Severe Depression Research Articles

Impact of high-frequency rTMS combined with pharmacotherapy on the left dorsolateral prefrontal cortex in treating major depressive disorder: A real-world study

BackgroundRepetitive transcranial magnetic stimulation (rTMS) combined with pharmacotherapy is a promising treatment method for depression. However, its treatment mechanism needs further research. MethodsThis study recruited 38 healthy individuals (HC) and 52 patients with severe depression (MDD) and divided patients into two treatment groups: the rTMS combined antidepressant (rTMS+ADP) group and the single antidepressant (ADP) group. We used functional magnetic resonance imaging to calculate the fractional amplitude of low-frequency fluctuations (fALFF) in the left dorsolateral prefrontal cortex (DLPFC) to investigate the functional change after treatment. ResultThe fALFF in the left DLPFC was significantly lower in the MDD group than that in the HC group (p < 0.05). In addition, fALFF values of the left DLPFC negatively correlated with HAMD-24 scores (r = −0.294, p = 0.005). After treatment, both MDD groups showed a significant decrease in HAMD-24 scores, with a response rate of 88.89 % and a remission rate of 62.96 % in the rTMS+ADP group, compared to 64 % response and 56 % remission rates in the ADP group. The fALFF values in patients' left DLPFC significantly reduced in the rTMS+ADP group (p < 0.05), but not in the ADP group. LimitationsOur study only focused on the treatment effect in the left DLPFC, without exploring the other brain regions or networks. ConclusionsThis study emphasizes the significance of the left DLPFC in MDD treatment. However, combined left DLPFC rTMS with ADP causes deviation from the normal resting brain function of the left DLPFC, indicating that future research should explore targeted treatment methods to normalize the left DLPFC.

Electroconvulsive therapy combined with esketamine improved depression through PI3K/AKT/GLT-1 pathway

Neuron excitotoxic damage induced by extracellular glutamate accumulation pathologically is one of the main mechanisms of depression. Glutamate transporter-1 (GLT-1) expressed in astrocyte is responsible for glutamate clearance to maintain glutamate balance. Electroconvulsive therapy (ECT) is prevalently recommended for severe depression due to its significant anti-depressant effect. Esketamine could offer advantages of rapid anti-depressant effect and neuron protection. The aim of this study is to investigate the anti-depressant efficacy of esketamine plus ECT, and further to explore the mechanism.Firstly, total 12 patients were randomized into anesthesia with propofol (P) or propofol+esketamine (PK) before ECT. 24-Hamilton Depression Scale (HAMD) was used to evaluate the severity of depression after each ECT. Then, depressive rat model was built using chronic unpredictable mild stress method, and subsequently received infusion of esketamine (5 mg/kg) or saline before ECT treatment (0.5 mA; 100 V) for consecutive 10 days. Tests including sucrose preference test, open field test and forced swimming test were used to evaluate depression-like behaviors. In next experiments, rats were injected with RIL, DHK or LY294002 intracerebroventricularly for continuous 10 days before individual treatment.After the fifth and sixth ECT, PK group displayed lower HAMD score compared to P group. In rat model, we found that esketamine plus ECT could significantly improve depression-like behaviors and decrease glutamate level. Esketamine and ECT could both activate PI3K/Akt/GLT-1 pathway. The GLT-1 agonist RIL made equivalent effect as esketamine plus ECT. Furthermore, after using PI3K/Akt inhibitor LY294002 and GLT-1 inhibitor DHK, esketamine plus ECT could neither improve depression-like symptoms, nor upregulate GLT-1 level. Our present study suggested that esketamine plus ECT could dramatically improve depression symptom. The activation of PI3K/Akt/GLT-1 pathway may be the potential mechanism.

Spiritual coping “tri hita karana” and depression prevention behavior among the elderly during the Covid-19 pandemic

The elderly commonly struggle with mental health issues, especially depression. Spiritual coping is one of the factors that might prevent depression. The aim of this study is to investigate cultural involvement in spiritual coping to depression prevention among the Balinese elderly.From January to March 2021, this study was carried out on 273 elderly members of the Integrated Primary Public Health service in seven districts in Gianyar, Bali. The study used a cluster random sampling method to collect data and focused on quantitative measurements related to participant characteristics, depression prevention, and spiritual coping. The investigation into spiritual coping was based on the tri hita karana, a concept from Balinese philosophy. Bivariate analysis was used to assess the relationship between spiritual coping and depression prevention behaviour. The study comprised 146 male and 127 female participants aged between 65 and 79 years old.Among all participants, 190 (69,6%) were diagnosed with mild to moderate depression, while 83 (30,4%) with moderate to severe depression. However, for the majority, depression prevention was good 163 (59,7%), the rest was moderate 103 (37,7%), and poor 7 (2,6%). Tri hita karana spiritual coping for the majority was good 17 (53,8%). Spiritual coping has a strong correlation with depression prevention (r=0.230). Thus, spiritual coping has a strong correlation with depression prevention among the Balinese elderly.It can be concluded that the implementation of tri hita karana becomes a potent spiritual coping enhance depression prevention. Indigenous philosophy embedded in daily life supports social capital in dealing with stress.

Safety and Efficacy of Mirtazapine Compared to Sertraline in Hemodialysis Patients with Major Depressive Disorder: A Randomized Controlled Clinical Trial

Background: This study aimed to compare the efficacy and tolerability of mirtazapine and sertraline in moderately depressed patients undergoing chronic hemodialysis therapy. Methods: In this double-blind clinical study, 54 hemodialysis patients diagnosed with moderate to severe depression, scoring greater than 18 on the Beck Depression Inventory, version II (BDI-II), were randomly assigned to receive 12 weeks of treatment with either mirtazapine (15mg/day) plus placebo or sertraline (50 mg/day) plus placebo. Efficacy outcomes were assessed by evaluating changes in baseline BDI-II scores, as well as rates of response and remission at weeks 2, 4, 8, and 12 of treatment. The impact of the antidepressant treatment on the patient’s health-related quality of life was also assessed at the end of the treatment phase, with ratings ranging from 0 (the worst impact) to 10 (the best impact). Safety and tolerability of the study medications were monitored using an antidepressant side effect checklist and through spontaneous participant reports. Both efficacy and tolerability analyses were conducted on the intent-to-treat sample. The p-values less than 0.01 based on Bonferroni's multiple-testing correction method were considered statistically significant. Results: The mixed models for repeated measures analysis revealed a significant time effect on depression symptoms (p &lt; 0.001), indicating improvement in both treatment groups over the study period. However, the treatment effect was not significant (p = 0.160), suggesting no overall difference in depressive symptoms between groups. The interaction between time and treatment was significant (p = 0.020), indicating varying changes in depressive symptoms over time between treatment groups. At week two, patients receiving mirtazapine had a lower mean BDI-II score than those receiving sertraline (15.62±5.24 versus 18.92±5.03), but the difference between the groups was not statistically significant (p-value = 0.022). Subsequent assessments at weeks 4, 8, and 12 showed comparable mean BDI-II scores between both treatment groups. Furthermore, at all assessment points, the rate of responders (≥50% reduction in BDI-II total score from baseline) and the rate of remitters (BDI-II total score of &lt;10) were similar between the treatment groups. However, mirtazapine- treated patients scored higher in assessing the overall impact of the treatment on their quality of life compared to the sertraline-treated group (7.40±1.18 versus 6.51±1.15 p-value = 0.007). Regarding safety and tolerability, although there were differences in the pattern of adverse effects between the treatment groups, the proportion of patients experiencing at least one adverse effect and the rate of dropouts were similar between the two groups, indicating comparable tolerability for both medications. Conclusion: Our results suggest that the efficacy and tolerability of mirtazapine are equivalent to those of sertraline in treating moderate depression in hemodialysis patients. However, mirtazapine appears to have a more favorable effect on patients' health-related quality of life compared to sertraline. Trial Registration: The trial was registered at the Iranian Registry of Clinical Trials (https://www. irct.ir/trial/66756, identifier code: IRCT20120215009014N445). Registration date: 2022-11-09.

Association Between Impulsivity, Self-Harm, Suicidal Ideation, and Suicide Attempts in Patients with Traumatic Brain Injury.

Traumatic brain injury (TBI) affects over 48 million people worldwide each year. Suicide is common in TBI, and there are several known contributing factors, including severe TBI, depression, alcohol use, and male sex. Impulsivity, or the tendency to act quickly with little thought, may be an early predictor of suicidality following TBI. The purpose of this study was to evaluate the risk of suicidality in patients with a prior history of impulsivity following a traumatic brain injury (TBI). Using de-identified electronic health records from the TriNetX United States Collaborative Network with Natural Language Processing, three cohorts were generated: the impulsivity TBI cohort (I+TBI+) included subjects with a diagnosis of impulsivity before a diagnosis of TBI; the no impulsivity TBI cohort (I-TBI+) included patients with TBI but no impulsivity; the impulsivity no TBI cohort (I+TBI-) included patients with impulsivity but TBI. Two analyses were conducted, including analysis 1 (impulsivity TBI vs. no impulsivity TBI) and analysis 2 (impulsivity TBI vs. impulsivity no TBI). Patients were 1:1 propensity score matched by age, sex, race, ethnicity, psychiatric diagnoses, and antidepressant use. Outcomes included a diagnosis of self-harm, suicidal ideation, or a suicide attempt within one year after the index event. The all-time incidence of each outcome was assessed across different age categories. The chi-square test (categorical variables) and t-test (numerical variables) were used to assess for differences between groups. A total of 1,292,776 TBI patients were identified in the study. After 1:1 propensity score-matching, there were 20,694 patients (mean [SD] age, 48.1 [21.8]; 8,424 females [40.7%]) with impulsivity and TBI (I+TBI+), 1,272,082 patients (mean [SD] age, 46.0 [23.1]; 562,705 females [44.2%]) with TBI alone (I-TBI+), and 90,669 patients (mean [SD] age, 43.7 [22.6]; 45,188 females [49.8%]) with impulsivity alone (I+TBI-). Within the first year after a TBI, patients with impulsivity were more likely to exhibit self-harm (P < 0.001), suicidal ideation (P < 0.001) or a suicide attempt (P < 0.001). Compared to TBI patients without impulsivity, those with impulsivity had a four-fold increase in the incidence of self-harm (2.81% vs. 0.63%), an eight-fold increase in suicidal ideation (52.42% vs. 6.41%), and a twenty-one-fold increase in suicide attempts (32.02% vs. 1.50%). This study suggests that impulsivity diagnosed before a TBI may increase the risk of post-traumatic suicidality, with a four-fold increased risk of self-harm, an eight-fold increased risk of suicidal ideation and a twenty-one-fold increased risk of suicide attempts. This characterizes a group of at-risk individuals who may benefit from early psychiatric support and targeted interventions following a TBI.

Assessment of stress level and depression among orthopaedic surgeons in Saudi Arabia

PurposeThe aim of this study was to assess the stress level and depression among orthopaedic surgeons in Saudi Arabia. In addition, to evaluate orthopedic training programs related factors that might have a critical role in the development of depression among orthopaedic surgeons.MethodsThe study adopted a cross-sectional study design. Two validated questionnaires were utilized, the Patient Health Questionnaire 9 (PHQ-9) and the Perceived Stress Scale (PSS-10) for assessing depressive symptoms and stress levels. Data was collected by sending the survey to the Saudi Commission for Health Specialties so they could be distributed throughout all registered orthopaedic surgeons.ResultsThe study sample consisted of 325 participants. The results revealed that the severity of depression varied across the different groups. As per the PHQ-9 criteria, 74 (22.8%) were initially diagnosed with major depression. Among assistant consultants, 39.5% reported severe depression, while 34.9% reported mild depression. Consultants predominantly reported moderate perceived stress (82.9%) with a notable proportion experiencing high perceived stress (12.4%). Assistant consultants showed a balanced distribution, with 93.0% reporting moderate perceived stress and 4.7% reporting high perceived stress. Demographic variables gender, relationship status and having children revealed statistically significant relationship with PHQ-9 scores (p-value < 0.05) but not with PSS-10 scores.ConclusionThe study highlights pressing need to address mental health concerns within orthopaedic surgeons. To address these challenges, healthcare institutions should implement comprehensive mental health support programs offering resources for stress management, counseling services, and peer support groups.

Navigating the skies: a cross-sectional study of depression among Saudi Arabian airline pilots

BackgroundDepression poses a significant challenge globally, including in safety-critical industries such as aviation. In Saudi Arabia, where the aviation sector is rapidly expanding, pilots encounter unique stressors inherent to their profession. However, research on pilot mental health, particularly within the Saudi context, remains limited despite its critical role in flight safety.MethodsThis cross-sectional survey was designed to estimate the self-reported prevalence of depression in a convenience sample of airline pilots in Saudi Arabia. Participants were recruited from various commercial airlines in Saudi Arabia. Recruitment efforts utilized targeted outreach on social media platforms, focusing on pilot forums and groups. The survey was administered online for accessibility and convenience. The structured questionnaire, developed through a literature review and expert consultation, comprises sections on demographic and professional characteristics, occupational information, health habits, and depression assessment via the Patient Health Questionnaire-9 (PHQ-9).ResultsThis study enrolled 310 participants, with the largest cohort (34.8%, n = 108) falling within the 30–39 years age group, closely followed by individuals under 30 years (30.0%, n = 93). Males dominated the sex distribution (99.0%, n = 307). The mean PHQ-9 score was 8.2 ± 5.4. Notably, 40.6% (n = 126) of the participants had a score of 10 or higher, indicating the potential for moderate, moderate-severe, or severe depression. Multivariable binary logistic regression analysis revealed that pilots with 11–15 years of experience had greater odds of experiencing depression than did those with 0–10 years of experience did (odds ratio [OR]: 3.0, 95% confidence interval [CI]: [1.1–8.4], p = 0.04). Pilots with rest times exceeding 24 h had lower odds of depression than did those with rest times less than 1 h (OR: 0.3, 95% CI: [0.1–0.8], p = 0.02). Engaging in regular exercise was associated with reduced odds of depression (OR: 0.3, 95% CI: [0.2–0.5], p < 0.01), as was longer sleep duration (> 8 h) (OR: 0.2, 95% CI: [0.1–1.0], p = 0.04).ConclusionOur study estimates the prevalence and severity of self-reported depressive symptoms among airline pilots in Saudi Arabia, surpassing global estimates. The identified factors, including lack of regular exercise, short sleep duration, and insufficient rest between flights, underscore the complex mental health challenges faced by pilots in this region. Addressing these issues is crucial not only for pilot well-being but also for flight safety.

Transdiagnostic depression severity and its relationship to global and prefrontal-amygdala structural properties in people with major depression and post-traumatic stress disorder.

While some studies have used a transdiagnostic approach to relate depression to metabolic or functional brain alterations, the structural substrate of depression across clinical diagnostic categories is underexplored. In a cross-sectional study of 52 patients with major depressive disorder and 51 with post-traumatic stress disorder, drug-naïve, and spanning mild to severe depression severity, we examined transdiagnostic depressive correlates with regional gray matter volume and the topological properties of gray matter-based networks. Locally, transdiagnostic depression severity correlated positively with gray matter volume in the right middle frontal gyrus and negatively with nodal topological properties of gray matter-based networks in the right amygdala. Globally, transdiagnostic depression severity correlated positively with normalized characteristic path length, a measure implying brain integration ability. Compared with 62 healthy control participants, both major depressive disorder and post-traumatic stress disorder patients showed altered nodal properties in regions of the fronto-limbic-striatal circuit, and global topological organization in major depressive disorder in particular was characterized by decreased integration and segregation. These findings provide evidence for a gray matter-based structural substrate underpinning depression, with the prefrontal-amygdala circuit a potential predictive marker for depressive symptoms across clinical diagnostic categories.

Prevalence and Risk Factors of Psychiatric Symptoms among Type 2 Diabetes Mellitus Patients in South India: A Cross-Sectional Study.

Background: Type 2 diabetes mellitus poses a momentous challenge when accompanied by psychiatric symptoms like depression, anxiety, and stress, adding to the complaint's threat. Research on these factors in patients with uncontrolled chronic illnesses in India, particularly in Tamil Nadu, is limited. Hence, this study aims to determine the prevalence and risk factors of these psychiatric symptoms among Type 2 diabetes patients.  Methods: A cross-sectional study was conducted in Alpha Hospital and Research Center in Madurai, South India, from April 2020 to March 2021, enrolling 614 participants (307 with Type 2 diabetes mellitus and 307 general population). Data were collected using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and Perceived Stress Scale. The IBM SPSS version 23 was used for statistical analysis.  Results: Two-thirds of youth women with type 2 diabetes have higher fasting blood sugar levels than men when compared to general population. 82.61% of patients with uncontrolled diabetes developed severe stress, surpassing those with well-controlled and pre-diabetes. Severe depression is most prevalent among patients with neuropathic foot ulcers (54.76%) and nephropathy (61.54%). Predominant mental health risk factors include being single, high school education, poor glycemic control, comorbid hypertension, and family history. Interestingly, lifestyle factors like alcohol use and smoking positively impact mental health outcomes.  Conclusion: This study shows the intricate connection between Type 2 diabetes and mental health problems in Madurai, emphasizing the necessity for a multidisciplinary strategy to enhance outcomes and reduce financial burden. Future research in nursing has to focus on implementing and assessing therapies aimed at reducing patients' stress, anxiety and depression.

Impacts of Electroconvulsive Therapy on the Neurometabolic Activity in a Mice Model of Depression: An Ex Vivo 1H-[13C]-NMR Spectroscopy Study

Electroconvulsive therapy (ECT) is an effective treatment for severe and drug-resistant depression, yet its mode of action remains poorly understood. This study aimed to evaluate the effects of ECT on neurometabolism using ex vivo 1H-[13C]-NMR spectroscopy in conjunction with intravenous infusion of [1,6-13C2]glucose in a chronic variable mild stress (CVMS) model of depression. Both CVMS and control mice were subjected to seven sessions of electroconvulsive shock under mild isoflurane anesthesia. The CVMS mice exhibited a reduction in sucrose preference (CVMS 67.1 ± 14.9%, n = 5; CON 86.5 ± 0.6%, n = 5; p = 0.007), and an increase in immobility duration (175.9 ± 22.6 vs. 92.0 ± 23.0 s, p &lt; 0.001) in the forced-swim test. The cerebral metabolic rates of glucose oxidation in glutamatergic (CMRGlc(Glu)) (CVMS 0.134 ± 0.015 µmol/g/min, n = 5; CON 0.201 ± 0.045 µmol/g/min, n = 5; padj = 0.04) and GABAergic neurons (CMRGlc(GABA)) (0.030 ± 0.002 vs. 0.046 ± 0.011 µmol/g/min, padj = 0.04) were reduced in the prefrontal cortex (PFC) of CVMS mice. ECT treatment in CVMS mice normalized sucrose preference [F(1,27) = 0.0024, p = 0.961] and immobility duration [F(1,28) = 0.434, p = 0.515], but not the time spent in the center zone (CVMS + ECT 10.4 ± 5.5 s, CON + sham 22.3 ± 11.4 s, padj = 0.0006) in the open field test. The ECT-treated CVMS mice exhibited reduced (padj = 0.021) CMRGlc(Glu) in PFC (0.169 ± 0.026 µmol/g/min, n = 8) when compared with CVMS mice, which underwent the sham procedure (0.226 ± 0.030 µmol/g/min, n = 8). These observations are consistent with ECT’s anticonvulsant hypothesis for its anti-depressive action.

Relationship Between Depression and Medication Adherence Among Chronic Disease Patients in the Middle East.

Background and aim Medication adherence is a crucial factor in the management of chronic diseases. Depression is a common psychiatric disorder that has been correlated with poor adherence to medication. Adherence to medication in patients with chronic diseases is a well-known concern among the medical community, particularly when considering the adverse outcomes of adherence failure in such patients. Therefore, this study aims to investigatethe relationship between depression and medication adherence among chronic disease patients in the Middle East. Methodology This cross-sectional study was conducted between January 2024 and April 2024 among patients with chronic diseasesfrom the Middle East. The data were collected through convenient sampling using structured online-based questionnaires that included demographic information, type of chronic condition, medication adherence (measured by the Adherence to Refills and Medications Scale (ARMS)), and depression severity (measured by the Patient Health Questionnaire-9 (PHQ-9)). Statistical analyses were conducted to examine the associations between these variables. Results The study involved492 participantswith chronic diseases and found significant associations between demographic factors and medication adherence. Female participants were more likely to be non-adherent than males (p = 0.001), and younger participants aged 20-30 years exhibited higher non-adherence rates (46.7%) compared to older participants, 61 years and above (16.1%, p = 0.001). Non-working individuals showed higher non-adherence (45.4%) compared to retired individuals (21.5%, p = 0.003). Depression severity was inversely related to medication adherence; participants with severe depression were significantly more likely to be non-adherent (relative risk (RR) = 8.41, 95% confidence interval (CI): 4.26-16.57, p < 0.001). In addition, certain chronic conditions were more impactful on medication adherence and depression rates, such as patients withrheumatoid disease that had lower rates of none to minimal depression (8.6%) and higher rates of moderately severe - severe depression each (28.6%). Meanwhile, asthma patients showed notably lower adherence rates (41.0%) and higher levels of severe depression (24.6%). Conclusion The study highlights the intricate relationships between demographic factors, chronic conditions, medication adherence, and depression in patients with chronic diseases in the Middle East. Gender, age, occupational status, and marital status significantly influence adherence and depression levels. Depression is a significant factor associated with decreased levels of adherence among patients with chronic conditions. Regular screening todetect and manage depression among chronically ill patients is advised to help improve medication adherence.

A closer look at depression and sleep quality relation: A cross-sectional study of taxi drivers in Tabriz metropolis.

Taxi drivers play a significant role in urban mobility and safety as professional drivers. They typically have poor incomes, long work hours, lack of sleep, and high levels of stress, which increase the risk of physical and mental illnesses. The goal of this study was to explore the relationship between sleep disorders and depression among Tabriz metropolis taxi drivers. Using the street intercept technique, a cross-sectional study was conducted with the participation of 402 taxi drivers in Tabriz during January and March 2020. Data collection tools included the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire as well as demographic information. Twenty taxi stops were used as sampling sites, and the method used was random sampling based on the number of drivers at each stop. Statistical analysis was performed using Stata 13. The majority of drivers worked an average of 6 days each week, with a mean tenure of 13.3 years. The sleep quality mean score for drivers was 5 (SD = 2.3). Approximately, 21% of them had sleep disorder (PSQI >6). Moderate depression was recognized in 13% of drivers and moderately severe depression has been found in 5% of them. Drivers were more likely to experience sleep disorders if they had mild (odds ratio [OR] = 3.9), moderate (OR = 16.4), or fairly severe depression symptoms (OR = 35.3). A seven times higher risk of depression was identified among drivers with sleep disorders. It might be contended that a mutual relationship has been found between sleep disorders and depression, and disregarding this will deteriorate sleep turbulences. Considering the pivotal role of taxi drivers in urban mobility, accommodating initiatives that give a break time for drivers and improve their mental health is recommended.

Frequency &amp; Predictors of Depression in Patients of Chronic Heart Failure with Reduced Ejection Fraction (HFrEF)

Background: Clinically significant depression is estimated to occur in a significant portion of chronic heart failure (CHF) patients and increases sharply with increase in heart failure severity. However, the frequency and predictors of depression in this group of patients are underreported. This study was designed to assess frequency &amp; predictors of depression in patients of chronic heart failure with reduced ejection fraction (HFrEF). Methods: This cross-sectional analytical study was performed in the department of Cardiology, Dhaka Medical College Hospital, Dhaka, during the period from October’2018 to Septemeber’2019. One hundred and fifty-two CHF patients with reduced ejection fraction (&lt;40%) either admitted in the department of Cardiology or attended Cardiology OPD, Dhaka Medical College Hospital (DMCH), Dhaka who fulfilled the selection criteria were included into the study. A translated and validated Patient Health Questionnaire (PHQ-9) in Bengali was used to assess depression level in CHF patients in this study. Informed written consent was taken from each patient. Approval for the study was taken from Ethical Review Committee (ERC) of Dhaka Medical College before commencement of the study. After compiling data from all participants, statistical analyses were performed using the Statistical Package for Social Science (SPSS), version 22.0 for windows. Results: Mean age of the patients was 58.68±9.40 years, ranging from 36 to 75 years. Male predominance was noted (72% vs 28%). Overall, frequency of depression was 56%. Among the depressed patients (n=85), majority (40%) had minimal depression while 27%, 19% and 14% had mild, moderate and severe depression. respectively. Among the different risk factors, DM and sedentary lifestyle were significantly associated with depression (p&lt;0.05). Age &gt;65 years, sedentary lifestyle, and H/O past MI were independently associated with depression among chronic HErEF patients. Widowed patients, diabetes, hospital readmission in last 2 months before study inclusion and NYHA class III/IV were also significantly associated with depression among patients with chronic HFrEF (p&lt;0.05). Conclusion: More than half of the patients with chronic HFrEF had concurrent depression of varied severity. Proper care of depression along with HF may improve the survival and quality of life of these patients. Bangladesh Heart Journal 2024; 39(2): 74–84

Biological, Psychological, Social, and Spiritual Domains of Teachers in a Philippine University

Countries worldwide have experienced an unprecedented event that changed the educational systems and suddenly forced our teachers to adopt online classes. This greatly affected our teacher's mental health. This study aimed to determine the harmony of the biological, psychological, social, and spiritual domains and also looked into the challenges encountered among university teachers during the COVID-19 pandemic. The findings served as bases for the intervention plan. The data were treated using frequency, rank, simple percentage, mean, standard deviation, rank, Chi-square test of independence, and ANOVA. Results showed teachers have poor health habits in the physical domain. In the area of the psychological domain, it showed that teachers experienced severe depression. Results of the spiritual domain suggest that teachers lack spiritual enrichment. In addition, the teachers in the social domain have warm relationships. The biological domain of teachers reveals a meaningful relationship with gender. Also, teachers' civil status is related to the social domain. Results also show that teachers can cope with resourcefulness, adjusting one's mindset and patience. Results show that teachers have biological conditions, severe psychological depression, warm social relationships with people around them, and less spiritual life after the COVID-19 pandemic. Therefore, it is recommended that an intervention plan be implemented, monitored, and evaluated to improve their living conditions while doing their job as facilitators of learning.

Depression Takes a Toll on Academic Performance: Evidence from Rural Students in China.

Depression is a growing public health concern around the world. For adolescents, depression not only impedes healthy development, but is negatively associated with academic performance. The purpose of this paper is to examine the prevalence of adolescent depressive symptoms in a sample of rural primary and junior high school students. Additionally, we examine various factors to identify subgroups within the sample that may be more vulnerable to depression. Finally, we explore the extent to which depression correlates with academic performance and conduct a series of heterogeneity analyses. We utilize cross-sectional data derived from 30 schools in underdeveloped regions of rural China encompassing primary and junior high school students (n = 1,609). We find a high prevalence of depression, with 23% and 9% of students experiencing general depression (depression score ≥ 14) and severe depression (depression score ≥ 21), respectively. Female gender, elevated stress and anxiety levels, boarding at school, exposure to bullying, and having depressed caregiver(s) are positively correlated with depressive symptoms, while high social support exhibits a negative association. Importantly, our analyses consistently show a significantly negative link between depression and academic performance, which is measured using standardized math tests. For instance, transitioning from a non-depressed state to a state of general depression (depression score ≥ 14) is linked to a decline of 0.348-0.406 standard deviations in math scores (p < 0.01). Heterogeneity analyses reveal that this adverse relationship is more pronounced for male students, boarding students, those with lower social support, individuals with more educated mothers, and those with lower family assets. Our findings underscore the high prevalence of depression in rural schools and the detrimental impact on academic performance. We advocate for the implementation of policies aimed at reducing student depression, particularly within vulnerable populations and subgroups.

The First Pilot Epigenetic Type Improvement of Neuropsychiatric Symptoms in a Polymorphic Dopamine D2 (-DRD2/ANKK (Taq1A)), OPRM1 (A/G), DRD3 (C/T), and MAOA (4R) Compromised Preadolescence Male with Putative PANDAS/CANS: Positive Clinical Outcome with Precision-Guided DNA Testing and Pro-Dopamine Regulation (KB220) and Antibacterial Therapies.

Pediatric autoimmune neuropsychiatric disorders associated with or without streptococcal and other bacterial infections (PANDAS/CANS) are emerging as a featured pediatric disorder. Although there is some controversy regarding treatment approaches, especially related to the behavioral sequelae, we have hypothesized in other published work that it is characterized by the rapid onset of Reward Deficiency Syndrome (RDS) in children. We propose utilizing a multi-systems biological approach involving the coupling of genetic addiction risk testing and pro-dopamine regulation (KB220/POLYGEN®) to help induce "dopamine homeostasis" in patients with PANDAS, especially those with known DNA-induced hypodopaminergia. This case study examines a 12-year-old Caucasian male with no prior psychiatric issues who presented with a sudden onset of severe anxiety, depression, emotional liability, and suicidal ideation. The patient underwent genotyping and the genetic addiction risk score (GARS) testing, which revealed risk polymorphisms in the dopamine D2 (-DRD2/ANKK (Taq1A), OPRM1 (A/G), DRD3 (C/T), and MAOA (4R) genes. These polymorphisms have been linked to hypodopaminergia. The patient was subsequently placed on research ID-KB220ZPBMPOLY (POLYGEN®), and albeit the possibility of bias, based upon self and parental assessment, a marked rapid improvement in psychiatric symptoms was observed. In the second phase of treatment (102 days utilizing KB220), the patient received standard antibody testing, which was positive for Lyme. Antibacterial therapy started immediately, and KB220z was discontinued to provide a wash-out period. A monotonic trend analysis was performed on each outcome measure, and a consistently decreasing trend was observed utilizing antibacterial therapy. Our recommendation, albeit only one case, is to utilize and further research a combined therapeutic approach, involving precision-guided DNA testing and pro-dopamine regulation along with antibacterial therapy, as well as glutathione to address offensive enhanced cytokines, in patients with suspected PANDAS/CANS.

The Role of Spiritual Well-Being and Religious Coping in Psychiatric Morbidities Associated with Breast Cancer Patients: A Cross-Sectional Analysis

Background: Spirituality and religious resources support and enhance both overall and emotional well-being during adversity such as diagnosis of breast cancer. Breast cancer patients are at higher risk of developing severe anxiety, depression, and potential mood disorders. Aim: The aim is to assess, compare, and correlate spiritual well-being and religious coping in patients with breast cancer with and without psychiatric disorders (anxiety and depression). Materials and Methodology: Recently diagnosed 90 treatment-naïve breast cancer patients were selected in adherence to the inclusion and exclusion criteria. Hospital Anxiety and Depression Scale (HADS), Spiritual Assessment Scale, and Brief Religious Coping Scale were applied to the sample population. The study population was divided into two groups depending on scores of HADS, those having psychiatric disorders, and those who did not have. The data were analyzed using Mann‒Whitney test and Pearson’s correlation coefficient in the SPSS version 21. Results: More than half (61.1%) of the females suffered from psychiatric disorders after diagnosis of breast cancer. About 50% and 38.9% of the study population developed significant emotional distress, leading to the diagnosis of cases of anxiety and depression, respectively. Females suffering from psychiatric disorders have significantly lower spirituality, positive religious coping, and significantly higher negative religious coping than females without any psychiatric disorder. Total spirituality score (P = 0.034) is making a significant contribution toward predicting depression. Negative religious coping is making a significant contribution toward predicting both anxiety (P = 0.008) and depression (P = 0.045). Conclusion: The study suggests that spirituality and religion-based coping facilitates adaptive psychological adjustment to cancer and decreases the prevalence of anxiety and depression.

Obsessive-Compulsive Disorder Comorbid With or Without Obsessive-Compulsive Personality Disorder: Conceptual Implications, Clinical Correlates, and Brain Morphometries

BackgroundObsessive-compulsive disorder (OCD) is often comorbid with obsessive-compulsive personality disorder (OCPD). The relationship between OCD and OCPD is complex, and the impact of comorbid OCPD on OCD remains underexplored, necessitating further research. In this study, we aimed to investigate the clinical correlates and brain morphometries associated with comorbid OCPD in a large sample of unmedicated patients with OCD. MethodsA total of 248 unmedicated patients diagnosed with OCD (45 comorbid with OCPD) were included in this study. All participants were assessed for OCD symptoms, OCPD traits, obsessive beliefs, depression, and anxiety. Among them, 145 patients (23 comorbid with OCPD) volunteered to receive magnetic resonance imaging brain scans. ResultsApproximately 18% (45/248) of patients with OCD were comorbid for OCPD. OCD comorbid with OCPD (OCD+OCPD) exhibited more severe OCD symptoms, obsessive beliefs, depression, and anxiety than OCD comorbid without OCPD. Additionally, the severity of OCPD was positively correlated with OCD symptoms and obsessive beliefs. Furthermore, patients with OCD+OCPD exhibited increased cortical complexity in the left superior parietal lobule and left precuneus, which mediated the relationship between OCPD and OCD symptoms only in OCD patients comorbid without OCPD. ConclusionsThe co-occurrence of OCPD may contribute to the heightened severity of psychopathological symptoms and associated brain morphological alterations in patients with OCD, indicating distinct but interrelated constructs between these 2 disorders.

Depression and Cognitive Function in Accordance with the Nutritional Status of Elderly Women Residing in Rajarhat-Newtown Area of Kolkata, India

ABSTRACT Introduction: The nutritional status of elderly persons is reported to be affected by depression and cognitive function. The most prevalent psychological issue in old age is depression, and cognitive decline is also seen in this age range. Objective: The aim of the present study was to establish the relationship between nutritional status, depression scale, and cognitive function in older women. Materials and Methods: A total of 250 older women participated in a cross-sectional study (residing at Rajarhat-Newtown area). The lengthy version of the Mini-Nutritional Assessment tool (MNA®) was used to evaluate the participants’ nutritional status. The Geriatric Depression Scale (GDS 30) was used to evaluate the severity of the depression. Using the Folstein Mini-Mental State Examination, cognitive function was assessed. Using SPSS software, the Chi-square, Kruskal–Wallis test, and Spearman’s rho correlation coefficient were computed. Multinominal logistic regression model was used by taking nutritional status as dependent variable while depression and cognitive function as independent variables. Results: Participants with mild depression made up about 50.8% and those with severe depression made up 9.2%. Age-related cognitive function was found to be severely impaired in 1.6% and mild or moderate impairment was found in 70.4% of older women. A multinominal logistic regression model validated the finding that there was a significant relationship between dietary status and both depression and cognitive performance (P &lt; 0.05). Conclusions: Both depression and impairment in cognitive function can cause malnutrition or vice versa among older women.

Depression in type 2 diabetes mellitus: Prevalence, characteristics, associated factors, and treatment outcomes

BackgroundPrevious studies have demonstrated that sertraline has a positive impact on improving depression; however, data on the prevalence and treatment outcomes of sertraline among patients with comorbid Type 2 diabetes mellitus and depression remain limited. ObjectivesDetermine the prevalence and associated factors of depression, and evaluate the treatment outcomes of sertraline intervention at two dosage levels (50 mg per day and 100 mg per day) in patients with comorbid depression and type 2 diabetes mellitus in Vietnam. Materials and methodsThe study included type 2 diabetes mellitus patients receiving outpatient treatment at Bac Lieu General Hospital from March 2023 to March 2024. Following the assessment of depression prevalence and associated factors, a randomized, single-blind clinical trial was conducted. Patients were randomly assigned to two groups: odd-numbered patients received treatment with 50 mg/day sertraline dosage, while even-numbered patients received treatment with 100 mg/day sertraline dosage. The criteria for success included improvement in symptoms and severity of depression after 6 months of treatment. ResultsA total of 225 type 2 diabetes mellitus patients with a mean age of 63.8 ± 10.7 years were included, among whom 72 were diagnosed with depression, accounting for a prevalence rate of 32 %. Among these patients, 51 were female (70.8 %) and 21 were male (29.2 %). Female gender, overweight, obesity, diabetes duration over 36 months, and a history of cardiovascular disease were found to be associated with depression. However, in the multivariate model, only overweight, obesity, HbA1c ≥ 6.5 %, and a history of cardiovascular disease were identified as independent factors contributing to depression in type 2 diabetes mellitus patients, with odds ratios of 4.12 (95 % CI: 1.78–9.56; p = 0.001), 0.37 (95 % CI: 0.15–0.95; p = 0.038) and 25.90 (95 % CI: 9.05–74.12; p < 0.001), respectively. Following 6 months of treatment, in the 50 mg/day dosage group, the proportion of patients with moderate to severe depression decreased from 77.8 % to 33.3 % (p < 0.001). Similarly, in the 100 mg/day dosage group, the proportion of patients with moderate to severe depression decreased from 94.4 % to 52.8 % (p < 0.001). ConclusionDepression accounts for approximately one-third of type 2 diabetes mellitus cases. Overweight, obesity, HbA1c levels, and cardiovascular disease are independent factors associated with depression. Intervention with sertraline for depression treatment at both 50 mg/day and 100 mg/day dosages demonstrates significant improvements in depression severity after 6 months of treatment.