Motivational Symptoms Research Articles

Episode-specific drinking-to-cope motivation, daily mood, and fatigue-related symptoms among college students.

The goal of the present study was to examine whether within-person, episode-specific changes in drinking-to-cope (DTC) motivation from the previous evening were associated with concurrent daily mood and fatigue-related symptoms among college student drinkers (N = 1,421; 54% female). We conducted an Internet-based daily diary study in which students reported over 30 days on their previous night's drinking level and motivation and their current mood (i.e., sadness, anxiety, anger/hostility, and positive mood) and fatigue-related symptoms. Hypotheses were tested using hierarchical linear models in which the current day's outcome was predicted by last night's levels of DTC motivation and drinking, controlling for drinking to enhance motivation, sex, current day's physical symptoms and drinking, and yesterday's level of the outcome. Subsequent models also predicted outcomes 2 days following the drinking event. Relative increases in previous night's DTC motivation were associated with higher levels of current day negative mood and fatigue-related symptoms and lower levels of positive mood. Also, the association between episode-specific DTC motivation and negative mood was stronger in the positive direction when individuals reported higher levels of nonsocial drinking from the previous night. Last, episode-specific DTC showed similar associations with sadness and anger/hostility 2 days after the drinking event. The results are generally consistent with the posited attention allocation and ego-depletion mechanisms. Findings suggest that the deleterious effects of repeated episodes of DTC, over time, could help to explain the increased likelihood of alcohol-related problems seen in prior studies.

Depression in later life: A more somatic presentation?

BackgroundDepression later in life may have a more somatic presentation compared with depression earlier in life due to chronic somatic disease and increasing age. This study examines the influence of the presence of chronic somatic diseases and increasing age on symptom dimensions of late-life depression. MethodsBaseline data of 429 depressed and non-depressed older persons (aged 60–93 years) in the Netherlands Study of Depression in Old Age were used, including symptom dimension scores as assessed with the mood, somatic and motivation subscales of the Inventory of Depressive Symptomatology-Self Report (IDS-SR). Linear regression was performed to investigate the effect of chronic somatic diseases and age on the IDS-SR subscale scores. ResultsIn depressed older persons a higher somatic disease burden was associated with higher scores on the mood subscale (B=2.02, p=0.001), whereas higher age was associated with lower scores on the mood (B=−2.30, p<0.001) and motivation (B=−1.01, p=0.006) subscales. In depressed compared with non-depressed persons, a higher somatic disease burden showed no different association with higher scores on the somatic subscale (F(1,12)=9.2; p=0.003; partial η2=0.022). LimitationsBecause the IDS-SR subscales are specific for old age, it was not feasible to include persons aged <60 years to investigate differences between earlier and later life. ConclusionsIt seems that neither higher somatic disease burden nor higher age contributes to more severe somatic symptoms in late-life depression. In older old persons aged ≥70 years, late-life depression may not be adequately recognized because they may show less mood and motivational symptoms compared with younger old persons.

The VMAT-2 inhibitor tetrabenazine affects effort-related decision making in a progressive ratio/chow feeding choice task: reversal with antidepressant drugs.

Behavioral activation is a fundamental feature of motivation, and organisms frequently make effort-related decisions based upon evaluations of reinforcement value and response costs. Furthermore, people with major depression and other disorders often show anergia, psychomotor retardation, fatigue, and alterations in effort-related decision making. Tasks measuring effort-based decision making can be used as animal models of the motivational symptoms of depression, and the present studies characterized the effort-related effects of the vesicular monoamine transport (VMAT-2) inhibitor tetrabenazine. Tetrabenazine induces depressive symptoms in humans, and also preferentially depletes dopamine (DA). Rats were assessed using a concurrent progressive ratio (PROG)/chow feeding task, in which they can either lever press on a PROG schedule for preferred high-carbohydrate food, or approach and consume a less-preferred lab chow that is freely available in the chamber. Previous work has shown that the DA antagonist haloperidol reduced PROG work output on this task, but did not reduce chow intake, effects that differed substantially from those of reinforcer devaluation or appetite suppressant drugs. The present work demonstrated that tetrabenazine produced an effort-related shift in responding on the PROG/chow procedure, reducing lever presses, highest ratio achieved and time spent responding, but not reducing chow intake. Similar effects were produced by administration of the subtype selective DA antagonists ecopipam (D1) and eticlopride (D2), but not by the cannabinoid CB1 receptor neutral antagonist and putative appetite suppressant AM 4413, which suppressed both lever pressing and chow intake. The adenosine A2A antagonist MSX-3, the antidepressant and catecholamine uptake inhibitor bupropion, and the MAO-B inhibitor deprenyl, all reversed the impairments induced by tetrabenazine. This work demonstrates the potential utility of the PROG/chow procedure as a rodent model of the effort-related deficits observed in depressed patients.

Self-loathing aspects of depression reduce postoperative opioid cessation rate.

We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%-64%) reduction in the rate of opioid cessation following surgery. We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs somatic) associated with a decreased rate of opioid cessation after surgery. We conducted a secondary analysis of the data from a previously reported prospective, longitudinal, observational study of opioid use after five distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression. The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75-0.99, P value 0.037). Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.

Poster #T42 DURABILITY OF REINFORCEMENT LEARNING CHANGES AFTER COGNITIVE REMEDIATION

Motivation and negative symptom research has recently been hampered by a series of inconsistent findings, leading to calls for a greater consensus on the type of measures used across studies. To inform this issue, we conducted a meta-analysis that quantified the association between motivation measures (self-report, performance-based) and clinician-rated negative symptom measures as well as a series of moderator analyses to develop a greater understanding of the measurement factors impacting this relationship. Forty-seven eligible studies with people with schizophrenia-spectrum disorders were included. Using a random-effects meta-analytic model, a small but significant overall effect size emerged between motivation and clinician-rated negative symptoms (r = −0.18). Several significant moderators were identified, including the generation of negative symptom measures such that there was a significantly stronger relationship between motivation and second-generation (r = −0.38) than first-generation negative symptom measures (r = −0.17). Further, the type of performance-based measure used moderated the relationship, with effort discounting tasks most strongly related to negative symptoms (r = −0.44). The domain of motivation assessed (intrinsic, extrinsic, amotivation) also moderated the relationship. These findings help to identify sources of inconsistencies observed in prior studies and point to both second-generation and effort discounting tasks as the most promising types of measures, particularly for those interested in validating motivation measures or assessing the effectiveness of motivation treatments. Although additional research is needed, our results suggest that using these measures may help to reduce inconsistencies across studies and move the field forward.

A longitudinal study of the effects of coping motives, negative affect and drinking level on drinking problems among college students

We examined among college students the interactive effects of drinking to cope (DTC) motivation, anxiety and depression symptoms, and drinking level in predicting drinking-related problems (DRPs). Using an Internet-based survey, participants (N = 844, 53% women) first reported on their drinking motives and monthly for up to three months, they reported on their drinking level, anxiety, depression, and DRPs. We found a three-way interaction between DTC motivation and average levels of drinking and anxiety (but not depression) in predicting DRPs. Specifically, among individuals with stronger DTC motives, higher mean levels of anxiety were associated with a stronger positive association between mean drinking levels and DRPs. We did not find three-way interactions in the models examining monthly changes in anxiety, depression, and drinking in predicting monthly DRPs. However, individuals high in DTC motivation showed a stronger positive association between changes in drinking level and DRPs. The results are discussed in terms of mechanisms related to attention-allocation and self-control resource depletion.

Impaired awareness of deficits in individuals with neuropsychiatric symptoms after acquired brain injury: Associations with treatment motivation and depressive symptoms.

The purpose of this study was to investigate impaired awareness of deficits in relation to treatment motivation and depressive symptoms in patients with neuropsychiatric symptoms after acquired brain injury. The study had a Cross-sectional design with 93 outpatient brain injury patients with neuropsychiatric symptoms in the chronic phase after injury. Awareness was measured by the discrepancy in answers between patients and significant others and/or clinicians. Patients were divided into 3 awareness groups: underestimation, accurate estimation, and overestimation of competencies. Treatment motivation and depressive symptoms were measured with self-report questionnaires. Average discrepancy scores suggested patients had accurate awareness of deficits. However, when dividing patients into 3 awareness groups, 30% underestimated, 38% accurately estimated, and 32% overestimated their competencies. Linear regression analysis with discrepancy scores showed overestimation of competencies (positive discrepancy scores) was associated with less depressive symptoms, whereas underestimation (negative discrepancy scores) was associated with more depressive symptoms (β = -.28 to -.42, p < .05). Group analysis revealed that the underestimation group reported significantly more depressive symptoms than the overestimation group (β = .43 to .44, p < .05). No significant difference between the accurate estimation and overestimation group was found (p > .05). An association between awareness and treatment motivation was not statistically confirmed. This study demonstrated that when considering awareness groups, more nuanced results arise than when only considering discrepancy scores. From a clinical and scientific standpoint, it is important to distinguish awareness groups in addition to considering mean discrepancy scores.

Co-Occurring Depressive and Substance Use Disorders in Adolescents: An Examination of Reward Responsiveness During Treatment.

The goals of the present study were to examine: (a) putative dysfunctions in reward responsiveness in a sample of adolescents (n = 40) with co-occurring depressive and substance use disorders; (b) possible links between reward responsiveness and symptoms of depression, anhedonia, anxiety, and motivation for change in relation to alcohol and drug use; and (c) potential gender differences in findings. Before and after a 2-week residential treatment, adolescents completed self-report assessments of depression, anhedonia, anxiety symptoms, and motivation for change in relation to substance use. In addition, participants completed a computer-based Probabilistic Reward Task (PRT) to examine reward responsiveness (i.e., participants' ability to modulate behavior as a function of reinforcement history). Results indicated that depression and anhedonia symptoms decreased, and motivation for change in relation to drug use increased. Improved reward responsiveness over the course of residential treatment emerged in female, but not male, participants.

Cognition, Function, and Disability in Patients with Schizophrenia: A Review of Longitudinal Studies

This paper aims to review longitudinal studies assessing the impact of cognition on function in patients with schizophrenia. PubMed and Scholars Portal were searched using search terms related to schizophrenia, cognition, function, and longitudinal studies. Some functional abilities have been studied more than others. Some studies suggest that the impact of cognition on function depends on the severity of baseline cognitive deficits. Other studies suggest that the impact of cognition on function depend on what phase of the illness the patient is in or what stage in that particular function the patient is involved in. Finally, few studies assessed interactions between cognition and other aspects of schizophrenia in predicting function, such as functional capacity, insight, motivation, and negative symptoms. More longitudinal and comprehensive studies are needed. A focus on community living is of high public significance as patients with schizophrenia continue to grow old. Future studies should also focus on the longitudinal interactions between cognition and other dimensions of schizophrenia as well as on the biological factors that underlie these interactions.

Changing Unit Culture and Fostering Well-being of Staff

Introduction:The key role of healthcare leaders is to create and sustain an environment that optimizes high-quality, safe, and effective patient-centered care. The leader's role is to ensure the best possible physical environment and provide a culture that supports healthcare team members in the stressful work of providing direct care. A positive approach is to empower nurses and other health team members with effective skills and techniques to help them transform stressful situations into more therapeutic scenarios.Methods:The nursing leadership team decided to test an approach to positive coping and resiliency designed to teach individuals on the oncology unit to recognize their stress symptoms and to use learned skills to counteract the negative impact of stress. Sixty-three participants voluntarily participated in the HeartMath educational class where they were taught techniques that could be used “in the moment” and throughout the day. A champions group was then identified to develop tools that would be used on the oncology unit to keep these techniques at the forefront of the staff's mind throughout each day. Staff members were encouraged to use the tools every day.Results:Staff members were surveyed using the Personal and Organizational Quality Assessment survey pre-intervention, post-intervention, and again at 7 months post-intervention. Results at the 7-month post-intervention showed statistically significant differences for each of the personal indicators (positive outlook, gratitude, motivation, calmness, fatigue, anxiety, depression, anger management, resentfulness, and stress symptoms). The organizational indicators at the 7 month post-intervention all trended in the expected direction, but only statistically significant differences were found in the indicators of goal clarity, productively, communication effectiveness, and time pressure. Other areas of improvement noted were decreased turnover on the oncology unit, improved employee satisfaction scores, and patient satisfaction scores with nursing care.Conclusion:Changing unit culture and fostering well-being of staff begins with nursing leadership. Recognizing that nurses and health team members are stressed, we implemented HeartMath as a team approach with staff taking an active role as champions to bring out ideas to keep the techniques at the forefront of everyone's mind everyday. By encouraging use of these tools at work, personal and organizational gains were found that were beneficial for the staff as well as the organization.

Selective Overexpression of Dopamine D3 Receptors in the Striatum Disrupts Motivation but not Cognition

Evidence indicating an increase in dopamine D2 receptor (D2R) density and occupancy in patients with schizophrenia comes from positron emission tomography studies using ligands that bind both D2Rs and dopamine D3 receptors (D3Rs), questioning the role of D3Rs in the pathophysiology of the disease. Dopamine D3 receptor positron emission tomography ligands have recently been developed and antagonists with preferential affinity for D3R versus D2R are undergoing clinical evaluation. To determine if an increase in D3Rs in the striatum could produce phenotypes relevant to schizophrenia, we generated a transgenic model of striatal D3R overexpression. A bi-transgenic system was used to generate mice with increased D3Rs selectively in the striatum. Mice with overexpression of D3R were subjected to an extensive battery of behavioral tests, including several relevant to schizophrenia. Ligand binding and quantitative reverse transcription polymerase chain reaction methods were used to quantify the effect of D3R overexpression on dopamine D1 receptors (D1Rs) in the striatum. Mice with overexpression of D3R show no abnormalities in basic behavioral functions or cognitive tests but do display a deficit in incentive motivation. This was associated with a reduction in striatal D1R ligand binding, driven by a downregulation at the level of transcription. Both motivation and D1R expression were rescued by switching off the transgene in adulthood. Overexpression of D3Rs in the striatum of mice does not elicit cognitive deficits but disrupts motivation, suggesting that changes in D3Rs may be involved in the negative symptoms of schizophrenia. These data imply that it will be important to evaluate the effects of D3R antagonists on motivational symptoms, which are not improved by currently available antipsychotic medications.

Effort-related motivational effects of the VMAT-2 inhibitor tetrabenazine: implications for animal models of the motivational symptoms of depression.

Motivated behaviors are often characterized by a high degree of behavioral activation, and work output and organisms frequently make effort-related decisions based upon cost/benefit analyses. Moreover, people with major depression and other disorders often show effort-related motivational symptoms such as anergia, psychomotor retardation, and fatigue. It has been suggested that tasks measuring effort-related choice behavior could be used as animal models of the motivational symptoms of depression, and the present studies characterized the effort-related effects of the vesicular monoamine transport (VMAT) inhibitor tetrabenazine. Tetrabenazine produces depressive symptoms in humans and, because of its selective inhibition of VMAT-2, it preferentially depletes dopamine (DA). Rats were assessed using a concurrent fixed-ratio 5/chow feeding choice task that is known to be sensitive to dopaminergic manipulations. Tetrabenazine shifted response choice in rats, producing a dose-related decrease in lever pressing and a concomitant increase in chow intake. However, it did not alter food intake or preference in parallel free-feeding choice studies. The effects of tetrabenazine on effort-related choice were reversed by the adenosine A2A antagonist MSX-3 and the antidepressant bupropion. A behaviorally active dose of tetrabenazine decreased extracellular DA in nucleus accumbens and increased expression of DARPP-32 in accumbens medium spiny neurons in a pattern indicative of reduced transmission at both D1 and D2 DA receptors. These experiments demonstrate that tetrabenazine, which is used in animal models to produce depression-like effects, can alter effort-related choice behavior. These studies have implications for the development of animal models of the motivational symptoms of depression and related disorders.

Effort-related motivational effects of the pro-inflammatory cytokine interleukin 1-beta: studies with the concurrent fixed ratio 5/ chow feeding choice task

Effort-related motivational symptoms such as anergia and fatigue are common in patients with depression and other disorders. Research implicates pro-inflammatory cytokines in depression, and administration of cytokines can induce effort-related motivational symptoms in humans. The present experiments focused on the effects of the pro-inflammatory cytokine interleukin 1-beta (IL-1β) on effort-related choice behavior. Rats were tested on a concurrent fixed ratio 5 lever pressing/chow feeding choice procedure, which assesses the tendency of rats to work for a preferred food (high carbohydrate pellets) in the presence of a concurrently available but less preferred substitute (laboratory chow). IL-1β (1.0-4.0 μg/kg IP) shifted choice behavior, significantly decreasing lever pressing and increasing intake of the freely available chow. The second experiment assessed the ability of the adenosine A2A antagonist (E)-phosphoric acid mono-[3-[8-[2-(3-methoxyphenyl)vinyl]-7-methyl-2,6-dioxo-1-prop-2-ynyl-1,2,6,7-tetrahydropurin-3-yl] propyl] ester disodium salt (MSX-3) to reverse the behavioral effects of IL-1β. MSX-3 attenuated the effort-related impairments produced by IL-1β, increasing lever pressing and also decreasing chow intake. In the same dose range that shifted effort-related choice behavior, IL-1β did not alter food intake or preference in parallel free-feeding choice studies, indicating that these low doses were not generally suppressing appetite or altering preference for the high carbohydrate pellets. In addition, IL-1β did not affect core body temperature. These results indicate that IL-1β can reduce the tendency to work for food, even at low doses that do not produce a general sickness, malaise, or loss of appetite. This research has implications for the involvement of cytokines in motivational symptoms such as anergia and fatigue.

More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes

Apathy is common in nursing home (NH) residents and it overlaps with depression. This study examines the effects of a multidisciplinary depression program on apathy and depressive motivational and mood symptoms. Secondary analyses of a stepped-wedge cluster-randomized controlled trial were conducted with six measurements. Sixteen dementia NH units and 17 somatic units were enrolled. In the intervention condition, a program containing depression assessment procedures and multidisciplinary treatment (activating strategies, psychotherapy, and medication) was introduced. Usual care was provided in the control condition. Outcomes were assessed using the 10-item Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia. Intention-to-treat analyses showed that the whole depression management program reduced apathy in dementia units (p < 0.001; Cohen's d, -0.35), and depressive motivational symptoms in somatic units (p = 0.008; Cohen's d, -0.40). Depressive mood symptoms were not affected in both unit types. The effect on apathy in dementia units was mainly attributed to activating strategies (p < 0.001; Cohen's d, -0.73). The effect on motivational symptoms in somatic units was mainly attributed to psychotherapy (p = 0.002; Cohen's d, -0.80). Apathy worsening was associated with pharmacological depression treatment in both unit types (p = 0.009; Cohen's d, 0.35). Depression management may affect apathy and depressive symptoms differently, which underpins the position of apathy as a distinct syndrome. NH professionals can effectively use activating strategies in dementia units, and psychotherapy in somatic units. More research is needed on treating depressive mood symptoms, and on effects of antidepressants in NHs.

Motivation, Work-stress and Somatic Symptoms of Romanian Preschool and Primary School Teachers

Problem StatementPursuing high performances in student's competitions is an extracurricular activity that generates stress and the intensity of this stress is positively and high correlated with the frequency of somatic symptoms generated by stress. Purpose and objectives of the studyThis study was focused on the stress which generated somatic symptoms at Romanian teachers from kindergarten and primary schools, studying its connection with the stress generated by one of the extracurricul ar activities. There were compared two types of motivations for work and their effect on the relation between stress and somatic symptoms. MethodologyData were collected from a total number of 1169 teachers from Romania, Iaşi County, aged from 19 to 60 (M=42): 501 teachers were from kindergarten and 668 from the primary school. Somatic complaints, stress related to curricular and extracurricular activities, and intrinsic-extrinsic motivations are measured with Likert 6 point scales. Findings and conclusionIntrinsic-extrinsic motivation, stress related to extracurricular activities and somatic complaints are evaluated. The associations between the stress generated by the imposed extracurricular activities and somatic complaints (a) headaches, (b) inability to concentrate, (c) colds, (d)sore throats, and (e)dizziness) are described. As expected, their relations are stronger when the motivation for the extracurricular activities is extrinsic then when these are intrinsic. As main result there was found that the frequency of somatic symptoms was significantly and positively correlated with teacher's stress generated by pursuing high performance in children's competitions.

Interactive contributions of self-regulation deficits and social motivation to psychopathology: unraveling divergent pathways to aggressive behavior and depressive symptoms.

Poor self-regulation has been implicated as a significant risk factor for the development of multiple forms of psychopathology. This research examined the proposition that self-regulation deficits differentially predict aggressive behavior and depressive symptoms, depending on children's social approach versus avoidance motivation. A prospective, multiple-informant approach was used to test this hypothesis in 419 children (M age = 8.92, SD = 0.36). Parents rated children's inhibitory control. Children completed measures of social approach-avoidance motivation and depressive symptoms. Teachers rated children's aggressive behavior. As anticipated, poor inhibitory control predicted aggressive behavior in boys with high but not low approach motivation and low but not high avoidance motivation, whereas poor inhibitory control predicted depressive symptoms in girls with high but not low avoidance motivation. This research supports several complementary theoretical models of psychopathology and provides insight into the differential contributions of poor self-regulation to maladaptive developmental outcomes. The findings suggest the need for targeted intervention programs that consider heterogeneity among children with self-regulatory deficits.

Self-Determined to Exercise? Leisure-Time Exercise Behavior, Exercise Motivation, and Exercise Dependence in Youth

Scant research has examined the determinants of primary exercise dependence symptoms in youth. Study purposes were to examine sex differences across leisure-time exercise behavior, motivation, and primary exercise dependence symptoms in youth and the extent to which exercise behavior and motivation predicted exercise dependence within the Self-Determination Theory framework. Adolescents (N = 805; mean age = 15 years; 46% girls) completed measures of exercise behavior, motivation, and exercise dependence in health/PE classes. One-way ANOVA revealed boys scored higher than girls on leisure-time exercise behavior, exercise dependence symptoms, and most of the exercise motivation subscales. Hierarchical regression analyses indicated a) sex, exercise behavior, motivation, and their interaction terms explained 39% of the variance in primary exercise dependence; b) Integrated Regulation and Introjected Regulation were important determinants of exercise dependence; and c) sex moderated the contributions of External Regulation for predicting exercise dependence such that boys in the high and low external regulation groups had higher symptoms than girls in the high and low external regulation groups. These preliminary findings support the controlled dimensions of Integrated Regulation (boys, girls), Introjected Regulation (boys, girls), and External Regulation (boys only) are important determinants of primary exercise dependence symptoms.

Am I Motivated? A Look at the Motivation Styles, Symptoms and Working Conditions that Best Motivate Human Resource Practitioners in Jamaica

Human Resource Practitioners, like any other employees within organizations having different motivation styles, are faced with various motivational problems, and are exposed to different working conditions that best motivate them. The environment and factors greatly influence the motivational levels of these practitioners and thus job satisfaction and engagement are affected. This paper outlines the motivation problems experienced by three persons in their work environment and gives suggestions as to the strategies necessary to deal with them. The Pritchard Motivation Symptoms Questionnaire, the Conner Motivation Style Assessment and the Spitzer Motivation Self Assessment Questionnaire were used in the study. Results show that goal orientated and learning oriented motivation styles are best practiced by participants neglecting the relationship motivation style. These Participants were either highly motivated or had experienced some motivation problems. They had major desires for power, achievement, ownership, and competence. Inter-item correlation revealed a statistically significant relationship between desires for activity, competence, power and achievement, which were highly correlated.

The Role of Depressive Symptoms in the Relation between Dieting Motivation and Weight Change

In general, a high level of dieting motivation is associated with successful weight loss. However, this may not be equally true for everyone. The goal of the current longitudinal study was to test the interactive effect of dieting motivation and depressive symptoms on weight change in a sample of 142 participants (M age = 46.7; 112 females). Height and weight were measured twice: at baseline and after a year. Some evidence was found for the hypothesized interactive effect of dieting motivation and depressive symptoms on weight change. The BMI of participants without depressive symptoms decreased with increasing motivation, whereas the BMI of participants with depressive symptoms increased with increasing motivation. Taken together, these data suggest that depressive symptoms should be taken into account in weight-loss treatments because they may interfere with weight loss goals.

Lacunar Infarcts in Deep White Matter Are Associated with Higher and More Fluctuating Depressive Symptoms During Three Years Follow-up

Disruption of frontal-subcortical circuits by cerebral small-vessel disease is thought to predispose to depression characterized by motivational symptoms. We examined the influence of lacunar infarcts and white matter lesions (WML) on severity and course of depressive symptoms during 3 years follow-up. Within the SMART-Medea study, analyses were performed in 650 patients with symptomatic atherosclerotic disease (62±9 years). Volumetric WML measures (deep and periventricular) were obtained with 1.5T magnetic resonance imaging at baseline; infarcts were rated visually. Depressive symptoms were assessed with Patient Health Questionnaire-9 at baseline and during five follow-up times and categorized into motivational and mood scores. Using generalized estimating equation models, a relation between lacunar infarcts in deep white matter and an increased severity (mean difference=1.47, 95% confidence interval .33-2.60) and more fluctuating course (p value interaction infarcts * time=.04) of depressive symptoms during follow-up was found, adjusted for age, sex, education, vascular risk, and cognition. This relation was primarily driven by motivational symptoms. Lacunar infarcts were not associated with severity or course of depressive symptoms. Deep WML were associated with a more fluctuating but not more severe course of depressive symptoms. Excluding patients with major depressive disorder did not change the results. In patients with symptomatic atherosclerotic disease and relatively mild depressive symptoms, depressive symptoms, characteristic of motivational problems, remained higher during 3 years follow-up in patients with lacunar infarcts in deep white matter and that symptom severity fluctuated over time.