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Journal of affective disorders [journal]
- Patterns of women׳s mood after delivery: A growth curve analysis. [JOURNAL ARTICLE]
- J Affect Disord 2014 Nov 24.:201-208.
The course and predictors of women׳s mood following childbirth have informed clinically significant phenomena, such as postpartum depression (PPD), with some contradictory findings due to methodological limitations. It is important to further investigate mood during this unique period of time to inform assessment and improve interventions.Recently delivered mothers (n=216) recruited from the maternity unit at a University hospital completed sociodemographic questions and the Daily Experiences Questionnaire (DEQ), a measure of Negative Affect (NA) and Positive Affect (PA), for 10 consecutive days. The Structured Clinical Interview for DSM-IV was administered to assess postpartum depression diagnosis.Growth curve modeling (GCM) techniques revealed average trends in mood following delivery. NA changed in a curvilinear fashion with a peak at day 5. PA declined rapidly during the days immediately following delivery and then stabilized. Women diagnosed with PPD experienced higher overall levels of NA and lower levels of PA from delivery to 10 days postpartum. Patterns of mood varied as a function of neuroticism and several well-established sociodemographic variables.Small sample size and relatively few ethnic minority participants may affect generalizability of the findings.NA changed in a pattern consistent with the "peaking phenomenon". Well-established risk factors of the blues had significant associations with mood from delivery to day 10. Increased understanding into the nature of NA and PA in the early postpartum, and its role in identifying women susceptible to experiencing PPD, can inform screening and therapeutic interventions for PPD.
- A new measure of multimorbid illness and treatment representations: The example of diabetes and depression. [JOURNAL ARTICLE]
- J Affect Disord 2014 Dec 3.:192-200.
Depression is two to three times more common in people with diabetes than in the general population. Although multimorbid diabetes and depression is associated with poor health outcome, existing research has focused on patients׳ understanding and management of each condition in isolation. This study describes the development and validation of the Diabetes and Depression Representation and Management Questionnaire (DDRMQ), a measure of understanding, management and medication beliefs in people with diabetes and depression.In Study 1, DDRMQ items were developed through further analysis of an earlier qualitative study and refined through 18 cognitive interviews. In Study 2, 334 adults with diabetes and depression from general practices, diabetes clinics and support groups completed the DDRMQ, demographic questions and validating measures.Factor analysis of the DDRMQ using principal axis factoring resulted in a 35 item scale organised into ten subscales. The modified measure had adequate internal and test-retest reliability. Initial evidence of construct validity was also demonstrated.Low participant response rates and the high percentage of well-educated white participants limit the generalisability of results. As Study 2 was cross-sectional, future research is needed to establish if different ways of thinking about and managing diabetes and depression can predict patient outcome.The DDRMQ is the first measure of patient understanding, management and medication beliefs in people with established diagnoses of both diabetes and depression. The DDRMQ will facilitate an increased awareness of the patient experience of diabetes and depression and help inform patient centred care and intervention development for people with multiple conditions.
- Is the BPRS-5 subscale of the psychotic depression assessment scale a reliable screening tool for psychotic depression?: Results from the CRESCEND Study. [JOURNAL ARTICLE]
- J Affect Disord 2014 Dec 1.:188-191.
The detection of psychotic depression (PD) among patients with depressive disorders is important for both treatment and monitoring. Therefore, in continuation of our previous work, this study aimed to test the ability of the five-item Brief Psychiatric Rating Scale (BPRS-5) of the Psychotic Depression Assessment Scale (PDAS) in separating patients with psychotic depression from those with non-psychotic depression (non-PD) and to compare this discriminative validity to that of other item sets.A receiver operating characteristics curve was used to identify the optimal cut-off score of the BPRS-5 subscale for sensitive and specific distinction between PD and non-PD in a sample of 494 patients with depressive disorders (53 with PD and 441 with non-PD).Using an optimal cut-off score of 1, the sensitivity and the specificity of the BPRS-5 subscale in detecting PD were 71.2% and 87.2%, respectively. The BPRS-5 outperformed other item sets of the PDAS and the positive symptom subscale of the BPRS in identifying patients with PD.The inter-rater reliability of the PDAS and the BPRS-5 subscale was not evaluated in this study.The BPRS-5 subscale can be regarded as a more sensitive screening method for PD compared to other item sets from the PDAS and the BPRS. Hence, from a screening perspective, a positive score on any of the five symptoms of the BPRS-5 subscale (hallucinatory behavior, unusual thought content, suspiciousness, blunted affect, and emotional withdrawal) is indicative of PD, and should lead to more thorough diagnostic assessment.
- Anxiety comorbidity in bipolar spectrum disorders: The mediational role of perfectionism in prospective depressive symptoms. [JOURNAL ARTICLE]
- J Affect Disord 2014 Nov 21.:180-187.
Bipolar spectrum disorders (BSDs) are highly comorbid with anxiety, which is associated with an extended duration and exacerbation of depressive symptoms. Unfortunately, the underlying mechanisms are not known. This study examined the role of maladaptive cognitive styles in the co-occurrence of BSDs and anxiety disorders and prediction of depressive symptoms.Participants included 141 young adults (69.6% female, mean age=20.24, SD=2.11), in one of three groups: a BSD group (bipolar II, cyclothymia, n=48), a comorbid BSD/anxiety group (n=50), and a demographically-matched healthy control group (n=43), who were followed prospectively. Participants completed the Cognitive Style Questionnaire (CSQ), Depressive Experiences Questionnaire (DEQ), Dysfunctional Attitudes Scale (DAS), Sociotropy Autonomy Scale (SAS), Halberstadt Mania Inventory (HMI) and Beck Depression Inventory (BDI) at the initial assessment. One year later, participants completed the BDI and HMI again to assess severity of depressive and hypomanic/manic symptoms.A multivariate analysis of co-variance (MANCOVA) revealed significant differences between the three groups on their DAS Perfectionism, DEQ Dependency, DEQ Self-Criticism, CSQ Negative, SAS Autonomy, and Time 2 BDI scores, with the BSD/anxiety group scoring higher than the BSD only group on all measures except the CSQ. Preacher and Hayes׳ (2008) bootstrapping method was used to test for mediational effects of the significant cognitive style measures on depressive symptoms at follow-up. The 95% confidence intervals for the indirect effect of group on follow-up depressive symptoms through DAS Perfectionism did not include zero, indicating the presence of a significant mediating relationship for perfectionism.This study only used two waves of data; three waves of data would allow one to investigate the full causal effect of one variable on another. Further, a comorbid anxiety diagnosis consisted of any anxiety disorder. Further research should separate groups by their specific anxiety diagnoses; this could afford a more complete understanding of the effect of types of anxiety on prospective depressive symptoms.After taking into account initial levels of depressive and hypomanic/manic symptoms, we found that those with BSD/anxiety comorbidity experienced more severe depressive symptoms, but not more severe hypomanic/manic symptoms. Further, their more severe prospective depressive symptoms are explained by a perfectionistic cognitive style.
- Neurophysiological handover from MMN to P3a in first-episode and recurrent major depression. [JOURNAL ARTICLE]
- J Affect Disord 2014 Dec 3.:173-179.
Mismatch negativity (MMN) and P3a components are sequential and co-occur. MMN represents the pre-attentive index of deviance detection and P3a represents the attention orienting response. Major depressive disorder (MDD) is characterized by impaired pre-attentive information processing. To assess whether impaired pre-attentive information processing can lead to an impairment of subsequent orienting process as the neurophysiological transmission spreads from MMN to P3a in MDD.MMN/P3a was obtained during a two-tone auditory paradigm with 8% duration deviants in 45 first-episode major depression subjects (F-MD), 40 recurrent major depression subjects (R-MD), and 46 healthy controls (HC).Compared with HC, F-MD and R-MD had lower MMN amplitudes and no differences were found between F-MD and R-MD. Notably, R-MD had lower P3a amplitudes and longer P3a latencies compared to HC, while F-MD had no differences. Interestingly, no correlations were found between the severity of depression and the deficits of MMN amplitude. The deficits of P3a amplitude, however, were negatively correlated with the severity of depression in F-MD and R-MD. Furthermore, the P3a amplitude deficits were positively correlated with the number of episodes in R-MD.Patients were on antidepressant medication.The recurrence of depressive episodes can lead to impaired pre-attentive information processing, causing an impairment of subsequent orienting process as the neurophysiological transmission from MMN to P3a. It further suggests that the impaired processing indexed by MMN amplitude may be a stable trait biomarker for the appearance of depression, while P3a amplitude can be used a potential biomarker for recurrence.
- Prefrontal cortex activation is associated with a discrepancy between self- and observer-rated depression severities of major depressive disorder: A multichannel near-infrared spectroscopy study. [JOURNAL ARTICLE]
- J Affect Disord 2014 Nov 24.:165-172.
Studies on major depressive disorder (MDD) show that the degree of correlation between the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAMD) varies widely. We aimed to determine whether this discrepancy reflects specific functional abnormalities in the frontotemporal cortex.Mildly depressed or euthymic patients with MDD (n=52), including 21 patients with MDD with the discrepancy, i.e., those with low HAMD17 scores (≤13) but high BDI-II scores (>28), and 31 patients without the discrepancy, i.e., those with low HAMD17 scores and low BDI-II scores (≤28), participated in the study along with 48 control subjects. Regional changes of oxygenated hemoglobin (oxy-Hb) levels during a verbal fluency task (VFT) were monitored using a 52-channel near-infrared spectroscopy (NIRS) device.In the frontotemporal regions, mean oxy-Hb changes induced by the VFT were significantly smaller in patients with MDD than in control subjects. In 5 channels within frontal regions, the increase in mean oxy-Hb levels was significantly greater in MDD patients with the BDI-HAMD discrepancy than in those without the discrepancy. In 6 channels within the frontal region of the patients with MDD, significant positive correlations were observed between mean oxy-Hb changes and BDI total scores (ρ=0.38-0.59; P<0.05, false discovery rate corrected).Our findings required replication in severely depressed patients, particularly those with melancholia.The distinct pattern of activation of the prefrontal cortex suggests that MDD with the BDI-HAMD discrepancy is pathophysiologically different from MDD without the discrepancy.
- Pre-treatment insomnia as a predictor of single and combination antidepressant outcomes: A CO-MED report. [JOURNAL ARTICLE]
- J Affect Disord 2014 Nov 22.:157-164.
Most patients with major depressive disorder (MDD) report clinically significant sleep problems. Pre-treatment insomnia has been associated with poorer treatment outcomes in some antidepressant trials, leading to suggestions that combined treatment regimens may be more successful in this subgroup. This study investigated this question using data from the CO-MED trial.Adult outpatients with chronic and/or recurrent MDD were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram+placebo, (2) bupropion-sustained-release+escitalopram, or (3) venlafaxine-extended-release+mirtazapine. We compared baseline characteristics, tolerability, and treatment outcomes at 12 and 28 weeks for patients with and without pre-treatment insomnia.Of the 665 evaluable patients, the majority (88.3%) reported significant pre-treatment insomnia. Those with pre-treatment insomnia were more likely to be female (69.3% vs. 57.7%) and African-American (29.1% vs. 11.8%). Those with pre-treatment insomnia symptoms reported higher rates of concurrent anxiety disorders, lower rates of alcohol and substance use disorders, and greater impairment in psychosocial functioning. The two groups did not differ in either tolerability or treatment outcomes among the three antidepressant treatments.Insomnia symptoms, while common in patients with chronic/recurrent MDD were not predictive of response, remission, or tolerability with either single or combined antidepressant medications.
- Beliefs of people taking antidepressants about the causes of their own depression. [JOURNAL ARTICLE]
- J Affect Disord 2014 Nov 28.:150-156.
The beliefs of people receiving treatment about the causes of their own mental health problems are researched less often than the causal beliefs of the public, but have important implications for relationships with prescribers, treatment choices and recovery.An online survey on a range of beliefs about depression, and experiences with antidepressants, was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants.Six of 17 beliefs about the causes of their own depression were endorsed by more than half the sample: chemical imbalance, family stress, work stress, heredity, relationship problems and distressing events in childhood. There were some marked differences in content, structure and level of conviction of beliefs about one׳s own depression and the sample׳s previously published beliefs about depression in general. There were also significant differences between the beliefs of demographic groupings. Regression analyses revealed that self-reported effectiveness of the antidepressants was positively associated with bio-genetic causal beliefs. The quality of the relationship with the prescribing doctor was positively related to a belief in chemical imbalance as a cause and negatively related to a belief in unemployment as a cause.The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression.People experiencing depression hold complex, multifactorial and idiosyncratic sets of beliefs about the causes of their own depression, apparently based at least in part on their own life experiences and circumstances. Exploring those beliefs may enhance the doctor-patient relationship and selection of appropriate treatment modality.
- Clinical characteristics and temperament influences on 'happy' euphoric and 'snappy' irritable bipolar hypo/manic mood states. [JOURNAL ARTICLE]
- J Affect Disord 2014 Nov 29.:144-149.
While mood elevation and euphoria are the most commonly described phenotypic descriptors of hypo/mania, irritability and anger may dominate. This study was designed to pursue possible determinants of such differing states.Patients with bipolar I or II disorder were assigned to an 'irritable/snappy' or 'euphoric/happy' sub-set on the basis of their dominant hypo/manic symptoms. Group differences were examined across clinical, personality, lifestyle and illness impact measures.The two sub-sets did not differ on age of depression onset, family history of mood disorders, or depression severity and impairment. The snappy sub-set reported higher levels of irritability in depressed phases and were more likely to have a comorbid anxiety disorder. Their hypo/manic episodes were shorter and they were more likely to be hospitalized at such times. On a temperament measure they scored as more irritable and self-focussed and as less cooperative and effective - indicative of higher levels of disordered personality functioning.Some comparison analyses were undertaken on a reduced sample size, giving rise to power issues. Our bipolar I and II diagnoses deviated to some extent from DSM-5 criteria in not imposing duration criteria for hypo/manic episodes.Findings support a spectrum model for the bipolar disorders linking temperament to bipolar symptomatic state and which may have treatment implications.
- Molecular imaging of striatal dopamine transporters in major depression-A meta-analysis. [REVIEW]
- J Affect Disord 2014 Dec 2.:137-143.
Increasing studies have revealed the dopamine transporter (DAT) availability altered in striatum associated with major depression. However, the results remain inconsistent.To assess the alteration of striatal DAT availability in major depression, we performed a meta-analysis based on 12 case-control molecular imaging studies, including a total of 209 depressed patients and 314 healthy controls. Hedges׳ g and corresponding 95% confidence intervals (CIs) for striatal DAT availability in major depression compared with controls were estimated.Our meta-analysis revealed no evidence for the alteration of striatal DAT availability in major depression (Hedges׳ g=0.09, CI 95% from -0.43 to 0.61, P=0.73). Meta-regression analyses suggested that there were no moderating effects for age, gender, year of publication, sample size, medication exposures and severity of depression on the hedges׳g values for striatal DAT availability.The results should be treated with caution because of the significant heterogeneity and the potential interference of confounding factors in this meta-analysis.Our results showed no altered striatal DAT availability in major depression and indicated that striatal DAT may not implicated in the pathophysiology of major depression.