Persistent Major Depressive Disorder Research Articles

Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study.

There are indications that problematic alcohol use may negatively impact the course of major depressive disorder (MDD). However, most studies on alcohol use and adverse MDD outcomes are conducted amongst MDD populations with (severe) alcohol use disorder in psychiatric treatment settings. Therefore, it remains unclear whether these results can be generalised to the general population. In light of this, we examined the longitudinal relationship between alcohol use and MDD persistence after a 3-year follow-up amongst people with MDD from the general population. Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric epidemiological prospective study comprising four waves amongst the adult Dutch general population (n = 6.646). The study sample (n = 642) consisted of those with 12-month MDD who participated at the follow-up wave. The outcome was 12-month MDD persistence after the 3-year follow-up, which was assessed via the Composite International Diagnostic Interview version 3.0. Weekly alcohol consumption was operationalised as non-drinking (0 drinks), low-risk drinking (⩽7 drinks; reference), at-risk drinking (women 8-13 drinks, men 8-20 drinks) and high-risk drinking (women ⩾14, men ⩾21 drinks). We performed univariate and multiple logistic regression analyses, which were adjusted for various socio-demographic and health-related factors. The majority (67.4%) of the MDD sample were female, while the mean age was 47.1 years. Amongst these, 23.8% were non-drinkers, 52.0% were low-risk drinkers and 14.3% and 9.4% were at-risk and high-risk drinkers, respectively. Around one-quarter of the sample (23.6%) met the criteria for a persistent MDD after 3-year follow-up. No statistically significant association was found between alcohol use and MDD persistence, either for the crude model or the adjusted models. In comparison to low-risk drinking, the full adjusted model showed no statistically significant associations between MDD persistence and non-drinking (odds ratio (OR) = 1.15, p = 0.620), at-risk drinking (OR = 1.25, p = 0.423), or high-risk drinking (OR = 0.74, p = 0.501). Contrary to our expectations, our findings showed that alcohol use was not a predictor of MDD persistence after 3-year follow-up amongst people with MDD from the general population.

0669 The Role Of Hypersomnolence In Depression: Results From A Longitudinal Study Of The American General Population

Abstract Introduction Insomnia symptoms have often been pointed out as an important factor for the relapse and/or the maintenance of depression. However, the contribution of hypersomnolence in depression is less studied and the conclusions are unclear. Our aim is to examine the association between hypersomnolence and depression in the US general population. Methods This longitudinal study was carried out in eight states in the U.S. A total of 12,218 subjects were interviewed by phone during the first wave (W1) and 10,931 at the second wave (W2) three years apart. The analyses included only the subjects who participated in the 2 waves (N=10,931). Hypersomnolence symptoms and Major Depressive Disorder (MDD) were assessed according to DSM-5 criteria. Results At W1, 27.2% (95% CI 26.4%-28.0%) of the sample had at least one hypersomnolence symptoms listed in the DSM5 occurring at least 3 days per week. This prevalence at W2 was 26.4% (95% CI 25.6%-27.2%). The incidence of DSM5 hypersomnolence symptoms was 20.5% which represents a yearly incidence of 5.8%. For MDD, the prevalence was 5.1% (95% CI 4.7%-5.5%) and 4.2% (95% CI 3.8%-4.6%) in W1 and W2, respectively. At W1, 54.2% of participants with a MDD also had hypersomnolence. At W2, 50.7% of MDD subjects also reported hypersomnolence. After adjusting for age, gender and medical conditions, persistent hypersomnolence (i.e., reported at both interviews) predicted incident MDD (i.e., absent at the first interview but present at the follow-up) with a relative risk of 2.0 (95% CI 1.5-2.8). Similarly, persistent hypersomnolence predicted persistent MDD with a relative risk of 3.8 (95% CI 2.5-5.8). After adjusting for the presence of insomnia, persistent hypersomnolence remained a strong predictor for persistent MDD (RR: 2.4) but not for incident MDD. Conclusion Hypersomnolence, especially when it is persistent, is an important contributing factor for persistent MDD. While the presence of insomnia mitigates the predictive value of hypersomnolence in incident MDD, it had little effect on the association between persistent hypersomnolence and persistent MDD. Support (If Any)

App-enhanced transdiagnostic CBT for adolescents with mood or psychotic spectrum disorders

BackgroundAlthough transdiagnostic forms of cognitive-behavioral therapy (CBT) have been evaluated in individuals with depressive and anxiety disorders, few studies have examined their suitability for more severe disorders, such as recurrent or persistent major depressive disorder, bipolar disorder, or psychotic spectrum disorders. This study examined the acceptability and initial efficacy of an app-enhanced Unified Protocol for Adolescents [UP-A] when including youth with more severe mood disorders or psychotic spectrum disorders. MethodsWe first adapted a mobile application (app), based on user-centered feedback from adolescents and their parents, to assist participants in reviewing session content, practicing skills learned in previous treatment sessions, and monitoring symptomatic progress. A total of 24 adolescents (M age = 15.2 years, SD = 1.6) with mood or psychotic spectrum disorders and their parents then participated in an open trial of the app-enhanced group treatment given over 9 weekly sessions. ResultsAdolescent participants and their parents rated the group treatment and mobile app as acceptable and useful. We observed significant improvements over the 9-week treatment in adolescents' depressive symptoms, attenuated psychotic symptoms, and global functioning. The frequency with which adolescents used the mobile app between sessions was positively related to symptomatic and functional gains. ConclusionsInitial findings suggest the acceptability and feasibility of a mobile app that enabled adolescent participants and their parents to review session content and practice treatment skills. Findings also indicated improvements in psychiatric and functional outcomes among the adolescent participants over the course of the app-enhanced treatment. Randomized clinical trials are needed to evaluate the efficacy of app-enhanced CBT in improving symptoms and functioning in adolescents with mood or psychotic spectrum disorders.

The impact of self-efficacy on first onset and prognosis of major depressive disorder: findings from a longitudinal study in a sample of Chinese first-year university students.

Self-efficacy is a pivotal factor in the etiology and prognosis of major depression. However, longitudinal studies on the relationship between self-efficacy and major depressive disorder (MDD) are scarce. The objectives were to investigate: (1) the associations between self-efficacy and the 1-year and 2-year risks of first onset of MDD and (2) the associations between self-efficacy and the 1-year and 2-year risks of the persistence/recurrence of MDD, in a sample of first-year university students. We followed 8079 first-year university students for 2 years from April 2018 to October 2020. MDD was ascertained by the Chinese version of the Composite International Diagnostic Interview (CIDI-3.0) based on self-report. Self-efficacy was measured by the 10-item General Self-efficacy (GSE) scale. Random effect logistic regression modeling was used to estimate the associations. Among participants without a lifetime MDD, the data showed that participants with high baseline GSE scores were associated with a higher risk of first onset of MDD over 2 years [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.08]. Among those with a lifetime MDD, participants with high baseline GSE scores were less likely to have had a MDD over 2 years (OR 0.93, 95% CI 0.88-0.99) compared to others. A high level of GSE may be protective of the risk of persistent or recurrent MDD. More longitudinal studies in university students are needed to further investigate the impact of GSE on the first onset of MDD.

Does the millennial generation of women experience more mental illness than their mothers?

BackgroundThere is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age.MethodsPregnant women were recruited during 1981–1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008–11). Offspring were administered the CIDI at the 30-year follow-up (2010–2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes.ResultsWhen comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD.ConclusionsIn the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.

Comparison of Incidental Findings in Major Depressive Disorder Versus Healthy Controls Using Ultrahigh Field [7 Tesla] MRI

It has been suggested that Major Depressive Disorder (MDD) is accompanied by neurodegenerative changes, particularly in individuals with severe or persistent MDD. However, literature shows conflicting findings regarding MDD-related abnormalities compared to healthy controls (HC). This study aims to characterize differences in brain abnormalities in ultrahigh field MRI in MDD’s and HC’s.

The bi-factor structure of the 17-item Hamilton Depression Rating Scale in persistent major depression; dimensional measurement of outcome

The 17-item Hamilton Depression Rating Scale (HDRS17) is used world-wide as an observer-rated measure of depression in randomised controlled trials (RCTs) despite continued uncertainty regarding its factor structure. This study investigated the dimensionality of HDRS17 for patients undergoing treatment in UK mental health settings with moderate to severe persistent major depressive disorder (PMDD). Exploratory Structural Equational Modelling (ESEM) was performed to examine the HDRS17 factor structure for adult PMDD patients with HDRS17 score ≥16. Participants (n = 187) were drawn from a multicentre RCT conducted in UK community mental health settings evaluating the outcomes of a depression service comprising CBT and psychopharmacology within a collaborative care model, against treatment as usual (TAU). The construct stability across a 12-month follow-up was examined through a measurement equivalence/invariance (ME/I) procedure via ESEM. ESEM showed HDRS17 had a bi-factor structure for PMDD patients (baseline mean (sd) HDRS17 22.6 (5.2); 87% PMDD >1 year) with an overall depression factor and two group factors: vegetative-worry and retardation-agitation, further complicated by negative item loading. This bi-factor structure was stable over 12 months follow up. Analysis of the HDRS6 showed it had a unidimensional structure, with positive item loading also stable over 12 months. In this cohort of moderate-severe PMDD the HDRS17 had a bi-factor structure stable across 12 months with negative item loading on domain specific factors, indicating that it may be more appropriate to multidimensional assessment of settled clinical states, with shorter unidimensional subscales such as the HDRS6 used as measures of change.

Major Depressive Disorder Among HIV Infected Youth in Uganda: Incidence, Persistence and Their Predictors.

Incidence and persistence of major depressive disorder (MDD) in children and adolescents with HIV (CA-HIV) in Uganda is described. 1339 CA-HIV attending care were enrolled and followed up for 12months. MDD was assessed using the DSM-5 referenced Child and Adolescent Symptom Inventory-5 (CASI-5), with a prevalence for MDD at baseline of 5% (95% CI 3.3-7.3). Kaplan-Meir method was used to estimate incidence of MDD and Cox models were fitted to investigate predictors of incident MDD. Cumulative incidence of MDD over 12months was 7.6 per 100 person-years 95% CI (6.2-9.4) and a rate of persistent MDD of 10/105 (9.5% CI 3.9-15.1). Significant independent predictors of incident MDD were: highest educational level of CA-HIV (protective), increasing depressive scores and decreasing CD4 Nadir. These finding have implications for what should constitute components of a mental health integration model in HIV youth services and for the future development of individualised mental health care.

Helping clients ‘restart their engine’ – use of in-session cognitive behavioural therapy behavioural experiments for engagement and treatment in persistent depression: a case study

Abstract Behavioural experiments (BEs) are a major cognitive ingredient in the cognitive behavioural therapy (CBT) model which can be applied in-session or between-sessions. In-session BEs are particularly effective and widely demonstrated in anxiety disorders, yet they remain under-utilised in depression. Clients presenting with persistent depression are often difficult to engage due to the chronicity of their symptoms and their learnt self-perpetuating demoralised states. Research to date demonstrates the effectiveness of in-session BEs in engagement and treatment in depression. This case study details the treatment of a client presenting with persistent major depressive disorder (MDD) with hopelessness and how in-session BEs effected engagement and treatment. This case study is discussed with reference to strengths, limitations, clinical implications and recommendations for practice and development. Key learning aims It is hoped that the reader of this case study will increase their understanding of the following: (1) Using BEs to help engagement and treatment in persistent MDD. (2) Instilling hope by starting in-session BEs during the assessment stage. (3) When to plan or seize opportunities for off-the-cuffin-session BEs. (4) Setting no-lose BEs to enable clients to widen their perceptual field. (5) The importance of repeated BEs to consolidate experiential learning.

Relapse Prevention After Recovery in Patients With Persistent Major Depressive Disorder—An Active Pursuit

Relapse Prevention After Recovery in Patients With Persistent Major Depressive Disorder—An Active Pursuit

Smartphone Ownership, Use, and Willingness to Use Smartphones to Provide Peer-Delivered Services: Results from a National Online Survey.

Assess certified peer specialists' smartphone ownership, use, and willingness to use smartphones to provide peer-delivered services. Certified peer specialist from 38 states completed an online survey. The final sample of 267 certified peer specialists included respondents from 38 states. The majority of certified peer specialists were female (73%; n= 195) and Caucasian (79.8%; n= 213), with an average age of 50.9 (SD= 12) years, range from 21 to 77years. More than half of the certified peer specialists (82.1%; n= 184) were currently working in peer support positions. Of those who reported their mental health diagnoses, 11% reported their diagnosis as schizophrenia spectrum disorder, 22% of respondents reported bipolar disorder, and 23% reported persistent major depressive disorder. Nearly all respondents owned a smartphone (94.8%; n= 253), and everyone indicated that smartphones and tablets could enhance the services they deliver. Certified peer specialists reported substantial ownership and use of smartphones, comparable to existing national data. They are willing to deliver smartphone interventions for mental health and physical health self-management, suggesting that smartphones may be an increasingly useful tool for offering evidence-based care. Without Medicaid mandate, certified peer specialists are naturally trying to enhance peer delivered services with technology. Peer support could act as a mechanism to promote consumer engagement in a smartphone-based intervention. Certified peer specialist own and utilize smartphones, and the majority are willing to deliver technology-based and technology-enhanced interventions using these devices to address medical and psychiatric self-management.

Factor structure and longitudinal measurement invariance of PHQ-9 for specialist mental health care patients with persistent major depressive disorder: Exploratory Structural Equation Modelling

BackgroundThe Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument for measuring levels of depression in patients in clinical practice and academic research; its factor structure has been investigated in various samples, with limited evidence of measurement equivalence/invariance (ME/I) but not in patients with more severe depression of long duration. This study aims to explore the factor structure of the PHQ-9 and the ME/I between treatment groups over time for these patients. Methods187 secondary care patients with persistent major depressive disorder (PMDD) were recruited to a randomised controlled trial (RCT) with allocation to either a specialist depression team arm or a general mental health arm; their PHQ-9 score was measured at baseline, 3, 6, 9 and 12 months. Exploratory Structural Equational Modelling (ESEM) was performed to examine the factor structure for this specific patient group. ME/I between treatment arm at and across follow-up time were further explored by means of multiple-group ESEM approach using the best-fitted factor structure. ResultsA two-factor structure was evidenced (somatic and affective factor). This two-factor structure had strong factorial invariance between the treatment groups at and across follow up times. LimitationsParticipants were largely white British in a RCT with 40% attrition potentially limiting the study's generalisability. Not all two-factor modelling criteria were met at every time-point. ConclusionPHQ-9 has a two-factor structure for PMDD patients, with strong measurement invariance between treatment groups at and across follow-up time, demonstrating its validity for RCTs and prospective longitudinal studies in chronic moderate to severe depression.

Ziprasidone Augmentation of Escitalopram for Major Depressive Disorder: Cardiac, Endocrine, Metabolic, and Motoric Effects in a Randomized, Double-Blind, Placebo-Controlled Study.

To examine motoric, cardiovascular, endocrine, and metabolic effects of adjunctive ziprasidone in adults with major depressive disorder (MDD) and prior nonresponse to 8 weeks of open-label escitalopram. A multicenter, parallel, randomized, double-blind, placebo-controlled trial was conducted at 3 US academic medical centers from July 2008 to October 2013. Recruited were 139 outpatients with persistent DSM-IV MDD following an 8-week open-label trial of escitalopram. Subjects were then randomized to adjunctive ziprasidone (escitalopram + ziprasidone, n = 71) or placebo (escitalopram + placebo, n = 68) for 8 additional weeks. Cardiac and metabolic measures were obtained at each treatment visit. Barnes Akathisia Scale and Abnormal Involuntary Movement Scale (AIMS) scores were also obtained. Changes in outcome measures for each treatment group were compared by independent-samples t test. A trend toward significance (P = .06) in corrected QT interval (QTc) increase was observed for ziprasidone (mean [SD] = 8.8 [20.2] milliseconds) versus placebo (-0.02 [25.5] milliseconds). Ziprasidone-treated patients had a significantly greater increase in global akathisia scores (P = .01) and significant weight increase (mean [SD] = 3.5 [11.8] kg, or 7.7 [26.1] lb) compared to placebo (1.0 [6.4] kg, or 2.2 [14.1] lb) (P = .03). No significant changes in AIMS scores were observed for either treatment group. Adjunctive ziprasidone, added to escitalopram, led to a greater weight gain and greater but modest akathisia compared to placebo. The effect of ziprasidone on QTc showed a trend toward significance, and therefore caution should be used in the administration of ziprasidone. While ziprasidone augmentation in patients with MDD appears safe, precautions should be taken in practice, specifically regular monitoring of electrocardiogram, weight, extrapyramidal symptoms, and involuntary movements. ClinicalTrials.gov identifier: NCT00633399​​.

Maternal postnatal depression and anxiety and their association with child emotional negativity and behavior problems at two years.

Postnatal maternal depression is associated with poorer child emotional and behavioral functioning, but it is unclear whether this occurs following brief episodes or only with persistent depression. Little research has examined the relation between postnatal anxiety and child outcomes. The present study examined the role of postnatal major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptom chronicity on children’s emotional and behavioral functioning at 24 months. Following postnatal screening mothers (n = 296) were identified as having MDD, GAD, MDD and GAD, or no disorder at 3 months postnatal; the average age was 32.3 (SD = 5.0), 91.9% self-identified as Caucasian, and 62.2% were married. Maternal disorder symptom severity was assessed by questionnaires and structured interview at 3, 6, 10, 14, and 24 months postpartum. At 24 months, child emotional negativity and behavior were assessed using questionnaires and by direct observation. Latent trait–state-occasion modeling was used to represent maternal disorder symptom chronicity; both stable trait and time-specific occasion portions of maternal symptomatology were examined in relation to child outcomes. Only the stable trait portion of maternal MDD and GAD symptom severity were related to maternal report of child behavior problems and higher levels of emotional negativity. Persistent maternal MDD, but not GAD, symptom severity was related to higher levels of child emotional negativity as measured observationally. These data suggest that children’s behavior problems and emotional negativity are adversely affected by persistent maternal depression, and possibly anxiety. This has implications for interventions to prevent negative effects of postnatal psychopathology on children.

Incidence and Persistence of Major Depressive Disorder Among People Living with HIV in Uganda.

Data on the course of major depressive disorder (MDD) among people living with HIV (PLWH) are needed to inform refinement of screening and interventions for MDD. This paper describes the incidence and persistence rate of MDD in PLWH in Uganda. 1099 ART-naïve PLWH attending HIV clinics in Uganda were followed up for 12months. MDD was assessed using the DSM IV based Mini-International Neuropsychiatric Interview with a prevalence for MDD at baseline of 14.0% (95% CI 11.7-16.3%) reported. Multivariable logistic regression was used to determine predictors of incident and persistent MDD. Cumulative incidence of MDD was 6.1 per 100 person-years (95% CI 4.6-7.8) with significant independent predictors of study site, higher baseline depression scores and increased stress. Persistence of MDD was 24.6% (95% CI 17.9-32.5%) with independent significant predictors of study site, higher baseline depression scores, and increased weight. Risks of incident and persistent MDD observed in this study were high. Potentially modifiable factors of elevated baseline depressive scores and stress (only for incident MDD) were important predictors of incident and persistent MDD.

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.

Associations between depression, chronic physical health conditions, and disability in a community sample: A focus on the persistence of depression

BackgroundPrevious research has demonstrated that comorbid depression and chronic physical health conditions are associated with disability. The distinction between persistent and transient depression in the relationship between physical health conditions and disability, however, is poorly understood. The present study examined the interactive effects of major depressive disorder (MDD) and chronic physical health conditions on disability in a community sample; the effects of persistent or transient depression on disability were also examined. MethodsParticipants were from the Epidemiological Catchment Area of Montreal South-West Study (total N=2202). Past 12-month MDD, chronic physical conditions, functional disability, and disability days experienced within the past month were concurrently assessed. A subsample (n=1226) was used to examine the persistence of depression across three waves of data collection over approximately six years. ResultsIndividuals with comorbid MDD and chronic physical health conditions were approximately thirteen times more likely to have moderate to severe functional disability and had the highest mean number of disability days compared to those without MDD or a chronic physical health condition. Persistent MDD was most strongly associated with functional disability and disability days, and persistence of MDD interacted with physical health conditions to increase likelihood of concurrent disability. LimitationsOur study is limited by a single assessment point for disability and chronic health conditions and by the use of self-report. ConclusionsOur findings suggest that MDD, particularly when persistent, is associated with disability among individuals with a broad range of chronic physical health conditions.

Rate and Predictors of Persistent Major Depressive Disorder in a Nationally Representative Sample.

This study examined predictors of persistent major depressive disorder over 10years, focusing on the effects of clinical variables, physical health, and social support. Data from the National Survey of Midlife Development in the United States in 1995-1996 and 2004-2006 were analyzed. Logistic regression was used to predict non-recovery from major depression among individuals who met clinical-based criteria for major depressive disorder at baseline. Fifteen percent of the total sample was classified as having major depression in 1995-1996; of these individuals, 37% had major depression in 2004-2006. Baseline variables that were significantly associated with persistent major depression at follow-up were being female, having never married, having two or more chronic medical conditions, experiencing activity limitation, and less contact with family. Therefore, treatment strategies focused on physical health, social support, and mental health needs are necessary to comprehensively address the factors that contribute to persistent major depressive disorder.

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

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

BackgroundThe present study investigated the relationship between daily cigarette smoking and risk of onset and persistence of major depressive disorder (MDD) over a 10-year period among adults in the United States and whether successful smoking cessation reduced the risk for MDD. MethodData were drawn from the Midlife Development in the United States Survey (MIDUS; n=2101) Waves I and II. Logistic regressions were used to investigate the relations between smoking and the onset and persistence of MDD, adjusting for demographic characteristics and substance use problems. ResultsDaily smoking in 1994 [OR=1.9 (1.2–3.2)] and persistent daily smoking (in 1994 and 2005) [OR=2.2 (1.3–3.7)] were both associated with a significantly increased likelihood of MDD in 2005. Additionally, abstinence, compared to daily smoking, for more than 10years significantly reduced the risk of MDD in 2005 [OR=0.5 (0.3–0.87)] and persistent MDD in 1994 and 2005; [OR=0.5 (0.3–0.87)]. ConclusionsFindings from this study provide new insights into the role of smoking in the onset and persistence of MDD. Namely, among those in mid-adulthood, smoking is associated with greater MDD risk and quitting may help to reduce such risk. These results suggest that there may be merit in targeting smoking to reduce the risk of MDD and the mental health benefits of quitting smoking in the form of reduced risk of MDD could usefully be added to common information listed as reasons to quit.