Psychometric properties of the Beck Depression Inventory-II: a comprehensive review

Effect of Acute Physical Exercise on Executive Functions and Emotional Recognition: Analysis of Moderate to High Intensity in Young Adults

Physical exercise (PE) is associated with cognitive changes and brain function. However, it is required to clarify the effect of PE in different intensities, population groups conditions and the EF duration over different cognitive domains. Besides, no studies are known to have evaluated the contextual emotional recognition. Therefore, we studied the effect of acute PE of moderate intensities up to higher ones to the executive functions and the contextual emotional recognition. The participants were evaluated and classified in two experiments according to the IPAQ short form self-report and control measures. In both experiments, the groups were randomized, controlled, and exposed to one session of indoor cycling through intervals of high measure intensity (75–85% HRmax). Experiment 1 comprised young adults who were physically active (PA) and healthy, apparently (n = 54, M_age = 20.7, SD = 2.5). Experiment 2 involved young adults who were physically inactive (IP) and healthy, apparently (n = 36, M_age = 21.6, SD = 1.8). The duration was the only factor that varied: 45 min for PA and 30 min for PI. The executive functions were evaluated by the Stroop, TMT A/B, and verbal fluency, and the emotional recognition through a task that includes body and facial emotions in context, simultaneously. The analysis of factorial mixed ANOVA showed effects on the right choices of the indoor cycling groups in the PA, and the time response in PI. Also, other effects were observed in the controlled groups. TMT-A/B measures showed changes in the pre-test–post-test measures for both experiments. Verbal fluency performance favored the control group in both experiments. Meanwhile, the emotional recognition showed an effect of the PE in error-reduction and enhanced the scores in the right choices of body emotions. These results suggest that the EF with intensities favored cognitive processes such as inhibitory control and emotional recognition in context. We took into account the importance of high-complexity tasks design that avoid a ceiling effect. This study is the first on reporting a positive effect of PE over the emotional contextual recognition. Important clinical and educational implications are presented implications which highlight the modulatory role of EF with moderate to high intensities.

The paradox of relaxation training: Relaxation induced anxiety and mediation effects of negative contrast sensitivity in generalized anxiety disorder and major depressive disorder

BACKGROUND

The Contrast Avoidance Model postulates that individuals with generalized anxiety disorder (GAD) fear a sharp spike in negative emotion, and thus, prefer to worry to maintain their negative affect rather than being in a more euthymic state, such as relaxation. Relaxation induced anxiety (RIA) is a paradoxical phenomenon wherein people experience a spike in their anxiety during relaxation training. Because these phenomena may be related and may also operate among individuals with major depressive disorder (MDD), we attempted to test whether negative contrast sensitivity was a mediator of GAD or MDD in the prediction of RIA.

METHODS

Individuals with GAD (n = 32), MDD (n = 34), and healthy controls (n = 30) were exposed to a negative emotional contrast by engaging with relaxation practice and then watching a negative emotional video. This was followed by the assessment of their negative contrast sensitivity. After this, participants engaged again with relaxation and RIA was measured. We examined mediation effects of negative contrast on the relationship between diagnostic status and RIA.

RESULTS

Negative contrast sensitivity fully mediated GAD and partially mediated MDD in predicting RIA.

CONCLUSIONS

Our findings support the hypotheses that negative contrast sensitivity is the mediator of both GAD and MDD in predicting RIA. This may have implications for assessment and treatment of GAD and MDD.

The relationship between study skills and depressive symptoms among medical residents

BACKGROUND

The cost of depression among residents is staggering as it extends into the quality and safety of patient care. Finding an explanation to resident depression by investigating the associated factors is therefore important. Study skills can be a possible factor, and a clear gap in the literature exists in this regard. We sought to investigate the relationship between depressive symptoms among residents and their study skills.

METHODS

This was a correlational study and a non-probability sample of 240 residents completed the Beck Depression Inventory II (BDI-II) and the Study Skills Inventory (SSI). Chi-square test was used to compare different categorical variables, while student t-test and ANOVA for continuous data. Pearson's correlation coefficient was performed to find the relationship between depressive symptoms and study skills and the association that these measures have with the demographic variables.

RESULTS

Overall, 186 residents (76%) filled out the questionnaire. The SSI total score was found to have a significant negative association with the BDI-II depression score (Pearson correlation = - 0.447and p < 0.000). No significant association was found between the total SSI score and the residents' sex, age, marital status, smoking status, training years or specialties.

CONCLUSION

Poor study skills were found to be correlated with higher depressive symptoms. Future studies are required to develop a deeper understanding of this relationship and reconfigure the approach to study skills for the well-being of the future physicians.

The Influence of Race-Related Stress on Eating Pathology: The Mediating Role of Depression and Moderating Role of Cultural Worldview Among Black American Women

The current study aimed to advance the eating pathology literature through investigating the association between a salient stressor for Black American women (race-related stress) and eating pathology, while also examining the potential mediating role of depressive symptoms on this association. In addition, the study aimed to examine the potential protective role of cultural worldview in this model. A community sample of 119 Black women between the ages of 18 and 60 years ( M = 36.34, SD = 12.51) were recruited for the study. Results supported a significant indirect effect of race-related stress on eating pathology through depressive symptoms. Moderated mediation analyses revealed a conditional effect of depression at various levels of worldview. Contrary to our hypotheses, participants with a more collectivistic and spiritual worldview often engaged in more eating pathology as a result of self-reported depressive symptoms stemming from experiences of race-related stress. Implications and future directions are discussed.

Effect of psychosocial work factors on the risk of depression: a protocol of a systematic review and meta-analysis of prospective studies

INTRODUCTION

Depression is a common and disabling health problem that contributes to an important social and economic burden, particularly among the working age population. The deleterious effect of psychosocial work factors on depression has been documented. However, the most recent systematic reviews had restrictive eligibility criteria and, since their publications, several original studies have been published. The proposed systematic review aims to update, evaluate and synthesise the effect of psychosocial work factors from three recognised theoretical models, the demand-control-support, effort-reward imbalance and organisational justice models, on the risk of depression among workers.

METHOD AND ANALYSIS

A systematic literature search will be conducted in seven academic databases (Medline, Embase, CINAHL, Web of Science, PsycInfo, Sociological abstracts and IBSS) as well as three grey literature databases. The search strategy was first run on January 2017, updated in October 2017 and will be updated 6 months prior to submission for publication. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations, study selection will be carried out using a rigorous multistep screening process in duplicate by independent reviewers. Prospective studies evaluating the effect of at least one psychosocial work factor from the three theoretical models on depression or antidepressant medication use among working adults will be included. Extracted data will be used for evidence synthesis as well as to assess risk of bias and methodological quality. Meta-estimates will be provided after considering homogeneity and number of studies.

ETHICS AND DISSEMINATION

This study will only draw from published studies and grey literature available in electronic databases; ethics approval is not required. The results of this review will be published in a peer review journal and presented at relevant conferences. Given that psychosocial work factors are frequent and modifiable, the results can help reduce the social and economic burden of depression and support public policy-makers to improve occupational health standards.

PROSPERO REGISTRATION NUMBER

CRD42018107666.

Collaborative care vs consultation liaison for depression and anxiety disorders in general practice: study protocol for two randomized controlled trials (the Danish Collabri Flex trials)

Background

Models of collaborative care and consultation liaison propose organizational changes to improve the quality of care for people with common mental disorders, such as anxiety and depression. Some literature suggests only short-term positive effects of consultation liaison on patient-related outcomes, whereas collaborative care demonstrates both short-term and long-term positive effects. To our knowledge, only one randomized trial has compared the effects of these models. Collaborative care was superior to consultation liaison in reducing symptoms of depression for up to 3 months, but the authors found no difference at 9-months' follow-up. The Collabri Flex Trial for Depression and the Collabri Flex Trial for Anxiety aim to compare the effects of collaborative care with those of a form of consultation liaison that contains potential contaminating elements from collaborative care. The trials build on knowledge from the previous cluster-randomized Collabri trials.

Methods

Two randomized, investigator-initiated, parallel-group, superiority trials have been established: one investigating the effects of collaborative care vs consultation liaison for depression and one investigating the effects of collaborative care vs consultation liaison for generalized anxiety, panic disorder and social anxiety disorder at 6-months' follow-up. Participants are recruited from general practices in the Capital Region of Denmark: 240 in the depression trial and 284 in the anxiety trial. The primary outcome is self-reported depression symptoms (Beck Depression Inventory (BDI-II)) in the depression trial and self-reported anxiety symptoms (Beck Anxiety Inventory (BAI)) in the anxiety trial. In both trials, the self-reported secondary outcomes are general psychological problems and symptoms (Symptom Checklist 90-Revised), functional impairment (Sheehan Disability Scale) and general well-being (World Health Organization-Five Well-Being Index). In the depression trial, BAI is an additional secondary outcome, and BDI-II is an additional secondary outcome in the anxiety trial. Explorative outcomes will also be collected.

Discussion

The results will supplement those of the cluster-randomized Collabri trials and provide pivotal information about the effects of collaborative care in Denmark.

Trial registration

ClinicalTrials.gov, NCT03113175 and NCT03113201. Registered on 13 April 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3657-0) contains supplementary material, which is available to authorized users.

Improving the Course of Depressive Symptoms After Inpatient Psychotherapy Using Adjunct Web-Based Self-Help: Follow-Up Results of a Randomized Controlled Trial

Background

We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression.

Objective

The aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up.

Methods

Overall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3).

Results

At follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group.

Conclusions

Web-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists’ concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed.

Trial Registration

ClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896.

Therapeutic writing as a tool to facilitate therapeutic process in the context of living with HIV: A case study examining partner loss

For people with HIV/AIDS (PWHA), partner loss has unique factors that complicate the grieving process and can lead to prolonged bereavement. Empirical evidence has demonstrated the benefits of emotional disclosure through therapeutic writing on physical symptoms, immune responses, and psychological distress. Therapeutic writing is based on the assumption that writing about one's deepest thoughts and feelings allows cognitive, behavioral, and kinesthetic processing of stressful life events and/or traumas. The present case study explores the benefits and challenges of using expressive writing, in addition to cognitive-behavioral therapy, to address partner loss and disenfranchised grief in the context of living with HIV. This article (a) reviews the literature on coping with loss and factors that can make PWHA more vulnerable to disenfranchised grief; (b) describes a former patient whose partner loss was complicated by lack of closure around the termination of his 6-year-long relationship, the death of that partner without the family informing him, and his anger surrounding his partner infecting him with HIV; and (c) discusses how the therapist created a comprehensive treatment plan using therapeutic writing to improve emotional processing. Results suggest that therapeutic writing assisted with symptom alleviation, improvement in psychological well-being, and increased overall quality of life. Although the loss of a partner is a common human experience, therapists need to be aware that PWHA may have additional or different care needs that can put them at risk of heightened or prolonged bereavement. Recommendations for using therapeutic writing are included. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

S-Ketamine's Effect Changes the Cortical Electrophysiological Activity Related to Semantic Affective Dimension of Pain: A Placebo- Controlled Study in Healthy Male Individuals

Background

Previous studies using the electroencephalogram (EEG) technique pointed out that ketamine decreases the amplitude of cortical electrophysiological signal during cognitive tasks, although its effects on the perception and emotional-valence judgment of stimuli are still unknown.

Objective

We evaluated the effect of S-ketamine on affective dimension of pain using EEG and behavioral measures. The hypothesis was that S-ketamine would be more effective than placebo, both within and between groups, to attenuate the EEG signal elicited by target and non-target words.

Methods

This double-blind parallel placebo-controlled study enrolled 24 healthy male volunteers between 19 and 40 years old. They were randomized to receive intravenous S-ketamine (n = 12) at a plasmatic concentration of 60 ng/ml or placebo (n = 12). Participants completed a computerized oddball paradigm containing written words semantically related to pain (targets), and non-pain related words (standard). The volunteers had to classify the words either as “positive,” “negative” or “neutral” (emotional valence judgment). The paradigm consisted in 6 blocks of 50 words each with a fixed 4:1 target/non-target rate presented in a single run. Infusion started during the interval between the 3rd and 4th blocks, for both groups. EEG signal was registered using four channels (Fz, Pz, Pz, and Oz, according to the 10–20 EEG system) with a linked-earlobe reference. The area under the curve (AUC) of the N200 (interval of 100–200 ms) and P300 (300–500 ms) components of event-related potentials (ERPs) was measured for each channel.

Results

S-ketamine produced substantial difference (delta) in the AUC of grand average ERP components N200 (P = 0.05) and P300 (P = 0.02) at Pz during infusion period when compared to placebo infusion for both targets and non-targets. S-ketamine was also associated with a decrease in the amount of pain-related words judged as negative from before to after infusion [mean = 0.83 (SD = 0.09) vs. mean = 0.73 (SD = 0.11), respectively; P = 0.04].

Conclusion

Our findings suggest that S-ketamine actively changed the semantic processing of written words. There was an increase in electrophysiological response for pain-related stimuli and a decrease for standard stimuli, as evidenced by the increased delta of AUCs. Behaviorally, S-ketamine seems to have produced an emotional and discrimination blunting effect for pain-related words.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier NCT03915938.

Is resting state frontal alpha connectivity asymmetry a useful index to assess depressive symptoms? A preliminary investigation in a sample of university students

BACKGROUND

Frontal alpha asymmetry (FAA) has been widely investigated in depressive disorders (DDs) with contradictory and not conclusive results. The main aim of the current study was to explore the association between a new neurophysiological index, the so-called frontal alpha connectivity asymmetry index (FACA-I), and depressive symptoms.

METHODS

One hundred and thirteen participants (45 men and 68 women, mean age: 22.83 ± 2.26 years) were enrolled. Electroencephalographic (EEG) recordings were performed during 5 min of resting state (RS). FACA-I was computed by subtracting connectivity at left frontal regions from right frontal regions and dividing by their sum. RS FAA were also computed and compared to the FACA-I in all analyses.

RESULTS

After controlling for the presence of potential confounding variables (i.e., sex, age and anxiety symptoms), only FACA-I scores between medial prefrontal cortex and subgenual anterior cingulate cortex were negatively associated with both somatic and cognitive/affective depressive symptoms and were lower in individuals with significant level of depressive symptoms.

LIMITATIONS

We focused on a sample of university students with no formal diagnosis of depression and we did not assess FAA and FACA-I during cognitive and/or emotional tasks, which make our interpretation specific to the RS condition.

CONCLUSIONS

Taken together our data suggest that alpha connectivity asymmetry between medial prefrontal cortex and subgenual anterior cingulate cortex may be a useful neurophysiological index in the assessment of depressive symptoms.

Depression Suppresses Treatment Response for Traumatic Loss-Related Posttraumatic Stress Disorder in Active Duty Military Personnel

There are multiple well-established evidence-based treatments for posttraumatic stress disorder (PTSD). However, recent clinical trials have shown that combat-related PTSD in military populations is less responsive to evidence-based treatments than PTSD in most civilian populations. Traumatic death of a close friend or colleague is a common deployment-related experience for active duty military personnel. When compared with research on trauma and PTSD in general, research on traumatic loss suggests that it is related to higher prevalence and severity of PTSD symptoms. Experiencing a traumatic loss is also related to the development of prolonged grief disorder, which is highly comorbid with depression. This study examined the association between having traumatic loss-related PTSD and treatment response to cognitive processing therapy in active duty military personnel. Participants included 213 active duty service members recruited across two randomized clinical trials. Results showed that service members with primary traumatic loss-related PTSD (n = 44) recovered less from depressive symptoms than those who reported different primary traumatic events (n = 169), B = -4.40. Tests of mediation found that less depression recovery suppressed recovery from PTSD symptoms in individuals with traumatic loss-related PTSD, B = 3.75. These findings suggest that evidence-based treatments for PTSD should better accommodate loss and grief in military populations.

Behavioral Activation as a Treatment for Posttraumatic Stress Disorder Among Returning Veterans: A Randomized Trial

OBJECTIVE

Although evidence-based, trauma-processing treatments exist for posttraumatic stress disorder (PTSD), many individuals do not seek out, complete, or fully respond to these treatments, pointing to the need for alternative treatments. In this study, the authors evaluated the effectiveness of behavioral activation therapy modified to address PTSD among veterans.

METHODS

In a randomized trial, behavioral activation was compared with treatment as usual (referral to PTSD "standard care") among a sample of 80 veterans of the wars in Iraq and Afghanistan who were enrolled at the U.S. Department of Veterans Affairs (VA) Portland Health Care System and the VA Puget Sound Health Care System.

RESULTS

Levels of PTSD symptoms decreased for both groups across posttreatment and at 3-month follow-up as measured by clinical interview and self-report measures. The behavioral activation group had greater improvement on PTSD as evidenced by the self-report measure of symptom severity. Both groups also showed improvement on self-report measures of depression and overall functioning across time, with greater improvement on depression evidenced by the behavioral activation group. Ratings of treatment satisfaction were high for both groups.

CONCLUSIONS

Behavioral activation is a promising alternative treatment for PTSD.

Does Blocking Facial Feedback Via Botulinum Toxin Injections Decrease Depression? A Critical Review and Meta-Analysis

Researchers have proposed that blocking facial feedback via glabellar-region botulinum toxin injections (GBTX) can reduce depression. Random-effects meta-analyses of studies that administered GBTX to individuals with depression indicate that, 6 weeks postintervention, GBTX groups were significantly less depressed compared to placebo groups ( d = 0.83) and pretreatment levels ( d = 1.57). However, we noted the following concerns: (a) effect sizes were extraordinarily large, (b) authors failed to provide information to compute 51% of relevant effect sizes, (c) 96% of effect sizes came from studies conducted by investigators with conflicts of interest, (d) there is some evidence of publication bias, and (e) studies used ineffective blinding procedures. These considerations suggest that confidence in GBTX as a treatment for depression is premature.

Transcranial Direct Current Stimulation on Opium Craving, Depression, and Anxiety: A Preliminary Study

OBJECTIVES

Transcranial direct current stimulation can be effective in reducing the craving for food, alcohol, and methamphetamine. Because its effects have not been tested on patients with opium use disorder, we investigated its efficacy when it is combined with a standard methadone maintenance therapy protocol.

METHODS

We carried out a pretest-posttest control group method to evaluate the effect of transcranial direct current stimulation at the dorsolateral prefrontal cortex (right anodal/left cathodal) on opium craving, depression, and anxiety symptoms. We considered opium craving as a primary outcome as well as depression and anxiety symptoms as secondary outcomes. Sixty participants with opium use disorder were randomly assigned into 3 groups (n = 20 for each group): (1) an active transcranial direct current stimulation with methadone maintenance treatment (active tDCS group), (2) sham transcranial direct current stimulation with methadone maintenance treatment (sham tDCS group), and (3) only methadone maintenance treatment (methadone maintenance treatment group). All participants completed the Desire for Drug Questionnaire, Obsessive-Compulsive Drug Use Scale, Beck Depression Inventory II, and Beck Anxiety Inventory a week before and a week after the treatment. The outcomes were assessed by independent assessors who were blind to the treatment conditions.

RESULTS

The active tDCS group had a significant reduction in opium craving, depression, and anxiety symptoms compared with the other 2 groups.

CONCLUSIONS

Our results provide a preliminary support for using the transcranial direct current stimulation along with methadone maintenance therapy in the treatment of patients with opium use disorder.

Dimensions of Depressive Symptoms and Their Association With Mortality, Hospitalization, and Quality of Life in Dialysis Patients: A Cohort Study

OBJECTIVE

Unraveling specific dimensions of depressive symptoms may help to improve screening and treatment in dialysis patients. We aimed to identify the best-fitting factorial structure for the Beck Depression Inventory-II (BDI) in dialysis patients and to assess the relation of these structure dimensions with quality of life (QoL), hospitalization, and mortality.

METHODS

This prospective study included chronic dialysis patients from 10 dialysis centers in five hospitals between 2012 and 2017. Dimensions of depressive symptoms within the BDI were analyzed using confirmatory factor analysis. To investigate the clinical impact of these dimensions, the associations between symptom dimensions and QoL, hospitalization rate, and mortality were investigated using logistic, Poisson, and Cox proportional hazard regression models. Multivariable regression models included demographic, social, and clinical variables.

RESULTS

In total, 687 dialysis patients were included. The factor model that included a general and a somatic factor provided the best-fitting structure of the BDI-II. Only the somatic dimension scores were associated with all-cause mortality (hazard ratio of 1.7 [1.2-2.5], p < .007) in the multivariable model. All dimensions were associated with increased hospitalization rate and reduced QoL.

CONCLUSIONS

The somatic dimension of the BDI-II in dialysis patients was associated with all-cause mortality, increased hospitalization rate, and reduced QoL. Other dimensions were associated with hospitalization rate and decreased QoL. These findings show that symptom dimensions of depression have differential association with adverse clinical outcomes. Future studies should take symptom dimensions into account when investigating depression-related pathways, screening, and treatment effects in dialysis patients.

How to assess negative affective reactivity to daily life stress in depressed and nondepressed individuals?

Intensive longitudinal data studies on affective reactivity to daily life stress have used various dimensions of stress. Based on an evidence-based conceptual model of stress, the current study included unpredictability, uncontrollability and unpleasantness, and examined whether and how these predict affective reactivity in depressed and non-depressed individuals in daily life. Participants (27 depressed, 27 non-depressed) completed a diary 3 times a day for a period of 30 days. Multilevel analyses were performed to investigate unpleasantness, uncontrollability and unpredictability of daily events as univariate predictors of negative affect (NA). Multivariable models were composed to determine the optimal combination of stress dimensions, and whether the strength of the predictions differed between the depressed and non-depressed groups. Unpleasantness, uncontrollability and unpredictability each predicted subsequent NA independently. However, a combination of all three dimensions, together with an interaction between unpleasantness and uncontrollability, predicted subsequent NA best. The stress dimensions predicted NA more strongly in the depressed than the non-depressed group. This was mostly accounted for by an increased NA response to unpleasantness. Thus, unpleasantness seems to be the most important aspect of daily stress to distinguish depressed from non-depressed individuals. Nevertheless, for a comprehensive assessment of affective reactivity, a multidimensional model of event stressfulness is recommended.

Development and change in attachment: A multiwave assessment of attachment and its correlates across childhood and adolescence

This research examines the contextual factors that facilitate development and change in attachment during later childhood, adolescence, and early adulthood using a longitudinal cohort design involving 690 children (7-19 years old) and their parents. At each wave, a variety of interpersonal variables (e.g., parent-child stress) were measured. We examined alternative developmental processes (i.e., long-term, catalytic, and short-term processes) that have not been previously distinguished in attachment research. Preregistered analyses revealed that nondevelopmental processes can explain the associations between almost all of the interpersonal variables of interest and attachment security, suggesting that previous research using traditional longitudinal methods may have misattributed nondevelopmental processes for developmental ones. For example, we found that friendship quality, although prospectively associated with attachment both in prior work and in the current study, was not developmentally associated with attachment. However, after controlling for nondevelopmental sources of covariation, we identified a number of developmental processes that may help explain change in attachment. For example, we found that initial levels of parental depression, as well as growth in parent-child stress, were related to growth in adolescent insecurity over 3 years. We also examined 12 genetic variants studied in previous research and found that they were not related to average levels or changes in attachment. These results highlight how distinguishing unique kinds of developmental processes allows for a more comprehensive understanding of attachment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice

Background

Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed.

Objectives

(1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting.

Method

A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised.

Results

6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice.

Conclusions

These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.

Implementation of a Mindfulness Intervention for Women in Treatment for Opioid Use Disorder and Its Effects on Depression Symptoms

Background: Many women in treatment for opioid use disorder (OUD) also experience mental health co-morbidities. Mindfulness intervention has demonstrated effectiveness for improving mental health in the general population, but has not been tested with female populations in OUD treatment. The purpose of this study was to describe characteristics associated with participation in a mindfulness intervention provided to women in treatment for OUD, and also to evaluate the effectiveness of a mindfulness intervention on depression symptoms. Aims: To evaluate participation characteristics associated with a mindfulness intervention and to assess the impact of a mindfulness intervention on depression symptoms for women with OUD. Methods: A secondary data analysis of a mindfulness intervention with women in treatment for OUD was accomplished. Bivariate analysis was conducted to determine any sociodemographic variables associated with intervention participation. Depression scores were assessed pre and post intervention using paired samples t tests for the intervention group (n = 65) and the control group (n = 8). Results: A 45% of women in the study reported moderate to severe depression symptoms at baseline, and 63% reported high levels of childhood trauma. There was a significant decrease in depression scores (M = 3.6 [1.2,6.1]) following the mindfulness intervention for the intervention group (t(64) = 3.1, p = .003). Participants entering the intervention group with moderate to severe depression scores experienced the most significant decrease in depression symptoms (M = 6.6, SD = 13.5), (t(64) = -2.1, p < .05). Conclusions: Women in treatment for OUD experience high levels of depression symptoms and past trauma, and mindfulness is a feasible intervention for OUD populations which may improve depression symptoms.

Relationship Between Sleep Apnea and Coronary Artery Calcium in Patients With Ischemic Stroke

Study Objectives: Coronary artery disease is considered to be the major cause of death amongst patients with ischemic stroke. The coronary artery calcium (CAC) score is related not only to sleep-disordered breathing, but also with future risk of cardiovascular mortality. We investigated the association between the severity of sleep-disordered breathing and CAC score in patients with ischemic stroke.

Methods: We included 32 patients who underwent coronary multichannel computed tomography and polysomnography (within 2 years of the stroke event) amongst the patients admitted to our clinic due to acute ischemic stroke. We investigated vascular risk factors, polysomnography findings, and sleep questionnaire scores, and their relationships with the CAC score.

Results: All patients were found to have sleep apnea of any degree, and 23 (72%) had severe sleep apnea. Twenty-three (72%) patients had a positive CAC score. Higher CAC scores were associated with elevated respiratory disturbance index (RDI), apnea index, oxygen desaturation index, and STOP-BANG test scores. Multivariate analysis after adjusting for potential confounding factors revealed independent relationships between the CAC score and the RDI (ß [SE] = 5.3 [2.1], p = 0.01), oxygen desaturation index (ß [SE] = 6.8 [2.8], p = 0.02), and STOP-BANG test score (ß [SE] = 90.3 [37.7], p = 0.02).

Conclusion: Our findings indicate a relationship between coronary atherosclerotic burden measured by the CAC score and the severity of sleep apnea. Performing polysomnography could be useful for investigating the severity of hidden coronary artery disease among these patients.

A comprehensive analysis of the factor structure of the Beck Depression Inventory-II in a sample of outpatients with adjustment disorder and depressive episode

OBJECTIVES

Despite being commonly used in research and clinical practice, the evidence regarding the factor structure of the Beck Depression Inventory-II (BDI-II) remains equivocal and this has implications on how the scale scores should be aggregated. Researchers continue to debate whether the BDI-II is best viewed as a unidimensional scale, or whether specific subscales have utility. The present study sought to test a comprehensive range of competing factor analytic models of the BDI-II, including traditional non-hierarchical multidimensional models and confirmatory bifactor models.

METHOD

Participants (n=370) were clinical outpatients diagnosed with either depressive episode or adjustment disorder. Confirmatory factor analysis and confirmatory bifactor modelling were used to test 15 competing models. The unidimensionality of the best fitting model was assessed using three strength indices (explained common variance, percentage of uncontaminated correlations and ω hierarchical).

RESULTS

Overall, bifactor solutions provided superior fit than both unidimensional and non-hierarchical multidimensional models. The best fitting model consisted of a general depression factor and three specific factors: cognitive, somatic and affective. High factor loadings and strength indices for the general depression factor supported the view that the BDI-II measures a single latent construct.

CONCLUSIONS

The BDI-II should primarily be viewed as a unidimensional scale, and should be scored as such. Although it is not recommended that scores on individual subscales are used in isolation, they may prove useful in clinical assessment and/or treatment planning if used in conjunction with total scores.

Changes in posttraumatic stress disorder (PTSD) and depressive symptoms over the course of prolonged exposure

OBJECTIVE

Prior studies of prolonged exposure therapy (PE) suggested that reduction of posttraumatic stress disorder (PTSD) precedes reduction in depression, yet no research has collapsed data across multiple studies to examine whether the directionality of reduction remains consistent in larger and diagnostically diverse samples. Thus, the objective of this study is to conduct an evaluation of bidirectional associations between PTSD and depression in PE.

METHOD

Participants (n = 216) from three randomized controlled trials of PE alone, PE + alcohol use disorder treatment, and PE + nicotine use disorder treatment completed weekly PTSD and depression severity measures. First, we analyzed the directional relationship between PTSD and depression over time in 2 single models to separately examine the effects of PTSD on depression and vice versa. Second, we analyzed a combined model to examine the simultaneous effects of reduction in PTSD on reduction in depression over and above the effects of reduction in depression on reduction in PTSD, and vice versa.

RESULTS

Two single models suggested that reductions in PTSD lead to reductions in depression and vice versa. The combined models suggested that both directions of change are important and reciprocal. The strength of predictive power from PTSD to depression, and vice versa, is approximately equal. Most significant prediction of PTSD from depression and vice versa occurred early in treatment.

CONCLUSION

The relationship between reductions in PTSD and depression during PE is transactional. Regardless of whether PTSD or depression decreases first, reduction in the other symptom cluster is likely to follow. (PsycINFO Database Record

Self-Help for Social Anxiety: Randomized Controlled Trial Comparing a Mindfulness and Acceptance-Based Approach With a Control Group

There are many barriers to the delivery of evidence-based treatment, including geographical location, cost, and stigma. Self-help may address some of these factors but there is a paucity of research on the efficacy of self-help for many problems, including social anxiety. The present research evaluated the efficacy of a mindfulness and acceptance-based self-help approach for the treatment of social anxiety. Individuals seeking help for social anxiety or shyness were recruited from the community. Participants (N = 117) were randomly assigned to a book (n = 58) or wait-list control condition (n = 59) on a 1:1 ratio. Hierarchical linear modelling results supported the efficacy of the self-help condition with between-group effect sizes on social anxiety outcomes ranging from .74 to .79. Significant change was also observed on self-compassion, mindfulness, acceptance, and depression. Some variables, including social anxiety and acceptance, were assessed weekly for those in the book condition. Additional participants (n = 35) were recruited for the book condition increasing the sample size to 93 for the latent change score modelling analyses. A unidirectional model was supported: increases in acceptance were associated with subsequent decreases in social anxiety. Overall these results support the use of a mindfulness and acceptance-based self-help approach for social anxiety.

Ethnic Differences in the Association of Depressive Symptoms with Clinical Outcome in Dialysis Patients

BACKGROUND

Studies show mixed results on the association between depressive symptoms and adverse clinical outcomes in patients on dialysis therapy. Ethnicity may play a role in these heterogeneous results. No studies have investigated the interplay between ethnicity and depressive symptoms on clinical outcome in this patient population. This study aims to examine interaction between ethnicity and depressive symptoms on hospitalization and mortality in dialysis patients.

METHODS

A multi-ethnic cohort in 10 dialysis centers included 687 dialysis patients between 2012 and 2017, with an average follow-up of 3.2 years. Depressive symptoms were measured using the Beck Depression Inventory. Interaction was assessed by investigating excess risk on an additive scale using both absolute rates and relative risks. Multivariable regression models included demographic, social, and clinical variables.

RESULTS

Adverse outcomes are more pronounced in native patients, compared to immigrant patients. The risk for mortality and hospitalization is considerably higher in native patients compared to immigrants. An excess risk on an additive scale indicates the presence of possible causal interaction.

CONCLUSIONS

Depressive symptoms are a risk factor for hospitalization and mortality, especially in native dialysis patients. Adverse clinical events associated with depressive symptoms differ among ethnic groups. This differential association could play a role in the conflicting findings in literature. Ethnicity is an important factor when investigating depressive symptoms and clinical outcome in dialysis patients. Future research should focus on the possible mechanisms and pathways involved in these differential associations.

Is countertransference a valid source of clinical information? Investigating emotional responses to audiotaped psychotherapy sessions

The study aimed to test whether countertransference reactions contain valid information about the patient. The authors examined whether a significant part of the variance in emotional, cognitive, and motivational responses to recorded therapy sessions is attributable to the patient. Six student raters listened to 605 audiotaped sessions of 81 patients with major depression treated by 19 therapists and indicated their reactions using a modified version of the Countertransference Questionnaire. The relative amount of variance in countertransference reactions due to differences between patients, ranging from 2% to 16%, was significant for most of the countertransference dimensions. Reactions were influenced by type of treatment and severity of depression but not by comorbid personality disorder or interpersonal problems. The relative amount of variance due to differences between raters was large, averaging at 23%. The authors conclude that-albeit having a relatively low "signal-to-noise ratio"in raters without psychotherapy training-countertransference reactions contain valid clinical information.

Therapeutic alliance in inpatients with severe anorexia nervosa

OBJECTIVE

Therapeutic alliance (TA) is a relevant aspect in anorexia nervosa (AN), but data on inpatients are lacking. We aimed to evaluate the influence of motivation to change, diagnostic subtypes, and duration of illness on TA at hospital discharge; we also investigated if baseline clinical characteristics were associated with discharge TA, and the TA-outcome association.

METHOD

We enrolled 137 adult inpatients with AN completing Eating Disorder Examination-Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Anorexia Nervosa Stages of Change-Questionnaire, EuroQoL-Quality of Life Scale-Visual Analogue Scale, and Working Alliance Inventory-Short Revised.

RESULTS

Patients with different AN subtypes and duration of illness reported similar TA. Baseline depression, state anxiety, and motivation to change were statistically significantly associated with TA at discharge. After controlling for all these variables and duration of illness, only motivation to change remained statistically significant. Statistically significant correlations were also found between improvements in body mass index and quality of life and discharge TA.

CONCLUSIONS

Few data exist on TA in inpatients with AN and a long duration of illness. Our findings suggest that baseline motivation to change correlates with TA at discharge independently of other variables. Future studies should ascertain as to whether a causal link exists or not.

Psychosocial factors associated with treatment outcomes in women with obesity and major depressive disorder who received behavioral activation for depression

Behavioral activation is an empirically supported treatment for depression, but much is unknown about factors associated with treatment response. The present study aimed to determine whether baseline levels and subsequent changes in psychosocial factors were associated with improvement in depression in women with comorbid obesity who received behavioral activation treatment for depression and a lifestyle intervention. Multilevel modeling was used to estimate the associations between psychosocial factors and change in depression scores during the first 10 weeks of treatment and associations between changes in psychosocial factors from baseline to 6-month follow-up and change in depression over the same time period. No baseline psychosocial factors were associated with depression improvement during treatment (p = 0.110-0.613). However, greater improvement in hedonic capacity (p = 0.001), environmental reward (p = 0.004), and social impairment (p = 0.012) were associated with greater reductions in depression over 6 months. Findings highlight the differential relationship specific psychosocial factors have with depression treatment outcomes.

Association between illness perception and health-related quality of life in patients with preexisting premature coronary artery disease

OBJECTIVES

Illness perception in younger age differs from that in older age. We aimed to examine the association between illness perception and health-related quality of life (HRQoL) in patients with premature coronary artery disease (CAD).

METHODS

In a cross-sectional design, between November 2016 and September 2017, a total of 779 adults (52.5% female) with premature CAD (diagnosed in men aged ≤ 45 y and women aged ≤ 55 y) completed the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Brief Illness Perception, and the Short-Form Health Survey 36 questionnaires in an outpatient clinic 8 years after the diagnosis.

RESULTS

The patients were treated with coronary artery bypass graft surgery (24.6%), percutaneous coronary intervention (39.5%), and medical treatment (35.8%). The cognitive, emotional, and comprehension aspects of illness perception had significant associations with both physical and mental health in univariable analysis (all Ps < 0.001). After adjustments for potential confounding factors, higher cognitive perception was independently associated with greater physical health [OR = 4.13, Confidence interval (CI): 3.53-4.72] and mental health (OR = 3.17, CI: 2.57-3.77). Additionally, emotional perception was also directly associated with higher physical (OR = 1.62, CI: 1.17-2.06) and mental (OR = 1.52, CI: 1.07-1.96) health; all Ps < 0.001.

CONCLUSIONS

Of the 3 different aspects of illness perception, cognitive perception appeared to have the greatest influence on HRQoL, either physical or mental health. Further studies are needed to investigate whether cognitive interventions can improve HRQoL in premature CAD patients and, thus, their outcome.

Irrational Beliefs, Cognitive Distortions, and Depressive Symptomatology in a College-Age Sample: A Mediational Analysis

Dysfunctional cognitions such as irrational beliefs (IBs) of Ellis' rational emotive behavior therapy (REBT) model and cognitive distortions (CDs) or cognitive errors from Beck's cognitive behavioral therapy (CBT) model are known to correlate with depressive symptomatology. However, most studies focus on one cognitive theoretical model in predicting psychopathology. The current study examined the relationship between both IBs and CDs in predicting depression. A college-age sample of 507 participants completed the Attitudes and Beliefs Scale-2, the Cognitive Distortions Scale, and the Beck Depression Inventory-II. Half of the sample showed minimal depression, while the remaining sample exhibited mild-moderate (37.4%) to severe (11.1%) depression symptomatology. Through regression analyses, the study aimed to examine whether IBs accounted for more of the variance in depression symptomatology after the effects of CDs were considered. Moreover, it tested whether CDs served as a moderator or mediator between IBs and depression. Each of Ellis' IBs (demandingness, awfulizing, self-downing, and low frustration tolerance) accounted for significantly more variance in depression after the variance of CDs was entered with the IB of self-downing explaining the most variance in depression severity. Moreover, while no moderation effect was found, CDs partially mediated the effect of IBs on depression. Both IBs and CDs contributed unique variance in predicting depression. Findings support the clinical notion that IBs and CDs are associated as well as highlight the clinical utility of both conceptualizations of dysfunctional cognitions in explaining depressive symptomatology. Clinicians might consider that each dysfunctional cognition might not be subject to change if not directly targeted. Rather than choosing to focus exclusively on IBs or CDs underlying negative automatic thoughts, psychotherapeutic efforts might benefit from identifying and challenging both types of dysfunctional cognitions.

Group exposure and response prevention for college students with social anxiety: A randomized clinical trial

OBJECTIVE

Social anxiety increases college student drop-out risk and stifles employment opportunities. Group cognitive-behavioral therapy with exposure (CBT ERP) has the potential to alleviate campus resource strain but remains under-researched with college students. The present study investigated the efficacy of group CBT ERP in a randomized clinical trial on a college campus.

METHOD

Thirty-one postsecondary students were randomly assigned to an exposure-only group or an active control.

RESULTS

Linear mixed-effects models indicated significant Group × Time interactions for general social anxiety (t = -2.02, g = 0.62) and depression (t = -2.77, g = 0.55); nonsignificant main effects were found for group and time variables. On a measure of fear of negative evaluation, only the main effect of time was significant (t = 2.15, p = 0.032).

CONCLUSIONS

When compared to an active control group, CBT ERP is an efficacious and time-effective treatment for college students experiencing social anxiety.

Mindfulness dispositions and defense style as positive responses to psychological distress in oncology professionals

PURPOSE

Working in oncology departments is a stressful and emotionally consuming experience and oncology professionals are particularly at risk for developing stress-related syndromes. Defense mechanisms (high-adaptive) and mindfulness dispositions are known as facilitators of well-being and adaptation. In this study we analysed the role of these unconscious and conscious strategies in protecting the oncology clinicians from stress-related symptoms.

METHOD

A convenience sample of 63 oncology professionals was assessed on defense style, mindfulness disposition, depression and anxiety symptoms using self-reported questionnaires. Demographic and professional information was included in data collection.

RESULTS

Results did not show significance differences in demographic and professional characteristics among all studied variables. Mature defense style and mindfulness were highly and negatively correlated with depression and anxiety, while a positive association was found between immature defense style and both depression and anxiety symptoms. Hierarchical multiple regression analyses found defense styles and mindfulness as predictors of depression, whereas only immature defense style predicted anxiety.

CONCLUSIONS

The present study provides the first empirical evidence of the influence of unconscious defense mechanisms and conscious mindfulness dispositions in protecting oncology professionals from depression and anxiety symptoms. Defense mechanisms and mindfulness share several common-points and should be seen as complementary in enhancing physical and psychological well-being. Further studies are required for a deeper understanding of the impact of mindfulness and defenses in improving adaptation.

Motor, cognitive and behavioral differences in MDS PSP phenotypes

INTRODUCTION

Movement Disorder Society (MDS) new diagnostic criteria for Progressive Supranuclear palsy (PSP) identifying different disease phenotypes were recently released. The aim of the present study is to report on the cognitive and behavioral features of the different phenotypes diagnosed according to the MDS criteria.

METHODS

Forty-nine PSP patients underwent an extensive battery of clinical assessments. Differences between PSP subtypes were computed with χ² or ANOVA tests. Using the z scores, subjects were classified as having normal cognition, mild cognitive impairment, single or multiple domain, and dementia. A logistic regression model was implemented to investigate the major determinants of PSP non-Richardson's syndrome phenotype.

RESULTS

Half of the cohort presented Richardson's syndrome (46.9%), followed by PSP with parkinsonism and corticobasal syndrome (22.4% and 14.2%, respectively). Richardson's syndrome and PSP with corticobasal syndrome presented a similar burden of disease. The only cognitive testing differentiating the phenotypes were semantic fluency and ideomotor apraxia. The majority of our cohort was either affected by dementia or presented normal cognition. Richardson's syndrome presented the highest rate of dementia. The only marker of PSP non-Richardson's syndrome phenotype was better performance in visuo-spatial testing, implying worse visuo-spatial abilities in PSP Richardson's syndrome.

CONCLUSION

Available clinical assessments hardly capture differences between PSP phenotypes. The cognitive testing differentiating the PSP phenotypes were semantic fluency and ideomotor apraxia. In PSP, mild cognitive impairment likely represents an intermediate step from normal cognition to dementia. The only marker of PSP non-Richardson's syndrome phenotype was better performance in visuo-spatial testing.

Reproductive needs of PLHIV in Jamaica: relationship between fertility desire, motives and depression

Background/objective: Advances in antiretroviral therapy and assisted reproduction technology which allow for longer and healthier lives and safer conception options necessitate a new understanding of the sexual and reproductive needs of persons living with HIV (PLHIV). This study examines fertility desire and motives for having children among PLHIV in Jamaica and explores the association with depressive symptoms.Methods: In a cross-sectional study, 251 PLHIV in their reproductive years voluntarily completed an interviewer-administered questionnaire. SPSS analyses involved bivariate and logistic regression models significant at p < .05.Results: A desire to have children was expressed by 66% (n = 166), mostly males and persons younger than 40 years. Of those in a current relationship (n = 126), not having previous children best predicted fertility desire (p = .001; CI 0.04-0.44) as well as motives to conceive (p = .02; CI 0.01-0.66). PLHIVs in their reproductive years who are at depression risk are those in a sero-discordant relationship (p = .01; CI 1.48-30.22) and who have been diagnosed between 1 and 4 years (p = .05; CI 0.01-1.04).Conclusions: HIV status does not dampen the desire to have future children. There is need to evaluate the sexual, reproductive and mental health needs of PLHIV.

Role of cerebral hypoperfusion in multiple sclerosis (ROCHIMS): study protocol for a proof-of-concept randomized controlled trial with bosentan

Background

Axonal degeneration is related to long-term disability in patients with multiple sclerosis (MS). The underlying mechanism remains ill understood but appears to involve axonal energetic dysfunction. A globally impaired cerebral blood flow (CBF) has been observed in the normal-appearing white matter (NAWM) of patients with MS, which is probably related to astrocytic overexpression of endothelin-1 (ET-1). Cerebral hypoperfusion has been associated with reduced mitochondrial activity and disabling symptoms (e.g. fatigue and cognitive decline) of MS. Countering this process could therefore be beneficial in the disease course. Short-term CBF restoration with a single 62.5-mg dose of the ET-1 receptor antagonist bosentan has already been demonstrated in patients with MS.

Methods

The ROCHIMS study is a proof-of-concept double-blind randomized clinical trial in which patients with relapsing-remitting MS will receive either 62.5 mg bosentan or matching placebo twice daily during 28 ± 2 days. Clinical evaluation and brain magnetic resonance imaging (MRI) will be performed at baseline and treatment termination. Based on previous work, we expect a global increase of CBF in the individuals treated with bosentan. The primary outcome measure is the change of N-acetyl aspartate in centrum semiovale NAWM, which is a marker of regional axonal mitochondrial activity. Other parameters of interest include changes in fatigue, cognition, motor function, depression, and brain volume.

Discussion

We hypothesize that restoring cerebral hypoperfusion in MS patients improves axonal metabolism.

Early positive effects on fatigue and cognitive dysfunction related to MS might additionally be detected. There is a medical need for drugs that can slow down the progressive axonal degeneration in MS, making this an important topic of interest.

Trial registration

Clinical Trials Register, EudraCT 2017-001253-13. Registered on 15 February 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3252-4) contains supplementary material, which is available to authorized users.

Improvement of quality of life and mental health in patients with spasmodic torticollis after microvascular decompression

OBJECTIVE

Although not life threatening, spasmodic torticollis (ST) impairs patients' daily activity, socialization and work. The aim of this study was to evaluate the quality of life (QOL) and mental health in patients with ST after microvascular decompression (MVD).

PATIENTS AND METHODS

From June 2014 to June 2017, patients with ST who underwent MVD in our department were included in this study. Toronto Western Sparse Torticollis Rating Scale (TWSTRS) were used to evaluate the ST symptoms. Quality of life was assessed by the craniocervical dystonia questionnaire (CDQ-24). Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI) were used to evaluate the mental health. Intraoperative findings and follow-up results were analyzed.

RESULTS

A total of 104 consecutive patients were enrolled in this study. At the 12 months follow-up, the total effective rate was 81.73%. After MVD surgery, 88(84.62%) ST patients experienced QOL improvement. The severity of ST symptoms was positively correlated with the CDQ-24 score(r = 0.31, P = 0.02). Forty-eight patients (46.16%) with ST have moderate to severe depression and nine (8.65%) have depression preoperatively. Pain and disability domains of TWSTRS were found have high relation with BDI-II score(r = 0.27, P = 0.02; r = 0.33, P = 0.03). There was a positive correlation of educational levels with the BDI-II scores(r = 0.45, P = 0.02).

CONCLUSION

ST affects patients' QOL both physically and mentally. MVD for ST not only provides high spasm-relief rate but also leads to significantly higher QOL after surgery. Not only ST symptoms, but also psychiatric status of patients should be routinely followed. Psychological care and psychopharmaceuticals should also be considered for these patients.

Measurement invariance of depression symptom ratings across African American, Hispanic/Latino, and Caucasian adolescent psychiatric inpatients

The Beck Depression Inventory-II (BDI-II) is widely used to assess adolescent depressive symptom severity. Psychometric investigations, including factor-analytic studies, with adolescents support the reliability and validity of the BDI-II. However, a major limitation of this research is that samples have been predominantly Caucasian/White. This is critical because depressive illness is highly prevalent across race and ethnicity, and the extent to which reliability and findings generalize to non-Caucasian populations is in question. The present study recruited African American/Black (n = 96), Hispanic/Latino(a) (n = 151), and Caucasian/White (n = 97) adolescent psychiatric inpatients (Mage = 14.73) to test the measurement invariance of the BDI-II, using Osman and colleagues' two-factor solution while also assessing within-group reliability and concurrent validity by examining associations with other symptom measures. Across groups, the two-factor solution, factor loadings, and indicator thresholds were invariant. Within-group reliability estimates were adequate, and the concurrent validity was supported. This suggests BDI-II symptom comparisons between African American/Black, Hispanic/Latino(a), and Caucasian/White adolescent inpatients are valid. Critical extensions of this work may include the examination of potential invariance across depressive symptom clusters via network analysis and invariance testing of depression symptom ratings over time in ethnoracially diverse children and adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea

BACKGROUND/OBJECTIVES

Obstructive sleep apnea (OSA) has been linked to an increased risk for Alzheimer's disease (AD), but little prospective evidence exists on the effects of OSA treatment in preclinical AD. The objective was to determine if continuous positive airway pressure (CPAP) treatment adherence, controlling for baseline differences, predicts cognitive and everyday function after 1 year in older adults with mild cognitive impairment (MCI) and to determine effect sizes for a larger trial.

DESIGN

Quasi-experimental pilot clinical trial with CPAP adherence defined as CPAP use 4 hours or more per night over 1 year.

SETTING

Sleep and geriatric clinics and community.

PARTICIPANTS

Older adults, aged 55 to 89 years, with an apnea-hypopnea index of 10 or higher participated: (1) MCI, OSA, and CPAP adherent (MCI +CPAP), n = 29; and (2) MCI, OSA, CPAP nonadherent (MCI -CPAP), n = 25.

INTERVENTION

CPAP.

MEASUREMENTS

The primary cognitive outcome was memory (Hopkins Verbal Learning Test-Revised), and the secondary cognitive outcome was psychomotor/cognitive processing speed (Digit Symbol subtest from the Wechsler Adult Intelligence Scale Substitution Test). Secondary function and progression measures were the Everyday Cognition, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, and Clinical Dementia Rating.

RESULTS

Statistically significant improvements in psychomotor/cognitive processing speed in the MCI +CPAP group vs the MCI -CPAP group were observed at 1 year after adjustment for age, race, and marital status (parameter estimate = 1.68; standard error = 0.47; 95% confidence interval = 0.73-2.62), with a 6-month effect size (ES) of 0.46 and a 1-year ES of 1.25. There were small to moderate ESs for memory (ES 0.20, 6 mo), attention (ES 0.25, 1 y), daytime sleepiness (ES 0.33, 6 mo and ES 0.22, 1 y), and everyday function (ES 0.50, 6 mo) favoring the MCI +CPAP group vs the MCI -CPAP group.

CONCLUSION

Controlling for baseline differences, 1 year of CPAP adherence in MCI +OSA significantly improved cognition, compared with a nonadherent control group, and may slow the trajectory of cognitive decline.

TRIAL REGISTRATION NUMBER

Memories; NCT01482351; https://clinicaltrials.gov/ct2/show/NCT01482351?cond=MCI+and+OSA&rank=1 J Am Geriatr Soc 67:558-564, 2019.

Measuring depressive symptoms during adolescence: what is the role of gender?

AIMS

The higher prevalence of depressive symptoms among females is well recognised but the reasons for this gender difference are not fully understood. There is growing evidence that current diagnostic criteria and instruments used to assess depression are less sensitive to depression in men, but studies about this issue among adolescents are scarce, especially in Latin countries. Our aim was to assess sex differences in the intensity of depressive symptoms, measured using the Beck Depression Inventory second edition (BDI-II), among Portuguese adolescents, at 13 and 17 years of age.

METHODS

Urban adolescents born in 1990 and enrolled in schools of Porto, Portugal, in 2003-2004 (EPITeen study) completed the BDI-II at 13 and 17 years of age. The final sample included 1988 (52.2% girls) and 2131 (53.0% girls) adolescents at 13 and 17 years, respectively. Sex differences in the frequency of endorsing the statements on the 21 items of the BDI-II were examined using the χ2 test and effect sizes were estimated (Cohen's w). To examine whether responses were linked systematically to sex, we used a differential item functioning (DIF), based on the logistic regression approach. Option characteristic curves were estimated for items with differential endorsement and a new BDI-II score was computed excluding those items.

RESULTS

Girls and boys at the same level of depression expressed similar severity ratings for most of the depressive symptoms. We had four items with DIF at 13 and 17 years of age. At 13 years, two items provided lower scores (sadness and crying items) and two higher scores (punishment feelings and loss of interest in sex items) among boys, comparing with equally depressed girls. At 17 years, the four items with DIF provided lower scores among boys (sadness, crying, self-dislike and tiredness or fatigue items). After excluding these items the prevalence of depression remained higher among girls but at 17 years the difference between sexes was attenuated.

CONCLUSIONS

Sex differences were found in the functioning of the BDI-II, more relevant at 17 years of age, which may lead to an overestimation of symptoms among girls as well as to lower reported rates of depression among boys. For a higher diagnostic accuracy it is important that the criteria and instruments used to assess depression adequately reflect female and male common symptoms and experiences of depression.

The Efficacy of Adapted MBCT on Core Symptoms and Executive Functioning in Adults With ADHD: A Preliminary Randomized Controlled Trial

OBJECTIVE

The aim of this study was to examine the effectiveness of mindfulness as a treatment for adults diagnosed with ADHD. A 12-week-adapted mindfulness-based cognitive therapy (MBCT) program is compared with a waiting list (WL) group.

METHOD

Adults with ADHD were randomly allocated to MBCT ( n = 55) or waitlist ( n = 48). Outcome measures included investigator-rated ADHD symptoms (primary), self-reported ADHD symptoms, executive functioning, depressive and anxiety symptoms, patient functioning, and mindfulness skills.

RESULTS

MBCT resulted in a significant reduction of ADHD symptoms, both investigator-rated and self-reported, based on per-protocol and intention-to-treat analyses. Significant improvements in executive functioning and mindfulness skills were found. Additional analyses suggested that the efficacy of MBCT in reducing ADHD symptoms and improving executive functioning is partially mediated by an increase in the mindfulness skill "Act With Awareness." No improvements were observed for depressive and anxiety symptoms, and patient functioning.

CONCLUSION

This study provides preliminary support for the effectiveness of MBCT for adults with ADHD.

The transportability of Memory Specificity Training (MeST): adapting an intervention derived from experimental psychology to routine clinical practices

Background

Accumulating evidence shows that a cognitive factor associated with a worsening of depressive symptoms amongst people with and without diagnoses of depression – reduced Autobiographical Memory (rAMS) – can be ameliorated by a group cognitive training protocol referred to as Memory Specificity Training (MeST). When transporting interventions such as MeST from research to routine clinical practices (RCPs), modifications are inevitable, with potentially a decrease in effectiveness, so called voltage drop. We examined the transportability of MeST to RCPs as an add-on to treatment as usual with depressed in- and out- patients.

Methods

We examined whether 1) MeST was adaptable to local needs of RCPs by implementing MeST in a joint decision-making process in seven Belgian RCPs 2) without losing its effect on rAMS. The effectiveness of MeST was measured by pre- and post- intervention measurements of memory specificity.

Results

Adaptations were made to the MeST protocol to optimize the fit with RCPs. Local needs of RCPs were met by dismantling MeST into different subparts. By dismantling it in this way, we were able to address several challenges raised by clinicians. In particular, multidisciplinary teams could divide the workload across different team members and, for the open version of MeST, the intervention could be offered continuously with tailored dosing per patient. Both closed and open versions of MeST, with or without peripheral components, and delivered by health professionals with different backgrounds, resulted in a significant increase in memory specificity for depressed in- and out- patients in RCPs.

Conclusions

MeST is shown to be a transportable and adaptable add-on intervention which effectively maintains its core mechanism when delivered in RCPs.

Trial registration

ISRCTN registry, IDISRCTN10144349, registered on January 22, 2019. Retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s40359-019-0279-y) contains supplementary material, which is available to authorized users.