Current Depressive Symptoms Research Articles

Dissociation as a mediator of interpersonal trauma and depression: adulthood versus childhood interpersonal traumas3

Extensive research has established that interpersonal trauma is related to depression and dissociation severity. Extending prior research, this study found that childhood and adulthood interpersonal traumas are related to depressive symptoms and examined the role of dissociative process as a mediator. Two hundred eighty-nine adult participants retrospectively reported on traumatic experiences and current symptoms of dissociation and depression, indicating that both childhood and adulthood interpersonal traumas are related to the severity of depression. However, childhood interpersonal trauma was associated with a higher level of dissociative symptoms. Moreover, it was suggested that dissociation serves as a pathway through which childhood interpersonal trauma influences depression, although this relationship was not observed for adulthood interpersonal trauma. In conclusion, this study highlights the potential role of dissociation in the development and maintenance of depression, particularly among individuals who have experienced childhood interpersonal trauma. These findings suggest that interventions targeting dissociation show potential for mitigating retrospective depression, especially for survivors of childhood interpersonal trauma.

A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression-the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial.

Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA. This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)-an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk. This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development. The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ≥66% for questionnaires and ≥48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication. The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients. ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696. DERR1-10.2196/56882.

Depression, anxiety and cognitive function in persons with inflammatory rheumatic diseases: cross-sectional results from the German National Cohort (NAKO)

ObjectiveTo assess the presence of mental health disorders in persons with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and Sjögren’s disease (SjD) (all: inflammatory...

Unraveling the Associations Between Voice Pitch and Major Depressive Disorder: A Multisite Genetic Study.

Major depressive disorder (MDD) often goes undiagnosed due to the absence of clear biomarkers. We sought to identify voice biomarkers for MDD and separate biomarkers indicative of MDD predisposition from biomarkers reflecting current depressive symptoms. Using a two-stage meta-analytic design to remove confounds, we tested the association between features representing vocal pitch and MDD in a multisite case-control cohort study of Chinese women with recurrent depression. Sixteen features were replicated in an independent cohort, with absolute association coefficients (beta values) from the combined analysis ranging from 0.24 to 1.07, indicating moderate to large effects. The statistical significance of these associations remained robust, with P-values ranging from 7.2 × 10-6 to 6.8 × 10-58. Eleven features were significantly associated with current depressive symptoms. Using genotype data, we found that this association was driven in part by a genetic correlation with MDD. Significant voice features, reflecting a slower pitch change and a lower pitch, achieved an AUC-ROC of 0.90 (sensitivity of 0.85 and specificity of 0.81) in MDD classification. Our results return vocal features to a more central position in clinical and research work on MDD.

Mental Health, Socioeconomic Position, and Oral Health: A Path Analysis.

Mental health conditions and poor oral health outcomes share bidirectional links, and both are linked to factors related to socioeconomic position (SEP). We used nationally representative survey data to describe the complex interplay of SEP, mental health, oral health behaviors, dental treatment seeking, and oral health. We used data from the 2022 State of Oral Health Equity in America survey, which collects data from US adults on prior depression diagnosis and current depressive symptoms via the Patient Health Questionnaire-9 and demographic characteristics (age, sex/gender, race, ethnicity), SEP (education, income, employment, home ownership, dental insurance), oral health behaviors (brushing and flossing frequency), dental treatment seeking (time since last visit, plans for visit in the coming year), and self-rated oral health (feeling self-conscious due to poor oral health, having symptoms of poor oral health). We used structural equation modeling to identify latent variables and fit the path analytic models. In the total sample (N = 5,682), SEP was significantly associated with dental treatment seeking (standardized parameter estimate [SE] = 0.55 [0.05]), oral health behaviors (standardized parameter estimate [SE] = 0.34 [0.04]), and mental health (standardized parameter estimate [SE] = 0.59 [0.05]). These factors, in turn, were significantly associated with self-rated oral health (estimates ranging from 0.20 to 0.54, SEs ranging from 0.04 to 0.05). SEP, which involves several major social determinants of health, is directly associated with mental health and indirectly associated with self-rated oral health status, with mental health modifying the relationship between SEP and self-rated oral health. Findings emphasize the need to integrate medical, dental, and behavioral health with the goal of providing comprehensive person-centered care.

Barriers And Facilitators Tophysical Activity Among Adults With And Without Current Depressive Symptoms

Barriers And Facilitators Tophysical Activity Among Adults With And Without Current Depressive Symptoms

Holiday or hell? Emotion regulation and memory of depressive symptoms during lockdown.

The ongoing repercussions of the COVID-19 pandemic provide an unparalleled context to examine how distressing events are remembered. Prior theory and research suggest that (a) distress during lockdowns may fade and be remembered as less distressing, or remain salient and be remembered as more distressing, than initially experienced and (b) emotional suppression and cognitive reappraisal may predict these memory biases. We test these possibilities by assessing depressive symptoms and emotion regulation during two lockdowns: at the start of the pandemic (Lockdown 2020) and 17 months later (Lockdown 2021) in a sample of parents with young children (N = 272). We assessed tracking accuracy, directional bias, and projection bias in memory of depressive symptoms in Lockdown 2020, and the moderating role of emotion regulation at the time of encoding (Lockdown 2020) and recall (Lockdown 2021). People experiencing more depressive symptoms later in the pandemic (2021) remembered the start of the pandemic (2020) to involve more depressive symptoms than initially experienced (projection bias). People engaging in greater emotional suppression at recall (2021) were less likely to project their current depressive symptoms onto memory of the prior lockdown (lower projection bias) and remembered feeling lower depressive symptoms than initially experienced (underestimation directional bias). By contrast, people engaging in cognitive reappraisal at recall (2021) remembered feeling greater depressive symptoms than they initially experienced (overestimation directional bias). These unexpected results indicate that emotion regulation may shape memory of emotion during real-life challenges differently than patterns observed in lab-based research and may reflect helpful coping with life events. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Major depression recurrence is associated with differences in obesity-related traits in women, but not in men.

Obesity-related cardiometabolic comorbidity is common in major depressive disorder (MDD). However, sex differences and MDD recurrence may modify the MDD-obesity-link. Sex-specific associations of MDD recurrence (single [MDDS] or recurrent episodes [MDDR]) and obesity-related traits were analyzed in 4.100 adults (51.6% women) from a cross-sectional population-based cohort in Germany (SHIP-Trend-0). DSM-IV-based lifetime MDD diagnoses and MDD recurrence status were obtained through diagnostic interviews. Obesity-related outcomes included anthropometrics (weight, body mass index, waist- and hip-circumference, waist-to-hip ratio, waist-to-height ratio), bioelectrical impedance analysis of body fat mass and fat-free mass, and subcutaneous (SAT) and visceral adipose tissue (VAT) from abdominal magnetic resonance imaging. Sex-stratified linear regression models predicting obesity-related traits from MDD recurrence status were adjusted for age, education, and current depressive symptoms. 790 participants (19.3%) fulfilled lifetime MDD criteria (23.8% women vs. 14.5% men, p<0.001). In women, MDDS was inversely associated with anthropometric indicators of general and central obesity, while MDDR was positively associated with all obesity-related traits, except waist-to-hip ratio and fat-free mass. In women, MDDR versus MDDS was associated with higher levels of obesity across all outcomes except fat-free mass. In men, MDD was positively associated with SAT regardless of MDD recurrence. Additionally, lifetime MDD was positively associated with VAT in men. Results remained significant in sensitivity analyses after exclusion of participants with current use of antidepressants. The MDD-obesity association is modified by MDD recurrence and sex independent of current depressive symptoms. Accounting for sex and MDD recurrence may identify individuals with MDD at increased cardiometabolic risk.

Mental health in midwifery students: A French nationwide survey

BackgroundPoor mental health in health students is a major public health issue, impacting personal quality of life and functioning, curriculum and care quality to patients. ProblemFew studies to date have examined mental health in midwifery students. AimTo evaluate the midwifery students'mental health. MethodsAn online cross-sectional survey was performed between 02/11/2023 and 11/12/2023. Anonymous questionnaires were sent to midwife students via academic emails by all midwife faculties in France. We assessed the prevalence of current depressive symptoms, current generalised anxiety symptoms, burnout for students in internship, 12-month major depressive disorder and 12-month suicidal ideation, humiliation, sexual harassment, and sexual aggression during their curriculum with specific questions. Multivariate logistic regression was performed to identify the main factors associated with major depressive disorder and suicidal ideation. FindingsAmong midwifery students, 1920 (response rate: 51.9 %) were included. The prevalences of current depressive symptoms, anxiety symptoms, burnout, 12-month major depressive disorder, and 12-month suicidal ideation were 62 %, 47 %, 44 %, 13 % and 14 %, respectively. Humiliation, sexual harassment and sexual aggression were reported by 19 %, 1.8 % and 0.7 %, respectively. In multivariable analyses, having important financial difficulties and sexual violence were associated with higher rates of major depressive episodes and suicidal ideation. Discussion>1 in 10 students suffered from 12-month depression and/or suicidal ideation, and almost half of them expressed various distressing symptoms. ConclusionThese alarming results highlighted the need for interventions to improve mental health in midwifery students, including safer conditions of education and living.

Effect of Parenting Style, attachment to parents and self-compassion on the occurrence and recovery motivation for non-suicidal self-injury in adolescents.

Non-suicidal self-injury (NSSI) is a worldwide mental health problem that deserves thorough investigation. This study aims to explore the effect of parenting styles, attachment to parents, and self-compassion on the occurrence of non-suicidal self-injury (NSSI) behavior in adolescents and whether these factors influence their recovery motivation. A total of 132 adolescents who had engaged in NSSI within the last year and 72 adolescents who had never engaged in NSSI were recruited from the Shenzhen Kangning Hospital and from primary and secondary schools and communities. Differences in the Hamilton Depression Scale (HAMD), Inventory of Parent and Peer Attachment (IPPA), Egma Minn av. Bardndosnauppforstran (EMBU), and Self-Compassion Scale (SCS) of participants were compared. A binary logistic model was established to measure the odds ratios of these variables on the occurrence of NSSI. In the NSSI adolescent sample, separate binary logistic models were created with NSSI impulse inhibition, NSSI resistance activity, and NSSI recovery motivation as dependent variables and with parenting styles, attachment to parents, and self-compassion as independent variables. Compared with adolescents with no NSSI behavior, those who had engaged in NSSI within the past year had higher scores on the HAMD, as well as higher EMBU-negative father parental behavior (punishment, excessive interference, rejection, and overprotection), EMBU-negative mother parental behavior (excessive interference, rejection, and punishment), and SCS negative self-compassion scores. Moreover, adolescents with NSSI had lower EMBU-father emotional warmth, EMBU-mother emotional warmth, IPPA-attachment to father, IPPA-attachment to mother, and SCS positive self-compassion scores. Current depressive symptoms and maternal punishment are risk factors for NSSI in adolescents, while positive self-compassion was a protective factor. Positive self-compassion can positively predict NSSI impulse inhibition, NSSI resistance activity, and NSSI recovery motivation. However, we unexpectedly found that the father's emotional warmth negatively predicts NSSI resistance activity. This study found that positive self-compassion has a significant impact on the prevention of and recovery from NSSI behavior in adolescents.

Exploring the relationship between low energy availability, depression and eating disorders in female athletes: a cross-sectional study

ObjectiveThis cross-sectional study aimed to investigate the role of low energy availability (LEA) in the interplay between depression and disordered eating/eating disorders (DE/EDs) among female athletes. The International Olympic Committee...

Association of dietary flavonoid intake with the prevalence and all-cause mortality of depressive symptoms: Findings from analysis of NHANES

BackgroundThis study aimed to explore the relationship between flavonoids intake and the prevalence and all-cause mortality of depressive symptoms in American adults. MethodsAnalyzing 2007–2008, 2009–2010, and 2017–2018 NHANES data, we examined the association between dietary flavonoid and depressive symptoms, including specific subclasses assessment and mortality outcomes tracking until December 31, 2019. Our methodology included weighted multivariate logistic regression, weighted cox proportional hazards regression and restricted cubic spline (RCS) models, supported by stratified and sensitivity analyses. ResultsAmong the 12,340 participants in total, 1129 exhibited depressive symptoms. The multiple logistic regression analysis showed a significant reduction in total flavonoid and subclass intake in individuals with current depressive symptoms. Adjusted odds ratios (ORs) for the highest quartiles were 0.69 for anthocyanidins and 0.63 for flavones. Interaction effects emerged in non-hypertensive, higher-income, and normal-weight groups for flavones intake. The RCS model indicated an L-shaped association between depressive symptoms and total flavonoid intake, with inflection points at 346 mg/day. During a median follow-up of 119 months, 148 deaths occurred among patients with depressive symptoms. Hazard ratios (HRs) for all-cause mortality showed a significant positive correlation between total flavonoid intake and survival in model 1 (HR = 0.56), with an optimal intake range of 45.2–948.3 mg/day according to the RCS model. LimitationsThe study relied on U.S. population survey data, potentially limiting generalizability. Unmeasured confounding factors may exist, and genetic factors were not considered. ConclusionsAdequate intake of flavonoids, especially anthocyanidins and flavones, is associated with reduced odds of depressive symptoms. Additionally, optimal intake ranges of flavonoid intake for mental health benefits were observed for all-cause mortality in population with depressive symptoms.

Acceptance and Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress: A Randomized Controlled Trial.

The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapeutic interventions such as acceptance and commitment therapy (ACT) on biopsychosocial outcomes. We aimed to examine the efficacy of an ACT program (intervention) in comparison with a cognitive behavioral therapy-informed psychoeducation program (active control) for individuals with IBD and coexistent psychological distress. Both programs were delivered online through a hybrid format (i.e., therapist-led and participant-led sessions). A total of 120 adults with IBD were randomized to either the intervention (N = 61) or active control groups (N = 59). Efficacy was determined using linear mixed models for group differences, in rate of changes in study outcomes, between baseline, postintervention, and 3-month follow-up. The primary outcome health-related quality of life significantly improved in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to postintervention ( t [190] = 2.15, P = 0.033) in favor of the intervention group with a medium effect size (β = 0.41, mean difference = 0.07, 95% confidence interval 0.01-0.12, P = 0.014). Similarly, the secondary outcome Crohn's disease activity significantly reduced in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to 3-month follow-up ( t [90] = -2.40, P = 0.018) in favor of the intervention group with a large effect size (β = -0.77, mean difference = -9.43, 95% confidence interval -13.72 to -5.13, P < 0.001) ( P = 0.014). Furthermore, when observing the rate of change in outcomes over time for the groups separately, anxiety symptoms and pain significantly improved in the intervention group only, and conversely, ulcerative colitis activity and stress symptoms significantly improved in the active control group only. All other outcomes (N = 14) significantly improved over time in both groups including IBD activity, gastrointestinal unhelpful thinking patterns, visceral anxiety, fatigue interference, fatigue severity, fatigue frequency, psychological inflexibility, self-efficacy, resilience, current health status, depression symptoms, IBD control, and pain catastrophizing; however, these changes were not significantly different between the groups. Both programs were of benefit to people with IBD and distress. However, ACT offers a significant added benefit for health-related quality of life and self-reported Crohn's disease activity and may be a useful adjuvant therapy in integrated IBD care.

The impact of neural emotion reactivity and regulation on the association between depression and suicide ideation in high-risk adults

BackgroundDepression is closely related to suicidal ideation (SI); however, it is unclear who is most vulnerable to SI within the context of depression. Research suggests that individual differences in emotion reactivity and regulation may be potential moderators of the link between depression and SI. Therefore, the current study tested this hypothesis using objective markers of emotion reactivity and volitional cognitive regulation capacity during functional magnetic resonance imaging (fMRI). MethodsAdults (n = 91) with active SI completed validated self-report measures of current depressive symptoms and SI severity. Participants completed an fMRI task designed to probe neural response to aversive stimuli and during cognitive reappraisal – a form of volitional emotion regulation. Activation of the amygdala during aversive emotion reactivity was measured. Activation of ventrolateral, dorsolateral, and dorsomedial prefrontal cortex (vlPFC, dlPFC, and dmPFC) during cognitive reappraisal were also measured. A series of hierarchical linear regressions testing the unique and interactive effects of depression symptoms and neural activation on severity of SI were conducted. ResultsAnalyses revealed a depression x amygdala activation interaction. The positive association between depression and SI severity was more robust in the context of high amygdala reactivity than low amygdala reactivity. Analyses also indicated there was no PFC activity (neural cognitive reappraisal) by depression interaction. LimitationsPsychoactive medications were allowed and all participants endorsed suicidal intent. ConclusionStrategies aimed at targeting exaggerated emotion reactivity within the context of depression may be beneficial.

Antitrans Policy Environment and Depression and Anxiety Symptoms in Transgender and Nonbinary Adults

With the increasing legislation restricting health care access for transgender and nonbinary (trans) populations in recent years, there has been limited research on how awareness of and concerns about legislative restrictions and protections influence mental health outcomes. To examine whether awareness of and concerns about the current policy environment regarding trans individuals are associated with depression and anxiety symptoms among trans adults. This study uses cross-sectional data collected between March and April 2023 from the Washington Priority Assessment in Trans Health (PATH) Project, an online study designed by, with, and for trans communities. All participants were trans adults, aged 18 years or older, living in Washington state. Awareness and concerns about the antitrans policy environment. The primary outcomes were depression and anxiety symptoms, assessed via the Patient Health Questionnaire-4. A series of multivariable regression models was used to assess the association between awareness and concerns about the antitrans policy environment and depression and anxiety symptoms. Models were adjusted for covariates, including demographics, social marginalization, and health care experiences. A total of 797 participants (653 women [81.93%]; 455 aged 18-29 years [57.09%]) were included. The majority screened positive for current depression (689 individuals [86.45%]) and anxiety (686 individuals [86.07%]) symptoms. Trans individuals who were concerned or worried about their rights being taken away (vs not) had significantly higher odds of current depression symptoms (adjusted odds ratio [aOR], 1.66; 95% CI, 1.08-2.54), as well as current anxiety symptoms (aOR, 2.67; 95% CI, 1.63-4.36). Those who knew (vs did not know) about state-level protective legislation had significantly lower odds of current depression symptoms (aOR, 0.44; 95% CI, 0.28-0.67), as well as current anxiety symptoms (aOR, 0.11; 95% CI, 0.04-0.25). When examining interaction effect estimates, trans individuals who correctly knew about the protective policies and were not worried about having their rights taken away reported the lowest odds of depression and anxiety. The findings of this cross-sectional study are consistent with research elucidating the negative mental health consequences of policies limiting health care access and provide insights into informing policies and interventions that target trans populations' worsened mental health outcomes as a result of antitrans legislation.

Psychosocial and sexual health among men with and without HIV who have sex with men: A cross-sectional nationwide study in Denmark.

The HIV/AIDS epidemic has disproportionately affected men who have sex with men (MSM) since its onset. Despite important medical advancements in treatment, the enduring effects of living with HIV continue to adversely impact the health and well-being of this population. This cross-sectional nationwide study examined psychosocial and sexual health among MSM in Denmark, comparing those living with and without HIV. Data from MSM living with HIV were collected from the SHARE study, a Danish nationwide survey that investigated psychosocial, sexual and reproductive health among people with HIV, and compared with data from MSM without HIV, retrieved from the nationally representative cohort study, Project SEXUS. Associations between HIV status and psychosocial and sexual health outcomes were examined using logistic regression models while controlling for potentially confounding variables. Among 369 MSM with HIV and 1002 MSM without HIV, logistic regression analyses revealed that living with HIV was significantly associated with having current symptoms of anxiety and depression and greater dissatisfaction with one's body. Additionally, MSM with HIV significantly more often than MSM without HIV reported low sexual desire, sexual inactivity, a lack of sexual needs in the last year and erectile dysfunction. Having received payment for sex was more frequently reported by MSM with HIV, as was sexualised drug use, including chemsex drugs. Compared with MSM without HIV, MSM with HIV in Denmark report a higher burden of mental health and sex life challenges.

Medical Debt and the Mental Health Treatment Gap Among US Adults

Medical debt is common in the US and may hinder timely access to care for mental disorders. To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care. Cross-sectional, nationally representative survey study of US adult participants in the 2022 National Health Interview Survey who had current or lifetime diagnoses of depression or anxiety. Self-reported lifetime clinical diagnoses of depression and anxiety; moderate to severe symptoms of current depression (Patient Health Questionnaire-8 score ≥10) and anxiety (Generalized Anxiety Disorder-7 score ≥10) irrespective of lifetime diagnoses; and past-year medical debt. Self-reported delaying and forgoing mental health care because of cost in the past year. Among 27 651 adults (15 050 [54.4%] female; mean [SD] age, 52.9 [18.4] years), 5186 (18.2%) reported lifetime depression, 1948 (7.3%) reported current depression, 4834 (17.7%) reported lifetime anxiety, and 1689 (6.6%) reported current anxiety. Medical debt was more common among adults with lifetime depression (19.9% vs 8.6%; adjusted prevalence ratio [aPR], 1.97; 95% CI, 1.96-1.98), lifetime anxiety (19.4% vs 8.8%; aPR, 1.91; 95% CI, 1.91-1.92), current depression (27.3% vs 9.4%; aPR, 2.34; 95% CI, 2.34-2.36), and current anxiety (26.2% vs 9.6%; aPR, 2.24; 95% CI, 2.24-2.26) compared with adults without the respective mental disorders. Medical debt was associated with delayed health care among adults with lifetime depression (29.0% vs 11.6%; aPR, 2.68; 95% CI, 2.62-2.74), lifetime anxiety (28.0% vs 11.5%; aPR, 2.45; 95% CI, 2.40-2.50), current depression (36.9% vs 17.4%; aPR, 2.25; 95% CI, 2.13-2.38), and current anxiety (38.4% vs 16.9%; aPR, 2.48; 95% CI, 2.35-2.66) compared with those without these diagnoses. Medical debt was associated with forgone health care among adults with lifetime depression (29.4% vs 10.6%; aPR, 2.66; 95% CI, 2.61-2.71), lifetime anxiety (28.2% vs 10.7%; aPR, 2.63; 95% CI, 2.57-2.68), current depression (38.0% vs 17.2%; aPR, 2.35; 95% CI, 2.23-2.48), and current anxiety (40.8% vs 17.1%; aPR, 2.57; 95% CI, 2.43-2.75) compared with those without the diagnoses. Medical debt is prevalent among adults with depression and anxiety and may contribute to the mental health treatment gap. In the absence of structural reform, new policies are warranted to protect against this financial barrier to mental health care.

Linking mentalizing capacity, shame, and depressive symptoms in the context of childhood maltreatment

BackgroundExperiences of childhood maltreatment have been shown to be a crucial predictor of depressive symptoms. ObjectiveThis study investigated the association between a history of maltreatment and depressive symptoms in a mixed sample of adults, exploring whether feelings of shame and impairments in mentalizing mediate this association and potentially represent health-affecting factors associated with an increase in depressive symptoms. Further, the association between feelings of shame and depressive symptoms was expected to be moderated by impairments in mentalizing. Participants and settingA mixed sample of 796 adults, including clinical and non-clinical participants, completed questionnaires assessing retrospectively rated experiences of childhood maltreatment, feelings of shame, mentalizing capacities, and current depressive symptoms in a cross-sectional design. MethodsThe hypotheses were tested using structural equation modelling. ResultsAssociations were found between childhood maltreatment, feelings of shame, impairments in mentalizing, and depressive symptoms. Impairments in mentalizing and feelings of shame partially mediated the link between maltreatment and depressive symptoms. However, impairments in mentalizing did not moderate the link between shame and depressive symptoms. ConclusionThe current study provides evidence for the role of metacognitive processes that affect mental health problems in the domain of depression. Psychological treatments that promote mentalizing capacities might be helpful in reducing feelings of shame, and consequently in reducing depressive symptoms.

A - 53 Age of First Exposure to Football and Later-Life Health Issues in Community-Dwelling Adults

Abstract Purpose This study assessed whether age of first exposure (AFE) to football was associated with later-life psychiatric and neurobehavioral symptoms, cognitive difficulties, and general health problems in a cohort of former amateur football players. Method A cross-sectional survey study of men with a history of amateur football exposure was conducted using the ResearchMatch online platform. Independent variables included demographics, number of lifetime concussions, AFE to football (dichotomized as AFE &amp;lt; 12 years vs. AFE ≥ 12 years), and total years of football participation. Main outcomes included current depressive (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorders-7), cognitive (British Columbia Cognitive Complaints Inventory), and neurobehavioral symptoms (Neurobehavioral Symptom Inventory). T-tests (AFE &amp;lt; 12 vs. AFE ≥ 12) and multivariable regressions assessed for associations between AFE and outcome variables, adjusting for age, number of prior concussions, and years of football exposure. Results A total of 107 male participants (mean age = 60.6 ± 15.1 years) reported an average of 4.2 ± 2.7 years of exposure to amateur football, with 41 participants reporting AFE &amp;lt; 12 (38.3%). In multivariable analyses, AFE &amp;lt; 12 was not a significant predictor of depressive (B = 0.51, SE = 1.25, p = 0.682), anxiety (B = 0.09, SE = 0.95, p = 0.926), cognitive (B = -0.65, SE = 0.77, p = 0.403), or neurobehavioral symptom scores (B = -0.56, SE = 2.93, p = 0.850). However, having more prior concussions were associated with worse depressive (B = 0.44, SE = 0.10, p &amp;lt; 0.001), anxiety (B = 0.33, SE = 0.07, p &amp;lt; 0.001), cognitive (B = 0.26, SE = 0.06, p &amp;lt; 0.001), and neurobehavioral symptoms (B = 1.04, SE = 0.23, p &amp;lt; 0.001). Conclusions AFE to football was not associated with adverse psychiatric, cognitive, or neurobehavioral difficulties. However, these outcomes were associated with a greater number of lifetime concussions.

Change in Mindfulness Profiles After Mindfulness-Based Cognitive Therapy for Major Depressive Disorder

ObjectivesMindfulness-Based Cognitive Therapy (MBCT) reduces recurrence and current depressive symptoms in patients with major depressive disorder (MDD). To understand how and for whom MBCT works, a person-centered approach focusing on mindfulness profiles can be useful. Four mindfulness profiles, each associated differently with mental health outcomes, have previously been identified. So far, no studies have examined whether profiles change after MBCT and whether these changes are related to treatment outcome.MethodLatent transition analysis (LTA) was performed on pre- and post-MBCT subscale scores of the Five Facet Mindfulness Questionnaire (FFMQ) in patients with current or remitted MDD (n=500). LTA allowed the assessment of individual changes in mindfulness profile after MBCT and the relation between profile change and corresponding changes in measures of mental health, including depressive symptoms, overall functional impairment, worry, and self-compassion.ResultsLTA re-established the four profiles previously identified cross-sectionally: “Very low mindfulness” (VLM), “Non-judgmentally aware” (NJA), “Judgmentally observing” (JO), and “High mindfulness” (HM). For 71 out of 168 patients with VLM profiles changed to NJA and for another 30 to HM. For 49 out of the 129 patients with NJA and for 37 out of 141 patients with JO profiles changed to HM. All 61 patients starting with HM kept HM. In general, change was related to greater than average improvement in mental health, while no change in profile was related to less than average improvement in mental health (except for HM).ConclusionsOur findings indicate that changes in mindfulness profile after MBCT was differentially related to clinical change. These results from a person-centered approach offer new avenues to further elucidate the working mechanism of MBCT and improve its outcome.PreregistrationThis study was not preregistered.