Prior Depression Research Articles

Impact of gestational diabetes diagnosis on concurrent depression in pregnancy

Background Gestational diabetes mellitus (GDM) affects nearly 5% of US pregnancies and is associated with poor outcomes. Perinatal depression is also associated with substantial risks to both the fetus and mother. There is limited data about the relationship between GDM and antenatal depression. Therefore, we looked at whether a GDM diagnosis would be associated with an increased risk of depression during pregnancy. Methods We studied 562 pregnant women from 1 July 2013 to 30 June 2015, in a prospective multi-part survey on clinical obstetrical outcomes. Results Of the 562 patients, 46 patients (8.0%) were diagnosed with GDM. There was no statistical difference between the groups for either history of prior or post-partum depression. Diagnosis of depression was present in 15.2% of the GDM group but only 6.2% of the control group. Regression modeling demonstrated an adjusted odds ratio (AOR) of 2.46 for a diagnosis of depression when the patient had a diagnosis of GDM (95% CI 1.01–6.03, p=.049). Conclusions The diagnosis of GDM was associated with an elevated risk of concomitant pregnancy diagnosis of depression. Given the elevated risk to patients diagnosed with GDM, a more frequent depression screening interval could be considered during the remainder of the pregnancy, such as each prenatal visit.

Depresión posparto en mujeres puérperas del Hospital General Materno Infantil San Pablo: La información cruda anonimizada se compartirá a solicitud por el autor corresponsal. . Los autores declaran que no hubo financiamiento para la realización de este trabajo. .La información cruda anonimizada se compartirá a solicitud por el autor corresponsal.

Objectives: To determine the prevalence of postpartum depression in women attended at the San Pablo Maternal and Child General Hospital between June and August 2018, describe the sociodemographic characteristics of patients and identify diseaserelated factors. Materials and methods: Observational, descriptive crosssectional prospective study performed on 140 women who had a newlyborn between June and August 2018 at the San Pablo Maternal and Child General Hospital, public hospital from Asuncion, Paraguay, dependency of the Public Health and Social Welfare Secretary. The diagnosis of postpartum depression was made by applying the Edinburgh postpartum depression scale. It measures age, ethnicity, previous illnesses, prenatal complications, pregnancy planning, toxicological habits, living with the newborns father or with a family member, relationship with newborns father, personal and family history of depression, support family, parity, origin, area, birth route, marital status, schooling, number of pregnancies, history of parental separation in childhood and newborns hospitalization. Descriptive statistics and univariate analysis were performed in order to determine diseaserelated factors. Results: Among the 140 women studied, 47 women had an Edinburgh scale score greater than or equal to 10, therefore, a prevalence of 34% of postpartum depression was found among respondents. Among women with positive score, 15% (7) reported suicidal ideation in the previous week. The univariate analysis showed that the personal history of previous depression (p <0.05; OR: 3.17), newborns hospitalization (p <0.05; OR: 2.34), domestic violence (p <0.05; 0R: 6.15), prior and postpartum stress due to various circumstances (p <0.05; OR: 3.01) and live outside the city (p <0.05; OR: 5.37) are significantly related to the development of postpartum depression. Conclusion: the prevalence of depressive traits was high in the study population, pregnant women with a history of prior depression have a high risk of developing the disease and will need additional evaluations and the establishment of preventive treatment. In adittion, there are diseaserelated factors identified in the development of postpartum depression such as newborns hospitalization, being a victim of domestic violence, prior and postpartum stress, and living outside the city.

Longitudinal Occurrence and Predictors of Patient-Provider Discordance Between Global Assessments of Disease Activity in Rheumatoid Arthritis: A Case-Control Study.

To identify longitudinal predictors of discordance between patients with rheumatoid arthritis (RA) and their health care providers, where patient global assessment of disease activity is substantially higher than provider global assessment. This retrospective case-control study included 102 cases with positive discordance (i.e., ≥25 mm between patient and provider global assessments) and 102 controls without discordance who were matched for age, sex, RA duration, and Clinical Disease Activity Index (CDAI) score. Data were collected at the baseline visit (date of diagnosis or earliest available visit), the index visit (participation in a previous cross-sectional study), and at up to 11 additional visits before the index visit. Data included patient characteristics, disease activity measures, Disease Activity Score in 28 joints (3-variable) using the C-reactive protein level (DAS28-CRP), and medications. Data were analyzed by using linear and logistic regression models with smoothing splines for nonlinear trends. Overall, the mean age was 63 years, 75% of patients were female, and the mean RA duration was 10 years. Compared with controls, cases had higher rates of discordant visits during the 4 years before the index visit, and they had a higher CDAI score and DAS28-CRP earlier in the disease course. Cases more frequently had antinuclear antibodies, nonerosive disease, prior depression, or prior use of antidepressants or fibromyalgia medications. Disease-modifying medication use was not different between cases and controls. The findings inform new hypotheses about the relationships of disease activity and antinuclear antibodies to the later occurrence of positive discordance among patients with RA.

Network outcome analysis identifies difficulty initiating sleep as a primary target for prevention of depression: a 6-year prospective study.

Study ObjectivesMajor depressive disorder (MDD) is the leading cause of disability worldwide. Its high recurrence rate calls for prevention of first-onset MDD. Although meta-analysis suggested insomnia as the strongest modifiable risk factor, previous studies insufficiently addressed that insomnia might also occur as a residual symptom of unassessed prior depression, or as a comorbid complaint secondary to other depression risks.MethodsIn total, 768 participants from the Netherlands Study of Depression and Anxiety who were free from current and lifetime MDD were followed-up for four repeated assessments, spanning 6 years in total. We performed separate Cox proportional hazard analyses to evaluate whether baseline insomnia severity, short-sleep duration, and individual insomnia complaints prospectively predicted first-onset MDD during follow-up. The novel method of network outcome analysis (NOA) allowed us to sort out whether there is any direct predictive value of individual insomnia complaints among several other complaints that are associated with insomnia.ResultsOver 6-year follow-up, 141 (18.4%) were diagnosed with first-onset MDD. Insomnia severity but not sleep duration predicted first-onset MDD (HR = 1.11, 95% CI: 1.07–1.15), and this was driven solely by the insomnia complaint difficulty initiating sleep (DIS) (HR = 1.10, 95% CI: 1.04–1.16). NOA likewise identified DIS only to directly predict first-onset MDD, independent of four other associated depression complaints.ConclusionsWe showed prospectively that DIS is a risk factor for first-onset MDD. Among the different other insomnia symptoms, the specific treatment of DIS might be the most sensible target to combat the global burden of depression through prevention.

Microvascular Dysfunction Is Associated With Worse Cognitive Performance: The Maastricht Study.

Microvascular dysfunction may be associated with worse cognitive performance. Most previous studies did not adjust for important confounders, evaluated only individual measures of microvascular dysfunction, and showed inconsistent results. We evaluated the association between a comprehensive set of measures of microvascular dysfunction and cognitive performance in the population-based Maastricht Study. We used cross-sectional data including 3011 participants (age 59.5±8.2; 48.9% women; 26.5% type 2 diabetes mellitus [oversampled by design]). Measures of microvascular dysfunction included magnetic resonance imaging features of cerebral small vessel disease, plasma biomarkers of microvascular dysfunction, albuminuria, flicker light-induced retinal arteriolar and venular dilation response and heat-induced skin hyperemia. These measures were summarized into a microvascular dysfunction composite score. Cognitive domains assessed were memory, processing speed, and executive function. A cognitive function score was calculated as the sum of the scores on these 3 cognitive domains. The microvascular dysfunction score was associated with a worse cognitive function score (standardized β, -0.087 [95% CI, -0.127 to -0.047]), independent of age, education level, sex, type 2 diabetes mellitus, smoking, alcohol use, hypertension, total/HDL (high-density lipoprotein) cholesterol ratio, triglycerides, lipid-modifying medication, prior cardiovascular disease, depression and plasma biomarkers of low-grade inflammation. The fully adjusted β-coefficient of the association between the microvascular dysfunction score and the cognitive function score was equivalent to 2 (range, 1-3) years of aging for each SD higher microvascular dysfunction score. The microvascular dysfunction score was associated with worse memory and processing speed but not with worse executive function. The present study shows that microvascular dysfunction is associated with worse cognitive performance.

The Incidence and Prevalence of Anxiety, Depression, and Post-traumatic Stress Disorder in a National Cohort of US Veterans With Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) are more susceptible to mental health problems than the general population; however, temporal trends in psychiatric diagnoses' incidence or prevalence in the United States are lacking. We sought to identify these trends among patients with IBD using national Veterans Heath Administration data. We ascertained the presence of anxiety, depression, or posttraumatic stress disorder among veterans with IBD (ulcerative colitis or Crohn's disease) during fiscal years 2000-2015. Patients with prior anxiety, depression, or posttraumatic stress disorder before their first Veterans Health Administration IBD encounter were excluded to form the study cohort. We calculated annual prevalence, incidence rates, and age standardized and stratified by gender using a direct standardization method. We identified 60,086 IBD patients (93.9% male). The prevalence of anxiety, depression, and/or posttraumatic stress disorder increased from 10.8 per 100 with IBD in 2001 to 38 per 100 with IBD in 2015; 19,595 (32.6%) patients had a new anxiety, depression, and/or posttraumatic stress disorder diagnosis during the study period. The annual incidence rates of these mental health problems went from 6.1 per 100 with IBD in 2001 to 3.6 per 100 in 2015. This trend was largely driven by decline in depression. The prevalence of anxiety, depression, and posttraumatic stress disorder is high among US veterans with IBD and increasing, given the chronicity of IBD and psychological diagnoses. Incidence, particularly depression, appears to be declining. Confirmation and reasons for this encouraging trend are needed.

STRENGTHENING LATE-LIFE DEPRESSION COLLABORATIVE CARE THROUGH COMMUNITY ENGAGEMENT: CARE PARTNERS INITIATIVE

Despite the availability of effective treatments for late life depression, many older adults with depression either do not access or fully engage in treatment. The goal of this study was to examine the feasibility and two-year outcomes from an Archstone Foundation funded Care Partners Initiative to strengthen depression care for adults 65 years of age and older. Seven sites throughout California implemented evidence-based collaborative care through partnerships between primary care organizations, community-based organizations (CBOs), and families of older adults with depression. Evaluation used a mixed-methods approach incorporating both qualitative and quantitative data. Of the seven sites, six formed partnerships between primary care clinics and CBOs and one site only focused on engaging family members in treatment. In the first two years, 274 patients were enrolled and rates of depression improvement were comparable to prior depression care effectiveness trials. Overall, 49% of patients at CBO sites interacted 3+ times with CBO staff/clinicians, while at the family site, 79% of patients had 3+ contacts including a family member. Using data from key informant interviews, focus groups, and site progress documents, seven core components were identified that facilitated successful implementation and delivery of partnered collaborative care, including three foundational components: strong stakeholder buy-in, effective patient engagement, and the promotion of depression treatment as a core value across organizations. Multiple complexities of partnering between primary care clinics and CBOs or families were identified. Challenges and lessons learned from this initiative will also be discussed.

Physical activity offsets genetic risk for incident depression assessed via electronic health records in a biobank cohort study.

Physical activity is increasingly recognized as an important modifiable factor for depression. However, the extent to which individuals with stable risk factors for depression, such as high genetic vulnerability, can benefit from the protective effects of physical activity, remains unknown. Using a longitudinal biobank cohort integrating genomic data from 7,968 individuals of European ancestry with high-dimensional electronic health records and lifestyle survey responses, we examined whether physical activity was prospectively associated with reduced risk for incident depression in the context of genetic vulnerability. We identified individuals with incident episodes of depression, based on two or more diagnostic billing codes for a depressive disorder within 2 years following their lifestyle survey, and no such codes in the year prior. Polygenic risk scores were derived based on large-scale genome-wide association results for major depression. We tested main effects of physical activity and polygenic risk scores on incident depression, and effects of physical activity within stratified groups of polygenic risk. Polygenic risk was associated with increased odds of incident depression, and physical activity showed a protective effect of similar but opposite magnitude, even after adjusting for BMI, employment status, educational attainment, and prior depression. Higher levels of physical activity were associated with reduced odds of incident depression across all levels of genetic vulnerability, even among individuals at highest polygenic risk. Real-world data from a large healthcare system suggest that individuals with high genetic vulnerability are more likely to avoid incident episodes of depression if they are physically active.

Reciprocal associations between depression, anxiety and work-related injury

ObjectiveTo examine the reciprocal longitudinal associations between depression or anxiety with work-related injury (WRI) at a large employer in the southwestern United States.MethodThree administrative datasets (2011–2013) were merged: employee eligibility,...

A tangled web: The reciprocal relationship between depression and educational outcomes in China

Research on depression and education usually focuses on a unidirectional relationship. This paper proposes a reciprocal relationship, simultaneously estimating the effects of depression on education and of education on depression. China, which has the world's largest education system, is used as a case study. This paper applies structural equation modeling to three datasets: the China Family Panel Studies, the China Education Panel Survey, and the Gansu Survey of Children and Families. Analyses reveal a reciprocal and negative relationship between depression and educational outcomes. Specifically, early depression reduces later educational achievement, and higher educational achievement also lowers the level of subsequent depression by resulting in less peers' unfriendliness, less pressure from parents' expectations, and less teachers' criticism. More time spent on studies is not associated with higher educational achievement but significantly increases the level of depression. Children from lower SES families bear more pressure and spend more time on studies, which does not correspond to higher educational achievement but rather to higher levels of depression. In the long term, prior depression lowers educational attainment and, after controlling for prior depression, lower educational attainment is also associated with higher levels of subsequent depression. This paper shows that the lower achievers, not the high achievers, bear the major psychological burden of the education system's quest to produce high achievement. This situation reinforces these students' educational disadvantage.

Criminal Justice Involvement and Young Adult Health: The Role of Adolescent Health Risks and Stress

Although some studies have found that incarceration is associated with young adults' poor health, confounding factors including adolescent health risks, and mediating influences such as stress have not been examined in the same study. We assessed whether variation in criminal justice system experience (none, arrest only, incarceration) influenced young adults' self-reported depressive symptoms and poor physical health after accounting for prospective risks to health including adolescent health risks. We then assessed whether stress mediated associations between criminal justice involvement and the two health indicators. Data are from Toledo Adolescent Relationships Study (TARS) (n =990), which included young adults, age 22-29, who have matured during the era characterized by mass incarceration. The dependent variables included a depressive symptoms scale and self-reported poor health. The adolescent health risks included economic disadvantage, body mass index, delinquency, problems with drugs, and prior depressive symptoms. We considered stress as a mediating variable. Sociodemographic characteristics included race/ethnicity, age, and gender. We used ordinary least squares regression and logistic regression analyses. We tested gender, race/ethnicity, and age interactions. In multivariable models, incarceration, and adolescent health risks (economic disadvantage, prior depression, problems with drugs) were associated with young adults' depressive symptoms, and stress was a mediating influence. Adolescent delinquency and stress, but not incarceration, were significantly associated with young adults' self-reported poor health. This study provided a more nuanced understanding of incarceration and health by accounting for several key confounding factors and testing stress as a mechanism underlying the association. Care for prisoner health during and after incarceration is important for successful reintegration.

Sleep disturbance and physiological regulation among young adults with prior depression

Sleep disturbance and respiratory sinus arrhythmia (RSA) are well-known to be independently associated with depression. Yet, it remains unclear how sleep disturbance and impaired physiological regulation (indexed by RSA) may synergistically contribute to depression risk. The current study examined the relationship between sleep disturbance (duration, insomnia) on daily depressive symptoms, and whether RSA moderated this relationship in a sample of young adults with a history of depression. To examine hypotheses, participants (N = 102, ages 18–22) completed a laboratory socio-evaluative stressor task to assess RSA at rest and reactivity. Participants then completed daily measures of sleep duration, insomnia symptoms, and depressive symptoms for two weeks. For main effects, multilevel modeling indicated that shorter overall sleep duration (but not insomnia) predicted higher depressive symptoms, and individual fluctuations in insomnia symptoms (but not sleep duration) predicted higher levels of next-day depressive symptoms. Lower resting RSA, but not reactivity, potentiated these relationships. Individual differences in sleep disturbance (duration and insomnia) predicted prospective levels of depressive symptoms among individuals with lower physiological regulation (indexed by lower RSA), who were particularly vulnerable to the daily effects of sleep disturbance on depressed mood. These results suggest the need to examine both daily sleep disturbance and physiological regulation to understand who may be at greatest risk for depression.

Particulate Air Pollutants and Trajectories of Depressive Symptoms in Older Women

Although several environmental factors contribute to the etiology of late-life depressive symptoms, the role of ambient air pollution has been understudied. Experimental data support the neurotoxicity of airborne particulate matter with aerodynamic diameter of ≤2.5 μm (PM2.5), but it remains unclear whether long-term exposure is associated with late-life depressive symptoms. Our secondary aim was to explore whether the observed associations between exposure and depressive symptoms are explained by dementia risk. Prospective community-dwelling cohort study from the Women's Health Initiative Study of Cognitive Aging (1999-2010). Our analyses included 1,989 older women (baseline age 73.3 ± 3.75) with no prior depression or cognitive impairment. Participants completed annual assessments of depressive symptoms (15-item Geriatric Depression Scale). Average ambient PM2.5 exposure at the residential location was estimated by spatiotemporal modeling for the 3-years preceding each neuropsychological assessment. Participants underwent separate annual examinations for incident dementia defined by DSM-IV. Latent-class mixture models examined the association between PM2.5 and identified trajectories of symptoms. Six trajectories of depressive symptoms were identified. Across all women, PM2.5 exposure was positively associated with depressive symptoms. The effect was especially strong in two clusters with sustained depressive symptoms (n = 625 sustained-mild [31%]; n = 125 sustained-moderate; [6%]). Among those with sustained-moderate symptoms, the estimated adverse effect of PM2.5 exposure was greater than that of hypertension. Among women without dementia, associations were modestly attenuated. Long-term exposure to ambient fine particles was associated with increased depressive symptoms among older women without prior depression or cognitive impairment.

The Correlation Between Dry Eyes, Anxiety and Depression: The Sicca, Anxiety and Depression Study.

To determine whether improvement in the severity of dry eye disease (DED) symptoms correlates with improvement in anxiety and depression. This prospective interventional case series recruited 45 adults with evidence of DED. Patients were administered the University of North Carolina Dry Eye Management Scale (DEMS), Generalized Anxiety Disorder 7-item scale (GAD-7), and Personal Health Questionnaire Depression Scale (PHQ-8) to evaluate the severity of DED symptoms, anxiety, and depression, respectively. Standard of care treatment was provided for patients for 3 to 6 months, followed by re-administration of the DEMS, GAD-7, and PHQ-9 surveys. Statistical analysis was performed to assess the relationships between changes in survey scores. Participants had a mean age of 65.5 (SD, 13.3) years, and 37 (84.6%) were women. Seven patients were lost to follow-up. DEMS and GAD-7 significantly improved from 5.8 ± 1.8 to 4.6 ± 0.2.2 (P = 0.01) and from 5.6 ± 5.5 to 3.3 ± 4.6 (P = 0.05), respectively. Changes in DEMS correlated with changes in PHQ-8 (ρ = 0.3 P = 0.05), but not with changes in GAD-7 (ρ = 0.2 P = 0.3). Changes in DEMS correlated with changes in both PHQ-8 and GAD-7 in the subgroup of patients without prior depression or anxiety diagnosis (ρ = 0.6, P = 0.002; ρ = 0.4, P = 0.02). A multivariate analysis showed that the relationship between DEMS, PHQ-8, and GAD-7 was independent of a prior diagnosis of depression or anxiety and of the presence of comorbidities. There is a significant correlation between the severity of DED and symptoms of depression and anxiety. Effective DED treatment could have a positive impact on the symptoms of depression and anxiety.

Emerging Adulthood and Prospective Depression: A Simultaneous Test of Cumulative Risk Theories.

Past research indicates that a history of depression and exposure to abuse and neglect represent some of the most robust predictors of depression in emerging adults. However, studies rarely test the additive or interactive risk associated with these distinct risk factors. In response, the present study explored how these three risk factors (prior depression, abuse, and neglect) synergistically predicted prospective depressive symptoms in a sample of 214 emerging adults (Mage = 21.4 years; SDage = 2.4; 78% females). Subtypes of maltreatment and lifetime history of depression were assessed through semi-structured interviews, and depressive symptoms were assessed annually for three years via self-report measures. The results indicated that for both males and females, a lifetime history of depression, abuse, and neglect-exposure uniquely conferred risk for elevated depressive symptoms. Furthermore, the interaction between neglect and prior depression forecasted increasing depressive symptoms, and a history of abuse also predicted increasing depressive symptoms, but only in females. These findings are contextualized within extant developmental psychopathology theories, and translational implications for trauma-informed depression prevention efforts are discussed.

Abstract 183: Predictors of Good Functional Outcome at Discharge in Stroke Patients with Depression in the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study

Background: Stroke is the fifth leading cause of death in the US and results in major disability. Modifiable factors that increase risk of poor outcome need to be identified. Depression is related to worse post-stroke outcomes with Hispanics having a higher burden of stroke and depression than non-Hispanics. The goal of this study was to determine the effect of ethnicity and prior depression on post-stroke outcomes. Methods: We analyzed 80,687 cases (84 institutions) from the FL-PR Stroke Registry (2014-2017). Pre-existing depression was identified by prior history or use of anti-depressant medications. Univariate analyses of patient characteristics (age, race/ethnicity, insurance), medical history [prior stroke/TIA, hypertension (HTN), diabetes mellitus (DM), dyslipidemia, tobacco, peripheral vascular disease (PVD), atrial fibrillation (AF), heart failure (HF), and chronic renal insufficiency (CRI)], mode of arrival, initial stroke severity (NIHSS), and independent ambulation prior to stroke, and multilevel multivariate logistic regressions using discharge modified Rankin Score (mRS) and ambulatory status were developed. Results: Of 80,687 cases analyzed, 10,085 (12.5%) had depression: 15% white, 7% black, 11% Florida Hispanic, 7% Puerto Rico Hispanic. In multivariate models, depression decreased the likelihood of good clinical outcomes (mRS 0-2, OR: 0.85, 95% CI 0.78, 0.92; independent ambulation at discharge, OR: 0.86, 95% CI 0.80, 0.94). Age ≥65, black, female, Medicare, no insurance or Medicaid, NIHSS ≥5, prior stroke/TIA, HTN, DM, AF, PVD, HF, CRI, and arrival by EMS were negatively associated with mRS 0-2; whereas dyslipidemia and premorbid independent ambulation showed positive association (p&lt;0.05). Age ≥ 65, black, female, Medicare, initial NIHSS ≥ 5, history of stroke or TIA, HTN, DM, PVD, HF, CRI, and arrival via EMS were negatively associated with independent ambulation at discharge; whereas history of dyslipidemia or being a smoker and independent ambulation prior to stroke showed a positive association (p&lt;0.05). Conclusions: Pre-stroke depression adversely affected functional outcomes at discharge. Various comorbidities also negatively impacted functional outcome, whereas independent ambulation and dyslipidemia prior to stroke increased likelihood of good outcome. Future studies should evaluate if antidepressant medications and intensive management of risk factors improve delayed outcomes.

Interhemispheric plasticity is mediated by maximal potentiation of callosal inputs

Central or peripheral injury causes reorganization of the brain's connections and functions. A striking change observed after unilateral stroke or amputation is a recruitment of bilateral cortical responses to sensation or movement of the unaffected peripheral area. The mechanisms underlying this phenomenon are described in a mouse model of unilateral whisker deprivation. Stimulation of intact whiskers yields a bilateral blood-oxygen-level-dependent fMRI response in somatosensory barrel cortex. Whole-cell electrophysiology demonstrated that the intact barrel cortex selectively strengthens callosal synapses to layer 5 neurons in the deprived cortex. These synapses have larger AMPA receptor- and NMDA receptor-mediated events. These factors contribute to a maximally potentiated callosal synapse. This potentiation occludes long-term potentiation, which could be rescued, to some extent, with prior long-term depression induction. Excitability and excitation/inhibition balance were altered in a manner consistent with cell-specific callosal changes and support a shift in the overall state of the cortex. This is a demonstration of a cell-specific, synaptic mechanism underlying interhemispheric cortical reorganization.

Journal Digest

Journal Digest

Editors' note: Evaluating depression and suicidality in tetrabenazine users with Huntington disease

After a 2006 randomized clinical trial of 84 patients identified suicidality in 2 tetrabenazine (TBZ) users, the Food and Drug Administration issued a black box warning for this Huntington disease (HD) medication. Using the retrospective Enroll-HD database, Schultz et al. sought to clarify this relationship in a larger cohort. In keeping with the results of a prior observational study by Dorsey et al. (1,360 subjects), Schultz et al. observed no statistically significant increase in suicidality among TBZ users in the 4,091-patient cohort. In fact, this risk seemed to be attenuated by TBZ use after multivariable adjustment ( p = 0.043). This finding has become the subject of much contention among HD specialists. Several groups highlight major concerns with the study's methodology—notably the selection bias introduced by nonrandomized treatment, confounding by treatment indication (whereby patients who were more depressed, and perhaps more likely to have suicidality, would be less likely to receive TBZ), and survival bias due to TBZ discontinuation in the retrospective treatment arm. Schultz et al. acknowledge the limitations of their retrospective design and confirm their findings that TBZ remains safe using a propensity score–matched analysis that accounted for prior depression. While these results may be promising for patients with HD, all investigators seem to agree that these results should be interpreted with caution. After a 2006 randomized clinical trial of 84 patients identified suicidality in 2 tetrabenazine (TBZ) users, the Food and Drug Administration issued a black box warning for this Huntington disease (HD) medication. Using the retrospective Enroll-HD database, Schultz et al. sought to clarify this relationship in a larger cohort.

Predicting postpartum depression among adolescent mothers: A systematic review of risk.

Postpartum depression (PPD) is a debilitating illness with negative consequences for affected mothers and their children (e.g., poor maternal-infant attachment, deficits in children's social, emotional, and cognitive development). While it is suggested that adolescent mothers are at increased risk of PPD, there is a paucity of research exploring factors that place adolescent mothers at risk. This systematic review aims to identify risk factors associated with adolescent PPD and appraise the quality of this evidence-base. A systematic review was conducted in May of 2018, using PsycINFO, EMBASE, MEDLINE, ASSIA, CINAHL, MIDIRS, and ProQuest Dissertations and Theses Global database, following PRISMA guidelines. Inclusion criteria included studies from developed countries; published after 1992; using a validated measure of PPD; with onset of illness within 12 months of childbirth, but which had persisted past two-weeks postpartum; adolescent mothers < 20 years of age; and risk factor(s) that occurred prior to birth. Fourteen studies were included, ranging from weak-to-strong in quality. Results suggest several risk factors implicated in the onset of adolescent PPD, including prior depression, lack of familial social support, and socio-economic hardship. Awareness of risk factors for healthcare professionals working with pregnant adolescents is of high importance to better facilitate early identification and to provide support for adolescents at risk. Future research ought to consider employing prospective longitudinal designs, along with clearly defined, timely and validated measurements of risk factors and PPD. Limitations include only studies published in English and low agreement on the included studies selection bias.