Development Of Depressive Episodes Research Articles

(015) Vulvar Lichen Sclerosus is Associated with New Diagnoses of Mood Disorders

Abstract Introduction Vulvar lichen sclerosus (VLS) often presents with chronic pruritus. While VLS is associated with feelings of isolation, risk of mood disorders among females with VLS has yet to be quantified on a large scale. Objective Our objective was to assess the association of VLS with development of depressive episode, anxiety disorder, major depressive disorder (MDD), and prescription of antidepressants and benzodiazepines, and to evaluate the impact of VLS treatment. Methods A US claims database network (TriNetX Diamond Network) was queried from 2009 to 2022. Cohorts included women aged ≥18 with lichen sclerosus (LS) (ICD-10: L90.0) without prior diagnosis of MDD (F33), depressive episode (F32), or anxiety disorder (F40-F48) or previously prescribed antidepressants (VA: CN600) or benzodiazepines (CN302). We compared a control cohort of women with LS sparing the vulva with women with LS affecting the vulva (N90.4). We conducted a sub-analysis by age (18-40, 41-55, and >55 years). We compared women aged ≥18 with VLS who received treatment (topical steroids (DE200), vaginal estrogen (GU500), prednisone (8640), hydroxyzine (5553), amitriptyline (704), gabapentin (25480), or tacrolimus (42316)) with women aged ≥18 with VLS who did not receive treatment within 6 months of VLS diagnosis. Finally, we compared women receiving only topical VLS treatment (topical steroids, vaginal estrogen, and tacrolimus) with those receiving no treatment. Outcomes of interest were depressive episodes, anxiety disorder, MDD or prescription of antidepressants or benzodiazepines within 6 months of VLS diagnosis. Propensity score matching was performed for age, ethnicity, race, type 1 diabetes (E10), vitiligo (L80), autoimmune thyroiditis (E06.3), alopecia areata (L63), pernicious anemia (D51.0), overweight and obesity (E66), type 2 diabetes (E11), hyperlipidemia (E78), essential hypertension (I10), and alcohol abuse (F10.10). Results 124,237 patients had LS sparing the vulva and 16,676 had VLS. VLS was associated with increased risk of depressive episode (risk ratio (RR) [95% Confidence Interval] 1.62 [1.32-1.99]), anxiety disorder (RR 1.82 [1.50-2.22]), and MDD (RR 2.61 [1.69-4.03]) (Table 1) compared to LS sparing the vulva. Women with VLS were also more likely to receive antidepressants (RR 1.91 [1.60-2.29]) and benzodiazepines (RR 1.70 [1.44-2.01]). Among menopausal women, VLS was associated with increased risk of anxiety disorder (RR 2.00 [1.10-3.63]) (Table 2). Among postmenopausal women, VLS was associated with increased risk of depressive episode (RR 1.73 [1.38-2.17]), MDD (RR 2.60 [1.64-4.12]), anxiety disorder (RR 1.58 [1.29-1.94]), antidepressants (RR 1.55 [1.30-1.86]), and benzodiazepines (RR 1.48 [1.24-1.76]). Among women with VLS, VLS treatment was associated with decreased risk of depressive episode (RR 0.68 [0.47-0.98]) and increased risk of antidepressants (RR 2.00 [1.54-2.59]) and benzodiazepines (RR 1.70 [1.31-2.20]) compared to women without VLS treatment (Table 3). Stratifying by treatment type, women treated solely with topicals had numerically, but not significantly, lower risk of developing depressive episode (RR 0.73 [0.48-1.11]) compared to women without VLS treatment. Conclusions We demonstrate that women with VLS, compared to those with LS sparing the vulva, have an increased risk of antidepressant and benzodiazepine prescriptions and development of depressive episode, anxiety disorder, or MDD. Patients with VLS should be screened for these conditions, and VLS treatment should be considered. Disclosure No

Character configuration, major depressive episodes, and suicide-related ideation among Japanese undergraduates.

To enable early identification of university students at high risk for suicide, we examined personality as a predictive factor for major depressive episodes and suicide-related ideation. From 2011 to 2013, we administered the Patient Health Questionnaire-9 (PHQ-9) and the Temperament and Character Inventory (TCI) to 1,997 university students at enrollment (T1). We previously conducted a study using the same data set; this is a re-analysis of the dataset. To prevent contamination of data, participants diagnosed with a depressive episode were excluded at T1. Three years after enrollment (T2), we re-administered the PHQ-9 to the same students. We statistically compared TCI scores at T1 among depressive episode groups and suicide-related ideation groups. Two-way ANOVA and Cochran-Armitage trend tests were used to analyze the relationships between personality traits, depressive episodes, and suicide-related ideation. The PHQ-9 summary scores at baseline (T1) were 3.0 (±2.7), with female students scoring 4.6 (±2.9) and male students 2.9 (±2.6, p = 0.025). The major depressive episode group at T2 had lower self-directedness (SD) scores at T1 than the non-depressive episode control group. The suicide-related ideation (SI) group at T2 also had higher harm avoidance (HA), lower SD, and lower cooperativeness (C) scores than the non-SI group at T1. The Cochran-Armitage trend tests revealed significant associations between character configurations composed of SD and C, and both depressive episodes at T2 and SI at T2. The temperament feature of high HA at baseline and character configurations of low SD and low C at baseline are the most contributory predictors for the novel development of depressive episodes and SI among Japanese university students.

Effects of perceived job insecurity on depression, suicide ideation, and decline in self-rated health in Korea: a population-based panel study.

To investigate the effects of job security on new development of depressive episode, suicide ideation, and decline in self-rated health. Data from the Korea Welfare Panel Study from 2012 to 2015 were analysed. A total of 2912 waged workers self-assessed their depressive episode, suicide ideation, and health annually by answering the questionnaire. Participants were divided into three groups according to the level of job security: high, intermediate and low. To evaluate the influence of job security, we performed survival analysis after stratification by gender with adjustment for covariates. The result was further stratified by whether the respondent was the head of household. After adjusting for covariates, men in low job security group showed significantly higher hazard ratios (HRs) for depression (HR 1.27, 95% CI 1.01-1.60), suicide ideation (HR 3.25, 95% CI 1.72-6.16), and decline in self-rated health (HR 1.73, 95% CI 1.16-2.59). Women showed significantly higher HR of depression in the intermediate (HR 1.37, 95% CI 1.01-1.87) and low (HR 1.50, 95% CI 1.12-1.99) job security group. Male head of household with low job security showed significantly higher HR of depression, suicide ideation, and decline in self-rated health. Non-head-of-household women with intermediate and low job security showed higher risk of depression than those with high job security. We found that perceived job insecurity is associated with the new development of depressive episode, suicide ideation, and decline in self-rated health.

Role of baseline depressive symptoms in the development of depressive episode in patients receiving antiviral therapy for Hepatitis C infection

ObjectiveThis study aimed to evaluate the symptom profile and the role of baseline depressive symptoms in the development of depressive episode in patients receiving pegylated IFN-alpha and ribavirin. Methods82 consecutive patients with HCV infection in whom combination of pegylated interferon-α 2a/2b and ribavirin was prescribed were assessed at baseline and thereafter at 2, 4, 8 and 12weeks. At the baseline, patients were assessed on Patient Health Questionnaire (PHQ-9), Mini International Neuropsychiatric Interview (MINI) and Beck Depression Inventory (BDI-II). Thereafter patients were assessed on PHQ-9 and when ever found to have Major Depressive Disorder as per PHQ-9, they were assessed on MINI. Those found to have Major Depressive Episode (MDE) on MINI were rated on BDI-II for phenomenology and severity of depression. ResultsCommon symptoms of pegylated IFN-alpha and ribavirin induced MDE include sadness, irritability, work inhibition, sleep disturbance, fatigability and loss of appetite. Presence of certain depressive symptoms i.e., presence of little interest or pleasure in doing things, feeling tired or having little energy, poor appetite, social withdrawal and work inhibition at the baseline were associated with development of depression during the course of pegylated IFN-alpha plus ribavirin therapy. ConclusionDepressive symptoms in patients with pegylated IFN-alpha and ribavirin induced MDE are influenced by the symptoms of depression prior to starting of pegylated IFN-alpha and ribavirin combination. A short screening questionnaire may be constructed which will include the symptoms which predict the development of depression to screen patients at high risk for the development of depression.

Methodology of China's national study on the evaluation, early recognition, and treatment of psychological problems in the elderly: the China Longitudinal Aging Study (CLAS).

SummaryCognitive and depressive disorders are common in elderly Chinese and are becoming an increasingly important public health problem, partly because of the rapid aging of the population. To help address this issue China's national government has funded a major study to establish national standards for the early identification, evaluation and treatment of common psychological disorders in the elderly. The present paper describes the overall methodology of this study. Fifteen centers in eight provinces will recruit representative samples of subjects aged 60 and over, collect a detailed history, conduct a physical and neurological examination, administer a comprehensive battery of psychological tests, and carry out a diagnostic exam using the Structured Clinical Interview for DSM-IV (SCID). These subjects will participate in follow-up evaluations one year and three years after the initial evaluation. Subsamples of subjects with mild cognitive impairment (MCI) and subclinical depression will be enrolled in randomized controlled trials of a cognitive training program (for MCI) or group cognitive behavioral therapy (for subclinical depression). The results of the study will be used to estimate the prevalence of cognitive and affective disorders in the elderly, to develop a standard screening procedure for these conditions that can be promulgated nationally, and to promote the use of specific interventions that can prevent the development of dementia in persons with MCI and the development of depressive episodes in elderly individuals with subclinical depression.

1115 – A biopsychosocial model of interferon-α-induced depression in patients with chronic hepatitis C infection

Introduction The aim of this prospective study was to gain a complete picture of the biopsychosocial effects of interferon-α treatment of patients with chronic hepatitis C. The predictors of depressive development and changes in health-related quality of life, life satisfaction and cognitive ability would be measured with the inclusion of the social context. Furthermore, the effects of interferon treatment on indoleamine 2,3-dioxygenase, the level of tryptophan supply in the brain, the development of neurotoxic kynurenine metabolites, and the thyroid glands were investigated. Therefore, for the first time the conditions for the development of depressive episodes in HCV patients treated with interferon-α were examined over the entire period of treatment as well as three months later, applying a holistic biopsychosocial model. Methods Psychiatric and biological assessments were carried out at six different times: before, during (at one, three, six and nine months), and after the end of interferon-α treatment. Results During IFN-α treatment 22 (53.7%) patients fulfilled the criteria for a treatment-related depressive disorder at least once during treatment. Contributing factors are tryptophan depletion (tryptophan to competing amino acids quotient), increased neurotoxic challenge (kynurenine to kynurenic acid quotient), less social support, female gender, preexisting psychiatric vulnerability, means of transmission, low financial security, impaired sexual satisfaction, small circle of friends, impaired role physical, strong body pain, low general health and vitality, reduced social functioning, impaired mental health and role emotional. Conclusions The awareness of relevant risk factors of IFN-α treatment-induced depression is essential to develop preventative treatment strategies.

Factores condicionantes en el desarrollo de episodios depresivos en universitarios: Una perspectiva desde Dorothea Orem

Objetivo: Determinar los factores condicionantes en el desarrollo de episodios depresivos en universitarios, a partir de los elementos básicos considerados en la Teoría General del Déficit de Autocuidado de Dorothea Orem. Metodología: Estudio cuantitativo, prospectivo, descriptivo, correlacional-causal y de corte transversal. Muestra de 819 alumnos de los diversos semestres y carreras (Licenciatura en Enfermería, Licenciatura en Administración, Contador Público, Ingeniero Civil y Licenciatura en Mercadotecnia). Se utilizó un instrumento creado exprofeso para medir los diversos factores, con un alfa de Crombach de 0.92. El procesamiento estadístico se realizó a través del programa SPSS versión 17, utilizándose análisis descriptivo y regresión lineal logística. Resultados: El 14.6% de las universitarias presentan episodios depresivos, mientras que en los estudiantes de género masculino este padecimiento se presenta en un 5.7%. Los factores condicionantes básicos identificados por medio del análisis cuantitativo son los sociodemográficos (p = 0.002), estado de salud (p = 0.040, promedio) y ambiente (p = 0.000). Conclusión: Se brinda un panorama de acción diferente y complementario, para proporcionar una atención de calidad a partir de la prioridad de Orem, que es controlar y dirigir los factores hacia un equilibrio biopsicosocial y espiritual.

Relationship between cognitive sensitivity to (symbolic) light in remitted seasonal affective disorder patients and the onset time of a subsequent depressive episode

The role of cognitive sensitivity to light in the development of seasonal affective disorder (SAD, winter type) was studied by comparing 29 SAD patients during remission with 29 non-depressed controls matched by sex and age, and by relating measures for cognitive sensitivity of remitted SAD patients to the onset of a depressive episode during the following autumn/winter. To ensure that only cognitive processes were involved, the subjects were exposed to symbolic light. Three schematic drawings of ambiguous faces expressing different emotions were embedded in light or dark backgrounds for this purpose. The subjects rated the various facial expressions with respect to the degree of elation-sadness, rejection-invitation, and activation-sleepiness. SAD patients saw larger differences in activation between faces embedded in light and dark backgrounds than controls, perceiving less activation in faces with dark backgrounds. Furthermore, the larger the difference that SAD patients saw in invitation between faces with light and dark backgrounds, the earlier they became depressed in the subsequent autumn/winter. Only the SAD patients who became depressed early (before December 21) differed from controls in the perception of invitation. Results are interpreted within the framework of psychological theories on the development of depression and suggest that altered cognitive sensitivity of SAD patients to light plays a role in the development of depressive episodes.