Depressed Participants Research Articles

Risk Prediction Models for Depression in Community-Dwelling Older Adults

ObjectiveTo develop streamlined Risk Prediction Models (Manto RPMs) for late-life depression. DesignProspective study. SettingThe Survey of Health, Ageing and Retirement in Europe (SHARE) study. ParticipantsParticipants were community residing adults aged 55 years or older. MeasurementsThe outcome was presence of depression at a 2-year follow up evaluation. Risk factors were identified after a literature review of longitudinal studies. Separate RPMs were developed in the 29,116 participants who were not depressed at baseline and in the combined sample of 39,439 of non-depressed and depressed subjects. Models derived from the combined sample were used to develop a web-based risk calculator. ResultsThe authors identified 129 predictors of late-life depression after reviewing 227 studies. In non-depressed participants at baseline, the RPMs based on regression and Least Absolute Shrinkage and Selection Operator (LASSO) penalty (34 and 58 predictors, respectively) and the RPM based on Artificial Neural Networks (124 predictors) had a similar performance (AUC: 0.730–0.743). In the combined depressed and non-depressed participants at baseline, the RPM based on neural networks (35 predictors; AUC: 0.807; 95% CI: 0.80–0.82) and the model based on linear regression and LASSO penalty (32 predictors; AUC: 0.81; 95% CI: 0.79–0.82) had satisfactory accuracy. ConclusionsThe Manto RPMs can identify community-dwelling older individuals at risk for developing depression over 2 years. A web-based calculator based on the streamlined Manto model is freely available at https://manto.unife.it/ for use by individuals, clinicians, and policy makers and may be used to target prevention interventions at the individual and the population levels.

Population Pharmacokinetics and Pharmacodynamics of the Therapeutic and Adverse Effects of Ketamine in Patients With Treatment‐Refractory Depression

We aimed to develop population pharmacokinetic/pharmacodynamic (PK/PD) models that can effectively describe ketamine and norketamine PK/PD relationships for Montgomery–Åsberg Depression Rating Scale (MADRS) scores, blood pressure (BP), and heart rate (HR) following i.v., s.c., and i.m. ketamine administration in patients with treatment‐refractory depression. Ketamine PK/PD data were collected from 21 treatment‐refractory depressed participants who received ketamine (dose titration 0.1–0.5 mg/kg as single doses) by i.v., s.c., or i.m. administration. Model development used nonlinear mixed effect modeling. Ketamine and norketamine PK were best described using two‐compartment models with first‐order absorption after s.c. and i.m. administration. Estimated ketamine bioavailability after i.m. and s.c. was ~ 64% with indistinguishable first‐order absorption rate constants. Allometric scaling of body weight on all clearance and volumes of distribution improved the model fit. The delay in the concentration‐response relationship for MADRS scores was best described using a turnover model (turnover time ~ 42 hours), whereas for the BP and HR rates this was an immediate effect model. For all PD effects, ketamine alone was superior to models with norketamine concentration linked to an effect. No covariates were identified for PD effects. The estimated half‐maximal effective concentration from the MADRS score, BP, and HR were 0.44, 468, and 7,580 ng/mL, respectively. The integrated population models were able to effectively describe the PK/PD relationships for MADRS scores, BP, and HR after i.v., s.c., and i.m. ketamine administration. These findings allow for a deeper understanding of the complex relationships between route of ketamine administration and clinical response and safety.

Altered motivation of effortful decision-making for self and others in subthreshold depression.

BackgroundAmotivation is a typical feature in major depressive disorders and refers to individuals exhibiting reduced willingness to exert effort for rewards. However, the motivation pattern when deciding whether to exert effort for self versus others in people with depression remains unclear.MethodsWe conducted a functional magnetic resonance imaging study and employed an adapted Effort‐Expenditure for Rewards Task in subthreshold depressive (SD) participants (n = 33) and healthy controls (HC) (n = 32). This required participants to choose between a fixed low‐effort/low‐reward and a variable high‐effort/high‐reward option, and then immediately exert effort to obtain corresponding rewards for themselves or for unfamiliar people.ResultsCompared with the HC group, the SD group showed blunted activity in the left dorsal anterior cingulate cortex/dorsomedial prefrontal cortex, bilateral anterior insula (AI), and right putamen‐left dorsolateral prefrontal cortex functional connectivity when choosing to exert effort for themselves. Additionally, the SD group exhibited increased willingness and greater activation in the bilateral AI when choosing to exert effort for others. Furthermore, these brain activations and functional connectivity were positively related to self‐reported motivation.ConclusionsThese findings show altered motivation during effort‐based decision‐making in individuals with the mild depressive state, particularly with higher motivation for others. Thus, this suggests that motivational behaviors and prefrontal–striatal circuitry are altered in individuals with SD, which can be utilized to discover treatment targets and develop strategies to address mental illness caused by motivation disorders.

Associations between implicit and explicit affective inhibitory control, trait rumination and depressive symptoms

IntroductionInhibitory control is the executive function component which underlies one’s ability to maintain goal-directed behavior by inhibiting prepotent responses or ignoring irrelevant information. Recent models suggest that impaired inhibition of negative information may contribute to depressive symptoms, and that this association is mediated by rumination. However, the exact nature of this association, particularly in non-clinical samples, is unclear.ObjectivesThe goal of the current study was to assess the relationship between inhibitory control over emotional vs. non-emotional information, rumination and depressive symptoms.MethodsA non-clinical sample of 119 participants (mean age: 36.44 ± 11.74) with various levels of depressive symptoms completed three variations of a Go/No-Go task online; two of the task variations required either explicit or implicit processing of emotional expressions, and a third variation contained no emotional expressions (i.e., neutral condition).Results We found that for participants who reported elevated depressive symptoms, their inhibitory control ability was reduced for all three task variations, relative to less depressed participants. However, for the task variation that required implicit emotion processing (rather than explicit), depressive symptoms were associated with inhibitory deficits for sad and neutral, but not for happy facial expressions. An exploratory analysis showed that the relationship between inhibition and depressive symptoms occurs in part through trait rumination for all three tasks, regardless of emotional content.Conclusions Collectively, these results indicate that elevated depressive symptoms are associated with both a general inhibitory control deficit, as well as affective interference from negative emotions, with implications for the assessment and treatment of mood disorders.DisclosureNo significant relationships.

Basal and LPS-stimulated inflammatory markers and the course of individual symptoms of depression and anxiety

IntroductionA cross-sectional relationship between low-grade inflammation –characterized by increased blood levels of C-reactive protein (CRP) and pro-inflammatory cytokines– and both MDD and anxiety has been reported, but the potential longitudinal symptom-specific relationships has been less well studied.ObjectivesWe aimed to test our hypothesize that inflammation is predictive of the severity and the course of a subset of MDD and anxiety symptoms, especially symptoms that overlap with sickness behavior, such as anhedonia, anorexia, low concentration, low energy, loss of libido, psychomotor slowness, irritability, and malaise.MethodsWe tested the association between basal and lipopolysaccharide (LPS)-induced inflammatory markers with individual MDD symptoms (measured using the Inventory of Depressive Symptomatology Self-Report) and several measures for symptom domains of anxiety over a period of up to 9 years using multivariate-adjusted mixed models in up to 2872 Netherlands Study of Depression and Anxiety (NESDA) participants.ResultsAt baseline, 53.9% of the participants had a current mood or anxiety disorder. We found that basal and LPS-stimulated inflammatory markers were more strongly associated with sickness behavior symptoms at up to 9-year follow up compared to non-sickness behavior symptoms of depression. The associations with anxiety symptoms attenuated by 25%-30% after adjusting for the presence of (comorbid) MDD.ConclusionsInflammation was related to the presence and the course of specific MDD symptoms, of which the majority overlaped with sickness behavior. The associations between inflammatory markers and anxiety symptoms were partly driven by co-morbid MDD. Anti-inflammatory strategies should be tested in the subgroup of MDD patients who report depressive symptoms related to sickness behavior.DisclosureNo significant relationships.

Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression

The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms.Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session.Large treatment effects were observed for depression (CES-D: d = 0.99, p < .001; PHQ-9: d = 0.87, p = .002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d = 0.88–0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p = .289), or only exhibited statistical tendencies (p = .049 to .071). Client satisfaction, system usability, and treatment adherence were high.Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.

0655 The Impact of Slow-Wave Sleep Disruption on Response Inhibition in Individuals with Depression

Abstract Introduction Individuals with Major Depressive Disorder (MDD) exhibit reductions in slow-wave sleep (SWS) and impairments in neuroplasticity. For example, decreased executive functioning, including poorer response inhibition compared to healthy controls, has been reported. SWS has been implicated in the homeostatic regulation of neuroplasticity, however it is unclear if the cognitive deficits seen in MDD are directly associated with SWS. In this study, we aimed to examine if disrupting SWS, thereby altering neuroplasticity, could improve response inhibition in patients with MDD. Methods Participants in this study (n=29) included 19 individuals with depression and 10 healthy controls. Data were collected after two overnight sleep studies separated by one week. During one of the two nights, participants’ slow-wave sleep was disrupted via auditory tones. In the morning following each night, participants completed a neurocognitive task battery including an auditory Go/No-Go task. Accuracy scores were calculated as the percentage of trials on which the participant responded correctly to the “Go” or “No-Go” stimulus. Repeated measures ANOVA and paired t-tests were then performed to examine changes from baseline to SWD, assessing the role of SWD on response inhibition. Results Following SWD, depressed participants’ performance on the Go/No-Go task was significantly more accurate (t=-2.067, p=.027) than following baseline sleep, while healthy controls showed no significant change between nights (t=-.231, p=.411). The interaction between group (MDD vs. healthy control) and condition (baseline vs. SWD) did not reach statistical significance (p=.175). Conclusion In a sample of individuals with depression, accuracy on the Go/No-Go task improved significantly after undergoing SWD compared to following baseline sleep, indicating improved response inhibition. However, healthy controls did not exhibit this same improvement in accuracy. These findings highlight a possible disparity in the role that SWS plays in the regulation of neuroplasticity in those with depression and those without. Support (If Any) Goldschmied: K23MH118580 (NIMH)

Internalized and Perceived Stigma and Depression in Pulmonary Tuberculosis: Do They Explain the Relationship Between Drug Sensitivity Status and Adherence?

BackgroundAdherence to medication for tuberculosis (TB) has been found to be deleteriously affected by psychosocial issues, including internalized and perceived stigma (IPS) and depression, usually resulting in the emergence of multidrug-resistant TB (MDR-TB). The objective of the study was to find the prevalence of depression among patients receiving treatment for pulmonary TB, and how stigma and depression affect the relationship between drug sensitivity status (DSS) and treatment adherence.MethodIt was a cross-sectional observational study conducted between January 2019 and July 2020 in two centers in Sikkim, India. The Patient Health Questionnaire-9 (PHQ-9), Internalized Social Stigma Scale (ISSS), and Tuberculosis Medication Adherence Scale were used to assess depression, IPS, and medication adherence, respectively. A path analysis was performed with DSS, treatment adherence, IPS, and depression. Education in years was included in the model as it was significantly correlated with IPS.ResultsA total of 71 patients who were on drug-sensitive TB (DS-TB) regimen (n = 26) and MDR-TB regimen (n = 45) participated in the study. Notably, 56.3% (n = 40) of the participants were found to have depression. Among the depressed participants, 32.5% were on the DS-TB regimen and 67.5% were on the MDR-TB regimen. The path analysis indicated that IPS and depression were serially mediating the relationship between DSS and treatment adherence (β = −0.06, p < 0.05, 95% CI = −3.20, −0.02). Finally, years of education had an exogenous predictor role, not only directly affecting IPS (β = −0.38, p < 0.001, 95% CI = −0.99, −0.31) but also affecting treatment adherence through IPS and depression (β = 0.08, p = 0.02, 95% CI = 0.03, 0.47). This indicated that with more years of education, the IPS decreases, which decreases depression and ultimately leads to better adherence.ConclusionWe found an important relationship between different psychosocial factors which may affect treatment adherence. Patients who have higher IPS are more likely to develop depression which negatively affect adherence. Patients on the MDR-TB regimen have higher stigma. There is an urgent need to integrate mental health services with TB Control Programs.

How did the COVID-19 Pandemic Affect Pediatric Neurologists?

BackgroundIn addition to physical health, pandemics affect mental health. The aim was to reveal problems encountered during the coronavirus disease 2019 (COVID-19) pandemic by pediatric neurologists and pediatric neurology residents in Turkey. MethodsParticipants were sent a survey form using Google Forms between November 05, 2020, and December 07, 2020. The form included questions about demographic information, changes to services offered, effects of the COVID-19 pandemic on patient follow-up/treatment and doctor decision-making, the Depression-Anxiety-Stress Scale 21, and the Impact of Events scale for posttraumatic stress disorder. ResultsA total of 232 pediatric neurologists and residents (mean age: 40.67 ± 7.8 years) participated. Of these 182 participants (78.4%) stated the pandemic had affected decisions during diagnosis and treatment management. A total of 222 participants completed the Depression-Anxiety-Stress Scale 21 and Impact of Events scale. Of these, points at levels that were “severe and very severe” were present for 42 participants (18.9%) for depression, 29 participants for anxiety (13%), and 31 participants for stress (14%). Impact of Events scale points were high at “severe” levels for 122 participants (55%). All scores were higher for those with individuals at risk in terms of COVID-19 in their family compared with those without individuals at risk in the family (P < 0.05). ConclusionsAs we emerge from the destruction caused by COVID-19, it will be beneficial not only for our professional practice but also in terms of our individual health to learn lessons that will assist in managing the next pandemic waiting in our future.

Automaticity and depression: Daily mood-reactive rumination in people with and without depression history.

Depressive rumination has been conceptualized as a mental habit that is initiated automatically without conscious awareness, intent, or control in response to negative mood. However, it is unknown whether depression vulnerability is characterized by elevated levels of mood-reactive rumination at the level of short-term dynamics. Using mobile ecological momentary assessment, formerly depressed individuals with a recurrent history of depression (n = 94) and nonclinical controls (n = 55) recorded in-the-moment affect and rumination 10 times daily over 6 days, after completing baseline measures of trait ruminative brooding, early life stress, and habitual characteristics of negative thinking (e.g., automaticity, lack of conscious awareness, intent, and control). Momentary fluctuations in negative affect were prospectively associated with greater rumination at the next sampling occasion in formerly depressed participants whereas this pattern of mood-reactive rumination was not observed in nonclinical controls. In formerly depressed participants, habitual characteristics of negative thinking was associated with greater mood-reactivity of rumination, particularly among those with a history of early life stress. Mood-reactive rumination was not, however, associated with depression course nor with the frequency of trait ruminative brooding. Rumination may be triggered in response to negative affect with a high degree of automaticity, making it difficult to control. Greater mood-reactivity of rumination might be associated with increased depression risk, independent of the depressive course and may be exacerbated by early life stress. Future studies may need to go beyond frequency and focus on the role of mood-reactivity and automaticity of ruminative thinking in depression vulnerability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Actigraphically measured psychomotor slowing in depression: systematic review and meta-analysis.

Psychomotor slowing is a key feature of depressive disorders. Despite its great clinical importance, the pathophysiology and prevalence across different diagnoses and mood states are still poorly understood. Actigraphy allows unbiased, objective, and naturalistic assessment of physical activity as a marker of psychomotor slowing. Yet, the true effect-sizes remain unclear as recent, large systematic reviews are missing. We conducted a novel meta-analysis on actigraphically measured slowing in depression with strict inclusion and exclusion criteria for diagnosis ascertainment and sample duplications. Medline/PubMed and Web-of-Science were searched with terms combining mood-keywords and actigraphy-keywords until September 2021. Original research measuring actigraphy for ⩾24 h in at least two groups of depressed, remitted, or healthy participants and applying operationalized diagnosis was included. Studies in somatically ill patients, N < 10 participants/group, and studies using consumer-devices were excluded. Activity-levels between groups were compared using random-effects models with standardized-mean-differences and several moderators were examined. In total, 34 studies (n = 1804 patients) were included. Patients had lower activity than controls [standardized mean difference (s.m.d.) = -0.78, 95% confidence interval (CI) -0.99 to -0.57]. Compared to controls, patients with unipolar and bipolar disorder had lower activity than controls whether in depressed (unipolar: s.m.d. = -0.82, 95% CI -1.07 to -0.56; bipolar: s.m.d. = -0.94, 95% CI -1.41 to -0.46), or remitted/euthymic mood (unipolar: s.m.d. = -0.28, 95% CI -0.56 to 0.0; bipolar: s.m.d. = -0.92, 95% CI -1.36 to -0.47). None of the examined moderators had any significant effect. To date, this is the largest meta-analysis on actigraphically measured slowing in mood disorders. They are associated with lower activity, even in the remitted/euthymic mood-state. Studying objective motor behavior via actigraphy holds promise for informing screening and staging of affective disorders.

A Body Shape Index and Body Roundness Index in Relation to Anxiety, Depression, and Psychological Distress in Adults.

BackgroundDespite the large evidence on the association between obesity and psychological disorders, studies investigating new anthropometric indices in relation to mental health are limited. We aimed to explore the association between A Body Shape Index (ABSI) and Body Roundness Index (BRI) and common psychological disorders (anxiety, depression, and psychological distress) among Iranian adults.MethodsIn this cross-sectional investigation, anthropometric measures of 3213 Iranian adults were gathered using a validated self-reported questionnaire. ABSI and BRI values of participants were calculated through pre-defined formulas. General Health Questionnaire (GHQ) and Hospital Anxiety and Depression Scale (HADS) validated for Iranians were used to assess psychological distress, anxiety, and depression.ResultsMean age of participants was 36.6 ± 7.73, and 62.8% of them were women. ABSI and BRI were higher in subjects with anxiety and psychological distress. Also, depressed participants had higher BRI. After considering potential confounders, individuals in the last tertile of ABSI, compared to the first tertile, had higher odds of anxiety (OR: 1.41, 95%CI: 1.04, 1.93) and psychological distress (OR: 1.39, 95%CI: 1.09, 1.79). Also, a marginal association was found between the highest category of ABSI and depression (OR: 1.27; 95%CI: 1.00, 1.61). In the sex-stratified analysis, ABSI was positively related to odds of anxiety (OR: 1.58; 95%CI; 1.12, 2.22), depression (OR: 1.40; 95%CI; 1.07, 1.84), and psychological distress (OR: 1.51; 95%CI; 1.13, 2.01) among women, but not men. We failed to find any significant association between BRI and depression, anxiety and psychological distress.ConclusionWe found that ABSI was associated with anxiety, depression and psychological distress among females, but not males. However, we did not find a significant relation between BRI and the outcomes. Further prospective studies are required to confirm our findings.

The Effect of Cumulative Lifetime Estrogen Exposure on Cognition in Depressed Versus Non-Depressed Older Women.

Two-thirds of individuals living with Alzheimer's disease are women. Declining estrogen levels influence mood and cognition. Cumulative lifetime estrogen exposure (CLEE) correlates with cognition later in life. We examined the relationship of CLEE to depression and cognition in older women with major depression compared to non-depressed women. Older women (age ≥60years) with depression were compared to non-depressed women using a lifetime estrogen exposure questionnaire. CLEE was defined as combined durations of reproductive span (age of menopause minus age of menarche) and any post-menopausal hormone replacement therapy use. Higher vs lower CLEE groups were based on a median of 474 months of estrogen exposure. University hospital outpatient research program. 135 women ≥60 years; 64 depressed and 71 non-depressed. Participants completed a comprehensive cognitive test battery. General linear models were used to examine the association between cognitive domain scores and CLEE in depressed and non-depressed women, controlling for age, education, and ethnicity. Depressed and non-depressed groups had significantly different levels of CLEE, measured in months: mean 495.7 (SD 108.6) vs 456.4 (SD 66.0) months, F(1,130) = 5.01, p = .03. Within the non-depressed participants, higher CLEE was associated with improved delayed recall (F(1,59) = 5.94, p = .02, effect size = .61), while no such relationship was observed in the depressed group. Higher CLEE was associated with improvement in delayed recall among non-depressed, but not among depressed participants. This suggests a protective role of estrogen on memory in non-depressed older postmenopausal women. Further research should examine the role of the CLEE in antidepressant response and cognitive decline.

Psychophysiological effects of rhythmic music combined with aerobic exercise in college students with minimal depressive symptoms

Mental health problems are common during the transition from adolescence to young adulthood. Previous studies reported that rhythmic music plus aerobic exercise can have a beneficial effect on emotional state. We examined whether the beneficial effect differed between aerobic exercise interventions with or without rhythmic music. A sample of 94 college students who either had no depressive symptoms (n ​= ​47) or minimal depressive symptoms (n ​= ​47) underwent 30-min interventions in a randomized and counterbalanced order: rest, rhythmic music, aerobic exercise and aerobic exercise plus rhythmic music. Response time and accuracy of selective attention to positive and negative images were recorded using the spatial cueing paradigm. Participants’ heart rate during all conditions and perceived exertion after each condition were measured to clarify physiological and perceptual responses, respectively. The results revealed that a multimodal intervention combining aerobic exercise and rhythmic music had a significant facilitatory effect on attentional bias to positive emotional cues in minimal depressive participants (t ​= ​−2.336, p ​= ​0.024), including less perceived exertion and higher heart rate after/during the intervention process. The single-modality intervention of aerobic exercise had significant positive effects for individuals with no depressive symptoms (t ​= ​−2.510, p ​= ​0.016). The multimodal intervention was more effective than the single-modality intervention for individuals with minimal depressive symptoms, but the single-modality aerobic exercise intervention was more effective for individuals with no depressive symptoms, providing new evidence for the specificity of the intervention effect for people with different degrees of depressive symptoms.

What networks of attention are affected by depression? A meta-analysis of studies that used the attention network test

• Alerting and orienting attention networks were found to be unaffected in depression. • Credible differences in executive control were found in depressed individuals compared to controls. • A first meta-analytical review of attention and depression using the attention network test. Depression is an all-too-common mood disorder that has been linked in various ways to the cognitive concept of attention. The Attention Network Test, based on the influential taxonomy of attention originally proposed by Posner, can be used to measure the efficacy of three components or networks of attention: Alerting, Orienting and Executive Control. Our focus here is to discover how depression might affect these networks. Studies related to attention and depression were selected for this meta-analytic review using the online Attention Network Test (ANT) Database (Arora, Lawrence & Klein, 2020) resource. Based on the inclusion and exclusion criteria, 5 publications were analyzed with a Bayesian hierarchical model to compare participants with and without a diagnosis of depression. The posterior distribution of our model revealed no credible differences in the Alerting and Orienting networks but showed credible non-zero values for Executive Control. This suggests that Executive Control is less efficient in individuals suffering from depression. As literature using the ANT with depressed participants is limited, the methodological variability between studies in this meta-analysis should be considered when interpreting these results. This meta-analysis review is the first quantitative review that aimed to address the ANT-depression literature. A consistent finding of no alerting and no orienting deficit but a deficit in the executive control suggests that some, but not all, components of attention are impaired in depression.

Multiple Pre-Treatment miRNAs Levels in Untreated Major Depressive Disorder Patients Predict Early Response to Antidepressants and Interact with Key Pathways.

Major depressive disorder (MDD) is a life-impairing disorder, and early successful treatment is important for a favorable prognosis. However, early response to antidepressants differs widely among individuals, and is difficult to predict pre-treatment. As miRNAs have been reported to play important roles in depression, identification of miRNAs associated with antidepressant treatment responses and their interacting genes and pathways will be beneficial in understanding the predictors and molecular mechanisms of depression treatment. This randomized control trial examined miRNAs correlated with the early therapeutic effect of selective serotonin reuptake inhibitors (SSRIs; paroxetine or sertraline) and mirtazapine monotherapy. Before medication, we comprehensively analyzed the miRNA expression of 92 depressed participants and identified genes and pathways interacting with miRNAs. A total of 228 miRNAs were significantly correlated with depressive symptoms improvements after 2 weeks of SSRIs treatment, with miR-483.5p showing the most robust correlation. These miRNAs are involved in 21 pathways, including TGF-β, glutamatergic synapse, long-term depression, and the mitogen-activated protein kinase (MAPK) signaling pathways. Using these miRNAs enabled us to predict SSRI response at week 2 with a 57% difference. This study shows that pre-treatment levels of miRNAs could be used to predict early responses to antidepressant administration, a knowledge of genes, and an identification of genes and pathways associated with the antidepressant response.

Life-Satisfaction, Engagement and Social Support: Do they Predict Depression Severity, Suicide Ideation, and History of Attempt in Late-life Depression?

<h3>Introduction</h3> Older adults are at the highest risk for death by suicide in almost all countries in the world. Certain protective factors, such as objective and subjective social support, have long been stated as protective factors for suicidal behavior in the elderly. Trait-level mindfulness, and life satisfaction and engagement have also been stated to be protective factors against suicide, however, their relationship with risk for suicide in late life has yet to be examined. We examined the effects of a combination of these protective factors in late life in a high suicide risk sample of depressed older adults. Specifically, we examined the effects of these protective factors on depression severity, presence and severity of suicidal ideation, and history of suicidal behavior. <h3>Methods</h3> Participants included 297 adults aged 55+ (mean age: 64.2, range: 55-90, 56.6% female, 84.5% White). We contrasted depressed participants (unipolar non-psychotic major depression as diagnosed by the Structured Clinical Interview for DSM Disorders) who had a history of suicide attempt (N=92) with depressed non-attempters (N=138) who had no history of suicidal behavior but may or may not have had ideation. In addition, 67 healthy controls (no lifetime history of psychiatric illness) served as a benchmark comparison group. We used the Beck Scale for Suicidal Ideation to measure the severity of suicidal ideation, and the Hamilton Depression Rating Scale to measure depression severity. We used a combination of 6 self-report scales (Flourishing Scale, Interpersonal Support Evaluation List [Tangible, Belonging, Self-esteem, and Appraisal support subscores], Mindfulness Attention Awareness Scale, Satisfaction with Life Survey, Life Engagement Test and the Social Network Index [network diversity, number of people in social networks, embedded networks subscores]). All variables were scaled and then averaged to calculate one overall protective factor value to represent levels of mindfulness, satisfaction and engagement with life, objective and subjective social support, and subjective well-being. We used this protective factor as the predictor variable and conducted binomial logistic regression to assess its relationship with presence of ideation and past attempt, and linear regression models for its relationship with depression and ideation severity. <h3>Results</h3> The overall protective factor value significantly predicted depression severity (p=0.003) and likelihood of ideation (p=0.030) but did not predict ideation severity (p=0.136) or likelihood of past suicide attempt (p=0.954). <h3>Conclusions</h3> Previously identified factors that have been associated with psychological resilience in late life may, in fact, be more predictive of depression severity and presence of ideation than severity of ideation or suicide attempt. Thus, interventions to decrease suicidal behavior in late-life depression may need to go beyond focusing on traditionally stated social support or life-satisfaction/engagement measures and consider other factors such as personality and cognitive capacity. <h3>This research was funded by</h3> NIMH R01-MH085651-10

Effects of an immersive psychosocial training program on depression and well-being: A randomized clinical trial

Psychiatry stands to benefit from brief non-pharmacological treatments that effectively reduce depressive symptoms. To address this need, we conducted a single-blind randomized clinical trial assessing how a 6-day immersive psychosocial training program, followed by 10-min daily psychosocial exercises for 30 days, improves depressive symptoms. Forty-five adults were block-randomized by depression score to two arms: (a) the immersive psychosocial training program and 10-min daily exercise group (36 days total; total n = 23; depressed at baseline n = 14); or (b) a gratitude journaling control group (36 days total; total n = 22; depressed at baseline n = 13). The self-report PHQ-9 was used to assess depression levels in both groups at three time points: baseline, study week one, and study week six. Depression severity improved over time, with a significantly greater reduction in the psychosocial training program group (−82.7%) vs. the control group (−23%), p = 0.02 for baseline vs. week six. The effect size for this reduction in depression symptoms was large for the intervention group (d = −1.3; 95% CI, −2.07, −0.45; p < 0.001) and small for the control group (d = −0.3; 95% CI, −0.68, 0.03; p = 0.22). Seventy-nine percent (11/14) of depressed participants in the intervention condition were in remission (PHQ-9 ≤ 4) by week one and 100% (14/14) were in remission at week six. Secondary measures of anxiety, stress, loneliness, and well-being also improved by 15–80% in the intervention group (vs. 0–34% in the control group), ps < 0.05. Overall, this brief, immersive psychosocial training program rapidly and substantially improved depression levels and several related secondary outcomes, suggesting that immersive interventions may be useful for reducing depressive symptoms and enhancing well-being.

Comparison of decision-making under ambiguity in patients with temporal lobe and frontal lobe epilepsy

ObjectiveThe effect of the frontal lobe on cognitive functions is a subject that has been studied frequently. However, cognitive impairments that can be seen in frontal lobe epilepsy are less addressed. In previous studies on decision-making disorders in patients with epilepsy, patients with temporal lobe epilepsy (TLE) were frequently studied, and it was reported that decision-making disorders could be encountered in this patient group. In this study, we aimed to compare the decision-making performance of patients with cryptogenic frontal lobe epilepsy (FLE) and TLE in ambiguous situations. MethodsTwenty patients with TLE (mean age: 34.10 ± 11.71 years) and 20 patients with FLE (mean age: 32.25 ± 11.92 years) were enrolled in the study and their cognitive performance was compared with 20 healthy controls (mean age: 33.15 ± 13.66 years). Neuropsychological tests were performed on the participants for sleep, depression, anxiety, impulsivity, intelligence, attention, language functions, memory and learning, and frontal axis functions. Decision-making performance in ambiguous situations was studied using the Iowa Gambling Task (IGT). ResultsIowa Gambling Task performances of patients with FLE and TLE were found to be worse than in healthy controls (p = 0.049). Although there was no statistically significant difference when the decision-making of patients with TLE and FLE was compared, it was observed that patients with FLE chose higher risk cards compared with those with TLE. The performances of the neuropsychological subgroup tests of patients with TLE and FLE in attention, language functions, memory and learning, and frontal axis functions were found to be significantly worse than in healthy subjects. ConclusionDecision-making in patients with TLE and FLE in ambiguous situations is similarly impaired compared with healthy controls.

Bidirectional Longitudinal Study of Frailty and Depressive Symptoms Among Older Chinese Adults.

ObjectiveFrailty and depression, as two common conditions among older adults in China, have been shown to be closely related to each other. The aim of this study was to investigate the bidirectional effects between frailty and depressive symptoms in Chinese population.MethodsThe bidirectional effect of frailty with depressive symptoms was analyzed among 5,303 adults ≥ 60 years of age from the China Health and Retirement Longitudinal Study (CHARLS). Phenotype and a frailty index were used to measure frailty. Depressive symptoms were evaluated using the Epidemiological Studies Depression Scale (CES-D). Logistic regression and Cox proportional hazard regression models were used to determine the bidirectional effects of frailty and depressive symptoms in cross-sectional and cohort studies, respectively. Subgroup and sensitivity analyses were further used to further verify the associations.ResultsIn the cross-sectional study, the multivariate-adjusted ORs (95% CIs) for depressive symptoms among pre-frail and frail adults, as defined by the frailty index and phenotype, were 3.05 (2.68–3.49), and 9.78 (8.02–12.03), respectively. Depressed participants showed higher risks of pre-frailty and frailty [frailty index, 3.07 (2.69–3.50); and phenotypic frailty, 9.95 (8.15–12.24)]. During follow-up, the multivariate-adjusted HRs (95% CIs) for depressive symptoms among pre-frail and frail participants, as defined by the frailty index and phenotype, were 1.38 (1.22–1.57), and 1.30 (1.14–1.48), respectively. No significant relationship existed between baseline depressive symptoms and the incidence of frailty. Moreover, the results from subgroup and sensitivity analyses were consistent with the main results.ConclusionAlthough a cross-sectional bidirectional association between depressive symptom and frailty has been observed in older (≥60 years old) Chinese adults, frailty may be an independent predictor for subsequent depression. Moreover, no effect of depressive symptoms on subsequent frailty was detected. Additional bidirectional studies are warranted in China.