Journal of affective disorders [journal]
- Resting-state functional MRI of abnormal baseline brain activity in young depressed patients with and without suicidal behavior. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 9.:252-263.
Suicide among youth is a major public health challenge, attracting increasing attention. However, the neurobiological mechanisms and the pathophysiology underlying suicidal behavior in depressed youths are still unclear. The fMRI enables a better understanding of functional changes in the brains of young suicide attempters with depressive disorder through detecting spontaneous neural activity. The purpose of this study was to identify the relationship between abnormalities involving local brain function and suicidal attempts in depressed youths using resting-state fMRI (RS-fMRI).Thirty-five depressed youths aged between 15 and 29 years with a history of suicidal attempts (SU group), 18 patients without suicidal attempts (NSU group) and 47 gender-, age- and education-matched healthy controls (HC) underwent psychological assessment and R-fMRI. The differences in fractional amplitude of low-frequency fluctuation (ALFF) among the three groups were compared. The clinical factors correlated with z-score ALFF in the regions displaying significant group differences were investigated. The ROC method was used to evaluate these clusters as markers to screen patients with suicidal behavior.Compared with the NSU and HC groups, the SU group showed increased zALFF in the right superior temporal gyrus (r-STG), left middle temporal gyrus (L-MTG) and left middle occipital gyrus (L-MOG). Additionally, significantly decreased zALFF values in the L-SFG and L-MFG were found in the SU group compared with the NSU group, which were negatively correlated with BIS scores in the SU group. Further ROC analysis revealed that the mean zALFF values in these two regions (sensitivity=83.3% and specificity=71.4%) served as markers to differentiate the two patient subtypes.The SU group had abnormal spontaneous neural activity during the resting state, and decreased activity in L-SFG and L-MFG was associated with increased impulsivity in SU group. Our results suggested that abnormal neural activity in these brain regions may represent a potential neurobiological diathesis or predisposition to suicidal behavior in youth depression.
- Developmental risk factors in generalized anxiety disorder and panic disorder. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 5.:94-102.
There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).This study investigated whether GAD and PD could be discriminated through differences in developmental etiological factors including childhood parental loss/separation, psychological disorders, and maternal and paternal attachment.Twenty people with adult generalized anxiety disorder (GAD), 20 with adult panic disorder (PD), 11 with adult comorbid GAD and PD, and 21 adult non-anxious controls completed diagnostic interviews to assess symptoms of mental disorders in adulthood and childhood. Participants also reported on parental attachment, loss and separation.Childhood diagnoses of GAD and PD differentiated clinical groups from controls as well as from each other, suggesting greater likelihood for homotypic over heterotypic continuity. Compared to controls, specific phobia was associated with all three clinical groups, and childhood depression, social phobia, and PTSD were uniquely associated with adult GAD. Both maternal and paternal attachment also differentiated clinical groups from controls. However, higher levels of subscales reflecting maternal insecure avoidant attachment (e.g., no memory of early childhood experiences and balancing/forgiving current state of mind) emerged as more predictive of GAD relative to PD. There were no group differences in parental loss or separation.These results support differentiation of GAD and PD based on developmental risk factors. Recommendations for future research and implications of the findings for understanding the etiology and symptomatology of GAD and PD are discussed.
- Sexual orientation and treatment-seeking for depression in a multilingual worldwide sample. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 15.:87-93.
Prior research has found higher rates of mental health problems among sexual minority individuals. We examine treatment-seeking for depression, as well as its relationship with sexual orientation, in a large, multilingual, international sample.Participants in an automated, quintilingual internet-based depression screening tool were screened for depression, and completed several background measures, including sexual orientation (with an option to decline to state) and past and current depression treatment seeking.3695 participants screened positive for current or past depression and responded to the sexual orientation question. Those who declined to state their sexual orientation were far less likely to seek any treatment than individuals endorsing any orientation; they were especially unlikely to seek psychotherapy. Individuals identifying as bisexual sought both psychotherapy and alternative treatments at a higher rate than other groups. An interaction was observed between sexual orientation and gender, such that lesbian women were especially likely to have used psychotherapy. Other variables that emerged as significant predictors of treatment-seeking for depression included age and participant's language.Limitations include possible misinterpretation of translated terms due to regional differences, and possible limits to generalizability due to this study being conducted on the internet.Our results suggest that individuals who decline to state their sexual orientation may be more likely to forgo effective treatments for depression. Further studies of depression service utilization should focus on developing treatment modalities that could better engage sexual minority individuals, especially those who are reluctant to disclose their orientation.
- Effective self-management strategies for bipolar disorder: A community-engaged Delphi Consensus Consultation study. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 11.:77-86.
Self-management represents an important complement to psychosocial treatments for bipolar disorder (BD), but research is limited. Specifically, little is known about self-management approaches for elevated mood states; this study investigated self-management strategies for: (1) maintaining balance in mood, and (2) stopping progression into hypomania/mania.To identify the common components of BD self-management, Delphi Consensus Consultation methods were combined with a Community-Based Participatory Research (CBPR) approach across five study phases: (1) Qualitative dataset content analysis; (2) Academic/grey literature reviews; (3) Content analysis; (4) Two Delphi rounds (rating strategies on a 5-point Likert scale, Very Unhelpful-Very Helpful), and; (5) Quantitative analysis and interpretation. Participants were people with BD and healthcare providers.Phases 1 and 2 identified 262 and 3940 candidate strategies, respectively; 3709 were discarded as duplicates/unintelligible. The remaining 493 were assessed via Delphi methods in Phase 4: 101 people with BD and 52 healthcare providers participated in Round 1; 83 of the BD panel (82%) and 43 of the healthcare provider panel (83%) participated in Round 2-exploratory factor analysis (EFA) was conducted on Round 2 results.EFA was underpowered and sample was not ethnically diverse, limiting generalizability.High concordance was observed in ratings of strategy effectiveness between the two panels. Future research could usefully investigate the provisional discovery here of underlying factors which link individual strategies. For example, 'maintaining hope' underpinned strategies for maintaining balance, and 'decreasing use of stimulants' underpinned strategies to interrupt hypo/manic ascent. There is merit in combining CBPR and Delphi methods.
- Self-help strategies for sub-threshold anxiety: A Delphi consensus study to find messages suitable for population-wide promotion. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 19.:68-76.
Many self-help strategies have been recommended for anxiety, but it is not clear which strategies are most effective and could be encouraged as part of an early intervention approach. This study used the Delphi expert consensus method to identify which strategies for mild (sub-threshold) anxiety are thought to be helpful and feasible to implement for individuals without professional assistance.Participants were an international sample of 51 clinicians/researchers and 32 consumer advocates with expertise in anxiety. The scientific and lay literature was systematically searched for strategies claimed to be effective for anxiety. Participants rated the likely helpfulness of each strategy in reducing sub-threshold anxiety (related to generalised anxiety, social anxiety, or non-specific anxiety symptoms) and the feasibility of implementation in an iterative process across three questionnaire rounds.66 out of 324 candidate strategies were endorsed by at least 80% of both consumers and clinicians/researchers as likely to be helpful, and 18 were judged as feasible to carry out. Endorsed strategies were most frequently related to cognitive strategies and other psychological methods, interpersonal strategies, reducing physical tension, and lifestyle strategies. Few strategies were endorsed that were related to diet, supplements, or complementary medicine.Findings may not apply to other forms of mild anxiety related to panic attacks or specific phobias.This study contributes to the evidence-base on strategies that individuals can use to improve mild anxiety symptoms. Research is now required to evaluate whether promoting the strategies can help reduce the overall community burden from anxiety disorders.
- Depression and serum low-density lipoprotein: A systematic review and meta-analysis. [REVIEW, JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 19.:55-67.
A cross-sectional association between depression and serum low-density lipoprotein (LDL) has been noted in the literature. This study aims to employ meta-analytic techniques to clarify the relationship between depression and serum LDL.Published articles through April 2015 were identified through systematic query of PubMed with follow-up manual searches. Data from 36 studies reporting mean difference and 7 studies reporting odds ratios were analyzed separately.Meta-analysis of studies modeling serum LDL as a continuous measure demonstrates overall significantly lower serum LDL in depression (Mean difference=-4.29, 95% CI=-8.19, -0.40, p=0.03). Meta-analysis of studies modeling serum LDL as a categorical measure demonstrates a marginally significant lower odds of depression in the presence of low serum LDL relative to high serum LDL (OR=0.90, 95% CI=0.80, 1.01, p=0.08).High heterogeneity was noted across sampled studies, which may be a function of variations in study design, participants sampled, or other factors. The potential for publication bias was also assessed.This meta-analysis demonstrates a cross-sectional link between depression and low serum LDL.
- When social anxiety and depression go together: A population study of comorbidity and associated consequences. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 18.:48-54.
Despite several studies suggesting higher depression severity and dysfunction occurring in individuals with major depressive disorder (MDD) comorbid with social anxiety disorder (SAD), a clear understanding of the specific risks associated with this comorbidity is lacking. In this study we compared the disease characteristics and level of disability of individuals with MDD-SAD with other comorbidities between depression and anxiety.Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N=20,013) were used. Individuals were divided in four groups comparing MDD-SAD with MDD alone, as well as other comorbidities between MDD and one anxiety (MDD-1ANX) or more than two anxiety disorders (MDD≥2ANX), with respect to several clinical, demographic, and functional characteristics.MDD-SAD comorbidity in the general population occurred in younger people, particularly men, and seemed to have an earlier onset of MDD. Occupational and social dysfunction was similar between individuals with MDD-SAD and those with MDD-1ANX. However, individuals with MDD≥2ANX had significantly higher severity as measured by suicidality as well as substance abuse and social and occupational dysfunction. SAD was the most prevalent comorbid anxiety in this group.The findings of this study were derived from the cross-sectional data.Our results suggest that the particular risks associated with MDD-SAD are the early onset and likelihood of additional anxiety, leading to higher severity and disability levels. Clinicians should increase the screening and treatment of SAD and other anxiety disorders in individuals with MDD given the higher associated health risk and functional impairment.
- Risk of incident cardiovascular events amongst individuals with anxiety and depression: A prospective cohort study in the east London primary care database. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 19.:41-47.
It is unknown how risk of myocardial infarction and stroke differ for patients with and without anxiety or depression, and whether this risk can be explained by demographics, medication use, cardiovascular risk factors. The aim of this study is to quantify differences in risk of non-fatal MI or stroke among patients with anxiety or depression.Prospective cohort study examining risk of incident MI and stroke between March 2005 and March 2015 for 524,952 patients aged 30 and over from the east London primary care database for patients with anxiety or depression.Amongst 21,811 individuals with depression at baseline, 1.2% had MI and 0.4% had stroke. Of 22,128 individuals with anxiety at baseline, 1.1% had MI and 0.3% had stroke. Depression was independently associated with both MI and stroke, whereas anxiety was associated with MI only before adjustment for cardiovascular risk factors. Antidepressant use increased risk for MI but not stroke. Mean age at first MI was lower in those with anxiety, while mean age at first stroke was lower in those with depression.The study was limited to patients currently registered in the database and thus we did not have any patients that died during the course of follow-up.Patients with depression have increased risk of cardiovascular events. The finding of no increased cardiovascular risk in those with anxiety after adjusting for cardiovascular risk factors is of clinical importance and highlights that the adequate control of traditional risk factors is the cornerstone of cardiovascular disease prevention. Targeting management of classical cardiovascular risk factors and evaluating the risks of antidepressant prescribing should be prioritized.
- Patterns of depressive disorders across 13 years and their determinants among midlife women: SWAN mental health study. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 5.:31-40.
Little is known about the course of depression in midlife women. This study aims to identify factors that distinguish risk factors for persistent or recurrent depression from those of a milder course across 13-years of follow-up.297 Black and White premenopausal women aged 42-52 were enrolled at the Study of Women's Health Across the Nation Pittsburgh site. Psychiatric interviews obtained information on lifetime psychiatric diagnoses at baseline and occurrences of depression annually. We identified four depression patterns: 91(31%) had Persistent/recurrent major depressive disorder (MDD), 27(9%) Single Episode MDD, 35(12%) Minor Depression (minD) only, 144(48%) No Depression. We compared baseline risk factors for the Persistent/recurrent MDD group with each of the other three.A lifetime history of major or minor depression (p-values =.001-.08) and 2+ very upsetting life events in the previous year (p-values=.003-.04) were more likely to be reported by women in the Persistent/recurrent group than in the other three. The Persistent/recurrent group was more likely to report a family history of depression (p=.03) than the MinD group, and to report current sleep problems (p=.002) at baseline than the Single Episode MDD group.Small numbers of women with minD or a Single Episode MDD. Childhood maltreatment and family depression history were retrospectively reported.A Persistent/recurrent depression course is common during midlife. In addition to personal and family histories of depression, providers of midlife health care should recognize that current sleep problems and recent very upsetting events are strong risk factors for a pernicious depression course.
- Effect of a human serotonin 5-HT2A receptor gene polymorphism on impulsivity: Dependence on cholesterol levels. [JOURNAL ARTICLE]
- J Affect Disord 2016 Jul 19.:23-30.
Impulsivity is multidimensional: Low impulse control may result in behavioural disorders, but acting on the spur of moment may also be advantageous. Previous studies have shown negative associations between different facets of impulsivity and serotonergic function. Other investigations have found negative correlations between serum lipid levels and impulsivity.We have investigated whether the functional polymorphism -1438A/G in the serotonin 5-HT2A receptor gene (HTR2A) is associated with impulsivity levels and whether there is any interaction with serum lipid levels. This analysis was based on data of the population-representative Estonian Children Personality Behaviour and Health Study at age 25. Impulsivity was self-reported with the Adaptive and Maladaptive Impulsivity Scale.Subjects with the A/A genotype of the HTR2A -1438A/G polymorphism had higher scores of Maladaptive impulsivity, but not Adaptive impulsivity. In females, high LDL and total cholesterol levels increased the genotype effect. In males, in the highest quartile of total or LDL cholesterol the genotype effect was altered, with G/G homozygotes having the highest Maladaptive impulsivity levels.Only one cohort of the European Youth Heart Study (EYHS) was used in the current study and impulsivity measures were self-reported.Our results do not support the notion that low cholesterol levels universally lead to higher impulsivity, but it was found that high total and LDL cholesterol levels moderate the effect of the HTR2A gene promoter polymorphism. This suggests that future studies on impulsivity need to consider the interaction of serotonergic measures with the whole range of cholesterol levels.