Self-report Questionnaires For Depression Research Articles

Zero-Shot Strike: Testing the generalisation capabilities of out-of-the-box LLM models for depression detection

Depression is a significant global health challenge. Still, many people suffering from depression remain undiagnosed. Furthermore, the assessment of depression can be subject to human bias. Natural Language Processing (NLP) models offer a promising solution. We investigated the potential of four NLP models (BERT, Llama2-13B, GPT-3.5, and GPT-4) for depression detection in clinical interviews. Participants (N = 82) underwent clinical interviews and completed a self-report depression questionnaire. NLP models inferred depression scores from interview transcripts. Questionnaire cut-off values for depression were used as a classifier for depression. GPT-4 showed the highest accuracy for depression classification (F1 score 0.73), while zero-shot GPT-3.5 initially performed with low accuracy (0.34), improved to 0.82 after fine-tuning, and achieved 0.68 with clustered data. GPT-4 estimates of symptom severity PHQ-8 score correlated strongly (r = 0.71) with true symptom severity. These findings demonstrate the potential of AI models for depression detection. However, further research is necessary before widespread deployment can be considered.

The relationship between disease-specific psychosocial stressors and depressive symptoms in Huntington’s disease

BackgroundHuntington’s disease (HD) is an inherited neurodegenerative disease involving motor abnormalities, cognitive decline, and psychological difficulties. Depression is among the most common psychological difficulties in HD. People with HD encounter numerous stressors related to their diagnosis and the impact of HD on their daily lives. Understanding the relationship between HD-specific psychosocial stressors and depression symptoms is critical for optimising treatment and developing a holistic, disease-specific model of depression in HD.MethodsFifty-seven adults with the HD gene expansion (33 pre-symptomatic, 24 symptomatic) completed a self-report depression questionnaire and rated how much stress they experienced in relation to 20 psychosocial challenges commonly associated with HD. We examined associations between depression symptoms and each stressor individually, and after clustering using principal components analysis.ResultsDepression symptoms were significantly associated with most of the psychosocial stressors assessed. Clustering with principal components analysis revealed that higher depression scores had significant independent associations with greater stress related to the future implications of HD (β = .44, p = .001) and sleep and psychological difficulties (β = .28, p = .005), but not with stress related to functional limitations (β = .11, p = .33) or interpersonal issues caused by HD (β = .15, p = .21).ConclusionsStressful experiences associated with HD constitute an important risk factor for depression in HD. Our findings support the use of more psychologically informed models of depression in HD and necessitate further research on tailored psychosocial interventions for HD patients with depression.

Impact of the Coronavirus Disease Pandemic on Mental Health Among School Students in Korea During the COVID-19 Pandemic.

The coronavirus disease (COVID-19) pandemic has had various effects on mankind, especially children and adolescents. Because children and adolescents spend a lot of time at school, COVID-19 has had a great impact on school mental health. In this study, we investigated the effect of prolonged COVID-19 on school mental health. We prepared self-report questionnaires for depression (Children's Depression Inventory, CDI), anxiety (Korean version of the Penn State Worry Questionnaire for Children; Generalized Anxiety Disorder-7, GAD-7), and post-traumatic stress (Primary Care Post-traumatic Stress Disorder, PC-PTSD) for administering to students aged between 7 and 18 years, recruited by a COVID-19 psychological prevention support group in the Gwangmyeong Mental Health Welfare Center for 2 years, in 2020 and 2021. For children aged 7-12 years, there was no significant difference between the years 2020 and 2021 in the assessment of depression, anxiety, and post-traumatic stress. Conversely, for adolescents aged 13-18 years, there was a significant increase in the scale scores (CDI, PC-PTSD, and GAD-7). Prolonged COVID-19 might have had a significant impact on the mental health of adolescents who spent a lot of time at school. When comparing the years 2020 and 2021, middle and high school students were more affected by COVID-19 than elementary school students.

A-25 Transcranial Photobiomodulation Treatment Effects In Former Athletes With Repetitive Head Hits

Abstract Purpose: Psychiatric symptoms, sleep disruption, reaction time, and fine motor coordination are associated with repetitive head hits. Transcranial photobiomodulation (tPBM) has been proposed as a non-invasive treatment for post-head injury symptoms. This proof-of-concept study begins to address tPBM’s potential utility in the neurorehabilitation of athletes with repetitive head hits. Methods: Study participants included 49 former male and female athletes (Mage = 45.90 years; SD = 14.45) with a history of repetitive head hits. Inclusion criteria were: aged 18–65 years and a self-reported history of concussive and/or repetitive sub-concussive events. We conducted a non-randomized study design wherein participants received active tPBM treatment for 8 weeks. At pre- and post-treatment timepoints, self-report questionnaires for depression (CES-D), posttraumatic stress (PCL-5), adjustment (MPAI-4), and sleep quality (PSQI) were obtained, as were assessments of simple reaction time, grip strength, and hand dexterity (Grooved Pegboard). Paired t-tests analyzed pre- and post-treatment effects. Results: Following tPBM treatment, study participants demonstrated statistically significant reductions in self-reported depression (t = 4.54, p < 0.001, d = 0.75), posttraumatic stress (t = 3.43, p < 0.001, d = 0.54), and adjustment (t = 5.23, p < 0.001, d = 0.83) symptoms compared to pre-treatment levels. Sleep quality (t = 3.72, p < 0.001, d = 0.57), simple reaction time (t = 4.57, p < 0.001, d = 0.73), dominant hand grip strength (t = 2.59, p = 0.013, d = 0.41), and nondominant hand grip strength (t = 4.18, p < 0.001, d = 67) improved following tPBM treatment. Bilateral hand dexterity did not significantly change following treatment. Conclusions: Results suggest that tPBM may reduce psychiatric symptoms and improve sleep quality, simple reaction time, and grip strength among former athletes with repetitive head hits. These data support future research on the potential neurorehabilitative effects of tPBM.

Understanding the experience of rumination and worry: A descriptive qualitative survey study.

Rumination and worry have been implicated in the onset, severity, maintenance and relapse risk of depression and anxiety disorders. Despite this, little research has examined individuals' personal experiences of these processes. This study investigates how individuals experience these processes, which will provide insight into these common features of mental disorders and inform the development of an online intervention specifically targeting rumination and worry. An online qualitative survey was conducted to gain insight into people's personal definitions, experiences with and understandings of rumination and worry. Participants answered open- and close-ended questions about their personal understanding of rumination and worry, typical thought content, triggers, frequency, duration and coping strategies. Participant responses were coded into themes. Participants also completed self-report questionnaires of depression, anxiety and stress and repetitive negative thinking. Two hundred and seven adults completed the online survey (76% female; mean age=28.2 years, range=17-71), 51% of whom reported previously experiencing depression and anxiety. All participants were familiar with the concept of worry, whereas 28% of participants indicated they had never heard of rumination. Participants reported most commonly ruminating and/or worrying about personal relationships, past mistakes, negative experiences and conversations/social interactions. The most commonly reported triggers for rumination and/or worry were social situations/interpersonal interactions (25%) and negative events/experiences (24%). Distraction was the most common coping strategy (48%); however, 21% reported being unable to stop themselves from ruminating and/or worrying. The results provide a unique insight into the personal experiences and understandings of rumination and worry of potential end users of treatment programs targeting these processes.

Prevalence and correlates of suicidality in obsessive-compulsive disorder

BackgroundA growing body of evidence suggest individuals with obsessive-compulsive disorder (OCD) are at an increased risk for suicidal thoughts and behaviors (SITB). However, the literature on suicidality in OCD remains limited. Thus, the present study examined the prevalence and predictors of suicidality in a sample of adults seeking treatment for OCD. MethodsA total of 687 patients seeking care through a network of intensive treatment centers consented to participate. Participants completed validated self-report questionnaires of depression and OCD symptom severity, as well as psychodiagnostic interviews. ResultsAlmost half of the participants reported current suicidal ideation. The presence of a comorbid diagnosis was associated with increased likelihood of more severe SITB. Specifically, the presence of a co-occurring anxiety, depressive, or bipolar mood disorder predicted increased severity of SITB. In addition, obsession severity was positively associated with suicidality, while compulsion severity negatively predicted the severity of SITB. Regarding OCD symptom dimensions, repugnant thoughts emerged as a significant predictor of SITB severity. ConclusionsSITB is a prevalent concern in treatment-seeking patients with OCD. Clinicians are encouraged to assess and consider the treatment implications of SITB, particularly among patients with co-occurring mood and anxiety disorders, or symptoms involving taboo thought content. Future directions and theoretical considerations are discussed.

Involvement in compensation litigation and outcome from an online pain management program.

To report on the effect of involvement in civil litigation on outcome for patients enrolled in a validated Internet-delivered pain management program, the Pain Course. Data from a randomized controlled trial (RCT) on the effect of varying levels of clinician support was used to examine the effect of involvement in civil litigation on outcome in a free online pain management course. Outcome measures were changes in scores on self-report questionnaires for depression, anxiety, and disability (PHQ-9, GAD-7, and RMDQ) from baseline to 3-month follow-up for those still involved in litigation and those who had completed litigation, compared with outcomes for those who did not report involvement in litigation. The use of regular and as-required opioid medication at assessment and follow-up were also compared. Of the 397 patients enrolled in the pain course, 290 (73.0%) were not involved in litigation, 80 (20.2%) reported involvement in litigation that had been resolved and 27 (6.8%) reported ongoing litigation. Those still involved in litigation had the highest scores on depression scales and the highest rate of opioid use. The completion rates and symptom improvement was lower among current litigants but were still positive, with effect sizes on the outcome measures of between 0.56 and 0.73, as well as a reduction in the use of opioids. Current involvement in compensation litigation was associated with lower treatment completion and less symptom improvement. Nevertheless, the positive findings have significant implications for people involved in workers' compensation and other litigation who report pain as one of their symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The role of microbiota and inflammation in self-judgement and empathy: implications for understanding the brain-gut-microbiome axis in depression

RationaleThe gut-brain axis includes bidirectional communication between intestinal microbiota and the central nervous system. Bifidobacterium and Lactobacillus spp. have been implicated in psychological health, such as depression, through various pathways (e.g. inflammation). Research needs a better understanding of direct and indirect effects through examination of psychological factors that make people susceptible to, or offer protection against, depression.ObjectiveThis study investigated the relationships between gut microbiota, inflammation and psychological risk and resilience factors for depression.MethodsForty participants (13 m/27 f) recruited from the general population completed self-report questionnaires for depression, self-judgement, over-identification and affective and cognitive empathy. Faecal and blood samples were taken to assay microbiota (Bifidobacterium; Lactobacillus spp.) and pro-inflammatory molecules (C-reactive protein, CRP and interleukin-6, IL-6), respectively.ResultsHierarchical regression analyses (controlling for sex, age and the shared variance of risk and resilience factors) showed that (i) cognitive depression was significantly predicted by negative self-judgement and reduced cognitive empathy; (ii) abundance of Lactobacillus spp. was directly related to positive self-judgement but only indirectly to cognitive depression and lower affective empathy (both through self-judgement); and (iii) CRP was the strongest predictor of reduced cognitive empathy, with suppression effects seen for age (negative) and IL-6 (positive) after controlling for CRP.ConclusionsFindings suggest that lactobacilli and inflammation may be differentially associated with mood disorder via brain mechanisms underpinning self-judgement and cognitive empathy, respectively. Further trials investigating interventions to increase Lactobacillus spp. in depression would benefit from direct measures of self-judgement and affective empathic distress, whilst those that aim to reduce inflammation should investigate cognitive empathy.

Preschool Executive Control and Internalizing Symptoms in Elementary School.

Depression and anxiety are prevalent and impairing forms of psychopathology in children and adolescents. Deficits in early executive control (EC) may contribute to the development of these problems, but longitudinal studies with rigorous measurement across key developmental periods are limited. The current study examines EC in preschool as a predictor of subsequent depression and anxiety symptoms in elementary school in a community sample (N = 280). Child participants completed a battery of nine developmentally-appropriate tasks designed to measure major aspects of EC at age 5years, 3months. Children later participated in an elementary school follow-up phase, during which they completed validated norm-referenced self-report questionnaires of depression and anxiety symptoms in fourth grade. Results indicate that poorer preschool EC was significantly associated with both greater depression and anxiety symptoms in elementary school, controlling for baseline depression and anxiety symptoms in preschool and other relevant variables. These findings suggest that poor EC may be an important risk factor for the development of internalizing psychopathology in childhood. Given emerging evidence for the modifiability of EC, particularly in preschool, EC promotion interventions may hold promise as a potential target in psychopathology prevention.

Prognostic Utility of a Self-Reported Depression Questionnaire versus Clinician-Based Assessment on Renal Outcomes

Background: The prognostic utility of self-administered depression scales in chronic kidney disease (CKD) independent of a clinician-based major depressive disorder (MDD) diagnosis is neither clearly established nor are the optimal cutoff scores for predicting outcomes. The overlap between symptoms of depression and chronic disease raises the question of whether a cutoff score on a depression scale can be substituted for a time-consuming diagnostic interview to prognosticate risk. Methods: The 16-item Quick Inventory of Depression Symptomatology-Self Report scale (QIDS-SR₁₆) was administered to 266 consecutive outpatients with non-dialysis CKD, followed prospectively for 12 months for an apriori composite outcome of death or dialysis or hospitalization. Association of QIDS-SR₁₆ best cutoff score, determined by receiver/responder operating characteristics curves, with outcomes was investigated using survival analysis. The effect modification of an interview-based clinician MDD diagnosis on this association was ascertained. Results: There were 126 composite events. A QIDS-SR₁₆ cutoff ≥8 had the best prognostic accuracy, hazards ratio (HR) = 1.77, 95% CI 1.24-2.53, p = 0.002. This cutoff remained significantly associated with outcomes even after controlling for comorbidities, estimated glomerular filtration rate, hemoglobin and serum albumin, adjusted HR (aHR) = 1.80, 95% CI 1.23-2.62, p = 0.002, and performed similarly to a clinician-based MDD diagnosis (aHR = 1.72, 95% CI 1.14-2.68). Adjustment for MDD conferred the association of QIDS-SR₁₆ with outcomes no longer significant. Conclusions: QIDS-SR₁₆ cutoff ≥8 adds to the prognostic information available to practicing nephrologists during routine clinic visits from comorbidities and laboratory data. This cutoff score performs similar to a clinician diagnosis of MDD and provides a feasible and time-saving alternative to an interview-based MDD diagnosis for determining prognosis in CKD patients.

Postpartum physiology, psychology and paediatric follow up study (P4 Study) - Study protocol.

Women who have had hypertension in pregnancy are at greater risk of long term cardiovascular disease (CVD). Little is known about their cardiovascular risk postpartum or the effects on the woman's mental health and the outcomes of their infants. In this project we will study the physiological and psychological health of women and the physical health and development of their infants six months, two years and five years after birth. We will establish normal blood pressure (BP) and metabolic function for women who were normotensive in pregnancy and use these to assess women who had gestational hypertension (GH) or preeclampsia (PE). Women will be asked to participate if they have given birth in the preceding six months. They will be excluded if they had diabetes, hypertension, renal or other serious maternal disease prior to pregnancy or congenital anomaly in the pregnancy. We will recruit 292 women who were normotensive and their babies, 100 who had GH and 100 who had PE and their babies. They will be assessed at six months, two and five years after birth. At each assessment mothers will have their blood pressure (BP) assessed peripherally with a liquid crystal sphygmomanometer and 24h ambulatory blood pressure monitoring (ABPM), and centrally with non-invasive applanation tonometry. Additional physiological testing will include: body composition; energy balance; vascular compliance; cardiac function; liver and renal function, lipids and biochemistry; glucose and insulin; and urinalysis. Psychological status will be assessed with validated self-report questionnaires for depression, anxiety, post-traumatic stress disorder (PTSD) and mother-infant bonding. The babies will have a medical examination by a paediatrician at each assessment. Their behavioural development will be assessed with an Ages and Stages Questionnaire completed by their mother at each assessment and a developmental assessment by a child psychologist at two and five years. This study will re-define normal BP and other physiological parameters for young parous women thereby permitting a more sensitive assessment of post-partum BP and other cardiovascular risk markers in women who have had GH or PE. It will also determine the extent, if any, of psychological disorders in these women and developmental or other concerns in their babies. Australian and New Zealand Clinical Trials Registry Number: ACTRN12613001260718.

81 Postpartum physiology, psychology and paediatric study – P4 study

Background Women who have had hypertension in pregnancy are at greater risk of future cardiovascular disease. Little is known about their cardiovascular risk postpartum or the effects of hypertensive pregnancy on a woman’s mental health and the outcomes of her infant. Aims In this project we are studying the physiological and psychological health of women and the physical health and development of their infants six months, two years and five years after birth. We will establish normal ranges for women who were normotensive in pregnancy and compare these in women who had gestational hypertension (GH) or preeclampsia (PE). Methods Women are asked to participate if they have given birth in the preceding six months. Exclusion criteria include diabetes mellitus, chronic hypertension, renal or other serious maternal disease prior to pregnancy or congenital anomaly in the pregnancy. Recruitment has commenced for 300 women with prior normotensive pregnancy, 100 who had PE and 100 who had GH, and their babies. They are assessed at six months, two and five years after birth. At each assessment, women have their blood pressure (BP) assessed peripherally with a manual liquid crystal sphygmomanometer and 24 h ambulatory blood pressure monitoring, and centrally with non-invasive applanation tonometry. Additional physiological testing includes: body composition; energy balance; vascular compliance; cardiac function; liver and renal function, lipids and biochemistry; glucose and insulin; and urinalysis. Psychological status is assessed using validated self-report questionnaires for depression, anxiety, posttraumatic stress disorder and mother-infant bonding. The babies are examined by a paediatrician at each assessment. Their behavioural development is assessed with an age appropriate Ages and Stages Questionnaire completed by their mother at each assessment and a developmental assessment by a child psychologist at two and five years. Results Recruitment began in July 2013 and by the end of 2015, 210 women completed their six month assessments. Of the 210 women assessed, 161 were normotensive in pregnancy and 49 hypertensive (40 PE, 9 GH). Both groups were similar in age, ethnicity, level of education and body mass index (BMI). A number of abstracts will be presented at this meeting with progress results in more detail. Conclusions When complete, this study will re-define normal BP and other physiological parameters for young parous women thereby permitting a more sensitive assessment of post-partum BP and other cardiovascular risk markers in women who have had GH or PE. It will also determine the extent, if any, of psychological disorders in these women and developmental or other concerns in their babies.

Self‐reported versus informant‐reported depressive symptoms in adults with mild intellectual disability

Virtually nothing is known about potential differences in the types of depression symptoms reported by adults with mild intellectual disability (ID) on self-reported questionnaires as compared with the types of symptoms reported by caregivers on informant questionnaires. Moreover, little is known about how the presentation of depression among adults with mild ID varies based on socio-demographic characteristics. We compared findings from two self-reported questionnaires, the Self-Reported Depression Questionnaire (SRDQ) and the Glasgow Depression Scale for People with a Learning Disability (GDS), to that of an informant questionnaire of depressive symptoms, the Glasgow Depression Scale--Caregiver Supplement (CGDS), in 80 adults with mild ID. We also examined the association between age, sex, IQ and the presence of a co-occurring psychiatric disorder and frequency of affective, cognitive and somatic depressive symptoms in our sample of adults with mild ID. Adults with mild ID self-reported a higher frequency of affective and cognitive depressive symptoms than staff reported on the informant measure. Staff reported a higher frequency of somatic symptoms than adults with mild ID on one of the self-reported questionnaires (GDS) and a similar frequency on the other self-reported questionnaire (SRDQ). Important differences were found in the types of depressive symptoms based on their IQ, age and presence of a co-occurring psychiatric disorder. Informant questionnaires offer valuable information, but assessment should include self-reported questionnaires as these questionnaires add unique information about internalised experiences (affective and cognitive symptoms) of adults with mild ID that may not be apparent to caregivers. Health care providers should be made aware of the important differences in the presentation of depressive based on their IQ, age and presence of a co-occurring psychiatric disorder.

L’éducation thérapeutique de proximité

The American Psychiatric Association's recently revised guidelines for the treatment of major depressive disorder indicated that it is important to consider symptom severity in initial treatment selection. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we conducted two studies of psychiatric outpatients examining the correlates of severity classification based on a self-report depression scale. The first sample consisted of 470 depressed outpatients who completed the Clinically Useful Depression Outcome Scale (CUDOS) and measures of psychosocial morbidity at the time of presentation. The second sample consisted of 112 depressed outpatients who completed the CUDOS and were evaluated with the Hamilton Depression Rating Scale at baseline and after 3 months of treatment. Compared to mildly depressed patients, moderately depressed patients reported significantly more psychosocial morbidity across all functional domains. The same differences were found between moderately and severely depressed patients. Greater severity of depression was associated with lower rates of response and remission. The results of the present studies suggest that a self-report depression questionnaire can validly subtype depressed patients according to gradations of severity.

Determining severity subtypes of depression with a self-report questionnaire

The American Psychiatric Association's recently revised guidelines for the treatment of major depressive disorder indicated that it is important to consider symptom severity in initial treatment selection. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we conducted two studies of psychiatric outpatients examining the correlates of severity classification based on a self-report depression scale. The first sample consisted of 470 depressed outpatients who completed the Clinically Useful Depression Outcome Scale (CUDOS) and measures of psychosocial morbidity at the time of presentation. The second sample consisted of 112 depressed outpatients who completed the CUDOS and were evaluated with the Hamilton Depression Rating Scale at baseline and after 3 months of treatment. Compared to mildly depressed patients, moderately depressed patients reported significantly more psychosocial morbidity across all functional domains. The same differences were found between moderately and severely depressed patients. Greater severity of depression was associated with lower rates of response and remission. The results of the present studies suggest that a self-report depression questionnaire can validly subtype depressed patients according to gradations of severity.

Discriminative Hypomania Checklist-32 Factors in Unipolar and Bipolar Major Depressive Patients

Background: Although manic or hypomanic episodes define bipolar disorder (BD), most patients show a predominance of depressive symptomatology, often associated with delayed or disregarded BD diagnosis. The Hypomania Checklist-32 (HCL-32) has therefore been developed and tested internationally to facilitate BD recognition. Sampling andMethods: Five hundred seventy-one (563 eligible) patients diagnosed with a major depressive episode according to DSM-IV criteria were consecutively enrolled in a cross-sectional, multicenter, observational study (Come To Me). Lifetime manic or hypomanic features were assessed by the HCL-32, and severity of depressive and anxious symptomatology was assessed using the Zung’s self-report questionnaires for depression and anxiety. Results: Among the patients diagnosed with BD (n = 119), either type I or type II, the occurrence of (hypo)manic symptoms was significantly higher compared to major depressive disorder (MDD) symptoms according to HCL-32 total and subscale scores obtained using a score of 14, which ensured an optimal discrimination between BD and MDD with a sensitivity of 0.85 and a specificity of 0.78. Conclusions: Although some false positives might occur, the HCL-32 was confirmed to be a useful instrument in the detection of past hypomania in MDD patients, finally contributing to proper therapeutic choices.

Conduites alimentaires et symptômes émotionnels dans l’obésité infantile : étude exploratoire transversale à partir d’autoquestionnaires chez 63 enfants et adolescents

The main objective was to assess emotional symptoms (anxiety and depression) and to describe eating behaviours in a population of children and adolescents consulting for obesity. The second objective was to examine the interactions between these parameters. A cross-sectional exploratory study in obese children and adolescents was conducted using self-report questionnaires for depression (Child Depression Inventory), anxiety (State-Trait Anxiety Inventory for Children), binge eating (Binge Eating Scale adapted for children), emotional, external, and restrained eating (Dutch Eating Behaviour Questionnaire adapted for children) in obese children and adolescents, from both sexes, aged 7-15 years old. Fourty-one children and 22 adolescents were assessed, two-third were female, the mean age was 11 years ± 2.3 and the mean BMI z-score was 4.2 ± 0.9. Nearly half had significant anxiety, nearly one-third had depressive symptoms, and 15% had severe binge eating symptoms. Girls reported more anxiety than boys. Emotional and external eating, binge eating, and emotional symptoms were strongly associated. Binge eating was independently associated with emotional eating, depression, and anxiety (r=0.86, P<0.001). Emotional eating and emotional symptoms were strongly associated in the child and adolescent overweight population in these out-patient pediatric departments. Emotional symptoms and eating behavior assessments are needed in overweight children and adolescents in order to implement multidisciplinary treatment.

Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgeia

Interventions based on Cognitive Behavioral Therapy (CBT) are widely used to treat chronic pain, but the brain mechanisms responsible for these treatment effects are poorly understood. The aim of this study was to validate the relevance of the cortical control theory in response to an exposure-based form of CBT, Acceptance and Commitment Therapy, in patients with chronic pain. Forty-three female patients diagnosed with fibromyalgia syndrome were enrolled in a randomized, 12-week, waiting-list controlled clinical trial (CBT n=25; controls n=18). CBT was administered in groups of six patients during 12 weekly sessions. Functional magnetic resonance imaging (fMRI) during pressure-evoked pain was assessed before and after treatment or the 12-week period. Self-report questionnaires of depression and anxiety were administered pre- and posttreatment as well as 3months following end of treatment. Patients treated with CBT reported larger improvement of fibromyalgia on the Patient Global Impression of Change measure, and improved depression and anxiety symptoms, compared to the waiting-list controls. However, there were no effects on clinical pain or pain sensitivity measures. An analysis of fMRI scans revealed that CBT led to increased activations in the ventrolateral prefrontal/lateral orbitofrontal cortex; regions associated with executive cognitive control. We suggest that CBT changes the brain’s processing of pain through an altered cerebral loop between pain signals, emotions, and cognitions; leading to increased access to executive regions for reappraisal of pain. Our data thereby support our hypothesis about the activation of a cortical control mechanism in response to CBT treatment in chronic pain.

Positive and negative affect produce opposing task-irrelevant stimulus preexposure effects.

In three experiments, groups were exposed to either positive or negative affect video clips, after which they were presented with a series of task-irrelevant stimuli. In the subsequent test task, subjects were required to learn an association between the previously irrelevant stimulus and a consequence, and between a new stimulus and a consequence. Induced positive affect produced a latent inhibition effect (poorer evidence of learning with the previously irrelevant stimulus than with the novel stimulus). In opposition to this, induced negative affect resulted in better evidence of learning with a previously irrelevant stimulus than with a novel stimulus. In general, the opposing effects also were present in participants scoring high on self-report questionnaires of depression (Experiments 2 and 3). These unique findings were predicted and accounted for on the basis of two principles: (a) positive affect broadens the attentional field and negative affect contracts it; and (b) task-irrelevant stimuli are processed in two successive stages, the first encodes stimulus properties, and the second encodes stimulus relationships. The opposing influences of negative and positive mood on the processing of irrelevant stimuli have implications for the role of emotion in general theories of cognition, and possibly for resolving some of the inconsistent findings in research with schizophrenia patients.

An association between depressive symptoms and survival in incident dialysis patients

Depression in end-stage renal disease patients is detrimental to quality of life, and is also associated with adverse clinical outcomes. The aim of this study was to examine whether depression symptoms in 'incident dialysis' patients predicted survival. One hundred and sixty incident haemodialysis and peritoneal dialysis patients completed a self-report depression questionnaire (Beck Depression Inventory-II, BDI) at a point soon after dialysis initiation. Over the study period (May 2007-December 2009), patients were followed up with all-cause mortality recorded as the end point. The median follow-up time for the cohort was 511 days (min 47 days and max 1027 days). There were 27 deaths (16.9%). Depression symptoms were evaluated both as a continuous variable and using a defined cut-off for depressed patients (BDI ≥ 16). In a Cox proportional hazards model, adjusted for several covariates including albumin and extra renal comorbidity, depression score was an independent predictor of mortality (HR = 1.07, 95% CI 1.02-1.11, P = 0.002). In an additional adjusted model, a BDI score ≥ 16 was associated with a 2.7 times increase in the hazard for death (HR = 2.7, 95% CI 1.06-6.8, P = 0.037). The severity of depression symptoms following the start of dialysis treatment is an independent predictor of survival. Further studies will be required to determine whether the treatment of depression would alter health-related outcomes, including survival.