Past-year Major Depressive Disorder Research Articles

Quantifying skip-out information loss when assessing major depression symptoms.

Large-scale mental health surveys screen participants for the presence of the core diagnostic criteria of a mental disorder such as major depressive disorder (MDD). Only participants who screen positive are administered the full diagnostic module; the remainder "skip-out." Although this procedure adheres faithfully to the psychiatric classification of mental disorders, it limits the use of the resulting survey data for conducting high-quality research of importance to scientists, clinicians, and policymakers. Here, we conduct a series of exploratory analyses using the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD) data, a unique survey which suspended the skip-out procedure for assessing past-year MDD. Adult twins (N = 8,980) born between 1930 and 1974 were recruited from a multiple-birth record database established in 1980 and interviewed in mid-adulthood between 1987 and 1996. We compared the: (a) prevalence and levels of impairment of the diagnostic criteria (and disaggregated symptom items) of adults screening positive/negative and (b) patterns of associations between MDD diagnostic criteria (and disaggregated symptom items) under three conditions: (a) full data; (b) "skip-out" data substituted with zeros; and (c) "skip-out" data treated via listwise deletion. Important differences in the patterns of associations between diagnostic criteria and disaggregated symptom sets emerged which changed the statistical evidence regarding the dimensionality of the criteria/symptom items (i.e., Condition C). An ill-defined correlation matrix which was unsuitable for statistical analysis was produced (i.e., Condition B). Given the problems with these widely used approaches, we offer researchers and data analysts practical alternatives to using the skip-out procedure in future surveys. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association of State Supplemental Nutrition Assistance Program Eligibility Policies With Adult Mental Health and Suicidality

Food insecurity is associated with an increased likelihood of poor mental health and suicidality. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the US; under broad-based categorical eligibility (BBCE), states have the option to expand SNAP eligibility to a greater number of households by eliminating the asset test or increasing the income limit for eligibility. To examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility with rates of mental health and suicidality outcomes among adults. This ecological cross-sectional study used 2014 to 2017 data on US adults from the National Vital Statistics System and 2015 to 2019 data on US adults from the National Survey on Drug Use and Health (NSDUH) State-Level Small Area Estimates. Analyses were conducted between September and November 2022. State elimination of the asset test only and state adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) for 2014 to 2017 from the SNAP Policy Database. Number of adults with a past-year major depressive disorder, mental illness, serious mental illness, or suicidal ideation and number of adults who died by suicide. Analyses included 407 391 adult NSDUH participants and 173 085 adults who died by suicide. State elimination of the asset test only was associated with decreased rates of past-year major depressive episodes (rate ratio [RR], 0.92; 95% CI, 0.87-0.98) and mental illness (RR, 0.91; 95% CI, 0.87-0.97) among adults. State adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) was associated with decreased rates of past-year major depressive episodes (RR, 0.92; 95% CI, 0.86-0.99), mental illness (RR, 0.92; 95% CI, 0.87-0.98), serious mental illness (RR, 0.91; 95% CI, 0.84-0.99), and suicidal ideation (RR, 0.89; 95% CI, 0.82-0.96). Results suggested a decreased rate of suicide death (RR, 0.93; 95% CI, 0.84-1.02) in states with both policies compared with states with neither policy, although this result was not statistically significant. State adoption of policies that expand SNAP eligibility may contribute to decreased rates of multiple mental health and suicidality outcomes at the population level.

Multimorbidity and Correlates of Comorbid Depression and Generalized Anxiety Disorder in a Nationally Representative US Sample.

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently occur together, but sociodemographic, behavioral, and diagnostic correlates of this comorbidity have not been comprehensively studied. Data from the nationally representative US sample surveyed in the National Epidemiologic Survey on Alcohol and Related Conditions-III ( N = 36,309) were used to define three groups, individuals with a) both past-year GAD and MDD ( n = 909, 16.9%), b) GAD only ( n = 999, 18.6%), and c) MDD only ( n = 3471, 64.5%). The comorbid group was compared with each single-diagnosis group on sociodemographic, behavioral, and diagnostic characteristics based on effect sizes (risk ratios and Cohen's d ) rather than p values because of the large sample sizes. Multivariable-adjusted logistic regression analyses were used to identify factors independently associated with the comorbid group. Bivariate analysis showed that the comorbid group had more parental and childhood adversities, additional psychiatric disorders, and poorer mental health quality of life than both single-disorder groups. Multivariable-adjusted logistic regression of the comorbid group showed that on two of five factors, additional psychiatric diagnoses were significantly more frequent than in the GAD-only group, and that on three of six factors, additional psychiatric diagnoses were significantly more frequent than in the MDD-only group. There is a significantly higher burden of social adjustment problems, comorbid psychiatric disorders, and poorer mental health-related quality of life among individuals with comorbid GAD-MDD than those with single disorders. The adversities associated with this non-SUD psychiatric comorbidity are comparable to those associated with the more extensively studied comorbidity of psychiatric and substance use disorders and deserve further research and treatment.

Maternal thoughts of self-harm and their association with future offspring mental health problems

IntroductionDepression and self-harm are leading causes of disability in young people, but prospective data on how maternal depression and self-harm thoughts contribute to these outcomes, and how they may interact is lacking. MethodsThe study sample consisted of 8,425 mothers and offspring from the Avon Longitudinal Study of Parents and Children, an ongoing birth cohort study. Exposures were maternal self-harm ideation and depression measured using the Edinburgh Postnatal Depression Scale, collected at eleven time points over the period 18 weeks’ gestation to 18 years post-partum. Outcomes were offspring past-year major depressive disorder and lifetime self-harm assessed at age 24. ResultsNearly one-fifth (16.7%) of mothers reported thoughts of self-harm on at least one of the eleven assessment points. The frequency of maternal self-harm ideation was related to both outcomes in a dose-response manner. Young adults whose mothers had self-harm ideation on 5–11 occasions were over three times more likely (Odds ratio (OR), 3.32; 95% CI, 1.63–6.76) to be depressed and over 1.5 times as likely (OR, 1.55; 95% CI, 0.73, 3.29) to have self-harmed than their peers whose mothers had never reported self-harm thoughts. Maternal self-harm thoughts remained associated with both offspring outcomes independent of maternal depression, and no evidence was found for an interaction between the two exposures. DiscussionClinicians collecting data on maternal depression may consider paying attention to questions about self-harm ideation in assessments. Examining accumulated maternal self-harm ideation over time may provide insights into which children are most at risk for later self-harm and depression.

Does Early Life Racial Discrimination Explain a Mental Health Paradox among Black Adults?

Objectives: To evaluate the impact of early life racial discrimination (ELRD) on mental health among Black adults. Methods: Data were from the Nashville Stress and Health Study (n = 618). Ordinary least squares regression models examined the relationship between ELRD and adult psychological distress; logistic regression estimated the probability of past-year major depressive disorder (MDD). We also assessed whether ELRD moderated the relationship between adult discrimination and mental health. Results: Childhood (b = 1.07, SE = .51, p = .04) and adolescent ELRD (b = 1.32, SE = .42, p = .002) were associated with adult distress. Individuals who experienced childhood ERLD had 88% lower odds of adult MDD than individuals with no ELRD. Significant interactions showed that childhood and adolescent ELRD was protective against adult discrimination. Discussion: While ELRD importantly shapes distress and MDD among Black adults, patterns vary by outcome. Results indicate that adult distress and MDD develop through cumulative adversity processes that are further influenced by sensitive periods in the life course.

Adverse childhood experience patterns, major depressive disorder, and substance use disorder in older adults

Objectives This article investigates distinct patterns of adverse childhood experiences (ACEs) in a representative sample of US older adults, and how the ACEs patterns relate to major depression and substance use disorder (SUD). Methods Data came from the National Epidemiologic Survey on Alcohol and Related Conditions III. The study sample consisted of older adults aged 55 or older (N = 11,386). The dependent variable was past-year SUD measuring any DSM-5 diagnosis for alcohol, tobacco, cannabis, and other illicit drugs. The independent variables were the classes of ACEs identified using 11 types of early adversities. The mediating variable was past-year major depressive disorder. We conducted a latent class analysis (LCA) to identify latent classes of ACEs, estimated the relationships between the ACEs classes, major depressive disorder, and SUD, and tested mediation by major depression. Results Results of the LCA identified four classes of ACEs: High Adversity (6%), Low Adversity (69%), Child Abuse (16%), and Parental Substance Use (8%). The three classes of High Adversity, Child Abuse, and Parental Substance Use showed significantly higher rates of SUD than the Low Adversity class. The High Adversity and Child Abuse classes were more likely to have major depression compared to the Low Adversity class. In addition, major depression mediated the association between ACEs and SUD for those two classes. Conclusion The findings provide evidence for a long-term impact of ACEs on mental health and SUD later in life and emphasize trauma-informed care principles in interventions for older adults with SUD.

ASSOCIATIONS OF ADVERSE CHILDHOOD EXPERIENCES WITH DSM-5 DEPRESSIVE DISORDERS AND SUICIDE ATTEMPT IN OLDER ADULTS

Adverse childhood experiences (ACEs) may have long-term effects on mental health. Using a life-course perspective, this study examines prevalence of ACEs and the associations of ACEs with depressive disorders and suicide attempt in US older adults. The study sample were those aged 65 and older who participated in the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (n=5,806 unweighted). ACEs, the key independent variable, were assessed using validated measures and outcome variables included lifetime and past-year major depressive disorder (MDD) and dysthymia using DSM-5 criteria, and lifetime suicide attempt. We estimated national prevalence of ACEs in older adults and used multivariable-adjusted logistic regression analyses to assess the association between ACEs and the outcomes after adjusting for socio-demographics and clinical co-morbidities. Overall, 34.7% of older adults, representative of 14.3 million older adults nationwide, reported some form of ACEs. The most common type was parental psychopathology (20.8%), followed by neglect (14.8%), and physical/psychological abuse (8.4%) (non-mutually exclusive). Having experienced any ACEs was associated with higher odds of having a past-year MDD diagnosis (adjusted odds ratio [aOR]=1.77; 95% confidence intervals [CI]=1.36, 2.29). Similar results were found for other depressive disorders. ACEs were also associated with higher odds of having a lifetime suicide attempt (aOR=4.34; 95% CI=2.64, 7.14). In conclusion, ACEs may expose older adults to an increased risk for mood disorders and suicide attempts, even over long periods of time as seen in this sample. Reducing ACEs is an important public health goal that may yield long-term benefits.

DOES EARLY-LIFE RACIAL DISCRIMINATION EXPLAIN A MENTAL HEALTH PARADOX AMONG BLACK ADULTS?

To evaluate the impact of early life racial discrimination (ELRD) on mental health among Black adults. Data were from the Nashville Stress and Health Study (n=618). OLS regression models examined the relationship between ELRD and adult psychological distress; logistic regression estimated the probability of past-year major depressive disorder (MDD). We also assessed whether ELRD moderated the relationship between adult discrimination and mental health. Childhood (b=1.07, SE=0.51, p=0.04) and adolescent ELRD (b=1.32, SE=0.42, p=0.002) were associated with adult distress. Individuals who experienced childhood ERLD had 88% lower odds of adult MDD than individuals with no ELRD. Significant interaction analyses showed that ELRD was generally protective against adult discrimination. While ELRD importantly shapes distress and MDD among Black adults, patterns vary by outcome. Results indicate that adult distress and MDD develop through cumulative adversity processes that are further influenced by sensitive periods in the life course.

Aberrant striatal tracking of reward magnitude in youth with current or past-year depression.

Reward dysfunction is often present in youth with major depressive disorder (MDD), but the specific neurobiological bases underlying reward valuation deficits remain unclear. The current study examined whether adolescents and young adults with MDD track brain and behavioral responses according to relative reward magnitude-a neurocognitive valuation process known as magnitude tracking. Female adolescents and young adults ages 15-20 years (n = 56 with current or past-year MDD; n = 26 healthy controls [HCs]) completed a task during functional neuroimaging in which they could win or lose money at high stakes (+$1/-50¢) and low stakes (+20¢/-10¢). Behaviorally, HC accelerated button press responses on high stakes compared to low-stakes trials, whereas MDD did not alter response speed across stakes. Neurally, HC increased recruitment of the ventral and dorsal striatum, canonical reward-processing regions, for high-magnitude versus low-magnitude rewards. However, the MDD group did not exhibit striatal magnitude tracking for low versus high rewards-an effect independent of MDD recency, MDD symptom severity, comorbid anxiety and substance use disorders, and psychiatric medication use. In contrast, striatal recruitment for overall reward reactivity, measured by comparing striatal activity for reward and loss feedback, was similar in the MDD and HC groups. However, reward reactivity was negatively correlated with current depression symptom severity in the MDD group. Taken together, these findings suggest that whereas reward reactivity may vary with current depression severity, reward magnitude tracking may represent an important aberrant valuation process in youth with depression-independent of symptom severity and recency. This valuation deficit may have implications for maladaptive motivation and learning observed in youth with MDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Does Social Support Moderate the Association Among Major Depression, Generalized Anxiety Disorder, and Functional Disability in Adults With Diabetes?

Diabetes requires complex self-management routines to prevent the development of functional disability. Relative to people without diabetes, those with diabetes are more likely to have comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD), which also increase the likelihood of functional disability. Social support is associated with positive health outcomes in people with comorbid diabetes and mental disorders and may serve as a buffer against functional disability, though this possibility has yet to be examined. This study examined whether social support moderates the association between MDD or GAD and functional disability in adults with diabetes. Adults with MDD or GAD were expected to report greater disability than those without MDD or GAD. This association was expected to be stronger in people reporting lower social support relative to those reporting higher social support. Data came from the cross-sectional 2012 Canadian Community Health Survey-Mental Health (n = 1764). Diabetes status, social support, and functional disability were assessed via self-report; past-year MDD and GAD were assessed with structured diagnostic interviews. Linear regression analyses, conducted separately for MDD and GAD, indicated main effects of past-year MDD and GAD, such that those with a mental disorder reported greater functional disability than those without a mental disorder. Social support did not moderate the associations between either MDD and functional disability or GAD and functional disability. In this nationally representative population study, both MDD and GAD predicted greater functional disability in adults with diabetes. Social support, however, did not moderate these associations.

Internalized Racism and Past-Year Major Depressive Disorder Among African-Americans: the Role of Ethnic Identity and Self-Esteem.

Although a large body of research focuses on discrimination as a risk for depression among African-Americans, only a dearth of research focuses on internalized racism (i.e., endorsement of negative stereotypes of one's racial group) as a risk factor. In addition, no studies have yet to examine mediators and/or moderators of the relationship between internalized racism and depression. To this end, the present study examined the mediating and moderating roles of (a) self-esteem and (b) ethnic identity on the relationship between internalized racism and past-year major depressive disorder (MDD), in a nationally representative sample of African-American adults (N = 3570) from the National Survey of American Life. Results from this study revealed an indirect association between internalized racism and past-year MDD via self-esteem, but no indirect relationship via ethnic identity. Further, results show that both self-esteem and ethnic identity individually moderate the relationship between internalized racism and past-year MDD. Collectively, these findings suggest a need to further investigate mechanisms through which internalized racism impacts mental health and factors that strengthen and/or weaken the association between internalized racism and depression.

Discrimination, internalized racism, and depression: A comparative study of African American and Afro-Caribbean adults in the US.

Emerging research suggests that both perceptions of discrimination and internalized racism (i.e., endorsement of negative stereotypes of one's racial group) are associated with poor mental health. Yet, no studies to date have examined their effects on mental health with racial/ethnic minorities in the US in a single study. The present study examined: (a) the direct effects of everyday discrimination and internalized racism on risk of DSM-IV criteria of past-year major depressive disorder (MDD); (b) the interactive effects of everyday discrimination and internalized racism on risk of past-year MDD; and (c) the indirect effect of everyday discrimination on risk of past-year MDD via internalized racism. Further, we examined whether these associations differed by ethnic group membership. We utilized nationally representative data of Afro-Caribbean (N = 1,418) and African American (N = 3,570) adults from the National Survey of American Life. Results revealed that experiencing discrimination was associated with increased odds of past-year MDD among the total sample. Moreover, for Afro-Caribbeans, but not African Americans, internalized racism was associated with decreased odds of meeting criteria for past-year MDD. We did not find an interaction effect for everyday discrimination by internalized racism, nor an indirect effect of discrimination on risk of past-year MDD through internalized racism. Collectively, our findings suggest a need to investigate other potential mechanisms by which discrimination impacts mental health, and examine further the underlying factors of internalized racism as a potential self-protective strategy. Lastly, our findings point to the need for research that draws attention to the heterogeneity within the U.S. Black population.

Effect of adolescent substance use and antisocial behavior on the development of early adulthood depression

Major depressive disorder (MDD) is a prevalent and frequently comorbid psychiatric disorder. This study evaluates the development of depressive symptoms, MDD diagnosis, and suicidal ideation in a high-risk sample (N=524) diagnosed with conduct disorder (CD) and substance use disorder (SUD) symptoms as youth and re-assessed approximately 6.5 years later. Dual trajectory classes of both alcohol and other drug use (AOD) and antisocial behavior (ASB), previously identified using latent class growth analyses (LCGA), were used to predict depression outcomes. The Dual Chronic, Increasing AOD/Persistent ASB, and Decreasing Drugs/Persistent ASB classes had higher past-week depression scores, more past-year MDD symptoms, and were more likely to have past-year MDD than the Resolved class. The Dual Chronic and Decreasing Drugs/Persistent ASB classes also had more past-year MDD symptoms than the Persistent AOD/Adolescent ASB class. Youth at highest risk for developing or maintaining depression in adulthood had the common characteristic of persistent antisocial behavior. This suggests young adulthood depression is associated more with persistent antisocial behavior than with persistent substance use in comorbid youth. As such, interventions targeting high-risk youth, particularly those with persistent antisocial behavior, are needed to help reduce the risk of severe psychosocial consequences (including risk for suicide) in adulthood.

Association of Symptom Network Structure With the Course of [corrected] Depression.

Major depressive disorder (MDD) is a heterogeneous condition in terms of symptoms, course, and underlying disease mechanisms. Current classifications do not adequately address this complexity. In novel network approaches to psychopathology, psychiatric disorders are conceptualized as complex dynamic systems of mutually interacting symptoms. This perspective implies that a more densely connected network of symptoms is indicative of a poorer prognosis, but, to date, no previous study has examined whether network structure is indeed associated with the longitudinal course of MDD. To examine whether the baseline network structure of MDD symptoms is associated with the longitudinal course of MDD. In this prospective study, in which remittent and persistent MDD was defined on the basis of a follow-up assessment after 2 years, 515 patients from the Netherlands Study of Depression and Anxiety with past-year MDD (established with the Composite International Diagnostic Interview) and at least moderate depressive symptoms (assessed with the Inventory of Depressive Symptomatology [IDS]) at baseline were studied. Baseline starting and ending dates were September 1, 2004, through February 28, 2007. Follow-up starting and ending dates were September 1, 2006, through February 28, 2009. Analysis was conducted August 2015. The MDD was considered persistent if patients had at least moderate depressive symptoms (IDS) at 2-year follow-up; otherwise, the MDD was considered remitted. Sparse network structures of baseline MDD symptoms assessed via IDS were computed. Global and local connectivity of network structures were compared across persisters and remitters using a permutation test. Among the 515 patients, 335 (65.1%) were female, mead (SD) age was 40.9 (12.1) years, and 253 (49.1%) had persistent MDD at 2-year follow-up. Persisters (n = 253) had a higher baseline IDS sum score than remitters (n = 262) (mean [SD] score, 40.2 [8.9] vs 35.1 [7.1]; the test statistic for the difference in IDS sum score was 22 027; P < .001). The test statistic for the difference in network connectivity was 1.79 (P = .01) for the original data, 1.55 for data matched on IDS sum score (P = .04), and 1.65 for partialed out data (P = .02). At the symptom level, fatigue or loss of energy and feeling guilty had the largest difference in importance in persisters' network compared with that of remitters (Cohen d = 1.13 and 1.18, respectively). This study reports that symptom networks of patients with MDD are related to longitudinal course: persisters exhibited a more densely connected network at baseline than remitters. More pronounced associations between symptoms may be an important determinant of persistence in MDD.

Descriptive epidemiology of major depressive disorder in Canada in 2012.

The epidemiology of major depressive disorder (MDD) was first described in the Canadian national population in 2002. Updated information is now available from a 2012 survey: the Canadian Community Health Study-Mental Health (CCHS-MH). The CCHS-MH employed an adaptation of the World Health Organization World Mental Health Composite International Diagnostic Interview and had a sample of n=25 113. Demographic variables, treatment, comorbidities, suicidal ideation, and perceived stigma were assessed. The analysis estimated adjusted and unadjusted frequencies and prevalence ratios. All estimates incorporated analysis methods to account for complex survey design effects. The past-year prevalence of MDD was 3.9% (95% CI 3.5% to 4.2%). Prevalence was higher in women and in younger age groups. Among respondents with past-year MDD, 63.1% had sought treatment and 33.1% were taking an antidepressant (AD); 4.8% had past-year alcohol abuse and 4.5% had alcohol dependence. Among respondents with past-year MDD, the prevalence of cannabis abuse was 2.5% and that of dependence was 2.9%. For drugs other than cannabis, the prevalence of abuse was 2.3% and dependence was 2.9%. Generalized anxiety disorder was present in 24.9%. Suicide attempts were reported by 6.6% of respondents with past-year MDD. Among respondents accessing treatment, 37.5% perceived that others held negative opinions about them or treated them unfairly because of their disorder. MDD is a common, burdensome, and stigmatized condition in Canada. Seeking help from professionals was reported at a higher frequency than in prior Canadian studies, but there has been no increase in AD use among Canadians with MDD.

Cigarette smoking and the onset and persistence of major depressive disorder among adults in the United States: 1994–2005

s / Drug and Alcohol Dependence 146 (2015) e2–e33 e33 Financial support: NIH/NIDA R01 DA003240 (MEC), F31DA036248-01 (NEZ). http://dx.doi.org/10.1016/j.drugalcdep.2014.09.768 Cigarette smoking and the onset and persistence of major depressive disorder among adults in the United States: 1994–2005 Michael Zvolensky1,2, Jafar Bakhshaie1, Renee Goodwin3,4 1 Psychology, University of Houston, Houston, TX, Unites States 2 MD Anderson Cancer Center, Houston, TX, Unites States 3 Psychology, Queens College, City University of New York, New York, NY, Unites States 4 Epidemiology, Columbia University, New York, NY, Unites States Aims: Thepresent study sought to investigatewhether cigarette smoking is (a) associated with increased risk of onset and persistence of major depressive disorder (MDD) and whether smoking cessation maintenance reduces the risk of onset and persistence of MDD over a 10-year period among adults in the United States. Methods: Data were drawn from the Midlife Development in the United States Survey (MIDUS) Waves I and II (N=2101). Logistic regression analyses were used to investigate the relations between smoking and the onset and persistent of MDD, adjusting for demographic characteristics and substance use problems. Results: Daily smoking in 1994 and persistent daily smoking (from 1994 to 2005) predicted a significantly increased likelihood of past-year incident and persistent MDD by 2005. These associations largely remained statistically significant after adjusting for demographics and substance use problems. Successful smoking abstention significantly reduced the risk of recent incidence and persistence of MDD. Conclusions: The present longitudinal data provide novel insights into the role of smoking in the onset and persistence of MDD. Namely, smoking is associated with a significant increased risk of MDD and quitting helps to reduce such risk. Specifically, the longer the duration of abstinence/successful quitting, the lower the riskof subsequentonset ofMDD. Themental healthbenefits of quitting smoking in the form of reduced risk of MDD should be added to common information listed as the reasons to quit. Financial support: None. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.777

Major depressive disorder and smoking relapse among adults in the United States: A 10-year, prospective investigation

This study investigated the relation between major depressive disorder (MDD) and smoking relapse in the U.S. over a 10-year period. Data were drawn from the Midlife Development in the United States (MIDUS) Survey Waves I & II. Logistic regression analyses were used to explore the associations between past-year MDD in 1994, past-year MDD in 2005 and persistent depression (1994 and 2005) and risk of smoking relapse in 2005 among former smokers, adjusting for demographics, anxiety disorders, and substance use problems and smoking characteristics. Among former smokers, MDD in 1994, compared to without MDD in 1994, was associated with significantly increased odds of smoking relapse by 2005. Current MDD in 2005 was associated with an even stronger risk of relapse in 2005 and persistent depression even more strongly predicted relapse by 2005. These associations remained significant and were not substantially attenuated by the covariates. In conclusion, MDD appears to confer long-term vulnerability to smoking relapse among adults in the general population. These results suggest interventions for smoking cessation should include screening and treatment for MDD if programs are to be optimally effective at achieving initial quit success as well as enduring abstinence.

Examining vulnerability to smokeless tobacco use among adolescents and adults meeting diagnostic criteria for major depressive disorder.

Smoking prevalence is unevenly distributed in the U.S. population, with those with mental illness, other substance use disorders, and lower socioeconomic status being especially vulnerable. Less research has been conducted on the association between these same vulnerabilities and smokeless tobacco (ST) use. The present study examined cigarette and ST use among adolescents and adults who met diagnostic criteria for major depressive disorder in the National Survey on Drug Use and Health (NSDUH). Utilizing the most recent (2011) NSDUH, we compared odds for current cigarette smoking and ST use among adolescents and adults meeting criteria for past-year major depressive disorder to the general population, after adjusting for potential confounding influences of sociodemographic and other substance use characteristics. Analyses were conducted to examine sex as a moderator of the relation between major depressive disorder and tobacco use. Odds for current cigarette smoking among those classified with major depressive disorder were increased among adolescents (OR = 1.33, 95% CI [1.05, 1.69], p = .021) and adults (OR = 1.70, 95% CI [1.47, 1.97], p < .0005), and odds for current ST use did not differ among adolescents (OR = 0.90, 95% CI [0.54, 1.49], p = .678) and were lower among adults (OR = 0.68, 95% CI [0.51, 0.91], p = .010). Sex was not a significant moderator in adolescents or adults. Major depressive disorder is associated with increased risk for smoking but not ST use among adolescents and adults further demonstrating heterogeneity in predictors of vulnerability to use of different tobacco products.

MAJOR DEPRESSIVE DISORDER IN VULNERABLE GROUPS OF OLDER ADULTS, THEIR COURSE AND TREATMENT, AND PSYCHIATRIC COMORBIDITY

Although a number of epidemiology studies of major depressive disorder (MDD) in older adults have been reported, most of them suffer four limitations: (1) the sample was not nationally representative; (2) the sample was relatively small or only one or two sociodemographic correlates of MDD were examined; (3) psychiatric comorbidity was not examined; and (4) the clinical characteristics of MDD were not reported. This study (1) examines the prevalence of DSM-IV MDD across different demographics, especially the vulnerable ones; (2) identifies clinical characteristics of DSM-IV MDD, such as onset, course, and treatment; and (3) evaluates the comorbidity of DSM-IV MDD with anxiety disorder, substance-use disorder, and personality disorder. We analyzed data on 8,205 individuals aged 65 or older from the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002), a nationally representative survey of the noninstitutionalized U.S. household population. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version assessed MDD, anxiety, substance use, personality disorders, and pathological gambling. The survey also included demographic characteristics: age, sex, race/ethnicity, marital status, education, employment status, personal income, urban vs. rural residence, and region of the country. Marital status and gender were associated with MDD, whereas race and socioeconomic characteristics were not. Specifically, the prevalence rates of past-year MDD were significant greater for females (3.6%) than males (2.0%) and higher for widowed (4.9%) or separated/divorced (3.5%) than married (1.85%). The mean onset age was 50 years and the average number of lifetime episodes was 4.4. Only half of older adults with MDD had received treatment, even though one-fourth had thought about suicide. Anxiety disorder, substance dependence, and pathological gambling were highly associated with MDD. Prevention could be targeted to older women and those who were widowed, separated, or divorced and low treatment rate was also alarming. More research is needed for the comorbid psychiatric disorders in late-life depression because of their impact on the course and prognosis of MDD.

Differential mental health effects of neighborhood relocation among youth in vulnerable families: results from a randomized trial.

CONTEXT Extensive observational evidence indicates that youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. OBJECTIVE To use experimental evidence to assess whether gender and family health problems modify the mental health effects of moving from high- to low-poverty neighborhoods. DESIGN Randomized controlled trial. SETTING Volunteer low-income families in public housing in 5 US cities between 1994-1997. PARTICIPANTS We analyze 4- to 7-year outcomes in youth aged 12 to 19 years (n=2829, 89% effective response rate) in the Moving to Opportunity Study. INTERVENTION Families were randomized to remain in public housing (control group) or to receive government-funded rental subsidies to move into private apartments (experimental group). Intention-to-treat analyses included intervention interactions by gender and health vulnerability (defined as prerandomization health/developmental limitations or disabilities in family members). MAIN OUTCOME MEASURES Past-year psychological distress (Kessler 6 scale [K6]) and the Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD). RESULTS Male gender (P=.02) and family health vulnerability (P=.002) significantly adversely modified the intervention effect on K6 scores; male gender (P=.01), but not health vulnerability (P=.17), significantly adversely modified the intervention effect on the BPI. Girls without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6: β=-0.21; 95% CI, -0.34 to -0.07; P=.003; MDD: odds ratio=0.42; 95% CI, 0.20 to 0.85; P=.02). For boys with health vulnerabilities, intervention was associated with worse K6 (β=0.26; 95% CI, 0.09 to 0.44; P=.003) and BPI (β=0.24; 95% CI, 0.09 to 0.40; P=.002) values. Neither girls with health vulnerability nor boys without health vulnerability experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD, but estimates were imprecise owing to low prevalence. CONCLUSIONS Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies and may need additional program supports.