressive suppression, avoidance coping) and (2) drinking to cope motives. The temporal relationships between improvement in depression and reduction of ARP and HED were also examined. MethodsData from 94 college students with depression and HED randomized to either eight weeks of CBT alone or CBT + BMI collected during a previous trial were utilized. Multilevel structural equation models were adopted to investigate mediation models. A cross-lagged panel analysis examined temporal relationships between depression, ARP, and HED. ResultsMediators associated with improvement did not differ between the two interventions. In both, depression amelioration was mediated by increased cognitive reappraisal and reduction of avoidance coping and drinking to cope. Reduction of drinking to cope mediated improvements in ARP. LimitationsIt is uncertain whether observed changes can be solely attributed to CBT, or if other factors may have played a role. ConclusionsTreatment programs providing emotion regulation skills to cope with aversive affect, as an alternative to alcohol misuse, may lead to depression improvement.

Expressive suppression and cognitive reappraisal pathways from social anxiety to depression: A six-month longitudinal study

This study examines the relationships between social anxiety, individual differences in emotion regulation strategies such as expressive suppression (ES) and cognitive reappraisal (CR), and their effects on depressive symptoms. Drawing upon a sample of 369 university students, the study employs a three-wave longitudinal design. Findings indicate a significant association between social anxiety and ES, but not with CR. Additionally, ES is positively associated with depressive symptoms, while CR is not. Path analysis results reveal that social anxiety at Time 1 predicts ES at Time 2, which, in turn, predicts depressive symptoms at Time 3. Furthermore, mediation analysis suggests that ES mediates the relationship between social anxiety and depressive symptoms. These findings underscore the importance of strategies aimed at reducing emotional suppression tendencies in clinical interventions targeting co-occurring social anxiety and depression.

Psychological Interventions for Autistic Adolescentswith Co-Occurring Anxiety and Depression: Considerations Linked to Autism Social Identity and Masking

Psychological Interventions for Autistic Adolescentswith Co-Occurring Anxiety and Depression: Considerations Linked to Autism Social Identity and Masking