Emotional Depressive Symptoms Research Articles

Differential effects of guided imagery and progressive muscle relaxation on physical and emotional symptoms in nursing students taking initial clinical training: A randomized clinical trial

BackgroundThe initial clinical training has been reported by nursing students as the most challenging component of the nursing programs. Although progressive muscle relaxation and guided imagery have been reported to improve emotional and physical health, the use of such approaches among nursing students rarely exist. PurposeThe purpose of this study was to examine the deferential effects of progressive muscle relaxation [PMR] and guided imagery [GI] on physical and emotional symptoms in nursing students taking their initial clinical training. MethodsUsing a three-group, randomized, single blinded study conducted in a large Jordanian university, 156 nursing students were randomly allocated into one of three study groups (PMR group, GI group, and control group). The physical symptoms and emotional symptoms of depression, anxiety, and stress were assessed at baseline and end of the intervention. The study protocol was registered in ClinicalTrail.gov, identifier: xxxxxx. ResultsUsing one-way MANOVA and post-hoc comparisons, the results showed that PMR and GI significantly reduced more physical symptoms than control condition although PMR was more effective than GI in this regard. GI significantly decreased more emotional symptoms such as anxiety, depression, and stress than PMR and control condition. PMR decreased anxiety, depression, and stress but the results were not statistically significant. ConclusionThe findings of this study support the ABC relaxation theory claiming that PMR im-proves better physical symptoms while GI improves better emotional symptoms. However, further studies using students from multiple settings are needed.

Cognitive and Affective Empathy as Indirect Paths Between Heterogeneous Depression Symptoms on Default Mode and Salience Network Connectivity in Adolescents.

Depression amongst adolescents is a prevalent disorder consisting of heterogeneous emotional and functional symptoms-often involving impairments in social domains such as empathy. Cognitive and affective components of empathy as well as their associated neural networks (default mode network for cognitive empathy and salience network for affective empathy) are affected by depression. Depression commonly onsets during adolescence, a critical period for brain development underlying empathy. However, the available research in this area conceptualizes depression as a homogenous construct, and thereby miss to represent the full spectrum of symptoms. The present study aims to extend previous literature by testing whether cognitive and affective empathy indirectly account for associations between brain network connectivity and heterogeneous depression symptoms in adolescents. Heterogeneous functional and emotional symptoms of depression were measured using the child depression inventory. Our results indicate that cognitive empathy mediates the association between default mode network functional connectivity and emotional symptoms of depression. More specifically, that adolescents with a stronger positive association between the default mode network and cognitive empathy show lower emotional depression symptoms. This finding highlights the importance of cognitive empathy in the relationship between brain function and depression symptoms, which may be an important consideration for existing models of depression in adolescents.

Cortical thinning in preschoolers with maladaptive guilt

Maladaptive guilt is a central symptom of preschool-onset depression associated with severe psychopathology in adolescence and adulthood. Although studies have found that maladaptive guilt is associated with structural alterations in the anterior insula (AI) and dorsomedial prefrontal cortex (dmPFC) in middle childhood and adolescence, no study has examined structural neural correlates of maladaptive guilt in preschool, when this symptom first emerges. This study examined a pooled sample of 3-to 6-year-old children (N = 76; 40.8% female) from two studies, both which used the same type of magnetic resonance imaging scanner and conducted diagnostic interviews for depression that included clinician ratings of whether children met criteria for maladaptive guilt. Preschoolers with maladaptive guilt displayed significantly thinner dmPFC than children without this symptom. Neither children's depressive severity nor their vegetative or other emotional symptoms of depression were associated with dmPFC thickness, suggesting that dmPFC thinning is specific to maladaptive guilt. Neither AI gray matter volume or thickness nor dmPFC gray matter volume differed between children with and without maladaptive guilt. This study is the first to identify a structural biomarker for a specific depressive symptom in preschool. Findings may inform neurobiological models of the development of depression and aid in detection of this symptom.

Using Expressive Writing to Test an Evolutionary Hypothesis About Depressive Rumination: Sadness Coincides with Causal Analysis of a Personal Problem, Not Problem-solving Analysis

The analytical rumination hypothesis proposes that depression is an evolved response to complicated life stressors or problems. As part of this response, depressive symptoms promote analytical rumination, a prolonged and distraction-resistant style of thinking that functions to address the triggering problem. Analytical rumination involves analytical thinking about why the problem happened (i.e., causal analysis) and how it can be solved or alleviated (i.e., problem-solving analysis). Previous research analyzing cross-sectional data suggests that causal analysis is directly related to depressive symptoms and precedes problem-solving analysis, but this finding should be supported with experimental methods. We used an expressive writing paradigm to investigate the temporal order of the emotional symptoms of depression, causal analysis, and problem-solving analysis in a non-clinical sample. In two studies, we randomized participants to write about their personal problems or a neutral topic (i.e., control writing). All participants reported on their emotions during writing, and they retrospectively reported on their thoughts after writing. Consistent with our predictions, expressive writing reliably increased self-reported sadness and causal analysis but not problem-solving analysis. Linguistic analyses partially supported our predictions. Relative to control writing, expressive writing contained more words related to causal thoughts and problem-solving. Since causal analysis and sadness increased over the short time frame of the writing intervention, while problem-solving analysis was unaffected, the results support our prediction that causal analysis precedes problem-solving analysis. We discuss the limitations of our studies, as well as EW’s utility for studying the analytical rumination hypothesis.

What comes first, negative emotions, positive emotions, or moderate-to-vigorous physical activity?

BackgroundAlthough there is no doubt that indicators of physical activity (PA), negative and positive emotions are associated, the order in which they operate is not well-established. In this study, we investigated indirect associations between a negative emotions indicator (emotional symptoms of depression; henceforth: depression), a positive emotions indicator (physical activity [PA] liking), and moderate-to-vigorous physical activity (MVPA), in order to identify which one of the three variables is likely to precede the others. MethodsData were collected twice, with a 7–8-month follow-up. 879 adults from the general population (N = 879 at Time 1, T1; N = 603 at Time 2, T2) filled in questionnaires measuring depression, PA liking and MVPA. ResultsMediation analyses showed that a higher level of depression (T1) predicted a lower level of PA liking (T2) which in turn explained a lower MVPA level (T2). Additionally, a higher level of PA liking (T1) predicted a lower level of depression (T2), which in turn was associated with a higher MVPA level at T2. Analyses with MVPA operating as the independent variable or the mediator were not significant. ConclusionsResults indicated that both negative and positive emotions precede rather than follow MVPA engagement.

Apathy in Parkinson's Disease.

The normal maintenance of human motivation depends on the integrity of subcortical structures that link the medial and lateral prefrontal cortex with the limbic system. Apathy is highly prevalent in Parkinson's disease and causes major impact on the quality of life of patients and caregivers, comparable to depression or cognitive impairment. The clinical differentiation of apathy from the emotional symptoms of depression, and from difficulties in planning or organizing mental programs as a consequence of executive dysfunction, may guide a rationale for individualized treatment approach of apathetic symptoms, which is presently lacking. To review the different apathetic syndromes that can be diagnosed in clinical practice by appropriate scales, as well as the brain systems that subserve each syndrome, helps to explain how dopaminergic, antidepressant, or cholinergic medications may lead to individual improvements in apathy.

Association between pain severity, depression severity, and use of health care services in Japan: results of a nationwide survey.

BackgroundDepression is often associated with painful physical symptoms. Previous research has seldom assessed the relationship between the severity of physical symptoms and the severity of mental and emotional symptoms of depression or other health outcomes, and no such studies have been conducted previously among individuals with depression in Japan. The aim of this study was to assess the relationship between the severity of physical pain and depression and other outcomes among individuals in Japan diagnosed with depression.MethodsData for individuals aged 18 and older in Japan who reported being diagnosed with depression and also reported physical pain were obtained from the Japan National Health and Wellness Survey. These respondents were characterized on sociodemographics and health characteristics, and the relationship between ratings of severity on pain in the last week and health outcomes were assessed using bivariate correlations and generalized linear models. Measures included the Patient Health Questionnaire for depression severity, Medical Outcomes Study 12-Item Short Form Survey Instrument for health-related quality of life, the Work Productivity and Activity Impairment for work and activity impairment, and 6-month report of health care use.ResultsMore severe physical pain in the past week was correlated with more severe depression, worse health-related quality of life, lower health utility, greater impairment at work, and more health care provider visits. These relationships remained significant after incorporating sociodemographics and health characteristics in the statistical models.ConclusionIndividuals whose depression is accompanied by more severe physical pain have a higher burden of illness than those whose depression includes less severe pain, suggesting that even partially ameliorating painful physical symptoms may significantly benefit patients with depression. Clinicians should take the presence and severity of physical pain into account and consider treating both the physical and emotional symptoms of these patients.

Social Adaptive Functioning, Apathy, and Nondysphoric Depression among Nursing Home-Dwelling Very Old Adults

Background: Apathetic and subsyndromal depressive conditions are common in the oldest old. This study examined whether nondysphoric depression (NDD), a clinical condition characterized by ideational and vegetative but no emotional symptoms of depression, belongs to the apathetic presentations of late-life depression. Rates of NDD, dysphoric depression (DD), apathy, and social functional impairment were examined in a sample of nondemented very old (mean age 87.5 years, SD = 7.7) nursing home residents. It was hypothesized that individuals with NDD show greater apathy and greater social functional impairment relative to DD and nondepressed individuals. Methods: Social functioning was measured using the Social-Adaptive Functioning Evaluation (SAFE) and apathy was measured using the global apathy rating on the Scale for the Assessment of Negative Symptoms (SANS). Results: The rates of DD (50.0%) and NDD (27.4%) were quite high. Participants with DD reported greater apathy than those with NDD (and nondepressed individuals). NDD and DD subjects showed greater social functional impairment relative to the comparison group. There was no difference in social functioning between DD and NDD individuals. Conclusions: The present data are inconsistent with the view that NDD among the oldest old is an apathetic form of depression. NDD involves social functional impairment. Limitations include rather selected population of nursing home residents that may have included individuals with early dementia, lack of data on prior depressive episodes, and apathy assessment not validated on the specific population.

A Review of the Serotonin-Norepinephrine Reuptake Inhibitors: Pharmacologic Aspects and Clinical Implications for Treatment of Major Depressive Disorder and Associated Painful Physical Symptoms

Background: Depression is characterized by low mood, low self-esteem, and loss of interest or pleasure. Painful physical symptoms (PPS) associated with depression have a negative impact on the probability of remission. Because both norepinephrine and serotonin are involved with the central regulation of pain, the serotonin-norepinephrine reuptake inhibitors (SNRIs) may have more success than the selective serotonin reuptake inhibitors (SSRIs) in impacting PPS as well as the core emotional symptoms of depression. Methods: Published preclinical and clinical data on the SNRIs (i.e., milnacipran, venlafaxine, and duloxetine) have been reviewed, paying special attention to the differentiation of the pharmacological aspects of the SNRIs. The efficacy and safety results on depression and associated PPS have also been summarized. Results: Each of the SNRIs has different profiles regarding the inhibition of binding to human serotonin and norepinephrine uptake transporters and clinical pharmacokinetics. All SNRIs have data for alleviating the core symptoms of depression; duloxetine and venlafaxine show efficacy for PPS associated with depression. There are also differences in tolerability and adverse events profiles. Conclusions: Although all SNRIs have the same dual mechanism of action for the treatment of depression, they have different pharmacologic profiles that may impact clinical outcomes.

The Same Antidepressant Elicits Contrasting Patterns of Synaptic Changes in the Amygdala vs Hippocampus

As depression-like symptoms are often precipitated by some form of stress, animal models of stress have been used extensively to investigate cellular mechanisms of depression. Despite being implicated in the emotional symptoms of depression, the amygdala has received little attention compared to the hippocampus in the past studies of antidepressant action. Further, these investigations have not taken into account the contrasting effects of chronic stress on the hippocampus vs amygdala. If an antidepressant is to be equally effective in countering the differential effects of stress on both brain areas, then it is faced with the challenge of eliciting contrasting effects in these two structures. We tested this prediction by examining the impact of tianeptine, an antidepressant with proven clinical efficacy, on neurons of the lateral amygdala (LA) and hippocampal area CA1. Tianeptine reduces N-methyl-D-aspartate (NMDA)-receptor-mediated synaptic currents, without affecting α-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) currents, in LA neurons. By contrast, tianeptine enhances both NMDA and AMPA currents in area CA1. Tianeptine also lowers action potential firing in LA neurons. As tianeptine modulates cellular metrics that, in addition to mediating amygdalar behavioral output, are also affected by stress, we tested if tianeptine succeeds in countering stress effects in the intact animal. We find that tianeptine prevents two important functional consequences of chronic stress-induced plasticity in the amygdala--dendritic growth and enhanced anxiety-like behavior. These results provide evidence for antidepressant action on amygdalar neurons that are not only distinct from the hippocampus, but also protect against the debilitating impact of stress on amygdalar structure and function.

Onset of Clinical Effects and Plasma Concentration of Fluvoxamine in Japanese Patients

It is widely accepted that selective serotonin reuptake inhibitors (SSRIs) require 2 to 4 weeks of administration before improvements in emotional symptoms of depression are seen. We evaluated whether early monitoring of Hamilton Rating Scale for Depression (HAMD) scores in patients treated with the SSRI fluvoxamine could predict antidepressant response, and also assessed the relationship between the onset of clinical response following the start of fluvoxamine administration and its plasma concentration. Twelve depressed patients (baseline HAMD score ≥15) received an initial dose of fluvoxamine (50 mg/d) followed by an optimized maintenance dose according to their clinical symptoms after 7 d. HAMD scores and plasma drug concentrations were determined at 7 and 28 d after the first administration. There were 7 responders and 5 non-responders on day 28, as evaluated by HAMD scores. The HAMD score for the responders was significantly lower than that for the non-responders on day 7 (mean±S.D., 11.6±6.1 vs. 26.6±6.5, p=0.006). Thus, the reduction in HAMD score on day 7 was clearly divided between responders and non-responders. On day 28, the plasma concentration of fluvoxamine in responders was lower than that in non-responders (14.2±10.5 ng/ml vs. 44.2±28.1 ng/ml, p=0.051). Furthermore, receiver operating characteristic curve analysis conducted on day 28 revealed an upper concentration threshold of 28.2 ng/ml (p=0.042), with none in the responder group above that level. Our results suggest that HAMD score after the first week of treatment with fluvoxamine and the upper threshold of plasma drug concentration could predict whether a patient is a non-responder.

Effectiveness of antidepressants in the treatment of major depressive disorder in Latin America

Objective. Painful physical symptoms occur frequently in patients with major depressive disorder (MDD), and although numerous studies report the effect of antidepressants on emotional aspects of depression, few focus on their effect on physical symptoms. This observational study was conducted, in a clinical practice setting, to determine antidepressant treatment decisions and their outcome on the physical and emotional symptoms of MDD. Methods. Patients with a mean score ≥2 for pain-related items on the Somatic Symptom Inventory (SSI) were classified with painful physical symptoms (PPS +) and differentiated from the remaining patients (PPS −). Severity of depression and physical pain were determined using the 17-item Hamilton Depression Rating Scale (HAMD17) and Clinical Global Impressions of Severity Scale (CGI-S), and Visual Analog Scale (VAS), respectively. Results. At baseline, 72.6% of patients were PPS+. Compared to PPS- patients, PPS +patients were, on average, significantly more depressed at baseline (mean difference [95% CI]: HAMD17 4.6 [3.6, 5.5] and CGI-S 0.3 [0.2, 0.4]; all p<0.0001), and remained more depressed and in greater pain at endpoint (HAMD17p=0.0074, CGI-S P =0.0151, and VAS P <0.0001). In addition, fewer PPS+ patients (65.8%) achieved remission (total HAMD17≤7) compared to PPS- patients (74.6%, P =0.0180). Conclusions. Painful physical symptoms are prevalent in MDD patients, highlighting the importance of addressing both the physical and emotional symptoms of depression.

Sex differences in predictors of illness intrusiveness 1 year after a cardiac event

Objective This prospective study examined sex differences in illness intrusiveness and in baseline predictors of illness intrusiveness in cardiac patients' 1-year postcardiac event. Methods Patients diagnosed with a myocardial infarction (MI) or unstable angina (UA) completed a baseline questionnaire during their hospitalization (139 men and 104 women). Eighty-one men and 67 women completed the follow-up questionnaire 1-year postcardiac event. The questionnaire included measures of illness intrusiveness in three life domains, depressive symptomatology, social support, medical information, risk factors for heart disease, and sociodemographic information. Results A MANCOVA with the three Illness Intrusiveness subscales as dependent variables, sex as the between-group factor, and partnership status as a covariate found a sex effect for the Intimacy subscale, but not for the Instrumental and the Relationships/Personal Development subscales. Men reported more intrusiveness in the Intimacy domain of their life as compared to women. After controlling for sociodemographic factors and risk factors for heart disease, hierarchical regressions indicated sex differences in baseline predictors of 1-year follow-up illness intrusiveness in the three life domains. For men, being satisfied with support from partner at baseline was associated with less intrusiveness in the Instrumental Life domain 1 year after the cardiac event. For women, surprisingly, more satisfaction with support from their partner at baseline was associated with more intrusiveness in their intimate lives 1 year after their cardiac event. In addition, emotional symptoms of depression at baseline were predictive of increased illness intrusiveness in Relationship/Personal Development and Intimacy domains for men and in Instrumental and Intimacy domains for women. Conclusion Support from partner may have a differential impact for men and women after a cardiac event. Depressive symptomatology during initial hospitalization, particularly emotional symptoms, is a prominent indicator of illness intrusiveness for both sexes 1 year after the cardiac event.

Hopelessness in a Community Population: Factorial Structure and Psychosocial Correlates

The factorial structure of the Beck Hopelessness Scale (BHS; A. T. Beck, A. Weissman, D. Lester, & L. Trexler, 1974) was examined in a nonclinical sample (N = 154) in Japan, and the relationships between dimensions of hopelessness and psychosocial variables were analyzed. A semistructured interview was used, as well as a questionnaire consisting of the BHS, the Eysenck Personality Questionnaire (EPQ; H. J. Eysenck & S. B. Eysenck, 1975), and the Parental Bonding Instrument (PBI; G. Parker, H. Tupling, & L. B. Brown, 1979). A factor analysis with principal components solution after oblimin rotation yielded 2 factors—Doubt About a Hopeful Future (Factor 1) and Belief About a Hopeless Future (Factor 2). Significant, positive correlations were found between Factor 2 and (a) the number of emotional symptoms of depression in a 4-day depressive episode and (b) scores on the Neuroticism subscale of the EPQ. The Factor 1 score was significantly and negatively correlated with the Extraversion subscale of the EPQ and the Paternal Care subscale of the PBI.