Subclinical Depression Research Articles

Altered spontaneous neural activity in the precuneus, middle and superior frontal gyri, and hippocampus in college students with subclinical depression

BackgroundSubclinical depression (ScD) is a prevalent condition associated with relatively mild depressive states, and it poses a high risk of developing into major depressive disorder (MDD). However, the neural pathology of ScD is still largely unknown. Identifying the spontaneous neural activity involved in ScD may help clarify risk factors for MDD and explore treatment strategies for mild stages of depression.MethodsA total of 34 ScD subjects and 40 age-, sex-, and education-matched healthy controls were screened from 1105 college students. The amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) of resting-state fMRI were calculated to reveal neural activity. Strict statistical strategies, including Gaussian random field (GRF), false discovery rate (FDR), and permutation test (PT) with threshold-free cluster enhancement (TFCE), were conducted. Based on the altered ALFF and ReHo, resting-state functional connectivity (RSFC) was further analyzed using a seed-based approach.ResultsThe right precuneus and left middle frontal gyrus (MFG) both showed significantly increased ALFF and ReHo in ScD subjects. Moreover, the left hippocampus and superior frontal gyrus (SFG) showed decreased ALFF and increased ReHo, respectively. In addition, ScD subjects showed increased RSFC between MFG and hippocampus compared to healthy controls, and significant positive correlation was found between the Beck Depression Inventory-II (BDI-II) score and RSFC from MFG to hippocampus in ScD group.ConclusionSpontaneous neural activities in the right precuneus, left MFG, SFG, and hippocampus were altered in ScD subjects. Functional alterations in these dorsolateral prefrontal cortex and default mode network regions are largely related to abnormal emotional processing in ScD, and indicate strong associations with brain impairments in MDD, which provide insight into potential pathophysiology mechanisms of subclinical depression.

Subclinical depression and anxiety impact verbal memory functioning differently in men and women —an fMRI study

BackgroundDepressive symptoms are known to affect memory efficiency in various populations. More specifically, several studies conducted in patients suffering from schizophrenia have indicated that memory efficiency is affected by depressed mood in female patients and by anxiety in male patients. We investigated, using neuroimaging techniques, whether similar gender-specific associations with subclinical depression and anxiety could be observed in a non-clinical sample. MethodForty-five healthy Spanish-speaking individuals (23 females) were administered a verbal memory task. Lists of high- and low-frequency words were presented. Immediate free recall was requested after the learning of each list, and a yes/no recognition task was completed during the acquisition of the fMRI data. ResultsRegression analyses revealed that higher depression scores in women, and higher anxiety scores in men, were associated with poorer recall. In women, higher depression scores were further associated with decreased cerebral activity in the right temporoparietal junction, left inferior occipitotemporal gyrus, bilateral thalamus, and left anterior cingulate during correct recognition of target words. In men, anxiety scores were not associated with any cerebral activity. ConclusionsSubclinical depression in women appears to affect memory efficiency by impacting cerebral regions specifically recruited for the cognitive demands of the task, as well as cerebral regions more generally involved in arousal, decision-making, and emotional regulation. Anxiety in men might impact the encoding memory processes. The results, although preliminary, suggest that gender differences may need to be taken into account when developing strategies for the cognitive and pharmacological remediation of memory impairment.

The psychological impact of active surveillance in men with prostate cancer: implications for nursing care.

Active surveillance is a conservative management approach to treating prostate cancer involving regular testing and close monitoring by the health professional. The aim of this literature review is to establish whether men experience a psychological impact of active surveillance and what the prevalent effects might be. The search was carried out in three databases: CINAHL, Medline and PsycINFO. Articles published in English, from October 2015 to March 2018, which focused on the psychological impact of active surveillance, were included. A total of eight quantitative studies were included in this report. The review identified key psychological impacts of active surveillance, including anxiety, sub-clinical depression, illness uncertainty and hopelessness. Active surveillance was seen by some patients as a positive treatment approach that limited the side effects associated with active treatment. The evidence found a negative impact of active surveillance might be felt by men at any stage during treatment and at differing levels of severity. The article highlights key demographic areas, including ethnicity and age, for future research and recommends more qualitative studies are conducted.

Effects of subclinical depression on prefrontal-striatal model-based and model-free learning.

Depression is characterized by deficits in the reinforcement learning (RL) process. Although many computational and neural studies have extended our knowledge of the impact of depression on RL, most focus on habitual control (model-free RL), yielding a relatively poor understanding of goal-directed control (model-based RL) and arbitration control to find a balance between the two. We investigated the effects of subclinical depression on model-based and model-free learning in the prefrontal-striatal circuitry. First, we found that subclinical depression is associated with the attenuated state and reward prediction error representation in the insula and caudate. Critically, we found that it accompanies the disrupted arbitration control between model-based and model-free learning in the predominantly inferior lateral prefrontal cortex and frontopolar cortex. We also found that depression undermines the ability to exploit viable options, called exploitation sensitivity. These findings characterize how subclinical depression influences different levels of the decision-making hierarchy, advancing previous conflicting views that depression simply influences either habitual or goal-directed control. Our study creates possibilities for various clinical applications, such as early diagnosis and behavioral therapy design.

Preliminary Comparison of Subcortical Structures in Elderly Subclinical Depression: Structural Analysis with 3T MRI.

Depression in the elderly population has shown increased likelihood of neurological disorders due to structural changes in the subcortical area. However, further investigation into depression related subcortical changes is needed due to mismatches in structural analysis results between studies as well as scarcities in research regarding subcortical connectivity patterns of subclinical depression populations. This study aims to investigate structural differences in subcortical regions of aged participants with subclinical depression using 3Tesla MRI. In structural analysis, volumes of each subcortical region were measured to observe the volumetric difference and asymmetry between groups, but no significant difference was found. In addition, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) did not show any significant differences between groups. Structural analysis using probabilistic tractography indicated that the connection strength between left nucleus accumbens-right hippocampus, and right thalamus-right caudate was higher in the control group than the subclinical depression group. The differences in subcortical connection strength of subclinical depression groups, have shown to correlate with emotional and cognitive disorders, such as anxiety and memory impairment. We believe that the analysis of structural differences and cross-regional network measures in subcortical structures can help identify neurophysiological changes occurring in subclinical depression.

Differential neural structures, intrinsic functional connectivity, and episodic memory in subjective cognitive decline and healthy controls

The neural correlates of subjective cognitive decline (SCD; i.e., without objectifiable deficit) remain to be elucidated. Possible causes of SCD include early neurodegeneration related to Alzheimer's disease or functional and structural changes related to sub-clinical depression. We investigated the relationship between episodic memory performance or memory complaints and structural or functional magnetic resonance imaging (MRI) measures in participants with SCD (n=18) but without psychiatric disorders and healthy controls (n=31). In SCD, memory complaints were not associated with memory performance but with sub-clinical depression and executive functions. SCD-associated memory complaints correlated with higher amygdala and parahippocampal gyrus (specifically subiculum) gray matter density. In controls, but not in SCD, mesiotemporal gray matter density and superior frontal gyrus functional connectivity predicted memory performance. In contrast, in SCD, only a trend toward a correlation between memory performance and gray matter density in the parietooccipital lobes was observed. In our memory-clinic sample of SCD, we did not observe incipient neurodegeneration (limited to structural and functional MRI) but rather sub-clinical depression underlying subjective cognitive complaints.

Associations Between Depression and Brain Structure Across the Lifespan: Preliminary Results From the European Lifebrain Consortium

Depression diagnosis is associated with decreased prefrontal thickness and hippocampal volume. Less is known about these associations in the general population and across the lifespan. We investigate associations between (subclinical) depression and brain structure, and moderating effects of age and sex.

Intensification of functional neural control on heartbeat dynamics in subclinical depression

Subclinical depression (dysphoria) is a common condition that may increase the risk of major depression and leads to impaired quality of life and severe comorbid somatic diseases. Despite its prevalence, specific biological markers are unknown; consequently, the identification of dysphoria currently relies exclusively on subjective clinical scores and structured interviews. Based on recent neurocardiology studies that link brain and cardiovascular disorders, it was hypothesized that multi-system biomarkers of brain–body interplay may effectively characterize dysphoria. Thus, an ad hoc computational technique was developed to quantify the functional bidirectional brain–heart interplay. Accordingly, 32-channel electroencephalographic and heart rate variability series were obtained from 24 young dysphoric adults and 36 healthy controls. All participants were females of a similar age, and results were obtained during a 5-min resting state. The experimental results suggest that a specific feature of dysphoria is linked to an augmented functional central-autonomic control to the heart, which originates from central, frontopolar, and occipital oscillations and acts through cardiovascular sympathovagal activity. These results enable further development of a large set of novel biomarkers for mood disorders based on comprehensive brain–body measurements.

Overweight and obese individuals with depressive symptoms from the MooDFOOD prevention trial: Role of sociodemographic, somatic health, and weight related factors

• Sociodemographics are not related to history of MDD in subsyndromal and obese people. • No difference in health claims among obese people with and without history of MDD. • In subclinical depression and obesity, anthropometrics are not related to lifetime MDD. Major depression disorder (MDD) 1 1 Abbreviations : BMI: Body mass index; MDD: Major depressive disorder; WHR: wait-to-hip-ratio and obesity are among the most common public health problems. The majority of epidemiological studies demonstrated a strong relationship between sociodemographic factors like age and socioeconomic status and depression. Also, a bidirectional link between depression and obesity is discussed. However, differences regarding sociodemographic factors and obesity between participants with and without lifetime MDD might occur, but potentially not in all individuals. This study intends to contribute to this discussion by investigating whether or not sociodemographic factors, chronic illness status, and overweight differ between individuals with and without lifetime MDD. In the MooDFOOD depression prevention trial, 1025 overweight or obese participants with subsyndromal symptoms of depression were recruited. Lifetime history of MDD, number of lifetime MDD episodes, sociodemographic data, and chronic illness were assessed via clinical interview, also standardized anthropometric measures (body mass index [BMI], waist-to-hip ratio [WHR]). A lifetime MDD diagnosis was present in 33.5% of the sample. Individuals with lifetime MDD and individuals who never suffered from MDD did not differ regarding sex, age, marital status, educational level, employment status, and income. Further, there were no significant differences in BMI, WHR, and number of chronic illnesses between participants with and without lifetime MDD. The cross-sectional nature of the data prohibited causal inferences. Sociodemographic variables, chronic illness status and anthropometric measures seem not to be related to the status of having suffered from MDD in the past vs. not having suffered from MDD in people who are currently overweight or obese.

Evidence of Age-Related Hemodynamic and Functional Connectivity Impairment: A Resting State fMRI Study.

Purpose: To assess age-related changes in intrinsic functional brain connectivity and hemodynamics during adulthood in the context of the retrogenesis hypothesis, which states that the rate of age-related changes is higher in late-myelinating (prefrontal, lateral-posterior temporal) cerebrocortical areas as compared to early myelinating (parietal, occipital) regions. In addition, to examine the dependence of age-related changes upon concurrent subclinical depression symptoms which are common even in healthy aging.Methods: Sixty-four healthy adults (28 men) aged 23–79 years (mean 45.0, SD = 18.8 years) were examined. Resting-state functional MRI (rs-fMRI) time series were used to compute voxel-wise intrinsic connectivity contrast (ICC) maps reflecting the strength of functional connectivity between each voxel and the rest of the brain. We further used Time Shift Analysis (TSA) to estimate voxel-wise hemodynamic lead or lag for each of 22 ROIs from the automated anatomical atlas (AAL).Results: Adjusted for depression symptoms, gender and education level, reduced ICC with age was found primarily in frontal, temporal regions, and putamen, whereas the opposite trend was noted in inferior occipital cortices (p < 0.002). With the same covariates, increased hemodynamic lead with advancing age was found in superior frontal cortex and thalamus, with the opposite trend in inferior occipital cortex (p < 0.002). There was also evidence of reduced coupling between voxel-wise intrinsic connectivity and hemodynamics in the inferior parietal cortex.Conclusion: Age-related intrinsic connectivity reductions and hemodynamic changes were demonstrated in several regions—most of them part of DMN and salience networks—while impaired neurovascular coupling was, also, found in parietal regions. Age-related reductions in intrinsic connectivity were greater in anterior as compared to posterior cortices, in line with implications derived from the retrogenesis hypothesis. These effects were affected by self-reported depression symptoms, which also increased with age.

Efficacy of an Internet-Based Intervention for Subclinical Depression (MoodBox) in China: Study Protocol for a Randomized Controlled Trial.

Background: Subclinical depression is a prevalent mental health problem and increases the incidence of the onset of major mood disorders, such as major depressive disorder (MDD). Psychological interventions have been proved to be effective for reducing depressive symptoms for people with subclinical depression and can prevent the onset of MDD. However, people have limited access to face-to-face psychotherapy. Internet-based psychological intervention is an alternative treatment option. The aim of the study is to evaluate the efficacy of MoodBox, an online psychological intervention program, for subclinical depression.Methods: This study is a multicenter, randomized, controlled, non-blinded superiority study with three parallel groups. A total of 435 first-year university students with subclinical depression will be recruited. Eligible participants will be randomly assigned to the MoodBox group, the online psychoeducation group, and the naturalistic observation group at a ratio of 1:1:1. The intervention period is 8 weeks, and participants will be continuously followed up for 1 year. The primary outcome of the study is the efficacy of the intervention, defined as measured by the Patient Health Questionnaire (PHQ-9).Discussion: This is the first study to innovatively develop and test an intervention to improve psychological well-being and decrease the incidence of MDD in a subclinical depression population in China. Once proven effective and acceptable, MoodBox could be potentially integrated into the routine clinical service to facilitate the management for people with subclinical depression.Clinical Trial Registration: The trial is registered with the Chinese Clinical Trial Registry on 21 July 2020 (No. ChiCTR2000034826).

Association of markers of endothelial dysfunction with depression in middle-aged patients with cerebral microangiopathy

To assess the ratio of levels of peripheral markers of inflammation and biomarkers of endothelial dysfunction (ED) with the severity of depression in middle-aged patients with cerebral microangiopathy. In an observational study of outpatients (n=262, 42.1% of men, 57.9% of women, average age 54.2±7 years), the severity of depressive disorders was assessed with HADS. Levels of peripheral markers of endothelial inflammation (C-reactive protein (CRP), monocytic chemoattractant protein-1 (MCP-1)) and ED biomarkers (endothelin-1, endothelial NO synthase, vascular endothelial growth factor, desquamated endotheliocytes, S100 protein, von Willebrand factor, fibrinogen) were determined by enzyme immunoassay. The initial sample of patients is divided into two groups: with clinical (n=146) and subclinical (n=116) depression. Based on the indicators of the ED biomarkers, a factor analysis was performed to calculate the integrative indicator of endothelial function (IIEF). Patients with clinically defined depression compared with patients with subclinical depression had an increased level of peripheral markers of inflammation (CRP 6.11 vs 2.03 mg/L; p<0.05; MCP-1 2.02 vs 0.66 ng/ml; p<0.05). The severity of depression was directly correlated with the level of peripheral markers of inflammation (CRP, r=0.85, p<0.05; MCP-1, r=0.8, p<0.05, respectively). Patients with clinically expressed depression were characterized by a lower IIEF compared with patients with subclinical depression (0.12±0.04 vs 1.14±0.3; p<0.05, respectively). Odds ratios adjusted for age, obesity, type 2 diabetes mellitus were as follows: 1.5; 95% CI (1.3-1.8), p<0.001 for CRP; 1.67; 95% CI (0.63-2.85), p<0.001 for MCP-1; 1.21; 95% CI (1.19-1.35), p<0.001 for IIEF. Pro-inflammatory ED contributes to the development of depression in middle-aged patients with cerebral microangiopathy associated with arterial hypertension. The severity of depression depends on the degree of ED. The association between the degree of ED, the pro-inflammatory activity of the endothelium and the severity of depression is relatively independent of age, obesity, type 2 diabetes mellitus.

ЛИЧНОСТНЫЕ ОСОБЕННОСТИ ЮНОШЕЙ С САМОПОВРЕЖДАЮЩИМ ПОВЕДЕНИЕМ И С СУБКЛИНИЧЕСКОЙ ДЕПРЕССИЕЙ

The article presents the results of empirical research studying the personal characteristics of young men with self-injurious behavior and subclinical depression. Relevance of this topic is conditioned by the frequency of self-injurious behavior. A general hypothesis of the study was the statement that there are significant differences in the intensity of personality traits in young men with subclinical depression who have a history of self-injurious behavior as opposed to young men with subclinical depression but without self-injurious behavior, and also opposed to the test audience without the symptoms of depression and self-harm. The survey sample consisted of 169 young men aged from 18 to 22 years (average age — 19.2). We applied the methods of testing, polling, subjective scaling, statistical analysis. In the group with subclinical depression and self-harm were noted low self-esteem, high levels of situational anxiety, personal anxiety, proneness to conflict, neuroticism, spontaneous aggressiveness, irritability, and emotional lability. Young men from this group demonstrated lower rates of inherent worth, self-acceptance, self-attachment, mirror self, and sociability than those with subclinical depression but without self-harm. A positive correlation was revealed between the severity of self-harm and situational aggressiveness, proneness to conflict, self-accusation, neuroticism, spontaneous aggressiveness, depression, low self-esteem; a negative correlation was found between the severity of self-harm and inherent worth, self-acceptance, self-attachment and the mirror self. There is a positive correlation between depression and cynicism, hostility, aggressiveness, anxiety, proneness to conflict, irritability, and low self-esteem, and a negative correlation between depression and sociability and openness.

Распространенность депрессивных симптомов у пациентов с хронической пояснично-крестцовой радикулопатией

Study Objective: To study the prevalence of depressive syndromes in patients with chronic lumbosacral radiculopathy and pain syndrome, and to identify correlations between neuropathic pain and psychoemotional disturbances. Study Design: open perspective study. Materials and Methods. The study included 126 patients (45 (35.7%) males and 81 (64.3%) females) of 19 to 78 years old with verified unilateral lumbosacral radiculopathy of L4, L5, S1 radicules resulting from degenerative damage of the spine lasting for more than 12 weeks. For assessment, we used the Pain Detect Questionnaire, visual analogue scale for pain syndrome, Oswestry Disability Index, and Beck Depression Inventory. Study Results. Among patients with chronic lumbosacral radiculopathy, depressive syndromes were diagnosed in 74 (587%) cases as follows: 26 (20.6%) patients had mild (subclinical) depression, 33 (26.2%) cases were of moderate intensity, 12 (9.5%) patients had marked, and 3 (2.4%) had severe depression. We used Spearmen’s rank-order correlation to identify statistically significant correlations between Beck Depression Inventory score and neuropathic pain syndrome intensity (Pain Detect Questionnaire) (r = 0.861; p = 0.006). Pain Detect Questionnaire and Oswestry score correlated as well (r = 0.745; p = 0.001). Conclusion. Chronic pain syndrome in patients with lumbosacral radiculopathy resulting from degenerative damage of the spine is characterised by high comorbidity with depression. The results justify inclusion of psychoemotional assessment into a routine screening program for patients with lumbosacral radiculopathy. Keywords: depression, chronic back pain, lumbosacral radiculopathy, neuropathic pain syndrome.

ANXIETY AND DEPRESSIVE DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION

The aim: To study the influence of anxiety and depressive disorders on life quality of patients with arterial hypertension. Materials and methods: 55 patients with arterial hypertension (AH) of 2nd stage were examined to reach the goal. Age diapason was 25-73 years, the middle age was 53.56+10.28. There were 58.2% (32) of women and 41.8% (23) of men among the patients. Results: Results analysis of the investigation of patients with arterial hypertension and anxiety and depressive disorders using the Spielberger-Khanin anxiety inventory showed moderate (30.9%) and high (69.1%) level of trait anxiety. As for the state anxiety the high level of it was confirmed in 74.6% of studied patients and moderate level of state anxiety in 25.5% of patients. During the analysis of gender-based distribution the trait anxiety level was significantly higher in women (p<0.05). Results of PHQ-9 showed subclinical depression level (12.7%), mild (49.1%) and moderate (16.4%). Moderate manifestations of depression were found in 12.7%, severe depression in 9.1% (5 individuals). As for the gender-based distribution, anxiety indicators were significantly higher in women (p<0.01). HADS method did not show significant difference of depression levels of gender-based distribution. Conclusions: The majority of individuals with arterial hypertension and nonpsychotic mental disorders have a high level of trait and state anxiety. Direct correlation was found between the trait anxiety indicator and depression severity, which were defined according to HADS and PHQ-9 questionnaires. The level of anxiety and depressive episode severity were found to be reliably higher in women in gender-based distribution, that/which was accompanied by decrease in most of the life quality indicators.

Effectiveness and cost-effectiveness of a lifestyle modification programme in the prevention and treatment of subclinical, mild and moderate depression in primary care: a randomised clinical trial protocol

IntroductionMajor depression is a highly prevalent pathology that is currently the second most common cause of disease-induced disability in our society. The onset and continuation of depression may be related...

Is frequent sighing an indicator of dispositional negative emotionality? A multi-sample, multi-measure naturalistic-observation study

Sighing is a common nonverbal everyday behavior thought to signal the experiencing of negative emotions. Prior research from a small-scale study suggests that observed daily expressions of sighing is associated with subclinical depression (Robbins, Mehl, Holleran, & Kasle, 2011). This paper replicates and extends these findings, hypothesizing that individual differences in negative emotionality are associated with frequency of spontaneous sighing. Study 1 (N = 320) documents a strong lay assumption that frequent sighing signals dispositional negative emotionality. Study 2 estimates the actual association between daily sighing, assessed naturalistically using the Electronically Activated Recorder (EAR), and negative emotionality in a large, diverse, pooled sample (N = 469). Bayesian tests across six measures (neuroticism, depression, anxiety, stress, fatigue, loneliness) strongly support the null model. Together, results suggest the common intuition that people who sigh frequently experience more negative emotionality is inaccurate. Assessing whether an individual sighs more (or less) than others cannot be used to infer that they experience more negative emotions.

The Architecture of Cognitive Vulnerability to Depressive Symptoms in Adolescence: A Longitudinal Network Analysis Study

Rates of subclinical symptoms and full-blown depression significantly increase during adolescence. Hence, understanding how multiple cognitive risk factors are related to depression in adolescence is of major importance. For this purpose, we simultaneously considered multiple cognitive vulnerabilities, as proposed by three major cognitive theories for depression, namely Beck’s cognitive theory, hopelessness theory, and response style theory. In this four-wave study, we investigated the architecture, interplay, and stability of cognitive vulnerability mechanisms, depressive symptoms, and stressors in a large group of adolescents over a period of one year (n = 469; mean age = 15 years; 64% female). Network analysis was used to shed light on the structure of cognitive vulnerabilities in a data-driven fashion. Analyses revealed that different cognitive vulnerabilities were intertwined and automatic thoughts played the role of hub node in the network. Moreover, the interplay among cognitive vulnerabilities and depressive symptoms was already markedly stable in adolescence and did not change over a 12-month period. Finally, no evidence was found that cognitive vulnerabilities interacted with stressors, as proposed by diathesis-stress models. These findings advance our understanding of multiple cognitive risk factors for depression in adolescence.

Design of a health-economic Markov model to assess cost-effectiveness and budget impact of the prevention and treatment of depressive disorder

ABSTRACT Background/objective: To describe the design of ‘DepMod,’ a health-economic Markov model for assessing cost-effectiveness and budget impact of user-defined preventive interventions and treatments in depressive disorders. Methods: DepMod has an epidemiological layer describing how a cohort of people can transition between health states (sub-threshold depression, first episode of mild, moderate or severe depression (partial) remission, recurrence, death). Superimposed on the epidemiological layer, DepMod has an intervention layer consisting of a reference scenario and alternative scenario comparing the effectiveness and cost-effectiveness of a user-defined package of preventive interventions and psychological and pharmacological treatments of depression. Results are presented in terms of quality-adjusted life years (QALYs) gained and healthcare expenditure. Costs and effects can be modeled over 5 years and are subjected to probabilistic sensitivity analysis. Results: DepMod was used to assess the cost-effectiveness of scaling up preventive interventions for treating people with subclinical depression, which showed that there is an 82% probability that scaling up prevention is cost-effective given a willingness-to-pay threshold of €20,000 per QALY. Conclusion: DepMod is a Markov model that assesses the cost-utility and budget impact of different healthcare packages aimed at preventing and treating depression and is freely available for academic purposes upon request at the authors.

Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort

BackgroundDuring pregnancy, about 10 to 20% of women experience depressive symptoms. Subclinical depression increases the risk of peripartum depression, maternal neuro-endocrine dysregulations, and adverse birth and infant outcomes. Current treatments often comprise face-to-face psychological or pharmacological treatments that may be too intensive for women with subclinical depression leading to drop-out and moderate effectiveness. Therefore, easily accessible, resilience enhancing and less stigmatizing interventions are needed to prevent the development of clinical depression. This paper describes the protocol of a prospective cohort study with an embedded randomized controlled trial (RCT) that aims to improve mental resilience in a sample of pregnant women through a self-help program based on the principles of Acceptance and Commitment Therapy (ACT). Maternal and offspring correlates of the trajectories of peripartum depressive symptoms will also be studied.MethodsPregnant women (≥ 18 years) receiving care in Dutch midwifery practices will participate in a prospective cohort study (n ~ 3500). Between 12 and 18 weeks of pregnancy, all women will be screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score ≥ 11 will be evaluated with a structured clinical interview. Participants with subclinical depression (n = 290) will be randomized to a 9-week guided self-help ACT-training or to care as usual (CAU). Primary outcomes (depressive symptoms and resilience) and secondary outcomes (e.g. anxiety and PTSD, bonding, infant development) will be collected via online questionnaires at four prospective assessments around 20 weeks and 30 weeks gestation and at 6 weeks and 4 months postpartum. Maternal hair cortisol concentrations will be assessed in a subsample of women with a range of depressive symptoms (n = 300). The intervention’s feasibility will be assessed through qualitative interviews in a subsample of participants (n = 20).DiscussionThis is the first study to assess the effectiveness of an easy to administer intervention strategy to prevent adverse mental health effects through enhancing resilience in pregnant women with antepartum depressive symptomatology. This longitudinal study will provide insights into trajectories of peripartum depressive symptoms in relation to resilience, maternal cortisol, psychological outcomes, and infant developmental milestones.Trial registrationNetherlands Trial Register (NTR), NL7499. Registered 5 February 2019.