Depression Outcomes Research Articles

Maternal Psychological Symptom Trajectories From 2 to 24 Months Postpartum: A Latent Class Growth Analysis.

Postpartum women experience an array of psychological symptoms that are associated with adverse health behaviors and outcomes including postpartum suicidal ideation and long-term depression. To provide early management of postpartum psychological symptoms, it is important to understand how the symptom experiences change over time. The aim of this study was to examine maternal psychological symptom trajectories over 2, 6, 15, and 24 months postpartum using latent class growth analysis and to examine how each trajectory is associated with maternal depression outcome at 24 months. We used secondary data from the Family Life Project ( N = 1,122) and performed multitrajectory latent class growth analysis based on four observed symptom variables (depression, anxiety, somatization, and hostility). After the final model was identified, bivariate analyses were conducted to examine the association between each trajectory and (a) individual characteristics and (b) outcome (Center for Epidemiologic Studies Depression Scale [CES-D]) variables. A four-class model was selected for the final model because it had better fit indices, entropy, and interpretability. The four symptom trajectories were (a) no symptoms over 24 months, (b) low symptoms over 24 months, (c) moderate symptoms increasing over 15 months, and (d) high symptoms increasing over 24 months. More postpartum women with the trajectory of high symptoms increasing over 24 months (Trajectory 4) were in low economic status (92.16%), unemployed (68.63%), or did not complete 4-year college education (98.04%). Most postpartum women (95.56%) in Trajectory 4 also had higher CES-D cutoff scores, indicating a possible clinical depression at 24 months postpartum. Postpartum women who experience increasing symptom trajectories over 15-24 months (Trajectories 3 and 4) could benefit from tailored symptom management interventions provided earlier in the postpartum period to prevent persistent and worsening symptom experiences.

Effectiveness of e-based cognitive behavioral therapy for insomnia on enhancing depression and insomnia outcome in Chinese youth with both diagnoses

Effectiveness of e-based cognitive behavioral therapy for insomnia on enhancing depression and insomnia outcome in Chinese youth with both diagnoses

Assessing the Role of Sports Participation on Depression, Suicide Ideation, and Suicide Behaviors Among Adolescents Before and During COVID-19.

To assess the association between sports participation, depression, suicide ideation, and suicide behaviors in a nationally representative sample of US adolescents before COVID-19 and during COVID-19. Data from the 2019 Youth Risk Behavior Survey (n = 13,526) and the 2021 Adolescent Behaviors and Experiences Survey (n = 7677) were used to analyze the association between past-year depression/suicide ideation/suicide behaviors and past-year sports participation. The analysis found that 57.4% of adolescents indicated participating in at least 1 sport in 2019; this dropped to 47.7% in 2021. Furthermore, 36.7% of adolescents indicated feeling sad or hopeless almost every day for 2 weeks or more in a row in 2019; this increased to 44.2% in 2021. The percentage of adolescents who indicated considering suicide, making a suicide plan, attempting suicide, and attempted suicide that lead to an injury was similar during 2019 and 2021. Multivariable analysis found that participation in 2 or more sports in 2019 was associated with lower odds of each of the outcomes for depression, suicide ideation, and suicide behaviors, whereas in 2021, participation in 2 or more sports was only associated with lower odds of indicating being sad or hopeless (an indicator for depression) for a 2-week period (adjusted odds ratios = 0.70; 95% confidence interval, 0.58-0.85). Participation in 2 or more sports lowered the risk of feeling sad or hopeless, suicide ideation, and suicide behaviors in 2019, but this effect was absent in 2021. Given the presence of multiple stressors during the COVID-19 pandemic, sports participation alone may not offer sufficient protective effects against suicide behaviors as it did pre pandemic.

Discrimination experiences and mental health outcomes among African American homeless smokers

ABSTRACT Daily discrimination experiences are associated with both the physical and psychological well-being among African Americans (AAs). Little is known about the impact of daily discrimination on mental health among people experiencing homelessness (PEH), especially AA persons experiencing homelessness (AA PEH). In this study, we measured perceived discrimination, depression, and anxiety using the Everyday Discrimination Scale, the Centers for Epidemiologic Studies-Depression Scale, and the Generalized Anxiety Disorder Scale-7, respectively. Multivariable linear regression modeling was used, with depression and anxiety as outcome variables. We used a change in estimate approach to select the variables included in the final models between everyday discrimination and mental health outcomes of depression and anxiety. Participants (n = 100) reported race (43%) and homelessness (37%) as the main reasons for discrimination experiences. After adjusting for anxiety, age, and education, everyday discrimination was significantly associated with depression scores (b = 0.187; CI: 0.01, 0.37; p = 0.04). Everyday discrimination may be associated with depressive symptoms among AA PEH. Future research should further examine the association between diverse forms of discrimination and mental health outcomes among AA PEH and explore effective coping strategies tailored to this subgroup. Interventions to reduce the occurrence and impact of discrimination experiences may be warranted for AA PEH.

The effectiveness of microcurrent neurofeedback on depression, anxiety, post-traumatic stress disorder, and quality of life.

The world faces a mental health crisis with elevated rates of depression, anxiety, and post-traumatic stress, leaving a profound impact on daily quality of life (QOL). Current treatments show varying degrees of efficacy and carry burdensome challenges. Evidence exists for use of an innovative neurotechnology to reduce symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), but the science is lacking for use in the general population. The purpose of this pilot study was to explore the effects of microcurrent neurofeedback on depression, anxiety, PTSD symptoms, and QOL in adults. This was a one-group, exploratory pilot study that tested outcomes of depression, anxiety, PTSD risk, suicide risk, and QOL in 20 adults using convenience sampling. IASIS microcurrent neurofeedback (I-MCN) was the intervention that was delivered twice a week for 10 weeks; data collection was baseline, 5 weeks, and 10 weeks. Depression, anxiety, PTSD risk, and QOL improved significantly by the 10th and 20th session; suicidal risk showed nonsignificant reduction. Use of a more feasible interventional procedure established a foundation for use in clinical settings for the population. Using a more simpler procedure than what was used in a previous study reflected positive outcomes earlier and sustained over 10 weeks. This safe and effective technology carries rare but easily overcome adverse effects and could be an alternative to existing treatments or treatment-resistant conditions. Advanced practice nurses can apply the evidence to reduce symptoms of depression, anxiety, and PTSD. Randomized controlled trials and testing on diverse populations are needed.

Efficacy and Safety of Adding Lurasidone to Ongoing Therapy With Lithium or Valproate for the Treatment of an Acute Bipolar Depressive Episode: A Post Hoc Analysis of 2 Placebo-Controlled Trials.

The aim of this study was to compare the efficacy and safety profile of lurasidone combined with either lithium or valproate, in the short-term treatment of patients with bipolar depression. Data were pooled from two 6-week, double-blind, placebo-controlled trials of patients with bipolar depression on stable doses of lithium or valproate randomized to lurasidone (20-120 mg/d) or placebo. Efficacy measures included the Montgomery-Åsberg Depression Rating Scale, Clinical Global Impressions Bipolar Scale, and the Quick Inventory of Depressive Symptomatology via self-assessment and were analyzed using a mixed model for repeated measures approach. Notably larger week 6 effect sizes were observed when lurasidone was added to lithium, compared with when lurasidone was added to valproate, on 2 of the 3 depression outcome measures, Montgomery-Åsberg Depression Rating Scale total score (d = 0.45 vs 0.22) and Quick Inventory of Depressive Symptomatology via self-assessment (d = 0.63 vs 0.29); the efficacy advantage was smaller on the Clinical Global Impressions Bipolar Scale depression score (d = 0.34 vs 0.29). Similar adverse event profiles were observed for lurasidone treatment in combination with either lithium or valproate. The most frequently reported events (≥5%) in both groups were nausea, parkinsonism, somnolence, akathisia, and insomnia. Minimal changes in weight, lipids, and measures of glycemic control were observed during treatment with lurasidone combined with either lithium or valproate. Lurasidone added to either lithium or valproate was found to be an effective treatment for bipolar depression, with a larger antidepressant effect observed when lurasidone was combined with lithium. There were no clinically meaningful differences in the safety or tolerability of lurasidone when used adjunctively with lithium or valproate.

Demographic and clinical characteristics associated with anxiety and depressive symptom outcomes in users of a digital mental health intervention incorporating a relational agent

BackgroundDigital mental health interventions (DMHIs) may reduce treatment access issues for those experiencing depressive and/or anxiety symptoms. DMHIs that incorporate relational agents may offer unique ways to engage and respond to users and to potentially help reduce provider burden. This study tested Woebot for Mood & Anxiety (W-MA-02), a DMHI that employs Woebot, a relational agent that incorporates elements of several evidence-based psychotherapies, among those with baseline clinical levels of depressive or anxiety symptoms. Changes in self-reported depressive and anxiety symptoms over 8 weeks were measured, along with the association between each of these outcomes and demographic and clinical characteristics.MethodsThis exploratory, single-arm, 8-week study of 256 adults yielded non-mutually exclusive subsamples with either clinical levels of depressive or anxiety symptoms at baseline. Week 8 Patient Health Questionnaire-8 (PHQ-8) changes were measured in the depressive subsample (PHQ-8 ≥ 10). Week 8 Generalized Anxiety Disorder-7 (GAD-7) changes were measured in the anxiety subsample (GAD-7 ≥ 10). Demographic and clinical characteristics were examined in association with symptom changes via bivariate and multiple regression models adjusted for W-MA-02 utilization. Characteristics included age, sex at birth, race/ethnicity, marital status, education, sexual orientation, employment status, health insurance, baseline levels of depressive and anxiety symptoms, and concurrent psychotherapeutic or psychotropic medication treatments during the study.ResultsBoth the depressive and anxiety subsamples were predominantly female, educated, non-Hispanic white, and averaged 38 and 37 years of age, respectively. The depressive subsample had significant reductions in depressive symptoms at Week 8 (mean change =—7.28, SD = 5.91, Cohen’s d = -1.23, p < 0.01); the anxiety subsample had significant reductions in anxiety symptoms at Week 8 (mean change = -7.45, SD = 5.99, Cohen’s d = -1.24, p < 0.01). No significant associations were found between sex at birth, age, employment status, educational background and Week 8 symptom changes. Significant associations between depressive and anxiety symptom outcomes and sexual orientation, marital status, concurrent mental health treatment, and baseline symptom severity were found.ConclusionsThe present study suggests early promise for W-MA-02 as an intervention for depression and/or anxiety symptoms. Although exploratory in nature, this study revealed potential user characteristics associated with outcomes that can be investigated in future studies.Trial RegistrationThis study was retrospectively registered on ClinicalTrials.gov (#NCT05672745) on January 5th, 2023.

Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

Comorbid depression is common among patients with degenerative lumbar spine disease. Although a well-researched topic, the evidence of the role of depression in spine surgery outcomes remains inconclusive. To investigate the association between preoperative depression and patient-reported outcome measures (PROMs) after lumbar spine surgery. A systematic search of PubMed, Cochrane Database of Systematic Reviews, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov was performed from database inception to September 14, 2023. Included studies involved adults undergoing lumbar spine surgery and compared PROMs in patients with vs those without depression. Studies evaluating the correlation between preoperative depression and disease severity were also included. All data were independently extracted by 2 authors and independently verified by a third author. Study quality was assessed using Newcastle-Ottawa Scale. Random-effects meta-analysis was used to synthesize data, and I2 was used to assess heterogeneity. Metaregression was performed to identify factors explaining the heterogeneity. The primary outcome was the standardized mean difference (SMD) of change from preoperative baseline to postoperative follow-up in PROMs of disability, pain, and physical function for patients with vs without depression. Secondary outcomes were preoperative and postoperative differences in absolute disease severity for these 2 patient populations. Of the 8459 articles identified, 44 were included in the analysis. These studies involved 21 452 patients with a mean (SD) age of 57 (8) years and included 11 747 females (55%). Among these studies, the median (range) follow-up duration was 12 (6-120) months. The pooled estimates of disability, pain, and physical function showed that patients with depression experienced a greater magnitude of improvement compared with patients without depression, but this difference was not significant (SMD, 0.04 [95% CI, -0.02 to 0.10]; I2 = 75%; P = .21). Nonetheless, patients with depression presented with worse preoperative disease severity in disability, pain, and physical function (SMD, -0.52 [95% CI, -0.62 to -0.41]; I2 = 89%; P < .001), which remained worse postoperatively (SMD, -0.52 [95% CI, -0.75 to -0.28]; I2 = 98%; P < .001). There was no significant correlation between depression severity and the primary outcome. A multivariable metaregression analysis suggested that age, sex (male to female ratio), percentage of comorbidities, and follow-up attrition were significant sources of variance. Results of this systematic review and meta-analysis suggested that, although patients with depression had worse disease severity both before and after surgery compared with patients without depression, they had significant potential for recovery in disability, pain, and physical function. Further investigations are needed to examine the association between spine-related disability and depression as well as the role of perioperative mental health treatments.

The quest for a biological phenotype of adolescent non-suicidal self-injury: a machine-learning approach

Non-suicidal self-injury (NSSI) is a transdiagnostic psychiatric symptom with high prevalence and relevance in child and adolescent psychiatry. Therefore, it is of great interest to identify a biological phenotype associated with NSSI. The aim of the present study was to cross-sectionally investigate patterns of biological markers underlying NSSI and associated psychopathology in a sample of female patients and healthy controls. Comprehensive clinical data, saliva and blood samples, heart rate variability and pain sensitivity, were collected in n = 149 patients with NSSI and n = 40 healthy participants. Using machine-based learning, we tested the extent to which oxytocin, dehydroepiandrosterone (DHEA), beta-endorphin, free triiodothyronine (fT3), leukocytes, heart rate variability and pain sensitivity were able to classify participants regarding their clinical outcomes in NSSI, depression and borderline personality disorder symptomatology. We evaluated the predictive performance of several models (linear and logistic regression, elastic net regression, random forests, gradient boosted trees) using repeated cross-validation. With NSSI as an outcome variable, both logistic regression and machine learning models showed moderate predictive performance (Area under the Receiver Operating Characteristic Curve between 0.67 and 0.69). Predictors with the highest predictive power were low oxytocin (OR = 0.55; p = 0.002), low pain sensitivity (OR = 1.15; p = 0.021), and high leukocytes (OR = 1.67; p = 0.015). For the psychopathological outcome variables, i.e., depression and borderline personality disorder symptomatology, models including the biological variables performed not better than the null model. A combination of hormonal and inflammatory markers, as well as pain sensitivity, were able to discriminate between participants with and without NSSI disorder. Based on this dataset, however, complex machine learning models were not able to detect non-linear patterns of associations between the biological markers. These findings need replication and future research will reveal the extent to which the respective biomarkers are useful for longitudinal prediction of clinical outcomes or treatment response.

Estimating Transition Probabilities for Modeling Major Depression in Adolescents by Sex and Race or Ethnicity Combinations in the USA.

About one-fifth of US adolescents experienced major depressive symptoms, but few studies have examined longitudinal trends of adolescents developing depression or recovering by demographic factors. We estimated new transition probability inputs, and then used them in a simulation model to project the epidemiologic burden and trajectory of depression of diverse adolescents by sex and race or ethnicity combinations. Transition probabilities were first derived using parametric survival analysis of data from the National Longitudinal Study of Adolescent to Adult Health and then calibrated to cross-sectional data from the National Survey on Drug Use and Health. We developed a cohort state-transition model to simulate age-specific depression outcomes of US adolescents. A hypothetical adolescent cohort was modeled from 12-22years with annual transitions. Model outcomes included proportions of youth experiencing depression, recovery, or depression-free casesand were reported for a US adolescent population by sex, race or ethnicity, and sex and race or ethnicity combinations. At 22 years of age, approximately 16% of adolescents had depression, 12% were in recovery, and 72% had never developed depression. Depression prevalence peaked around 16-17years-old. Adolescents of multiracial or other race or ethnicity, White, American Indian or Alaska Native, and Hispanic, Latino, or Spanish descent were more likely to experience depression than other racial or ethnic groups. Depression trajectories generated by the model matched well with historical observational studies by sex and race or ethnicity, except for individuals from American Indian or Alaska Native and multiracial or other race or ethnicity backgrounds. This study validated new transition probabilities for future use in decision models evaluating adolescentdepression policies or interventions. Different sets of transition parameters by demographic factors (sex and race or ethnicity combinations) were generated to support future health equity research, including distributional cost-effectiveness analysis. Further data disaggregated with respect to race, ethnicity, religion, income, geography, gender identity, sexual orientation, and disability would be helpful to project accurate estimates for historicallyminoritized communities.

Additional Chronic Conditions as Barriers to Depression Management Among Adults Living with HIV

Introduction: An estimated 20% to 30% of people living with HIV (PLHIV) suffer from depression. While the collaborative care model (CCM) is an evidence-based intervention designed to reduce depression, little is known of the impact of additional chronic conditions (ACC) on depression management and CCM response among PLHIV.Methods: A retrospective cohort study was conducted among 412 PLHIV enrolled in CCM at a large urban community hospital in Cuyahoga County, Ohio, between July 1, 2015, and June 30, 3017. Study participants were identified as clinically depressed at enrollment with at least two PHQ-9 measurements within a year of enrollment. Additional chronic conditions were studied to assess their association with depression treatment response or remission during the study period. Multivariable logistic regression was used to model response and remission considering ACC while adjusting for demographic, program-related, and clinical measures.Results: Depression outcomes were no different based on the presence or number of ACC. Study participants age 50 years or over with obesity (aOR: 0.15; 95% CI: 0.04-0.64) or heart disease (aOR: 0.15; 95% CI: 0.03-0.84) were less likely to achieve remission. Participants irrespective of age with musculoskeletal disease (MSD) were less likely to achieve remission compared to others without MSD (aOR: 0.48; 95% CI: 0.25-0.93).Conclusion: Strategies that address obesity may be necessary adjuncts to successfully treating depression among older adults with HIV, while barriers posed by heart disease or MSD should be further investigated.

Immune cell markers associated with early life major depressive episodes

Emerging evidence indicates an association between altered immune system functioning, inflammatory response activation, and major depression (MD). This study examined the association between major depression in young people and the monocyte-to-lymphocyte (MLR) and neutrophil-to-lymphocyte ratio (NLR). Inflammation markers were estimated from DNA methylation data using an established cell-mixture deconvolution algorithm and examined in a well-characterized, antidepressant free epidemiological sample of young twins (N = 170). No statistically significant differences were observed between young persons with and without Lifetime MD for the MLR and NLR. A post-hoc analysis of time since last major depressive episode (MDE) indicated that more recent MDEs were associated with higher MLR and NLR levels compared to temporally distant MDEs. A second post-hoc analysis using the full sample determined that past year MDEs were associated with elevated MLR and NLR scores compared to persons unaffected by lifetime MD and person experiencing their last MDE over one year ago. Finally, T cell immunity was most consistently associated with recent MDEs, suggesting that levels of this adaptive immune cell were diminished. Young people experiencing a recent MDE demonstrated increased levels of inflammation with T cells exhibiting the most persistent associations with depression outcomes. Etiological and treatment implications of results are discussed.

Effectiveness of Aerobic Exercise in Geriatric Individuals with Depression

Backround Although there are studies showing the effects of physical exercises on depression, there are not many studies that clearly demonstrate the effect of aerobic exercise in geriatric depression with a clear protocol. Aim To examine the effect of aerobic exercises on depression in geriatric individuals. Methods 38 sedentary individuals diagnosed with geriatric depression participated in this prospective cohort study. Vital signs, depression levels and quality of life were evaluated before and after the program. Statistical significance was accepted as p < 0.05 in the analyzes. Results The respiratory frequency, Clinically Useful Depression Outcome Scale scores (p < 0.05), blood pressure and heart rate values (p < 0.001) decreased, and the change in median quality of life values increased (p < 0.001) after the aerobic exercise program. Conclusion Aerobic exercises have positive effects on geriatric depression. The effectiveness of treatments can be increased by adding aerobic exercises to geriatric depression treatment protocols.

Evaluation of a psychiatric pharmacist consultation service in a multispecialty outpatient clinic

AbstractBackgroundIntegrated care programs provide both medical and mental health care in clinical settings. Psychiatric pharmacists play a key role in optimizing patient care when integrated into a healthcare team. This project describes the implementation and trends of a psychiatric pharmacist consultation service in a multispecialty outpatient through an integrated behavioral healthcare model.MethodsThis is a retrospective study analyzing a psychiatric pharmacist consultation service at an academic multispecialty outpatient clinic. Eligible patients were aged ≥17 years and seen by the psychiatric pharmacist between June 1, 2019 and June 30, 2022. Patient demographics, reasons for referral, and pharmacist interventions were collected. Patient outcomes on depression, anxiety, and diabetes were also explored. Descriptive statistics were used to quantify information.ResultsA total of 572 encounters were identified. Of those, 285 (49.8%) represented unique patients. Over the 36‐month period, an average of 16 consults were conducted per month. Anxiety and depressive disorders, pain syndromes, and adult attention‐deficit/hyperactivity disorder were the most common diagnoses listed as reasons for consultation. An average of five recommendations or interventions were provided by the psychiatric pharmacist at each initial consultation. Anxiety and depression symptom scores, as well as hemoglobin A1c (HbA1c) values, were lower following pharmacist consultation.ConclusionPsychiatric pharmacists can serve a unique role at multispecialty clinics by providing consultation for patients with psychiatric conditions, chronic pain, medical conditions, and polypharmacy. This study demonstrates the successful utilization of such a service and suggests a psychiatric pharmacist's expertise contributes to improved depression, anxiety, and glycemic outcomes. The multispecialty outpatient setting represents an opportunity to further explore growth for psychiatric pharmacists and the impact these services have on patient outcomes.

Measurement-Based Care for Depression in Youth: Practical Considerations for Selecting Measures to Assess Depression, Associated Features and Functioning.

Identification and management of major depressive disorder (MDD) in children and adolescents remains a significant area of public health need. The process for identifying depression (e.g. screening) and management (e.g. measurement based care [MBC]) is substantially enhanced by utilization of clinical measures and rating scales. Measures can be self- or caregiver reported or clinician rated. They can aid recognition of at-risk individuals for future assessment and assist in clinical diagnosis and management of depression. In addition to assessing symptoms of depression, rating scales can be used to assess important associated features (e.g. anxiety, trauma) and functional outcomes (e.g. quality of life, performance/productivity). In this manuscript, we discuss practical considerations for clinicians and researchers when selecting rating instruments for assessing depression, associated factors, functioning, and treatment outcomes (i.e. adherence and side effects) as part of MBC in youth and provide a summary of rating scales commonly used in research and clinical settings.

Readiness for treatment predicts depression outcomes in a partial hospital program.

Evidence-based interventions vary in effectiveness for individuals with depression, which has a large public health burden. Readiness for change or treatment can be an important individual difference predictor of depression outcomes. To inform public service initiatives targeting readiness for treatment, characterizing readiness across settings and levels of care is key. However, limited data exist on the role of readiness for treatment in acute psychiatric settings and in particular, partial hospital programs which are key points in the continuity of inpatient and outpatient care. The present study assessed readiness for treatment in terms of importance, confidence, and motivation to engage in a partial hospital program and tested whether higher levels of readiness were associated with better treatment outcomes among clients with depression. Participants (N = 192) with major depressive disorder rated their readiness for treatment (Readiness Rulers), depression (Patient Health Questionnaire-9), and global improvement (Clinical Global Impression Scale-Improvement Self-Report) while enrolled in a partial hospital program. Generalized linear regression models assessed the effect of baseline readiness on outcomes at discharge, adjusted for baseline level of the outcome, age, sex, race, and ethnicity. Greater baseline readiness predicted reduced depression and better global improvement at discharge. Higher confidence and motivation to engage in treatment, but not importance, were associated with better depression outcomes. Identifying and addressing readiness for treatment by leveraging public health systems and services (e.g., help lines, family interventions) prior to or upon starting a partial hospital program may be useful to maximize gains in treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adverse Childhood Experiences and Depression among Homeless Young Adults: A Social Determinants of Health Perspective.

Homelessness is a pervasive issue in the United States that presents significant challenges to public health. Homeless young adults (HYAs) are at particular risk for increased incidence and severity of depression. Using primary survey data (n = 205) collected in the Phoenix Metropolitan Area, Arizona, from June to August 2022, this study aims to examine the relationship between adverse childhood experiences (ACEs) and depression among HYAs. We adopted the ACEs 10-item scale to measure childhood traumatic experiences, whereas depression was measured by using a PHQ-4 depression scale and diagnosed depression. Regression models were conducted to test the relationships between ACEs and depression outcomes while controlling for the covariates at the individual, interpersonal, and socioeconomic/living environment levels. The average PHQ-4 score was 5.01 (SD = 3.59), and 59.69% of HYAs reported being diagnosed previously with depression. The mean ACEs score was 5.22 out of 10. Other things being equal, for every one unit increase in ACEs scores, the odds of being diagnosed with depression increased by 11.5%, yet it was not statistically significant, while the PHQ-4 score increased by 0.445 (p < 0.001). Overall, HYAs were disproportionately affected by depression. This study elucidates the complex relationship between ACEs and depression among HYAs.

Family dementia caregivers with suicidal ideation improve with mentalizing imagery therapy: Results from a pilot study

BackgroundFamily caregivers of persons living with dementia often experience increased depression and suicidal ideation (SI). However, the feasibility and impact of therapies on caregiver SI has remained largely unexplored. Mentalizing imagery therapy (MIT) helps reduce psychological symptoms through mindfulness and guided imagery. This pilot study examined the feasibility of participation by caregivers with SI in a randomized controlled trial (RCT) of MIT versus a psychosocial support group (SG), and the respective impact of group on SI, depression, and secondary outcomes. MethodsA secondary analysis of data from an RCT of 4-week MIT or SG for caregivers (n = 46) was performed, identifying SI (n = 23) and non-SI (n = 23) cohorts. Group attendance and home practice were compared between cohorts. In the SI cohort (total n = 23, MIT n = 11, SG n = 12), group differences in SI, depression, and secondary outcomes were evaluated post-group and at 4-month follow-up. ResultsAttendance in both groups and home practice in MIT were similar between SI and non-SI cohorts. In the SI cohort, MIT evinced greater improvements relative to SG in SI (p=.02) and depression (p=.02) post-group, and other secondary outcomes at follow-up. LimitationsLimitations include small sample size and single-item assessments of SI from validated depression rating scales. ConclusionsParticipation in an RCT was feasible for caregivers with SI. MIT resulted in important benefits for SI and depression, while SG showed no acute SI benefit. The role of MIT in improving SI should be confirmed with adequately powered trials, as effective therapies to address caregiver SI are critical.

A randomized sham-controlled trial of high-dosage accelerated intermittent theta burst rTMS in major depression: study protocol

BackgroundIntermittent theta burst stimulation (iTBS), a novel form of repetitive transcranial magnetic stimulation (rTMS), can be administered in 1/10th of the time of standard rTMS (~ 3 min vs. 37.5 min) yet achieves similar outcomes in depression. The brief nature of the iTBS protocol allows for the administration of multiple iTBS sessions per day, thus reducing the overall course length to days rather than weeks. This study aims to compare the efficacy and tolerability of active versus sham iTBS using an accelerated regimen in patients with treatment-resistant depression (TRD). As a secondary objective, we aim to assess the safety, tolerability, and treatment response to open-label low-frequency right-sided (1 Hz) stimulation using an accelerated regimen in those who do not respond to the initial week of treatment.MethodsOver three years, approximately 230 outpatients at the Centre for Addiction and Mental Health and University of British Columbia Hospital, meeting diagnostic criteria for unipolar MDD, will be recruited and randomized to a triple blind sham-controlled trial. Patients will receive five consecutive days of active or sham iTBS, administered eight times daily at 1-hour intervals, with each session delivering 600 pulses of iTBS. Those who have not achieved response by the week four follow-up visit will be offered a second course of treatment, regardless of whether they initially received active or sham stimulation.DiscussionBroader implementation of conventional iTBS is limited by the logistical demands of the current standard course consisting of 4–6 weeks of daily treatment. If our proposed accelerated iTBS protocol enables patients to achieve remission more rapidly, this would offer major benefits in terms of cost and capacity as well as the time required to achieve clinical response.Trial registrationClinicalTrials.gov Identifier: NCT04255784.

Cortical glutamate, Glx, and total N-acetylaspartate: potential biomarkers of repetitive transcranial magnetic stimulation treatment response and outcomes in major depression

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for individuals with major depressive disorder (MDD) who have not improved with standard therapies. However, only 30–45% of patients respond to rTMS. Predicting response to rTMS will benefit both patients and providers in terms of prescribing and targeting treatment for maximum efficacy and directing resources, as individuals with lower likelihood of response could be redirected to more suitable treatment alternatives. In this exploratory study, our goal was to use proton magnetic resonance spectroscopy to examine how glutamate (Glu), Glx, and total N-acetylaspartate (tNAA) predict post-rTMS changes in overall MDD severity and symptoms, and treatment response. Metabolites were measured in a right dorsal anterior cingulate cortex voxel prior to a standard course of 10 Hz rTMS to the left DLPFC in 25 individuals with MDD. MDD severity and symptoms were evaluated via the Inventory of Depression Symptomatology Self-Report (IDS-SR). rTMS response was defined as ≥50% change in full-scale IDS-SR scores post treatment. Percent change in IDS-SR symptom domains were evaluated using principal component analysis and established subscales. Generalized linear and logistic regression models were used to evaluate the relationship between baseline Glu, Glx, and tNAA and outcomes while controlling for age and sex. Participants with baseline Glu and Glx levels in the lower range had greater percent change in full scale IDS-SR scores post-treatment (p < 0.001), as did tNAA (p = 0.007). Low glutamatergic metabolite levels also predicted greater percent change in mood/cognition symptoms (p ≤ 0.001). Low-range Glu, Glx, and tNAA were associated with greater improvement on the immuno-metabolic subscale (p ≤ 0.003). Baseline Glu predicted rTMS responder status (p = 0.025) and had an area under the receiving operating characteristic curve of 0.81 (p = 0.009), demonstrating excellent discriminative ability. Baseline Glu, Glx, and tNAA significantly predicted MDD improvement after rTMS; preliminary evidence also demonstrates metabolite association with symptom subdomain improvement post-rTMS. This work provides feasibility for a personalized medicine approach to rTMS treatment selection, with individuals with Glu levels in the lower range potentially being the best candidates.