Elevated Depressive Symptoms Research Articles

Universal depressive symptom screening in middle schools in Istanbul: An epidemiologic study

IntroductionDepression is a significant public health concern, with severe adolescent morbidity and mortality. Promoting adolescents' mental health is increasingly recognized, and schools are proposed as screening and preventive intervention sites. This cross-sectional study aimed to screen self-reported elevated depressive symptom prevalence among secondary school students in Istanbul, Turkey. The secondary objectives were determining behavioral problems, resilience, positive attitudes, and risk factors associated with depressive symptoms. MethodsData collection was conducted between April–June 2022. Six thousand one hundred ten students from nine randomly selected schools from different city districts were approached. Depression was screened by the Centre for Epidemiological Studies Depression Scale for Children (CES-DC). The Strengths and Difficulties Questionnaire (SDQ) was used for screening behavioral problems and positive attitudes. Resilience was evaluated by the Child and Youth Resilience Measure (CYRM). ResultsThe final study sample comprised 2780 participants (response rate 47.7 %) with a mean age of 12.4 ± 1.1 years (females:52.7 %). Elevated depressive symptoms were detected in 31.2 % of the students. Female students exhibited higher scores in CES-DC and total difficulties but lower resilience scores in CYRM than male students. In a multiple regression analysis, female gender, higher total difficulties score, lower resilience score, and lower perceived academic performance significantly predicted CES-DC [F(6,2279) = 421, p < 0.01]. DiscussionOur findings showed high rates of elevated self-reported depressive symptoms in a city sample among Turkish adolescents at middle schools, in addition to coexisting behavioral difficulties and decreased resilience indicating poor psychosocial functioning. Given the prevalent depressive symptoms, screening and intervention programs involving resilience promotion may involve school systems to prevent adolescent depression.

Mental health symptom burden in elite ice hockey players and its association with self-reported concussive events

BackgroundSome studies suggest that elite athletes experience adverse mental health symptoms at rates commensurate with the general population, despite the well-established buffering effects of exercise. Within contact sports, such as ice-hockey, recurrent concussions may be a source of this discrepancy. We compared the point prevalence of various mental health outcomes with other athlete and general population samples, as well as investigated their relationship with concussive events.MethodsWe surveyed 648 active ice hockey players from the top two men’s tiers and the top women’s tier in Swedish elite ice hockey on lifetime concussive events, hazardous alcohol use, problematic social media use, depression, anxiety, and burnout.ResultsHazardous alcohol use was more prevalent among male ice hockey players (29.5% AUDIT-C ≥ 6) compared to other athlete and general population samples, while other mental health symptoms were less common. Female ice hockey players reported higher hazardous alcohol consumption (36.4% AUDIT-C ≥ 4) than another athlete sample and more burnout (19.1%) than the general population. After adjusting for covariates, athletes with 3+ concussive events had 2.1 times the odds of elevated depressive symptoms and 3.5 times the odds of elevated burnout symptoms compared to those with no concussion history. Treating lifetime concussive events as a continuous predictor revealed positive correlations with all outcomes except for hazardous alcohol use.ConclusionsMental health outcome rates among active elite ice hockey athletes differ from those of other athlete and general population samples, whilst concussive events may be particularly linked to elevated symptoms of depression and burnout.

The role of affective control, strategy repertoire and subjective emotion regulation success in developmental internalising psychopathology

Adolescence poses significant challenges for emotion regulation (ER) and is thus a critical phase in the emergence of various mental disorders, specifically internalising disorders such as anxiety and depression. Affective control, defined as the application of cognitive control in affective contexts, is crucial for effective ER. However, the relationship between ER and affective control is unclear. This study examined the predictive role of ER strategies and difficulties in affective control, measured as the congruency effect and error rate on an Emotional Stroop task (EST), in a sample of adolescents and young adults (aged 14–21, M = 17.28, 22% male). It was hypothesised that participants with internalising disorders would show higher congruency effects and error rates on the EST than healthy controls after a psychosocial stress induction, indicating lower affective control. Surprisingly, our findings revealed no significant differences in these measures between the groups. However, higher depression scores were associated with increased EST errors. While ER strategies and difficulties did not predict affective control, exploratory analyses unveiled associations between depression scores and ER strategy repertoire, perceived ER success and the ER strategy Acceptance. These findings underscore the importance of implicit ER facets, particularly perceived ER success and flexibility to change between applied strategies for adolescents and young adults with elevated depressive symptoms.

Depressive symptoms over the final menstrual period: Study of Women's Health Across the Nation (SWAN)

BackgroundWomen may be vulnerable to elevated depressive symptoms during the menopause transition (MT). Studies generally have not considered premenopausal depressive symptom history or examined symptoms in relation to the final menstrual period (FMP). ObjectiveTo identify specific time points in relation to the FMP when depressive symptoms increase or decrease. MethodsParticipants were 1582 multiracial/ethnic women from the longitudinal Study of Women's Health Across the Nation (SWAN). Biological, psychosocial, and depressive symptom data were collected approximately annually. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CESD) scale. ResultsWomen with high baseline depressive symptoms (CES-D ≥ 16) declined in symptoms (M = −1.04/yr., 95 % CI = −1.58, −0.50) until 4 years before the FMP, followed by a smaller decrease (M = −0.50/yr., 95 % CI = −0.72, −0.28) until 18 months after the FMP. Depressive symptoms increased (M = 0.21/yr., 95 % CI = 0.11, 0.30) in those with low baseline symptoms until 1 year before the FMP, and decreased (M = −0.06/yr., 95 % CI = −0.11, −0.008) going forward. Greater social support, higher levels of follicle stimulating hormone and estradiol, and less sleep disturbance contributed to greater decline in depressive symptoms among those with high baseline depressive symptoms. Anxiety, experiencing stressful life events, lower body mass index, and poor role-physical function contributed to an increase in depressive symptoms among those with low baseline symptoms. LimitationsExcluded women had higher baseline CES-D scores. Lacked pre-MT depression for pre/early perimenopausal women at baseline. ConclusionAccounting for baseline depressive symptom level and focusing on the FMP more precisely characterize depressive symptom change over the MT.

Psychological and socio-economic correlates of cardiovascular health among young adults in Puerto Rico

ObjectiveWe aimed to determine the relationship between socioeconomic and psychological factors and overall cardiovascular health (CVH), as defined by the American Heart Association's Life's Essential 8 (LE8), among young adults in Puerto Rico. MethodsParticipants were 2156 young adults, between the ages of 18–29 years, enrolled in the PR-OUTLOOK study. The analysis included survey, laboratory, and physical measurement data collected from September 2020 to November 2023. Assessed socioeconomic indicators included food insecurity, housing instability, economic insecurity, and subjective social standing. Evaluated psychological factors comprised symptoms of depression, anxiety, post-traumatic stress, and overall perceived stress. LE8 scores were calculated and classified as suboptimal (poor/intermediate range) vs. ideal CVH. Logistic regression models estimated associations between each socioeconomic and psychological measure and suboptimal CVH, and dominance analysis assessed the importance of each measure. ResultsParticipants' mean age was 22.6 (SD = 3.1), 60.9 % were female, about one-third (34.2 %) had high school education or less, and over one-third had public or no health insurance (38.4 %). Participants reporting socioeconomic adversity (i.e., high food insecurity, housing instability and economic insecurity, and low subjective social standing) and elevated psychological symptoms (i.e., symptoms of anxiety, depression, post-traumatic stress, and overall perceived stress) had lower CVH scores. However, in the adjusted analysis, only lower subjective social standing (OR = 1.38, 95 % CI = 1.13–1.69) and elevated symptoms of anxiety (OR = 1.63, 95 % CI = 1.25–2.13) and depression (OR = 1.30, 95 % CI = 1.03–1.65) emerged as the primary contributors to suboptimal CVH (vs. ideal). ConclusionEfforts to preserve and enhance CVH among young Puerto Ricans on the island should target these factors.

Brief Educational Workshops in Secondary Schools Trial (BESST): a cluster randomised controlled trial. Secondary analysis in those with elevated symptoms of depression

BackgroundDepression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief self-referral stress workshop programme for sixth-form students aged...

Sexual Identity Development, Psychiatric Risk, and Protective Factors Among Bisexual People in Mainland China, Hong Kong, and Taiwan.

Purpose: This study aimed to uncover sexual identity development and investigate the psychiatric risks for bisexual people across mainland China, Hong Kong, and Taiwan by examining ecologically informed factors at the individual, family, and community levels. Methods: An internet-based survey was administered to 685 respondents, from June to August 2021, reached primarily through lesbian, gay, bisexual, transgender, and queer community organizations and professional networks. Participants reported their demographics, identity milestones, and psychiatric symptoms. Results: Significant birth cohort and regional differences were observed regarding bisexual identity milestones. Individuals who were older, transgender and/or nonbinary, and based in Taiwan disclosed their sexual identity more. All respondents reported clinically elevated depression and anxiety symptoms, with a majority experiencing moderately severe depression (60%) and moderate or severe anxiety (80%). Approximately half of respondents contemplated suicide in the past year. Compared with cisgender women, identifying as transgender and nonbinary assigned female at birth was significantly associated with increased depression and higher odds of suicidal ideation in the past year. Enhanced self-esteem was associated with greater well-being and decreased psychiatric symptoms. Experiencing family shame was associated with increased anxiety and depression. At the community level, living in Hong Kong was linked to lower depression and suicidal ideation compared to mainland China. The presence of an LGBT group correlated with improved psychological well-being. Conclusions: Chinese bisexual people face substantial risks for depression, anxiety, and suicidal ideation, influenced by factors including self-esteem, transgender and nonbinary gender identity, family dynamics, and community context. Significant birth cohort and regional differences in bisexual identity development exist.

Empowerment of Posyandu Lansia cadres in overcoming depression and violence among elderly women after the Covid-19 pandemic in Dukuh Panggungan

Introduction: The COVID-19 pandemic has significantly impacted the mental health and safety of the elderly, particularly affecting elderly women. Research indicates a rise in anxiety and depression among older adults, with pre-existing elevated depressive symptoms exacerbating their resilience during this period. Increased isolation, financial strain, and restricted access to support services have led to a surge in elder abuse cases, disproportionately affecting women. Effective strategies, such as raising awareness and ensuring timely provision of resources, are crucial to safeguarding the mental well-being of the elderly. Indonesia's commitment to sustainable development and health equity, exemplified through initiatives like the Sustainable Development Goals, must address the specific challenges faced by elderly women in communities like Panggungan Village. The demographic shift towards an aging population, coupled with the pandemic's effects, further magnifies vulnerabilities. Empowering community-based resources can provide holistic support to elderly women, contributing to sustainable health development and social equity. Methods: The approach targets 15 Posyandu Lansia cadres and 20 elderly women in Panggungan Village through an offline community service program adhering to health protocols. Tools used in this study were the Mental Health Improvement Module, Geriatric Depression Scale questionnaire, and knowledge/skills assessment for Posyandu Lansia cadres. A combined quantitative and qualitative analysis was applied. Results: Results showed that 55% prevalence of verbal violence, 45% neglect, and 35% exploitation violence among elderly women. Post-training, these figures improved to 25% for verbal violence, 10% for exploitation violence, and 15% for neglect violence. Depression tendencies witnessed a 25% shift. Cadres’ knowledge increased from 58.2 to 82.1, and skills improved from 63.5 to 79.2. Conclusion: Elevated violence and depression tendencies that were quite high, negatively impact elderly women's mental health in Panggungan Village. Cadre’s training significantly enhances residents' well-being and mental health, offering a meaningful solution.

The relationship of mental health symptoms to chemotherapy toxicity risk in older adults with cancer: Results from the geriatric assessment-driven intervention study.

Depression and anxiety are prevalent in older adults with cancer but are often undertreated. Older adults are also at increased risk of chemotherapy toxicity (CT). This study evaluated the impact of depression and anxiety symptoms on severe CT risk in older adults with cancer. This is a secondary analysis of a randomized trial (2:1) evaluating geriatric assessment-driven intervention (GAIN) versus standard of care (SOC) to reduce grade 3+ CT in older adults with cancer. Mental health was assessed via the Mental Health Inventory 13. CT was graded by National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. A total of 605 patients enrolled (402 GAIN; 203 SOC). Overall, 35% were depressed and 47% were anxious. Patients with depression had increased CT in the SOC arm (70.7% vs. 54.3%; p=.02) but not in the GAIN arm (54.3% vs. 48.5%; p=.27). CT was more likely in SOC patients with depression (odds ratio [OR], 2.03; 95% CI, 1.10-3.72). This association persisted after adjusting for Cancer and Aging Research Group toxicity score (OR,1.98; 95% CI, 1.07-3.65) and for demographic, disease, and treatment factors (OR,2.00; 95% CI, 1.03-3.85). Depression and CT were not associated in the GAIN arm (OR, 1.26; 95% CI, 0.84-1.91). Anxiety and CT were not associated in either arm. Elevated depression symptoms are associated with increased risk of severe CT in older adults with cancer, which was mitigated with GAIN. This suggests that treating depression symptoms may lower toxicity risk. Future studies are needed to confirm and investigate the impact of depression-specific interventions on outcomes.

Older Bereaved Individuals’ Experiences of Cognitive-Behavioral Therapy for Complicated Grief Reactions: A Qualitative Multistage Focus Group Approach

Bereavement is particularly common in old age. A small proportion of bereaved people develop complicated grief reactions (CGR) characterized by elevated symptoms of depression, prolonged grief disorder, anxiety, and/or posttraumatic stress. Cognitive-behavioral therapy for CGR (CBTgrief) is found to be an effective treatment. Detailed knowledge about older adults’ experiences of CBTgrief is needed to optimize treatment and to give recommendations to practice. To explore older adults’ experience of CBTgrief to gain insight into elements that were helpful or less helpful. Four multistage focus group interviews were conducted with nine older adults who lost a partner and received CBTgrief and three researchers. Five participants received group therapy and four individual therapy (mean age = 69.67 years, 89% women). The participants found exposure exercises, psychoeducation in grief, and letter writing particularly helpful. The participants requested options for family sessions, a combined individual/group format, and follow-up sessions. Awareness of potential memory problems and adapting to new practical tasks should receive greater focus in therapy. This study gives important insights into older adults’ experiences of CBTgrief and evaluates the helpful and less helpful elements in grief therapy. This may guide improvements in the treatment of bereaved older adults with CGR.

The moderating role of diabetes distress on the effect of a randomized eHealth intervention on glycemic control in Black adolescents with type 1 diabetes.

Due to systemic inequities, Black adolescents with type 1 diabetes are more likely to have suboptimal glycemic control and high rates of diabetes distress, but tailored interventions for this population are lacking. In primary outcomes of a randomized clinical trial, a family-based eHealth intervention improved glycemic control in Black adolescents with type 1 diabetes and elevated depressive symptoms. The present study is a secondary analysis of these clinical trial data examining the moderating effect of diabetes distress on the efficacy of the intervention. Using secondary data from a multicenter randomized clinical trial (Clinicaltrials.gov [NCT03168867]), caregiver-adolescent dyads were randomly assigned to either up to three sessions of an eHealth parenting intervention (n = 75) or a standard medical care control group (n = 74). Black adolescents (10 years, 0 months to 14 years, 11 months old) with type 1 diabetes and a caregiver willing to participate were eligible. Adolescents reported their diabetes distress at baseline, and hemoglobin A1c (HbA1c) data were collected at baseline, 6-, 13-, and 18-month follow-up. No between-group contrasts emerged in a linear mixed-effects regression (p's > .09). Within-group contrasts emerged such that adolescents assigned to the intervention who reported high diabetes distress had lower HbA1c at the 18-month follow-up relative to baseline (p = .004); the 18-month decrease in HbA1c was -1.03%. Black adolescents with type 1 diabetes and high levels of diabetes distress showed significant decreases in HbA1c following a family-based eHealth intervention, suggesting diabetes distress may be a key moderator of intervention efficacy within this population.

Factors Associated with Fathers’ Mental Health Difficulties in an Australian Help-Seeking Sample

Fathers are at increased risk of mental health difficulties such as depression during the first postnatal year, however little is currently known about the extent to which fathers experience symptoms of anxiety and stress, and the factors associated with these symptoms. This study aimed to: (1) investigate the extent to which fathers accessing support to strengthen their coparenting relationship through a community health organisation experience depressive, anxiety and stress symptoms during the first postnatal year, and (2) examine associations between a broad range of individual, child, and family factors and fathers’ depressive, anxiety, and stress symptoms during the first postnatal year. This study involved secondary analysis of routinely collected data from 170 fathers of children aged 0–12 months who were enroled in a coparenting intervention programme delivered by a community health organisation in Melbourne, Australia. Elevated symptoms of stress were reported by ~28% of fathers, while elevated symptoms of depression and anxiety were reported by ~26% and 16% of fathers, respectively. Multiple regression analyses revealed evidence for associations between reduced parental self-efficacy and higher depressive and stress symptoms, while infant regulation difficulties and increased interparental conflict were associated with higher levels of stress. This study highlights that fathers are at risk of mental health difficulties during the first postnatal year. Findings demonstrate the importance of undertaking a broad assessment of fathers’ mental health during the first postnatal year and provide important insights into individual, child, and family factors that may represent optimal targets for prevention and early intervention.

Predictors of Depressive Symptoms in Autistic Youth-A Longitudinal Study From the Province of Ontario Neurodevelopmental Disorders (POND) Network: Prédicteurs des symptômes dépressifs chez les jeunes autistes-une étude longitudinale du Réseau des troubles neurodéveloppementaux de la province de l'Ontario (réseau POND).

The objective of this study was to identify longitudinal predictors of depressive symptoms in autistic children and youth. Participants were youth with a diagnosis of autism who were part of the Province of Ontario Neurodevelopmental Disorders Network longitudinal substudy. Depressive symptoms were assessed using the child behaviour checklist (CBCL) affective problems subscale. Univariate and multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between clinical and demographic characteristics at baseline (T1) and clinically elevated depressive symptoms (CEDS) approximately 4 years later (T2). The mean age of participants (n = 75) at T1 was 9.8 years (SD = 2.7) and at T2 was 14.1 years (SD = 2.8). A total of 37% and 35% of participants had CEDS at T1 and T2, respectively. Additionally, 24% of participants had CEDS at both T1 and T2. T1 characteristics associated with T2 CEDS were: loneliness (OR = 3.0, 95% CI, 1.1 to 8.8), self-harm (OR = 4.0, 95% CI, 1.1 to 16.9), suicidal ideation (OR = 3.9, 95% CI, 1.0 to 16.5), more social and adaptive skills (OR = 0.3, 95% CI, 0.1 to 0.9), elevated restricted and repetitive behaviours (OR = 3.8, 95% CI, 1.3 to 11.6), psychotropic medication use (OR = 3.0, 95% CI, 1.1 to 8.4), attention-deficient/hyperactivity disorder (OR = 2.8, 95% CI, 1.1 to 7.8), and T1 CEDS (OR = 8.8, 95% CI, 3.1 to 27.0) (uncorrected for multiple comparisons). Associations persisted after adjusting for age and intelligence quotient (IQ) differences. Age, sex, IQ, teasing/bullying on the CBCL, family psychiatric history and family income were not associated with T2 CEDS. Our results highlight both high prevalence and high potential for the persistence of depressive symptoms in autism and emphasize the importance of early support to address loneliness and social participation.

Prenatal determinants of anxiety symptoms in middle childhood. Evidence from Growing Up in New Zealand

BackgroundEarly life environments can have long-lasting impacts on future health and wellbeing. Maternal health during pregnancy, including experiencing stress or mood disorders, has been associated with psychopathology in later life. Anxiety disorders are one of the most prevalent mental health conditions, affecting approximately 7 % of children and adolescents globally, with a lifetime prevalence of 15–20 %. Identifying prenatal risk factors can support future and current public health interventions and maternity care. MethodsData were obtained from the Growing Up in New Zealand longitudinal study of child development. Prenatally, mothers provided sociodemographic information as well as data on their mental health, potential teratogens, and lifestyle factors such as supplement intake and exercise levels. At 8-years old, 4922 children self-completed the PROMIS-SF anxiety measure. Bivariate analyses and backward stepwise regression were used to determine the best multivariable model. ResultsSignificant prenatal predictors of anxiety symptoms at 8-years old included elevated maternal depression symptoms, body mass index in the overweight/obese range, exercise patterns, and paracetamol, anti-inflammatory and alcohol intake. LimitationsSample attrition from baseline to 8-year may have affected statistical power. To further untangle the effect of timing and duration of the exposures reported in this study, larger sample sizes would be required. ConclusionsPrenatal mental health and wellbeing was significantly associated with child anxiety symptoms at 8-years of age. This study highlights the importance of supporting expectant mothers' health and wellbeing during pregnancy to ensure children have the best opportunity to have good mental health.

Reducing intrusive suicidal mental images in patients with depressive symptoms through a dual-task add-on module: Results of a multicenter randomized clinical trial.

To examine the safety and efficacy of a brief cognitive dual-task (using eye movements) add-on module to treatment as usual (TAU) in reducing the severity and frequency of intrusive suicidal mental images and suicidal ideation. We conducted a single-blind, parallel multicenter randomized trial (No. NTR7563) among adult psychiatric outpatients (N = 91; Mage = 34.4, SD = 13.54; 68% female) with elevated depressive symptoms and experiencing distressing suicidal intrusions in the Netherlands. Primary outcome was the severity (Suicidal Intrusions Attributes Scale) and frequency (Clinical Interview for Suicidal Intrusions) of suicidal mental imagery intrusions at 1-week posttreatment and 3-month follow-up. Primary analysis was intention-to-treat. Between November 27, 2018 and September 13, 2021, 91 patients were included and randomly assigned to intervention group (Cognitive Dual Task Add-on + TAU) (n = 46) or TAU-only (n = 45). Cognitive Dual Task Add-on + TAU had greater reductions in severity (mean difference, -15.50, 95% CI [23.81, -7.19]; p < .001, d = 0.60), and frequency (geometric mean difference, 0.47, 95% CI [0.29, 0.79]; p = .004) of suicidal intrusions over time than TAU-alone. Cognitive Dual Task Add-on + TAU patients also showed lower suicidal ideation over time (p = .008, d = 0.42). There were no significant group differences in reductions in depressive symptoms, rumination, or hopelessness. Four serious adverse events occurred (three Cognitive Dual Task Add-on + TAU; one TAU-only); all unlikely attributable to intervention/trial. Findings provide support for the effectiveness of adding a cognitive dual-task module to the treatment of psychiatric outpatients with elevated depressive symptoms in reducing suicidal intrusions and ideation and can be executed safely. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study.

Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences. This study leverages adolescents' everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers. A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent's person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers. As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit. This study leverages depressed adolescents' everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents. DERR1-10.2196/43931.

Association of both depressive symptoms scores and specific depressive symptoms with all-cause and cardiovascular disease mortality

BackgroundThe presence of depression related to an increased risk of all-cause and cardiovascular disease (CVD) mortality has been reported. However, studies conducted on certain specific depressive symptoms are scarce. Our purpose was to assess the effect of both depressive symptoms scores and certain specific depressive symptoms on all-cause and CVD mortality.MethodsIn the present cohort study, all participants, aged 18 years or older, were enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2014. Depressive symptoms score was assessed using the validated 9-item Patient Health Questionnaire Depression Scale (PHQ-9), which ranges from 0 to 27, with a PHQ-9 score ≥ 10 diagnosed as depression. The outcome events were all-cause and CVD mortality, which were followed up from 2005 to 2014. The associations of both depressive symptoms score and certain specific depressive symptoms with all-cause and CVD mortality were examined by weighted multivariable proportional hazards models.ResultsA total of 26,028 participants aged ≥ 18 years were included in the statistical analysis, including 12,813 (49.2%) males and 13,215 (50.8%) females, with a mean (SD) age of 47.34 (18.86) years. During the 9.32 (3.20) years of mean (SD) follow-up, 3261 deaths were recorded, of which 826 were cardiovascular deaths. All-cause mortality was 16.87/1000 person-years in subjects with depression. In terms of CVD mortality, these figures were 4.53/1000 person-years. In the full model (model 3), elevated depressive symptoms scores were independently associated with an increased risk of all-cause mortality (Highest depression symptom score group: adjusted hazard ratio, 1.63; 95% CI 1.44–1.85) and CVD mortality (Highest depression symptom score group: adjusted hazard ratio, 1.73; 95% CI 1.34–2.24). All 9 specific depressive symptoms that make up the PHQ-9 were related to an increased risk of all-cause mortality. However, only 3 symptoms, including trouble sleeping or sleeping too much, poor appetite or overeating, and suicidal ideation, were no significantly associated with an increased risk of CVD mortality.ConclusionsThe elevated depressive symptoms scores were strongly associated with an increased risk of all-cause and CVD mortality in US adults. Furthermore, all 9 specific depressive symptoms were associated with high all-cause mortality. However, trouble sleeping or sleeping too much, poor appetite or overeating, and suicidal ideation might not increase the risk of CVD mortality.

Depressive symptoms predict cannabis vaping initiation among young adults

BackgroundYoung adults in the United States, including college students, have the highest prevalence of cannabis use compared with other age groups. Although cannabis vaping is increasingly prevalent during young adulthood, little is known about factors contributing to the onset of cannabis vaping during this developmental period. MethodsParticipants were 3085 cannabis vaping naïve young adults aged 18–25 years (M = 20.60; SD = 1.80), initially recruited from 24 Texas colleges and participating in a multi-wave, longitudinal study. A survival analysis was conducted to determine if participants reporting elevated depressive symptoms had an increased risk of onset of cannabis vaping over six follow-up waves from fall 2015 to spring 2019 compared to their peers with lower levels of depressive symptoms. Socio-demographic characteristics, time-varying past 30 day substance use, and time-varying peer nicotine vaping were included as covariates in the model. ResultsTwenty-five percent of participants initiated cannabis vaping during the four-year study period, with stable initiation rates from 2015 to 2017 but doubling from 2017 to 2019. Analyses, both unadjusted and adjusted for study covariates, indicated that elevated depressive symptoms were significantly associated with an increased risk of cannabis vaping initiation. ConclusionFindings indicate that initiation of cannabis vaping during young adulthood is common, and particularly more likely among those with greater depressive symptoms, thus underscoring the importance of prevention programs that include mental health support services tailored to young adults.

Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements.

Depression is a major contributor of young people's burden of disease. In this study we aim to estimate the effect of elevated depressive symptoms on physical health-related quality of life. We used self-reported information from the prospective BELLA cohort study, which included adolescents selected from the general population in Germany. The baseline assessment (2003-2006) and the 1-, 2-, and 6-year follow-up waves provide the data basis. The baseline study population consisted of 1,460 adolescents between the ages of 12 and 17 who, according to their caregivers, did not suffer from depression. The primary outcome, as measured by the physical component score (PCS) of the SF-36 at a 6-year follow-up (range: 0-100), is physical health-related quality of life. The exposure of interest is depressive symptoms, as measured by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) at baseline, 1-year follow-up and 2-year follow-ups (range: 0-60). We dichotomized the exposure into subthreshold (≤15) and elevated depressive symptoms (>15). For the main analyses we considered a cumulative index for elevated depressive symptoms across the three time points (range: 0-3). Considered confounders are sex, age, socioeconomic status, migrant background, social support, anxiety symptoms, physical activity, chronic diseases, and sleeping problems. We used multiple imputation to account for missing values. Within each imputed dataset, we applied inverse probability weighting (IPW) to estimate the effect of the cumulative index for elevated depressive symptoms at baseline, 1- and 2-year follow-up on physical health-related quality of life at 6-year follow-up. We derived 95% confidence intervals by bootstrapping. After adjusting with IPW, the effect of the cumulative index per one unit increase of elevated depressive symptoms on the physical component score was -1.71 (95% CI: -3.51 to -0.04). The adjusted effect estimates of single exposure of elevated depressive symptoms on physical health-related quality of life were -0.83 (95% CI: -3.69 to 1.87) at baseline, -2.96 (95% CI: -4.94 to -0.52) at 1-year follow-up and -1.32 (95% CI: -3.85 to 1.15) at 2-year follow-up. Findings suggest that elevated depressive symptoms during adolescence decrease physical health-related quality of life in young adulthood.

Neuropathological implication of high blood bilirubin in patients and model rats with depression

PurposeElevated bilirubin levels have been associated with major depressive disorder (MDD); however, the exact impact of bilirubin on MDD and the underlying molecular mechanisms remain unclear. Here, we explored the influence of bilirubin on MDD and sought to identify the mechanisms via which bilirubin induces depressive-like behavior. Patients and methodsForty patients who were diagnosed with MDD and received treatment with selective serotonin reuptake inhibitors (SSRIs) were included, with 43 healthy volunteers serving as controls. Clinical symptoms were evaluated using Hamilton depression rating scale-24 (HAMD-24) and the Hamilton anxiety rating scale. Serum concentrations of total bilirubin (TBIL) and indirect bilirubin (IBIL) were measured at baseline and after treatment using an automated biochemical analyzer. The connection between clinical symptoms and TBIL or IBIL was examined using Pearson correlation. Chronic restraint stress (CRS) was employed to generate a rat model of depression. TBIL, IBIL in rat serum were measured by ELISA. Reactive oxygen species (ROS) contents in rat hippocampal tissues were quantified by flow cytometry. The levels of microglial markers and the extent of neuronal damage in the rat hippocampus were assessed by immunofluorescence and transmission electron microscopy, respectively. ResultsSerum TBIL and IBIL levels were higher in patients with MDD than in the healthy controls. After treatment with SSRIs, the serum levels of TBIL and IBIL in MDD patients were significantly reduced. The levels of TBIL and IBIL were associated with HAMD-24 in MDD patients. Compared with the controls, the serum levels of TBIL, IBIL and the hippocampal ROS contents were elevated in CRS-exposed rats. Fluoxetine lowered inflammatory factor levels, mitigated oxidative stress. ConclusionOur findings indicate a possible correlation between elevated serum bilirubin and depressive symptoms. Increases in ROS levels, along with neuronal damage, may represent pathological mechanisms underlying MDD.