Inventory Of Depressive Symptomatology Self-Report Research Articles

Use of Staging Models for Treatment-Resistant Depression Is Not Helpful in Predicting Nonresponse to Acute Intravenous Ketamine Treatment.

Some staging models for treatment-resistant depression (TRD) have been developed in the attempt to predict treatment outcome, in particular with electroconvulsive therapy. However, these models have not been tested in predicting clinical outcome of ketamine treatment. We assessed the relationship between patients' classification with different TRD staging models and subsequent nonresponse to acute intravenous ketamine treatment. A sample of 120 patients with TRD who received acute ketamine treatment from October 2018 to November 2020 were included. Intravenous ketamine was administered twice weekly for 3 weeks as acute treatment. Generalized linear models were fitted to examine if staging classification at baseline could predict percent change in the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16) scale. Potential confounders such as age, sex, and primary diagnosis were included in the models. Other generalized linear models were also fitted with the Bonferroni correction to investigate if other clinical variables of potential relevance could predict percent change in the QIDS-SR16. No TRD staging model proved accurate in predicting depressive improvement after acute ketamine treatment. Clinical variables such as age (F = 6.68, P = 0.01) and history of neuromodulation therapy (F = 5.12, P = 0.03) were negatively associated with subsequent percent improvement in the QIDS-SR16 with acute ketamine treatment. The efficacy of acute intravenous ketamine treatment was similar in subjects with higher and lower level of treatment resistance, using definitions based on different TRD staging models. Further exploration of ketamine treatment predictors such as age and neuromodulation therapy is warranted.

Psychometric and Clinical Evaluation of the Clinician (VQIDS-C5) and Self-Report (VQIDS-SR5) Versions of the Very Quick Inventory of Depressive Symptoms.

PurposeEvaluate the psychometric properties of the 5-item Very Quick Inventory of Depressive Symptomatology self-report and clinician-rated versions (VQIDS-SR5/VQIDS-C5), compare their relative performance, create crosswalks between their total scores and other accepted depressive symptom ratings, and define clinically relevant depressive symptom severity thresholds and categorical outcomes for both versions.Patients and MethodsThe Sequenced Treatment Alternatives to Relieve Depression trial obtained baseline and exit 17-item Hamilton Rating Scale for Depression (HRSD17) and 30-item Inventory of Depressive Symptomatology – Clinician-rated scores, and baseline and visit-wise QIDS-SR16 and QIDS-C16 ratings from the first treatment step (citalopram). The VQIDS-C5 and the VQIDS-SR5 items (sad mood, self-outlook, involvement, fatigue, psychomotor slowing) (each rated 0–3), extracted from the corresponding 16-item ratings, were selected to best reflect the 6-item HRSD (HRSD6) (exclusive of anxiety). Classical Test Theory (CTT) and Item-Response Theory (IRT) analyses assessed psychometric features. IRT analyses produced total score crosswalks between the VQIDS5, QIDS-C16, QIDS-SR16 and HRSD6. Clinically relevant VQIDS symptom severity thresholds and treatment outcomes were estimated based on cross-walks from the parent QIDS16 ratings.ResultsBoth VQIDS versions were unifactorial with acceptable internal consistencies (Cronbach’s alphas >0.80), item-total correlations (0.57–0.74) by CCT, and strong IRT item performance. Based on QIDS16 severity thresholds (none 0–5; mild 6–10; moderate 11–15; severe 16–20; and very severe 21–27), comparable thresholds were 0–2; 3–5; 6–9; 9–12; and >12 for VQIDS-C5, and 0–2; 2–5; 6–8; 9–12; and >12 for VQIDS-SR5. Kappa values were acceptable in comparing categories of outcomes (eg, no benefit, remission, etc) based on VQIDS and corresponding QIDS categories.ConclusionThe VQIDS-C5 and VQIDS-SR5 assess selected core depressive symptoms with psychometrically acceptable properties. Theelf-report and clinician-rated versions provide virtually identical information, symptom severity thresholds and symptom change categories. Both are as sensitive to change as the corresponding QIDS16, making them suitable for use in busy practices.

Treating Insomnia with High Risk of Depression Using Therapist-Guided Digital Cognitive, Behavioral, and Circadian Rhythm Support Interventions to Prevent Worsening of Depressive Symptoms: A Randomized Controlled Trial

Introduction: The global disease burden of major depressive disorder urgently requires prevention in high-risk individuals, such as recently discovered insomnia subtypes. Previous studies targeting insomnia with fully automated eHealth interventions to prevent depression are inconclusive: dropout was high and likely biased, and depressive symptoms in untreated participants on average improved rather than worsened. Objective: This randomized controlled trial aimed to efficiently prevent the worsening of depressive symptoms by selecting insomnia subtypes at high risk of depression for internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS), with online therapist guidance to promote adherence. Methods: Participants with an insomnia disorder subtype conveying an increased risk of depression (n = 132) were randomized to no treatment (NT), CRS, CBT-I, or CBT-I+CRS. The Inventory of Depressive Symptomatology – Self Report (IDS-SR) was self-administered at baseline and at four follow-ups spanning 1 year. Results: Without treatment, depressive symptoms indeed worsened (d = 0.28, p = 0.041) in high-risk insomnia, but not in a reference group with low-risk insomnia. Therapist-guided CBT-I and CBT-I+CRS reduced IDS-SR ratings across all follow-up assessments (respectively, d = –0.80, p = 0.001; d = –0.95, p < 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening (p = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57–62%). Conclusions: The findings tentatively suggest that the efficiency of population-wide preventive strategies could benefit from the possibility to select insomnia subtypes at high risk of developing depression for therapist-guided digital CBT-I+CRS. This treatment may provide effective long-term prevention of worsening of depressive symptoms. Trial registration: the Netherlands Trial Register (NL7359).

Anterior cingulate cortex in individuals with depressive symptoms: A structural MRI study

Several magnetic resonance imaging (MRI) studies have reported reduction in anterior cingulate cortex (ACC) volume in individuals with major depressive disorder (MDD). However, some MRI studies did not find significant ACC volumetric changes in MDD, and sample sizes were generally small. This cross-sectional structural MRI study examined the relationship between current depressive symptoms and ACC volume in a large community sample of 1803 adults. A series of multiple linear regression analyses were conducted to predict right and left ACC volumes using Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) scores, intracranial volume, age, sex, race/ethnicity, alcohol use, tobacco use, and psychotropic medications as predictor variables. Right ACC volume was significantly negatively associated with QIDS-SR scores, while no significant association was found between left ACC volume and QIDS-SR scores. In addition, there was a significant negative association between QIDS-SR scores and right but not left ACC volumes in males, and no significant association between QIDS-SR scores and right or left ACC volumes in females. These findings suggest that right ACC volume is reduced in people with greater self-reported depressive symptom severity, and that this association is only significant in men.

PAX-D: study protocol for a randomised placebo-controlled trial evaluating the efficacy and mechanism of pramipexole as add-on treatment for people with treatment resistant depression

IntroductionClinical depression is usually treated in primary care with psychological therapies and antidepressant medication. However, when patients do not respond to at least two or more antidepressants within a depressive...

Comparison of Body Image Perception and Depression in Polycystic Ovarian Syndrome (PCOS) and Non-PCOS Women

Objectives: The aim of the current study was to appraise the relationship between women’s body image perception and depression in case and controls. Methods: In this case-control study 60 polycystic ovarian syndrome patients established agreeing to the Rotterdam criteria and 60 healthy controls of reproductive age group were enrolled. The PCOS patients and healthy controls were evaluated on questionnaire for physical appearance and depression. Body image perception was accessed using the validated Body Esteem Scale. The symptoms of Depression were evaluated with the Quick Inventory of Depressive Symptomatology-Self Report. Results: 55% of PCOS patients had depression while 36.7% were found with depression in the control group. In the PCOS group 65% of patients were found with positive body image while 98.3% of patients were found with positive body image. Significant association of study cases group was found with BMI group (p=0.049), diet habit (p=0.013), depression (p=0.044) and body image (p=0.000). Patients with depression are also more likely to have PCOS in comparison with those who haven’t (OR=2.111). Conclusion: There was a significant association of study group with body image perception and depression. Therefore, health of the patients with this set of symptoms is essential to be acknowledged more fully, predominantly in relation to the despair and poor body image. The outcomes of this study foster implications for clinical practice and propose that a multidisciplinary team should be involved in treatment of PCOS. Key words: Polycystic Ovary Syndrome (PCOS), Quick Inventory of Depressive Symptomatology (QIDS), Depression.

Unhappy While Depressed: Examining the Dimensionality, Reliability and Validity of the Subjective Happiness Scale in a Spanish Sample of Patients with Depressive Disorders.

Despite the considerable amount of research evidence on the significant role of subjective happiness on mental health, there is no psychometric study of the Subjective Happiness Scale (SHS) in psychiatric samples. This study was aimed at exploring the psychometric properties of the SHS in a Spanish sample of patients with depressive disorders. Participants were 174 patients with a depressive disorder (70% diagnosed as major depressive disorder) who completed the SHS, the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16), and the EQ-5D Visual Analogue Scale (EQ-5D VAS). Depressive symptoms were also assessed by means of the 17-item Hamilton Depression Rating Scale (HDRS17) and the Clinical Global Impression-Severity (CGI-S) Scale. Dimensionality, internal consistency reliability, construct validity, and responsiveness to change of the SHS were examined. Confirmatory factor analysis replicated the original one-factor structure of the scale. The SHS exhibited good-to-excellent results for internal consistency (α = 0.83) and for convergent [EQ-5D VAS (r = 0.71)] and divergent [QIDS-SR16 (r = −0.72), HDRS17 (r = −0.60) and CGI-S (r = −0.61)] construct validity. The ability of the SHS to differentiate between depression severity levels as well as its responsiveness to clinical change were both highly satisfactory (p < 0.001 in both cases). The SHS retained the soundness of psychometric properties showed in non-clinical samples in a sample of patients with depressive disorders, which supports its use as a reliable and valid outcome measure in the treatment of such disorders.

Relationships between Cognitive Function and Odor Identification, Balance Capability, and Muscle Strength in Middle-Aged Persons with and without Type 2 Diabetes.

Aim We investigated the relationship between cognitive function and olfactory and physical functions in middle-aged persons with and without type 2 diabetes (T2D) to examine the potential of olfactory and physical functions as biomarkers for early cognitive impairment. Methods Enrolled were 70 T2D patients (age 40 to <65 y) and 81 age-matched control participants without diabetes. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA), Trail Making Test parts A and B (TMT-A/-B), Wisconsin Card Sorting Test (WCST), Quick Inventory of Depressive Symptomatology Self-Report (QIDS), and Starkstein Apathy Scale (SAS). Multiple linear regression analyses were performed. Results Odor identification was an independent determinant shown in the results of the TMT-A in the entire participant group and was independently associated with the MoCA and TMT-B in the T2D group. Balance capability assessed with a stabilometer was independently associated with all cognitive function tests except for QISD and SAS in the entire participant group and the T2D group and was independently associated with TMT-A in the control group. Knee extension strength was independently associated with the SAS in the entire participant group and the T2D group. Conclusions Odor identification, balance capability, and knee extension strength were potential markers for cognitive decline in middle-aged persons with T2D.

Comparison of Residual Depressive Symptoms, Functioning, and Quality of Life Between Patients with Recurrent Depression and First Episode Depression After Acute Treatment in China.

ObjectiveThis prospective study aimed to investigate the prognosis and rehabilitation of patients with recurrent depression and first episode depression after acute treatment in China.MethodsA total of 434 patients with first-episode or recurrent depression who received acute treatment respectively from sixteen hospitals in thirteen cities in China were enrolled in this prospective study. All patients were followed up for 6 months after acute treatment. The following data were collected at baseline period and 1, 3, and 6 months after acute treatment: general information of patients, medication information and patient’s condition changes, brief 16-item quick inventory of depressive symptomatology self-report (QIDS-SR16), patient health questionnaire-15 (PHQ-15), quality of life enjoyment and satisfaction questionnaire-short form (Q-LES-Q-SF), Sheehan disability scale (SDS) and digit symbol substitution test (DSST).ResultsDuring the baseline period, there was a significant difference in QIDS-SR16 between recurrent patients and first-episode patients (p < 0.05), and there was no significant difference in other indicators (p > 0.05). At one month after acute treatment, there were significant differences in the total QIDS-SR16 score, the total Q-LES-SF score, the social life score, and the family life/home responsibilities score of SDS in patients with recurrent depression and first-episode depression (p < 0.05). At three months after acute treatment, there were significant differences in the total Q-LES-SF score and social life score of SDS in patients with recurrent depression and first-episode depression (p < 0.05). At six months after acute treatment, there were significant differences in the total QIDS-SR16 score, the social life score, and the total Q-LES-SF score in patients with recurrent depression and first-episode depression (p < 0.05). Compared with that data during the baseline period, the QIDS-SR16 scores and the SDS scores of all patients decreased, and the Q-LES-SF scores of all patients gradually increased as time went on during the consolidation period.ConclusionThe recurrent patients have more severe social function impairment, depressive symptoms, and lower life quality than that of the first-episode depressed patients. Given the negative impact of depressed symptom on recurrent patient, more attention should be paid to the treatment of recurrent patient and recurrence prevention of first episode patient.

Difference in the regulation of biological rhythm symptoms of Major depressive disorder between escitalopram and mirtazapine

BackgroundBiological rhythm plays an important role in major depressive disorder (MDD). The efficacy of antidepressant in biological rhythm remains unclear. This study is designed to explore the efficiency of escitalopram and mirtazapine in improving circadian rhythm, diurnal mood variation(DMV) and daily activity in MDD patients. MethodsFour-hundred and fifty participants diagnosed with MDD were randomized to receive treatment with escitalopram (TWE), treatment with mirtazapine (TWM) or treatment as usual (TAU). Biological rhythm symptoms were assessed by relevant biological subscale in the Hamilton depression scale (HAMD) and the quick inventory of depressive symptomatology self-report (QIDS). The participants were assessed by trained evaluators at baseline and week 2, 4, 6 and 8. ResultsThe differences of HAMD score among TWE(58%, 69%, 72%), TWM(56%, 64%, 76%) and TAU(49%, 57%, 68%) were significant(P<0.05). But the differences were significant only in patients without DMV; (2) Sleep rhythm items (difficulty falling asleep and early-wake) were significantly improved in TWM (P <0 .05) for both HAMD and QIDS. Decreased appetite and weight were significantly improved in TWM (P<0 .05) for both scales. (3) For daily activity-related items, feeling slowed down and concentration were significantly improved in TWE. And the retardation was significantly improved in TWE and in TWM. ConclusionsBoth escitalopram and mirtazapine have superior anti-depressive effect, especially for MDD patients without DMV. Escitalopram was significantly more effective in daily activity, feeling slowed down and concentration difficulty, while mirtazapine was significantly more effective in improving sleep, appetite and weight of MDD.

Prevalence of Fatigue and Unrecognized Depression in Patients with Inflammatory Bowel Disease in Remission under Immunosuppressants and Biologicals.

Background: Although highly prevalent among inflammatory bowel disease (IBD) patients, fatigue remains an unmet clinical need. The aim was to describe the prevalence of fatigue in an IBD population in remission and identify factors associated with fatigue. Methods: IBD patients in clinical and biochemical remission under treatment with immunomodulators or biologicals were included. Fatigue, physical tiredness and depression were assessed using the fatigue Visual Analogue Scale (fVAS), the Shortened Fatigue Questionnaire (SFQ) and the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR), respectively. Relevant clinical and biochemical parameters were included in regression analyses to identify factors associated with physical fatigue. Results: In total, 157 IBD patients were included. Up to 45.9% of patients reported fatigue, physical tiredness was observed in 51% and depression in 10.8%. The majority of patients with subclinical depression were fatigued. Female sex (OR = 4.17 [1.55–6.78], p = 0.002) was independently associated with physical fatigue. Transferrin saturation (OR = −0.11 [−0.22–−0.007], p = 0.037) and treatment with adalimumab (compared to infliximab, OR = −3.65 [−7.21–−0.08], p = 0.045) entailed a lower risk of fatigue. Conclusion: Fatigue is observed in about half of IBD patients in remission and can be a symptom of underlying undetected depression. Sex, transferrin saturation and medication were identified as independent risk factors.

Relationship of Childhood Trauma with Transcranial Magnetic Stimulation Outcome for Depression

Background: Childhood trauma has lasting effects on treatment outcomes for many illnesses including major depressive disorder (MDD) but the relationship with transcranial magnetic stimulation (TMS) is unknown.Methods: Childhood Trauma Questionnaire (CTQ), a questionnaire to assess severity and type of childhood trauma, was collected in a naturalistic outpatient setting from patients receiving TMS for treatment resistant MDD. Inventory of Depressive Symptomatology Self Report (IDS-SR) was used to assess depression symptom severity, clinical response and remission. Standard treatment was given at 10 Hz stimulation to the dorsolateral left prefrontal cortex at 120% maximum intensity relative to their motor threshold for 3000-4000 pulses/daily for six weeks.Results: 117 patients receiving TMS completed CTQ. More severe trauma showed less improvement after TMS as seen via a negative correlation between IDS-SR %change and CTQ total score (r=-.251, p<0.01). Specifically, less improvement correlated with degree of physical abuse (r=-.245, p<0.01) and physical neglect (r=-.251, p<0.01). Non-responders had significantly worse scores in physical abuse (p<.01), sexual abuse (p<.05), and physical neglect (p<.05) compared to responders. Significant chi-square associations between physical neglect and non-response (χ=8.623, p<0.05); and sexual abuse and non-remission (χ=9.214, p<0.05) were present.Conclusion: Our data show that certain types of trauma may have more impact on TMS outcomes than others. Based on these results, future studies examining the possible biological pathways and mechanisms contributing to the differences in severely depressed patients with and without certain types of childhood trauma could lead to a more personalized treatment algorithm leading to improved efficacy of TMS.Conflicts of Interest: None to reportFunding: This work was supported by grants from the National Institute of Mental Health (NIMH) R25MH101076 (Dr. AM Fukuda) and P20GM130452 (E Tirrell & Dr. LL Carpenter), and by Butler Internal Funding. Background: Childhood trauma has lasting effects on treatment outcomes for many illnesses including major depressive disorder (MDD) but the relationship with transcranial magnetic stimulation (TMS) is unknown. Methods: Childhood Trauma Questionnaire (CTQ), a questionnaire to assess severity and type of childhood trauma, was collected in a naturalistic outpatient setting from patients receiving TMS for treatment resistant MDD. Inventory of Depressive Symptomatology Self Report (IDS-SR) was used to assess depression symptom severity, clinical response and remission. Standard treatment was given at 10 Hz stimulation to the dorsolateral left prefrontal cortex at 120% maximum intensity relative to their motor threshold for 3000-4000 pulses/daily for six weeks. Results: 117 patients receiving TMS completed CTQ. More severe trauma showed less improvement after TMS as seen via a negative correlation between IDS-SR %change and CTQ total score (r=-.251, p<0.01). Specifically, less improvement correlated with degree of physical abuse (r=-.245, p<0.01) and physical neglect (r=-.251, p<0.01). Non-responders had significantly worse scores in physical abuse (p<.01), sexual abuse (p<.05), and physical neglect (p<.05) compared to responders. Significant chi-square associations between physical neglect and non-response (χ=8.623, p<0.05); and sexual abuse and non-remission (χ=9.214, p<0.05) were present. Conclusion: Our data show that certain types of trauma may have more impact on TMS outcomes than others. Based on these results, future studies examining the possible biological pathways and mechanisms contributing to the differences in severely depressed patients with and without certain types of childhood trauma could lead to a more personalized treatment algorithm leading to improved efficacy of TMS. Conflicts of Interest: None to report Funding: This work was supported by grants from the National Institute of Mental Health (NIMH) R25MH101076 (Dr. AM Fukuda) and P20GM130452 (E Tirrell & Dr. LL Carpenter), and by Butler Internal Funding.

A tangled start: The link between childhood maltreatment, psychopathology, and relationships in adulthood

BackgroundAdults with a history of childhood maltreatment are more likely to experience distrust, feel distant from others, and develop an insecure attachment style which may also affect relationship quality. Furthermore, childhood maltreatment has been linked to several mental health problems; including, depression, anxiety, and alcohol dependance severity, that are also known to relationship quality. ObjectiveThe current study was designed to investigate to what extent childhood maltreatment is associated with adult insecure attachment and intimate relationships and whether this association is mediated by psychopathology. Participants and MethodIn a study comprised of 2035 adults aged 18–65, we investigated whether childhood maltreatment was associated with insecure adult attachment styles and the quality of intimate relationships and whether this was mediated by depression, anxiety, and alcohol dependence severity (based on repeated assessments of the Inventory of Depressive Symptomatology-Self Report, Beck Anxiety Index, and Alcohol Use Disorders Identification Test respectively). ResultsThe path model showed an acceptable fit, RMSEA = 0.05, and suggested full mediation of the association of childhood maltreatment with quality of intimate relationships by depression severity and a) anxious attachment (β = −4.0 ∗ 10−2; 95% CI = −5.5 ∗ 10−2, −2.7 ∗ 10−2) and b) avoidant attachment (β = −7.2 ∗ 10−2; 95% CI = −9.6 ∗ 10−2, −4.9 ∗ 10−2). Anxiety and alcohol dependence severity were not significant mediators. Conclusions: Childhood maltreatment is associated with a lower quality of intimate relationships, which is fully mediated by depression severity and insecure attachment styles.

No antidepressant effects of low intensity transcranial pulsed electromagnetic fields for treatment resistant depression

BackgroundNoninvasive neurostimulation with transcranial Pulsed Electromagnetic Fields (tPEMF) may be a promising method for treatment resistant depression (TRD). Studies shown substantial improvement of depressive symptoms in patients with TRD, but there is no information on long-term antidepressant effects. The aim of this study was to investigate the short- and long-term efficacy of tPEMF in participants with TRD. MethodsEligible participants with TRD in this sham-controlled double-blind multicenter trial were randomly assigned to five weeks either daily active or sham tPEMF. Severity of depression and anxiety was assessed pre- and directly post-treatment and five and fifteen weeks post-treatment. Primary outcome was change on the 17-item Hamilton depression rating scale directly post-treatment. Secondary outcome was change on the Hamilton-17 during follow-up and change on the Inventory of Depressive Symptomatology Self-Report and the Beck Anxiety Index. ResultsOf the 55 included participants, 50 completed the treatment protocol. Depressive symptoms improved over time in both groups. The improvement continued until the last follow-up measure. There was no difference in outcome between the active and the sham group on change in depression post-treatment or on any secondary measure. ConclusionTreatment with this type of active tPEMF was not superior to sham in patients with TRD. This is in contrast to a previous study using a similar design and power calculation, but a higher magnetic field strength, that reported improvement of depression after treatment with tPEMF compared to sham. An important limitation of our study was the fact that no different dosing regimens were tried.

Multimodal Elements of Suicidality Reduction After Transcranial Magnetic Stimulation

ObjectivesRepetitive transcranial magnetic stimulation (TMS) is a promising treatment for suicidality, but it is underlying neural mechanisms remain poorly understood. Our prior findings indicated that frontostriatal functional connectivity correlates with the severity of suicidal thoughts and behaviors. In this secondary analysis of data from an open label trial, we evaluated whether changes in frontostriatal functional connectivity would accompany suicidality reductions following TMS. We also explored the relationship between frontostriatal connectivity change and underlying white matter (WM) organization.Materials and MethodsWe conducted seed‐based functional connectivity analysis on participants (N = 25) with comorbid post‐traumatic stress disorder and depression who received eight weeks of 5 Hz TMS to left dorsolateral prefrontal cortex. We measured clinical symptoms with the Inventory of Depressive Symptomatology‐Self Report (IDS‐SR) and the PTSD Checklist for DSM‐5 (PCL‐5). We derived suicidality from IDS‐SR item 18. Magnetic resonance imaging data were collected before TMS, and at treatment end point. These data were entered into analyses of covariance, evaluating the effect of suicidality change across treatment on striatal and thalamic functional connectivity. Changes in other PTSD and depression symptoms were included as covariates and results were corrected for multiple comparisons. Diffusion connectometry in a participant subsample (N = 17) explored the relationship between frontal WM integrity at treatment baseline and subsequent functional connectivity changes correlated with differences in suicidality.ResultsSuicidal ideation decreased in 65% of participants. Reductions in suicidality and functional connectivity between the dorsal striatum and frontopolar cortex were correlated (p‐False Discover Rate‐corrected < 0.001), after covariance for clinical symptom change. All other results were nonsignificant. Our connectometry results indicated that the integrity of frontostriatal WM may circumscribe functional connectivity response to TMS for suicide.ConclusionsTargeted reduction of fronto‐striatal connectivity with TMS may be a promising treatment for suicidality. Future research can build on this multimodal approach to advance individualized stimulation approaches in high‐risk patients.

Impact of measurement frequency on self-reported depressive symptoms: An experimental study in a clinical setting

Previous research suggests a relationship between measurement frequency of selfreported depressive symptoms and change in depressive symptom scores for the Beck Depression Inventory II (BDI-II). The goal of the current study was to investigate the differential effects of weekly and monthly completion of the BDI-II and Quick Inventory of Depressive Symptomatology self-report (QIDS-SR).

734 Prevalence and Correlates of Insomnia in Veterans with and without Military Sexual Trauma Receiving Care within a VA Med Center

Abstract Introduction A prior study showed a higher prevalence of insomnia among younger Veterans with military sexual trauma (MST) before receiving care at a VA Medical Center (VAMC). We extend the literature to investigate the prevalence and correlates of insomnia in male Veterans with and without MST currently receiving care within a VAMC. Methods We evaluated cross-sectional data from a survey within the Philadelphia VAMC (N=138) using the following instruments: Insomnia Severity Index (ISI) total score for insomnia; Sexual Harassment Scale (DRRI-2) to screen for MST; PTSD checklist for DSM-5 (PCL-5) PTSD symptoms; Quick Inventory of Depressive Symptomatology-Self report (QIDS-SR) to evaluate depressive symptoms; Alcohol Use Disorder Identification Test (AUDIT-C) to assess for harmful drinking; and, the nightmare question from the PCL-5 scale to screen for persistent nightmares. The association between ISI total score and variables were assessed separately in individuals with and without MST, using bivariate and multivariable analyses. Results The mean(SD) age was 55.2(12.8) years. They were likely to identify themselves as African-American (44.2%), and had a high school diploma (39.1%). MST was endorsed by 31.9% of the Veterans. Insomnia was more prevalent in those with MST [N=42(95.4%)] than those without [N=77(81.9%)]. Individuals with MST had higher ISI (19.9±5.0 Vs 16.7±7.2) and PCL-5 (48.4±14.4 Vs 38.1±19.7) total scores, than individuals without. Among those with MST, the bivariate analysis showed significant associations with PCL-5 (β=0.2, p&amp;lt;0.0001), QIDS (β=0.5, p=0.01), AUDIT-C (β=0.5, p=0.008), and nightmares (β=3.9, p=0.03). In the multivariable model, ISI total score was only associated with the PCL-5 total score (β=0.3, R2=0.18, p=0.0005). Among those without MST, the bivariate analysis showed significant associations between ISI total score and age (β=-0.1, p=0.02), total scores on the PCL-5 (β=0.2, p&amp;lt;0.0001), QIDS (β=0.9, p&amp;lt;0.00001), and nightmare (β=6.7, p&amp;lt;0.0001). In the multivariable model (R2=0.5, p&amp;lt;0.00001), the ISI total score was associated with PCL-5 (β=0.1, p=0.01), and QIDS (β=0.7, p=&amp;lt;0.0001) total scores. Conclusion There is a higher prevalence of insomnia among Veterans with MST currently receiving care within the VHA. Treatment of insomnia and PTSD is critical to improve their well-being and prevent complications. Support (if any) The study was supported by VA grant IK2CX000855 (S.C.).

Individual and common patterns in the order of symptom improvement during outpatient treatment for major depression

BackgroundResearch so far provided few clues on the order in which depressive symptoms typically remit during treatment. This study examined which depressive symptoms improve first, and whether symptoms changed before, simultaneous with, or after the core symptoms of depression (i.e., sad mood, loss of pleasure, and loss of interest). MethodsParticipants were 176 patients with Major Depressive Disorder (MDD) receiving outpatient treatment (a combination of pharmacotherapy and psychological interventions) for depression. Participants filled out the Inventory of Depressive Symptomatology - Self Report (IDS-SR) for 16 to 20 consecutive weeks. For each symptom, the timing of onset of a persistent improvement was determined for each single-subject separately. ResultsWhich symptoms improved first differed markedly across patients. The core depression symptoms improved 1.5 to 2 times more often before (48% - 60%) than after (19% -28%) depressive cognitions (‘view of myself’ and ‘view of the future’), anxiety symptoms (‘feeling irritable’ and ‘feeling anxious / tense’) and vegetative symptoms (‘loss of energy’, ‘slowed down’, and ‘physical energy’). Only improvements in suicidal thoughts were more likely to occur before (46% - 48%) than after (29%) improvements in the depression core symptoms. LimitationsNot all ‘core depression-non-core symptom’ combinations could be tested because some symptoms did not improve in a sufficient number of patients. ConclusionsWhich improvements mark the start of symptom remission differed between patients. Improvements in the core depression symptoms ‘sad mood’, ‘loss of interest’, and ‘loss of pleasure’ were more likely to occur before than after improvements in non-core symptoms.

Changes in sleep with transcranial magnetic stimulation in adults with treatment resistant depression: Preliminary results from a naturalistic study

IntroductionSleep disturbance specifically insomnia, non-restorative sleep, and hypersomnia are common symptoms of major depressive disorder (MDD). As it alleviates major depressive disorder, transcranial magnetic stimulation (TMS) may improve associated sleep disturbances, and may also have inherent sedating or activating properties.ObjectivesTo examine the impact of TMS on sleep disturbances in adults with treatment resistant depression in a clinical setting, we retrospectively reviewed de-identified data from naturalistically-treated MDD patients undergoing an initial acute course of TMS therapy at St.Louis Park MinCEP Clinic.MethodsAdults with treatment-resistant depression received daily TMS treatments. 9-item Patient Health Questionnaire (PHQ-9) total scores were used to calculate % change at endpoint (relative to pretreatment baseline); response on both measures was defined as 50% reduction in scores, with remission defined as a final total score 4 on the PHQ-9. Insomnia was measured with a 3-item subscale of the Inventory of Depressive Symptomatology Self Report (IDS-SR). Hypersomnia was measured with a single IDS-SR item. Pairwise comparisons were performed using Student’s T-test. Categorical variables were compared using Fisher’s Exact test. Continuous outcome measures were tested with an analysis of covariance, using baseline PHQ-9 score as a fixed effect covariate.ResultsTMS appears to have differential modulatory effects on insomnia and hypersomnia in adults with treatment resistant depression.ConclusionsThese results may provide the basis for further investigation into therapeutic applications of TMS in addressing sleep disturbances in treatment-resistant depression. Measures that separate hypersomnia and insomnia should be implemented in future work addressing effects of TMS in treatment-resistant depression.DisclosureNo significant relationships.

Personalized ESM monitoring and feedback to support psychological treatment for depression: a pragmatic randomized controlled trial (Therap-i)

BackgroundMajor depressive disorder (MDD) is a highly prevalent mental disorder with large disease burden, high levels of relapse or persistence, and overall suboptimal outcomes of protocolized pharmacological and psychotherapeutic treatments. There is an urgent need to improve treatment effectiveness, possibly through systematic treatment personalization. In psychotherapeutic treatments this can be achieved by case conceptualization. To support this process, we developed the Therap-i module, which consists of personalized Experienced Sampling Methodology (ESM) and feedback. The Therap-i module is integrated into outpatient psychotherapeutic treatment as usual (TAU) for depression. The study aim is to investigate the efficacy of the Therap-i module in decreasing symptomatology in unresponsive or relapsing patients diagnosed with MDD. We hypothesize that the Therap-i module will contribute to TAU by i) decreasing depressive symptoms, and ii) improving general functioning, therapeutic working alliance, and illness perception. This paper provides details of the study rationale, aims, procedures, and a discussion on potential pitfalls and promises of the module.MethodsPatients diagnosed with MDD (n = 100) will enrol in a pragmatic two-armed randomized controlled trial. Randomization is stratified according to the patient’s treatment resistance level assessed with the Dutch Method for quantification of Treatment Resistance in Depression (DM-TRD). All fill-out the Inventory of Depressive Symptomatology Self Report (IDS-SR), Outcome Questionnaire (OQ-45), Illness Perception Questionnaire Mental Health (IPQ-MH), and Work Alliance Inventory Self Report (WAI-SR). In the intervention arm, through close collaboration between patient, clinician, and researcher, a personalized ESM diary is developed based on the patient’s case conceptualization. During the ESM monitoring period (8 weeks, 5 assessments/day), patients receive feedback three times, which is discussed among the abovementioned three parties. Both patients and clinicians will evaluate the Therap-i module.ResultsData collection is ongoing.DiscussionThis is the first study in which personalized ESM and feedback is integrated in outpatient psychotherapeutic TAU for depression. The labour intensive procedure and methodological pitfalls are anticipated challenges and were taken into account when designing the study. When hypotheses are confirmed, the Therap-i module may advance treatment for depression by providing insights into personalized patterns driving or perpetuating depressive complaints.Trial registrationTrial NL7190 (NTR7381), registered prospectively 03-08-2018.