Persistent Depressive Symptoms Research Articles

Maternal Serotonin Reuptake Inhibitor Antidepressants Have Acute Effects on Fetal Heart Rate Variability in Late Gestation.

Background: Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants increases risk for adverse neurodevelopmental outcomes, yet little is known about whether effects are present before birth. In relation to maternal SRI pharmacokinetics, this study investigated chronic and acute effects of prenatal SRI exposure on third-trimester fetal heart rate variability (HRV), while evaluating confounding effects of maternal depressed mood.Methods: At 36-weeks' gestation, cardiotocograph measures of fetal HR and HRV were obtained from 148 pregnant women [four groups: SRI-Depressed (n = 31), SRI-Non-Depressed (n = 18), Depressed (unmedicated; n = 42), and Control (n = 57)] before, and ~5-h after, typical SRI dose. Maternal plasma drug concentrations were quantified at baseline (pre-dose) and four time-points post-dose. Mixed effects modeling investigated group differences between baseline/pre-dose and post-dose fetal HR outcomes. Post hoc analyses investigated sex differences and dose-dependent SRI effects.Results: Maternal SRI plasma concentrations were lowest during the baseline/pre-dose fetal assessment (trough) and increased to a peak at the post-dose assessment; concentration-time curves varied widely between individuals. No group differences in fetal HR or HRV were observed at baseline/pre-dose; however, following maternal SRI dose, short-term HRV decreased in both SRI-exposed fetal groups. In the SRI-Depressed group, these post-dose decreases were displayed by male fetuses, but not females. Further, episodes of high HRV decreased post-dose relative to baseline, but only among SRI-Non-Depressed group fetuses. Higher maternal SRI doses also predicted a greater number of fetal HR decelerations. Fetuses exposed to unmedicated maternal depressed mood did not differ from Controls.Conclusions: Prenatal SRI exposure had acute post-dose effects on fetal HRV in late gestation, which differed depending on maternal mood response to SRI pharmacotherapy. Importantly, fetal SRI effects were sex-specific among mothers with persistent depressive symptoms, as only male fetuses displayed acute HRV decreases. At trough (pre-dose), chronic fetal SRI effects were not identified; however, concurrent changes in maternal SRI plasma levels suggest that fetal drug exposure is inconsistent. Acute SRI-related changes in fetal HRV may reflect a pharmacologic mechanism, a transient impairment in autonomic functioning, or an early adaption to altered serotonergic signaling, which may differ between males and females. Replication is needed to determine significance with postnatal development.

The timing and duration of depressive symptoms from adolescence to young adulthood and young adults\u2019 NEET status: the role of educational attainment

PurposeDepressive symptoms are negatively associated with labour market outcomes but whether the timing and duration of depressive symptoms or educational attainment (EA) affect NEET (Neither in Employment, Education, nor Training) is unknown. Therefore, this study aims to examine the effects of timing and duration of depressive symptoms in adolescence and the moderating and mediating role of EA on NEET in young adulthood.MethodsData were used from 1512 participants in the Vestliv Study, a Danish prospective cohort study. Depressive symptoms were measured at age 14, 18 and 21. EA at age 21 and NEET at age 23 were derived from national registers. Logistic regression analyses and a 4-way decomposition approach were applied.ResultsAmong boys, depressive symptoms at ages 14 and 21 increased the risk of NEET (OR 1.65, 95% CI 1.00–2.74 and OR 2.20, 95% CI 1.37–3.53). Among girls, this regarded depressive symptoms at ages 18 and 21 (OR 1.76, 95% CI 1.26–2.46 and OR 1.59, 95% CI 1.13–2.22). For the duration of depressive symptoms, among boys any depressive symptoms increased the risk of NEET. Among girls, only persistent depressive symptoms increased the risk of NEET. EA did not mediate or moderate the association between depressive symptoms and NEET.ConclusionThe timing and duration of depressive symptoms in adolescence matter for the association with NEET in young adulthood, with a double burden for those with both depressive symptoms and low EA. The results emphasize the importance of support for those who experience depressive symptoms in the school-to-work transition.

The relationship of cumulative psychosocial adversity with antepartum depression and anxiety.

Exposure to multiple psychosocial risk factors may increase vulnerability for mental health conditions during pregnancy. This analysis examined the relationship of a novel psychosocial adversity index with the co-occurrence and persistence of depression and anxiety throughout pregnancy. This cross-sectional analysis included 1797 pregnant women screened in the second/third trimesters for depression and anxiety symptoms and for eight contextual and individual psychosocial factors. The factors were summed to create a psychosocial adversity index; reporting four or more factors indicated high adversity. Elevated symptoms in both trimesters indicated persistent depression/anxiety and elevated symptoms at the same trimester indicated comorbid symptoms. The associations between the psychosocial adversity index and mental health were estimated. Compared with a low psychosocial adversity index, women reporting a high level of psychosocial adversities had 2.06 (95% confidence interval [CI]: 1.51-2.82) times higher adjusted odds of only depressive or anxiety symptoms, and 5.57 (95% CI: 3.95-7.85) times higher adjusted odds of comorbid symptoms. The associations for persistent symptoms were of similar direction and magnitude. High psychosocial adversity was associated with persistent and comorbid depressive symptoms and anxiety during pregnancy. Assessing psychosocial adversity can help identify women at increased risk who would benefit from tailored mental health interventions.

The Relationship between Adherence to the Mediterranean Diet, Intake of Specific Foods and Depression in an Adult Population (45-75 Years) in Primary Health Care. A Cross-Sectional Descriptive Study.

Background: The relationship between the quality of the diet and the adherence to the Mediterranean diet with the presence of persistent or recurrent depressive symptoms have been described. The objective of this study is to analyze the relationship between adherence to the Mediterranean diet and the intake of specific foods in primary care patients aged 45 to 75, having subclinical or major depression. The study also specifically analyzes this relationship in individuals suffering from chronic diseases. Methods: A cross-sectional descriptive study was conducted. 3062 subjects met the inclusion criteria from the EIRA study. Sociodemographic variables, clinical morbidity, depression symptomatology (PHQ-9) and adherence to Mediterranean diet (MEDAS) were collected. Results: Being female, younger, with a higher BMI, consuming more than 1 serving of red meat a day and drinking more than one carbonated or sugary drink daily, not consuming 3 servings of nuts a week and not eating 2 vegetables cooked in olive oil a week are predictors of having higher depressive symptomatology. Conclusions: Assessing the type of diet of patients presenting depressive symptoms and promoting adherence to a healthy diet is important, especially in patients with chronic diseases. However, depression is a very complex issue and the relationship between nutrition and depression must be further examined.

Sleep disordered breathing symptoms are associated with depressive symptoms: A longitudinal study of Chinese adolescents

BackgroundLittle is known about the prospective association between sleep disordered breathing (SDB) and depressive symptoms in Chinese adolescents. This study examined the independent predictive role of SDB symptoms in depressive symptoms in a large sample of adolescents. MethodsA total of 11831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort and 7072 adolescents who were resurveyed 1 year later were included for the analyses. Adolescents completed a self-administered questionnaire about demographics, mental health, sleep problems, and family environment. SDB symptoms were assessed by 3 items about loud snoring, breathing pauses, and snorting/gasping. The Chinese Youth Self-Report anxious/depressed subscale was used to assess depressive symptoms. ResultsIn the cross-sectional analyses, 11.8% adolescents had depressive symptoms, and elevated frequency of SDB symptoms were significantly associated with depressive symptoms. In the longitudinal study, 4.5% of adolescents had persistent depressive symptoms, the incidence rate of depressive symptoms at 1-year follow-up was 6.5%, and elevated frequency of any SDB symptoms (often: OR=2.23, 95%CI:1.50-3.32) at baseline was significantly associated with incident depressive symptoms after adjusting for potential confounders. The associations between SDB symptoms and depressive symptoms were similar for boys and girls. LimitationSDB symptoms and depressive symptoms were measured by self-report. ConclusionSDB symptoms are an independent and significant predictor of depressive symptoms in adolescents. Further research is needed to understand the biological mechanisms between SDB and mood dysregulation in adolescents.

Low-grade inflammation and endothelial dysfunction predict four-year risk and course of depressive symptoms: The Maastricht study

BackgroundLow-grade inflammation (LGI) and endothelial dysfunction (ED) might play a key role in the development of depression. We investigated the associations and mediation of LGI and ED with four-year incidence and course of depressive symptoms (remitted, recurrent or persistent). Design, setting, participants, measurementsIn this prospective cohort study (mean age 59.6 ± 8.2 years, 48.9% women, 26.6% diabetes by design), Cox and multinomial regression analyses, adjusted for age, sex, educational level and diabetes status were used to investigate the associations of LGI and ED with onset and course of depressive symptoms as assessed by the PHQ-9 questionnaire. ResultsDuring 10,847 person-years of follow-up, 264 participants developed incident depression. Higher levels of LGI (OR [95%CI] per SD 1.32[1.16–1.49], p < 0.001) and ED (1.26[1.11–1.43], p < 0.001) were associated with incident depressive symptoms. In mediation analysis, 60% of the total effect of ED with incident depressive symptoms could be attributed to LGI. 76 out of 2637 participants had a persistent course of depressive symptoms. Higher levels of LGI (1.75[1.40–2.19], p < 0.001) and ED (1.33[1.04–1.71], p = 0.021) were associated with a persistent course of depressive symptoms. Higher ED was more strongly associated with persistent depressive symptoms (1.33[1.04–1.71], p = 0.021), while LGI was associated with remission of depression symptoms. ConclusionsLGI and ED were both associated with incident depressive symptoms, where the latter association was substantially mediated by LGI. ED was further associated with a persistent course of depressive symptoms, while LGI was not. These results suggest a temporal, vascular contribution of both LGI and ED to the etiology and chronicity of depressive symptoms.

Quality of Life, Depressive Symptoms, Anxiety, and Sexual Function in Mothers of Neonates with Congenital Syphilis in the Northeast Brazil

Background: Congenital syphilis is an important public health problem in low- and middle- income countries. Poor neonatal health outcomes associated with disease may lead to high levels of maternal psychological distress and feelings of helplessness. This study aimed to evaluate the quality of life, anxiety levels, depressive symptoms, and sexual function in mothers of neonates with congenital syphilis in the Northeast Brazil. Methods: This longitudinal study compared patient-centered outcomes between mothers of neonates with congenital syphilis and mothers of healthy neonates during the first three months of postpartum period. The study was conducted in Sergipe state, Northeast Brazil, a poor region of the country with one of the highest rates of congenital syphilis (14·1 cases per 1,000 live births). Quality of life, depressive symptoms, anxiety levels, and sexual function were evaluated by using the World Health Organization Quality of Live - shortened version (WHOQoL-BREF) instrument, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Female Sexual Function Index, respectively. Findings: Sixty-eight women were included in each group. During the in-hospital stay, mothers of neonates with congenital syphilis had lower scores for overall quality of life (p <0·0001; effect size -0·563) and higher levels of state anxiety (p <0·0001; effect size 0·337) and depressive symptoms (p <0·0001; effect size 0·556) than mother of healthy neonates. Three months after childbirth, we found persistent depressive symptoms (p = 0·021; effect size 0·216) and low overall sexual function (p = 0·041; effect size -0·201) among mothers of neonates with congenital syphilis compared to the control group. Interpretation: Mothers of neonates with congenital syphilis present poorer quality of life, mental health, and sexual function compared to mothers of healthy neonates. Funding: Brazilian Federal Agency for Coordination of Improvement of Higher Education Personnel (CAPES). Declaration of Interest: The authors declare that there is no conflict of ethics. Ethical Approval:This study was approved by the Ethics Committee of the Federal University of Sergipe (protocol number 78636017.5.0000.5546). Written informed consent was obtained from all study participants.

Impact of socioeconomic status on depression clinical outcomes at six months in a Midwestern, United States community

IntroductionLower socioeconomic status (SES) has been associated with poor healthcare outcomes in depression. However, reliable individual-level SES data rarely exists for clinical research. The HOUSES index relies on publicly available data allowing for evaluation of individual-level SES on patient outcomes. HypothesisPrimary care patients with depression within the lower SES quartile (Quartile 1 vs. Quartile 4, of the HOUSES index) would experience worse clinical outcomes of their symptoms six months after diagnosis. Study designA retrospective cohort study which followed 4313 adult primary care patients that were diagnosed with depression during the study period of 2008–2015. The outcome measures were the six month PHQ-9 scores. ResultsAt six months, a higher HOUSES quartile was associated with greater odds of remission of depressive symptoms (RDS) and lower odds of persistent depressive symptoms (PDS), after controlling for covariates. Patients in Quartile 4 had 27% more likelihood of RDS and a 24% lower likelihood of PDS at six months compared to a Quartile 1 patient. LimitationsAs a retrospective study only can observe associations but not causation. Only one institution participated and not all treatments were readily available, limiting the generalizability of these findings. ConclusionsLower SES as demonstrated by a lower HOUSES quartile (Quartile 1 versus 4) was associated with lower odds of RDS and increased odds of PDS at six months. HOUSES index is a useful tool for identifying patients at risk for worse clinical outcomes and may help health care systems plan resource allocation for depression care.

The association of markers of cerebral small vessel disease and brain atrophy with incidence and course of depressive symptoms - the maastricht study

BackgroundCerebral small vessel disease (CSVD) and neurodegeneration may be involved in the development and persistence of late-life depressive symptoms, but longitudinal evidence is scarce. We investigated the longitudinal associations of markers of CSVD and brain atrophy with incident depressive symptoms and the course of depressive symptoms, above and below 60 years of age. MethodsWhite matter hyperintensity volumes (WMH), presence of lacunar infarcts and cerebral microbleeds, and white matter, grey matter, and cerebral spinal fluid volumes were assessed at baseline by 3T MRI in The Maastricht Study (mean age 59.5±8.5 years, 49.6% women, n=4,347; 16,535 person-years of follow-up). Clinically relevant depressive symptoms (9-item Patient Health Questionnaire≥10) were assessed at baseline and annually over seven years. We used Cox regression and multinomial logistic regression analyses adjusted for demographic, cardiovascular, and lifestyle risk factors. ResultsAbove 60 years of age, larger WMH volumes were associated with an increased risk for incident depressive symptoms (HR[95%CI]:1.24[1.04;1.48] per SD) and a persistent course of depressive symptoms (OR:1.44[1.04;2.00] per SD). Total CSVD burden was associated with persistent depressive symptoms irrespective of age (adjusted OR:1.58[1.03;2.43]), while no associations were found for general markers of brain atrophy. LimitationssOur findings need replication in other large-scale population-based studies. ConclusionsOur findings may suggest a temporal association of larger WMH volume with the incidence and persistence of late-life depression in the general population and may provide a potential target for the prevention of chronic late-life depression.

Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre-exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial.

IntroductionAfrican adolescent girls and young women (AGYW) eligible for HIV pre‐exposure prophylaxis (PrEP) experience high levels of depressive symptoms. Depression can reduce PrEP adherence among adults, although analyses have considered depression as a time‐varying exposure rather than modelling distinct patterns of symptoms. The association between depressive symptoms and PrEP adherence has not been explored for AGYW. To address these gaps, we sought to understand depressive symptom trajectories among African AGYW initiating PrEP and the impact of time‐varying depressive symptoms and symptom trajectories on PrEP adherence.MethodsHPTN 082 was an open‐label PrEP study among AGYW (ages 16 to 24) in Zimbabwe and South Africa from 2016 to 2018. Depressive symptoms were measured at enrolment and Weeks 13, 26 and 52, using the 10‐item Center for Epidemiologic Studies scale; a score ≥10 is indicative of elevated depressive symptoms. PrEP adherence was defined as any detectable tenofovir diphosphate (TFV‐DP) levels. Group‐based trajectory modelling was used to model longitudinal patterns of depressive symptoms. We assessed psychosocial and behavioural predictors of depressive symptom trajectory membership (e.g. PrEP stigma, intimate partner violence [IPV], sexual behaviour). We modelled associations between (1) group trajectory membership and PrEP adherence at Week 52 and (2) time‐varying depressive symptoms and PrEP adherence through follow‐up.ResultsAt enrolment, 179 (41.9%) participants had elevated depressive symptoms. Group‐based trajectory models revealed persistent elevated depressive symptoms in 48.5%, declining symptoms in 9.4% and no consistent or mild depressive symptoms in 43.3%. AGYW who engaged in transactional sex, reported IPV, or had traumatic stress symptoms were more likely to be assigned to the persistent elevated symptom group compared with the consistent no/mild symptom group (Wald test p‐value all <0.01). Participants assigned to the persistent elevated depressive symptom trajectory had a significantly lower risk of detectable TFV‐DP at Week 52 than those in the no/mild symptom trajectory (adjusted prevalence ratio = 0.89; 95% CI: 0.80 to 0.98). Elevated depressive symptoms were significantly inversely associated with PrEP use throughout follow‐up (adjusted relative risk = 0.73; 95% CI = 0.53 to 0.99).ConclusionsPersistent depressive symptoms were common among African AGYW seeking PrEP. Integration of depressive symptom screening and treatment into PrEP programmes may improve PrEP effectiveness among African women.

Maternal mental health and gestational weight gain in a Brazilian Cohort

Depression and anxiety are common during pregnancy, but little is known about the influence of these disorders on gestational weight gain (GWG). Data from a prospective cohort of pregnant women followed in a public healthcare center in Rio de Janeiro, Brazil, were used to evaluate the association of depression, anxiety, and suicide risk with GWG. GWG was evaluated at 5–13, 20–26, 30–36, and 37–42 weeks, and GWG adequacy was determined. Statistical analyses included linear mixed-effect models and Poisson regression. We evaluated 206 women, in which 15% (n = 31) presented major depressive disorder, 19.4% (n = 34) suicide risk and 10% (n = 21) generalized anxiety disorder at baseline. Women with depression at the first trimester, persistent depressive symptoms, and anxiety symptoms at the second trimester presented significantly lower rates of GWG per week compared to those without depression or anxiety, respectively. Persistent depressive symptoms represented a 2.40 (95% CI 1.20; 4.81; p = 0.013) increase in the risk of insufficient GWG. There was no significant association between generalized anxiety disorder or suicide risk with GWG. The presence of depression, depressive symptoms, and anxiety during pregnancy were associated with lower GWG rates. Persistent depressive symptoms during pregnancy were directly associated with insufficient GWG.

Objective sleep efficiency but not subjective sleep quality is associated with longitudinal risk of depression in pregnant women: A prospective observational cohort study

BackgroundSleep disturbances are one of the most frequent chief complaints brought to the healthcare professionals during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide with women more likely to be affected than men. However, limited studies have prospectively investigated the association between sleep disturbances and longitudinal risk of depression in pregnant women, with no studies using actigraphy to objectively estimate daytime and nighttime sleep duration and the extent of sleep disruption. ObjectivesTo examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women. DesignA prospective observational cohort study. Methods204 1st trimester pregnant women recruited from a university-affiliated hospital provided socio-demographic and health information, wore a wrist actigraph for 7 days, and completed Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies - Depression Scale, and Epworth Sleepiness Scale. Identical data collection procedures were implemented again in the 2nd and 3rd trimester, with each data collection scheduled at least 8 weeks apart. We estimated unadjusted and multivariable adjusted odds ratios and 95% confidence intervals to evaluate various types of sleep disturbances at 1st trimester and risk of depression at follow-ups. Results121 (59.3%) 1st trimester women had a sleep efficiency of < 85% by actigraphy, and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.71-, 3.87-, and 5.27-fold increased odds having risk of depression at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively. ConclusionsHealthy pregnant women experience both objective and subjective sleep disturbances during the early trimester, with a substantial proportion of them also having high depressive symptoms throughout the pregnancy. Objectively assessed poor sleep quality in the 1st trimester, but not self-reported characteristics of disturbed sleep, may play a role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether an early intervention aiming at improving sleep may help reduce high depressive symptom risk and lower depression rate in women during pregnancy.Tweetable abstract: Objectively assessed poor sleep efficiency in the 1st trimester predicts both elevated and persistent high depressive symptoms in pregnancy.

Predictors of Quality of Life Improvement with Escitalopram and Adjunctive Aripiprazole in Patients with Major Depressive Disorder: A CAN-BIND Study Report.

Non-response to first-line treatment for major depressive disorder (MDD) is common; for such individuals, quality of life (QoL) impairments can be severe. Identifying predictors of QoL changes may support the management of cases with persistent depressive symptoms despite adequate initial pharmacological/psychological treatment. The present study aimed to explore predictors of domain-specific QoL improvement following adjunctive aripiprazole treatment for inadequate response to initial antidepressant therapy. We evaluated secondary QoL outcomes from a CAN-BIND (Canadian Biomarker Integration Network in Depression) study in patients with MDD who did not respond to an initial 8 weeks of escitalopram and received a further 8 weeks of adjunctive aripiprazole (n = 96). Physical, psychological, social, and environmental QoL domains were assessed using the World Health Organization QoL Scale Brief Version (WHOQOL-BREF). Clinician-rated depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Functioning was measured with the Sheehan Disability Scale (SDS). Satisfaction with medication was assessed with a single item from the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Exploratory t-tests were used to describe domain score changes. A hierarchical linear regression was used to explore demographic, clinical, and treatment-related predictors of improvement. Across domains, QoL improved with adjunctive aripiprazole treatment. Satisfaction with medication and MADRS and SDS scores similarly improved. Symptom reduction was a predictor for positive change to physical and psychological QoL; functioning improvements were predictive of increases to all QoL domains. Satisfaction with medication predicted improvements to physical and psychological domains, whereas number of medication trials was a predictor of worsening QoL in the physical domain. The final model explained the most variance in psychological (68%) and physical (67%) QoL. Less variance was explained for environmental (43%) and social QoL (33%), highlighting a need for further exploration of predictors in these domains. Strategies such as functional remediation may have potential to support QoL for individuals with persistent depressive symptoms. ClinicalTrials.gov identifier: NCT016557.

Vascular depression – regarding a case report

IntroductionAge-related vascular changes have long been documented as an etiopathogenic factor of some geriatric depressive syndromes. More recently, it has emerged the concept of “Vascular Depression” recognizing that cardiovascular disease may predispose, precipitate or perpetuate late life depression. This condition was defined by an episode of major depressive disorder within the preceding 12 months in elderly with cardiovascular/cerebrovascular disease, or major cardiovascular risk factors. Vascular Depression isn`t described in DSM-V, and that difficults clinical recognition and affects clinically informed systematic studies.ObjectivesRegarding a clinical case, we enphasize the clinical impact of Vascular Depression`s hypothesis.MethodsWe present a qualitative review of this topic using the Pubmed Central database.Results74 years old male patient, with major depressive disorder about ten years. Depressive and cognitive symptoms didn`t respond to antidepressive treatment and his functional state has gradually declined.ConclusionsVascular depression develops after the 60 – 65 years in the absence of personal and family history of affective disorder. The key symptoms are low energy, anhedonia, deficits in selfinitiation, psychomotor retardation, reduced processing speed and lack of insight into mood symptoms. Clinical assessment includes a review of history of vascular risk factors or/and disease, but also an imagiological evidence demonstrating subcortical white matter abnormalities. Insidious and chronic course tends to delay its recognition and management. This becomes critical because Vascular Depression is associated with poor response to antidepressant treatment and persistent depressive symptoms. It`s also associated with poor selfmanagement of comorbidities and impairment in daily function. Increased mortality from all causes is widely documented.

Association of early and later depressive symptoms with functional outcome after ischemic stroke

BackgroundPost-stroke depressive symptoms (DS) can be chronic or transient, occurring shortly or long after stroke and lasting only few months. It remains unclear if the prognosis differs between patients with DS in the acute phase of stroke and those who develop DS several months later. We aimed to determine whether outcomes vary among patients with different trajectories of post-stroke depressive symptoms.MethodsOf 698 enrolled patients with ischemic stroke, we included 335 participants (median age: 68, 48% female) who were assessed for DS both 8 days and 3 months post-stroke. We divided patients into 4 groups: without greater DS (Group 1), only earlier DS (Group 2), only later DS (Group 3), and persistent DS (Group 4). Logistic regression was used to determine the association between DS and 3- and 12-month functional outcome.ResultsGroup 2 was predominantly female and had the highest rate of previous stroke or transient ischemic attack. Group 3 was more likely to suffer from delirium and more severe stroke. Group 4 had the highest frequency of vascular risk factors, pre-morbid psychiatric symptoms, and cognitive decline. In multivariate analysis, Group 3, but not Groups 2 and 4, had an increased risk of poor 3- and 12-month functional outcome (adjusted OR 2.59, 95% CI 1.64–4.07, P < 0.01 and OR 3.97, 95% CI 2.32–6.76, P < 0.01, respectively) compared with Group 1.ConclusionsDifferent trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.

Metabolomic predictors for late-life depression

<h3>Introduction</h3> Depression is a major public health problem among older adults and among the leading causes of global burden of disease and disability. Yet, current understanding of pathophysiology and optimal prevention and/or treatment of late-life depression (LLD) is limited. Advanced approaches involving methods such as metabolomics present an innovative path to identify novel biomarkers of LLD outcomes. Several known biological pathways involving tryptophan and lipid-inflammatory molecules (eicosanoids) are relevant to depression; however, there have been few systematic investigations of metabolomic predictors of long-term trajectories of LLD. <h3>Methods</h3> This is a convenience sample of ∼7000 Nurses' Health Study (NHS) participants with known metabolites and who completed depression items every four years from 1992-2016. Between 1989 and 1990, blood samples were collected and stored under standard conditions. In NHS, data on known metabolites were generated by merging the data from multiple case-control studies; however, all metabolites were profiled using liquid chromatography mass spectrometry in the same laboratory. Continuous metabolite values were transformed to probit scores to account for batch effects. We used a previously developed harmonized depressive symptom scale that was indexed to the five-item Mental Health Inventory (MHI-5, range=0-100 points). For cross-sectional analysis, we performed multivariable logistic regression models to evaluate the associations of baseline metabolite levels and likelihood of the moderate or severe depressive symptoms (MHI-5 cut-off=60); for longitudinal analysis, we used latent growth-curve analysis to identify group-based trajectories of depressive symptoms and then related baseline metabolite levels to long-term trajectories. <h3>Results</h3> The mean age of female nurses at blood draw was 57.0 (range=42.6-70.2) years. There were ∼6300 NHS participants with available data on tryptophan metabolites and ∼1300 NHS participants with available data on eicosanoids. We observed stronger signals for cross-sectional associations of higher circulating levels of tryptophan, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) with lower risk of moderate or severe depressive symptoms, adjusted for age at blood draw, fasting status, case-control status, physical activity, body mass index, diet index, alcohol use, and cigarette smoking [multivariable odds ratio (95% confidence interval): for tryptophan=0.86 (0.80-0.93), p<0.01; for EPA=0.84 (0.71-1.01), p=0.06; for DHA=0.85 (0.71-1.02), p=0.07]. From 1992-2016, we identified four depressive symptom trajectory groups: minimal depressive symptoms (63%), worsening depressive symptoms (12%), improving depressive symptoms (20%), and persistent severe depressive symptoms (5%). Additional results from multinomial models evaluating the associations between metabolites and long-term LLD trajectories will be presented. <h3>Conclusions</h3> In this sample, tryptophan and omega-3 fatty acid metabolites were significantly related to LLD outcomes; these metabolites may play a role in the pathophysiology of LLD. <h3>Funding</h3> HMS Livingston Fellowship Award

Trajectories of suicidal ideation after first-episode psychosis: a growth mixture modeling approach.

The period immediately after the onset of first-episode psychosis (FEP) may present with high risk for suicidal ideation (SI) and attempts, although this risk may differ among patients. Thus, we aimed to identify trajectories of SI in a 2-years follow-up FEP cohort and to assess baseline predictors and clinical/functional evolution for each trajectory of SI. We included 334 FEP participants with data on SI. Growth mixture modeling was used to identify trajectories of SI. Putative sociodemographic, clinical, and cognitive predictors of the distinct trajectories were examined using multinomial logistic regression. We identified three distinct trajectories: Non-SI trajectory (85.53% sample), Improving SI trajectory (9.58%), and Worsening SI trajectory (6.89%). Multinomial logistic regression model revealed that greater baseline pessimistic thoughts, anhedonia, and worse perceived family environment were associated with higher baseline SI followed by an Improving trajectory. Older age, longer duration of untreated psychosis, and reduced sleep predicted Worsening SI trajectory. Regarding clinical/functional evolution, individuals within the Improving SI trajectory displayed moderate depression at baseline which ameliorated during the study period, while the Worsening SI subgroup exhibited persistent mild depressive symptoms and greater functional impairment at follow-up assessments. Our findings delineated three distinct trajectories of SI among participants with FEP, one experiencing no SI, another in which SI might depend on acute depressive symptomatology, and a last subset where SI might be associated with mild but persistent clinical and functional impairments. These data provide insights for the early identification and tailored treatment of suicide in this at-risk population.

Prevalence of persistent physical symptoms and association with depression, anxiety and health anxiety in Iceland

Persistent physical symptoms that are medically unexplained can result in significant functional impairment. The aim of this study was to estimate the prevalence of persistent physical symptoms among people seeking primary healthcare in Reykjavík, Iceland, how they relate to functional impairment, symptoms of depression, general anxiety and health anxiety, and estimate the proportion of people with such symptoms who would likely benefit from psychological treatment. Questionnaires measuring persistent physical symptoms, functional impairment, and symptoms of depression, general anxiety and health anxiety were administered to 106 patients attending two primary healthcare clinics. The prevalence of persistent physical symptoms was 27.4% among the primary care patients and they had a strong relationship to symptoms of mental disorders. Participants with persistent physical symptoms were 8 times more likely to have clinical levels of depression and general anxiety than participants without such symptoms, 4 times more likely to have clinical levels of health anxiety and 13 times more likely to have clinical levels of functional impairment. At least two-thirds of participants with persistent physical symptoms would likely benefit from psychological treatment. The prevalence of persistent physical symptoms among health care patients in the capital area of Iceland is in line with previous studies. Similarly, the strong relationship between persistent physical symptoms and symptoms of depression and anxiety corresponds to previous studies. It is likely that at least two out of three patients with persistent physical symptoms would benefit from psychological treatment. Transdiagnostic cognitive behavioural therapy for persistent physical symptoms might be particularly useful as is focuses on the interplay between physical and mental symptoms.

Prevalence and predictive nomogram of depression among hypertensive patients in primary care: A cross-sectional study in less developed Northwest China.

Hypertensive patients commonly co-exist persistent depressive symptoms. However, these issues are not always identified, especially in primary health care, which may worsen the prognosis of hypertension. Therefore, the aim of this study was to determine the prevalence and risk factor of depression, and to develop risk nomogram of depression in hypertensive patients from primary health care Northwest China.We used a stratified multistage random sampling method to obtain 1856 hypertensives subjects aged ≥18 years in Xinjiang between April and October 2019. The subjects were randomly divided into a training set (n = 1299) and a validation set (n = 557). Depression was evaluated by Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. Using the least absolute shrinkage and selection operator (LASSO) regression model, we identified optimized risk factors of depression in the training set, followed by the establishment of prediction nomogram. The discriminative ability, calibration, and clinical usefulness of nomogram were assessed. The results were verified by internal validation in validation set.13.7% hypertensive subjects displayed depression. Seven independent risk factors of depression were identified and entered into the nomogram including age, region, ethnicity, marital status, physical activity, sleep quality, and control of hypertension. The nomogram displayed robust discrimination with an AUC of 0.760 [95% confidence interval (CI): 0.724–0.797)] and 0.761 (95%CI: 0.702–0.819), and good calibration in training set and validation set, respectively. The decision curve analysis and clinical impact curve demonstrated clinical usefulness of predictive nomogram.There is a considerable prevalence of depression in patients with hypertension from primary care of Xinjiang, Northwest China. Our nomogram may help primary care providers assess the risk of depression in patients with hypertension.

Depressive-Like Behaviors Induced by Chronic Social Defeat Stress Are Associated With HDAC7 Reduction in the Nucleus Accumbens.

Persistent symptoms of depression indicate the adaptive involvement of stable molecules in the brain that may be manifested at the level of chromatin remodeling, such as histone acetylation. Former studies have identified alterations in histone acetylation and deacetylation in several animal models about depression. However, the specific histone deacetylases related with depression are needed to be explored. Here, social avoidance behaviors, anxiety-, and depression-like behaviors were all found in mice suffered from chronic social defeat stress. Moreover, we also discovered that the amount of the class II histone deacetylase, HDAC7 rather than HDAC2, was significantly decreased in the nucleus accumbens of defeated mice, which suggested that HDAC7 might be a crucial histone deacetylase in a chronic social defeat stress model. Our data showed that the depressive-like behaviors induced by chronic social defeat stress were associated with HDAC7 reduction in nucleus accumbens. HDAC7 might be a promising therapeutic target for depression.