Gut microbiota and major depressive disorder: A systematic review and meta-analysis

BACKGROUND

Growing attention has been paid to the field of gut microbiota for mental disorders over the last decade. However, to our knowledge, no studies have conducted systematic reviews on the association between gut microbiota and major depressive disorder (MDD) in both interventional and non-interventional studies.

METHODS

We conducted a systematic review and meta-analysis of 16 studies (10 observational [701 participants] and six interventional trials [302 participants]) examining gut microbiota in patients with MDD. The primary outcome measures were differences in the profile of microbiota in the observational studies, and symptom changes for depression between pre- and post-intervention with probiotics in the interventional trials.

RESULTS

In the observational studies, significant reductions in several taxa at the family and genus levels were observed in patients with MDD compared to non-depressed controls. In the interventional studies with probiotics, a significant improvement was found in depressive symptomatology compared to controls (SMD = -1.62, 95% CI = -2.73 to -0.51, p< 0.01).

LIMITATIONS

Lack of consideration of the effects of diet and pharmacotherapy was a possible limitation.

CONCLUSIONS

Our results indicate that several taxa at the family and genus levels, specifically family Prevotellaceae, genus Corprococcus, and Faecalibacterium, were decreased in MDD compared to non-depressed controls in observational studies, and depressive symptoms were improved compared to controls in interventional studies with probiotics. Due to the limited number of studies, further studies considering diet and pharmacotherapy are needed to explore the relationships between gut microbiota and MDD in humans.

Depressive symptoms mediate the relationship between sleep disturbances and type 2 diabetes mellitus

BACKGROUND

The current study aimed at examining whether individuals diagnosed with type 2 diabetes mellitus (T2DM) have more severe sleep disturbances compared to individuals who are healthy or have prediabetes and whether depressive symptoms mediate the relationship between sleep disturbances and having T2DM.

METHODS

T2DM patients (n = 107) were compared to individuals with prediabetes (n = 48) and healthy individuals (n = 154) regarding the severity of depressive symptoms, measured via the Beck Depression Inventory-II (BDI-II), and sleep disturbances, measured via the Mini Sleep Questionnaire (MSQ). Mediation analysis examined whether depressive symptoms mediated the relationship between sleep disturbances and T2DM.

RESULTS

Compared to healthy individuals and individuals with prediabetes, T2DM patients had more depressive symptoms and higher levels of insomnia, hypersomnia, and overall more sleep disturbances. The prediabetes group did not differ from the healthy control group on these measures, and these groups were thus combined for further analysis. Sleep disturbances were correlated with severity of depressive symptoms (r =0.43). After controlling for age, gender, and ethnic background, both severity of sleep disturbances (odds ratio [OR]: 1.04; 95% CI: 1.01-1.07, P <.001) and severity of depressive symptoms (OR: 8.54, 95% CI: 3.37-21.69, P <.001) predicted T2DM. Depression symptoms mediated the relationship between sleep disturbances and T2DM, whereas the direct relationship between sleep disturbances and T2DM was nonsignificant.

CONCLUSIONS

The findings imply that sleep disturbances may contribute to the development and progression of T2DM by promoting depressive symptoms. Thus, treatments for the emotional distress associated with sleep disturbances may help reduce the risk for T2DM and the progression of the disease.

Back pain and depressive symptoms: A systematic review and meta-analysis

BACKGROUND

Low back pain is a common disorder that has many consequences. This study is an attempt to meta-analyze the risk of depression symptoms in back pain.

METHOD

Four databases were selected for review, and this search was conducted using key words. Eleven eligible articles were selected for review and meta-analysis was conducted. Subgroup analyses were continued with study design and the method of measuring depression. Also, the heterogeneity and publication bias were examined.

RESULTS

Eleven cohort and cross-sectional articles are used in the meta-analysis between back pain and depressive symptoms. The odds ratio 2.07 was calculated for this relationship. In prospective-cohort studies, 1.71 (95% confidence interval = 1.24-2.36) results indicated that back pain is a risk factor for depression symptoms and in cross-sectional studies, pooled odds ratio (2.33; 95% confidence interval = 1.29-4.21) showed that back pain is associated with depression symptoms. Some degree of publication bias was not found in the study.

CONCLUSIONS

Back pain is an effective factor in increasing the likelihood of depression. Adoption of effective prevention and treatment approaches can play an important role in reducing the psychological consequences in these individuals.

CPR to the Rescue!: An Interprofessional Pilot Program: Cultivating Practices for Resilience (CPR) Camp

PURPOSE/OBJECTIVES

The hCATS (health Colleges Advancing Team Skills) to CPR (Cultivating Practices for Resilience) Camp was an interprofessional pilot program to promote resilience, introduce strategies for coping with stress, cultivate compassion, and promote work-life balance to prevent burnout among health profession students, faculty, and healthcare professionals who team to provide patient care.

PROGRAM DESCRIPTION

The University of Kentucky (UK) College of Nursing received funding to partner with the UK Center for Interprofessional Health Education for immersive weekend activities utilizing KORU and Mindfulness Based Stress Reduction models, conducted by certified UK faculty experts in self-stewardship techniques such as mindfulness practices.

OUTCOMES

Thirty-nine participants from 7 UK colleges and UK HealthCare participated in 4 distinct CPR Camps, completed program assessments, and created team projects. Mean scores from each cohort significantly increased in a retrospective pre/post analysis of student perception of knowledge in all of the following categories: (1) habits and practices for resilient people, (2) strategies for building resilience and preventing/coping with stress/burnout in self and others, and (3) work-life balance (with the exception of cohort 4, for work-life balance). Students indicated on open-response items specific strategies they were willing to adopt going forward. These outcomes met our objectives for developing participants' understanding of resilience practices and adopting useful stress reduction practices. Planning and implementation of team projects successfully brought different professions together to advance learning in resilience.

CONCLUSION

The CPR Camp initiative is an effective model for promoting and sustaining resilience-building strategies among health profession students. Similar programming conducted and/or attended by academic and/or health system leaders, such as clinical nurse specialists, can help cultivate practices for resilience among the members of the interprofessional workforce, enabling teams to better cope with stress, prevent burnout, and ultimately improve team-based care delivery for patients and their families.

The association between systemic lupus erythematosus and bipolar disorder – a big data analysis

Background:

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease that has a wide variety of physical manifestations, including neuropsychiatric features. Bipolar disorder (BD) is a chronic, episodic illness, that may present as depression or as mania. The objective of this study was to investigate the association between SLE and BD using big data analysis methods.

Methods:

Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of BD in a cross-sectional study. Chi-square and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis, adjusting for confounders. The study was performed utilizing the chronic disease registry of Clalit Health Services medical database.

Results:

The study included 5018 SLE patients and 25,090 matched controls. BD was found in a higher prevalence among SLE patients compared to controls (0.62% vs. 0.26%, respectively, P < 0.001). BD patients had a greater prevalence of smokers compared to non-BD patients (62.5% vs 23.5%, respectively, P < 0.001). In a multivariate analysis, smoking and SLE were both found to be significantly associated with BD.

Conclusions:

SLE was found to be independently associated with BD. These findings may imply that an autoimmune process affecting the central nervous system among SLE patients facilitates the expression of concomitant BD.

The prevalence of depression in patients living with implantable cardioverter defibrillator: a systematic review and meta-analysis

Depression is a common disorder in patients with implantable cardioverter defibrillator (ICD). There are a variety of studies estimated the prevalence of depression in these patients. The present study aimed to investigate the prevalence of depression in patients with ICD.

METHODS

In the present study, we conducted a systematic review of studies published in PubMed, Scopus, Web of Science (WoS), Medline, and EMBASE without any time filtration to obtain studies investigated the prevalence of depression in patients with ICD. Search terms consisted of "Implantable Cardioverter Defibrillator(s)" in combination with "depression," "depressive," "prevalence," "implanted cardioverter," "implantable," and "implantable defibrillator."

RESULTS

We identified 15 relevant studies, comprising data from 10,182 patients with ICD from whom 2400 (23.58%) (95% CI, 15.36-31.79) had depression. The results of the subgroup analysis showed that the prevalence of depression among middle-aged patients (28.58% with confidence interval of 95%, 21.51-35.65) was higher than elderly patients (22.23% with confidence interval of 95%, 11.21-33.24) and it was not significantly correlated with the mean age of samples (P = 0.255), sample size (P = 0.686), and the publication date (P = 0.784), although there was a significant correlation between the prevalence of depression and the quality of articles so that the prevalence was decreasing with an increase in the quality (P = 0.046).

CONCLUSION

Around 1 in 4 patients with ICD (23.58%) experiences depression progression after an ICD placement. This prevalence is comparable to that in the general population, and close to that of the patients with common chronic diseases.

Resting-state EEG beta band power predicts quality of life outcomes in patients with depressive disorders: A longitudinal investigation

BACKGROUND

Quality of life is severely impaired in patients with depressive disorders. Previous studies have focused on biomarkers predicting depressive symptomatology; however, studies investigating biomarkers predicting quality of life outcomes are limited. Improving quality of life is important because it is related not only to mental health but also to physical health. We need to develop a biomarker related to quality of life as a therapeutic target for patients with depressive disorders. Resting-state electroencephalography (EEG) is easy to record in clinical settings. The index of bandwidth spectral power predicts treatment response in depressive disorders and thus may be a candidate biomarker. However, no longitudinal studies have investigated whether EEG-recorded power could predict quality of life outcomes in patients with depressive disorders.

METHODS

The resting-state EEG-recorded bandwidth spectral power at baseline and the World Health Organization Quality of Life (QOL)-26 scores at 3-year follow-up were measured in 44 patients with depressive disorders.

RESULTS

The high beta band power (20-30 Hz) at baseline significantly predicted QOL at the 3-year follow-up after considering depressive symptoms and medication effects in a longitudinal investigation in patients with depressive disorders (β = 0.38, p = 0.01).

LIMITATIONS

We did not have healthy subjects as a comparison group in this study.

CONCLUSIONS

Our findings suggest that resting-state beta activity has the potential to be a useful biomarker for predicting future quality of life outcomes in patients with depressive disorders.

Psychosocial factors associated with pharmacists' antidepressant drug treatment monitoring

OBJECTIVE

Patients undergoing antidepressant drug treatment (ADT) may face challenges regarding its adverse effects, adherence, and efficacy. Community pharmacists are well positioned to manage ADT-related problems. Little is known about the factors influencing pharmacists' ADT monitoring. This study aimed to identify the psychosocial factors associated with pharmacists' intention to perform systematic ADT monitoring and report on this monitoring.

DESIGN

Cross-sectional study based on the Theory of Planned Behavior (TPB).

SETTING AND PARTICIPANTS

Community pharmacists in the province of Quebec, Canada.

OUTCOME MEASURES

Pharmacists completed a questionnaire on their performance of ADT monitoring, TPB constructs (intention; attitude; subjective norm; perceived behavioral control; and attitudinal, normative, and control beliefs), and professional identity. Systematic ADT monitoring was defined as pharmacists' reporting 4 or more consultations with each patient during the first year of ADT to address adverse effects, adherence, and efficacy. Hierarchical linear regression models were used to identify the factors associated with the intention and reporting of systematic ADT monitoring and Poisson working models to identify the beliefs associated with intention.

RESULTS

A total of 1609 pharmacists completed the questionnaire (participation = 29.6%). Systematic ADT monitoring was not widely reported (mean score = 2.0 out of 5.0), and intention was moderate (mean = 3.2). Pharmacists' intention was the sole psychosocial factor associated with reporting systematic ADT monitoring (P < 0.0001; R² = 0.370). All TPB constructs and professional identity were associated with intention (P < 0.0001; R² = 0.611). Perceived behavioral control had the strongest association.

CONCLUSION

Interventions to promote systematic ADT monitoring should focus on developing a strong intention among pharmacists, which could, in turn, influence their practice. To influence intention, priority should be given to ensuring that pharmacists feel capable of performing this monitoring. The main barriers to overcome were the presence of only 1 pharmacist at work and limited time. Other factors identified offer complementary intervention targets.

Genetic overlap between psychotic experiences in the community across age and with psychiatric disorders

This study explores the degree to which genetic influences on psychotic experiences are stable across adolescence and adulthood, and their overlap with psychiatric disorders. Genome-wide association results were obtained for adolescent psychotic experiences and negative symptom traits (N = 6297-10,098), schizotypy (N = 3967-4057) and positive psychotic experiences in adulthood (N = 116,787-117,794), schizophrenia (N = 150,064), bipolar disorder (N = 41,653), and depression (N = 173,005). Linkage disequilibrium score regression was used to estimate genetic correlations. Implicated genes from functional and gene-based analyses were compared. Mendelian randomization was performed on trait pairs with significant genetic correlations. Results indicated that subclinical auditory and visual hallucinations and delusions of persecution during adulthood were significantly genetically correlated with schizophrenia (rg = 0.27-0.67) and major depression (rg = 0.41-96) after correction for multiple testing. Auditory and visual subclinical hallucinations were highly genetically correlated (rg = 0.95). Cross-age genetic correlations for psychotic experiences were not significant. Gene mapping and association analyses revealed 14 possible genes associated with psychotic experiences that overlapped across age for psychotic experiences or between psychotic experiences and psychiatric disorders. Mendelian randomization indicated bidirectional associations between auditory and visual hallucinations in adults but did not support causal relationships between psychotic experiences and psychiatric disorders. These findings indicate that psychotic experiences in adulthood may be more linked genetically to schizophrenia and major depression than psychotic experiences in adolescence. Our study implicated specific genes that are associated with psychotic experiences across development, as well as genes shared between psychotic experiences and psychiatric disorders.

Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

How Early Life Adversity Influences Defensive Circuitry

Childhood maltreatment increases the likelihood of developing anxiety disorders in humans. Early life adversity (ELA) paradigms in rodents produce lasting increases in avoidant and inhibitory responses to both immediate and nonspecific threats, collectively referred to as defensive behaviors. This approach provides an opportunity to thoroughly investigate the underlying mechanisms, an effort that is currently under way. In this review, we consider the growing literature indicating that ELA alters the rhythmic firing of neurons in brain regions associated with defensive behavior, as well as potential neuronal, glial, and extracellular matrix contributions to functional changes in this circuitry. We also consider how ELA studies in rodents may inform us about both susceptible and resilient outcomes in humans.

Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

Optimization of food deprivation and sucrose preference test in SD rat model undergoing chronic unpredictable mild stress

BACKGROUND

The chronic unpredictable mild stress (CUMS) model has long been considered the best model for exploring the pathophysiological mechanisms underlying depression. However, there are no widely recognised standards for strategies for modeling and for behavioral testing. The present study aimed to optimize the protocols for food deprivation and the sucrose preference test (SPT) for the CUMS model.

METHODS

We first evaluated the effects of different long periods of food deprivation on the body weight of Sprague Dawley (SD) rats by testing food deprivation for 24 hours (8:00-8:00+), food deprivation for 12 hours during the daytime (8:00-20:00) and food deprivation for 12 hours at night (20:00-8:00+). Next, we established a SD rat CUMS model with 15 different stimulations, and used body weight measurement, SPT, forced swim test (FST), open field test (OFT) and Morris water maze (MWM) test to verify the success of the modeling. In the SPT, consumption of sucrose and pure water within 1 and 12 hours was measured.

RESULTS

Twelve hours of food deprivation during the daytime (8:00-20:00) had no effect on body weight, while 12 hours of food deprivation at night (20:00-8:00+) and 24 hours of food deprivation (8:00-8:00+) significantly reduced the mean body weight of the SD rats. When SPT was used to verify the successful establishment of the CUMS rat model, sucrose consumption measured within 12 hours was less variable than that measured within 1 hour.

CONCLUSIONS

Twelve hours of food deprivation in the daytime (8:00-20:00) may be considered a mild stimulus for the establishment of a CUMS rat model. Measuring sucrose consumption over 12 hours is recommended for SPT.

Immunological biomarkers in neuropsychiatric systemic lupus erythematosus: a comparative cross-sectional study from a tertiary care center in South India

INTRODUCTION

The prevalence of various immunological biomarkers in neuropsychiatric systemic lupus erythematosus (NPSLE) differs among various patients with varied neuropsychiatric manifestations and different populations. We studied the prevalence of these biomarkers; especially the neuron specific autoantibodies in patients with systemic lupus erythematosus (SLE) and compared them among patients with and without neuropsychiatric involvement.

METHODOLOGY

This is a comparative cross-sectional study conducted in a tertiary care hospital in South India. The prevalence of immunological biomarkers including complement levels, systemic and brain specific autoantibodies (anti-myelin antibody, anti-myelin oligodendrocyte glycoprotein and anti-myelin-associated glycoprotein antibody) were assessed and compared among those with and without NPSLE and with different NPSLE manifestations.

RESULTS

A total of 522 SLE patients were enrolled in the study. The mean age of the study participants was 28.5 ± 8.8 years and 93.5% were women. Neuropsychiatric manifestations were seen in 167 (32%) patients. Seizure was the most common neuropsychiatric manifestation seen in 41.3%, followed by psychosis (18.6%), mood disorder (16.8%), stroke (10.8%), mononeuropathy (10.2%), headache (9.6%), acute confusional state (6.6%) and aseptic meningitis (5.4%). Patients with NPSLE had a higher SLE disease activity index score. Most of the autoantibodies, that is anticardiolipin antibody (aCL), anti-β2 glycoprotein 1 antibody (β2GP1), lupus anticoagulant (LA), anti-nucleosome, anti-ribosomal P, anti-Ro52, anti-Ro60 and anti-La, were seen in higher proportion in the NPSLE group, although the difference failed to reach statistical significance. On subgroup analysis, psychosis was significantly higher in patients with anti-ribosomal P positivity than without (11.8% versus 4.1%, p.0.007; odds ratio (OR) 3.1, confidence interval (CI) 1.4-6.8), while stroke had a higher proportion among those with positive b2GP1 IgG (6.3% versus 1.8%, p.0.03; OR 3.6, CI 1.2-11.0). A higher proportion of demyelination was seen among the LA positive than the negative (10.3% versus 0.2%, p.0.03; OR 5.39, CI 1.15-24.17) and anti-myelin oligodendrocyte glycoprotein in mood disorder (14.3% versus 3.4%, p = 0.03; OR 4.66, CI 1.13-19.13).

CONCLUSION

No single biomarker correlated with NPSLE. Among different NPSLE manifestations, the prevalence of IgG β2GP1 in stroke, LA in demyelination, anti-ribosomal P in psychosis and anti-myelin oligodendrocyte glycoprotein in mood disorder were higher. Further studies on the pathogenic mechanisms underlying NPSLE and its different manifestations may help us to identify better biomarkers.

Nutritional Factors, Physical Health and Immigrant Status Are Associated with Anxiety Disorders among Middle-Aged and Older Adults: Findings from Baseline Data of The Canadian Longitudinal Study on Aging (CLSA)

The main purpose of this study was to compare the lifetime prevalence of anxiety disorders among foreign-born and Canadian-born adults in middle and later life. Using baseline data of the Canadian Longitudinal Study on Aging (2010–2015), multivariable binary logistic regression was conducted to investigate anxiety diagnosis and immigrant status, while controlling for socio-economic, health-related, and nutrition covariates. Of 26,991 participants (49.3% men, 82.5% Canadian born, 58.5% aged 45–65 years), the overall prevalence of self-reported physician diagnosis of anxiety disorders was 8.5%, with immigrants being lower than Canadian-born respondents (6.4% vs. 9.3%, p < 0.001). After accounting for all covariates, the adjusted odds ratio (aOR) for anxiety disorders was lower among immigrants (aOR = 0.77, 95% CI: 0.67–0.88) compared to those who were Canadian born. Identified risk factors included: younger age (aORs = 1.79–3.52), being a woman (aOR = 1.25, 95% CI: 1.07–1.46), single status (aOR = 1.27, 95% CI: 1.09–1.48), lower income (aORs = 1.28–2.68), multi-morbidities (aORs = 2.73–5.13), chronic pain (aOR = 1.31, 95% CI: 1.18–1.44), lifetime smoking ≥ 100 cigarettes (aOR = 1.35, 95% CI: 1.23–1.48), BMI < 18.5 (aOR = 1.87, 95% CI: 1.20–2.92), body fat ≥ 26% (aORs = 1.28–1.79), fruit and vegetable intake (<3/day; aORs = 1.24–1.26), and pastry consumption (>1/day; aOR = 1.55, 95% CI: 1.12–1.15) (p < 0.05). Targeting socio-economic and nutritional risk factors may reduce the burden of anxiety disorders in middle and late adulthood.

Neuropsychiatric lupus: new mechanistic insights and future treatment directions

Patients with systemic lupus erythematosus (SLE) frequently show symptoms of central nervous system (CNS) involvement, termed neuropsychiatric SLE (NPSLE). The CNS manifestations of SLE are diverse and have a broad spectrum of severity and prognostic implications. Patients with NPSLE typically present with nonspecific symptoms, such as headache and cognitive impairment, but might also experience devastating features, such as memory loss, seizures and stroke. Some features of NPSLE, in particular those related to coagulopathy, have been characterized and an evidence-based treatment algorithm is available. The cognitive and affective manifestations of NPSLE, however, remain poorly understood. Various immune effectors have been evaluated as contributors to its pathogenesis, including brain-reactive autoantibodies, cytokines and cell-mediated inflammation. Additional brain-intrinsic elements (such as resident microglia, the blood-brain barrier and other neurovascular interfaces) are important facilitators of NPSLE. As yet, however, no unifying model has been found to underlie the pathogenesis of NPSLE, suggesting that this disease has multiple contributors and perhaps several distinct aetiologies. This heterogeneity presents a challenge for clinicians who have traditionally relied on empirical judgement in choosing treatment modalities for patients with NPSLE. Improved understanding of this manifestation of SLE might yield further options for managing this disease.

Elevated expression of unfolded protein response genes in the prefrontal cortex of depressed subjects: Effect of suicide

BACKGROUND

Major Depressive Disorder (MDD) is a leading cause of mental disability worldwide. Despite many studies, the pathophysiology associated with MDD brain is not very clear. It is reported that cellular stress is related to depressive symptoms. Under stressful conditions, intracellular homeostasis processes can be disrupted, which can induce a process of unfolded protein response (UPR) in the subcellular lumen of endoplasmic reticulum (ER). The purpose of this study is to elucidate whether UPR is active in the depressed brain.

METHODS

The dorsolateral prefrontal cortex (dlPFC) was used from 23 non-psychiatric controls and 43 MDD subjects. The expression levels of UPR associated genes (GRP78, GRP94, XBP-1, CHOP, ATF4C, and ATF6C) were measured by qRT-PCR.

RESULTS

The level of mRNA expression in MDD subjects was significantly higher for GRP78 (p = 0.008), GRP94 (p = 0.018), and ATF4C (p = 0.03) compared to non-psychiatric controls. Further analysis suggested that changes in the expression of these genes were specifically higher only in those MDD subjects who died by suicide but not in those who died by causes other than suicide when compared with non-psychiatric controls (GRP78, p = 0.007; GRP94, p = 0.041; ATF4C, p = 0.037).

LIMITATIONS

This study was performed only in MDD subjects who had died by suicide. Suicide subjects with other psychiatric illnesses need to be included.

CONCLUSIONS

Given that UPR is involved in many physiological processes in the brain, including inflammatory response as well as apoptosis, increased expression of UPR genes indicates that ER stress and mediated UPR may be critical factors in suicidality among depressed patients.

Efficacy and safety of riluzole for depressive disorder: A systematic review and meta-analysis of randomized placebo-controlled trials

Glutamatergic modulators may have therapeutic potential in the treatment of depressive disorder (DD), riluzole, as a modulating drug of the glutamatergic system, its antidepressant efficacy and safety of riluzole for DD are inconsistent. This meta-analysis was performed to determine the efficacy and safety of riluzole used for DD. A systematic literature search was performed using PubMed, Embase, Cochrane Library, Web of Science, VIP and other databases from 1980 to 2019. The primary outcome was change in depression severity and meta-analysis was performed using comprehensive meta-analysis software. Seven randomized controlled trials (RCTs) were included. There was some difference in depression severity change in riluzole-citalopram therapy. No significant differences were observed in response rate, remission rate, relapse rate and adverse events, while, the relapse time in riluzole group was longer than placebo group. In this meta-analysis riluzole showed no antidepressant efficacy compared to placebo in monotherapy or riluzole-ketamine combined therapy, while it might relieve depression severity to some extent in riluzole-citalopram therapy. Furthermore, riluzole showed favorable safety for DD. The longer relapse time of riluzole group might have clinical significance to some extent, although this had no statistical difference. More studies are needed to clarify the potential association between riluzole and DD.

Predicting future onset of depression among community dwelling adults in the Republic of Korea using a machine learning algorithm

Because depression has high prevalence and cause enduring disability, it is important to predict onset of depression among community dwelling adults. In this study, we aimed to build a machine learning-based predictive model for future onset of depression. We used nationwide survey data to construct training and hold-out test set. The class imbalance was dealt with the Synthetic Minority Over-sampling Technique. A tree-based ensemble method, random forest, was used to build a predictive model. Depression was defined by 9 or more on the Center for Epidemiologic Studies - Depression Scale 11 items version. Hyperparameters were tuned throughout the 10-fold cross-validation. A total of 6,588 (6,067 of non-depression and 521 of depression) participants were included in the study. The area under receiver operating characteristics curve was 0.870. The overall accuracy, sensitivity, and specificity were 0.862, 0.730, and 0.866, respectively. Satisfactions for leisure, familial relationship, general, social relationship, and familial income had importance in building predictive model for the onset of future depression. Our study demonstrated that predicting future onset of depression by using survey data could be possible. This predictive model is expected to be used for early identification of individuals at risk for depression and secure time to intervention.

Chronic sub-anesthetic ketamine induces permanent hypolocomotion and impairment of hippocampus in adolescent cynomolgus monkeys

Ketamine has gained increasing popularity in adolescent drug abusers worldwide. However, relatively little is known about the long-term effects of recreational ketamine on adolescent hippocampus. The present study investigates the effects of different periods (1, 3 and 6 months) of recreational ketamine administration on locomotor activity and neuron damage in the hippocampus of adolescent cynomolgus monkeys. 32 4-year-old male cynomolgus monkeys were divided into control, 1-month, 3-month and 6-month groups. All animals in ketamine groups received daily intravenous injection with 1 mg/kg ketamine in saline for respective 1, 3 or 6 months while control group received normal saline. Automatic behaviors were recorded for 10 min before and after ketamine and saline administration. Meanwhile, the markers of apoptosis in the hippocampus were assessed using terminal deoxynucleotidyl transferase-mediated biotinylated dUTP nick end labeling (TUNEL), electron microscopy and western blotting. Results showed that ketamine significantly decreased locomotor activity, increased apoptotic neurons and pro-apoptotic proteins, cleaved Caspase-3 and Bax, while decreased the anti-apoptotic protein Bcl-2 in the hippocampus after 6-month ketamine administration. Our study suggested that chronically recreational ketamine might induce hypolocomotion and neurotoxic effect via apoptotic pathway in adolescent hippocampus of monkeys.

Metabolite Profiling Revealed That a Gardening Activity Program Improves Cognitive Ability Correlated with BDNF Levels and Serotonin Metabolism in the Elderly

Metabolomics is useful for evaluating the fundamental mechanisms of improvements in the health functions of the elderly. Additionally, gardening intervention as a regular physical activity for the elderly maintained and improved physical, psychology, cognitive, and social health. This study was conducted to determine whether the cognitive ability of the elderly is affected by participating in a gardening activity program as a physical activity with a metabolomic potential biomarker. The gardening program was designed as a low to moderate intensity physical activity for the elderly. Serum metabolites resulting from gardening were subjected to metabolite profiling using gas chromatography time-of-flight mass spectrometry and ultra-high-performance liquid chromatography-linear trap quadruple-orbitrap-mass spectrometry followed by multivariate analyses. The partial least squares-discriminant analysis showed distinct clustering patterns among the control, non-gardening, and gardening groups. According to the pathway analysis, tryptophan metabolism including tryptophan, kynurenine, and serotonin showed significantly distinctive metabolites in the gardening group. Brain-derived neurotrophic factor levels (BDNF) in the gardening group were significantly increased after the gardening program. Correlation map analysis showed that the relative levels of tryptophan metabolites were positively correlated with BDNF. Our results show that tryptophan, kynurenine, and serotonin may be useful as metabolic biomarkers for improved cognitive ability by the gardening intervention.

Genome Variation and Precision Medicine in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a complex autoimmune disease which is facing the difficulties in treatment. Genetics play an important role in SLE. Several studies have shown that genetic factors not only affect the development of SLE, but also affect its clinical progress. In this review article, we focus on exploring the influence of genetics on different aspects of SLE pathogenesis, clinical course, and treatment and will provide some references in further precision medicine for SLE patients. The coming era of precision medicine, SLE patients will be stratified by genetic profiling. This will enable us to make more effective and precise choices of treatment plan.

The Diagnostic Value of the Combination of Serum Brain-Derived Neurotrophic Factor and Insulin-Like Growth Factor-1 for Major Depressive Disorder Diagnosis and Treatment Efficacy

BACKGROUND

Last decades of psychiatric investigations have been marked by a search for biological markers that can clarify etiology and pathogenesis, confirm the diagnosis, screen individuals at risk, define the severity, and predict the course of mental disorders. In our study, we aimed to evaluate if BDNF and IGF-1 serum concentrations separately and in combination might be used as biomarkers for major depressive disorder (MDD) diagnosis and treatment efficacy and to evaluate the relationships among those proteins and clinical parameters of MDD.

METHODS

Forty-one MDD patients (according to DSM-5) and 32 healthy controls (HC) were included in this study. BDNF and IGF-1 serum concentrations, psychopathological (MADRS, CGI) and neuropsychological parameters (PDQ-5, RAVLT, TMT-B, DSST), functioning according to Sheehan Disability Scale were analyzed in all subjects at admission and 30 MDD patients after 8 weeks of vortioxetine treatment. Correlational analyses were performed to explore relationships between BDNF and IGF-1 and clinical characteristics. AUC-ROCs were calculated to determine if the value of serum BDNF and IGF-1 levels could serve for MDD diagnosis.

RESULTS

MDD patients had significantly lower serum BDNF (727.6 ± 87.9 pg/ml vs. 853.0 ± 93.9 pg/ml) and higher serum IGF-1 levels (289.15 ± 125.3 ng/ml vs. 170.2 ± 58.2 ng/ml) compared to HC. Significant correlations were obtained between BDNF levels and MDD status, depressive episode (DE) severity, precipitating factors, executive functions disruption (TMT-B, RAVLT immediate recall scores) and all subdomains of functioning. As for IGF-1, correlations were found between IGF-1 level and MDD status, DE severity, number and duration of DE, parameters of subjective and objective cognitive functioning (PDQ-5, RAVLT, TMT-B, DSST scores), and all subdomains of functioning. The associations between IGF-1 concentrations and cognitive tests' performance were stronger than those of BDNF. Separately both BDNF and IGF-1 demonstrated good discriminating ability for MDD diagnosis with AUC of 0.840 and 0.824, respectively. However, the combination of those neurotrophins had excellent diagnostic power to discriminate MDD patients from HC, providing an AUC of 0.916. Vortioxetine treatment significantly increased BDNF and attenuated IGF-1 serum concentrations, improved all psychopathological and neuropsychological parameters and functioning.

CONCLUSIONS

The combination of IGF-1 and BDNF might be considered as a diagnostic combination for MDD.

Preoperative psychological distress no reason to delay total knee arthroplasty: a register-based prospective cohort study of 458 patients

INTRODUCTION

Total knee arthroplasty (TKA) is effective in alleviating pain and improving function in patients with knee arthritis. Psychological factors are known to affect patient satisfaction after TKA. It is important to determine the effectiveness of TKA in patients with presurgical anxiety and/or depression to avoid excluding them from surgery.

MATERIALS AND METHODS

A prospective cohort study was conducted on all patients who underwent TKA during 2016-2018. Patients were divided into four groups: with anxiety, without anxiety, with depression, and without depression. Outcome measures comprised both generic and knee-specific instruments. Each patient group was compared regarding changes in outcome measures one year after surgery. Between-group comparison was also performed.

RESULTS

Of the 458 patients with complete data, 15.3% and 9.6% had experienced presurgical anxiety and depression, respectively. All patient groups displayed statistical (P < 0.001) and clinical improvement in all outcome measures. Patients with presurgical anxiety and/or depression generally displayed less improvement, though the only significant mean differences concerned the Knee Injury and Osteoarthritis Outcome Score (KOOS)-sport score in the non-anxiety and non-depression groups (P = 0.006 and 0.03, respectively), a higher proportion of clinically improved KOOS pain in the non-anxiety group (P = 0.03), and the general health state in the anxiety and depression groups (P = 0.004 and 0.04, respectively).

CONCLUSIONS

All patients improved in outcome measures 1 year after TKA, regardless of presurgical psychological state. Patients with presurgical anxiety and/or depression benefit greatly from surgery and should not be discriminated against based on presurgical psychological distress, though this fact should not eliminate the preoperative psychological assessment of patients.

LEVEL OF EVIDENCE

II.

Impact of the COVID-19 Pandemic on Physical and Mental Health in Lower and Upper Middle-Income Asian Countries: A Comparison Between the Philippines and China

Objective: The differences between the physical and mental health of people living in a lower-middle-income country (LMIC) and upper-middle-income country (UMIC) during the COVID-19 pandemic was unknown. This study aimed to compare the levels of psychological impact and mental health between people from the Philippines (LMIC) and China (UMIC) and correlate mental health parameters with variables relating to physical symptoms and knowledge about COVID-19. Methods: The survey collected information on demographic data, physical symptoms, contact history, and knowledge about COVID-19. The psychological impact was assessed using the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21). Findings: The study population included 849 participants from 71 cities in the Philippines and 861 participants from 159 cities in China. Filipino (LMIC) respondents reported significantly higher levels of depression, anxiety, and stress than Chinese (UMIC) during the COVID-19 (p < 0.01) while only Chinese respondents' IES-R scores were above the cut-off for PTSD symptoms. Filipino respondents were more likely to report physical symptoms resembling COVID-19 infection (p < 0.05), recent use of but with lower confidence on medical services (p < 0.01), recent direct and indirect contact with COVID (p < 0.01), concerns about family members contracting COVID-19 (p < 0.001), dissatisfaction with health information (p < 0.001). In contrast, Chinese respondents requested more health information about COVID-19. For the Philippines, student status, low confidence in doctors, dissatisfaction with health information, long daily duration spent on health information, worries about family members contracting COVID-19, ostracization, and unnecessary worries about COVID-19 were associated with adverse mental health. Physical symptoms and poor self-rated health were associated with adverse mental health in both countries (p < 0.05). Conclusion: The findings of this study suggest the need for widely available COVID-19 testing in MIC to alleviate the adverse mental health in people who present with symptoms. A health education and literacy campaign is required in the Philippines to enhance the satisfaction of health information.

Diagnostic and Predictive Applications of Functional Near-Infrared Spectroscopy for Major Depressive Disorder: A Systematic Review

INTRODUCTION

Major depressive disorder (MDD) is a global psychiatric disorder with no established biomarker. There is growing evidence that functional near-infrared spectroscopy (fNIRS) has the ability to aid in the diagnosis and prediction of the treatment response of MDD. The aim of this review was to systematically review, and gather the evidence from existing studies that used fNIRS signals in the diagnosis of MDD, correlations with depression symptomatology, and the monitoring of treatment response.

METHODS

PubMed, EMBASE, ScienceDirect, and Cochrane Library databases were searched for published English articles from 1980 to June 2019 that focused on the application of fNIRS for (i) differentiating depressed versus nondepressed individuals, (ii) correlating with depression symptomatology, and in turn (iii) monitoring treatment responses in depression. Studies were included if they utilized fNIRS to evaluate cerebral hemodynamic variations in patients with MDD of any age group. The quality of the evidence was assessed using the Newcastle-Ottawa quality assessment scale.

RESULTS

A total of 64 studies were included in this review, with 12 studies being longitudinal, while the rest were cross-sectional. More than two-thirds of the studies (n = 49) had acceptable quality. fNIRS consistently demonstrated attenuated cerebral hemodynamic changes in depressed compared to healthy individuals. fNIRS signals have also shown promise in correlating with individual symptoms of depression and monitoring various treatment responses.

CONCLUSIONS

This review provides comprehensive updated evidence of the diagnostic and predictive applications of fNIRS in patients with MDD. Future studies involving larger sample sizes, standardized methodology, examination of more brain regions in an integrative approach, and longitudinal follow-ups are needed.

Prevalence and associated factors of mental disorders in the nationwide primary care population in Latvia: a cross-sectional study

BACKGROUND

Mental disorders are common amongst patients in primary care. There are no published studies on the prevalence of mental disorders in primary care patients in Latvia. The purpose of the study was to evaluate the current prevalence of mental disorders in the nationwide Latvian primary care population and to study possible associated factors and comorbidity of mental disorders.

METHODS

A cross-sectional study within the framework of the National Research Program BIOMEDICINE 2014-2017 was performed at 24 primary care settings across Latvia. Adult patients seen over a 1-week time period at each facility were invited to participate in the study. Sociodemographic variables (age, sex, education, employment and marital status, place of residence, and ethnicity) were assessed onsite. A Mini-International Neuropsychiatric Interview assessment was conducted over the telephone within 2 weeks after the visit to the general practitioner (GP).

RESULTS

Overall, 1485 individuals completed the interview. The current prevalence of any mental disorder was 37.2% and was significantly greater in women. Mood disorders (18.4%), suicidality (18.6%) and anxiety disorders (15.8%) were the most frequent diagnostic categories. The current prevalence of any mood disorder was associated with being 50-64 years of age, female sex, economically inactive status, divorced or widowed marital status and urban place of residence, whilst any current anxiety disorder was associated with female sex, lower education, and single marital status; however, being of Russian ethnicity and residing in a small city were protective factors. Suicidality was associated with female sex, lower education, unemployment or economically inactive status, being divorced or widowed and residing in a small city. The comorbidity rates between mental disorders varied from 2.9 to 53.3%.

CONCLUSIONS

High prevalence rates of mental disorders, comorbidity and certain associated socio-demographic factors were found in primary care settings in Latvia. This highlights the importance of screening for depression and anxiety disorders and suicidal risk assessment by GPs. The results are fundamentally important for integrative medicine, monitoring and promotion of mental healthcare at the primary care level, as well as for healthcare policy and development of strategic plans in Latvia.

Association Between Depression, Health Beliefs, and Face Mask Use During the COVID-19 Pandemic

The 2019 novel coronavirus (COVID-19) pandemic is associated with increases in psychiatric morbidity, including depression. It is unclear if people with depressive symptoms understand or apply COVID-19 information differently to the general population. Therefore, this study aimed to examine associations between depression, health beliefs, and face mask use during the COVID-19 pandemic among the general population in Hong Kong. This study gathered data from 11,072 Hong Kong adults via an online survey. Respondents self-reported their demographic characteristics, depressive symptoms (PHQ-9), face mask use, and health beliefs about COVID-19. Hierarchical logistic regression was used to identify independent variables associated with depression. The point-prevalence of probable depression was 46.5% (n = 5,150). Respondents reporting higher mask reuse (OR = 1.24, 95%CI 1.17-1.34), wearing masks for self-protection (OR = 1.03 95%CI 1.01-1.06), perceived high susceptibility (OR = 1.15, 95%CI 1.09-1.23), and high severity (OR = 1.33, 95%CI 1.28-1.37) were more likely to report depression. Depression was less likely in those with higher scores for cues to action (OR = 0.82, 95%CI 0.80-0.84), knowledge of COVID-19 (OR = 0.95, 95%CI 0.91-0.99), and self-efficacy to wear mask properly (OR = 0.90 95%CI 0.83-0.98). We identified a high point-prevalence of probable major depression and suicidal ideation during the COVID-19 outbreak in Hong Kong, but this should be viewed with caution due to the convenience sampling method employed. Future studies should recruit a representative probability sample in order to draw more reliable conclusions. The findings highlight that COVID-19 health information may be a protective factor of probable depression and suicidal ideation during the pandemic. Accurate and up-to-date health information should be disseminated to distressed and vulnerable subpopulations, perhaps using digital health technology, and social media platforms to prompt professional help-seeking behavior.

Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19

Psychological health problems, especially emotional disorders, are common among adolescents. The epidemiology of emotional disorders is greatly influenced by stressful events. This study sought to assess the prevalence rate and socio-demographic correlates of depressive and anxiety symptoms among Chinese adolescents affected by the outbreak of COVID-19. We conducted a cross-sectional study among Chinese students aged 12-18 years during the COVID-19 epidemic period. An online survey was used to conduct rapid assessment. A total of 8079 participants were involved in the study. An online survey was used to collect demographic data, assess students' awareness of COVID-19, and assess depressive and anxiety symptoms with the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) questionnaire, respectively. The prevalence of depressive symptoms, anxiety symptoms, and a combination of depressive and anxiety symptoms was 43.7%, 37.4%, and 31.3%, respectively, among Chinese high school students during the COVID-19 outbreak. Multivariable logistic regression analysis revealed that female gender was the higher risk factor for depressive and anxiety symptoms. In terms of grades, senior high school was a risk factor for depressive and anxiety symptoms; the higher the grade, the greater the prevalence of depressive and anxiety symptoms. Our findings show there is a high prevalence of psychological health problems among adolescents, which are negatively associated with the level of awareness of COVID-19. These findings suggest that the government needs to pay more attention to psychological health among adolescents while combating COVID-19.

Determination of depression, anxiety and stress (DAS) levels in patients with atopic dermatitis: a case-control study

The present study was aimed at comparing depression, anxiety and stress (DAS) levels of individuals with atopic dermatitis with those of the individuals without atopic dermatitis, and to examine the DAS levels of the patients with atopic dermatitis in terms of their socio-demographic characteristics. Case control study conducted in a city in western Turkey. The present study in which the relational screening model was used was conducted with patients with atopic dermatitis who presented to the Dermatology Clinic/Polyclinic of a university hospital and healthy subjects, and volunteered to participate in the study. The study conducted between December 2017 and February 2018 included 150 people (75 healthy subjects, 75 patients with atopic dermatitis). To collect the study data, the participants were administered the Socio-demographic Characteristics Questionnaire prepared by the researcher and the Depression, Stress and Anxiety Scale (DASS-42). No significant difference was determined between the mean DASS scores obtained by the atopic dermatitis patients and those obtained by the healthy subjects in the control group (p > 0.05). Of the atopic dermatitis patients, 58.7%, 82.3% and 49.3% were within the normal ranges in terms of the mean scores they obtained from the stress, depression and anxiety subscales respectively. In the present study, the mean scores obtained from the depression and anxiety subscales by working atopic dermatitis patients were higher than those obtained by the nonworking patients (p < 0.05). The mean scores obtained from the stress subscale by the smokers with atopic dermatitis were higher than those obtained by the non-smokers with atopic dermatitis.

Dispensing patterns of selective serotonin reuptake inhibitors before, during and after pregnancy: a 16-year population-based cohort study from the Netherlands

Management of mental illness in the perinatal period with antidepressants is controversial, since evidence emerged on potential harmful effects to the unborn child. However, over time, the dispensing of antidepressants in the perinatal period has increased. We examined perinatal dispensing patterns over time and the role of a recently issued guideline in this regard. We identified a 16-year cohort of 153,952 Dutch pregnancies with a delivery date between January 1999 and December 2014. Data included exposure to selective serotonin reuptake inhibitors (SSRIs) related to phases of pregnancy (preconception, pregnancy and delivery, post-delivery). The chi-square test for trends was used. With standard logistic regression, we explored the influence of patient characteristics on continuation of SSRIs during pregnancy. A persistent significant rise of dispensing rates in all phases was observed, with the largest increase during pregnancy (from 0.8% in 1999/2000 to 2.1% in 2013/2014, chi-square for trend = 141.735, p < 0.001). A substantial change of practice in terms of the SSRI used (less paroxetine) and the policy towards continuation into pregnancy (more continuation over time) was visible. Concomitant use of psycholeptics halved the probability of continuation of SSRIs (OR 0.50, 95%CI 0.43-0.55, p < 0.01). Dispensing rates of SSRIs steadily increased last 16 years, especially during pregnancy, caused by an increase in the proportion of women continuing their medication during pregnancy. In view of the demonstrated impact of uncertainty regarding effectiveness and safety of SSRIs in pregnancy, future research should involve more detailed outcome research of SSRIs as it is, and research into viable alternatives.

Prevalence of Common Mental Disorders in South Asia: A Systematic Review and Meta-Regression Analysis

South Asian countries report the highest prevalence of common mental disorders (CMDs) globally. This systematic review and meta-analysis report the pooled prevalence of CMDs among the South Asian countries. Database searches were conducted in eight electronic databases. Titles, abstracts, full-text screening, and extraction of data on the event rate of 17 indicators of CMDs were performed by two independent reviewers. A total of 160 studies were included and data analysis was done using the Comprehensive Meta-analysis Software (v.3). A prevalence of depressive symptoms was 26.4% among 173,449 participants, alcohol abuse was 12.9% (n = 107,893); anxiety 25.8% (n = 70,058); tobacco smoking 18.6% (n = 84,965); PTSD 17.2% (n = 42,298); mixed anxiety and depression 28.4% (n = 11,102); suicidal behaviors 6.4% (n = 25,043); misuse of opiates 0.8% (n = 37,304); tobacco chewing 21.0% (n = 10,586); use of cannabis 3% (n = 10,977); GAD 2.9% (n = 70,058); bipolar disorder 0.6% (n = 7,197); IV drug abuse 2.5% (n = 15,049); panic disorder 0.01% (n = 28,087); stimulant use 0.9% (n = 1,414); OCD 1.6% (n = 8,784) and phobic disorders 1.8% (n = 27,754). This study reported a high prevalence of CMDs in South Asian countries; necessitating further research on psychiatric epidemiology in those contexts. It informs the need for effective policymaking and implementation of culturally appropriate multilevel interventions.

Genetic Overlap Between Type 2 Diabetes and Depression in a Sri Lankan Population Twin Sample

OBJECTIVE

Results from twin studies examining the genetic overlap between type 2 diabetes and depression are currently inconclusive. This question has not been addressed in non-Western populations. We aimed to examine whether there are common genetic factors between type 2 diabetes and depression in a Sri Lankan population using genetic model-fitting analysis.

METHOD

The Colombo Twin and Singleton Study-Phase 2 consists of 2019 singletons, and 842 monozygotic and 578 dizygotic twin pairs. The primary outcomes were self-reported type 2 diabetes diagnosis and Beck Depression Inventory scores. Standard bivariate twin models were fitted to estimate the genetic and environmental (co)variance of type 2 diabetes and depression.

RESULTS

In the best-fitting model, the phenotypic correlation between type 2 diabetes and depression was significant in female individuals only (r = 0.15 [0.08-0.21]). This association was primarily attributed to a significant genetic correlation between the traits (rA = 0.53 [0.19-0.98]).

CONCLUSIONS

In female individuals, but not male individuals, we found a significant genetic overlap between type 2 diabetes and depression in the context of a modest phenotypic correlation.

Global Estimates of the Prevalence of Depression among Prisoners: A Systematic Review and Meta-analysis

BACKGROUND

Prison populations tend to be marginalized and disadvantaged of the rights and freedoms that other people in the community benefit from. Their separation from families, a narrow room and lack of privacy in the prison, violence between prisoners, and the uncertainty about the future result in psychological distress, for example, depression. The review has synthesized previous studies conducted on the topic and summarized to formulate recommendations for future prison health care services.

METHODS

We systematically searched the databases: PubMed, Psych Info, and SCOPUS, as well as manual Google Scholar searches, were conducted to retrieve published literature globally. We have included observational studies, written in English language. Estimates were pooled using a random-effects model. The study protocol was registered in PROSPERO with protocol number CRD42020156108. Subgroup and sensitivity analysis was conducted, and heterogeneity across the studies was evaluated using Q and the I ²-test. Publication bias was assessed by inspection of the funnel plot and Egger's regression test.

RESULT

A total of 1313 studies were initially identified through the electronic database; among these, a total of 73 full-text articles were retrieved for further appraisal. Further, 32 full-text articles were included in the final systematic review and meta-analysis. In this meta-analysis, the pooled prevalence of depression among prisoners was 36.9% (95% CI; 27.3-47.6). The pooled prevalence of depression among prisoners in the developing and developed countries was 39.2% and 33.1%, respectively. Moreover, the prevalence of depression was 19.1% and 54% for the studies that used diagnostic and screen tools to diagnose or screen depression, respectively. A leave-one-out analysis revealed that the pooled prevalence of depression among prisoners was not dependent on a single study removal or addition. Thus, the pooled prevalence of depression ranges between 35.3 and 38.0%.

CONCLUSION

The prevalence of depression among prisoners was high. Therefore, regular and continuous screening of depressive symptoms for prisoners along with its appropriate management is highly recommended.

Linking childhood emotional abuse and adult depressive symptoms: The role of mentalizing incapacity

BACKGROUND

Accumulated evidence suggests that childhood emotional abuse is particularly related to adulthood depression. However, this connection demands further explanation regarding potential intermediate factors.

OBJECTIVE

This study aims to disentangle the independent effects of emotional abuse on adulthood depressive symptoms by statistically controlling for other forms of childhood maltreatment, and to examine mentalizing incapacity (i.e., hypermentalizing, hypomentalizing) as a potential mediator in this relationship.

PARTICIPANTS

A general sample of 205 adults were assessed online.

METHOD

Participants completed a set of self-report measures assessing childhood maltreatment history, mentalizing and depression symptoms. Hierarchical multiple regression was employed to assess the independent effect of emotional abuse on depression. Bootstrap analysis was used to test mediation models.

RESULTS

Emotional abuse continued to exert a significant effect on adulthood depression after controlling for other forms of childhood maltreatment and mentalizing incapacity. A mediation effect between childhood emotional abuse and adulthood depression symptoms via mentalizing incapacity, both hypermentalizing (b = 2.02, 95 % CI [0.96, 3.25]) and hypomentalizing, (b = 1.26, 95 % CI [0.59, 1.99]), was established.

CONCLUSIONS

This study provided preliminary evidence for hypermentalizing and hypomentalizing as mechanisms whereby early emotional abuse can lead to later depression. A normal to high level of mentalizing capacity might serve as a protective factor to suspend the pathway from childhood maltreatment to subsequent depression and become a promising target in psychological treatments. As cross-sectional data does not allow conclusions to be drawn on causal relationships, longitudinal data in a more representative sample is needed to capture relevant context and further examine our findings.

Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies

Background: In psychiatry, stigma is an attitude of disapproval towards people with mental illnesses. Psychiatric disorders are common in Asia but some Asians receive inadequate treatment. Previous review found that Asians with mental illness were perceived to be dangerous and aggressive. There is a need for renewed efforts to understand stigma and strategies which can effectively reduce stigma in specific Asian societies. The objective of this systematic review was to provide an up-to-date overview of existing research and status on stigma experienced by psychiatric patients and anti-stigma campaigns in China, Hong Kong, Japan, Singapore, Korea, and Thailand. Methods: A systematic literature search was conducted in the following databases, including PubMed, PsycINFO, Embase, Web of Science, and local databases. Studies published in English and the official language of included countries/territories were considered for inclusion in the systematic review. Any article on stigma related to any form of psychiatric illness in the six Asian societies was included. Results: One hundred and twenty-three articles were included for this systematic review. This review has six major findings. Firstly, Asians with mental illnesses were considered as dangerous and aggressive, especially patients suffering from schizophrenia and bipolar disorder; second, psychiatric illnesses in Asian societies were less socially-acceptable and were viewed as being personal weaknesses; third, stigma experienced by family members was pervasive and this is known as family stigma; fourth, this systemic review reported more initiatives to handle stigma in Asian societies than a decade ago; fifth, there have been initiatives to treat psychiatric patients in the community; and sixth, the role of supernatural and religious approaches to psychiatric illness was not prevailing. Conclusion: This systematic review provides an overview of the available scientific evidence that points to areas of needed intervention to reduce and ultimately eliminate inequities in mental health in Asia.

Prevalence of major depressive disorder in the general population of Iran: A systematic review and meta-analysis

Background: Major depressive disorder (MDD) is the most common psychological disorder and affects many people worldwide. Surveying the prevalence of mental disorders, especially general disorders, such as major depressive disorder, is highly important for health professionals and policymakers. Due to a wide variation of studies concerning the prevalence of major depressive disorder in Iran, the present study was conducted to integrate such results. Methods: To conduct this study, English (PubMed/Medline, Scopus and Web of Science) and Persian (MHRN, Noormgs, Magiran, Iran-Medex, Irandoc, and SID) databases, from 1990 to 2018, were explored. All articles related to the point prevalence of depressive disorders in the general population of Iran were reviewed. The inclusion criteria of the present study were as follow: cross sectional studies based on general populations; the expression of the point prevalence rate and incidence of major depressive disorder for people over 15 years; and the use of a structured or semi-structured clinical interview for diagnosis of the disorder. Studies that were not original (such as review studies) and those that did not represent general populations were excluded from the study. To analyze the data obtained from this study, the second version of Comprehensive Meta-Analysis (CMA) software was used. The total point prevalence was calculated using the meta-analysis method, and the I2 index was used to measure the heterogeneity of the studies. Results: Of 6734 studies, 30 studies with a total sample size of 37 867 were finally included based on proposed inclusion and exclusion criteria. The sample included 20641 women (55%), and 17 226 (45%) men. In the present meta-analysis study, due to significant heterogeneity (I=97.1%, p=0.001) among studies, the randomized method was used, and the total point prevalence was 4.1% (CI: 3.1% 5.5%). The overall point prevalence of major depressive disorder was 4.8% (CI: 3.6% -5.6%) in women and 2.3% (CI: 1.6% -3.6%)in men, which indicated that the incidence of this disorder was 1.95 times more in women than in men. Conclusion: This meta-analysis study found a considerable prevalence of major depressive disorder among Iranian participants and revealed that the point prevalence of the disease was more than two-fold in women compared to men. Considering these findings and the high burden of this disorder for communities, the need to formulate and implement prevention and treatment programs is highly required.

Inflammation-induced behavioral changes is driven by alterations in Nrf2-dependent apoptosis and autophagy in mouse hippocampus: Role of fluoxetine

Inflammation has been associated with the progression of many neurological diseases. Peripheral inflammation has also been vaguely linked to depression-like symptoms in animal models, but the underlying pathways that orchestrate inflammation-induced behavioral or molecular changes in the brain are still elusive. We have recently shown that intraperitoneal injections of lipopolysaccharide (LPS) to Swiss albino mice triggers systemic inflammation, leading to an activated immune response along with changes in monoamine levels in the brain. Herein we pinpoint the fundamental pathways linking peripheral inflammation and depression-like behavior in a mouse model, thereby identifying suitable targets of intervention to combat the situation. We show that LPS-induced peripheral inflammation provoked a depression-like behavior in mice and a distinct pro-inflammatory bias in the hippocampus, as evident from increased microglial activation and elevated levels of pro-inflammatory cytokines IL-6 and TNF-α, and activation of NFκB-p65 pathway. Significant alterations in Nrf2-dependent cellular redox status, coupled with altered autophagy and increased apoptosis were noticed in the hippocampus of LPS-exposed mice. We and others have previously shown that, fluoxetine (an anti-depressant) has effective anti-inflammatory and antioxidant properties by virtue of its abilities to regulate NFκB and Nrf2 signaling. We observed that treatment with fluoxetine or the Nrf2 activator tBHQ (tert-butyl hydroquinone), could reverse depression-like-symptoms and mitigate alterations in autophagy and cell death pathways in the hippocampus by activating Nrf2-dependent gene expressions. Taken together, the data suggests that systemic inflammation potentiates Nrf2-dependent changes in cell death and autophagy pathway in the hippocampus, eventually leading to major pathologic sequelae associated with depression. Therefore, targeting Nrf2 could be a novel approach in combatting depression and ameliorating its associated pathogenesis.

[Angedonia in the structure of affective disorders: therapeutic opportunities]

Anhedonia is one of the core features of depression. The article considers the place of anhedonia in the structure of affective disorders, its influence on the prognosis and effectiveness of therapy. The authors stress that various manifestations of anhedonia must be considered in correlation with the basic ability to feel pleasure. Therapy of anhedonia is not always effective. According to literature, agomelatin occupies a leading position among the drugs that reduce anhedonia.

Brain 5-HT Deficiency Prevents Antidepressant-Like Effects of High-Fat-Diet and Blocks High-Fat-Diet-Induced GSK3β Phosphorylation in the Hippocampus

Obesity is associated with an increased risk of depression and anxiety disorders, but the nature of the relationship(s) between obesity and mental illness remains highly controversial. Some argue that depression and anxiety lead to increased consumption of "comfort foods," the intake of which reduces negative affect and promotes obesity. In contrast, others have theorized that negative affect results from chronic excessive consumption of highly palatable foods. The brain serotonin (5-HT) system has long been implicated in both the development and treatment of mental illness. Preclinical studies have shown that low brain 5-HT exacerbates depression- and anxiety-like behaviors induced by stress and blocks reductions in depression-like behavior induced by antidepressants, but the effects of brain 5-HT deficiency on responses to high-fat diet (HFD) have not been explored. The current work used genetically modified mice to evaluate the effects of low 5-HT on behavioral and molecular alterations induced by chronic exposure to HFD. Our results reveal that HFD decreases depression-like behavior and increases some anxiety-like behaviors in wild-type (WT) mice. However, genetic brain 5-HT deficiency blocks HFD-induced reductions in forced swim immobility and prevents HFD-induced increases in hippocampal GSK3β phosphorylation despite having no significant effects on HFD-induced changes in body weight or anxiety-like behavior. Together, our results suggest that brain 5-HT deficiency significantly impacts a subset of behavioral and molecular responses to HFD, a finding that could help explain the complex relationships between obesity and mental illness.

The Psychometric Properties of the Patient Health Questionnaire-9 in a Sample of Korean University Students

OBJECTIVE

Depressive symptoms among university students are a major mental-health issue worldwide, and university students are particularly vulnerable to various stressors that can produce depression. Therefore, accurate and sustainable assessment of depressive symptoms among university students is of special importance. The Patient Health Questionnaire-9 (PHQ-9) is one such measure. The objective of the current study was to evaluate the psychometric properties of the PHQ-9 among Korean university students.

METHODS

A total sample of 582 university students attending a four-year private university in South Korea was recruited for the study. Confirmatory factor analyses (CFAs) were performed to compare the goodness-of-fit of four competing models suggested by extant literature on the PHQ-9. Convergent validity was assessed using a correlation analysis between the PHQ-9 and other psychiatric instruments, including the Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Generalized Anxiety Disorder Scale (GAD-7).

RESULTS

A one-factor structure of the PHQ-9 provided the best fit to the data. Internal consistency was adequate. The PHQ-9 demonstrated good convergent validity with related constructs.

CONCLUSION

The psychometric properties of the PHQ-9 proved to be adequate, with a robust and interpretable factor structure and good internal consistency. The PHQ-9's validity, reliability, brevity and ease of administration make it a useful screening instrument for depression among university students in Korea.

Diagnostic performance of aPS/PT antibodies in neuropsychiatric lupus and cardiovascular complications of systemic lupus erythematosus

Background: Systemic lupus erythematosus (SLE) is associated with a constellation of complications affecting multiple organs, including neuropsychiatric manifestations (NPSLE) and ischaemic events, leading to increased long-term morbidity. Antiphospholipid antibodies (aPL) are a major determinant of vascular inflammation and thromboembolic risk. The diagnostic role of anti-phosphatidylserine/prothrombin (aPS/PT) antibodies in this setting is incompletely defined.Aim: To verify whether aPS/PT add to diagnostics and disease stratification in patients with SLE with or without other aPL.Methods: 131 consecutive patients were studied, including 20 patients with SLE and secondary antiphospholipid syndrome (APS). aPS/PT IgG and IgM were assessed through ELISA and patients were stratified based on the presence of other aPL, on their clinical and laboratory features at time of blood sampling and on their clinical history. Synthetic indices of disease activity, chronic damage and cardiovascular risk were calculated at time of venipuncture.Results: Fifty-one (38.9%) patients with SLE had aPS/PT and 15 (11.5%) patients had aPS/PT as the only aPL (aPS/PT-only). aPS/PT-only patients had a significantly higher prevalence of NPSLE than quadruple aPL-negative patients (p = .007). Patients with aPS/PT were more likely to have a history of ischaemia, thrombocytopenia and Libman-Sacks' endocarditis. The presence of aPS/PT also associated with previous accrual of at least one damage item (p = .043), but had limited predictive values for damage progression in the short term.Conclusion: aPS/PT antibodies provide non-redundant information that could contribute to risk assessment and stratification of patients with SLE.

Leonurine promotes neurite outgrowth and neurotrophic activity by modulating the GR/SGK1 signaling pathway in cultured PC12 cells

Depression is a common psychiatric disorder that affects almost 10% of children and adolescents worldwide. Numerous synthetic chemical antidepressants used to treat depression have adverse side effects. Therefore, new therapeutic approaches for depression treatment are urgently needed. Leonurus cardiaca has recently been shown to be effective for the treatment of nervous system diseases such as depression, but its mechanism is not clear. In this study, we aimed to reveal the mechanism underlying leonurine’s antidepressant activity. Leonurine was used to treat corticosterone-induced PC12 cells to examine its effect on neurite outgrowth and neurotrophic factors after treatment with the inhibitor of glucocorticoid receptor (GR) and serum-inducible and glucocorticoid-inducible kinase 1 (SGK1). Methyl thiazolyl tetrazolium assays were used to evaluate the viability of cells. High content analysis was used to detect cell area, total neurite length, maximum neurite length, and expression of GR, SGK1, brain-derived neurotrophic factor (BDNF), neurotrophic factor-3 (NT-3), and B-cell lymphoma-2 (BCL-2). The results showed that leonurine increased cell viability in a concentration-dependent manner, with the maximal prosurvival effect at 60 μM. Leonurine increased cell area, total neurite length, and maximum neurite length of corticosterone-induced PC12 cells, increased the expression of GR, BDNF, NT-3, and BCL-2, and decreased the expression of SGK1. After treatment with GR inhibitor RU486, the expressions of GR, BDNF, NT-3, and BCL-2 were significantly decreased and SGK1 was increased. In contrast, treatment with GSK650394 had the opposite effect of RU486. Our data indicate that leonurine promotes neurite outgrowth and neurotrophic activity in cultured PC12 cells, and its potential mechanism may involve the GR/SGK1 signaling pathway.

Vortioxetine treatment for generalised anxiety disorder: a meta-analysis of anxiety, quality of life and safety outcomes

OBJECTIVES

The aim of this study was to investigate the efficacy, tolerability, safety, and impact on quality of life (QoL) and functional status of vortioxetine treatment for patients with generalised anxiety disorder (GAD) by performing a meta-analysis of randomised controlled trials (RCTs).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Data mining was conducted in January 2019 across PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials Cochrane Library, Web of science and ClinicalTrials.gov.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

All published RCTs, which assessed the effect of vortioxetine treatment for patients with GAD when compared with a placebo group, were included.

DATA EXTRACTION AND SYNTHESIS

Relevant data were extracted and synthesised narratively. Results were expressed as standardised mean differences or ORs with 95% CIs.

RESULTS

Our meta-analysis showed that multiple doses (2.5, 5 and 10 mg/day) of vortioxetine did not significantly improve the response rates, compared with placebo (OR 1.16, 95% CI 0.84 to 1.60, p=0.38; OR 1.41, 95% CI 0.82 to 2.41, p=0.21; and OR 1.05, 95% CI 0.76 to 1.46, p=0.75). Moreover, there was no statistically significant difference regarding the remission rates, discontinuation for any reason rates, discontinuation due to adverse events rates, Short-Form 36 Health Survey scores or Sheehan Disability Scale scores between administration of multiple doses (2.5, 5 and 10 mg/day) of vortioxetine and placebo.

CONCLUSIONS

Although our results suggest that vortioxetine did not improve the GAD symptoms, QoL and functional status impairment of patients with GAD, it was safe and well tolerated. Clinicians should interpret and translate our data with caution, as the meta-analysis was based on a limited number of RCTs.

Neurological Complications in Patients with Systemic Lupus Erythematosus

PURPOSE OF REVIEW

Systemic lupus erythematosus (SLE) is commonly associated with neurological manifestations. Rapid recognition and treatment of these complications may improve outcomes. In this article, we review the neurological conditions associated with SLE, their diagnosis and management strategies.

RECENT FINDINGS

Recent meta-analysis showed that patients with neuropsychiatric manifestations of SLE were more likely to have positive antiphospholipid, antiribosomal P, and antineuronal antibodies. Another meta-analysis showed an association between SLE and antiphospholipid antibodies with cognitive impairment. Two large retrospective studies have shown that the peripheral nervous system is commonly involved in SLE frequently alongside the central nervous system. Neurological manifestations occur in most of SLE patients. Antiphospholipid antibodies are common in patients with SLE and increase the odds of neurological complications. Management typically involved a combination of treatments directed toward the neurological complication and therapies directed toward SLE itself. The efficacy of these treatment protocols, however, has not been rigorously studied and deserves further investigation.

Mental health of parents of children with a developmental disability in British Columbia, Canada

Background

There is evidence in the literature that parents of children who have a developmental disability experience an increased risk of mental health problems.

Methods

This study used population-level administrative data from the Ministry of Health, British Columbia, Canada, to assess the mental health of parents of children who have a developmental disability compared with the mental health of parents of children who do not have a developmental disability. Population-level and individual explanatory variables available in the data were included in the models.

Results

At a population level, the study found strong evidence that parents of children who have a developmental disability experience higher odds of depression or other mental health diagnoses compared with parents of children who do not have a developmental disability. Age of the parent at birth of the child, income and location of healthcare services were all associated with outcomes.

Conclusion

Parents of children who have a developmental disability may be in need of programmes and services that support their mental health.

Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis

OBJECTIVE

This meta-analysis aimed to estimate the global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents.

METHODS

A systematic search for relevant articles published between 1989 to 2018 was performed in multiple electronic databases. The aggregate 12-month and lifetime prevalence of suicidal behavior, deliberate self-harm, and non-suicidal self-injury were calculated based on the random-effects model. Subgroup analyses were performed to compare the prevalence according to school attendance and geographical regions. Results: A total of 686,672 children and adolescents were included. The aggregate lifetime and 12-month prevalence of suicide attempts was 6% (95% CI: 4.7-7.7%) and 4.5% (95% CI: 3.4-5.9%) respectively. The aggregate lifetime and 12-month prevalence of suicidal plan was 9.9% (95% CI: 5.5-17%) and 7.5% (95% CI: 4.5-12.1%) respectively. The aggregate lifetime and 12-month prevalence of suicidal ideation was 18% (95% CI: 14.2-22.7%) and 14.2% (95% CI: 11.6-17.3%) respectively. The aggregate lifetime and 12-month prevalence of non-suicidal self-injury was 22.1% (95% CI: 16.9-28.4%) and 19.5% (95% CI: 13.3-27.6%) respectively. The aggregate lifetime and 12-month prevalence of deliberate self-harm was 13.7% (95% CI: 11.0-17.0%) and 14.2% (95% CI: 10.1-19.5%) respectively. Subgroup analyses showed that full-time school attendance, non-Western countries, low and middle-income countries, and geographical locations might contribute to the higher aggregate prevalence of suicidal behaviors, deliberate self-harm, and non-suicidal self-injury. Conclusions: This meta-analysis found that non-suicidal self-injury, suicidal ideation, and deliberate self-harm were the three most common suicidal and self-harm behaviors in children and adolescents.

Fluoxetine attenuates stress-induced depressive-like behavior through modulation of hippocampal GAP43 and neurogenesis in male rats

Based on the monoaminergic theory, Serotonin-Selective Reuptake Inhibitors (SSRIs) are used for treating depression. Recent hypotheses suggest that antidepressants may influence neurogenesis and synaptic plasticity. However, the mechanisms underlying these effects are still poorly understood. The aim of the present study was to evaluate the effect of fluoxetine, a widely used SSRI antidepressant, on the neurogenesis and the expression of Growth-Associated Protein 43 (GAP43), a synaptic protein, in the rat hippocampus exposed to Unpredictable Chronic Mild Stress (UCMS; the model of depressive-like behavior). We have analyzed the effects of chronic fluoxetine treatment on immobility behavior (forced swimming test), plasma interleukin-6 and corticosterone (enzyme-linked immunosorbent assay), BrdU-positive cells in the dentate gyrus and GAP43 expression in the CA3 region (Immunohistochemistry) of the hippocampus. This study provides evidence that fluoxetine is a potent enhancer of GAP-43, a protein related to the neuronal plasticity, in the hippocampus of the rat model of depression. Interestingly, our results showed that although fluoxetine significantly is effective in increasing BrdU positive cells, it is more effective in increasing the neurite formation compared with neurogenesis. The results support the idea that antidepressants can promote neuronal plasticity. We concluded that the increase of GAP-43- induced neurite formation may be an important mechanism by which fluoxetine augments hippocampal neuroplasticity and play its pivotal antidepressant role.

Nursing students and depressive symptomatology: an observational study in University of Palermo

Purpose

Depression is a common and serious medical illness, considered as a public health issue because it interferes with the interpersonal, social and professional functioning of the individual, and its frequency is constantly increasing. According to a recent review, approximately 34 per cent of nursing students had experienced depression worldwide. The university period may represent a moment in which the mental well-being of students is subjected to stress with a relative predisposition to the development of diseases related to mood disorders. The purpose of this study is to estimate the prevalence and examine the socio-demographic correlates of depressive symptomatology.

Design/methodology/approach

In April 2019, a questionnaire was administered to all the nursing students of University of Palermo of the three years of course, accompanied by informed consent. Multivariable logistic regression was performed. The statistical significance level chosen for all analyses was 0.05. The results were analyzed using the STATA statistical software version 14. Results are expressed as adjusted odds ratio (aOR) with 95 per cent confidence intervals.

Findings

The sample consists of 493 students who completed the questionnaire, and the average age of the sample participants is 21.88 years. The multivariable logistic regression model shows that the risk to have depressive symptomatology is significantly associated with the following independent variables: female gender (aOR 1.91), being single (aOR 1.87), second year of study (aOR 1.94), third year of study (aOR 1.92), not performing regular physical activity (aOR 1.78) and perceived low health status (aOR 3.08).

Originality/value

This study shows that belonging to the female gender, being further along in the years of study, having a chronic illness and perceiving a low state of health are all factors that can increase the risk of developing the symptoms of depression; rather, regular physical activity, friendship and romantic relationships can be considered factors protecting them from the risk of falling into depression that can undermine both the study and work performance. Certainly, it is important to analyze all the involved variables to improve the global health not only of the nursing students but of all the students.