Depression Severity Research Articles

Examining what works for whom and how in mindfulness-based cognitive therapy (MBCT) for recurrent depression: moderated-mediation analysis in the PREVENT trial.

Personalised management of recurrent depression, considering individual patient characteristics, is crucial. This study evaluates the potentially different mediating role of mindfulness skills in managing recurrent depression using mindfulness-based cognitive therapy (MBCT) among people with varying depression severity. Data from the Prevention of Depressive Relapse or Recurrence (PREVENT) trial, comparing MBCT (with antidepressant medication (ADM) tapering support, MBCT-tapering support) versus maintenance-ADM, were used. The study included pre, post, 9-, 12-, 18- and 24-month follow-ups. Adults with ≥3 previous major depressive episodes, in full/partial remission (below threshold for a current episode), on ADM, were assessed for eligibility in primary care practices in the UK. People were randomised (1:1) to MBCT-tapering support or maintenance-ADM. We used the Beck Depression Inventory-II to evaluate depressive symptom changes over the six time points. Pre-post treatment, we employed the Five Facets of Mindfulness Questionnaire to gauge mindfulness skills. Baseline symptom and history variables were used to identify individuals with varying severity profiles. We conducted Latent Profile Moderated-Mediation Growth Mixture Models. A total of 424 people (mean (s.d.) age = 49.44 (12.31) years; with 325 (76.7%) self-identified as female) were included. A mediating effect of mindfulness skills, between trial arm allocation and the linear rate of depressive symptoms change over 24 months, moderated by depression severity, was observed (moderated-mediation index = -0.27, 95% CI = -0.66, -0.03). Conditional indirect effects were -0.42 (95% CI = -0.78, -0.18) for higher severity (expected mean BDI-II reduction = 10 points), and -0.15 (95% CI = -0.35, -0.02) for lower severity (expected mean BDI-II reduction = 3.5 points). Mindfulness skills constitute a unique mechanism driving change in MBCT (versus maintenance-ADM). Individuals with higher depression severity may benefit most from MBCT-tapering support for residual symptoms. It is unclear if these effects apply to those with a current depressive episode. Future research should investigate individuals who are not on medication. This study provides preliminary evidence for personalised management of recurrent depression. ISRCTN26666654.

Quantile adaptive lasso: variable selection for quantile treatment effect estimation

Quantile treatment effects (QTEs) characterize different causal effects of treatment on outcome distribution. Propensity score (PS) methods are commonly employed for estimating QTEs in non-randomized studies. Previous studies have shown that insufficient and unnecessary adjustment for covariates in PS models leads to bias and efficiency loss of treatment effects. Confounders may vary across different quantiles of outcome distribution. To allow for the selection of covariates related to outcome at interesting quantiles corresponding to QTE, we proposed quantile adaptive lasso (QAL) to select covariates that can provide unbiased and efficient QTE estimation. QAL utilized linear quantile regression models to construct penalty weights. Theoretical analyses showed that QAL enjoys several asymptotic properties. Simulations showed the superiority of QAL over existing methods in variable selection and QTE estimation. We applied QAL to datasets from the China Health and Retirement Longitudinal Study to explore the impact of smoking on the severity of depression.

Effect of Esketamine Nasal Spray on Cognition in Patients with Treatment-Resistant Depression: Results from Four Phase-3 Studies.

While esketamine is effective in treatment-resistant depression (TRD), detailed information about the effect of esketamine on cognition is relatively scarce. This analysis assessed the effect of short-term (three double-blind [DB] studies; DB1, DB2, and DB4) or long-term maintenance treatment (DB3) with esketamine nasal spray (ESK) compared to an active-comparator+placebo (PBO), on cognition in patients with TRD. Patients (DB1/DB2/DB3: [18-64years, n=747]; DB4: [≥65years, n=137]) with TRD received ESK (DB1/DB2/DB3:56/84mg; DB4:28/56/84mg) or PBO+newly initiated oral antidepressant (OAD) as per treatment schedules. Cognitive assessments- Cogstate battery and Hopkins Verbal Learning Test-Revised, were administered at baseline, Day-28/early withdrawal, and follow-up visits in DB1/DB2/DB4 and at 12-week intervals in DB3 maintenance phase. Descriptive statistics were used to analyze ESK effects on cognition with effect sizes and 95% confidence intervals (CIs) used to express the nature/magnitude of treatment effects relative to active-comparator+PBO. Correlation between depression severity (MADRS scores) and cognition was assessed at baseline and endpoint(s). At baseline, mild-to-moderate impairment in psychomotor function, attention, and memory (working/episodic) were evident. For each DB1/DB2/DB4, group mean performance in z-scores for ESK+OAD and OAD+PBO groups on all cognitive tests remained similar/slightly improved from, baseline at endpoint (Day-28) and follow-up assessments. Similarly, in DB3(limited to participants ≥65years), both groups generally showed improvement in cognitive performance at endpoint(s). Correlations between MADRS scores and performance on the cognitive test battery were small at baseline and endpoint(s). This analysis did not identify evidence of negative effects on cognition following short-term or long-term maintenance treatment with ESK+OAD in patients with TRD.

Are S100B and VILIP-1 Involved in a Common Mechanism of Neuroinflammation in Major Depressive Disorder?

This study aimed to evaluate the role of neuroinflammation in neuronal and glial cells in the pathophysiology of Major Depressive Disorder (MDD) through different biomarkers.S100-B and VILIP-1 levels of patients diagnosed with MDD were evaluated before and after antidepressant treatment. A total of 65 patients diagnosed with MDD and 69 healthy controls were included. Serum levels of S100B and VILIP-1 were measured at the time of diagnosis and after eight weeks antidepressant treatment and compared with healthy controls. Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression Scale (CGI) were applied to assess the severity of depression. In our study, although serum S100B levels were higher in patients before treatment compared to healthy controls, this difference was not statistically significant. Regarding VILIP-1 levels, there was no statistically significant difference between patients and healthy controls. A positive and statistically significant correlation was found between S100B and VILIP-1 levels in MDD group before the treatment. At the eighth week of treatment, a statistically significant positive correlation was also found between S100B and VILIP-1 levels. Our research is the first study to evaluate MDD through two separate biomarkers specific to glial and neuronal cells.The fact that S100B and VILIP-1 levels showed significant correlations in patients diagnosed with MDD both before and after treatment suggests that they may play a shared role in the pathophysiology of the disorder. The correlation between S100B and VILIP-1 may serve as a guide in understanding the pathophysiology of the disorder and in identifying new drug development targets.

Which Psychosocial Risks Are Necessary for Developing Depression During Adolescence? A Novel Approach Applying Necessary Condition Analysis.

Although many factors predict adolescent depression, risks that operate as necessary conditions (i.e., the absence of the factor conveys the absence of the outcome) have been largely unexplored. This study aimed to evaluate which psychosocial risk factors might serve as necessary conditions for future onset of depression across adolescence. At baseline we assessed cognitive and personality risks, symptom severity, stressful events, and past depression history among 382 adolescents (225 girls; age M = 12.6), who were then followed over 2 years with repeated diagnostic interviews to ascertain depression onset. We applied an innovative statistical approach in mental health research, namely Necessary Condition Analysis (NCA). Results showed that baseline rumination (d = .50), stressful events (d = .37), depressive symptoms (d = .23), and self-criticism (d = .35) all emerged as significant necessary conditions for adolescents to be diagnosed with depressive disorder(s) over subsequent 24 months. Overall, 13.5% of the sample did not show all the necessary conditions (i.e., they lacked one or more conditions) and were therefore virtually immune from experiencing one or more major depressive episodes (MDEs) over the follow-up, and 65.5% did not meet all those conditions for experiencing three or more MDEs (i.e., recurrent depression). The findings can inform future theory building and testing as well as clinical applications via screening of necessary risk to future pediatric depression so that youth who may most benefit from effective interventions can be identified. The Necessary Conditions for Depressive Symptomsand Major Depressionin Adolescence; https://osf.io; b5ced. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial.

The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health-based intervention designed to systematically facilitate thought progression would substantially alleviate depression. The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was designed as an easy-to-use gamified app specifically aimed to facilitate thought progression through intense practicing of associative, semantically broad, fast, and creative thought patterns. A randomized clinical trial was conducted, comparing changes in depression symptoms between participants who used the app in the intervention group (n=74) and waitlist control group (n=27) over the course of 8 weeks. All participants filled out a battery of clinical questionnaires to assess the severity of depression at baseline and 4 and 8 weeks after starting the study. These primarily included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 as well as the Positive Affect Negative Affect Scale-Negative Affect Score, Ruminative Response Scale, and Symptoms of Depression Questionnaire. Additional questionnaires were implemented to assess anxiety, positive affect, anhedonia, and quality of life. The results indicate that across multiple clinical measurements, participants in the intervention group who played the gamified app showed greater and faster improvement in depressive symptoms compared with their waitlist control counterparts. The difference between the groups in MADRS improvement was -7.01 points (95% CI -10.72 to -3.29; P<.001; Cohen d=0.67). Furthermore, the difference in improvement between groups persisted up to 4 weeks posttrial (MADRS differences at week 12: F49,2=6.62; P=.003; ηp2=0.21). At the end of the trial, participants who played the app showed high interest in continuing using the app. The results demonstrate that a gamified app designed to facilitate thought progression is associated with improvement in depressive symptoms. Given its innovative and accessibility features, this gamified method aiming to facilitate thought progression may successfully complement traditional treatments for depression in the future, providing a safe and impactful way to enhance the lives of individuals experiencing depression and anxiety. ClinicalTrials.gov NCT05685758; https://clinicaltrials.gov/study/NCT05685758.

Modified dialectical behavior therapy–informed transdiagnostic intervention for emotional disorders: protocol for a randomized controlled trial

BackgroundAnxiety and depressive disorders, characterized by high incidence and functional impairments, are emotional disorders with shared etiological and maintenance mechanisms. Dialectical behavior therapy (DBT) is a promising approach for the transdiagnostic treatment of emotional disorders. Developing a brief DBT intervention can facilitate the adoption of evidence-based therapy.MethodsThis protocol is for a 3-year single-blinded, two-arm randomized controlled trial. Individuals with depressive or anxiety disorder will be randomly allocated to a modified DBT–informed transdiagnostic psychotherapy group or a treatment-as-usual group. The intervention group will receive DBT individual therapy for 15 weeks. Power analyses revealed that the cohort should include a minimum of 250 participants. Preintervention, postintervention, and follow-up (after 3 months) assessments will be conducted. Primary outcomes will be severities of depression and anxiety rated by blind assessors. Intent-to-treat and per-protocol analyses will be conducted using the hierarchical linear model. Effect sizes will be estimated using Cohen’s d.ResultTo the best of our knowledge, the proposed study will be the first randomized controlled trial to evaluate the efficacy of a modified DBT intervention in managing transdiagnostic emotional disorders in Chinese individuals.ConclusionThis intervention is expected to improve clinical outcomes, daily functioning, and quality of life. The trial will enrich the empirical evidence for transdiagnostic interventions, facilitating the implementation of evidence-based therapy and reducing the high prevalence and challenges (e.g., disability) of emotional disorders in the Chinese population.Trial registration numberNCT05989451

Effectiveness of a multi-component sleep-mood group intervention on improving insomnia in university students - a pilot randomized controlled trial.

Sleep and mental health problems are very common in university students. The objective of this study was to assess the effectiveness of a multi-component sleep-mood intervention on improving sleep and mental health in university students with clinically significant insomnia symptoms, and to investigate possible mediators. Thirty-five participants were randomized to the Sleep Mood Intervention: Live Effectively (SMILE) intervention (n = 23), or wait-list group (n = 12). SMILE is a multi-component group therapy and includes elements of cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and lifestyle modifications, in four weekly two-hour sessions. The primary outcome was insomnia severity. Secondary outcomes were severity of depression and anxiety, and quality of life (QoL). Dysfunctional beliefs and attitudes about sleep and pre-sleep arousal were assessed as mediators. Intention-to-treat analysis showed significant time x treatment interaction on insomnia symptoms p = .02, partial η²=0.15, d = 0.84 [95% CI: 0.63 to 1.14], with significantly lower insomnia severity for SMILE compared to waitlist at post-test. No significant effects were found on depression d = 0.02 [95% CI: -0.35 to 0.37], anxiety d = 0.15 [95% CI: -0.16 to 0.53], and QoL d = 0.09 [95% CI: -0.25 to 0.42]. Dysfunctional beliefs mediated the effect on insomnia severity, but pre-sleep arousal did not. This integrated group intervention is associated with reductions in insomnia symptoms in university students. Since no significant effects were detected on mood and QoL, future studies with larger sample size may explore the effects of this intervention on these outcomes. Registry: Overzicht van Medisch-wetenschappelijk Onderzoek. NL-OMON46359. Date of registration: September 18th, 2018.

Lower DTI-ALPS index in patients with major depressive disorder: Correlation with fatigue

Background and purposeDiffusion tensor imaging along perivascular spaces (DTI-ALPS) is an index that may provide insights into intracranial waste clearance processes. Glymphatic system dysfunction has been suggested to play a role in the development of major depressive disorder (MDD). Additionally, fatigue—a common precursor of MDD—is also closely connected to the waste clearance function of the central nervous system (CNS), further underscoring the significance of efficient waste removal in MDD. However, evidence linking altered DTI-ALPS index to MDD remains limited. This study aims to investigate the changes in the DTI-ALPS index in patients with MDD and explore the potential interplay between DTI-ALPS index alterations, fatigue, and the presence of MDD. Material and methodsA total of 46 patients with MDD and 55 healthy controls (HC) were included in the study. All participants underwent diffusion tensor imaging using the same 3-T MRI (3-Tesla Magnetic Resonance Imaging) scanner. The DTI-ALPS index was assessed, and the Chalder Fatigue Scale (CFS) was used to evaluate fatigue levels in both groups, and the 17-item Hamilton Depression Rating Scale (HAMD-17) was used to evaluate the severity of depression in the patients. We compared the DTI-ALPS index and clinical characteristics between the MDD and HC group, and explored the relationship among the DTI-ALPS index, CFS scores, and the presence of MDD through mediation analysis. ResultsThe DTI-ALPS index in the right hemisphere (DTI-ALPS-R) is significantly lower in patients with MDD (t = 2.41, P = 0.02). The MDD patients exhibited significantly higher scores on the CFS scales compared with HCs (t = 13.12, P <.001). Mediation analysis showed that the CFS score plays a significant mediating role between DTI-ALPS-R and the presence of MDD, acting as a full mediator (indirect effect β = −0.230, 95 % CI: [-0.388, −0.059]). ConclusionOur study found that patients with MDD have a reduced DTI-ALPS index. This reduction appears to contribute to the development of MDD by facilitating the accumulation of fatigue symptoms. These findings may provide a new perspective on the pathogenesis of MDD, suggest a potential new biomarker for MDD, and offer new insights for its treatment.

Unveiling Frequency-Specific Microstate Correlates of Anxiety and Depression Symptoms.

Electroencephalography (EEG) microstates are canonical voltage topographies that reflect the temporal dynamics of brain networks on a millisecond time scale. Abnormalities in broadband microstate parameters have been observed in subjects with psychiatric symptoms, indicating their potential as clinical biomarkers. Considering distinct information provided by specific frequency bands of EEG, we hypothesized that microstates in decomposed frequency bands could provide a more detailed depiction of the underlying neuropathological mechanism. In this study, with a large open access resting-state dataset (n = 203), we examined the properties of frequency-specific microstates and their relationship with anxiety and depression symptoms. We conducted clustering on EEG topographies in decomposed frequency bands (delta, theta, alpha and beta), and determined the number of clusters with a meta-criterion. Microstate parameters, including global explained variance (GEV), duration, coverage, occurrence and transition probability, were calculated for eyes-open and eyes-closed states, respectively. Their ability to predict the severity of depression and anxiety symptoms were systematically identified by correlation, regression and classification analyses. Distinct microstate patterns were observed across different frequency bands. Microstate parameters in the alpha band held the best predictive power for emotional symptoms. Microstates B (GEV, coverage) and parieto-central maximum microstate E (coverage, occurrence, transitions from B to E) in the alpha band exhibited significant correlations with depression and anxiety, respectively. Microstate parameters of the alpha band achieved predictive R-square of 0.100 for anxiety scores, which is much higher than those of broadband (R-square = -0.026, p < 0.01). Similar results were found in classification of participants with high and low anxiety symptom scores (68% accuracy in alpha vs. 52% in broadband). These results suggested the value of frequency-specific microstates in predicting emotional symptoms.

Worsening sleep predicts next-week suicidal ideation in a high-risk adolescent outpatient treatment sample.

Suicidal thoughts and behaviors often onset during adolescence, constituting a major public health concern. Despite rising rates in youth, psychotherapeutic and pharmacological treatment outcomes remain meager, indicating a need to identify modifiable risk factors. Experts suggest sleep may serve as a promising clinical indicator of risk and treatment progress, yet few studies have examined acute temporal associations between sleep and suicidal ideation. Participants were depressed and suicidal adolescents (age 13-19, n = 311) attending an intensive outpatient program (IOP). Patients completed weekly self-report assessments of sleep, depression, and suicidal ideation throughout IOP, with an average of 5 assessments over 30 days. Greater overall sleep difficulties, as well as within-person increases in sleep difficulties, were predictive of greater depression severity and suicidal ideation at subsequent assessments, above and beyond previous levels of symptoms. The reverse associations were not found. Inclusion of within-person changes in sleep difficulties significantly improved model fit compared to inclusion of overall sleep difficulties alone. This study provides additional evidence for a prospective relationship between worsening sleep difficulties and suicidal ideation in an IOP youth sample. Worsening sleep may be an important clinical indicator of subsequent depression and suicide risk among adolescents in treatment.

Impact of postpartum physical activity on maternal depression and anxiety: a systematic review and meta-analysis

ObjectiveTo examine the influence of postpartum exercise on maternal depression and anxiety.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases up to 12 January 2024, reference lists, recommended studies...

Persistent symptoms after COVID-19: an Australian stratified random health survey on long COVID.

To determine the impact of persistent symptoms after coronavirus disease 2019 (COVID-19) in an Australian population. We conducted a statewide health survey of a stratified random sample of adults who had had a confirmed acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19-positive group) and their close contacts (control group). The sample was drawn from Victoria's COVID-19 database between January 2020 and October 2022. Data were collected from 12 688 survey respondents between September 2022 and April 2023 (11 174 in the COVID-19-positive group and 1514 in the control group). Persistent new symptoms, recovery, and daily function using validated questionnaires for fatigue, neurocognitive symptoms, anxiety, depression and quality of life. At a mean of 12.6 months after infection, 4560 respondents in the COVID-19-positive group (39.1%; 95% CI, 37.9-40.3%) reported at least one persistent new symptom, compared with 216 respondents in the control group (20.8%; 95% CI, 18.5-23.1%). A total of 1656 respondents (14.2%; 95% CI, 13.4-15.0%) were classified as having clinical long COVID using the criteria of at least one persistent new symptom and less than 80% recovery three months after the infection. Of the respondents with clinical long COVID, 535 (3.2%; 95% CI, 2.6-3.8%) reported at least moderate problems with usual activities at 12 months after their infection. The proportion of respondents with clinical long COVID was lower for those with more recent infections. The risk factors for clinical long COVID were female sex, age 40-49 years, infection severity, chronic illness, and past anxiety or depression. Factors associated with a decreased risk of having clinical long COVID included infection when the Omicron strain was dominant and infection when the Delta strain was dominant, as compared with when the ancestral strain of the virus was dominant. Persistent symptoms after COVID-19 are common, though with a lower incidence following infection from less virulent strains. Although long COVID can be largely managed in primary care, a minority of people who have persistent symptoms and impaired function may require specialist care pathways, the effectiveness of which should be a focus of future research.

More than fun and games: Problematic sports betting and its adverse impact on mental health and well-being in young adults

BackgroundThe rapid rise in sports betting, especially among young adults (age 18–29), necessitates identifying health correlates of this addictive behavior. The present study examined associations between problem sports betting symptoms and mental health and well-being, which represents a timely literature gap. MethodThe sample was 221 young adult sport bettors from 36 different states (Mage = 24.4, 77.7% male). Regression models estimated associations between problem sports betting severity (PGSI-SB) and symptoms of depression, anxiety, psychological distress, loneliness, and stress, as well as indices of well-being, including satisfaction with life, optimism, connectedness, and social functioning. ResultsYoung adults with greater problem sports betting severity had significantly higher scores on each index of mental health symptomology and had poorer indices of well-being. The strongest relative effect size was the association between problem sports betting severity and stress (a 1SD increase in PGSI-SB score corresponded to 48% of a standard deviation increase in stress). ConclusionsThis study provides novel and timely evidence for associations between problem sports betting and various indices of mental health and well-being; thus, highlighting the need for rapid development of holistic prevention/intervention strategies aimed at the intersection of problem sports betting and mental health.

The role of shame and trauma type on posttraumatic stress disorder and depression severity in a treatment-seeking veteran population.

Research on how different types of trauma affect depression and posttraumatic stress disorder (PTSD) symptoms in veterans has yielded inconsistent results. Shame, a painful and negative self-evaluative emotion observed in PTSD and across interpersonal traumas, may help explain past findings. The present study explored (a) how trauma types (childhood abuse, combat exposure, and military sexual trauma [MST]) may be associated with depression and PTSD severity and (b) how shame may be associated with trauma type, PTSD symptoms, and depression symptoms in a treatment-seeking veteran sample. Veterans (N = 372) completed self-report questionnaires assessing trauma exposure, PTSD symptoms, depression symptoms, and shame upon admission to treatment programs across two Veterans Affairs Medical Centers. We found that veterans with combat exposure or MST had greater depression and PTSD symptoms than those without these trauma experiences. Among veterans without a history of combat exposure and MST, a history of childhood abuse was associated with depression symptoms. Among veterans who did not experience combat but did experience MST, a history of childhood abuse was not associated with depression symptoms. We found that characterological shame (i.e., shame about oneself) partially mediated MST status and PTSD symptoms and fully mediated MST status and depression symptoms. These results suggest that different trauma exposures can have complex effects on clinical presentations and that shame may be a mechanism of PTSD and depression severity in veterans with MST. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pleasurable emotions and internalizing psychopathology: A multi-study examination of specificity and alternative explanations.

Past research has been inconclusive regarding the specificity of associations between discrete pleasurable emotions and internalizing symptoms. Contentment may be especially relevant to depression, whereas tranquillity may be especially relevant to worry. The goal of the current research was to clarify the mixed findings regarding the relation between pleasure deficits and internalizing psychopathology. Participants from three samples (Total N = 757) completed alternative measures of depression and pleasurable emotions. Participants in Study 1 also completed a measure of anticipatory and consummatory pleasure, and close peers to a subset of participants (N = 64) reported their perceptions of participants' depression severity. Participants in Studies 2 and 3 also completed a measure of worry. Across the three samples, contentment was significantly negatively associated with self-reported depression. This association could not be accounted for by tranquillity, cheerfulness, anticipatory pleasure, or consummatory pleasure. Contentment was also strongly negatively associated with peer-reported depression. Contentment was more strongly associated with depression than was cheerfulness. However, the strength of the association between contentment and depression relative to the strength of the association between tranquillity and depression depended on how contentment and depression were measured. Conversely, tranquillity was more strongly associated with worry than were contentment or cheerfulness. This study provides further evidence of the potential importance of the role of contentment in depression and tranquillity in worry. It may be useful to attend to contentment when assessing and treating depression and to attend to tranquillity when assessing and treating elevated worry.

Exploring accessibility, user experience and engagement of digital media among older patients with depression: a pilot and observational screening study protocol of the DiGA4Aged study

IntroductionThe prevalence of mental health problems is increasing worldwide, particularly in the vulnerable group of older people. The limited availability of therapists, long wait periods and increasing shortage of healthcare...

The relationship between asthma and suggested alcohol dependence and heavy alcohol use in the Cooper Center longitudinal study: The role of depressive symptom severity

BackgroundAsthma appears to be associated with a variety of psychiatric illnesses including depression and alcohol use disorder. The current study examined the relationship between asthma, heavy alcohol intake and suggested alcohol dependence controlling for depressive symptom severity. MethodsData from 33,253 adult patients at the Cooper Clinic who enrolled in the Cooper Center Longitudinal Study, completed a medical history questionnaire including information on asthma, depressive symptoms and alcohol use were used. The association between lifetime asthma and heavy alcohol intake, while accounting for depressive symptoms (10-item Center for Epidemiological Studies-Depression (CESD)), and demographic variables was examined employing logistic regression with heavy alcohol intake (yes/no) as the outcome. Logistic regression was similarly utilized to examine the association between asthma and suggested alcohol dependence (CAGE scores ≥2: yes/no) among current drinkers (n = 26,028). ResultsMultivariable analysis revealed no significant association between asthma and heavy alcohol consumption with or without controlling for CES-D scores. Asthma was, however, associated with higher odds for suggested alcohol dependence (OR 1.18, CI 1.07, 1.31), which was attenuated but still significant when controlling for CES-D scores. ConclusionAsthma was associated with higher risk for suggested alcohol dependence while current heaving drinking risk was not increased. The suggested drinking findings were slightly less strong when controlling for CES-D scores. The differences between current heavy drinking and CAGE findings might be due to differences in perception of problematic drinking by people with asthma or the timeframe of the assessments (current for drinking, lifetime for CAGE).

A multisite observational real-world study on the effectiveness of repetitive transcranial magnetic stimulation therapy for patients with treatment-resistant depression in Japan

The objective of this study was to reveal the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for Japanese patients with treatment-resistant depression (TRD) in clinical practice, based on real-world data from a nationwide multicenter observational study in Japan.Clinical data of patients with TRD treated with rTMS (NeuroStar TMS treatment system) under public insurance coverage were retrospectively collected from 21 institutes nationwide between June, 2019 and December, 2023. Depression severity was assessed by the 17-item Hamilton Depression Rating Scale (HAMD-17). Response and remission were defined as ≥50% reduction from baseline and ≤7 points on the HAMD-17, respectively. The primary outcome was the changes in the HAMD-17 score from baseline to the endpoint following rTMS. Data from 497 patients with TRD were candidates for this study. The HAMD-17 scores (mean (SD)) improved significantly from 18.9 (5.3) to 9.7 (6.6), respectively. The response and remission rates at the end of rTMS therapy as assessed by the HAMD-17 were 53.5% and 42.8%, respectively. The dropout rate due to adverse effects was 4.2%, and the treatment was generally well tolerated. No convulsive seizures or manic changes were observed. These results indicate that conventional rTMS is effective and safe in Japanese patients with TRD.

Thalamic Volumes and Functional Networks Linked With Self-Regulation Dysfunction in Major Depressive Disorder.

Self-regulation (SR) dysfunction is a crucial risk factor for major depressive disorder (MDD). However, neural substrates of SR linking MDD remain unclear. Sixty-eight healthy controls and 75 MDD patients were recruited to complete regulatory orientation assessments with the Regulatory Focus Questionnaire (RFQ) and Regulatory Mode Questionnaire (RMQ). Nodal intra and inter-network functional connectivity (FC) was defined as FC sum within networks of 46 thalamic subnuclei (TS) or 88 AAL brain regions, and between the two networks separately. Group-level volumetric and functional difference were compared by two sample t-tests. Pearson's correlation analysis and mediation analysis were utilized to investigate the relationship among imaging parameters and the two behaviors. Canonical correlation analysis (CCA) was conducted to explore the inter-network FC mode of TS related to behavioral subscales. Network-based Statistics with machine learning combining powerful brain imaging features was applied to predict individual behavioral subscales. MDD patients showed no group-level volumetric difference in 46 TS but represented significant correlation of TS volume and nodal FC with behavioral subscales. Specially, inter-network FC of the orbital part of the right superior frontal gyrus and the left supplementary motor area mediated the correlation between RFQ/RMQ subscales and depressive severity. Furthermore, CCA identified how the two behaviors are linked via the inter-network FC mode of TS. More crucially, thalamic functional subnetworks could predict RFQ/RMQ subscales and psychomotor retardation for MDD individuals. These findings provided neurological evidence for SR affecting depressive severity in the MDD patients and proposed potential biomarkers to identify the SR-based risk phenotype of MDD individuals.