Onset Of Major Depression Research Articles

La cimentation complète ou partielle de l’embase tibiale d’une PTG n’influe pas sur la survie

Our study aims at replicating our previous finding of an association between COMT rs4680 G/A polymorphism and early onset major depression (MD). We included 462 MD, 147 bipolar disorders (BD) subjects and 295 healthy controls. We could partially replicate previous findings. In particular, rs4680 GG + AG genotypes were more represented in the subgroup of early onset MD patients (p = 0.04). Additionally, we observed an association between rs737865 alleles and early onset MD (p = 0.04). Rs4680 genotype was associated with early onset BD as well (p = 0.01). In conclusion, we partially replicated our previous findings confirming a possible influence of COMT variants in MD and BD, particularly in early onset subjects, though not with the same risk genotypes.

Allergic rhinitis in adolescence increases the risk of depression in later life: A nationwide population-based prospective cohort study

Background: Many cross-sectional studies have suggested an association between allergic rhinitis (AR) and depression, but the timing relationship was not determined. Using a nationwide population-based prospective cohort study (1:4, age-/gender-matched), we hypothesized that AR in adolescence would increase the risk of depression in later life. MethodsIn all, 1673 adolescents aged 12–15 that had AR between 1996 and 2000 were recruited for our study. Cases of major depressive disorder and any depressive disorder that occurred to the end of follow-up (December 31, 2010) were identified. ResultAdolescents with AR had a higher prevalence of major depression (2.5% vs. 1.2%, p<0.001) and any depressive disorder (4.9% vs. 2.8%, p<0.001) and an earlier onset of major depression (19.31±2.91 vs. 20.43±2.71 years, p=0.038) and any depressive disorder (19.35±2.63 vs. 20.43±2.62 years, p=0.002) compared with the controls. The Cox regression model showed that adolescents with AR had increased HRs of major depression (HR: 1.59, 95% CI: 1.02–2.50) and any depressive disorder (HR: 1.42, 95% CI: 1.04–1.93) after controlling residence location and comorbid allergic diseases. LimitationsThe prevalence of depressive disorder may be underestimated because only those who had medicine-seeking behaviors were enrolled. ConclusionsThis first cohort case–control study showed an association between AR in early adolescence and depression in late adolescence and early adulthood. Our results suggested that allergic responses played important roles in the development of depression.

Ruminative response style to depression and childhood onset major depression

Ruminative response style to depression and childhood onset major depression

Identifying target groups for the prevention of depression in early adolescence: The TRAILS study

Depression in adolescence is associated with long-term adverse consequences. The aim of the present study is to identify target groups at increased risk of developing depression in early adolescence, such that prevention is associated with the largest health benefit at population-level for the least effort. The analyses were conducted on data of the first (age range 10-12) and fourth (age range 17-20) wave of a population-based cohort study (N=1538). The Composite International Diagnostic Interview (CIDI) was used to assess onset of major depression in early adolescence. High-risk groups were identified using exposure rate, incidence rate and population attributable fraction. Prevention of depression onset in early adolescence is best targeted at children with one of the following risk profiles: a high body mass index in combination with (1) maternal depression (2) female gender, and (3) parental emotional rejection. Age of onset of depression was assessed retrospectively. Only a few risk indicators are needed to identify a relatively small group which accounts for a substantial percentage of the new cases of depression in early adolescence.

Pre-adult onset and patterns of suicidality in patients with a history of recurrent depression

BackgroundThis report assesses the association between age of onset of major depression and later suicidality in a sample of 276 recurrently depressed patients recruited for the Oxford/Bangor Staying Well after Depression (SWAD) Trial, and interviewed when in remission.MethodsThe study enrolled adult patients with a history of at least three episodes of non-psychotic major depressive disorder from primary care and psychiatric care practices and through community advertisements. At study entry, all participants estimated the age of their first onset of a major depressive episode and completed both self-report and interview-based assessments of past and current suicidal ideation and behavior. Participants were divided into pre-adult and adult onset groups using a cut-off age of 18.ResultsForty-eight percent of the sample reported a pre-adult age of onset. Pre-adult age of onset was significantly associated with suicidality, both from self-report and from interviewer assessment even when adjusting for differences in age, gender, employment status, length of the disorder and early adversity.LimitationsRelevant variables were all assessed through retrospective reports.ConclusionsPre-adult age of onset is closely associated with risk for and severity of later suicidality, replicating, in a sample of patients assessed when in remission, findings from studies that assessed patients when currently depressed. The association of pre-adult age of onset with suicidality is not due to differences in sociodemographic variables, length of the disorder and early adversity.

Persistent heavy smoking as risk factor for major depression (MD) incidence – Evidence from a longitudinal Canadian cohort of the National Population Health Survey

BackgroundReports of bidirectional associations between smoking and major depression (MD) have been interpreted as providing evidence for confounding by shared-vulnerability factors (SV) that predispose individuals to both conditions. If this is true, then smoking cessation may not reduce the risk of MD. From clinical practice and public health perspectives, the long-term outcomes associated with smoking persistence and cessation are potentially important and deserve exploration. To this end, the 12-year risk of MD in persistent heavy smokers and abstainers who were former-heavy smokers with and without adjustment for potential confounders were compared. MethodsFollow-up data from the National Population Health Survey (NPHS) was used. Multinomial logistic (ML) models were fit to identify potential confounders. Using proportional hazard (PH) models, unadjusted and adjusted hazard ratios (HRs) for MD outcome were estimated for different smoking patterns. ResultsThe unadjusted HR relating the risk of MD among current-heavy versus former-heavy smokers was 4.3 (95% CI: 2.6–6.9, p < 0.001). Current-heavy smoking predicted onset of MD (HR = 3.1, 95% CI: 1.9–5.2, p < 0.001) even after adjustment for age, sex and stress – the main confounders. However, this was not the case for the never, former-light, and current-light categories. Evidence of decreased risk of MD among former-heavy relative to current-heavy smokers as function of smoking cessation maintenance time was also found. ConclusionsContrary to common beliefs about the benefits of smoking for mental health, our results suggest that current-heavy rather than ever-heavy smoking is a major determinant of MD risk and point towards the benefits of smoking cessation maintenance.

Anomalous functional brain activation following negative mood induction in children with pre-school onset major depression

While major depressive disorder has been shown to be a significant mental health issue for school-age children, recent research indicates that depression can be observed in children as early as the preschool period. Yet, little work has been done to explore the neurobiological factors associated with this early form of depression. Given research suggesting a relation between adult depression and anomalies in emotion-related neural circuitry, the goal of the current study was to elucidate changes in functional activation during negative mood induction and emotion regulation in school-age children with a history of preschool-onset depression. The results suggest that a history of depression during the preschool period is associated with decreased activity in prefrontal cortex during mood induction and regulation. Moreover, the severity of current depressed mood was associated with increased activity in limbic regions, such as the amygdala, particularly in children with a history of depression. Similar to results observed in adult depression, the current findings indicate disruptions in emotion-related neural circuitry associated with preschool-onset depression.

Perception of a Naturalistic Stressor Interacts with 5-HTTLPR/rs25531 Genotype and Gender to Impact Reward Responsiveness

Background: Stressful life experiences frequently precede the onset of major depression; however, the mechanisms that underlie this link are poorly understood. Importantly, some individuals are more susceptible to the depressogenic effects of stress than others. Carriers of the S or L_G allele of the 5-HTTLPR/rs25531 polymorphisms (S’ participants) have been found to be more prone to developing depression under stress relative to L or L_A homozygotes (L’ participants). Moreover, emerging evidence indicates that stress-induced anhedonia may be a mechanism underlying links between stress and depression. Given these findings, we hypothesized that exposure to a naturalistic stressor (school final examinations) would disrupt reward responsiveness (a key behavioral component of anhedonia), and that this effect would be strongest in S’ participants. Methods: To objectively assess reward responsiveness, we administered a probabilistic reward task to 70 Bulgarian high school students over two sessions in the 6-month period preceding school finals. For each participant, the two sessions were designated as the ‘stress’ and ‘control’ conditions based on self-reported perceived stress. Results: A genotype × condition interaction emerged in males, with S’ participants showing larger stress-related reduction in reward responsiveness relative to L’ participants. Conclusion: While in need of replication in a larger sample, our results indicate that stress associated with a real-life event is linked to reduced reward responsiveness, the susceptibility to which is modulated by 5-HTTLPR/rs25531 genotype. Although preliminary, these findings identify anhedonia as a promising mechanism linking 5-HTTLPR/rs25531 genotype and stress to depression.

Examining the relationship between lifetime stressful life events and the onset of major depression in Chinese women.

BackgroundIn European and US studies, patients with major depressive disorder (MDD) report more stressful life events (SLEs) than controls, but this relationship has rarely been studied in Chinese populations.MethodsSixteen lifetime SLEs were assessed at interview in two groups of Han Chinese women: 1970 clinically ascertained with recurrent MDD and 2597 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.Results60% of controls and 72% of cases reported at least one lifetime SLE. Fourteen of the sixteen SLEs occurred significantly more frequently in those with MDD (median odds ratio of 1.6). The three SLEs most strongly associated with risk for MDD (OR > 3.0) preceded the onset of MDD the majority of the time: rape (82%), physical abuse (100%) and serious neglect (99%).LimitationsOur results may apply to females only. SLEs were rated retrospectively and are subject to biases in recollection. We did not assess contextual information for each life event.ConclusionsMore severe SLEs are more strongly associated with MDD. These results support the involvement of psychosocial adversity in the etiology of MDD in China.

Sex, stressful life events, and adult onset depression and alcohol dependence: Are men and women equally vulnerable?

Higher rates of major depression (MD) among females, and of alcohol dependence (AD) among males, are among the most routinely reported findings in psychiatric epidemiology. One of the most often pursued explanations for sex differences in both disorders suggests that males and females have a differential vulnerability to stressors, which is manifested in sex-specific ways (MD for females, AD for males). However, existing evidence in support of this explanation is mixed. In the present study, we investigated sex differences in the association between stressful life events and MD and AD in a large national sample of adults in the United States (n = 32,744) using a prospective design. Logistic regression was used to estimate associations between stressful life events and both MD and AD; sex-specific effects of stress on MD and AD were evaluated by testing interaction terms between sex and stressors in the prediction of both outcomes. The number of stressful life events was predictive of first onset MD and AD. This was true for both males and females, and sex-by-stress interaction terms did not support the hypothesis that sex-specific responses to stressful life events lead to sex differences in first onset of MD and AD among adults. These results indicate the resistance of sex differences in MD and AD to simple explanations, and suggest the need for more nuanced models that incorporate both physiological and social aspects of vulnerability.

COMT and age at onset in mood disorders: A replication and extension study

Our study aims at replicating our previous finding of an association between COMT rs4680 G/A polymorphism and early onset major depression (MD). We included 462 MD, 147 bipolar disorders (BD) subjects and 295 healthy controls. We could partially replicate previous findings. In particular, rs4680 GG + AG genotypes were more represented in the subgroup of early onset MD patients ( p = 0.04). Additionally, we observed an association between rs737865 alleles and early onset MD ( p = 0.04). Rs4680 genotype was associated with early onset BD as well ( p = 0.01). In conclusion, we partially replicated our previous findings confirming a possible influence of COMT variants in MD and BD, particularly in early onset subjects, though not with the same risk genotypes.

Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain

The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care. A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI). Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79-0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain. The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries.

Observed maternal responses to adolescent behaviour predict the onset of major depression

Two mechanisms have been proposed regarding relations between parental responses to adolescent affective behaviours and the development of depression: the elicitation of parental negativity and the suppression of parental aggression. This study aimed to investigate the boundary conditions under which these two mechanisms operate in relation to the prospective prediction of Major Depressive Disorder (MDD) onset in adolescence. A community sample of 159 adolescents (aged 11–13 years) with no history of MDD completed a family interaction assessment with their mothers, and were followed-up with a diagnostic interview 2–3 years later. Results showed that onset of MDD was prospectively predicted by the elicitation of maternal aggression in response to adolescent aggression (in girls only) and maternal dysphoria in response to adolescent aggression, as well as the suppression of maternal aggression and dysphoria in response to adolescent dysphoria. Thus, support was obtained for both the elicitation of negativity mechanism in relation to maternal responses to adolescents’ aggressive behaviours, and the suppression of aggression mechanisms in relation to maternal responses to adolescents’ dysphoric behaviours. Mothers’ responses to adolescents’ aggressive and dysphoric behaviours may differentially influence the risk of MDD onset for adolescents over time.

Sleep Interventions for the Treatment of Depression

Sleep disturbances are common in depressed patients. Insomnia may predate the onset of major depression, increases the likelihood of a depressive relapse, and is associated with an impaired response to treatment. Benzodiazepine drugs may have inherent antidepressant effects; thus, these and other sedative-hypnotic drugs can be beneficial for treating insomnia in depressed patients and may enhance the overall effectiveness of antidepressant drugs. Sedating antidepressant drugs are used for treating primary insomnia, but their sleep-promoting effects have been demonstrated primarily in depressed patients. Several second-generation antipsychotic drugs are used in low doses to promote sleep, but they also have inherent antidepressant effects. Cognitive-behavioral therapy targeting insomnia can effectively enhance the response to antidepressant medication. Sleep deprivation, which is also associated with a transient antidepressant effect, is difficult to use in routine clinical practice but might be an appropriate strategy for treatment-resistant forms of depression.

ASSOCIATIONS BETWEEN CHRONOTYPE, SLEEP QUALITY, SUICIDALITY, AND DEPRESSIVE SYMPTOMS IN PATIENTS WITH MAJOR DEPRESSION AND HEALTHY CONTROLS

Research interest concerning associations between sleep characteristics and suicidality in psychopathology has been growing. However, possible linkages of suicidality to sleep characteristics in terms of sleep quality and chronotypes among depressive patients have not been well documented. In the current study, the authors investigated the possible effects of sleep quality and chronotype on the severity of depressive symptoms and suicide risk in patients with depressive disorder and healthy controls. The study was conducted on 80 patients clinically diagnosed with major depression and 80 healthy subjects who were demographically matched with the patient group. All participants completed a questionnaire package containing self-report measures, including the Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Morningness–Eveningness Questionnaire (MEQ), and Suicide Ideation Scale (SIS), and subjects were interviewed with the suicidality section of the Mini-International Neuropsychiatric Interview (MINI). Results are as follows: (a) logistic regression analyses revealed that poor sleep quality and depression symptom severity significantly predicted onset of major depression; (b) morningness-type circadian rhythm may play as a significant relief factor after onset of major depression; (c) sleep variables of chronotype and sleep quality did not significantly predict suicide ideation after controlling for depressive symptoms in the major depression group; and (d) suicide ideation and poor sleep quality were antecedents of depression symptom severity in patients with major depression, and in healthy controls. Findings are discussed under the theoretical assumptions concerning possible relations between chronotype, sleep quality, depression, and suicidality. (Author correspondence: dryavuzselvi@yahoo.com)

Stressful Life Events, Genetic Liability, and Onset of an Episode of Major Depression in Women

Objective:This study was undertaken to clarify how genetic liability and stressful life events interact in the etiology of major depression. Method:Information about stressful life events and onset of major depressive episodes in the past year was collected in a population-based sample of female-female twin pairs including 2,164 individuals, 53,215 person-months of observation, and 492 onsets of depression. Results:Nine “personal” and three aggregate “network” stressful events significantly predicted onset of major depression in the month of occurrence, four of which predicted onset with an odds ratio of >10 and were termed “severe”: death of a close relative, assault, serious marital problems, and divorce/breakup. Genetic liability also had a significant impact on risk of onset of depression. Four severe stressful events, as well as for 10 of the 12 individuals stressful events, the best-fitting model for the joint effect of stressful events and genetic liability on onset of major depression suggested ge...

Can antidepressants prevent interferon-alpha-induced depression? A review of the literature

Objective To review the literature about the efficacy of antidepressant prophylaxis during interferon-alpha (IFN-α) therapy. Method We have performed a database search in PUBMED and ISI Web of Knowledge (1980–August 2009) for the available literature. The keywords “prevention” or “prophylaxis”, and “depression”, and “interferon”, and “antidepressant” or “antidepressive agents” were used. Results The six eligible studies comprise three randomized controlled trials, two in hepatitis C virus (HCV) patients and one in individuals with melanoma, and three open-label studies with HCV patients. The results of the randomized controlled trials suggest that antidepressant prophylaxis may blunt the magnitude of depressive symptoms in HCV patients and raise the rates of treatment completion. In melanoma patients, this preventive strategy may reduce the incidence of depression during IFN-α treatment. In addition, the open-label studies with HCV patients suggest that this strategy may reduce the onset of major depression in specific samples (current psychiatric diagnosis, major depression in remission, past history of IFN-α-induced depression) on IFN-α (re-)treatment. Conclusions In the face of so few trials about the usefulness of prophylaxis with antidepressants before IFN-α treatment, there is not enough information to sufficiently and widely support this strategy to prevent depression. However, this approach may, nonetheless, bring some beneficial outcomes, if applied to specific patient groups.

Caution Urged in Interpreting Antidepressant Efficacy Data

Caution Urged in Interpreting Antidepressant Efficacy Data

CS04-02 - Subthreshold depression: a clinically relevant condition?

Subclinical depression is a condition in which a person has clinically relevant depressive symptoms, but does not meet criteria for a depressive disorder. In this presentation, the different operationalizations of subthreshold depression will be presented, and we will focus on the importance from a clinical point of view, as well as from a public health public point of view. Subthreshold depression has important consequences for the quality of life, but not as much as major depression. It also results in huge economic costs on the individual level, but again less than the costs associated with major depression. Because subthreshold depression is more prevalent, the total costs of subthreshold depression on the population level are, however, comparable to those of major depression. It is also clear that subjects with subthreshold depression have an increased risk of developing a major depression. How large that chance is depends on several factors, including the definition of subthreshold depression. Finally, the results of a meta-analysis will be presented in which the effects of psychological treatments of subthreshold depression are examined. This meta-analysis shows that psychological treatments can be treated effectively, and there is a trend indicating that these interventions can prevent the onset of major depression.

P02-287 - Primary prevention in depression. How to inform primary care attendees about their risk level and risk profile of major depression?

IntroductionThe predictD study is a pioneering international study whose main objective was to develop a risk index for the onset of major depression in general practice attendees.ObjectiveThe aim of this exploratory study was to determine the opinion of primary care attendees and their general practitioners about how to implement primary prevention of major depression. The intervention consisted of informing primary care attendees about their risk level and risk profile for the onset of major depression.MethodsThe study participants were primary care attendees and general practitioners in urban health centres of 7 Spanish provinces. The methodology used was qualitative: there were 14 in-depth interviews (two from each province), 7 DAFO groups and 7 focus groups.ResultsThe results showed that attendees generally welcomed this precautionary measure. Some even proposed potential changes in their lifestyles to prevent depression, such as improving social relationships, taking things more calmly or doing more leisure activities, while others asked their GP for advice. The GPs were more resistant about informing primary care attendees, raising doubts about the validity-reliability of the instrument, their lack of education about what they should or should not advise their attendees, the danger of creating excessive fear in their attendees, or the barrier of lack of time in the office to do these activities.ConclusionsPrimary care attendees welcome this preventive measure more than their general practitioners.