Major Depressive Syndrome Research Articles

Refractory Depressive Disorder as the First Manifestation of Adolescent Sjögren's Syndrome, Successfully Treated with Rituximab.

The psychiatric manifestations of Sjögren's syndrome are often overlooked despite their prevalence. They can be revelatory of the disease and include anxiety, depression, dementia and, rarely, psychosis. We report a case of 18-year-old female in whom a major depressive syndrome revealed primary Sjögren's disease, with a favourable outcome after treatment with rituximab. The diagnostic of Sjögren's syndrome should be considered in patients who present with unexplained and refractory neuropsychiatric symptoms, even in the absence of sicca symptoms. Psychiatric manifestations secondary to Sjögren's syndrome are not rare but often overlooked.They can be indicative of the disease and precede systemic signs by years.The diagnostic of Sjögren's syndrome should be considered in patients who present with unexplained and refractory neuropsychiatric symptoms, even in the absence of sicca symptoms.

Trajectories of quality of life, return to work, psychopathology, and disability in survivors of the acute respiratory distress syndrome (ARDS): A three-year prospective cohort study (DACAPO)

PurposeDescribe the long-term development of outcomes for survivors of the Acute Respiratory Distress Syndrome (ARDS). Material and MethodsA cohort study with N = 877 ARDS survivors was conducted. Health related quality of life (HRQoL, Physical and Mental Component Scale: PCS, MCS of the SF-12), return to work (RtW), panic disorder, depressive symptoms (PHQD), and post-traumatic-stress-disorder (PTSD, PTSS-14) were assessed at 3, 6, 12, 24, and 36 months after discharge from ICU. ResultsPCS, MCS, and RtW increased during the first 12 months [e.g. PCS: Md = 36 (IQR 31–43) at 3 months, Md = 42 (IQR 34–52) at 12 months; MCS: Md = 44 (IQR 32–54) at 3 months, Md = 47 (IQR 33–57) at 12 months, RtW = 23.2% at 3 months, 54.5% at 12 months], and remained relatively stable afterwards. Proportion of major depressive syndrome decreased from 3 (14.2%) to 36 months (8.9%). Proportions of panic disorder (5.3% to 7.4%) and PTSD (27.1% to 32.6%) varied only slightly. ConclusionsMost of recovery in HRQoL and RtW occur during the first 12 months, after which a plateau is reached, indicating a chronification for many patients. Contrary to this, however, psychopathological symptoms remain stable, except for depressive symptoms. [200 words].

A population-based twin study of the symptomatic diagnostic criteria for major depression that occur within versus outside of major depressive episodes.

Are genetic risk factors for current depressive symptoms good proxies for genetic risk factors for syndromal major depression (MD)? In over 9000 twins from the population-based Virginia Adult Twin Study of Psychiatric and Substance Use Disorders, the occurrence of all nine DSM symptomatic criteria for MD in the last year was assessed at personal interview and then grouped by their temporal co-occurrence. The DSM criteria which occurred outside (OUT) v. inside of (IN) MD episodes were then separated. We calculated tetrachoric correlations for OUT and IN depressive criteria in monozygotic (MZ) and dizygotic (DZ) pairs and fitted univariate and bivariate ACE twin models using OpenMx. The mean twin correlations (±95% CIs) for IN depressive criteria were substantially higher than for OUT depressive criteria in both MZ [+0.35 (0.32-0.38) v. 0.20 (0.17-0.24)] and DZ pairs [0.20 (0.17-0.24) v. 0.10 (0.04-0.16]. The mean IN-OUT cross-correlation in MZ and DZ pairs was modest [+0.15 (0.07-0.24) and +0.07 (0.03-0.12)]. The mean heritability estimates for the nine In v. Out depressive criteria was 0.31 (0.22-0.41) and 0.15 (0.08-0.21), in MZ and DZ pairs, respectively. The mean genetic correlation between the nine IN and OUT depressive criteria was +0.07 (-0.07 to 0.21). Depressive criteria occurring outside depressive episodes are less heritable than those occurring within. These two ways criteria can manifest are not closely genetically related. Current depressive symptoms - most of which are occurring outside of depressive episodes - are not, for genetic studies, good proxies for MD.

An initial investigation of the role of depressive and anxious syndromes in Problematic Internet Use in adolescence and young adults

Depressive and anxious syndromes have been proposed as risk factors and as consequences of Problematic Internet Use (PIU). There has been no study relating affective symptoms in subjects with Problematic Internet Use and those with major depressive and anxious syndromes. In this study, three samples were collected: two from ambulatory clinical settings of the North Lisbon Hospital Centre (1. Centre for PIU and 2. Out-patient psychiatry consultation for adolescents and young adults) and a control group from Faculdade de Medicina da Universidade de Lisboa. Internet use profile and affective psychopathology were assessed and socio-demographic characteristics were controlled. The results revealed that both the PIU group and the clinical group presented significantly higher depression and anxiety scores than the control group while there was no significant difference between them. Also, Problematic Internet Users, similarly to the clinical group, tend to live in less functional families. We speculate that the similitude between samples and yet such different clinical presentations could be explained if Internet acted as a buffer to affective psychopathology. These findings warrant exploring the possibility of PIU as new (and generation biased) psychopathology of depressive or anxious states.

The modulatory effect of acupuncture on amygdala functional connectivity: narrative review of the clinical research

The amygdala is a brain area crucial for emotional, behavioural and visceral sensitivity/motor signals processing. To exert these functions, the amygdala is reciprocally connected with cortical and subcortical regions. Some studies have showed that acupuncture modulates the activity of the amygdala and its circuits. However, there is no literature review synthesizing and evidencing the actual research status about this subject. Thus, the aim of this paper is to present and discuss the newest evidence about the effect of acupuncture on the amygdala resting-state functional connectivity (rsFC) in the context of clinical research. The narrative review of clinical research was focused on published clinical trials (controlled and randomized) designed to analyze the effect of acupuncture on the modulation of the amygdala rsFC in clinical conditions. The search was conducted on Pubmed, ScienceDirect and Scielo databases up to March, 2022. The studies found were about patients with major depressive disorder, functional dyspepsia and premenstrual syndrome, which demonstrated that acupuncture significantly decreases its symptoms. In addition, this therapeutic effect were correlated with the modulation of the amygdala rsFC with a range of brain regions. According to the data reviewed, it can be concluded that the brain action’s mechanisms of acupuncture is related, at least in part for the clinical conditions analyzed, to its modulatory effect on the amygdala network. However, the studies about this theme are rare, and more studies should be done to clarify the amygdala involvement in the effect of the acupuncture.

La dépression majeure à caractéristique atypique comme facteur de risque du syndrome d’apnées obstructives du sommeil chez le jeune adulte

ObjectivesIn the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥40 years) which means that this problem has been little studied in young adults (<30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation. MethodsPolysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n=215) and a patient group with OSAS (n=49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi2 tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed. ResultsThe prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18–5.32), p-value=0.014], male gender [OR 4.53 (95% CI 2.20–9.34), P-value <0.001], presence of snoring [OR 2.51 (95% CI 1.33–4.75), P-value=0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19–4.28), P-value=0.012], body mass index>30 kg/m2 [OR 4.55 (95% CI 2.07–10.03), P-value <0.001] and ferritin ≥150 μg/L [OR 3.28 (95% CI 1.69–6.36), P-value<0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26–7.54), P-value=0.019] was a risk factor for OSAS in young adults. ConclusionsIn our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.

Using the CES-D-7 as a Screening Instrument to Detect Major Depression among the Inmate Population.

Major depression is one of the most prevalent mental health problems in the penitentiary context and has been related to different undesirable outcomes. The aim of the current research was to evaluate the utility of screening tools for major depression brief assessment in the jail context. We interviewed 203 male inmates and complimented the MCMI-III, the SCL-90-R, and the CES-D-7 self-informed scales. Major depression syndrome and disorder were determined based on MCMI-III criteria and the capability of SCL-90-R and CES-D-7 to identify true positives and true negatives when tested. SCL-90-R and CES-D-7 showed good sensitivity for major depression syndrome and disorder. The specificity of SCL-90-R was poor in all cases, but CES-D-7 showed good specificity depending on the cut-off score. Rigorous interviews are needed for better evaluation of major depression in jails, but screening tools like CES-D-7 are useful for rapid assessment considering the work overload of penitentiary psychologists.

Prevalence and participant characteristics associated with subjective memory complaint: Results from the Maule Cohort

AbstractBackgroundSubjective memory complaints (SMC) are common in later life and have been associated with increased risk of cognitive impairment and dementia. While there is much interest in SMC globally, no population‐based studies from South America have reported SMC prevalence.MethodData for this analysis was drawn from the Maule Cohort (MAUCO), a population‐based prospective cohort of Molina, Chile residents aged 35‐74 at baseline. MAUCO participants were stratified at age 60. Presence of SMC was determined by the questions “Does your memory fail frequently? Or Do you forget events, even recent, or some appointments?” Prevalence of SMC was estimated within age groups. Logistic regression was performed within age groups to evaluate factors associated with SMC.ResultsMost participants were female (56%), married (66%), with ≤ 8 years of education (49%), and reported good health (39%). There were 6,203 participants aged &lt; 60, and 2,517 aged ≥ 60. Prevalence of SMC was 16% and 24%, respectively. Within age groups, characteristics of participants who reported SMC were different. Among those age &lt; 60, those who reported SMC were more likely to use antidepressants, but this was not the case among the older group. In both age groups, those who reported SMC had significantly higher polypharmacy, higher anticholinergic burden, and higher use of benzodiazepines. Logistic regression analysis showed that for the age &lt; 60 group, being female, having bad self‐reported health (OR=2.4; 95% CI 1.4‐4.3), depression (OR=1.5; 1.1‐1.9), major depressive syndrome on PHQ‐9 (OR=3.0; 2.2‐4.1) and MMSE score (OR=0.97; 0.94‐0.99) were significantly associated with SMC. However, in the older group, only the history of cancer (OR=2.0; 1.1‐3.8), major depressive syndrome on PHQ‐9 (OR=2.7; 1.6‐4.7), depressive symptoms on PHQ‐9 (OR 1.50; 1.03‐2.15), and MMSE score (OR=0.92; 0.89‐0.94) were associated with odds of SMC. In the adjusted models, neither polypharmacy, use of benzodiazepines, nor high anticholinergic burden were significant in any of the models for the younger or older groups.ConclusionSMC was common in both younger and older MAUCO participants. SMC may be associated with different factors in younger vs. older adults, but was associated with objective cognitive function (MMSE) in both groups.

Orthorexic tendencies in the general population: association with demographic data, psychiatric symptoms, and utilization of mental health services

PurposeOrthorexia nervosa (ON) is characterized by a preoccupation to eat healthily and restrictive eating habits despite negative psychosocial and physical consequences. As a relatively new construct, its prevalence and correlates in the general population and the associated utilization of mental health services are unclear.MethodsAdults from the general population completed the Düsseldorf Orthorexia Scale (DOS), the Patient Health Questionnaire (PHQ), the Short Eating Disorder Examination (SEED).ResultsFive-hundred eleven (63.4% female) participants with a mean age of 43.39 (SD = 18.06) completed the questionnaires. The prevalence of ON according to the DOS was 2.3%. Considering only effects of at least intermediate size, independent samples t-tests suggested higher DOS scores for persons with bulimia nervosa (p < .001, Cohen’s d = 1.14), somatoform syndrome (p = .012, d = .60), and major depressive syndrome (compared p < .001, d = 1.78) according to PHQ as well as those who reported to always experience fear of gaining weight (p < .001, d = 1.78). The DOS score correlated moderately strong and positively with the PHQ depression (r = .37, p < .001) and stress (r = .33, p < .001) scores as well as the SEED bulimia score (r = .32, p < .001). In multivariate logistic regression analyses, only PHQ depression scores were associated with past psychotherapeutic or psychiatric treatment (OR = 1.20, p = .002) and intake of psychotropic medication in the last year (OR = 1.22, p = .013).ConclusionsThe prevalence of ON was low compared to international studies but is in line with other non-representative German studies. Orthorexic tendencies related to general mental distress and eating disorder symptoms but were no independent reason for seeking treatment.Level of evidenceLevel V, cross-sectional descriptive study.

Sleep disturbances in major depressive and burnout syndrome: A longitudinal analysis

Sleep quality (SQ) is considered to be a critical variable in major depressive syndrome (MD) as well as in burnout syndrome (B). Thus far, no study examined the differential influence of these syndromes on SQ. MD and B have been assessed in 4,415 participants at baseline and in 1,396 participants at follow-up based on the Patient Health Questionnaire-9 (PHQ-9) and the Maslach Burnout Inventory-General Survey (MBI-GS). The Pittsburgh Sleep Quality Index was used to measure SQ. Based on the PHQ-9 and MBI-GS at baseline assessment, participants were divided into four groups: a control group, a MD group, a B group, and a comorbid group suffering from MD and B. Multiple regression analyses showed that all groups demonstrate significantly worse SQ than the control group, while individuals with MD showed a lower SQ compared to individuals with B. The comorbid group showed the lowest SQ. Longitudinal analyses showed a significant bidirectional association between major depressive symptoms and SQ, whereas burnout symptoms were predictive for SQ but not vice versa. The study indicates differences between MD and B with regard to SQ, suggesting worse SQ in more severely burdened groups. Major depressive symptoms are bidirectionally linked to SQ, whereas burnout symptoms are only suggested a risk factor for impaired SQ.

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyperactivity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in thebrain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.

Major Depressive Syndrome (MDS) and its Association with Time of Residence among Spanish Speaking Au-Pairs Living in Germany.

The number of au-pairs in Germany is on the rise. In 2017, about 13,500 au-pairs were living in German families, almost half of them originating from non-European Union (EU) countries and many of them from Spanish speaking countries. Knowledge about mental health among au-pairs in Germany is limited. Therefore, the main objective of this study was to assess the prevalence of Major Depressive Syndrome (MDS) and its potential association with time of residence among Spanish speaking au-pairs living in Germany via an exploratory analysis. This study included a sample of 409 Spanish speaking au-pairs living in Germany. We classified the au-pairs into those who lived less than three weeks in Germany (newcomer au-pairs) and those who lived more than three weeks (experienced au-pairs). The participants were recruited by an online survey (Facebook and Instagram) from August 2018 to June 2019. Socio-demographic characteristics, time of residence in Germany and the level of education were assessed. MDS was assessed by the Patient Health Questionnaire depression module (PHQ-9). Poisson regression models were calculated to evaluate the association between time of residence in Germany and prevalence of MDS. Most of the participants were female (91%). Almost half of them came from Colombia (48%) and were in the age range between 22–24 years (40%). Prevalence of MDS was 8% among newcomers and 19% among experienced au-pairs (p = 0.002). Differences remained statistically significant after adjustment for potential confounders (age, level of education and time of residence in Germany) (prevalence ratio 2.25; 95% confidence interval: 1.22–4.14). In conclusion, au-pairs may develop mental symptoms during their time abroad. Future prospective studies should aim at identifying potential risk factors and preventive measures.

Speed of processing training and depression in assisted and independent living: A randomized controlled trial.

Late life depression is widely associated with lower quality of life and greater disability, making it an important target for prevention. Earlier randomized controlled trials [RCTs] demonstrated that speed of processing training [SOPT] led to reductions in depressive symptoms and clinical depression in community-dwelling adults. Our purpose was to evaluate depression outcomes related to SOPT among older adults who live in supported senior living settings. This two-arm, parallel RCT included 351 participants aged 55–102 years who resided in assisted and independent settings in 31 senior living communities. Participants were randomized within sites to computerized SOPT vs. computerized crossword puzzles with a targeted dose of 10 hours of playtime at baseline plus 4 hours of booster training at five and eleven months. Depression outcomes included the 9-item Patient Health Questionnaire [PHQ-9] scores, categorical levels, and dichotomous indicators. Random effects linear mixed effect models estimated SOPT effects in intention-to-treat complete case and multiple imputation analyses. Mean age of the sample was 81.0 years, 72.2% were women, and 41.0% resided in assisted living. At baseline 65.7% had no depression [PHQ-9 scores < 5] and 6.6% had clinically meaningful depression [PHQ-9 scores ≥ 10]. At 12 months we found significantly increased PHQ-9 scores [p = 0.006] and categorical levels [p = 0.003], and higher percentages of PHQ-2 scores > 3 [p = 0.016] and major depressive syndrome [p = 0.045] among the assisted living SOPT group. No significant change in depression was observed in the independent living SOPT or attention control groups. In summary, the SOPT known as Road Tour/Double Decision significantly increased, rather than decreased, the burden of depressive symptoms among participants residing in assisted living. Given these risks, this SOPT program should be avoided among older people in assisted living settings, and other SOPT interventions should be combined with systematic depression monitoring.

Cocaine- and amphetamine-regulated transcript peptide as a possible common biomarker for the symptoms expressed in major depressive disorders and amphetamine withdrawal syndrome

Cocaine- and amphetamine-regulated transcript peptide as a possible common biomarker for the symptoms expressed in major depressive disorders and amphetamine withdrawal syndrome

Analytical Method Validation of Vilazodone with Spectrofluorimetric Detection in Rabbit Plasma

Vilazodone (VLZ) is an antidepressant agent approved in 2011 by Food and Drug Administration (FDA) for the treatment of major depressive syndromes. Its chemical structure derives from trazodone which is used as an off-label drug for dogs and cats in order to induce sedation and reduce anxiety, behavioural and pre-and post-operative stress. VLZ could be a potentially useful compound in reducing severe anxiety responses in pet animals. The aim of the present research was to develop and validate a method to quantify VLZ in rabbit plasma. A 500 μL aliquot of rabbit control plasma was added to 50 µL of IS (0.1 ug/mL) and 100 µL of NaOH 0.1M. Then 1 mL of Et2O:EtOAc (70:30 v/v) was added and the sample, shaken and centrifuged. The organic layer was transferred into a clean polypropylene vial. This procedure was repeated twice. The combined supernatants were evaporated under nitrogen at 40°C and reconstituted with 100 µL of mobile phase. 50 µL of this latter solution was injected onto HPLC-FL. The mobile phase consisted of Na2HPO4 (0.02M, pH 5):ACN (67:33 v/v) at a flow rate of 1 mL/min. The analytical column (C18) was maintained at 40°C. Excitation and emission wavelengths were set at 353 and 486 nm, respectively. Times of retention of VLZ and IS were 3.26±0.09 and 4.70±0.08 minutes, respectively. The recovery of VLZ was about 83%. Limits of quantification and detection were 0.005 µg/mL and 0.001 µg/mL, respectively. This method was verified by determining VLZ concentration in rabbit plasma after a 1 mg/kg single IV administration. The analysis of samples allowed the calculation of the main pharmacokinetic parameters. In conclusion, the present research was able to quantify VLZ in rabbit plasma after VLZ administration. This method might have application for pharmacokinetic or toxicological studies.

Care Seeking Practices for Chronic Pain and its correlates among Adults: an experience from a Rural Block of West Bengal

Background: Chronic pain, though a most common cause of disability worldwide, is one of the most underestimated health problems throughout the world. With the ageing population and its increasing prevalence, understanding related care seeking practices is key to plan effective interventions. Objectives: To find out the characteristics of chronic pain and to study related and care-seeking practices and the influence of socio-demographic factors among adult chronic pain sufferers in a rural setting. Methods: Data were collected from 697 adults (&gt;18 years) chronic pain (&gt;12 weeks duration) sufferers chosen randomly from all 81 villages of Amdanga block, West Bengal, through a household-based survey in a cross-sectional design. A pre-designed, pre-tested structured questionnaire containing socio-demographic information, Brief Pain Inventory (BPI) and Patient Health Questionnaire-9 (PHQ-9) was used. During analysis, dimension reduction by Principal Component Analysis was done to derive pain intensity and interference scores. Results: Low back pain and knee pain were first and second most frequent. Major Depressive Syndrome (MDS) was found in 9.04 % [95% CI: 7.95% - 10.13%]. The severity of pain increased with age and decreased with advancing level of education &amp; income. Care-seeking was significantly predicted by MDS (AOR= 0.185), pain intensity (AOR=1.06) &amp; interference (AOR=1.06).Conclusion: Patients tend to seek care more at an advanced severity and more from a private facility. About 1 in 10 persons with chronic pain was seen to suffer from major depression, with which, persons were seen about five times less likely to seek care.

The effect of physical activity in an alpine environment on quality of life is mediated by resilience in patients with psychosomatic disorders and healthy controls

ObjectivePhysical activity (PA) in an outdoor environment has been shown to exert positive effects on mental well-being beyond those found for PA indoors. The specific effect of an alpine environment has not been investigated so far. Here we evaluate the association of PA in an alpine environment with resilience and quality of life (QOL) in patients with psychosomatic disorders and controls.Methods194 patients with psychosomatic disorders (mostly somatoform disorder and major depressive syndrome) and 326 healthy controls were included in this web-based cross-sectional study. PA was scored using an adapted version of the Global Physical Activity Questionnaire including the environmental aspect (indoor, outdoor, alpine environment). Resilience was assessed using the Resilience Scale-13, QOL using the WHOQOL-BREF. Group comparisons, correlation and mediation analyses were performed.ResultsPatients showed significantly lower levels of resilience (p < 0.001) and QOL (p < 0.001) compared to controls. PA in an alpine environment was associated with resilience (patients: r = 0.35, p < 0.001; controls r = 0.18, p < 0.001). There were no significant associations between PA in other environments (outdoor or indoor) and resilience. PA in all three environments correlated with subcategories of QOL. The effect of PA in an alpine environment on QOL was partly mediated by resilience in patients (68% of total effect mediated, p < 0.001) and controls (49% mediated, p = 0.006).ConclusionThere is a positive effect of PA in an alpine environment on mental health beyond that of physical activity itself. Preventive and therapeutic programs should thus include physical activity, but also take additional benefits of natural environments into account.

Prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in major depression: a observational and retrospective study on 703 subjects

BackgroundSeveral studies have investigated the prevalence and risk factors of depression in subjects with obstructive sleep apnea syndrome. However, few studies have investigated the prevalence and risk factors for obstructive sleep apnea syndrome in major depression. The aim of this study was to examine the prevalence and risk factors of moderate to severe obstructive sleep apnea syndrome in a large sample of individuals with major depression.MethodsData from 703 individuals with major depression recruited from the research database of the sleep laboratory of the Erasme Hospital were analysed. An apnea-hypopnea index of ≥15 events per hour was used as cut-off score for moderate to severe obstructive sleep apnea syndrome. Logistic regression analyses were conducted to examine clinical and demographic risk factors of moderate to severe obstructive sleep apnea syndrome in major depression.ResultsThe prevalence of moderate to severe obstructive sleep apnea syndrome in major depression is 13.94%. Multivariate logistic regression analysis revealed that male gender, snoring, excessive daytime sleepiness, lower insomnia complaint, presence of metabolic syndrome, age ≥ 50 years, BMI >30 kg/m2, ferritin >300 μg/L, CRP >7 mg/L and duration of sleep ≥8 h were significant risk factors of moderate to severe obstructive sleep apnea syndrome in major depression.ConclusionModerate to severe obstructive sleep apnea syndrome is a common pathology in major depression. The identification of these different risk factors advances a new perspective for more effective screening of moderate to severe obstructive sleep apnea syndrome in major depression.

Fruits and vegetables consumption and depressive symptoms: A population-based study in Peru.

ObjectivesAmong different factors, diet patterns seem to be related to depression. The aim of this study was to evaluate the association between the consumption of fruits and/or vegetables and depressive symptoms.Methodology/Principal findingsA secondary data analysis was conducted using information from a population-based survey from 25 regions from Peru. The outcome was the presence of depressive symptoms according to the Patient Health Questionnaire (cutoff ≥15 to define major depressive syndrome); whereas the exposure was the self-reported consumption of fruits and/or vegetables (in tertiles and using WHO recommendation ≥5 servings/day). The association of interest was evaluated using Poisson regression models controlling for the complex-sample survey design and potential confounders. Data from 25,901 participants were analyzed, mean age 44.2 (SD: 17.7) and 13,944 (54.0%) women. Only 910 (3.8%; 95%CI: 3.5%–4.2%) individuals reported consuming ≥5 servings of fruits and/or vegetables/day; whereas 819 (2.8%; 95%CI: 2.5%–3.1%) had depressive symptoms. Those in the lowest tertile of fruits and/or vegetables consumption had greater prevalence of depressive symptoms (PR = 1.88; 95%CI: 1.39–2.55) than those in the highest tertile. This association was stronger with fruits (PR = 1.92; 95%CI: 1.46–2.53) than vegetables (PR = 1.42; 95%CI: 1.05–1.93) alone.ConclusionsAn inverse relationship between consumption of fruits and/or vegetables and depressive symptoms is reported. Less than 5% of subjects reported consuming the amount of fruits and vegetables recommended by the WHO. There is a need to implement strategies to promote better diet patterns with potential impact on mental health.

Intervention development for the indicated prevention of depression in later life: the "DIL" protocol in Goa, India.

Because depression is a major source of the global burden of illness-related disability, developing effective strategies for reducing its incidence is an important public health priority, especially in low-income countries, where resources for treating depression are scarce. We describe in this report an intervention development project, funded by the US National Institute of Mental Health, to address “indicated” prevention of depression in older adults attending rural and urban primary care clinics in Goa, India. Specifically, participants in the “DIL” (“Depression in Later Life”) trial were older adults living with mild, subsyndromal symptoms of depression and anxiety and thus at substantial risk for transitioning to fully syndromal major depression and anxiety disorders. Building upon the MANAS treatment trial (“Promoting Mental Health”) led by Patel et al. in the same locale, we present here lessons learned in the development and implementation of a protocol utilizing lay health counsellors (LHCs) who deliver a multi-component depression prevention intervention organized conceptually around Problem Solving Therapy for Primary Care (PST), with additional components addressing brief behavioural treatment of sleep disturbances such as insomnia, meeting basic social casework needs, and education in self-management of prevalent comorbid chronic diseases, such as diabetes mellitus. To our knowledge, DIL is the first randomized clinical trial addressing the prevention of depressive disorders ever conducted in a low- or middle-income country.