Severe Depression Research Articles

Anxiety and Depression in Emerging Adults: Exploring Identity Centrality, Disability Self-Identification, and Self-Concept

ABSTRACT Both identity and mental health disorders are independently well studied areas of research, yet little research has examined the ways in which mental health is incorporated (or not) into a person’s identity and whether such disorders are considered by individuals to be disabilities. To address this gap, college students with clinical anxiety and/or depression disorders (N = 126) were asked to complete an online survey regarding demographic characteristics, disorder symptomatology, self-concept, and identity. Descriptive results revealed that most students viewed anxiety and depression as being both central to their identities and as disabilities. Regression analyses revealed that being older and having more severe depression symptoms were associated with depression identity centrality, while identifying as bisexual was correlated with anxiety identity centrality. Increased severity of both anxiety and depression were related to identifying the disorder as a disability, and older students also were more likely to identify anxiety as a disability. Greater disability self-identification among those with depression was associated with higher self-esteem, suggesting that identifying depression as a disability might be beneficial to college students.

Mental health and attitudes toward suicide amongst individuals with gender dysphoria in Iran

IntroductionGender dysphoria (GD) is associated with profound mental health challenges, including heightened suicide risk. This study aimed to explore the mental health status and attitudes toward suicide among individuals with GD in Iran.MethodsA comprehensive assessment was conducted using three validated tools: the General Health Questionnaire (GHQ-28) to gauge emotional distress and psychological well-being, the Beck Depression Inventory (BDI-II) to evaluate the severity of depressive symptoms, and the Predicament Questionnaire (PQ) to measure attitudes toward suicide in the context of social crises.ResultsAmong the 78 participants, 43 (55.1%) were identified as experiencing significant mental health issues, while 21 (26.9%) were found to suffer from severe depression. The average PQ score was 57.92, which aligns with findings from similar populations in previous studies, highlighting a concerning trend in suicide-related attitudes. Further statistical analysis revealed significant correlations between psychological distress (GHQ-28 scores) and attitudes toward suicide (PQ scores), as well as between depressive symptoms (BDI-II scores) and suicide-related attitudes.ConclusionsThese findings indicate a pervasive prevalence of psychological disorders, particularly depression, within this group, and underscore the strong association between depressive states and suicidal ideation. The study underscores the urgent need for targeted mental health interventions and comprehensive healthcare policies tailored to the specific needs of individuals with GD in Iran. Given the substantial mental health burden observed, particularly the risk of suicide, this research highlights the critical importance of integrating mental health care into broader support systems for this population.

The role of psychotropics on the associations between extreme temperature and heat-related outcomes among people with mental health conditions: population-based study.

The association between heatwave and heat-related outcomes in people with mental health conditions with and without psychotropics was unclear. We identified people with severe mental illness (SMI) and depression, respectively, using Japanese claim data of Ibaraki prefecture during 1/1/2014-31/12/2021. We conducted self-controlled case series to estimate the incidence rate ratio (IRR) of heat-related illness, myocardial infarction and delirium, respectively, during 5-day pre-heatwave, heatwave, and 5-day post-heatwave periods v. all other periods (baseline) within an individual, stratified by periods prescribed psychotropics and periods not prescribed psychotropics, respectively. Among people with SMI, heatwave was associated with an increased rate of heat-related illness v. baseline, with no evidence of a difference in the IRRs between those prescribed v. not prescribed antipsychotics (IRR: 1.48 [95% CI 1.40-1.56]; 1.45 [95% CI 1.35-1.56] respectively, p interaction: 0.53). Among people with depression, heatwave was similarly associated with heat-related illness, with no evidence of a difference in the IRRs between those prescribed v. not prescribed antidepressants (IRR: 1.54 [95% CI 1.46-1.64]; 1.64 [95% CI 1.57-1.71] respectively, p interaction: 0.33). Smaller increased rates of heat-related illness were also observed in pre- and post-heatwave periods, v. baseline in both cohorts. There was weak evidence of an increased risk of MI and delirium associated with heatwave v. baseline. We showed an increased risk of heat-related illness, myocardial infarction and delirium associated with heatwave in people with mental health conditions regardless of whether being prescribed psychotropics. Risks of heat-related illness, myocardial infarction and delirium associated with heatwave might not be factors to influence decisions about the routine use of psychotropics.

Severe depression episode with an incredible improvement after electroconvulsive therapy

Aim: The primary aim of this article is to present a case study of a patient with severe depressive episode that was refractory to extensive pharmacological treatment, but exhibited remarkable improvement following electroconvulsive therapy (ECT). Materials and Methods: The patient’s medical records were obtained from II Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin. Cited literature was searched on the PubMed database using the following keywords: Major depressive disorder or MDD, Electroconvulsive therapy, and Benzodiazepine dependence. Results and conclusions: A 55-year-old woman with recurrent depressive disorder and benzodiazepine dependance, unresponsive to multiple medications, requested an ECT. She was then treated with a cycle of 12 Seizure Electroconvulsive Therapy (SECT) sessions. Initially bedridden with severe anxiety, suicidal thoughts, and no clinical improvement despite maximal pharmacotherapy, she exhibited significant improvement after three SECT sessions. Her anxiety decreased, suicidal ideation resolved, and symptoms of anergy and anhedonia diminished. At the end of the SECT cycle, the patient's mood stabilised, and her activity level and social engagement increased. At discharge, she showed no suicidal ideation, tendencies, or psychotic symptoms.This case demonstrates the effectiveness of ECT in treating severe, pharmacologically resistant depressive episodes. It highlights the importance of considering patient requests in conjunction with clinical assessments to achieve positive outcomes. Raising awareness about ECT's safety and efficacy among the public and mental health professionals is crucial for optimizing treatment strategies for severe depression. Proper qualification and timely administration of ECT can significantly enhance treatment outcomes beyond pharmacotherapy alone.

A depressed patient in outpatient settings

Depression is a clinically significant and growing public health issue. As a major global disease burden, its prevalence has been steadily increasing over the years, affecting different demographic groups. Depressive disorder is characterized by a low mood, loss of strength, sadness, insomnia, and inability to feel pleasure. In outpatient settings, up to one-third of patients with depressive symptoms may have a comorbidity. Many different diseases have been associated with depressive symptoms. Cardiovascular, metabolic, inflammatory, oncological, and neurological disorders are associated with an increased risk of depression, potentially due to chronic inflammation, neurochemical dysregulation, and emotional and social issues. As different drugs can cause depressive symptoms, the patient's medical history should include an assessment of the use of such drugs. Primary care physicians play an important role in identifying and treating depression. It is recommended to perform depression screening in all adult female patients in primary care facilities. There are general recommendations for the initial treatment of mild to moderate depressive disorder in adults. In mild depression, initial preference should be given to psychotherapy and symptom monitoring, and if improvement is insufficient, pharmacotherapy is to be used. Psychotherapy, pharmacotherapy or a combination of both should be considered for patients with moderate depression. Psychiatric consultation is recommended for patients with severe depression and urgently for any patient with psychotic symptoms or suicidal thoughts and behaviour. Antidepressants are the basic therapy for depression. Selective serotonin reuptake inhibitors are considered the first-line drugs to treat depression.

What is the role of cognitive-behavioral career coaching in mitigating work anxiety and depression among public employees?

This editorial explores the study by Mkpoikanke Sunday Otu and Maximus Monaheng Sefotho on the use of cognitive-behavioral career coaching (CBCC) to reduce work anxiety and depression among public employees. Public sector workers often face significant psychological stressors, leading to mental health issues that impair well-being and job performance. The study employed a group-randomized trial design, involving 120 public employees diagnosed with severe anxiety and depression. Participants were divided into a treatment group, receiving CBCC, and a control group with no intervention. Results showed a significant reduction in anxiety and depression levels in the treatment group, sustained through follow-up assessments. The findings underscore the clinical relevance of CBCC as an effective intervention for improving mental health among public employees. Future research should explore the scalability of CBCC across different sectors and cultural contexts, as well as its integration with other mental health interventions. This editorial advocates for the broader implementation of CBCC practices in public service to enhance employee productivity and psychological well-being. By addressing cognitive distortions and fostering adaptive coping mechanisms, CBCC can help public employees navigate complex professional environments, ultimately contributing to a healthier and more efficient workforce.

Real-world effects of antidepressants for depressive disorder in primary care: population-based cohort study.

Antidepressants' effects are established in randomised controlled trials (RCTs), but not in the real world. To investigate real-world comparative effects of antidepressants for depression and compare them with RCTs. We performed a cohort study based on the QResearch database. We included people with a newly recorded diagnosis of depression, exposed to licensed antidepressants in the UK. We assessed all-cause dropouts (acceptability), dropouts for adverse events (tolerability), occurrence of at least one adverse event (safety), and response and remission on the Patient Health Questionnaire (PHQ)-9 (effectiveness) at 2 and 12 months. Logistic regressions were used to compute adjusted-odds ratio (aOR) with 99% CIs, assessing the associations between exposure to each antidepressant against fluoxetine (comparator) and outcomes of interest. We compared estimates from the real world with RCTs using ratio-of-odds ratio (ROR) with 95% CI. A total of 673 177 depressed people were studied: females 57.1%, mean age 42.8 (s.d. 17.7) years, mean baseline PHQ-9 17.1 (s.d. 5.0) (moderately severe depression). At 2 months, antidepressant acceptability was 61.4%, tolerability 94.4%, safety 54.5%, PHQ-9 decreased to 12.3 (s.d. 6.5). At 12 months, acceptability was 12.3%, tolerability 87.5%, safety 28.8%, PHQ-9 12.9 (s.d. 6.8). In the short and long term, tricyclics, mirtazapine and trazodone were worse than fluoxetine for most outcomes; citalopram had better acceptability than fluoxetine (aOR 0.95; 99% CI 0.92, 0.97), sertraline had lower tolerability (aOR 1.12; 99% CI 1.06, 1.18), and both citalopram and sertraline had lower safety (aOR 1.17 and 1.25, respectively). In the long term, citalopram had better acceptability (aOR 0.78; 99% CI 0.76, 0.81) and effectiveness (aOR 1.12 for both response and remission), but worse tolerability (aOR 1.09; 99% CI 1.06, 1.13) and safety (aOR 1.12; 99% CI 1.08, 1.16). Observational and randomised data were similar for citalopram and sertraline, while there was some difference for drugs less prescribed in the real world. Antidepressants showed low acceptability, moderate-to-high tolerability and safety, and small-to-moderate effectiveness in the real world. Real-world and RCT estimates showed similar findings only when the analyses were carried out using large datasets; otherwise, the results diverged.

Severe depression association with the addiction to fast food and smartphones in Jordanians: a cross-sectional study

BackgroundThe connection between psychiatry health, mental health, and lifestyle is under-studied in the Arab world. This study examined whether addictions to smartphones and fast food are associated with severe depressive symptoms in a cohort of Arab Jordanians.MethodThis research is cross-sectional. The Patient Health Questionnaire-9 was used to measure the severity of depression (PHQ-9), food addiction was assessed using the 9-item Modified Yale Food Addiction Scale (mYFAS), and smartphone addiction was assessed using the Arabic-validated Smartphone Addiction Scale. Using multivariable binary logistic regression, the relationship between food addiction, and depressive symptoms. Results: Data were analyzed from 426 participants, 264 participants (62.0%) reported being addicted to smartphones, and 156 (36.6%) reported severe depressive symptoms. The multivariable binary logistic regression revealed that severe depression was significantly associated with lower income (OR = 2.14, 95% Cl 1.34–3.41, P = 0.001), addiction to smartphones (OR = 2.15, 95% = 1.39–3.32, P = 0.001), and increased addiction to fast food (OR = 1.06, 95% = 1.04–1.08, P = < 0.001).ConclusionAddiction to smartphones, addiction to fast food, and low income were all associated with severe depression in Arab Jordanians, community awareness is highly required to adopt a healthy lifestyle.

Preventing Depression Among Older Adults With Severe Illness: The Mediating Role of Life Satisfaction and the Moderating Role of Gender.

The occurrence of severe illness, the risk for which increases as people age, often results in depression. The current study aimed to explore how and when severe illness leads to depression among older adults. Data collected from a sample of 756 older adults were analyzed using moderated mediation analysis to examine the underlying mechanism between severe illness and depression. Results, as verified by a robustness check, demonstrated that life satisfaction mediated the association between severe illness and depression among older men and women, and that gender moderated the direct relationship between severe illness and depression. The formation path of depression from severe illness among older adults varies according to gender. For men, severe illness did not directly trigger depression, but indirectly triggered depression through decreased life satisfaction; for women, severe illness not only triggered depression directly, but also indirectly triggered depression through decreased life satisfaction. Results yield theoretical and practical implications for gerontological nursing. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

Effects of support systems on the mental health of nursing students during the COVID-19 pandemic

Mental Health has been declining over the last three years, coinciding with the COVID-19 pandemic. A person’s support system can either improve or worsen their mental health. Nursing students likely have been severely impacted by COVID-19 and their support system may impact their mental health. This study used the Depression, Anxiety, and Stress Scale (DASS-21) and the Social Support Scale to measure the effects of a positive and negative social support system on undergraduate nursing students at a university in the Western United States during the COVID-19 pandemic. Descriptive statistics and correlations were used to examine the relationships between stress, anxiety, and depression and support systems among undergraduate nursing students. Data were collected from students prior to the start of their program through two pre-course surveys, including the DASS-21 symptom measure and a 11-item Social Support Scale. Both surveys had established reliability and validity. Results showed that 17.8% of participants scored with severe or extremely severe anxiety, 6.6% with severe or extremely severe depression and 6.7% with severe or extremely severe stress. The average score for instrumental support was M = 4.22 (SD = 0.72), positive support was M = 4.29 (SD = 0.73) and negative support was M = 3.96 (SD = 0.87). The correlational analyses support a significant relationship between negative support and stress (r = .26). The results indicate that nursing students had a strong positive and instrumental support system in place. The results also show a low number of students reporting negative social support. However, the significant correlation between negative social support and stress indicates the harmful effects of a negative support system on a student’s mental health when it did occur. These results help us to further understand how the COVID-19 pandemic impacted the mental health of undergraduate nursing students.

Postpartum depression in Gujarat, India: Associations with social support, breastfeeding attitudes, and self-efficacy

ABSTRACT Background: Postpartum depression (PPD) is a significant public health concern with detrimental effects on maternal and child well-being. Social support, breastfeeding attitudes, and self-efficacy have been identified as potential protective or risk factors for PPD. This study aimed to investigate the associations between PPD, social support, breastfeeding attitudes, and self-efficacy among postpartum women in Gujarat, India. Methods: A cross-sectional study was conducted among 403 postpartum women in Gujarat, India. Data on sociodemographic characteristics, obstetric factors, PPD (assessed using the Edinburgh Postnatal Depression Scale), social support, breastfeeding attitudes, and self-efficacy were collected through structured interviews. Bivariate and multivariate logistic regression analyses were performed to examine the associations between PPD and the independent variables. Results: The prevalence of PPD in the study population was 50.1% (n = 202), with 28.8% (n = 116) experiencing mild depression, 16.6% (n = 67) moderate depression, and 4.7% (n = 19) severe depression. Lower educational level (n = 120, 29.8%; AOR: 1.72, 95% CI: 1.04–2.85), lower socioeconomic status (n = 242, 60%; AOR: 1.84, 95% CI: 1.12–3.02), non-exclusive breastfeeding (n = 167, 41.4%; AOR: 1.68, 95% CI: 1.11–2.54), low social support (n = 101, 25.1%; AOR: 2.51, 95% CI: 1.57–4.02), and a history of depression (n = 93, 23.1%; AOR: 2.94, 95% CI: 1.82–4.75) were significantly associated with higher odds of PPD in the multivariate analysis. In addition, negative breastfeeding attitudes and low self-efficacy levels were associated with increased odds of PPD. Conclusions: The findings highlight the significant associations between PPD and various sociodemographic, obstetric, and psychosocial factors among postpartum women in Gujarat, India. Interventions targeting social support, breastfeeding attitudes, and self-efficacy, as well as targeted support for women with identified risk factors, may help mitigate the burden of PPD and promote maternal well-being.

A community-based peer-facilitated psychological and social support model to improve retention in care among Cameroonian adolescents perinatally infected with human immunodeficiency virus: A randomized controlled trial

BackgroundPsychological and social support for adolescents living with HIV remains undocumented and unaddressed in Central Africa. This study aimed at assessing effectiveness of a peer-facilitated community-based support model in improving retention in care among adolescents living with HIV and attending care in Chantal Biya Foundation, Yaounde, Cameroon. Materials and methodsWe conducted an analysis of adolescents aged 10–19 years old, perinatally infected with HIV, on follow-up in the Day Care Unit of a reference hospital in Yaounde, Cameroon, and enrolled in the IAS-CIPHER-2021/1214-ATE-SMAVI, a individually randomized controlled trial. While the control arm only received routine care in the health facility, the intervention arm, in addition, was assigned to an HIV association for sustained support model, including support groups, leisure workshops and home visits. Structured questionnaires, including validated French versions of mental health scales, were quarterly administered to the study participants in both study arms by trained healthcare providers. The main outcome was maintaining retention in care beyond the first 15-month period of the study start. Kaplan-Meier and Cox regression models were fitted to assess association between intervention and outcome. Hazard Ratio (HR) across categories of exposure variables were compared using Wald's test. p-value <0.05 was considered significant. ResultsIn total, 305 adolescents were recruited in the study at a median age of 15.2 years old, including 162 (53.1 %) females and 153 individuals in the intervention arm. Mental health troubles were prevalent: severe depression (26.9 %), high or very high anxiety (28.9 %), and low self-esteem (84.9 %). Noteworthy, all of the baseline characteristics were balanced irrelevant to the study arm. Probability of maintaining good retention in care beyond the first 15-month period of study start remained higher in the intervention arm (82.0 % [95 %CI: 73.7 %-88.4 %]) versus the control arm (71.0 % [95 %CI: 63.2 %-78.1 %]), [cHR (95 %CI): 2.0 (1.1–3.3), p=0.044]. ConclusionsCapacity should be built in terms of implementing community-based peer-facilitated support groups in local organizations providing care to adolescents living with HIV.

Identifying Pain Subtypes in Patients with Craniofacial Lesions of Fibrous Dysplasia/McCune-Albright Syndrome

BackgroundFibrous dysplasia/McCune-Albright Syndrome (FD/MAS) is a genetic disorder, marked by bone lesions, often affecting the craniofacial skeleton. Pain is a prevalent yet heterogenous symptom reported by patients with craniofacial FD. Effective treatments are currently lacking, posing a significant clinical challenge to patient care. PurposeThis preliminary study examined pain profiles in craniofacial FD and aimed to identify subtypes of patients based on pain phenotypes and emotional health. Study Design, Setting, SampleA prospective, cross-sectional study involving 15 patients with FD/MAS, conducted at Boston Children’s Hospital and Massachusetts General Brigham’s Hospitals. Predictor/Exposure/Independent VariableHeadache frequency, craniofacial pain severity, neuropathic pain quality, pain interference, allodynia, photophobia, depression, and anxiety were assessed using clinical questionnaires. Main Outcome Variable(s)The primary outcome variable was the symptom profile derived from standardized clinical questionnaires and analyzed using Principal Component Analysis (PCA) and K-means clustering. CovariatesCovariates included demographic data, diagnosis, and lesion location(s). AnalysesPCA and K-means clustering of patient-reported measures of pain and emotional health were performed. Analysis of variance was conducted to determine significant differences among patients subtypes. Statistical significance was set at (p < 0.05) ResultsThe study included 15 subjects with FD/MAS, with a mean age of 36.2 (13.9) years, including one male. Clustering analysis identified three subtypes of patients with distinct symptom profiles. Cluster 1 (n=2) averaged 70 (28.3) headache days in a 90-day period, pain level of 7.5 (0.7) on a 0-10 scale, and severe anxiety, depression, allodynia, photophobia, and pain interference. Cluster 2 (n=7) patients reported an average of 5.4 (7.5) headache days, average pain level of 2.7 (2.6), mild or no anxiety, depression, allodynia, photophobia, and pain interference. Cluster 3 (n=6) patients displayed a mixed symptom profile with an average 47.3 (36.4) headache days and pain level of 5.25 (1.4). Notably, patients with temporal and skull base lesions were predominantly found in Clusters 1 and 3, which exhibited the most severe symptomatology. Conclusions and RelevanceThis study establishes a basis for future longitudinal research aimed at understanding underlying pain mechanisms and evaluating the response to personalized pain management strategies in subtypes of patients with craniofacial FD.

Psychometric properties of the Bipolar Spectrum Diagnostic Scale in depressed youth.

Youth with depression may be at a higher risk of developing bipolar disorder (BD). Self-reported, dimensional measures, like the Bipolar Spectrum Diagnostic Scale (BSDS), aim to assess for BD in these groups. We explored properties of this instrument within a cohort of depressed, help-seeking youth. We used baseline data from two randomized controlled trials for depressed youth (aged 15-25 years) who had no history of BD or psychosis and who completed the BSDS (n = 240; mean Age = 19.9 years, SD = 2.7; Female = 57 %). Structured diagnostic assessments were repeated at 26-weeks to detect new-onset BD. We examined false-positive rates for concurrent BD using established thresholds on the BSDS, utilised factor analyses to determine its underlying structure, and explored associations between the BSDS and demographic, clinical, and personality variables using linear regressions. False-positives rates were high. Most (60 %) participants scored above BSDS thresholds at baseline, though none developed BD over the 26-week study period. A three-factor model best fit BSDS items, representing depression, mania, and lability factors. BSDS total, mania and lability sub-scale scores were associated with similar characteristics, with a different pattern of association for the BSDS depression subscale. With no long-term follow-up of the current sample nor a separate bipolar youth sample, we were unable to determine the overall discriminant validity, sensitivity, or longer-term predictive validity of the BSDS. At recommended thresholds, BSDS has high false positive rates for detecting current BD in youth with moderate to severe depression, especially with mental state or personality disorder comorbidities.

THE IMPACT OF VITAMIN D AND INTERLEUKIN-6 AS RISK FACTORS ASSOCIATED WITH DEPRESSION ADOLESCENTS

Background: Adolescents face an increased risk of depression due to hormonal fluctuations and the impact on physiological and immunological biomarkers, which are associated with a heightened risk of symptoms of depression during puberty. Aims: Investigate the roles of interleukin-6 (IL-6) and vitamin D (Vt.D) as influential factors in increasing the risk of depression among adolescents. Methods: Cross-sectional study of 130 adolescents aged 12 to 18, between November 2023 and February 2024. This study examined serum IL-6 and Vt.D levels. Additionally, the calculation relies on the Beck Depression Inventory to measure the severity of depression. Results: Adolescents have a significant increase in depression symptoms, with 59.2% showing signs of depression. Depressed adolescents show a significant increase (p&lt;0.001) in IL-6 and decreased Vt. D levels compared to non-depressed individuals. Depression scores were significantly correlated positively with IL-6 levels and negatively with Vt. D levels and Linear regression analysis exhibit a significant positive predictor of IL-6 (B: 4.430; 95% CI: 3.023 to 5.836). Vt. D is a significantly negative predictor (B: -0.145; 95% CI: -0.220 to -0.071) associated with depression scores. Logistics regression showed the risk of depression is higher in females (59.7%; OR: 2.33; p=0.002) compared to males (40.3%; OR: 0.939; p=0.803), overweight and obese adolescents (OR: 3.750, p=0.019; and OR: 2.333, p=0.022), than normal weight and underweight peers. They highly predicted depression in adolescents with deficiency Vt. D (OR: 24.4, p&lt;0.001), and depressed severity increased with no take Vt. D supplement (OR: 1.769, p=004), more than those who had taken Vt. D Supplement (OR: 0.571, p=0.207). Discussion: Vitamin D affects serotonin synthesis by a unique biological mechanism. Serotonin is always involved in the pathophysiology of depression. Vitamin D may have a neuroprotective effect on the inflammatory process in the body. Support immunomodulation leads to an increase in inflammatory cytokines and vitamins, which suppresses the synthesis of inflammatory cytokines such as IL-6 by monocytes. Conclusions: The likelihood of severe adolescent depression was found to be associated with elevated IL-6 levels and a deficiency in Vitamin D, serving as available predictors.

Exploring the effects of erythropoietin treatment on cortical thickness and hippocampal volume in patients with mood disorders undergoing electroconvulsive therapy: A randomized, placebo-controlled trial.

Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression. However, its utilization is limited to the most severely ill patients due to stigma, healthcare provider unfamiliarity, and concerns regarding cognitive side effects. Erythropoietin (EPO) is a promising add-on treatment during ECT due to its potential to increase neuroplasticity and cognition. To explore the effects of EPO administration on cortical thickness and hippocampal volumes. In a randomized, double-blinded, placebo-controlled trial, we previously investigated the impact of EPO (40,000 IU) versus placebo (saline) infusions on cognitive side effects of unipolar or bipolar depression patients undergoing eight ECT sessions over 2.5 weeks. This cross-sectional magnetic resonance imaging study explores the effect of EPO on cortical thickness and hippocampal volumes 3 days post-ECT in 37 of the EPO trial patients (EPO n = 21; placebo n = 16). Compared to the placebo group, EPO-treated patients displayed thicker cortex in distributed regions of the right hemisphere, predominantly in the parietal and occipital areas. There were no significant group differences in the hippocampal volumes or prefrontal cortex thickness. EPO treatment may produce a selective increase in the right-side occipito-parietal cortical thickness. In contrast, the thickness of other cognition-relevant structures was not significantly affected. This aligns with our previously reported finding that EPO has a selective effect on autobiographical memory and associated right-side parietal activity in the absence of changes in global cognition. It remains to be investigated whether longer EPO treatment and follow-up assessment may be necessary for overt structural changes in cognition-relevant brain networks.

Behind the Rubble: Psychological Trauma of wars and genocide on Women and Children in Gaza

This paper explores the profound psychological trauma experienced by children and women in Gaza as a result of decades of conflict, occupation, and military aggression. The Israeli blockade and recurrent military assaults have created a continuous cycle of violence, systematically eroding the mental health of Gaza’s population, particularly its most vulnerable groups. Women and children in Gaza are disproportionately affected, with many suffering from Complex Continuous Traumatic Stress (CCTS) due to chronic exposure to trauma without the opportunity for recovery. This trauma manifests in severe mental health disorders, including PTSD, anxiety, depression, developmental delays, and cognitive impairments. The genocidal violence since October 7th, 2023, has intensified these issues, with indiscriminate killings and the destruction of essential infrastructure further devastating the population. While mental health interventions have been proposed, true healing cannot begin without addressing the underlying causes of oppression. This paper argues that the mental health crisis in Gaza is inextricably linked to the Israeli occupation and calls for a comprehensive approach that includes ending the occupation and restoring basic human rights for Palestinians to facilitate meaningful psychological recovery.

Dietary intake and quality in irritable bowel syndrome: a comparative study with controls and the association with symptom severity.

Patients with irritable bowel syndrome (IBS) often attribute the onset or worsening of gastrointestinal symptoms to intake of food. Hence, in order to alleviate symptoms, patients with IBS may avoid triggering foods, potentially impacting their dietary intake and diet quality. This study aimed to compare the habitual diet intake and quality of IBS patients with controls, and to explore the association between dietary habits and symptoms in IBS patients. IBS patients were included from four clinical studies reporting habitual dietary intakes at baseline. Age- and sex-matched controls representing the general population were derived from the Swedish population-based Riksmaten study. Dietary intakes were assessed using 4-day food diaries. Diet quality was measured using a diet quality index (DQI-SNR), and diet diversity was scored based on the variety of food groups consumed. The study included 646 patients with IBS and 646 controls (38±14 years, 77% female). Both groups adhered to Nordic nutrition recommendations for macronutrients, except patients consumed fewer carbohydrates. Patients reported eating less carbohydrates, coffee, and dairy products, and more fats, lactose-free dairy products, and nuts and seeds compared to controls. Fewer patients had a good diet quality according to the DQI-SNR. In patients, symptom severity and gastrointestinal-specific anxiety were associated with reduced energy and carbohydrate intake, lower diet diversity, and worse diet quality. Poor diet quality was associated with younger age, more severe IBS symptoms, anxiety, and depression. Patients with IBS exhibit different dietary patterns compared to controls, with poorer dietary habits linked to more severe symptoms. Understanding food-symptom associations may enhance the optimization and personalization of dietary management for IBS patients.

The Impact of Post-Traumatic Stress Disorder Symptoms on Depressive Symptoms and Health-Promoting Behaviors Among Korean Coast Guards: The Mediating Role of Social Support.

Post-traumatic stress disorder (PTSD) can result in severe depression. Yet, it is not clear how to improve health-promoting behavior and reduce depressive symptoms. This study aimed to examine whether social support mediates the link between PTSD, depression, and health-promoting behaviors. A cross-sectional study was conducted with 308 Korean Coast Guards in Gangwon-do, South Korea, in October and November 2020. The variables of PTSD and depressive symptoms were assessed using the Korean versions of the Impact of Event Scale-Revised and the Center for Epidemiologic Studies Depressive Scale-Revised. Health-promoting behaviors and social support were assessed using the Health-Promoting Lifestyle Profile-II and the Korean version of the Personal Resource Questionnaire 85-Part 2. Multiple regression analysis and Sobel tests were performed. Higher levels of PTSD symptoms and lower levels of social support were significantly associated with higher levels of depressive symptoms. Social support had a significant partial mediating effect on the association between PTSD and depressive symptoms. In addition, lower levels of PTSD symptoms and higher levels of social support were significantly associated with higher levels of health-promoting behaviors. Social support has a full mediating effect on the association between PTSD symptoms and health-promoting behaviors. Our findings indicate that social support may mediate the association between PTSD symptoms and health outcomes. Occupational health nurses can use these findings to proactively develop interventions which improve social support for coast guard workers who are at risk of developing PTSD due to exposure to traumatic events on their job.

Relationship of interoceptive accuracy in acne vulgaris patients: A prospective, controlled study.

Acne vulgaris (AV) is a chronic inflammatory skin condition predominantly observed during adolescence. Interoception accuracy (IAc) refers to the ability to perceive internal bodily states such as hunger and thirst. Since the brain and skin originate from the same embryological layer, the ectoderm, it is hypothesized that skin changes and disorders might affect individual perceptions. The purpose of this study is to evaluate the relationship between IAc and AV. This study included 94 AV patients and 94 sex- and age-matched healthy controls. The participants completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Dermatology Life Quality Index (DLQI), and heartbeat perception task to assess IAc. The severity of acne was assessed using the Global Acne Grading System (GAGS). Acne patients had lower IAc scores than controls did (P = 0.026). Severe depression or anxiety symptoms were associated with lower IAc scores (P = 0.027, P = 0.046). Acne severity did not significantly affect IAc scores. There was a weak negative connection between the DLQI score and IAc (r = -0.208, P = 0.022), suggesting that lower quality of life is correlated with reduced IAc. Gender significantly influenced IAc. As a result, individuals with acne may have a reduced capacity to accurately perceive internal bodily states, potentially impacting overall well-being. Enhancing interoception might positively contribute to AV treatment and management.