Criteria For Major Depressive Disorder Research Articles

The Clinical Effectiveness of Blended Cognitive Behavioral Therapy Compared With Face-to-Face Cognitive Behavioral Therapy for Adult Depression: Randomized Controlled Noninferiority Trial

BackgroundInternet-based cognitive behavioral therapy (iCBT) has been demonstrated to be cost- and clinically effective. There is a need, however, for increased therapist contact for some patient groups. Combining iCBT with traditional face-to-face (FtF) consultations in a blended format may produce a new treatment format (B-CBT) with multiple benefits from both traditional CBT and iCBT, such as individual adaptation, lower costs than traditional therapy, wide geographical and temporal availability, and possibly lower threshold to implementation.ObjectiveThe primary aim of this study is to compare directly the clinical effectiveness of B-CBT with FtF-CBT for adult major depressive disorder.MethodsA 2-arm randomized controlled noninferiority trial compared B-CBT for adult depression with treatment as usual (TAU). The trial was researcher blinded (unblinded for participants and clinicians). B-CBT comprised 6 sessions of FtF-CBT alternated with 6-8 web-based CBT self-help modules. TAU comprised 12 sessions of FtF-CBT. All participants were aged 18 or older and met the diagnostic criteria for major depressive disorder and were recruited via a national iCBT clinic. The primary outcome was change in depression severity on the 9-item Patient Health Questionnaire (PHQ-9). Secondary analyses included client satisfaction (8-item Client Satisfaction Questionnaire [CSQ-8]), patient expectancy (Credibility and Expectancy Questionnaire [CEQ]), and working (Working Alliance Inventory [WAI] and Technical Alliance Inventory [TAI]). The primary outcome was analyzed by a mixed effects model including all available data from baseline, weekly measures, 3-, 6, and 12-month follow-up.ResultsA total of 76 individuals were randomized, with 38 allocated to each treatment group. Age ranged from 18 to 71 years (SD 13.96) with 56 (74%) females. Attrition rate was 20% (n=15), which was less in the FtF-CBT group (n=6, 16%) than in the B-CBT group (n=9, 24%). As many as 53 (70%) completed 9 or more sessions almost equally distributed between the groups (nFtF-CBT=27, 71%; nB-CBT=26, 68%). PHQ-9 reduced 11.38 points in the FtF-CBT group and 8.10 in the B-CBT group. At 6 months, the mean difference was a mere 0.17 points. The primary analyses confirmed large and significant within-group reductions in both groups (FtF-CBT: β=–.03; standard error [SE] 0.00; P<.001 and B-CBT: β=–.02; SE 0.00; P<.001). A small but significant interaction effect was observed between groups (β=.01; SE 0.00; P=.03). Employment status influenced the outcome differently between groups, where the B-CBT group was seen to profit more from not being full-time employed than the FtF group.ConclusionsWith large within-group effects in both treatment arms, the study demonstrated feasibility of B-CBT in Denmark. At 6 months’ follow-up, there appeared to be no difference between the 2 treatment formats, with a small but nonsignificant difference at 12 months. The study seems to demonstrate that B-CBT is capable of producing treatment effects that are close to FtF-CBT and that completion rates and satisfaction rates were comparable between groups. However, the study was limited by small sample size and should be interpreted with caution.Trial RegistrationClinicalTrials.gov NCT02796573; https://clinicaltrials.gov/ct2/show/NCT02796573International Registered Report Identifier (IRRID)RR2-10.1186/s12888-016-1140-y

Men's Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms?

Men's Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms?

Associations of High-Sensitivity C-Reactive Protein and Interleukin-6 with Depression in a Sample of Italian Adolescents During COVID-19 Pandemic

IntroductionMany studies highlighted the role of inflammation in the pathogenesis of depression, although not for every patient nor for every symptom. It is widely shared that stressors can increase inflammation and lead to depressive symptoms. Little is known about the symptom-specificity of the inflammation-depression link in adolescence, which we aimed to explore. The single symptom analysis is a core feature of the recent network approach to depression, supposing that psychiatric disorders consist of co-occurring symptoms and their tendency to cause each other.Patients and MethodsWe recruited 52 adolescents diagnosed with a Depressive Disorder during the COVID-19 stressful period. We used regression analysis to measure associations between high sensitivity C-Reactive Protein (hs-CRP) and Interleukin-6 (IL-6) and depressive symptoms assessed by the Children’s Depression Inventory 2 (CDI 2). For the study of symptom specificity, we selected 13 items from the CDI 2 Self Report corresponding with the DSM-5 diagnostic criteria for Major Depressive Disorder and we coded them as dichotomous variables to perform a regression analysis.ResultsWe found that a higher CDI 2-Parent Version total score was significantly predicted by higher hs-CRP (coefficient 3.393; p 0.0128) and IL-6 (coefficient 3.128; p 0.0398). The endorsement of the symptom self-hatred, measuring the DSM-5 symptom “feelings of worthlessness”, was significantly predicted by hs-CRP (OR 10.97; 95% CI 1.29–93.08; p 0.0282).ConclusionA novel symptom-specificity emerged, with hs-CRP significantly predicting the endorsement of the symptom self-hatred, recognized as a core feature of adolescent depression, following the network theory. We considered it a possible phenotypic expression of one depression endophenotype previously causally linked to inflammation. Due to the limited sample size, these preliminary findings require confirmation with future research focusing on the relationship between inflammation and self-hatred and other central nodes of the depression network, representing an opportunity for targeting interventions on crucial symptoms.

The Relationship between Sexual Dysfunctions and Depression in Premenopausal Women

Aims: To evaluate SD in depressed married premenopausal women and to study mood in married women with primary sexual complain.&#x0D; Study Design: Cross-sectional case control research.&#x0D; Place and Duration of Study: Neuropsychiatry and Obstetrics and Gynecology departments at Tanta University Hospital. The study was conducted from April 2019 to the end of March 2020.&#x0D; Methodology: This research involved 300 females. Subjects were allocated into three equal groups: group 1(females with major depressive disorders who met DSM-5 diagnostic criteria for Major depressive disorders and were drug naïve, group 2: females with primary sexual complain and/or disorders and group 3: normal healthy female did not have history of medical or psychiatric diseases. All cases were subjected to psychiatric interview by Arabic version of MINI, Arabic version of the female sexual index, Hamilton depression scale, Hamilton anxiety scale, quality of life (QOL) assessment and modified Fahmy and Sherbini scale for socioeconomic study.&#x0D; Results: There was positive significant correlations between female sexual index and Hamilton depression and anxiety score (p &lt;0.001, p=0.012 respectively). There were negative significant correlations between female sexual index and physical, Psychological, social domains and total score of modified Fahmy&amp; Sherbiny scale (p=0.073, 0.039, 0.003, 0.009) respectively.&#x0D; Conclusion: Severity of depression is correlated to severity of SD among female cases with major depressive disorder. QOL is affected significantly by depression and by presence of sexual complaints and/or disorders among women as high incidence of SD in women with probable depression and is linked with significantly worse QOL.

A study of flotation-REST (restricted environmental stimulation therapy) as an insomnia treatment.

ObjectivesFlotation-REST is a treatment for deep relaxation, where a person is contained in a stimuli-restricted environment and floats in water with high salt content. The aim was to investigate the effects from flotation-REST on people with insomnia diagnosis, as previous studies of flotation-REST have demonstrated some effects on sleep but have limitations regarding sample selections and sleep measures.Material and MethodsSix participants were recruited through an outpatient psychiatry clinic and posters on a university campus. All participants fulfilled criteria for insomnia diagnosis and four fulfilled criteria for major depressive disorder. Using a single case experimental design, daily changes were investigated on sleep logs regarding sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency over the course of 12 sessions consisting of 45 min of flotation-REST. No other treatments were offered simultaneously. Questionnaire data on insomnia severity (the ISI) and depressive severity (the MADRS) were also collected.ResultsThree participants improved on their most salient insomnia symptom (long SOL or WASO), and two improved on sleep efficiency. The improvements were maintained 2 months after treatment. Insomnia severity decreased for three patients, whereas depressive severity decreased for five. No changes in TST were found and two patients did not improve on any sleep measure. The two participants who benefitted the most were students in their 20s.DiscussionThe results were mixed. Flotation-REST may be beneficial for young adults with sleep-onset insomnia but more research is warranted.

Mental Health in the Consorci Sanitari del Maresme workers during the COVID-19 pandemic: A descriptive cross sectional study

IntroductionThe global health emergency caused by the COVID-19 pandemic has put healthcare professionals in an unprecedented challenge, considering them extremely at risk population.ObjectivesTo estimate the prevalence of clinically significant mental disorders and to assess associated factors among Consorci Sanitari del Maresme workers during the COVID-19 pandemic.MethodsWe made a descriptive cross-sectional study. All workers were invited to participate in an online survey during May 2021. Individual characteristics and frequency of direct exposure to COVID during professional activity were assessed. We used three Spanish versions of psychometric scales: the Patient Health Questionnaire to evaluate depressive symptomatology, the Generalized Anxiety Disorder scale, which detects anxiety, and the 4-item version of the PTSD checklist for DSM-5 for PTSD screening purposes. Chi-square tests and logistic regression were used to analyze the data.Results A total of 355 workers participated. Overall, 31% met the criteria for Major Depressive Disorder (PHQ-9&gt; 9), 36% for Generalized Anxiety Disorder (GAD-7&gt; 9) and 22% for Post-traumatic Stress Disorder (PCL-5&gt; 7). It has been found that young adult, women, those with prior mental disorders or those with greater exposure to COVID-19 are risk factors for any current mental disorder.ConclusionsThere are large mental healthcare needs among healthcare professionals. There is a clear need to closely monitor the extent to which these needs are adequately met. In the design of measures and interventions to reduce this impact, an individualized approach should be considered while taking into account sociodemographic variables, psychiatric history and the frequency of direct exposure to COVID-19.DisclosureNo significant relationships.

Moral Injury, Depression and Anxiety among Israeli Health and Social Care Workers During the COVID-19 Pandemic: The Moderating Role of Thwarted Belongingness

IntroductionThe COVID-19 pandemic can affect the mental health of health and social care workers (HSCWs) who are frontline workers in this continuous crisis. Following exposure to potentially morally injurious events (PMIEs) that undermine deeply held moral beliefs and expectations, HSCWs might experience moral injury (MI) and deleterious psychiatric consequences such as depression and anxiety symptoms.Objectives To examine associations between exposure to PMIEs, MI symptoms, depression, and anxiety symptoms. We also aim to assess the moderating role of thwarted belongingness in these associations.MethodsA sample of 243 Israeli HSCWs completed online validated self-report questionnaires in a cross-sectional designed survey in February and March 2021.ResultsAbout one-third (33.6%) of the sample met the criteria for major depressive disorder, 21.5% met the criteria for generalized anxiety disorder, and 19.1 % reported comorbidity of depression and anxiety. A moderated-mediation model shows that high thwarted belongingness intensified the relations between exposure to PMIEs and MI symptoms, and between MI symptoms and depression and anxiety symptoms. Importantly, the indirect effect of exposure to PMIEs on both depression and anxiety symptoms via MI symptoms existed only among those with high levels of thwarted belongingness.ConclusionsThe study’s findings highlight the mental burden of HSCWs during the COVID-19 pandemic and the contribution of MI to possible mental health consequences. Clinicians should be aware of the importance of high thwarted belongingness in depression and anxiety sequelae of exposure to PMIEs among HSCWs.DisclosureNo significant relationships.

The safety and efficacy of psilocybin therapy in patients with cancer and major depressive disorder.

12097 Background: More than 17 million people in the U.S. live with cancer and up to 25% of them have major depression. Depression leads to lower treatment adherence, reduced quality of life, and higher rates of mortality in cancer. Yet, interventions used to treat depression in patients with cancer have limited success. Prior trials using psilocybin to treat anxiety and depression associated with cancer suggested improvements in psychological distress. However, treatment in a homogenous psychiatric sample has yet to be investigated. Further, psilocybin has not been given in groups, and in a setting conducive to the “whole person” approach to treatment. This trial built upon previous studies and tested the safety, feasibility, and efficacy of psilocybin therapy in cancer patients diagnosed with major depressive disorder (MDD), with the novel use of group treatment in a cancer center setting. Methods: Phase II, single-center, open label trial, where 30 patients received a dose of 25 mg of psilocybin. Inclusion criteria: 1) age ≥ 18 years, 2) met criteria for MDD, 3) a Hamilton Depression Rating Scale score ≥ 18 at baseline, 4) diagnosis of a malignant neoplasm. Patients who had curative treatment for cancer as well as those with advanced metastatic disease were included. Patients were divided into cohorts and they received 1 group preparation session, simultaneous administration of psilocybin, and 2 group integration sessions. Therapeutic care was also provided before, during, and after the session using the 1:1 model of psychological support. The primary outcome measures for safety were adverse events, vital signs, ECGs, blood tests, and suicidality scores (C-SSRS). The secondary and exploratory outcome measures consisted of 15 assessments conducted at baseline and post-treatment at day 1, week 1, week 3, and week 8 to determine the efficacy of treatment. Results: A total of 30 patients were enrolled over the course of only 8 months with an attrition rate of 0%. All completed the trial with no serious adverse events. Beyond high tolerability of the treatment, we also found a clinically meaningful change in depressive symptoms. After a single administration of psilocybin therapy, the average score on the Montgomery Asberg Depression Rating Scale (MADRS) dropped by 19.1 points (95% CI, 22.3 to 16.0, p &lt; 0.0001). A sustained response rate (a decrease of ≥ 50% in the MADRS score from baseline to week 8) was seen by 24 patients. 50% of patients showed complete remission of depression symptoms (a MADRS score &lt; 10) one week after treatment, which was sustained for up to 8 weeks. Conclusions: This study adds to the growing body of psilocybin research with promising results showing the safety, feasibility, and efficacy of simultaneous psilocybin treatment in patients with cancer with MDD. The value of group support for patients with cancer was also explored, with implications for increased scalability of psilocybin therapy in real-world settings. Clinical trial information: NCT04593563.

Suicide attempt endophenotypes: Latent profiles of child and adolescent aggression and impulsivity differentially predict suicide attempt in females

Suicide is a leading cause of death in young adulthood. Identifying early prevention targets to reduce later suicide is a public health priority. Impulsivity and aggression in early childhood may represent actionable early prevention candidate endophenotypes for later suicidal behavior. Our objective is to to understand the association of aggression and impulsivity trajectories with mental health outcomes to inform future prevention efforts. Participants were part of a longitudinal cohort of a preventative intervention trial (n = 597) and predominantly Black. They were assessed for aggressive and impulsive behaviors yearly in 1st–3rd and 6th–12th grades, and provided mental health data via self-report beginning in 6th grade. Longitudinal latent profiles of aggressive and impulsive behaviors were derived for males and females and used to determine whether profiles was associated with lifetime suicide attempt and meeting diagnostic criteria for major depressive disorder. Two impulsivity and aggression classes were found for males, characterized by low behaviors or moderate to high behaviors across development. Three classes were found for females, one of which was characterized by an undulating pattern of behaviors. For females, the class of severe behaviors was associated with significant risk of suicide attempt (Wald = 6.01, p = 0.05). No relationship was found for males or for MDD diagnosis. An endophenotype model of impulsivity and aggression in predicting later suicide attempt was supported in females, but not males. Results underscore the importance of evaluating sex differences in suicide research and the potential identification of females at risk for later suicidal behavior in school settings.

Efficacy and Acceptability of Remote Cognitive Behavioral Therapy for Patients With Major Depressive Disorder in Japanese Clinical Settings: A Case Series

Remote cognitive and behavioral therapy (CBT) via videoconference has been garnering attention as a means of improving access to CBT for depression, in particular during the coronavirus disease 2019 pandemic. However, there is a lack of evidence supporting its implementation in Japanese clinical settings. This case series aimed to establish preliminary evidence of whether remote CBT can be an effective therapy for major depression in Japanese clinical settings. Five patients who met the diagnostic criteria for major depressive disorder were enrolled and underwent remote CBT via videoconference and face-to-face assessment interviews. The results showed that remote CBT via videoconference improved depressive symptoms, enabling a relatively high level of patient satisfaction and working alliance. Moreover, detailed feedback from our patients showed that continuous monitoring was preferable for increasing treatment engagement. Further research is warranted to test the efficacy and acceptability of remote CBT via videoconference for treating major depression.

The Psychological Impact of COVID-19 on Medical Students Interested in Obstetrics and Gynecology [A57

INTRODUCTION: The COVID-19 pandemic has caused mental health distress among health care professionals. This study aimed to evaluate the psychological impact of COVID-19 on medical students interested in obstetrics and gynecology at medical schools in two early epicenters of COVID-19. METHODS: This study was approved by the Weill Cornell Medicine Institutional Review Board. An online questionnaire was distributed to allopathic medical students in Washington and New York. The survey assessed mental health from March to April 2020 via the Patient Health Questionnaire, Generalized Anxiety Disorder Questionnaire, and questions on self-rated mental health. RESULTS: Out of 1,139 students who completed the survey, 63 reported a plan to pursue residency training in obstetrics and gynecology. Forty-six (74%) reported an overall deterioration in mental health, 34 (59%) reported depressive symptoms, and 38 (65%) reported anxiety symptoms. Seventeen (28%) students met criteria for major depressive disorder and 16 (27%) for anxiety disorder. Twenty-three (37%) reported at least one close contact with symptoms or diagnosis of COVID-19 and 7 (11%) reported at least one close contact with COVID-19-related death. Commonly cited self-care tactics included staying in touch with friends/family (92%), entertainment (81%), and fitness (65%). When compared to the overall population of students, there were no significant differences in responses for students interested in obstetrics and gynecology. CONCLUSION: Students in this study experienced high levels of depressive and anxiety symptoms. Medical trainees are already at an increased risk for depression and anxiety relative to the general population, making it critical for medical schools to understand students’ perspectives and prioritize mental health.

Inflammatory phenotype and T‐cell mitochondrial reactive oxygen species in young adults with major depressive disorder

BackgroundMajor depressive disorder (MDD) is prevalent in young adults and projected to rise further with the COVID pandemic. Notably, MDD is associated with an increased risk of cardiovascular disease (CVD) and mortality. Although the mechanisms are unclear, evidence supports chronic systemic inflammation as a major contributor to CVD risk in older adults with MDD. However, whether an inflammatory phenotype is present in young adults with MDD prior to the onset of CVD and other comorbidities is equivocal. Recent work has implicated the sympathetic nervous system and specifically norepinephrine as a potent driver of inflammation via stimulating an increase in T‐cell mitochondrial reactive oxygen species (T‐cell mitoROS). Given previous findings of elevated plasma norepinephrine and inflammation in MDD, the purpose of this study was to examine the potential for a T‐cell mitoROS pro‐inflammatory pathway in young otherwise healthy adults with MDD. We hypothesized that young adults with MDD but otherwise free of clinical disease would have augmented circulating pro‐inflammatory cytokines and T‐cell mitoROS compared to young healthy adults without MDD (HA).MethodsAll participants underwent a structured diagnostic neuropsychiatric interview to determine the presence or absence of MDD based on the DSM‐5 diagnostic criteria for MDD. Systemic pro and anti‐inflammatory cytokines and T‐cell mitoROS were measured in 14 healthy young adults with MDD of mild‐to‐moderate severity (non‐medicated; age: 23±2 years) and 11 HA (age: 22±1 years). Serum cytokines were detected using LEGENDplex Human Essential Immune Response panel and assessed by flow cytometry. Seven serum cytokines related to the norepinephrine‐T‐cell mitoROS‐inflammation pathway were measured. Immune cells were isolated from whole blood by red blood cell lysis. T‐cell mitoROS was measured by labeling with antibodies against CD3+ (total T cells) and mitoROS targeted fluorogenic dye (MitoSoxRED) and assessed by flow cytometry. All data are expressed as mean ± SE.ResultsFor pro‐inflammatory cytokines, there were no differences between MDD and HA for IL‐6 (41±18 pg/mL; 92± 66 pg/mL, P=0.66), IL‐17A (7±3 pg/mL; 17±8 pg/mL, P=0.13), TNF‐α (19±9 pg/mL; 36±18 pg/mL, P=0.20), IFNγ (120±70 pg/mL; 201±137 pg/mL, P=0.34) or IL‐2 (5±2 pg/mL; 13±6 pg/mL, P=0.25), respectively. Likewise, no differences were found in anti‐inflammatory cytokines between MDD and HA for IL‐10 (18±9 pg/mL; 78±57 pg/mL, P=0.19) or IL‐4 (33±15 pg/mL; 95±46 pg/mL, P=0.13), respectively. In contrast, T‐cell mitoROS was significantly elevated in MDD (34402±13353 a.u) compared to HA (6258±2942 a.u, P&lt;0.05).ConclusionThese preliminary findings suggest T‐cell mitoROS but not circulating cytokine profiles are different between young adults with and without MDD. Thus, an elevated T‐cell mitoROS may represent an early marker of immune system alterations and inflammation in MDD.

Low omega-3 polyunsaturated fatty acids predict reduced response to standard antidepressants in patients with major depressive disorder.

Major depressive disorder (MDD) is characterized by a high rate of treatment resistance. Omega (ω)-3 polyunsaturated fatty acids (PUFAs) were shown to correlate with depressive phenotype both in rodents and in humans. However, few studies to date have investigated the role of PUFAs in antidepressant response. The primary aim of this study was to assess the link between baseline PUFA composition and changes in depressive symptoms as well as antidepressant response in a multicenter study of depressed patients. Sixty depressed adults who met criteria for MDD according to DSM-IV-TR were recruited. Neuropsychiatric evaluations occurred at baseline and after 4 and 8 weeks of treatment with standard antidepressants, including escitalopram (N = 45), sertraline (N = 13) and venlafaxine (N = 2). At study endpoint, patients were stratified into responders (R) or non-responders (NR) based on their MADRS (Montgomery-Åsberg Depression Rating Scale) score. Baseline PUFA levels were assessed and their association with clinical response was determined. Lower ω-3 PUFA levels were associated to worse baseline symptomatology. Baseline levels of PUFAs were significantly different between R and NR, with R exhibiting lower docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and ω-3 index; and higher ω-6/ω-3 ratio than NR before the start of antidepressant treatment. DHA levels as well as the ω-3 index and ω-6/ω-3 ratio significantly predicted response to antidepressants at study endpoint. These results show that baseline levels of PUFAs predict later response to standard antidepressants in depressed subjects. They suggest that PUFA intake and/or metabolism represent a novel modifiable tool for the management of unresponsive depressed patients.

Adverse Childhood Experiences and (New Onset) Late-Life Depression, A Case Report.

<h3>Introduction</h3> Childhood abuse has been strongly related to late-life depression and its comorbidities. About one-third of later-onset disorders have been linked to childhood abuse. Individuals who experienced childhood abuse may be able to maintain psychological wellbeing throughout middle age but may be disturbed in later life. Older adults may recall old traumas when reflecting on their lives, and memory of their past traumas may function as new stressors. We report the case of a 72-year-old Black male who presented with suicidal ideation and other symptoms of a depressive episode. His history was significant for extensive childhood trauma. His depressive symptoms ensued after reflecting and ruminating on traumatic childhood experiences. <h3>Methods</h3> We reviewed current literature describing relationship between adverse childhood experiences and depression in late life. No written consent was obtained from the patient as there is no patient identifiable data included in this case report. <i>Case summary:</i> Patient is a 72-year-old black male with no known past psychiatric history, and past medical history of hypertension, diabetes, and dyslipidemia. Two weeks before presentation, he became irritable, and occasionally expressed suicidal ideation. He presented because of changes in behavior, outbursts, and aggression. He reported "miserable" and depressed mood, poor appetite, and fatigue in context of ruminating on traumatic childhood experiences. He endorsed reduced concentration, sleep problems, and anhedonia. He described frequent emotional and physical abuses by his father, from childhood until adolescence. He did most of the house chores while his younger siblings ate, and he ate what was left over. He also reported being treated unequally and unfairly by his paternal aunts. He believed this was due to his darker skin color compared to his siblings. He coped with the psychological effects of the childhood abuse most of his life until few weeks before presentation. He found himself ruminating more on these past experiences which made him depressed. He refused meals for 2-3 days and expressed suicidal thoughts prior to presentation. On examination, he exhibited psychomotor retardation. His affect was flat and constricted. Mini-mental State Exam score was 28 out of 30. Blood glucose was 33 mg/dL. CT head showed mild cerebral atrophy and mild periventricular white matter disease. Patient was admitted to telemetry for treatment of hypoglycemia. Psychiatry was consulted for evaluation of depressed mood, and aggression. Once medically stable, he continued to endorse depressive symptoms in context of rumination on childhood experiences. He met DSM-5 criteria for Major depressive disorder, single episode, severe. He was commenced on Mirtazapine 7.5 mg po at bedtime and was to follow-up in our clinic. However, he was lost to follow-up. When contacted, he declined further care. <h3>Results</h3> Our patient had significant childhood trauma. Major depressive disorder due to another medical condition was plausible on account of his past medical history. We also considered delirium, however patient continued to ruminate on childhood experiences after he was medically stable. It is unclear if our patient had undiagnosed chronic subclinical depression, hence it would be helpful to explore his core cultural beliefs and attitude toward mental health treatment. Our patient was going through life transitions like retirement and isolation related to the covid-19 pandemic. These psychosocial stressors may have precipitated a depressive episode or compounded his ruminations on his adverse childhood experiences. We also considered the possibility of prodromal neurocognitive disorder given findings on his brain imaging. Although his MMSE was noncontributory, continuous follow-up and further workup was needed. Despite the limitations and complexity of our case report, we postulate a strong link between our patient's major depressive episode and his adverse childhood experiences. While it is important to consider other differential diagnoses when assessing older adults with depression, it is helpful to screen for adverse childhood experiences. The ACE questionnaire is a reliable and valid measure of childhood adversity. Our case report corroborates findings shown in studies relating adverse childhood experience with new onset late-life depression and other disorders. <h3>Conclusions</h3> Our case report corroborates findings shown in studies relating adverse childhood experience with new onset late-life depression. We hope this article will increase awareness of the relationship between adverse childhood experiences and late-life depression and the need to screen older adults with depression for this important stressor. <h3>This research was funded by</h3> We did not receive any funding for this case report.

Optimizing Outcomes of Treatment-Resistant Depression (TRD) in Older Adults (OPTIMUM): Measures of Psychological Well-Being

<h3>Introduction</h3> The "Optimizing Antidepressants for Treatment-Resistant Depression in Older Adults" (OPTIMUM) study, funded by the Patient-Centered Outcomes Research Institute, is a 5-center collaboration that randomized 621 depressed individuals aged 60+ with treatment-resistant depression (TRD), the largest pharmacotherapy trial of TRD in late life. A key goal of this pragmatic trial was to measure outcomes of interest to patients, which in this trial included psychological wellbeing. This construct is closely tied to psychological and physical functioning and can be measured by self-report. <h3>Methods</h3> Participants were recruited and randomized if they were 60 years and older, met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for Major Depressive Disorder, and had a score of 10 or higher on the Patient Health Questionnaire (PHQ-9), despite having been treated with at least two antidepressants with an adequate dosage and for at least four weeks (with previous psychotropic medications being different from the medications being testing in OPTIMUM). Upon study entry, participants were randomized to one of three strategies: augmentation with aripiprazole, augmentation with bupropion, or switch to bupropion. Treatment effectiveness was assessed using the Montgomery Asberg Rating Scale (MADRS) after ten weeks of treatment. Participants were also tested at the beginning and end of this 10-week step with the NIH Toolbox Psychological Well-being battery. Two wellbeing scales were used: positive affect (34 items) and general life satisfaction (16 items). Positive affect is characterized as happiness, contentment, and interest in pleasurable or achievement–relevant activities. Each item is scored on a 5-point scale ranging from "not at all" to "very much". General life satisfaction is the cognitive evaluation of life experiences; items assessing this concept are usually phrased in a general or global way rather than having a momentary or recent recall period. These items administered are scored on either a 5-point or 7-point scale ranging from "strongly disagree" to "strongly agree." <h3>Results</h3> Of the 621 study participants, 212 were randomized to augmentation with aripiprazole, 206 to augmentation with bupropion, and 203 to a switch to bupropion. Participants randomized to augmentation with either aripiprazole or bupropion showed a statistically significant improvement in their general life satisfaction subscale score (aripipirazole: 2.99, p< 0.0001; bupropion: 2.61, p=0.0001), while those switched to bupropion did not. Participants in either of the two augmentation arms also showed a statistically significant improvement in positive affect (aripiprazole: 5.35, p< 0.0001; bupropion: 5.02, p< 0.0001) while those switching to bupropion did not. <h3>Conclusions</h3> Among older adults with TRD, augmentation with aripiprazole or bupropion was associated with a statistically significant improvement in psychological well-being and positive affect, while a switch to bupropion monotherapy did not. Further research is needed to replicate findings. <h3>This research was funded by</h3> Patient-Centered Outcomes Research Institute (PCORI)

Evaluating the Effects of the COVID-19 Pandemic on Depression and Resilience in Older Adults

IntroductionSince March 2020, the COVID-19 pandemic has affected the physical and mental health of older adults. We know how social isolation and loneliness may adversely affect one's health, mood, and cognition, specifically in adults over 65. However, when faced with adversity, studies have shown older adults to be at least, if not more, resilient than their younger counterparts. This study aimed to understand the extent of psychosocial impact the pandemic had on older adults with and without depression currently enrolled in the Neurobiology of Late-Life Depression (NBOLD) Study. In conjunction with the Brief Carroll Depression and Brief Resilience Scales, we used a novel measure of pandemic-related experiences across several life domains in older adults, the Epidemic-Pandemic Impacts Inventory-Geriatrics Adaptation (EPII-G).Based on prior knowledge of how detrimental social isolation can be on mental health and how resilient older people can be, we hypothesized that depression scores would increase during the pandemic. We also suspected that resilience scores at least remain constant or possibly improve.According to the Centers for Disease Control and Prevention, adults 65 and older account for 14.3% of cases and 80% of COVID-19 related deaths in the United States. Between “stay at home” guidelines and visitation restrictions along the continuum of aging services, there is concern over the lasting effects of social isolation. Therefore there is a need to examine and map the ways by which one's physical and social environments impact loneliness. Although loneliness is considered to be a subjective feeling related to a person's experience, it is one of three main factors leading to depression and a factor in cause of suicide.Despite this, one characteristic has shown to be protective against these stressors. Resilient individuals exhibit internal qualities like self-reliance and optimism and have external support systems in place allowing them to adapt more readily in the face of change.There is still little research available regarding outcomes and factors from COVID-19 impacting older adults’ depression and resilience, which this study aims to address, while strengthening the validity of the EPII-G.MethodsThe study population included older adults previously diagnosed with Major Depressive Disorder (MDD) and non-depressed controls, enrolled in the N-BOLD study at University of Connecticut Health Center. Inclusion criteria for participants included: age of 60 or greater, ability to read and write English, and Mini-Mental State Examination score of 25 or greater. Depressed subjects met the criteria for MDD, either episodic or recurrent. Participants provided additional informed consent for the study. Baseline data was collected prior to the COVID-19 pandemic, with second interviews taking place mid-2020, and additional follow-up summer 2021. The study utilized the EPII-G, Brief Carroll Depression Scale (BC), and Brief Resilience Scale (BRS). The surveys were verbally administered by the research staff both in-person and via phone interviews.ResultsFrom mid-2020 to summer 2021, both depressed and emotional control groups saw an increase in total BC depression score. Older adults with a history of depression showed BC scores increase from 2.47 to 3.12, and older controls experienced increases from 0.5 to 1.11.Despite an increase in depression score, both cohorts also saw an increase in BRS resilience score, with the depressed group and control group showing increases in BRS from 18.18 to 19.75 and 20.93 to 23.33 respectively.We found a negative correlation between positive home life of person in the home on EPII-G and BC scores, with a correlation coefficient of -0.3645 and p-value of 0.0616. There was also a positive correlation with positive home life of person in the home and social activities for self and BRS scores, with correlation coefficients of 0.26304 and 0.29869 and p-values of 0.0845 and 0.0489 respectively.ConclusionsIndividuals who didn't see disruption to their normal routine and had the means to communicate with loved ones had strong psycho-social supports in place, but were still vulnerable to the detrimental effects of isolation. Through their years of experience, older adults have had the time needed to develop protective factors such as self-reliance. They have also lived through poignant events such as war and economic depression, putting suffering into perspective. As many no longer work or attend school like their younger counterparts, they experienced less disruption to daily routine. This strong foundation has contributed to the resilience needed to overcome the stressors that surfaced during the pandemic.By continuing to follow these groups, we can evaluate changes in depressive symptoms, how long they persist, and if individuals return to baseline over time, as well as to continue to strengthen the EPII-G's validity.This research was funded byResearch is supported by National Institute of Mental Health grant R01 MH108578.Chart: https://apps.aagponline.org/abstracts/uploads/2022/f1peuxbywkablos.pdf

Comorbid major depressive disorder in cognitive-behavior group treatment for social anxiety disorder: An examination of processes of symptom change.

Individuals with social anxiety disorder (SAD) typically have elevated depressive symptoms and approximately 50% also meet criteria for major depressive disorder (MDD; Beesdo et al., 2007). In the present study, we examined the relationship between social anxiety and depressive symptoms during cognitive-behavior group treatment (CBGT) for SAD. Specifically, we compared individuals with SAD and comorbid MDD and individuals with SAD without MDD to examine the role of MDD as a moderator of social anxiety-depression relationship. Participants were 90 individuals seeking treatment for SAD (36% were diagnosed with MDD), who completed self-report measures of social anxiety and depression every 2 weeks during CBGT. Lower level mediational modeling indicated that for individuals without MDD, a reciprocal relationship was observed in which changes in both social anxiety and depressive symptoms mediated changes in each other. However, changes in social anxiety explained all subsequent changes in depression, whereas changes in depression explained 11.26% of subsequent changes in social anxiety. For individuals with both SAD and MDD, neither social anxiety nor depression significantly mediated changes in each other. Our findings suggest that different processes of change occur for individuals with and without MDD and clinical implications of these findings are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological Traits of Patients With Depression Comorbid With Chronic Pain: Are Complaint and Competitive Tendency Related to Pain?

BackgroundModern-Type Depression (MTD) is a category of depression that has been studied mainly in Japan; however, no study has attempted to determine its relation to chronic pain.AimTo determine possible associations between psychological traits related to MTD and the chronic pain of patients at psychiatric clinics.MethodTwo hundred and twenty-one first time patients who visited the psychiatric clinic at a Japanese university medical center or an associated clinic were enrolled. The Hamilton Depression Rating Scale was used to measure depressive symptoms. The 22-item Tarumi's Modern-Type Depression Trait Scale (TACS-22), Achievement Motive, and 20-item Toronto Alexithymia Scale were used to assess psychological traits related to depression and chronic pain. The clinical diagnosis of each patient was confirmed by use of the Structured Clinical Interview for DSM-IV Axis I Disorders, administered by experienced specialists. The medians of the psychological traits identified were compared between patients with or without chronic pain. Analysis was also done of patients with Major Depressive Disorder (MDD).ResultOf the 221 patients, 139 had chronic pain. Patients with chronic pain had more severe depressive symptoms, Alexithymia, and high scores for the complaint trait of MTD. Seventy-three of the 221 patients met the criteria for MDD (53 had chronic pain). Patients with MDD comorbid with chronic pain had a higher competitive achievement score, severe depression, and difficulty identifying feelings.ConclusionComplaint and competitive traits were shown to be related to chronic pain in psychiatric settings. Further study will allow us to design multidimensional approach for patients suffering from depression.

Do Sleep Disturbances Improve Following Psychoanalytic Psychotherapy for Adolescent Depression?

Sleep disturbance is often a prominent symptom in adolescents diagnosed with major depressive disorder (MDD). Recent evidence indicates that short-term psychoanalytic psychotherapy (STPP) for depression may have an effect in reducing co-occurring sleep disturbance in youth. It is unknown if transference work (exploration of the patient–therapist relationship) has an additional effect in reducing sleep disturbance. Adolescents aged 16–18 years (n = 69, 84% female) who met diagnostic criteria for MDD based on the Mini International Neuropsychiatric Interview (M.I.N.I) were randomized to either STPP with transference work or without. Sleep problems were assessed at baseline, therapy session 20 (20 weeks), post-treatment (28 weeks), and one-year follow-up (80 weeks) with the Symptom Checklist-90-R. At baseline, 69% of the adolescents exhibited moderately to extreme sleep difficulties. Sleep disturbance was significantly correlated to depression depth at session 20 and at follow-up. Symptoms of insomnia significantly decreased from baseline to the end of treatment. Treatment gains were maintained until follow-up. No differences in recovery of sleep disturbance were found between the two treatment groups. The findings suggest that sleep disturbance improves following STPP for depression, with or without transference work. Future research should assess those with residual symptoms by different sleep measures.

The wounded helper: moral injury contributes to depression and anxiety among Israeli health and social care workers during the COVID-19 pandemic

ABSTRACT Background The COVID-19 pandemic can affect the mental health of health and social care workers (HSCWs) who are frontline workers in this crisis. The pandemic poses unique challenges to HSCWs as they face morally daunting decisions while working with limited knowledge and resources. This study examined the relationships between exposure to potentially morally injurious events (PMIEs) and depression and anxiety among HSCWs. Method A sample of 243 Israeli HSCWs completed validated self-report questionnaires that include measures of depression, anxiety, exposure to PMIEs, perceived stress, and moral injury symptoms. Results About one-third (33.6%) of the sample met the criteria for major depressive disorder, 21.5% met the criteria for generalized anxiety disorder, and 19.1% reported comorbidity of depression and anxiety. Beyond demographic, COVID-19, and work-related characteristics, PMIEs contributed to depression and anxiety among HSCWs. The integrative model indicated the mediating role of perceived stress and moral injury symptoms in the associations of PMIEs with depression and anxiety. Conclusions The study’s findings highlight HSCWs’ mental burden during the COVID-19 pandemic and the important contribution of exposure to PMIEs to this burden. Clinicians treating HSCWs coping with depression and anxiety following the COVID-19 should also attend to moral injury symptoms.