Higher Severity Of Depressive Symptoms Research Articles

Depression and anxiety as predictors of performance status and life satisfaction in older adult neurological patients: a cross-sectional cohort study.

Neurological disorders are one of the leading causes of disability globally. Studies emphasise that the course and effectiveness of rehabilitation interventions may be influenced by emotional factors. The aim of the present study was to assess the prevalence of depressive and anxiety symptoms in patients with neurological disorders and examine whether depression and tendency to respond with anxiety are predictors of disability in these patients. The study included 229 individuals with neurological disorders aged over 55. Our findings show that stroke patients are more likely to experience depressive symptoms and are more likely to display trait anxiety as compared with patients with other neurological disorders. Advanced age, female sex, low level of education and the presence of trait anxiety are associated with a higher severity of depressive symptoms. Stroke survivors have significantly poorer ECOG performance scores and are more likely to be incapable for work. Both depression and trait anxiety are significant predictors of neurological patients' performance status, and the presence of depressive symptoms is a determinant of these patients' level of satisfaction with life. An understanding of psychological risk factors for poorer performance status in individuals with neurological disorders will make it possible to plan prophylactic interventions in order to minimise negative health impacts and facilitate access to mental health facilities.

Machine learning reveals differential effects of depression and anxiety on reward and punishment processing.

Recent studies suggest that depression and anxiety are associated with unique aspects of EEG responses to reward and punishment, respectively; also, abnormal responses to punishment in depressed individuals are related to anxiety, the symptoms of which are comorbid with depression. In a non-clinical sample, we aimed to investigate the relationships between reward processing and anxiety, between punishment processing and anxiety, between reward processing and depression, and between punishment processing and depression. Towards this aim, we separated feedback-related brain activity into delta and theta bands to isolate activity that indexes functionally distinct processes. Based on the delta/theta frequency and feedback valence, we then used machine learning (ML) to classify individuals with high severity of depressive symptoms and individuals with high severity of anxiety symptoms versus controls. The significant difference between the depression and control groups was driven mainly by delta activity; there were no differences between reward- and punishment-theta activities. The high severity of anxiety symptoms was marginally more strongly associated with the punishment- than the reward-theta feedback processing. The findings provide new insights into the differences in the impacts of anxiety and depression on reward and punishment processing; our study shows the utility of ML in testing brain-behavior hypotheses and emphasizes the joint effect of theta-RewP/FRN and delta frequency on feedback-related brain activity.

Associations between sleep health, negative reinforcement learning, and alcohol use among South Florida college students with elevated internalizing symptoms

Negative reinforcement is proposed to mediate associations between sleep and alcohol use, especially among people with depression and/or anxiety symptoms. Worse sleep (e.g., shorter duration, less efficiency, more irregular timing) exacerbates negative emotions, which alcohol may temporarily relieve. Not yet examined, we propose sleep indirectly impacts early stages of alcohol use via differences in negative reinforcement learning (NRL), since sleep impacts emotion, reward response, and learning. The current study aimed to replicate associations between sleep and alcohol use, test associations with NRL, and examine indirect associations between sleep health and alcohol use via NRL among 60 underage college students (ages 18-20 years, 77% female) varying in depression and anxiety symptoms. Participants wore Fitbit smartwatches and completed daily diaries measuring sleep and substance use for ∼14 days before completing two computer tasks assessing social (SNRL) and monetary (MNRL) negative reinforcement learning. Robust generalized linear models tested direct associations within the proposed model. SNRL performance was positively associated with alcohol use, but no other associations were observed. Statistical mediation models failed to indicate indirect effects of sleep on alcohol use via SNRL or MNRL performance. Post-hoc exploratory models examining depression and anxiety symptoms as moderators of direct associations indicated several interactions. Positive associations between sleep timing variability and alcohol use were weakened at higher anxiety symptom severity and stronger at higher depression symptom severity. The positive association between SNRL performance and alcohol use was also stronger at higher depression symptom severity. Among students with elevated depression symptoms, variable sleep timing and stronger SNRL performance were independently associated with more alcohol use, but indirect effects were not supported. Future research should replicate findings, confirm causality of interactions, and examine sleep timing and behavioral responses to negative social stimuli as targets for improving alcohol-related outcomes among underage college students with elevated depressive symptoms.

Relationships of Self-reported Opioid Use and Misuse and Pain Severity With Probable Major Depression Among Participants With Spinal Cord Injury

ObjectivesTo examine the relations of pain intensity, opioid use, and opioid misuse with depressive symptom severity and probable major depression (PMD) among participants with spinal cord injuries (SCI), controlling for demographic, injury, and socioeconomic characteristics. Study DesignCohort study. SettingMedical University in the Southeastern United States (US). ParticipantsParticipants (N=918) were identified from 1 of 2 sources including a specialty hospital and a state-based surveillance system in the Southeastern US. Participants were a minimum of 18 years old at enrollment and had SCI with non-complete recovery. Participants were on average 57.5 years old at the time of the study and an average of 24.4 years post SCI onset. InterventionsNot applicable. Main Outcome MeasuresParticipants completed a self-report assessment that included frequency of prescription opioid use and misuse, based on the National Survey on Drug Use and Health (NSDUH), and the PHQ – 9 to measure depressive symptom severity and PMD. ResultsOpioid use, opioid misuse, and pain intensity were related to elevated depressive symptom severity and higher odds of PMD. Non-Hispanic Blacks had fewer depressive symptoms and lower odds of PMD, as did those with higher incomes. Veterans had lower risk of PMD, whereas ambulatory participants had a higher risk of PMD. Age at SCI onset had a mixed pattern of significance, whereas years of education and years since injury were not significant. ConclusionsThe relation between pain intensity with depressive symptom severity and PMD was profound, consistent with the biopsychosocial model of pain. The greater risk of PMD and higher depressive symptom severity among those using opioids and misusing opioids raises further concern about long-term prescription opioid use. Alternative treatments are needed.

Entrée or Sampler? A Randomized Controlled Trial of Two Approaches to Single Session Internet-Based Interventions

BackgroundInterventions teaching cognitive-behavioral skills feature prominently among evidence-based treatments for emotional disorders. However, the relative impact of interventions that teach one cognitive-behavioral skill in-depth (i.e., an entrée intervention) versus those that provide limited coverage of multiple skills (i.e., a sampler intervention) remains unclear. In this study, we compared these two approaches using unguided single-session internet-based cognitive-behavioral interventions.MethodsA total of 657 participants living in the U.S. with elevated depressive symptoms were randomly assigned to the entrée, sampler, or no-intervention control conditions. The entrée approach focused in-depth on developing one skill and the sampler condition introduced three skills. Both interventions lasted approximately 30 min. All participants completed measures of depressive symptoms, loneliness, and coping skill use and quality before the intervention and a week after the intervention.ResultsThere were no condition differences in change in depressive symptoms, coping skill usage, coping skill quality, or loneliness. Those in the sampler condition were less likely to drop out than those in the entrée condition. In addition, condition differences were moderated by initial depressive symptom severity, such that among the more severely depressed the sampler condition led to greater symptom reduction than the entrée and control conditions.ConclusionsWe did not find overall differences between the entrée, sampler, and control conditions on primary outcomes. Nonetheless, the differences that did emerge suggest offering a variety of skills improves retention and provides greater relief for those with high initial depressive symptom severity in single-session internet-based interventions.Clinicaltrials.gov ID NCT04643964, registered on 11/12/2020.

Using a longitudinal network structure to subgroup depressive symptoms among adolescents

BackgroundNetwork modeling has been proposed as an effective approach to examine complex associations among antecedents, mediators and symptoms. This study aimed to investigate whether the severity of depressive symptoms affects the multivariate relationships among symptoms and mediating factors over a 2-year longitudinal follow-up.MethodsWe recruited a school-based cohort of 1480 primary and secondary school students over four semesters from January 2020 to December 2021. The participants (n = 1145) were assessed at four time points (ages 10–13 years old at baseline). Based on a cut-off score of 5 on the 9-item Patient Health Questionnaire at each time point, the participants were categorized into the non-depressive symptom (NDS) and depressive symptom (DS) groups. We conducted network analysis to investigate the symptom-to-symptom influences in these two groups over time.ResultsThe global network metrics did not differ statistically between the NDS and DS groups at four time points. However, network connection strength varied with symptom severity. The edge weights between learning anxiety and social anxiety were prominently in the NDS group over time. The central factors for NDS and DS were oversensitivity and impulsivity (3 out of 4 time points), respectively. Moreover, both node strength and closeness were stable over time in both groups.ConclusionsOur study suggests that interrelationships among symptoms and contributing factors are generally stable in adolescents, but a higher severity of depressive symptoms may lead to increased stability in these relationships.

Impact of interleukin-1β single nucleotide polymorphisms and depressive symptoms in individuals with chronic viral hepatitis.

Elevated levels of interleukin 1β (IL-1β) have been identified in patients with chronic viral hepatitis and have been associated with depressive symptoms. Given the high prevalence of depression in this patient population, this study sought to explore the potential influence of IL-1β genetic variations on the severity of depressive symptoms. In a cohort of 181 Taiwanese patients with chronic viral hepatitis, we investigated the impact of five common IL-1β single nucleotide polymorphisms (SNPs), including rs16944, rs1143627, rs1143630, rs1143643, and rs3136558, on depressive symptoms using the Beck's Depression Inventory-II. Additionally, we analyzed the primary domains of IL-1β-related depressive symptoms according to Beck's six symptom categories of depression. Our analysis revealed significant associations between depressive symptoms and three intronic IL-1β SNPs. After controlling for age, sex, marital status, and education level, patients with the rs1143630 GG, rs1143643 CC, and rs3136558 AA genotypes demonstrated higher severity of depressive symptoms in the domains of indecision (p = 0.004), agitation (p = 0.001), and feelings of punishment (p = 0.005), respectively, compared to rs1143630 GA+AA, rs1143643 CT, and rs3136558 AG+GG genotypes. According to Beck's categorization, these symptoms can be classified into three dimensions: disturbances in emotion regulation, energy, and cognition. Our findings demonstrate the association between IL-1β polymorphisms and depressive symptoms and suggest a potential underlying mechanism for specific depressive symptoms within the chronic viral hepatitis population. These insights could improve our understanding and treatment of depressive symptoms in individuals with viral hepatitis.

Inflammation and severity of depressive symptoms in physically active individuals after COVID-19 – An exploratory immunopsychological study investigating the effect of inflammation on depressive symptom severity

BackgroundSARS-CoV-2 infection is a risk factor for the development of depressive symptoms such as lack of energy, loss of interest, and depressed mood. Inflammatory processes might underline this association. The aim of this study was to investigate the association between inflammatory markers and the severity of depression after SARS-CoV-2 infection and the predictive effect of inflammatory markers on the severity of depressive symptoms. Lifestyle factors and lifestyle-related diseases can influence inflammation and depressive symptoms. As these lifestyle factors and lifestyle-related diseases are less common in physically active individuals, they are a suitable population for investigating this research question. MethodsWe investigated 61 at least moderate physically active individuals on average ∼6 months (SD = 4.22, range = 0.5–19 months) after SARS-CoV-2 infection (t0) and performed a follow-up after 3 months (t1). Depressive symptoms and biomarkers of inflammation (interleukin [IL]-1β, IL-8, IL-10, Ferritin, Lipopolysaccharide-binding-protein [LBP], neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], lymphocyte-to-monocyte ratio [LMR]) and kynurenine [KYN] were measured at both time points. Concentrations of inflammatory markers at t0 were used to predict the severity of depressive symptoms at t0 and t1. ResultsConcentrations of KYN were negatively related to the severity of depressive symptoms at t0. Concentrations of LMR predicted higher depressive symptoms at t0 as well as at t1. Furthermore, individuals with lower concentrations of LBP at t0 showed a higher severity of depressive symptoms at t1. No correlation was found between severity of depressive symptoms and IL-1β, IL-8, IL-10, ferritin, NLR, and PLR at both time points. ConclusionsKYN, LBP and LMR might be useful as a predictive factor of depressive symptoms in physically active individuals after SARS-CoV-2 infection. While the results for KYN confirm the current scientific evidence, our results highlight the importance of the innovative inflammatory markers LMR and LBP. LMR and LBP might be interesting targets for predicting the development of depressive symptoms in SARS-CoV-2 infected populations and should be further investigated in future studies.

Strategies Used to Manage Chronic Pain in HIV-Disease: Comparing Persons Prescribed Opioids Versus Persons not Receiving Opioids.

Chronic pain is common in people living with HIV (PLWH), causes substantial disability and is associated with limitations in daily activities. Opioids are commonly prescribed for pain treatment among PLWH, but evidence of sustained efficacy is mixed. There is little information available on how PLWH who have chronic pain use multimodal strategies in pain management. The current cross-sectional study examined background characteristics, self-reported pain, and the use of other pain treatments among 187 PLWH with chronic pain and depressive symptoms who were and were not prescribed opioids. Approximately 20.9% of participants reported using prescription opioids at the time of the study interview. These individuals were significantly more likely to report having engaged in physical therapy or stretching, strengthening or aerobic exercises in the previous 3 months, recent benzodiazepine use, and receiving disability payments. There were no significant differences in pain characteristics (pain-related interference, average pain severity, and worst pain severity) between the two groups. Those not prescribed opioids were more likely to report better concurrent physical functioning and general health, and fewer physical role limitations, but higher depression symptom severity. Our findings suggest that many PLWH with chronic pain and depressive symptoms express high levels of pain with deficits in physical function or quality of life despite their use of opioids. The high rate of co-use of opioids and benzodiazepines (30.8%) is a concern because it may increase risk of overdose. An integrated care approach that includes a variety of effective non-pharmacologic treatment strategies such as physical therapy may be beneficial in reducing the reliance on opioids for pain management.

Evaluation of the effectiveness of migraine therapy using functional resting MRI with course rhythmic transcranial magnetic stimulation

Introduction. In the context of the search for new migraine therapy options, strict control of their eff ectiveness by means of objective examination methods is required.Objective. Objective assessment of the eff ectiveness of TMS in patients with migraine on the basis of functional magnetic resonance imaging (fMRI) data.Material and methods. Resting-state fMRI before and after a fi ve-day course of TMS of the junction of the inferior frontal and temporal lobes bilaterally was performed in 19 patients with migraine. Changes in functional connectivity (FC) of the main neuronal networks of the brain, as well as clinical parameters of pain and quality of life of the patients were assessed before and after the course of TMS.Results. A decrease in pain intensity and anxiety scores, as well as a decrease in the number of acute pain medications taken, was observed against the background of the therapy. Changes in FC aff ected three main networks: the default mode network, the salience and visual networks. At the same time, decreased effi cacy of therapy was noted in patients with higher severity of depressive symptoms and presence of neuroimaging criteria of depression.Conclusion. The study suggests the effi cacy of TMS in patients with migraine based on neuroimaging criteria. It is worth paying special attention to the presence of depressive symptoms in migraine patients.

Hippocampal volume mediates the association between depression and cognitive function differently by sex

AbstractBackgroundSex differences are prominent features of both depression and Alzheimer’s disease, with women showing an increased lifetime risk relative to men. However, the neural mechanisms that explain sex differences in the relationship between depression and cognition are poorly understood. The goal of this study was to evaluate whether smaller brain volumes mediate the relationship between higher depression symptom severity and poorer cognition, and whether this association differed by sex.MethodUK Biobank participants were included in the sample based on availability of demographic variables, mental health assessments, structural MRI scans, and four cognitive measures (Fluid Intelligence, Numeric Function, Pairs Matching, and Symbol Digit Substitution). Depression symptom severity was evaluated using the Patient Health Questionnaire (PHQ‐9). The indirect effect of depression symptom severity on cognition via hippocampal volumes was evaluated using causal mediation analyses. Models were adjusted for age, sex, APOE‐e4 status, and Townsend Deprivation Index, a measure of material deprivation (Fig.1). A priori sex‐stratified models evaluated sex differences. Exploratory analyses assessed the indirect effect of depressive symptom severity on cognition with amygdalar and total brain volumes as separate mediators. The significance of indirect effects was evaluated using bootstrapping procedures.ResultThe study sample consisted of 39,692 middle‐aged and older adults (53% women, mean age±SD = 64.1±7.6 years, 28% APOE‐e4 carriers). Hippocampal and amygdalar volumes mediated the effect of depression symptom severity on cognition, for Fluid Intelligence, Numeric Function, and Symbol Digit Substitution, but not Pairs Matching. Total brain volume mediated the effect of depression symptom severity on Symbol Digit Substitution performance (Fig.1, Table1). In sex‐stratified analyses, the effect of depression symptom severity on Fluid Intelligence, Numeric Function, and Symbol Digit Substitution was mediated by hippocampal and amygdalar volumes in women. In men, the effect of depression symptom severity on Symbol Digit Substitution was mediated by total brain volume (Table2).ConclusionDepression symptom severity influences cognition via hippocampal and amygdalar volumes in women, while in men, total brain volume mediated the relationship with cognition. These data suggest sex‐specific neural pathways for the relationship between depression and cognition.

Pregnancy-related COVID worry, depressive symptom severity, and mediation through sleep disturbance in a low-income, primarily Latinx population in California's Central valley

PurposeThis study (1) assessed the psychometric properties of a pregnancy-related COVID worry scale, (2) explored variations in pregnancy-related COVID worry over the course of the pandemic, and (3) examined associations between pregnancy-related COVID worry and depressive symptom severity, and evaluated sleep disturbance as a mediator. MethodsData were drawn from an ongoing randomized trial comparing the effectiveness of two enhanced forms of prenatal care. The current analysis includes baseline pre-randomization data collected from participants who enrolled November 2020–November 2021 (n = 201). Participants were pregnant individuals with low income and primarily Latinx. ResultsOur 7-item scale was valid and reliable for assessing pregnancy-related COVID worry. Pregnancy-related COVID worry did not vary significantly by any participant characteristic or pandemic stage. Pregnancy-related COVID worry was significantly associated with depressive symptom severity in multivariate analysis (p = .002). For each unit increase on the 10-point pregnancy-related COVID worry scale, the odds of mild-to-severe depression increased by 16% (odds ratio = 1.16, 95% confidence interval 1.02–1.32, p = .02), holding all other variables constant. Sleep disturbance mediated the pregnancy-related COVID worry-depressive symptom relationship (48% of the total effect mediated). ConclusionsWorry about how COVID may impact their baby, birth, and postpartum experiences was associated with higher depressive symptom severity, partly through its effect on sleep. These findings suggest that interventions related to improving sleep quality among perinatal populations may reduce depressive symptoms. Trial registrationClinicalTrials.gov NCT04154423, “Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone (EMBRACE) Study".

The Association of Sport Specialization and Concussion History on Self-Reported Depressive Symptoms and Quality of Life Among High School Athletes.

To assess the association of sport specialization combined with sport-related concussion (SRC) history on depression and health-related quality of life (HRQoL) in a population of high school athletes. Cross-sectional study. High schools. Two thousand four hundred fifty-three athletes through the State of Wisconsin. Sport specialization and SRC history. Athletes completed questionnaires reporting their SRC history, sports participation (single-sport or multisport), Patient Health Questionnaire-9 (PHQ-9), and Pediatric Quality of Life 4.0 (PedsQL). We used multivariate binary logistic regression to assess the odds ratio (OR) for depressive symptoms based on SRC and sport participation history. Separate multilinear regression evaluated the association between the PedsQL, SRC, and sport participation history. The interaction of sport specialization and SRC history was explored in both regression models. High school athletes who participated in single-sport activities had a greater odds of reporting higher severity of depressive symptoms on PHQ-9 scores (OR, 1.50; 95% CI, 1.11-2.02) and reduced PedsQL ( P < 0.001) compared with their multisport counterparts. There were no associations between SRC history and either PHQ-9 or PedsQL scores. Statistically significant interactions between sport specialization and SRC were not found among all models. Single-sport high school athletes reported a reduction in HRQoL measures along with higher depressive symptoms when compared with the multisport athletes. The SRC history did not have a lingering effect on depression or HRQoL in this study. These findings raise some interesting concerns regarding the quality of mental health in adolescent athletes solely focused on single-sport endeavors.

Perspectives on the success rate of current antidepressant pharmacotherapy

ABSTRACT Introduction There has been growing debate about the effectiveness of traditional antidepressants for the treatment of depression, and whether the clinical trials literature overstates the value of existing agents. Antidepressant efficacy is limited by suboptimal remission rates, lack of robust efficacy across diverse depressed subgroups, slow onset, and challenges managing tolerability. Clinicians can better navigate uncertainties in this area by recognizing patient-specific clinical and prognostic factors that influence the likelihood of antidepressant drug response. Areas covered The author summarizes pertinent literature regarding drug-placebo differences in antidepressant outcome as well as patient-specific factors that influence antidepressant drug responsivity across subtypes of depressive disorders. Expert opinion Standardized effect sizes for most monoaminergic antidepressants are relatively modest. At least one-third of treatment response derives from nonspecific (yet substantial) placebo effects, limiting the ability to compare antidepressant medication effects to that of ‘no treatment.’ Patients with high baseline depressive symptom severity are less likely to respond to placebo but may be more responsive to antidepressant pharmacotherapy than is the case in mild forms of depression. Patient satisfaction with antidepressant response must take into consideration not only efficacy for reducing symptoms but also drug tolerability/acceptability and tangible improvement in functional outcome and quality of life.

Accounting for childhood trauma in patients with major depressive disorder

In their meta-analysis, the Childhood Trauma Meta-Analysis Study Group 1 Childhood Trauma Meta-Analysis Study GroupTreatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a meta-analysis. Lancet Psychiat. 2022; ([Prod: please update when known].) Google Scholar highlight that patients with major depressive disorder or elevated depressive symptoms with a history of childhood trauma have an improvement in symptoms after pharmacological and psychotherapeutic treatments that is similar to patients with major depressive disorder without childhood trauma. Although these results are very important and encouraging for clinical practice, we should be cautious in their interpretation. Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysisContrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatments, notwithstanding their higher severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status. Full-Text PDF

Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis

Childhood trauma is a common and potent risk factor for developing major depressive disorder in adulthood, associated with earlier onset, more chronic or recurrent symptoms, and greater probability of having comorbidities. Some studies indicate that evidence-based pharmacotherapies and psychotherapies for adult depression might be less efficacious in patients with a history of childhood trauma than patients without childhood trauma, but findings are inconsistent. Therefore, we examined whether individuals with major depressive disorder, including chronic forms of depression, and a reported history of childhood trauma, had more severe depressive symptoms before treatment, had more unfavourable treatment outcomes following active treatments, and were less likely to benefit from active treatments relative to a control condition, compared with individuals with depression without childhood trauma. We did a comprehensive meta-analysis (PROSPERO CRD42020220139). Study selection combined the search of bibliographical databases (PubMed, PsycINFO, and Embase) from Nov 21, 2013, to March 16, 2020, and full-text randomised clinical trials (RCTs) identified from several sources (1966 up to 2016-19) to identify articles in English. RCTs and open trials comparing the efficacy or effectiveness of evidence-based pharmacotherapy, psychotherapy, or combination intervention for adult patients with depressive disorders and the presence or absence of childhood trauma were included. Two independent researchers extracted study characteristics. Group data for effect-size calculations were requested from study authors. The primary outcome was depression severity change from baseline to the end of the acute treatment phase, expressed as standardised effect size (Hedges' g). Meta-analyses were done using random-effects models. From 10 505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open trials) contributed data of a maximum of 6830 participants (age range 18-85 years, male and female individuals and specific ethnicity data unavailable). More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma. Despite having more severe depression at baseline (g=0·202, 95% CI 0·145 to 0·258, I2=0%), patients with childhood trauma benefitted from active treatment similarly to patients without childhood trauma history (treatment effect difference between groups g=0·016, -0·094 to 0·125, I2=44·3%), with no significant difference in active treatment effects (vs control condition) between individuals with and without childhood trauma (childhood trauma g=0·605, 0·294 to 0·916, I2=58·0%; no childhood trauma g=0·178, -0·195 to 0·552, I2=67·5%; between-group difference p=0·051), and similar dropout rates (risk ratio 1·063, 0·945 to 1·195, I2=0%). Findings did not significantly differ by childhood trauma type, study design, depression diagnosis, assessment method of childhood trauma, study quality, year, or treatment type or length, but differed by country (North American studies showed larger treatment effects for patients with childhood trauma; false discovery rate corrected p=0·0080). Most studies had a moderate to high risk of bias (21 [72%] of 29), but the sensitivity analysis in low-bias studies yielded similar findings to when all studies were included. Contrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatments, notwithstanding their higher severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status. None.

The Contribution of Neighborhood Characteristics to Psychological Symptom Severity in a Cohort of Injured Black Men.

Traumatic injury is not evenly distributed by race and class in the USA. Black men are marginalized in the society, often reside in disadvantaged neighborhoods, and are at higher risk for injury mortality and ongoing physical and psychological problems following injury. Post-traumatic stress disorder (PTSD) and depressive symptom severity are among several problematic and disabling conditions faced by injury survivors. While much research has examined individual factors that lead to increased post-injury psychological symptom severity, the contribution of the social and physical environment has been relatively understudied. To examine the contribution of neighborhood characteristics to PTSD and depressive symptom severity in Black men following traumatic injury. Prospective cohort study. Participant data were linked via GIS to neighborhood characteristics (constructs established by factor analysis) to spatially model factors associated with increased post-injury psychological symptom severity using a GEE regression analysis, adjusting for injury mechanism and severity, age, and insurance. Four hundred fifty-one adult Black males hospitalized for traumatic injury. The 4 constructs were neighborhood disconnectedness, concentrated disadvantage/deprivation, crime/violence/vacancy, and race/ethnicity. High depressive and PTSD symptom severity was reported by 36.8% and 30.4% of participants, respectively. Higher PTSD symptom severity was associated with crime/violence/vacancy, and higher depressive symptom severity was associated with neighborhood disconnectedness. PTSD and depressive symptom severity were associated with intentional injury mechanisms and Medicaid/no insurance. Higher injury severity was associated with depressive symptoms. Neighborhood characteristics are associated with psychological symptom severity after injury.

Relationship between chronic obstructive pulmonary disease and cognition in an aging population

ObjectivesChronic obstructive pulmonary disease (COPD) is a common and severe respiratory illness. Prior research suggests that COPD may be associated with depression as well as cognitive impairment and increased risk of dementia. Many studies to date have been relatively small, have largely relied on global screening measures to identify cognitive impairment, and have not examined the potential role of comorbid depression on cognition. This cross-sectional study examined the relationship between COPD and multiple cognitive domains at two time points using data from a large longitudinal population database. MethodsLinear multivariate analyses were conducted using secondary data from the Wisconsin Longitudinal Study to determine the effect of lifetime COPD and depressive symptom severity, assessed with the Center for Epidemiological Studies Depression Scale (CESD), on multiple cognitive outcomes. ResultsIn both 2004 (n = 1608) and 2011 (n = 1743), lifetime COPD was found to be a non-significant predictor of all cognitive outcomes, while depressive symptom severity predicted significantly lower scores on the immediate recall and digit ordering tasks in 2004 and on all outcomes in 2011. Exploratory analyses in only those with lifetime COPD revealed COPD severity to be a non-significant factor for all outcomes in 2004 and 2011. ConclusionCOPD was not significantly associated with cognition. Conversely, higher depressive symptom severity was significantly associated with poorer performance on additional cognitive tasks in 2011 compared to 2004, suggesting that depression may contribute to cognitive decline, dependent upon the context of aging.

Patterns of activity correlate with symptom severity in major depressive disorder patients

Objective measures, such as activity monitoring, can potentially complement clinical assessment for psychiatric patients. Alterations in rest–activity patterns are commonly encountered in patients with major depressive disorder. The aim of this study was to investigate whether features of activity patterns correlate with severity of depression symptoms (evaluated by Montgomery–Åsberg Rating Scale (MADRS) for depression). We used actigraphy recordings collected during ongoing major depressive episodes from patients not undergoing any antidepressant treatment. The recordings were acquired from two independent studies using different actigraphy systems. Data was quality-controlled and pre-processed for feature extraction following uniform procedures. We trained multiple regression models to predict MADRS score from features of activity patterns using brute-force and semi-supervised machine learning algorithms. The models were filtered based on the precision and the accuracy of fitting on training dataset before undergoing external validation on an independent dataset. The features enriched in the models surviving external validation point to high depressive symptom severity being associated with less complex activity patterns and stronger coupling to external circadian entrainers. Our results bring proof-of-concept evidence that activity patterns correlate with severity of depressive symptoms and suggest that actigraphy recordings may be a useful tool for individual evaluation of patients with major depressive disorder.

A Validation Study of the EQ-5D-5L and ICEpop Capability Measure for Older People Among Older Individuals With Depressive Symptoms in Brazil

ObjectivesThis study aimed to assess the known-groups validity of the EQ-5D-5L and the ICEpop Capability Measure for Older People (ICECAP-O), 2 outcome measures used in economic evaluation, among older adults with depressive symptoms in socioeconomically deprived areas of Brazil. We also explored the role of education and income on responses to these measures. MethodsThis cross-sectional study used baseline data from PROACTIVE, a cluster randomized controlled trial to evaluate a psychosocial intervention for late-life depression among older adults. Participants aged ≥60 years with a 9-item Patient Health Questionnaire score ≥10 were recruited from 20 primary healthcare clinics. Ordered logistic regression models assessed the association between depressive symptoms severity, income, and education and dimension-level responses on the EQ-5D-5L and ICECAP-O. Multivariable regression models investigated the ability of EQ-5D-5L and ICECAP-O scores to discriminate between depressive symptoms severity levels and other characteristics, including education level and household income. ResultsA total of 715 participants were included in the study. Depressive symptoms severity was associated with all EQ-5D-5L and ICECAP-O dimensions, except the ICECAP-O enjoyment attribute. In contrast, household income was only associated with the ICECAP-O security attribute. Higher severity of depressive symptoms (9-item Patient Health Questionnaire scores) was also strongly associated with lower (ie, worse) scores on both measures in all models. Education level and household income showed no association with either EQ-5D-5L or ICECAP-O scores. ConclusionsTo best of our knowledge, this is the first study that investigated the validity of these 2 measures among older adults in Brazil. Both EQ-5D-5L and ICECAP-O showed evidence of validity in differentiating depressive symptom severity.