Depression Vulnerability Research Articles

Reduced approach disposition in familial risk for depression: Evidence from time-frequency alpha asymmetries.

Despite the promising role of alpha and delta power in reflecting reduced approach disposition in depression, to date, it is unclear whether these measures can be employed to identify at-risk individuals. Hence, the present study investigated affective disposition in 32 unaffected individuals with a family history of depression (23 F) and 30 individuals without a family history of depression (21 F) through a data-driven analysis of alpha and delta time-frequency power during the viewing of pleasant, neutral, and unpleasant pictures. Different patterns of posterior alpha asymmetry emerged within each group. Particularly, controls showed greater right posterior alpha desynchronization ~ 600 ms following emotional relative to neutral pictures presentation. Conversely, the group with a family history of depression showed greater posterior left alpha desynchronization only to unpleasant relative to neutral images in a later time window (> 900 ms). Hence, depression vulnerability seems to be characterized by a blunted reactivity to pleasant and delayed reactivity to unpleasant stimuli with a distinct posterior distribution relative to the controls. Finally, the two groups showed a comparable pattern of greater delta power to emotional relative to neutral cues. Overall, initial support was provided for the employment of time-frequency alpha power changes during affective processing in identifying blunted approach disposition in unaffected at-risk individuals.

Effects of peer victimization on cortical processing of social-evaluative stress in patients with major depressive disorder.

Peer victimization contributes to the development of major depressive disorders (MDDs). While previous studies reported differentiated peripheral physiological responses in peer-victimized individuals with depression, little is known about potential alterations of cortical event-related potentials (ERPs) in response to social stimuli in depressive patients with a history of peer victimization. Using a social condition paradigm, the present study examined whether peer victimization alters conditioned cortical responses to potentially threatening social stimuli in MDD patients and healthy controls. In the task, we studied ERPs to conditioned stimuli (CSs), i.e. still images of faces, that were coupled to unconditioned socially negative and neutral evaluative video statements. Peer victimization was related to more pronounced P100 amplitudes in reaction to negative and neutral CSs. Attenuated P200 amplitudes in peer-victimized individuals were found in response to negative CSs. Cortical responses to CSs were not influenced by a diagnosis of MDD. The results suggest altered responsiveness to interpersonal information in peer-victimized individuals. Facilitated early processing of social threat indicators may prevent peer-victimized individuals from adaptive responses to social cues, increasing their vulnerability for depression.

10-Week Trajectories of Candidate Psychological Processes Differentially Predict Mental Health Gains from Online Dyadic versus Mindfulness Interventions: A Randomized Clinical Trial.

Background: App-based contemplative interventions, such as mindfulness-based interventions, have gained popularity for the promotion of mental health; however, the understanding of underlying intervention-specific mechanisms remains limited, especially related to novel inter-relational dyadic practices. Methods: We tested (n = 253) seven putative mechanisms underlying two brief (daily 12-min) online mental interventions: attention-focused mindfulness and socio-emotional partner-based, both supported by weekly online coaching. Weekly self-reports of rumination, worry, psychological flexibility, affective control, social support, acceptance, and mindfulness were obtained over 10 weeks of intervention, and depression, anxiety, and resilience were assessed as pre- and post-intervention outcomes. Results: Significant week-to-week reductions in rumination and increases in psychological flexibility were observed in both interventions. Only attention-based practice led to temporal reductions in worry, and only socio-emotional dyadic practice led to temporal increases in affective control. Mediation analyses with slopes of weekly variables as mediators detected no significant indirect effects. However, exploratory moderation analyses revealed that intervention-related reductions in depressive symptomatology and anxiety vulnerability and increases in resilience were predicted by weekly increases in acceptance and affective control in the socio-emotional dyadic group, and by weekly reductions in rumination and worry in the mindfulness group. Limitations of the study include reliance on brief self-report measures, relatively small sample size, and absence of long-term follow-up assessments indicating the need for future well-powered longitudinal studies comparing intervention modalities. Conclusions: We present preliminary evidence for practice-specific active ingredients of contemplative interventions, which can be leveraged to enhance their efficiency for mental health.

Depression/anxiety symptoms versus depressive personality vulnerability in the adaptation to breast cancer: A matter of self-criticism?

Depression/anxiety symptoms versus depressive personality vulnerability in the adaptation to breast cancer: A matter of self-criticism?

Familial risk for depression is associated with reduced physical activity in young adults: evidence from a wrist-worn actigraphy study

Depression is characterized by reduced physical activity and sleep-wake cycle disturbances, often considered important features of the disease. While a few studies have suggested that self-reported reduced physical activity and sleep-wake cycle disturbances might both be linked to depression vulnerability, actigraphy-based measures in vulnerable samples remain largely unexplored. This study relied on actigraphy-based parameters to test whether these disturbances characterize depression vulnerability. Seven-day actigraphy data were collected from 20 (13 female) university students with a high vulnerability to depression, which was determined by the presence of a family history of the condition but no current symptoms, and 32 (21 female) controls with neither a family history of depression nor current depressive symptoms. Daily physical activity, namely gross motor activity, was quantified as average daily acceleration and time spent engaging in moderate-vigorous physical activity (MVPA). The sleep-wake cycle and circadian rhythms were assessed as total sleep duration per night (in hours), sleep within sleep period time (in hours), sleep efficiency (%), and relative amplitude (i.e., the difference between the activity during the day and the night, which reflects circadian rhythms amplitude). Results showed that individuals with a familial risk for depression exhibited reduced daily acceleration and time spent in MVPA relative to the control group, particularly on the weekend during their free time away from scheduled activities. On the other hand, the two groups were comparable in terms of sleep estimates. Taken together, reduced physical activity, but not sleep-wake disturbances, seem to be associated with vulnerability to depression and might be a viable target for identification and prevention efforts.

Physical activity as a tool for preventing and treating depression: Lessons learned from the COVID‐19 pandemic

AbstractPhysical activity (PA) is understood to be important for the prevention and treatment of depression, however, less is known about the effects of withdrawal from PA on mood. Here we consider evidence published since the outbreak of the SARS‐CoV‐2 virus to assess the impact of the COVID‐19 pandemic on PA patterns and to evaluate whether engagement in PA in the context of the pandemic had an impact on depression vulnerability. During the initial stages of the pandemic and consequent lockdowns, there were global decreases in PA, with women, ethnic minorities, lower‐education, lower‐income, younger, and elderly people displaying more marked reductions in PA. Less PA was associated with a higher risk of experiencing moderate‐to‐severe depression symptoms, particularly for those who decreased their PA levels compared to pre‐pandemic. Both PA and sedentary behavior were independently associated with depression, such that low activity and high amounts of sitting both increased the likelihood of clinically significant symptoms. We also consider the role social connection during movement; while both in‐person and online PA can foster a sense of belonging, there is some evidence that socially distant, pandemic‐safe movement might disincentivise certain groups such as older adults and experienced exercisers from participating in PA. We conclude with several implications for prospective public health communications regarding PA, especially in the event of another global pandemic.

Annual Research Review: Neuroimmune network model of depression: adevelopmental perspective.

Depression is a serious public health problem, and adolescence is an 'age of risk' for the onset of Major Depressive Disorder. Recently, we and others have proposed neuroimmune network models that highlight bidirectional communication between the brain and the immune system in both mental and physical health, including depression. These models draw on research indicating that the cellular actors (particularly monocytes) and signaling molecules (particularly cytokines) that orchestrate inflammation in the periphery can directly modulate the structure and function of the brain. In the brain, inflammatory activity heightens sensitivity to threats in the cortico-amygdala circuit, lowers sensitivity to rewards in the cortico-striatal circuit, and alters executive control and emotion regulation in the prefrontal cortex. When dysregulated, and particularly under conditions of chronic stress, inflammation can generate feelings of dysphoria, distress, and anhedonia. This is proposed to initiate unhealthy, self-medicating behaviors (e.g. substance use, poor diet) to manage the dysphoria, which further heighten inflammation. Over time, dysregulation in these brain circuits and the inflammatory response may compound each other to form a positive feedback loop, whereby dysregulation in one organ system exacerbates the other. We and others suggest that this neuroimmune dysregulation is a dynamic joint vulnerability for depression, particularly during adolescence. We have three goals for the present paper. First, we extend neuroimmune network models of mental and physical health to generate a developmental framework of risk for the onset of depression during adolescence. Second, we examine how a neuroimmune network perspective can help explain the high rates of comorbidity between depression and other psychiatric disorders across development, and multimorbidity between depression and stress-related medical illnesses. Finally, we consider how identifying neuroimmune pathways to depression can facilitate a 'next generation' of behavioral and biological interventions that target neuroimmune signaling to treat, and ideally prevent, depression in youth and adolescents.

Reduced reward responsiveness and depression vulnerability: Consideration of social contexts and implications for intervention.

Depression is a prevalent, heterogeneous, and debilitating disorder that often emerges in adolescence, and there is a need to better understand vulnerability processes to inform more targeted intervention efforts. Psychophysiological methods, like event-related potentials (ERPs), can offer unique insights into the cognitive and emotional processes underlying depression vulnerability. I review my and others' research examining ERP measures of reward responsiveness in youth depression and present a conceptual model of the development of low reward responsiveness, its role in depression vulnerability, and potential windows for targeted intervention. There is evidence that ablunted reward positivity (RewP) is observable in children at risk for depression, appears to be shaped in part by early social experiences, and predicts later depressive symptoms in combination with other risk factors like stress exposure. Further, a component consistent with RewP is reliably elicited in response to social acceptance feedback in computerized peer interaction tasks and demonstrates unique associations with social contextual factors and depressive symptoms, supporting the utility of developing psychophysiological tasks that may better capture youths' real-world experiences and social risk processes. In addition, I address the translational implications of clinical psychophysiological research and describe a series of studies showing that a reduced RewP predicts greater reductions in depressive symptoms with treatment but is not modifiable by current treatments like cognitive behavioral therapy. Finally, I describe our preliminary efforts to develop a positive emotion-focused intervention for the offspring of depressed mothers, informed by the RewP literature, and describe future directions for translating psychophysiological research to intervention and prevention.

Recurrent depression and relational trauma: a single case of memory processing

Abstract Cognitive behavioural therapy (CBT) is an effective treatment for depression, but a significant minority of clients are difficult to treat, including those with histories of relational trauma. The model of Beck et al. (1979) proposes that adverse childhood experiences lead to negative core beliefs, and these create a susceptibility to depression. However, Beck’s model does not identify trauma as a subset of adverse experiences. An alternative view is that traumatised clients internalise conflicting representations of self and it is conflict, interacting with trauma memories, that creates a vulnerability for depression. In this formulation, methods from the treatment of post-traumatic stress disorder (PTSD) could be incorporated into the treatment of depression, to emotionally process trauma memories and resolve self-identity conflicts. The aims of this study were to: (1) report the treatment of a 67-year-old man with recurrent depression and a history of prolonged relational trauma, and (2) to explore how memory processing from the treatment of PTSD can be incorporated into the treatment of recurrent depression. A single case observational design was used in the long-term treatment of a depressed traumatised client. The client received 47 individual sessions over 19 months in routine clinical practice in a tertiary CBT service. He completed repeated measures of mood, memory intrusions and sleep disruption. The client responded well to treatment with clinically significant improvements across measures of mood, memory and sleep. The effects were sustained over an 18-month follow-up. Memory processing was successfully integrated into a high-intensity treatment for recurrent depression. This is a promising approach for depressed clients with histories of relational trauma. Key learning aims (1) To consider how imaginal reliving can be incorporated into CBT for recurrent depression, when relational trauma is present. (2) To consider the cognitive processing mode of depressed traumatised clients when appraising beliefs about self and others. (3) To consider vulnerability to depression based on intrusive memories and conflicting self-representations, not only core beliefs.

위험회피 기질이 우울에 미치는 영향

The purpose of this study is to examine the mediating effect of Insecure Adult Attachment onthe relations of Harm Avoidance and Depression symptoms. and to find out the moderatedeffect of Cognitive Flexibility that are assumed to operate on the where Harm Avoidance hasdirect effect on Depression symptoms and to operate on a mediated indirect path that InsecureAdult Attachment. 384 adults aged over 19 years participated in the survery for this study, andSPSS 18 and SPSS PROCESS Macro 2.13 are used to analyze the collected data. The main resultsof the study are summarize as follows: Insecure Adult Attachment partially mediated the relationbetween Harm Avoidance and Depression symptoms. Cognitive Flexibility had significantmoderating effect within the relationship of Harm Avoidance and Depression symptoms. Cognitive Flexibility had significant moderating effect on indirect path that affects Insecure AdultAttachment within the relationship of Harm Avoidance and Depression symptoms. Thesefindings suggest the importance of improving the understanding of factors related to thedevelopment of depressive vulnerability. In addition, this implication and suggestions for futureresearch are provided.

Early life stress enhances the susceptibility to depression and interferes with neuroplasticity in the hippocampus of adolescent mice via regulating miR-34c-5p/SYT1 axis

Early life events are major risk factors for the onset of depression and have long-term effects on the neurobiological changes and behavioral development of rodents. However, little is known about the specific mechanisms of early life adversity in the susceptibility to subsequent stress exposure in adolescence. This study characterized the effect of maternal separation (MS), an animal model of early life adversity, on the behavioral responses to restraint stress in mice during adolescence and investigated the molecular mechanism underlying behavioral vulnerability to chronic stress induced by MS. Our results showed that MS exposure could further reinforce the depressive vulnerability to restraint stress in adolescent mice. In addition, miR-34c-5p expression was obviously up-regulated in the hippocampi of MS mice at postnatal day (P) 14 and P42. Further, synaptotagmin-1 (SYT1) was deemed as a target gene candidate of miR-34c-5p on the basis of dual luciferase assay. It was found that the downregulation of miR-34c-5p expression in the hippocampi of MS mice could ameliorate dysfunction of synaptic plasticity by targeting molecule SYT1, effects which were accompanied by alleviation of depressive and anxious behaviors in these mice. The results demonstrated that the miR-34c-5p/SYT1 pathway was involved in the susceptibility to depression induced by MS via regulating neuroplasticity in the hippocampi of mice.

Cognitive reappraisal and corresponding neural basis mediate the association between childhood maltreatment and depression

BackgroundChildhood maltreatment is considered as a robust predictor of depression. However, the underlying psychological and neurological mechanisms linking childhood maltreatment and depression remain poorly understood. Sufficient evidence demonstrates emotion dysregulation in individuals who have experienced childhood maltreatment, but it is unknown whether these changes represent vulnerability for depression. Here we speculated that decreased cognitive reappraisal and its corresponding neural basis might explain the relationship between childhood maltreatment and follow-up depression. MethodsFirst, we investigated whether cognitive reappraisal can explain the relationship between childhood maltreatment and depression, with a cross-sectional (n = 657) behavioral sample. Then we recruit 38 maltreated participants and 27 controls to complete the cognitive reappraisal functional magnetic resonance imaging (fMRI) task. The between-group difference in brain activation and functional connectivity (FC) were tested using independent t-tests. Finally, we investigated the relationship between childhood maltreatment, task-based brain activity and depression. ResultsThe behavior results suggested that cognitive reappraisal mediates the association between childhood maltreatment and depression. In addition, the maltreated group exhibited lower activation of orbitofrontal cortex (OFC) and higher FC of between the dorsolateral prefrontal cortex (DLPFC), posterior cingulate cortex (PCC), OFC, and amygdala during cognitive reappraisal, compared with healthy controls. Furthermore, the FC of DLPFC-amygdala mediates the association between childhood maltreatment and depression. ConclusionIn summary, childhood maltreatment is associated with inefficient cognitive reappraisal ability, manifesting as aberrant modulation of cortical areas on amygdala. These cognitive and neural deficits might explain the relationship between childhood maltreatment and risk of depression in later life.

Characterizing positive and negative valence systems function in adolescent depression: An RDoC-informed approach integrating multiple neural measures

Depression is a prevalent, debilitating, and costly disorder that often manifests in adolescence. There is an urgent need to understand core pathophysiological processes for depression to inform more targeted intervention efforts. The Research Domain Criteria (RDoC) Positive Valence Systems (PVS) and Negative Valence Systems (NVS) have both been implicated in depression symptomatology and vulnerability; however, the nature of NVS alterations is unclear across studies, and associations between single neural measures and symptoms are often small in magnitude and inconsistent. The present study advances characterization of depression in adolescence via an innovative data-driven approach to identifying subgroups of PVS and NVS function by integrating multiple neural measures (assessed by electroencephalogram [EEG]) relevant to depression in adolescents oversampled for clinical depression and depression risk based on maternal history (N = 129; 14–17 years old). Results of the k-means cluster analysis supported a two-cluster solution wherein one cluster was characterized by relatively attenuated reward and emotion responsiveness across valences and the other by relatively intact responsiveness. Youth in the attenuated responsiveness cluster reported significantly greater depressive symptoms and were more likely to have major depressive disorder diagnoses than youth in the intact responsiveness cluster. In contrast, associations of individual neural measures with depressive symptoms were non-significant. The present study highlights the importance of innovative neuroscience approaches to characterize emotional processing in depression across domains, which is imperative to advancing the clinical utility of RDoC-informed research.

Melatonin secretion patterns are associated with cognitive vulnerability and brain structure in bipolar depression

ABSTRACT Circadian rhythm disruption is a core symptom of bipolar disorder (BD), also reflected in altered patterns of melatonin release. Reductions of grey matter (GM) volumes are well documented in BD. We hypothesized that levels and timing of melatonin secretion in bipolar depression could be associated with depressive psychopathology and brain GM integrity. The onset of melatonin secretion under dim light conditions (DLMO) and the amount of time between DLMO and midsleep (i.e. phase angle difference; PAD) were used as circadian rhythm markers. To study the time course of melatonin secretion, an exponential curve fitting the melatonin values was calculated, and the slope coefficients (SLP) were obtained for each participant. Significant differences were found between HC and BD in PAD measures and melatonin profiles. Correlations between PAD and depressive psychopathology were identified. Melatonin secretion patterns were found to be associated with GM volumes in the Striatum and Supramarginal Gyrus in BD. Our findings emphasized the role of melatonin secretion role as a biological marker of circadian synchronization in bipolar depression and provided a novel insight for a link between melatonin release and brain structure.

Prevalence of postpartum major depression and depressive symptoms in Spanish women: A longitudinal study up to 1 year postpartum

ObjectiveDepression is a prevalent mental disorder in the postpartum period, with consequences for both the mother and her offspring. However, longitudinal studies determining the moments of greatest vulnerability and severity of depression during the postpartum period are scarce. The aims of this research were to determine the prevalence and trajectories of probable depression and major depression during the first year postpartum. DesignLongitudinal study. SettingInterviews were conducted personally at three times: 2 months, 6 months and 1 year postpartum. Participants561 postpartum women. Measurements and findingsDepression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders (DSM). Descriptive and comparative analyses have been carried out. The prevalence of probable depression at 2 months, 6 months and 1 year postpartum, using a cut-off point ≥ 10, was 30.3%, 26.0% and 25.3%, respectively; and that of major depression using SCID was 10.3%, 10.9% and 14.8, respectively. The prevalence of probable depression was highest at 2 months postpartum and that of major depression at 1 year postpartum. Probable depression followed a downward trajectory and major depression followed an upward trajectory. Key conclusions and implications for practiceThe clinical relevance of this research is that it has made it possible to demonstrate that depression is very prevalent in the first year postpartum and that, far from subsiding, the prevalence remains very high even at 1 year postpartum. Our findings highlight the importance of taking mental health care into account throughout at least the first year postpartum.

Do markers of daily affect mediate associations between interpretation bias and depressive symptoms? A longitudinal study of early adolescents.

Early adolescence represents a time of heightened vulnerability for depression. Negative interpretation biases have been associated with increases in depressive symptoms during this developmental period; however, the mechanisms underlying the association between interpretation biases and depression remain poorly understood. Cognitive theories posit that interpretation biases give rise to depression by modulating daily affect, particularly in the context of stress. However, this has not yet been directly examined. The present study tested affect intensity and instability as mechanisms linking negative interpretation biases with change in adolescent depressive symptoms. Ninety-four adolescents (aged 11-13 years; 51% boys) from Vancouver, Canada, were recruited for this longitudinal study. At baseline (Time 1), participants self-reported depressive symptoms and completed the Scrambled Sentences Task to assess negative interpretation biases. Next, participants completed daily diaries to assess positive affect (PA) and negative affect (NA) during a naturalistic stressor-the first 2 weeks of high school (Time 2). Finally, participants self-reported depressive symptoms 3 months later (Time 3). Path models were conducted to test whether PA and NA intensity and instability mediated prospective associations between negative interpretation biases and depressive symptom changes. Although NA intensity, NA instability, and PA instability predicted increases in depressive symptoms, only NA intensity mediated associations between interpretation biases and symptom changes. Neither PA intensity nor instability mediated these associations. Elevated daily NA represents a specific mechanism through which stronger negative interpretation biases predict increases in depressive symptoms in adolescence.

One-Year Survival after Cardiac Surgery in Frail Older People-Social Support Matters: A Prospective Cohort Study.

There are increasing rates of cardiac surgery in the elderly. Frailty, depression, and social vulnerability are frequently present in older people, and should be considered while assessing risk and providing treatment options. We aimed to analyse the impact of clinically relevant variables on survival at one year, and identify areas of future intervention. We performed a prospective cohort study at a University Hospital, with a sample of 309 elective cardiac surgery patients 65 years old and over. Their socio-demographic and clinical variables were collected. Frailty prevalence was 61.3%, while depression was absent in the majority of patients. Mortality was 1.6% and 7.8% at 30 days and 12 months, respectively. After Kaplan-Meier analysis, severe frailty (p = 0.003), severe depression (p = 0.027), pneumonia until 30 days (p = 0.014), and re-operation until 12 months (p = 0.003) significantly reduced survival, while social support increased survival (p = 0.004). In the adjusted multivariable Cox regression model, EuroSCORE II (HR = 1.27 [95% CI 1.069-1.499] p = 0.006), pneumonia until 30 days (HR = 4.19 [95% CI 1.169-15.034] p = 0.028), re-intervention until 12 months (HR = 3.14 [95% CI 1.091-9.056] p = 0.034), and social support (HR = 0.24 [95% CI 0.079-0.727] p = 0.012) explained time until death. Regular screening for social support, depression, and frailty adds relevant information regarding risk stratification, perioperative interventions, and decision-making in older people considered for cardiac surgery.

The impact of mood-induction on maladaptive thinking in the vulnerability for depression

Background and objectivesMind-wandering, and specifically the frequency and content of mind-wandering, plays an important role in the psychological well-being of individuals. Repetitive negative thinking has been associated with a high risk to develop and maintain Major Depressive Disorder. We here combined paradigms and techniques from cognitive sciences and experimental clinical psychology to study the transdiagnostic psychiatric phenomenon of repetitive negative thinking. This allowed us to investigate the adjustability of the content and characteristics of mind-wandering in individuals varying in their susceptibility to negative affect. MethodsParticipants high (n = 42) or low (n = 40) on their vulnerability for negative affect and depression performed a Sustained Attention to Response Task (SART) after a single session of positive fantasizing and a single session of stress induction in a cross-over design. Affective states were measured before and after the interventions. ResultsAfter stress, negative affect increased, while after fantasizing both positive affect increased and negative affect decreased. Thoughts were less off-task, past-related and negative after fantasizing compared to after stress. Individuals more susceptible to negative affect showed more off-task thinking after stress than after fantasizing compared to individuals low on this. LimitationsIn this cross-over design, no baseline measurement was included, limiting comparison to ‘uninduced’ mind-wandering. Inclusion of self-related concerns in the SART could have led to negative priming. ConclusionsStress-induced negative thinking underlying vulnerability for depression could be partially countered by fantasizing in a non-clinical sample, which may inform the development of treatments for depression and other disorders characterized by maladaptive thinking.

Neurobehavioral Reward and Sleep-Circadian Profiles Predict Present and Next-Year Mania/Hypomania Symptoms

BackgroundHeightened reward sensitivity/impulsivity, related neural activity, and sleep-circadian disruption are important risk factors for bipolar spectrum disorders, the defining feature of which is mania/hypomania. Our goal was to identify neurobehavioral profiles based on reward and sleep-circadian features and examine their specificity to mania/hypomania versus depression vulnerability. MethodsAt baseline, a transdiagnostic sample of 324 adults (18–25 years) completed trait measures of reward sensitivity (Behavioral Activation Scale), impulsivity (UPPS-P-Negative Urgency), and a functional magnetic resonance imaging card-guessing reward task (left ventrolateral prefrontal activity to reward expectancy, a neural correlate of reward motivation and impulsivity, was extracted). At baseline, 6-month follow-up, and 12-month follow-up, the Mood Spectrum Self-Report Measure – Lifetime Version assessed lifetime predisposition to subthreshold-syndromal mania/hypomania, depression, and sleep-circadian disturbances (insomnia, sleepiness, reduced sleep need, rhythm disruption). Mixture models derived profiles from baseline reward, impulsivity, and sleep-circadian variables. ResultsThree profiles were identified: 1) healthy (no reward or sleep-circadian disruption; n = 162); 2) moderate-risk (moderate reward and sleep-circadian disruption; n = 109); and 3) high-risk (high impulsivity and sleep-circadian disruption; n = 53). At baseline, the high-risk group had significantly higher mania/hypomania scores than the other groups but did not differ from the moderate-risk group in depression scores. Over the follow-up period, the high-risk and moderate-risk groups exhibited elevated mania/hypomania scores, whereas depression scores increased at a faster rate in the healthy group than in the other groups. ConclusionsCross-sectional and next-year predisposition to mania/hypomania is associated with a combination of heightened reward sensitivity and impulsivity, related reward circuitry activity, and sleep-circadian disturbances. These measures can be used to detect mania/hypomania risk and provide targets to guide and monitor interventions.

First-year Medical Students’ Varying Vulnerability to Developing Depressive Symptoms and Its Predictors: a Latent Profile Analysis

ObjectivePrevious meta-analytic data have demonstrated the propensity for mental morbidity among medical students (Rotenstein et al. JAMA. 2016;316(21):2214–36). However, there is a lack of research on medical students’ varying depression vulnerabilities and predictive factors. The present study aims to gain a better understanding of the development of mental health morbidity and its predictive factors among first-semester medical students.MethodsIn November 2020 and January 2021, 184 first-semester students from two medical schools were surveyed regarding depression (PHQ-9), self-efficacy, resilience, and cognitive self-regulation. Using latent profile analysis, we identified distinct depression development profiles. We applied a multinomial logistic regression analysis to determine how self-efficacy, resilience, and cognitive self-regulation and their changes predicted profile membership.ResultsFive profiles of depression development were identified: profile 1, no depression (53.8%); profile 2, mild depression (26.1%); profile 3, depression increase I (9.2%); profile 4, depression increase II (9.8%); and profile 5, persistent depression (1.1%). Students with initially high self-efficacy, resilience, and cognitive self-regulation levels were more likely to belong to the no depression profile. A decrease in self-efficacy and cognitive self-regulation was associated with both depression increase profiles (profiles 3 and 4), and a decrease in resilience was found to be a predictor of profile 4.ConclusionStudents who enter medical school have varying states of mental health, and they differ in their vulnerability to developing depressive symptoms. The promotion of resilience, self-efficacy, and cognitive self-regulation strategies may be key in preventing students’ depression in the first semester of medical school.