Stability Of Depressive Symptoms Research Articles

Perinatal Trajectories of Maternal Depressive Symptoms in Prospective, Community-Based Cohorts Across 3 Continents

Depressive symptoms during pregnancy influence the development and health of the offspring, underscoring the need for timely intervention. However, the course of depressive symptoms across the perinatal period remains unclear, thus complicating screening and referral guidelines. To examine the course and stability of depressive symptoms across the perinatal period in multiple, ethnically diverse independent observational cohorts. This cohort study included self-reported depressive symptoms at multiple time points from 7 prospective cohorts spanning 3 continents (United Kingdom: Avon Longitudinal Study of Parents and Children from 1991 to 1995; Canada: Maternal Adversity, Vulnerability and Neurodevelopment from 2003 to 2007; Montreal Antenatal Well-being Study from 2019 to 2022; Alberta Pregnancy Outcomes and Nutrition from 2009 to 2014; and Singapore: Growing Up in Singapore Toward Healthy Outcomes from 2009 to 2013; Singapore Preconception Study of Long-Term Maternal and Child Outcomes from 2015 to 2019; and Mapping Antenatal Maternal Stress from 2019 to 2022). Participants were recruited either during preconception or pregnancy and observed into the postnatal period. All data from each cohort were analyzed from July 2022 to April 2023. Self-reported depressive symptoms from pregnancy to 2 years following childbirth using either the Edinburgh Postnatal Depression Scale or the Center for Epidemiological Studies Depression were analyzed independently within each cohort using item response theory (IRT) techniques. K-means clustering was used to identify groups of participants with similar trajectories. A total of 11 563 pregnant women (mean [SD] age, 29 [5] years; 569 [4.9%] East Asian women; 304 [2.6%] Southeast Asian women; 10 133 [87.6%] White women) self-reported depressive symptoms from pregnancy to 2 years following childbirth. Analytic methods from Item Response Theory identified 3 groups of mothers based on depressive symptoms: low, mild, and high levels in each of the 7 cohorts. Mothers within and across all cohorts had stable trajectories of maternal depressive symptoms from pregnancy onwards. Mothers with clinical levels of depressive symptoms likewise showed stable trajectories from pregnancy into the postnatal period. In this study, trajectories of depressive symptoms remained stable from pregnancy across the perinatal period, a finding that conflicts with a continuing emphasis on postpartum or postnatal onset of depression that persists in some health policy guidelines. Interventions and public health initiatives should focus on reducing depressive symptoms during pregnancy in addition to following birth.

Sexual Trauma Informed Understanding of Longitudinal Depression among Repeat Juvenile Offenders

Childhood sexual assault (CSA) victimization and depression are global public health concerns that disproportionately affect youths involved in the juvenile justice system. Little research has examined the influence of CSA on the stability of depressive symptoms among repeat juvenile offenders. The present study tested a gendered model of the association between lifetime CSA victimization and depression for three time points: baseline juvenile assessment entry; second reentry; and third reentry. Further, covariate analyses were conducted to explore the impact of socio-demographics on CSA victimization and depression. Results indicate that CSA victimization was associated directly with baseline depression and indirectly with depression at second reentry for both male and female justice-involved youths. For white, male youth, there were significantly higher rates of depression over time, than other males. However, age, African American or Hispanic race/ethnicity, living situation, and urbanity were not significantly associated with CSA victimization at baseline or depression over time. These findings underscore the need for juvenile justice services that address exposure to childhood trauma and mental illness more effectively.

Parent and peer social-emotional support as predictors of depressive symptoms in the transition into and out of college

The objective of this study was to evaluate the developmental unfolding of how parent and peer support work together to predict subsequent depressive symptoms in the transition into and out of college. The longitudinal College Experiences Study was used to test hypotheses (N = 209, ~60% female, ~90% white); three waves of data were collected over a four-year period with adequate retention (80%+). Data were analyzed using random-intercept cross-lagged panel modelling (RI-CLPM). Results showed moderate stability in depressive symptoms over time, with little evidence of within-person effects (e.g., parent and peer support did not significantly predict subsequent depressive symptoms or vice versa). There was strong evidence for between-level effects (e.g., parent support, peer support, and depressive symptoms were stable and explained largely by a higher-order, correlated factor structure). Results were consistent across gender and there was no evidence for interactions between parent and peer support as predictors of depressive symptoms. Altogether, the prospective associations between parent, peer support, and depressive symptoms in the transition into and out of college appear to be largely by time-invariant, trait-like influences.

Association of childhood maltreatment and cortisol with the severity and stability of depression symptoms

BackgroundLittle is known about patterns of depression symptoms over time in older adults. This study aims to assess the association of childhood maltreatment and cortisol levels with latent classes of depression symptoms over ten years in older adults. MethodsA total of 752 participants (mean age 61.7±9.5, female 18%) in the Second Manifestations of ARTerial disease-Memory, depression and aging (SMART-Medea) study provided up to twenty measures of depression symptoms over ten years based on the Patient Health Questionnaire-9 (PHQ-9). At baseline, salivary cortisol was measured, and childhood maltreatment was assessed. Responses to the PHQ-9 were indicators in a latent class analysis. Multinomial regression determined associations between class membership and cortisol and maltreatment, adjusting for age, sex, and education. ResultsFour distinct classes were identified; never depressed (n=275, 37%), energy/sleep difficulties (n=237, 32%), mild depression symptoms (n=152, 20%) and fluctuating severe depression (n=88, 12%). Childhood maltreatment was associated with mild depression symptoms (OR=1.95, 95% CI: 1.17-3.25) and fluctuating severe depression (OR=3.50, 95% CI: 1.99-6.15). Blunted morning cortisol was associated with energy/sleep difficulties (OR=0.98, 95% CI: 0.95-1.00) and fluctuating severe depression (OR=0.96, 95% CI: 0.92-0.99). There was no evidence for interaction between maltreatment and cortisol. LimitationsThere is limited generalizability due to the cohort consisting of participants with atherosclerosis and being mostly male. This study utilizes retrospective self-reporting of childhood maltreatment. ConclusionChildhood maltreatment and blunted morning cortisol independently contribute to a worse depression course. Blunted morning cortisol may contribute to sub-clinical depression symptoms, specifically difficulties with energy levels and sleep.

Are Short-Term Temporal Relationships between Depressive and Anxious Symptoms Moderated by Sex?

The chief goal of the present study was to elucidate whether the short-term temporal relationships between depressive and anxious symptoms vary by sex. Three hundred and fifty-seven undergraduate students self-reported depressive and anxious symptomatology with the Beck Depression Inventory (BDI-II) and the Beck Anxiety Index (BAI) two times 11 weeks apart. A latent variable path model analysis found support for a bi-directional relationship between depressive symptoms and anxious symptoms for the overall sample. An equality constraint analysis revealed that depressive symptoms predicted anxious symptoms over time to a similar extent as anxious symptoms predicted depressive symptoms over time. However, several temporal relationships significantly varied by sex, namely, females demonstrated greater stability of depressive symptoms over time, and evidenced a stronger cross-lag relationship from depressive symptoms at Time 1 to anxious symptoms at Time 2, and males, on the other hand, exhibited a marginally more stable anxious symptoms test-retest relationship over time. The results supported the existence of a bi-directional relationship between depressive and anxious symptoms over a short-term period of time for emerging adults. We conclude that current states of depressive symptoms may be more influential for females’ subsequent negative affective states, whereas anxious symptoms may be more important for males’ subsequent negative affective states.

Do cultural orientations moderate the relation between Chinese adolescents’ shyness and depressive symptoms? It depends on their academic achievement

AbstractWe examined the moderating roles of individualistic and collectivistic cultural orientations and academic achievement on the relation between Chinese adolescents’ shyness and depressive symptoms. A sample of Chinese adolescents (N = 492) from an urban school participated in the study during seventh (T1) and eighth (T2) grades. Adolescents self‐reported their shyness, cultural orientations, and depressive symptoms. The school provided records of their academic achievement. Concurrently, shyness and individualism were positively whereas collectivism and academic achievement were negatively, associated with adolescents’ depressive symptoms. Longitudinally, T1 shyness (but not individualism, collectivism, or academic achievement) predicted T2 depressive symptoms after controlling for stability in depressive symptoms. Concurrent relations between shyness and depressive symptoms were moderated by adolescents’ cultural orientations. Specifically, collectivism was protective whereas individualism was harmful, for shy adolescents’ adjustment. Furthermore, collectivism and academic achievement jointly moderated the relations between shyness and depressive symptoms concurrently and longitudinally. The results suggest that cultural orientations may influence shy adolescents’ depression symptoms through individual‐level self‐evaluation, and indicate that cultural factors and academic achievement need to be considered comprehensively for understanding and improving shy Chinese adolescents’ psychological adjustment.

Physical Activity, Sedentary Behavior, and Symptoms of Major Depression in Middle Childhood.

The prospective relation between physical activity and Diagnostic and Statistical Manual of Mental Disorders-defined major depression in middle childhood is unknown, as is the stability of depression. We therefore aimed to (1) determine whether there are reciprocal relations between moderate-to-vigorous physical activity (MVPA) and sedentary behavior, on one hand, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition defined symptoms of major depressive disorder, on the other and (2) assess the extent of stability in depressive symptoms from age 6 to 10 years. A community sample of children living in Trondheim, Norway, comprising a total of 795 6-year-old children was followed up at 8 (n = 699) and 10 (n = 702) years of age. Physical activity was recorded by accelerometry and symptoms of major depression were measured through semistructured clinical interviews of parents and children. Bidirectional relationships between MVPA, sedentary activity, and symptoms of depression were analyzed through autoregressive cross-lagged models, and adjusted for symptoms of comorbid psychiatric disorders and BMI. At both age 6 and 8 years, higher MVPA predicted fewer symptoms of major depressive disorders 2 years later. Sedentary behavior did not predict depression, and depression predicted neither MVPA nor sedentary activity. The number of symptoms of major depression declined from ages 6 to 8 years and evidenced modest continuity. MVPA predicts fewer symptoms of major depression in middle childhood, and increasing MVPA may serve as a complementary method to prevent and treat childhood depression.

Serum brain-derived neurotrophic factor and stability of depressive symptoms in coronary heart disease patients: A prospective study

ObjectiveBrain-derived neurotrophic factor (BDNF) supports neurogenesis, angiogenesis, and promotes the survival of various cell types in the brain and the coronary system. Moreover, BDNF is associated with both coronary heart disease (CHD) and depression. The current study aims to investigate whether serum BDNF levels are associated with the course of depressive symptoms in CHD patients. MethodsAt baseline, N=225 CHD patients were enrolled while hospitalized. Of these, N=190 (84%) could be followed up 6 months later. Depressive symptoms were assessed both at baseline and at the 6-months follow-up using the Patient Health Questionnaire (PHQ-9). Serum BDNF concentrations were measured using fluorometric Enzyme-linked immunosorbent assays (ELISA). ResultsLogistic regression models showed that lower BDNF levels were associated with persistent depressive symptoms, even after adjustment for age, sex, smoking and potential medical confounders. The incidence of depressive symptoms was not related to lower BDNF levels. However, somatic comorbidity (as measured by the Charlson Comorbidity Index) was significantly associated with the incidence of depressive symptoms. ConclusionsOur findings suggest a role of BDNF in the link between CHD and depressive symptoms. Particularly, low serum BDNF levels could be considered as a valuable biomarker for the persistence of depressive symptoms among depressed CHD patients.

Postpartum Depressive Symptoms Following Consecutive Pregnancies

Postpartum depression is a major mental health issue for women and society. We examined stability and change in symptoms of depression over two consecutive pregnancies and tested life stress as a potential mechanism. The Community Child Health Network followed an ethnically/racially diverse sample from one month after a birth for two years. A subset of 228 women had a second birth. Interview measures of depression symptoms (EPDS) and life stress (life events, perceived stress, chronic stress, interpersonal aggression) were obtained during home visits. Three-quarters of the sample showed intra-individual stability in depressive symptoms from one postpartum period to the next, and 24% of the sample had clinically significant symptoms after at least one pregnancy (9% first, 7.5% second, 3.5% both). Each of the four life stressors significantly mediated the association between depressive symptoms across two postpartum periods. Stress between pregnancies for women may be an important mechanism perpetuating postpartum depression.

Gender Moderation of the Intergenerational Transmission and Stability of Depressive Symptoms from Early Adolescence to Early Adulthood.

Factors that might exacerbate or mitigate the transmission of depressive symptoms from parents to adolescents and the continuity of depressive symptoms into early adulthood are poorly understood. This study tested the hypothesis that the intergenerational transmission and stability of depressive symptoms would be stronger for girls than boys over adolescence and into early adulthood, while considering the possibility that the pattern of gender moderation might vary depending on parent gender and developmental timing. The participants were 667 rural Midwestern adolescents (52% female) and their parents. Survey data on maternal and paternal depressive symptoms (at youth age 11) and on adolescent and young adult depressive symptoms (at youth ages 11, 18, and 21) were analyzed via multiple group structural equation modeling. Maternal depressive symptoms predicted increased late adolescent depressive symptoms for girls but not boys, and adolescent depressive symptoms were more stable in girls. Paternal depressive symptoms predicted increased late adolescent depressive symptoms for all youth. The findings suggest the need for early, tailored interventions.

Change and stability in depressive symptoms in young adults with type 1 diabetes

This study examined inter-individual differences in depressive symptom development in young adults with type 1 diabetes. Individuals with persistent depressive symptoms were at risk for suboptimal development in terms of illness perceptions, illness functioning, and self-esteem. Individuals reporting no/minimal depressive symptoms over time were characterized by the most optimal development.

Stability of depressive symptoms over 3 months post-partum.

Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum. From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models. The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression. Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.

Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

Depression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular. As part of a prospective, population-based study on a random sample of 5632 subjects aged 65-84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors. Severity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15-1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32-0.95; men MHR 0.59, 95% CI 0.37-0.93). Neither sociodemographic nor medical confounders significantly modified these associations. Consistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

A Dynamic View of Depressive Symptoms and Neurocognitive Change Among Patients With Coronary Artery Disease

Older patients with coronary artery disease often experience depressive symptoms and are vulnerable to developing cognitive impairment. Whether depressive symptoms increase their risk of cognitive decline is unknown. To examine the association between the stability of depressive symptoms and cognitive decline for 30 months among patients undergoing coronary angiography and to explore whether any observed associations were modified by the presence of the apolipoprotein E (APOE) ε4 allele. Cohort study. Urban tertiary care hospital serving southern Alberta. Three hundred fifty patients 60 years or older (73.7% male) undergoing nonemergent catheterization (October 27, 2003, through February 28, 2007) without prior revascularization. We compared a baseline measure of depressive symptoms (Geriatric Depression Scale score ≥5) with a dynamic measure capturing change from baseline to 12 months. Mean change in domain (z scores for attention/executive function, learning/memory, and verbal fluency) and global (raw Mini-Mental State Examination) cognitive scores from baseline to 6, 12, and 30 months and from 12 to 30 months. In adjusted models, participants with persistent depressive symptoms (at baseline and ≥1follow-up visit) showed significantly greater declines at 30 months in attention/executive function (mean z score change, -0.22), learning/memory (-0.19), verbal fluency (-0.18), and global cognition (mean Mini-Mental State Examination [MMSE] score change, -0.99) compared with participants with no or baseline-only depressive symptoms. Persistent depressive symptoms were associated with significantly greater declines in all cognitive measures from 12 to 30 months after adjusting for sociodemographic and clinical factors. For global cognition, a significantly greater decline was evident for patients with persistent depressive symptoms and the APOE ε4 allele (mean MMSE score change, -2.93 [95% CI, -4.40 to -1.45]). Depressive symptoms persist in some patients with coronary artery disease, placing them at a greater risk for cognitive decline. Whether this decline is additionally modified by the presence of APOE ε4 requires further investigation.

Stability of dysfunctional attitudes and early maladaptive schemas: A 9-year follow-up study of clinically depressed subjects

The Dysfunctional Attitude Scale (DAS) and the Young Schema Questionnaire (YSQ) have been suggested as relatively stable vulnerability markers for depression and entrenched psychological disorders, respectively. One-hundred-and-forty-nine clinically depressed (CDs), previously depressed (PDs) and never-depressed subjects (NDs) completed the DAS, the YSQ and the Beck Depression Inventory in the index study and were followed-up nine years later. Results showed: (1) Elevated scores in CDs and PDs as compared to NDs; (2) Some stability of depressive symptoms; (3) Significant moderate test–retest correlations for DAS scales and YSQ scales Disconnection and Impaired Limits, also after controlling for depression severity; (4) A significant reduction in mean score for DAS total, Approval by Others and YSQ scales Disconnection and Impaired Limits; (5) Significant correlations between DAS and YSQ scales. Our results support a state-trait vulnerability model of depression comprising stable differences in availability of dysfunctional attitudes and early maladaptive schemas, but also fluctuating differences in accessibility of those schemas during the course of depression. The findings point to the significance of the YSQ scales as vulnerability markers for depression in addition to the more established DAS scales.

Predictors of depressive symptoms 12 months after surgical treatment of early‐stage breast cancer

Nearly half of the women with breast cancer (BC) show depressive symptoms in the first year after diagnosis. This has a major impact on patients' lives. Therefore, the aim of this study was to identify predictors of depressive symptoms 12 months after surgical treatment. Furthermore, the stability of depressive symptoms across 12 months was investigated for persons scoring high versus low/moderately on agreeableness, trait anxiety, and neuroticism. From the 609 women with an abnormality in the breast, 223 appeared to have early-stage BC. A depressive symptoms questionnaire (Center for Epidemiological Studies-Depression Scale) was completed before diagnosis and 1, 3, 6, and 12 months after surgical treatment. In addition, patients completed questionnaires on personality (State Trait Anxiety Inventory, Neuroticism-Extraversion-Openness-Five Factor Inventory), fatigue (Fatigue Assessment Scale), and aspects of quality of life (World Health Organization Quality of Life assessment instrument-100). Before diagnosis and 1 year later, 40.9% and 27.8% of the women, respectively, scored above the established cut-off score for depressive symptoms. Depressive symptoms significantly improved in this period. Patients reported higher scores, when they had a breast-conserving therapy (BCT), scored low on agreeableness, scored high on neuroticism, or reported higher scores on depressive symptoms or fatigue before diagnosis. Other clinical and socio-demographic factors did not predict depressive symptoms. Besides BCT, fatigue, and depressive symptoms, personality, especially neuroticism and agreeableness, predicted depressive symptoms 1 year after surgical treatment. Therefore, it is important to screen patients on these characteristics in order to prevent long-term depressive symptoms.

A 2-4 year follow up of depressive symptoms, suicidal ideation, and suicide attempts among adolescent psychiatric inpatients.

One hundred eleven (58%) of 191 adolescent inpatients previously admitted to the emergency wards at the Child and Adolescent Psychiatric Clinics in the cities of Uppsala and Göteborg participated in a 2-4 year follow-up evaluation. The prevalence, incidence, and stability of depressive symptoms, suicidal ideation, and suicide attempts among the adolescents, and predictors of follow-up functioning were examined. Although a majority of the patients substantially reduced their depressive symptoms over the 2-4 year period, a smaller group (13%), mainly girls (94%), continued reporting high symptom levels at follow-up, and one out of five adolescents had moderate-severe levels of suicidal ideation. The accumulated frequency of suicide attempts among the patients shortly prior to hospitalization and during the follow-up was 59% including two patients who committed suicide. Significant predictors of depressive symptom severity at follow-up were depressive symptom scores and V-diagnoses at inpatient assessment. Previous suicide attempts before hospitalization, high levels of self-reported depressive symptoms and nonintact family status at inpatient assessment predicted suicide attempts during the follow-up period. The high prevalence of attempted and completed suicide in this clinical group underscores the importance of developing effective treatments for suicidal adolescents.

The stability of depressive symptoms in college students: An empirical demonstration of regression to the mean

In a recent paper, Vredenburg, Flett, and Krames (1993) hypothesized that the apparent instability of depressive symptom scores in college students may be due, in part, to the phenomenon known as statistical regression to the mean. This statistical principle was demonstrated in the current study. A sample of 183 university students completed the Beck Depression Inventory (BDI) at two timepoints separated by a 3-month interval. Consistent with past results, analyses revealed substantial changes in symptom scores over time with decrements being evident among many subjects with elevated symptom scores at Time 1. Examination of the amount of change over time in BDI scores indicated a pattern of findings that approximated the regression to the mean phenomenon. Statistical tests confirmed that regression to the mean accounted for a significant amount of the change in symptom scores over time. The implications of these findings are discussed in terms of the nature of depressive symptoms in students and the inappropriateness of assigning subjects to depressed or nondepressed groups on the basis of elevated scores on a self-report measure.

Prevalence and short-term stability of depressive symptoms in schoolchildren.

This study examined the prevalence of depressive symptoms in a sample of 471 Swedish schoolchildren aged 8-13 years from urban and rural areas. Children self-reported their experience of depressive symptoms on a Swedish version of the Children's Depression Inventory (CDI). Short-term stability of children's depressive symptoms was evaluated for a 6- to 9-week period. In addition, the children's satisfaction with their school, home and leisure time was assessed. The results indicated that the prevalence of depressive symptoms was related to neither location (urban vs rural) nor age. Although girls experienced significantly more depressive symptoms than boys, the clinical importance of this difference is negligible. Approximately 1% of the schoolchildren reported severe suicidal thoughts. As expected, children's depression was negatively associated with their home and school satisfaction and leisure interest. A cut-off score of 13 on the CDI could identify the upper 10% of the children in the school sample as depressed and, at the follow-up, 44% of these children continued to be depressed. Overall, the total CDI mean scores obtained in this study were lower than those reported in comparative surveys in Anglo-Saxon countries.