Life stress, the "kindling" hypothesis, and the recurrence of depression: considerations from a life stress perspective

The Vestiges of Childhood Interparental Conflict: Adolescent Sensitization to Recent Interparental Conflict

This study examined whether childhood interparental conflict moderated the mediational pathway involving adolescent exposure to interparental conflict, their negative emotional reactivity to family conflict, and their psychological problems in a sample of 235 children (M_age  = 6 years). Significant moderated-mediation findings indicated that the mediational path among Wave 4 interparental conflict during adolescence, change in youth negative reactivity (Waves 4-5), and their psychological problems (Waves 4-6) was significant for teens who experienced low, rather than high, levels of childhood interparental conflict (Waves 1-3). Supporting the stress sensitization model, analyses showed that adolescents exposed to high interparental conflict during childhood evidenced greater increases in negative reactivity than their peers when recent parental conflicts were mild.

Alleviation of Depression by Glucagon-Like Peptide 1 Through the Regulation of Neuroinflammation, Neurotransmitters, Neurogenesis, and Synaptic Function

Depression has emerged as a major cause of mortality globally. Many studies have reported risk factors and mechanisms associated with depression, but it is as yet unclear how these findings can be applied to the treatment and prevention of this disorder. The onset and recurrence of depression have been linked to diverse metabolic factors, including hyperglycemia, dyslipidemia, and insulin resistance. Recent studies have suggested that depression is accompanied by memory loss as well as depressive mood. Thus, many researchers have highlighted the relationship between depressive behavior and metabolic alterations from various perspectives. Glucagon-like peptide-1 (GLP-1), which is secreted from gut cells and hindbrain areas, has been studied in metabolic diseases such as obesity and diabetes, and was shown to control glucose metabolism and insulin resistance. Recently, GLP-1 was highlighted as a regulator of diverse pathways, but its potential as the therapeutic target of depressive disorder was not described comprehensively. Therefore, in this review, we focused on the potential of GLP-1 modulation in depression.

Stress Enhances Proinflammatory Platelet Activity: the Impact of Acute and Chronic Mental Stress

The role of platelets in hemostasis and thrombosis has long been recognized, recently their contribution to immunological and inflammatory processes is emerging. Platelets could be the missing link between cardiovascular disease, chronic stress and depressive symptoms. Both physical and mental stressors cause platelet activation reflected by changes in platelet bioactivity and aggregation. Here we evaluate the proinflammatory platelet response to acute and chronic mental stress. In a prospective study design an acute mental stress test was administered to 55 healthy male participants once without and once in the presence of chronic mental stress. Blood was collected prior to and at three time points following an acute mental stress test (0, 30, 60 min). Platelet proinflammatory activation markers, were assessed using FACS analysis and aggregability was measured in response to ADP or epinephrine using PFA-100. A linear mixed model was used for analysis. Chronic mental stress lead to a significant increase in state anxiety (p < 0.001), depressive symptoms (p = 0.045) and perceived stress (p = 0.001). The factor “chronic mental stress” was significantly associated with increased numbers of CD63+ platelets (p = 0.009). The factor “acute mental stress” was associated with alterations in CD62P+ platelets (p < 0.001), CD63+ platelets (p = 0.011), PAC-1+ platelets (p < 0.001) as well as platelet leucocyte aggregates (p = 0.019). The recovery of CD62P function following the acute mental stress exposure was significantly impaired by chronic stress (p = 0.023). Aggregation was affected by chronic and acute mental stress. In conclusion, mental stress is linked to an increased and prolonged proinflammatory platelet bioactivity. This proinflammatory and immunomodulatory stimuli could help to explain the link between mental and somatic disorders.

The Contribution of Neighborhood Socioeconomic Disadvantage to Depressive Symptoms Over the Course of Adult Life: A 32-Year Prospective Cohort Study

The association between socioeconomic disadvantage and increased risk of depressive symptoms in adulthood is well established. We tested 1) the contribution of early exposure to neighborhood socioeconomic disadvantage to later depressive symptoms throughout life, 2) the persistence of the potential association between early exposure and depressive symptoms, and 3) the contributions of other known risk factors to the association. Data were collected from the Young Finns Study, a prospective, population-based 32-year follow-up study that included participants aged 3-18 years at baseline in 1980. Participants were followed up with repeated measurements of depressive symptoms between 1992 and 2012 (n = 2,788) and linked to national grid data on neighborhood disadvantage via residential addresses. We examined the associations in mixed models separately for the 5-, 10-, 15-, and 20-year follow-ups. Living in a disadvantaged neighborhood during childhood and adolescence was associated with a higher level of depressive symptoms in adulthood during all follow-up periods (β = 0.07, P = 0.001) than living in a nondisadvantaged area. Individual adulthood socioeconomic status mediated the associations. These findings suggest that living in a socioeconomically disadvantaged area during childhood and adolescence has a long-lasting negative association with mental health irrespective of family-related risks, partially due to socioeconomic adversity later in life.

Interparental conflict as a curvilinear risk factor of youth emotional and cortisol reactivity

This study examined interparental conflict as a linear and curvilinear predictor of subsequent changes in adolescents' negative emotional reactivity and cortisol functioning during family conflict and, in turn, their psychological difficulties. In addition, adolescents' negative emotional reactivity and cortisol functioning during family conflict were examined as subsequent predictors of their psychological difficulties. Participants included 258 adolescents (52% girls) and their parents and teachers who participated in 3 annual measurement occasions. Adolescents were 13 years old on average (standard deviation [SD] = .57) at the first measurement occasion, were generally from middle- and working-class backgrounds, and identified mostly as White (e.g., 74%). The results of latent-difference score analyses indicated that a multimethod and multiinformant assessment of interparental conflict linearly predicted subsequent changes in observational ratings of adolescent emotional reactivity and their overall cortisol output in response to family conflict over a 1-year period. These changes, in turn, predicted increases in multiinformant reports of adolescent psychological problems over a 2-year period. However, the linear association in the first link in the cascade was qualified by the quadratic effects of interparental conflict as a predictor. Consistent with risk-saturation models, the relatively strong associations among interparental conflict and youth emotional reactivity and cortisol output at mild and moderate exposure to conflict weakened as exposure to conflict reached higher levels. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The effects of mindfulness-based cognitive therapy on risk and protective factors of depressive relapse - a randomized wait-list controlled trial

Background

The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness–Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness.

Methods

Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC).

Results

Completers of MBCT (N = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC (N = 30) on measures of rumination (d = 0.59, p = .015), emotion regulation (d = 0.50, p = .028), emotional reactivity to stress (d = 0.32, p = .048), self-compassion (d = 1.02, p < .001), mindfulness (d = 0.59, p = .010), and depression (d = 0.40, p = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression.

Conclusions

Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants’ ability to be less self-judgmental and more self-compassionate.

Trial registration

ISRCTN, ISRCTN18001392. Registered 29 June 2018

Factors Associated With Depressive Episode Recurrences in Primary Care: A Retrospective, Descriptive Study

Introduction and Objective

The early identification of depressive patients having a poor evolution, with frequent relapses and/or recurrences, is one of the priority challenges in this study of high prevalence mental disorders, and specifically in depression. So, this study aims to analyze the factors that may be associated with an increased risk of recurrence of major depression episodes in patients treated in primary care.

Methods

A retrospective, descriptive study of cases-controls was proposed. The cases consisted of patients who had been diagnosed with major depression and who had presented recurrences (n = 101), in comparison with patients who had experienced a single major depression episode with no recurrence (n = 99). The variables of the study are age at first episode; number of episodes; perception of severity of the depression episode suffered prior to recurrence; number of residual symptoms; physical and psychiatric comorbidity; history of anxiety disorders; family psychiatric history; high incidence of stressful life events (SLEs); and experiences of physical, psychological, or sexual abuse in childhood. The differences of the variables were compared between the case subjects and the control subjects, using the Mann-Whitney, chi-square, and Fisher's U statistics. A multivariate analysis (ordinary logistic regression) was performed.

Results

The average age of those suffering more than one depressive episode is significantly older (5 years), and a higher percentage of subjects who have experienced more than one depressive episode have a history of anxiety disorders. In the multivariate analysis, the variables that obtained a significant value in the logistic regression analysis were age (OR: 1.03; value: 0.007) and having suffered sexual abuse during childhood (OR: 1.64; value: 0.072).

Conclusion

These indicators should be considered by primary care physicians when attending patients suffering from major depression.

Cardiometabolic risk in young adults with depression and evidence of inflammation: A birth cohort study

BACKGROUND

Young adults with depression and evidence of inflammation may represent a high-risk group for cardiometabolic disorders, but studies of cardiometabolic risk in this population are scarce. We aimed to examine: (1) the prevalence of low-grade inflammation in young-adults with depression; (2) cross-sectional and longitudinal associations between cardiometabolic risk factors and depression with or without evidence of inflammation.

METHOD

The ALSPAC birth cohort participants were assessed for depression and serum high-sensitivity C-Reactive Protein (CRP) levels at age 18, alongside cardiometabolic measures (fasting insulin, fasting plasma glucose, low-density lipoprotein, high-density lipoprotein, triglycerides, smoking, alcohol intake) at age 18 years, and body mass index at ages 9, 13 and 18 years. Low-grade inflammation was defined as CRP>3 mg/L. Multinomial regression was used to examine associations of cardiometabolic markers with depression cases with and without evidence of inflammation. Sensitivity analyses were conducted to examine for interactions between depression, inflammation and cardiometabolic traits.

RESULTS

Out of 2932 participants, 215 met ICD-10 criteria for depressive episode at age 18 years; 23 (10.7 %) had CRP>3 mg/L and 57 (26.5 %) had CRP 1-3 mg/L. Depressive episode with raised CRP (>3 mg/L) was associated with higher triglycerides (adjusted OR = 2.09; 95 % C.I., 1.35-3.24), higher BMI (adjusted OR = 1.13; 95 % C.I., 1.05-1.22) and insulin insensitivity (adjusted OR = 1.12; 95 % C.I., 1.01-1.26), and longitudinally with higher BMI at ages 9 (adjusted OR = 1.27; 95 % C.I., 1.10-1.48) and 13 (adjusted OR = 1.23; 95 % C.I., 1.09-1.38). There was evidence for interaction between BMI and CRP for the risk of depression at age 18 (adjusted OR for the interaction term = 1.56; 95 % C.I. 0.98-2.02) and between CRP and depressive symptoms for the risk of increased BMI at age 18 (adjusted β for the interaction term = 0.05; 95 % C.I. 0.00-0.12).

CONCLUSIONS

A notable proportion of young adults with depression have evidence of inflammation. These individuals are at increased risk of cardiometabolic disorders. Management of cardiometabolic risk in depressed individuals with evidence of inflammation should form part of routine clinical practice.

Effects of Aerobic Exercise on Cortisol Stress Reactivity in Response to the Trier Social Stress Test in Inpatients with Major Depressive Disorders: A Randomized Controlled Trial

Physical activity is associated with a favourable (blunted) cortisol stress reactivity in healthy people. However, evidence from experimental study and with psychiatric patients is missing. This study examines whether exercise training impacts on cortisol stress reactivity in inpatients with major depressive disorder (MDD). These new insights are important because the stress reactivity of healthy people and patients with severe symptoms of depression might differ. Methods: The study was designed as a randomized controlled trial (trial registration number: NCT02679053). In total, 25 patients (13 women, 12 men, mean age: 38.1 12.0 years) completed a laboratory stressor task before and after a six-week intervention period. Nine samples of salivary free cortisol were taken before and after the Trier social stress test (TSST). Fourteen participants took part in six weeks of aerobic exercise training, while 11 patients were allocated to the control condition. While the primary outcome of the study was depressive symptom severity, the focus of this paper is on one of the secondary outcomes (cortisol reactivity during the TSST). The impact of aerobic exercise training was examined with a repeated-measures analysis of variance. We also examined the association between change in depression and cortisol response via correlational analysis. Cortisol reactivity did not change from baseline to post-intervention, either in the intervention or the control group. Participation in six weeks of aerobic exercise training was not associated with participants' cortisol reactivity. Moreover, depressive symptom change was not associated with change in cortisol response. Aerobic exercise training was not associated with patients' stress reactivity in this study. Because many patients initially showed a relatively flat/blunted cortisol response curve, efforts might be needed to find out which treatments are most efficient to promote a normalization of HPA axis reactivity.

Anger and Depression in Middle-Aged Men: Implications for a Clinical Diagnosis of Chronic Traumatic Encephalopathy

OBJECTIVE

In recent years, it has been proposed that problems with anger control and depression define clinical features of chronic traumatic encephalopathy (CTE). The authors examined anger problems and depression in middle-aged men from the general population and related those findings to the proposed clinical criteria for CTE.

METHODS

A sample of 166 community-dwelling men ages 40-60 was extracted from the normative database of the National Institutes of Health Toolbox. All participants denied prior head injury or traumatic brain injury (TBI). Participants completed scales assessing anger, hostility, aggression, anxiety, and depression.

RESULTS

In response to the item "I felt angry," 21.1% of men reported "sometimes," and 4.8% reported "often." When asked "If I am provoked enough I may hit another person," 11.4% endorsed the statement as true. There were moderate correlations between anger and anxiety (Spearman's ρ=0.61) and between depression and affective anger (ρ=0.51), hostility (ρ=0.56), and perceived hostility (ρ=0.35). Participants were dichotomized into a possible depression group (N=49) and a no-depression group (N=117) on the basis of the question "I feel depressed," specific to the past 7 days. The possible depression group reported higher anxiety (p<0.001, Cohen's d=1.51), anger (p<0.001, Cohen's d=0.96), and hostility (p<0.001, Cohen's d=0.95).

CONCLUSIONS

Some degree of anger and aggression are reported by a sizable minority of middle-aged men in the general population with no known history of TBI. Anger and hostility are correlated with depression and anxiety, indicating that all tend to co-occur. The base rates and comorbidity of affective dysregulation in men in the general population is important to consider when conceptualizing CTE phenotypes.

How do stress, sleep quality, and chronotype associate with clinically significant depressive symptoms? A study of young male military recruits in compulsory service

OBJECTIVE

Although studies have shown an association between poor sleep and chronotype with psychiatric problems in young adults, few have focused on identifying multiple concomitant risk factors.

METHODS

We assessed depressive symptoms (Beck Depression Inventory [BDI]), circadian typology (Morningness-Eveningness Questionnaire [MEQ]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), perceived stress (Perceived Stress Scale [PSS]), social rhythm (Social Rhythm Metrics [SRM]), and salivary cortisol (morning, evening and night, n=37) in 236 men (all 18 years old). Separate analyses were conducted to understand how each PSQI domain was associated with depressive symptoms.

RESULTS

Depressive symptoms were more prevalent in individuals with higher perceived stress (prevalence ratio [PR] = 6.429, p < 0.001), evening types (PR = 2.58, p < 0.001) and poor sleepers (PR = 1.808, p = 0.046). Multivariate modeling showed that these three variables were independently associated with depressive symptoms (all p < 0.05). The PSQI items subjective sleep quality and sleep disturbances were significantly more prevalent in individuals with depressive symptoms (PR = 2.210, p = 0.009 and PR = 2.198, p = 0.008). Lower levels of morning cortisol were significantly associated with higher depressive scores (r = -0.335; p = 0.043).

CONCLUSION

It is important to evaluate multiple factors related to sleep and chronotype in youth depression studies, since this can provide important tools for comprehending and managing mental health problems.

Stress hypothesis overload: 131 hypotheses exploring the role of stress in tradeoffs, transitions, and health

Stress is ubiquitous and thus, not surprisingly, many hypotheses and models have been created to better study the role stress plays in life. Stress spans fields and is found in the literature of biology, psychology, psychophysiology, sociology, economics, and medicine, just to name a few. Stress, and the hypothalamic-pituitaryadrenal/interrenal (HPA/I) axis and sympathetic nervous system (SNS), are involved in a multitude of behaviors and physiological processes, including life-history and ecological tradeoffs, developmental transitions, health, and survival. The goal of this review is to highlight and summarize the large number of available hypotheses and models, to aid in comparative and interdisciplinary thinking, and to increase reproducibility by a) discouraging hypothesizing after results are known (HARKing) and b) encouraging a priori hypothesis testing. For this review I collected 214 published hypotheses or models dealing broadly with stress. In the main paper, I summarized and categorized 131 of those hypotheses and models which made direct connections among stress and/or HPA/I and SNS, tradeoffs, transitions, and health. Of those 131, the majority made predictions about reproduction (n = 43), the transition from health to disease (n = 38), development (n = 23), and stress coping (n = 18). Additional hypotheses were classified as stage-spanning or models (n = 37). The additional 83 hypotheses found during searches were tangentially related, or pertained to immune function or oxidative stress, and these are listed separately. Many of the hypotheses share underlying rationale and suggest similar, if not identical, predictions, and are thus not mutually exclusive; some hypotheses spanned classification categories. Some of the hypotheses have been tested multiple times, whereas others have only been examined a few times. It is the hope that multi-disciplinary stress researchers will begin to harmonize their naming of hypotheses in the literature so as to build a clearer picture of how stress impacts various outcomes across fields. The paper concludes with some considerations and recommendations for robust testing of stress hypotheses.

Web-Based Graphic Representation of the Life Course of Mental Health: Cross-Sectional Study Across the Spectrum of Mood, Anxiety, Eating, and Substance Use Disorders

BACKGROUND

Although patient history is essential for informing mental health assessment, diagnosis, and prognosis, there is a dearth of standardized instruments measuring time-dependent factors relevant to psychiatric disorders. Previous research has demonstrated the potential utility of graphical representations, termed life charts, for depicting the complexity of the course of mental illness. However, the implementation of these assessments is limited by the exclusive focus on specific mental illnesses (ie, bipolar disorder) and the lack of intuitive graphical interfaces for data collection and visualization.

OBJECTIVE

This study aimed to develop and test the utility of the Tulsa Life Chart (TLC) as a Web-based, structured approach for obtaining and graphically representing historical information on psychosocial and mental health events relevant across a spectrum of psychiatric disorders.

METHODS

The TLC interview was completed at baseline by 499 participants of the Tulsa 1000, a longitudinal study of individuals with depressive, anxiety, substance use, or eating disorders and healthy comparisons (HCs). All data were entered electronically, and a 1-page electronic and interactive graphical representation was developed using the Google Visualization Application Programming Interface. For 8 distinct life epochs (periods of approximately 5-10 years), the TLC assessed the following factors: school attendance, hobbies, jobs, social support, substance use, mental health treatment, family structure changes, negative and positive events, and epoch and event-related mood ratings. We used generalized linear mixed models (GLMMs) to evaluate trajectories of each domain over time and by sex, age, and diagnosis, using case examples and Web-based interactive graphs to visualize data.

RESULTS

GLMM analyses revealed main or interaction effects of epoch and diagnosis for all domains. Epoch by diagnosis interactions were identified for mood ratings and the number of negative-versus-positive events (all P values <.001), with all psychiatric groups reporting worse mood and greater negative-versus-positive events than HCs. These differences were most robust at different epochs, depending on diagnosis. There were also diagnosis and epoch main effects for substance use, mental health treatment received, social support, and hobbies (P<.001). User experience ratings (each on a 1-5 scale) revealed that participants found the TLC pleasant to complete (mean 3.07, SD 1.26) and useful for understanding their mental health (mean 3.07, SD 1.26), and that they were likely to recommend it to others (mean 3.42, SD 0.85).

CONCLUSIONS

The TLC provides a structured, Web-based transdiagnostic assessment of psychosocial history relevant for the diagnosis and treatment of psychiatric disorders. Interactive, 1-page graphical representations of the TLC allow for the efficient communication of historical life information that would be useful for clinicians, patients, and family members.

Recent Stressful Life Events in Euthymic Major Depressive Disorder Patients: Sociodemographic and Clinical Characteristics

BACKGROUND

Stressful life events (SLE) may influence the illness course and outcome. This study aimed to characterize socio-demographic and clinical features of euthymic major depressive disorder (MDD) outpatients with SLE compared with those without.

METHODS

The present sample included 628 (mean age=55.1 ± 16.1) currently euthymic MDD outpatients of whom 250 (39.8%) reported SLE and 378 (60.2%) did not.

RESULTS

After univariate analyses, outpatients with SLE were most frequently widowed and lived predominantly with friends/others. Moreover, relative to outpatients without SLE, those with SLE were more likely to have a family history of suicidal behavior, manifested melancholic features, report a higher Coping Orientation to the Problems Experienced (COPE) positive reinterpretation/growth and less likely to have a comorbid panic disorder, residual interepisodic symptoms, use previous psychiatric medications, and currently use of antidepressants. Having a family history of suicide (OR=9.697; p=≤.05), history of psychotropic medications use (OR=2.888; p=≤.05), and reduced use of antidepressants (OR=.321; p=.001) were significantly associated with SLE after regression analyses. Mediation analyses showed that the association between current use of antidepressants and SLE was mediated by previous psychiatric medications.

CONCLUSION

Having a family history of suicide, history of psychotropic medications use, and reduced use of antidepressants is linked to a specific "at risk" profile characterized by the enhanced vulnerability to experience SLE.

Systematic Review of Meta-Analyses: Exercise Effects on Depression in Children and Adolescents

BACKGROUND

Depression is a common threat to children and adolescents in terms of affecting psychosocial development and increasing their risk of suicide. Apart from conventional treatments for depression, physical exercise has become a promising alternative. This paper aims to systematically review the existing meta-analyses that focus on the impact of physical exercise on clinical and nonclinical depression in children and adolescents.

METHODS

A systematic literature search was conducted using PsycINFO, PsycARTICLES, MedLine, PubMed, and hand searching. Risk of bias analysis, effect sizes calculations, and evaluation of the methodological characteristics (AMSTAR 2) were carried out.

RESULTS

Four meta-analyses met the inclusion criteria. After analysing the overlap, the total sample contained 30 single studies (mostly including gender mixed samples) and 2,110 participants (age range 5-20 years). The medium duration of the interventions was 11.5 weeks. The sessions had a medium length of 41 min, and the frequency of implementation was three sessions per week. The most implemented intervention type was aerobic exercise, while control groups mainly continued with their regular routine, among other related options. The overall mean effect of physical exercise on depression was medium (d = -0.50). The additional analysis in clinically depressed samples documented a small to medium mean effect (d = -0.48) in favor of the intervention.

CONCLUSION

The small to medium but consistently positive effects that were found in the present study place physical exercise as a promising and helpful alternative for children and adolescents with clinical and nonclinical depression. The limited literature focused on children and adolescents in comparison with adult samples points to the need for further research.

Why Do People With Depression Use Faulty Emotion Regulation Strategies?

Why do people with psychopathology use less adaptive and more maladaptive strategies for negative emotions if such usage has self-destructive consequences? Although researchers have examined the reasons for people’s engagement in maladaptive “behaviors,” such as nonsuicidal self-injury, surprisingly little attention has been paid to the reasons why people might endorse maladaptive emotion regulation (ER) strategies. This article addresses this question, focusing on the case of depression, evaluating an array of 10 possible explanations. After considering the existing evidence, we provide a blueprint to help the field reach stronger conclusions about depression and other forms of psychopathology. Better understanding of the origins of healthy/unhealthy ER has implications for clinical science, clinical practice, as well as their integration.

Continuity of genetic and environmental influences on clinically assessed major depression from ages 18 to 45

BACKGROUND

Studies on the stability of genetic risk for depression have relied on self-reported symptoms rather than diagnoses and/or short follow-up time. Our aim is to determine to what degree genetic and environmental influences on clinically assessed major depressive disorder (MDD) are stable between age 18 and 45.

METHODS

A population-based sample of 11 727 twins (6875 women) born between 1967 and 1991 was followed from 2006 to 2015 in health registry data from primary care that included diagnoses provided by treating physicians. Individuals with schizophrenia or bipolar disorder (n = 163) were excluded. We modelled genetic and environmental risk factors for MDD in an accelerated longitudinal design.

RESULTS

The best-fitting model indicated that genetic influences on MDD were completely stable from ages 18 to 45 and explained 38% of the variance. At each age, the environmental risk of MDD was determined by the risk at the preceding observation, plus new environmental risk, with an environmental correlation of +0.60 over 2 years. The model indicated no effects of shared environment and no environmental effects stable throughout the observational period. All long-term stability was therefore explained by genetic factors.

CONCLUSIONS

Different processes unfolded in the genetic and environmental risk for MDD. The genetic component is stable from later adolescence to middle adulthood and accounted for nearly all long-term stability. Therefore, molecular genetic studies can use age-heterogenous samples when investigating genetic risk variants of MDD. Environmental risk factors were stable over a short span of years with associations rapidly decreasing and no evidence of permanent environmental scarring.

Interpersonal childhood adversity and stress generation in adolescence: Moderation by HPA axis multilocus genetic variation

Research suggests that childhood adversity (CA) is associated with a wide range of repercussions, including an increased likelihood of interpersonal stress generation. This may be particularly true following interpersonal childhood adversity (ICA) and for youth with high hypothalamic-pituitary-adrenal (HPA) axis-related genetic risk. In the current study, we applied a multilocus genetic profile score (MGPS) approach to measuring HPA axis-related genetic variation and examined its interaction with ICA to predict interpersonal stress generation in a sample of adolescents aged 14–17 (N = 241, Caucasian subsample n = 192). MGPSs were computed using 10 single nucleotide polymorphisms from HPA axis-related genes (CRHR1, NRC31, NRC32, and FKBP5). ICA significantly predicted greater adolescent interpersonal dependent stress. Additionally, MGPS predicted a stronger association between ICA and interpersonal dependent (but not independent or noninterpersonal dependent) stress. No gene–environment interaction (G×E) effects were found for noninterpersonal CA and MGPS in predicting adolescent interpersonal dependent stress. Effects remained after controlling for current depressive symptoms and following stratification by race. Findings extend existing G×E research on stress generation to HPA axis-related genetic variation and demonstrate effects specific to the interpersonal domain.

Serotonergic multilocus genetic variation moderates the association between major interpersonal stress and adolescent depressive symptoms: Replication and candidate environment specification

Serotonin-linked genetic risk and stressful life event (SLE) interaction research has been criticized for using single genetic variants with inconsistent replicability. A recent study showed that a multilocus genetic profile score (MGPS) capturing additive risk from five serotonin-linked polymorphisms moderated the association between major interpersonal SLEs and depression, but no subsequent replication attempts have been reported. Moreover, major interpersonal SLEs have been suggested as "candidate environments" for this MGPS, but it has never been demonstrated that gene-environment interactions (G × Es) for major interpersonal SLEs are significantly stronger than for other contexts. Adolescents (N = 241) completed contextual-threat life stress interviews and clinical interviews assessing depressive symptoms, and provided DNA. MGPS intensified the major interpersonal stress-depression association; the interaction accounted for 4% of depressive symptom variance. Genetic moderation was statistically unique to major interpersonal stress versus other environments. Extending previous findings, results support an MGPS approach and underscore the cruciality of the G × E candidate environment.

An evolutionary medicine perspective on pain and its disorders

Enormous progress in understanding the mechanisms that mediate pain can be augmented by an evolutionary medicine perspective on how the capacity for pain gives selective advantages, the trade-offs that shaped the mechanisms, and evolutionary explanations for the system's vulnerability to excessive and chronic pain. Syndromes of deficient pain document tragically the utility of pain to motivate escape from and avoidance of situations causing tissue damage. Much apparently excessive pain is actually normal because the cost of more pain is often vastly less than the cost of too little pain (the smoke detector principle). Vulnerability to pathological pain may be explained in part because natural selection has shaped mechanisms that respond adaptively to repeated tissue damage by decreasing the pain threshold and increasing pain salience. The other half of an evolutionary approach describes the phylogeny of pain mechanisms; the apparent independence of different kinds of pain is of special interest. Painful mental states such as anxiety, guilt and low mood may have evolved from physical pain precursors. Preliminary evidence for this is found in anatomic and genetic data. Such insights from evolutionary medicine may help in understanding vulnerability to chronic pain.

This article is part of the Theo Murphy meeting issue ‘Evolution of mechanisms and behaviour important for pain’.

Cortisol, Testosterone, and Prospective Risk for War-zone Stress-Evoked Depression

Introduction

The major challenges of efforts to reveal biological risk factors and biomarkers of depression include the complexity of underlying systems, interactions with other systems, and contextual factors governing their expression. Altered endocrine function is believed to be a central contributor to depressive illness, but across studies, evidence for a link between endocrine markers and depression has been mixed, inconclusive, or conditional in nature. In the present study, we evaluated basal testosterone (T), cortisol (C), and CO2 inhalation-stress-reactivity measures of these hormones (TR, CR) as pre-deployment moderators of the later impact of war-zone stressors on depression symptoms in-theater.

Materials and Methods

At pre-deployment, U.S. soldiers (N = 120) completed demographic, clinical and hormone measures, and during deployment, they completed monthly, web-based assessments of war-zone stressors and depression symptoms (N = 533 observations). Mixed effects models estimated the effects of the pre-deployment hormone profiles in moderating war-zone stressors' impact on in-theater depression. Models also tested whether hormonally linked risk for later stress-evoked depression depends on pre-existing depression.

Results

Controlling for pre-deployment depression, high T was protective; whereas TR had depressogenic effects that were amplified by pre-deployment depression. Further, high C was protective, but heightened CR was depressogenic, but only among those with elevated pre-deployment depression.

Conclusions

Findings highlight the importance of examining basal and reactivity measures of endocrine function, and use of prospective, longitudinal models to test hypothesized causal pathways associated with depression vulnerability in the war-zone. Results also suggest that pre-existing depression and cortisol may work in tandem to increase vulnerability for later stress-evoked depression in the war-zone.

Resting state coupling between the amygdala and ventromedial prefrontal cortex is related to household income in childhood and indexes future psychological vulnerability to stress

While child poverty is a significant risk factor for poor mental health, the developmental pathways involved with these associations are poorly understood. To advance knowledge about these important linkages, the present study examined the developmental sequelae of childhood exposure to poverty in a multiyear longitudinal study. Here, we focused on exposure to poverty, neurobiological circuitry connected to emotion dysregulation, later exposure to stressful life events, and symptoms of psychopathology. We grounded our work in a biopsychosocial perspective, with a specific interest in "stress sensitization" and emotion dysregulation. Motivated by past work, we first tested whether exposure to poverty was related to changes in the resting-state coupling between two brain structures centrally involved with emotion processing and regulation (the amygdala and the ventromedial prefrontal cortex; vmPFC). As predicted, we found lower household income at age 10 was related to lower resting-state coupling between these areas at age 15. We then tested if variations in amygdala-vmPFC connectivity interacted with more contemporaneous stressors to predict challenges with mental health at age 16. In line with past reports showing risk for poor mental health is greatest in those exposed to early and then later, more contemporaneous stress, we predicted and found that lower vmPFC-amygdala coupling in the context of greater contemporaneous stress was related to higher levels of internalizing and externalizing symptoms. We believe these important interactions between neurobiology and life history are an additional vantage point for understanding risk and resiliency, and suggest avenues for prediction of psychopathology related to early life challenge.

Adolescents' personal beliefs about sufficient physical activity are more closely related to sleep and psychological functioning than self-reported physical activity: A prospective study

BACKGROUND

Preliminary evidence among adults suggests that the ways in which individuals think about their physical activity (PA) behavior is more closely associated with their well-being than self-reported PA. This study therefore aimed to examine whether and how self-reported PA and personal beliefs about sufficient PA are associated with sleep and psychological functioning in a sample of Swiss adolescents, using both cross-sectional and prospective data.

METHODS

An overall sample of 864 vocational students (368 girls, 17.98 ± 1.36 years, mean ± SD) was followed prospectively over a 10-month period. At each measurement occasion, participants filled in a series of self-report questionnaires to assess their PA levels, their personal beliefs about whether or not they engage in sufficient PA, sleep (insomnia symptoms, sleep quality, sleep-onset latency, and number of awakenings), and psychological functioning (depressive symptoms, quality of life, perceived stress, and mental toughness).

RESULTS

Adolescents who believe that they are sufficiently physically active to maintain good health reported more restoring sleep. No differences in sleep were found between adolescents who meet PA recommendations vs. those who do not. Additionally, adolescents who believe that they were sufficiently physically active also reported better psychological functioning. This close relationship between adolescents' beliefs about their PA involvement and their sleep and psychological functioning was corroborated in the prospective analyses.

CONCLUSION

Cognitive factors should be studied more intensively when elucidating the relationship among PA, sleep, and psychological functioning in young people, particularly when aiming to develop new exercise interventions targeting psychological outcomes.

Resting-state mapping of neural signatures of vulnerability to depression relapse

BACKGROUND

Patients with major depressive disorder (MDD) can frequently develop new depressive episodes after remission. However, the neural mechanisms underlying the increased risk for depressive relapse remain unclear. Herein, we aimed to explore whether the specific changes to regional and inter-regional spontaneous brain activities within DMN are associated with the course of episodes in pooled MDD patients.

METHODS

Resting-state functional magnetic resonance imaging was performed on patients with single-episode MDD (SEMDD, n = 30) and multiple-episode MDD (MEMDD, n = 54), and 71 age-, gender-, and educational level-matched healthy controls (HCs). We then accessed the differences in both the fractional amplitude of low-frequency fluctuations (fALFF) and functional connectivity by using the right precuneus as the seed among different groups.

RESULTS

Compared to the MEMDD and HC groups, the SEMDD group exhibited increased fALFF values in the right subgenual anterior cingulate cortex and right middle temporal gyrus. Decreased fALFF values in the right thalamus in the MEMDD group were also identified relative to the SEMDD and HC group. The peak values of fALFF in the right precuneus showed a negative correlation with the number of depressive episodes across the entire pool of MDD patients. No correlation was identified between functional connectivity using the right precuneus as the seed and the number of depressive episodes for the pooled MDD patients.

LIMITATIONS

Medication, a relatively small sample size, and hypothesis driven study.

CONCLUSIONS

Our neuroimaging results identified depression relapse-associated neural signatures and also indicated the role of reduced emotional appraisals in the thalamus. It is now possible to believe that the regional activity not inter-regional connectivity within the DMN may be involved in the pathology of depression relapse.

Role of inflammation in depression relapse

Major depressive disorder (MDD) is a leading cause of disability worldwide. After the first episode, patients with remitted MDD have a 60% chance of experiencing a second episode. Consideration of therapy continuation should be viewed in terms of the balance between the adverse effects of medication and the need to prevent a possible relapse. Relapse during the early stages of MDD could be prevented more efficiently by conducting individual risk assessments and providing justification for continuing therapy. Our previous work established the neuroimaging markers of relapse by comparing patients with recurrent major depressive disorder (rMDD) in depressive and remitted states. However, it is not known which of these markers are trait markers that present before initial relapse and, consequently, predict disease course. Here, we first describe how inflammation can be translated to subtype-specific clinical features and suggest how this could be used to facilitate clinical diagnosis and treatment. Next, we address the central and peripheral functional state of the immune system in patients with MDD. In addition, we emphasize the important link between the number of depressive episodes and rMDD and use neuroimaging to propose a model for the latter. Last, we address how inflammation can affect brain circuits, providing a possible mechanism for rMDD. Our review suggests a link between inflammatory processes and brain region/circuits in rMDD.

Emerging Adulthood and Prospective Depression: A Simultaneous Test of Cumulative Risk Theories

Past research indicates that a history of depression and exposure to abuse and neglect represent some of the most robust predictors of depression in emerging adults. However, studies rarely test the additive or interactive risk associated with these distinct risk factors. In response, the present study explored how these three risk factors (prior depression, abuse, and neglect) synergistically predicted prospective depressive symptoms in a sample of 214 emerging adults (M_age = 21.4 years; SD_age = 2.4; 78% females). Subtypes of maltreatment and lifetime history of depression were assessed through semi-structured interviews, and depressive symptoms were assessed annually for three years via self-report measures. The results indicated that for both males and females, a lifetime history of depression, abuse, and neglect-exposure uniquely conferred risk for elevated depressive symptoms. Furthermore, the interaction between neglect and prior depression forecasted increasing depressive symptoms, and a history of abuse also predicted increasing depressive symptoms, but only in females. These findings are contextualized within extant developmental psychopathology theories, and translational implications for trauma-informed depression prevention efforts are discussed.

The psychological scars of suicide: Accounting for how risk for suicidal behavior is heightened by its past occurrence

Not only is suicidal behavior strongly predicted by its past occurrence, but the risk for recurrence appears to increase with each subsequent attempt. The current paper discusses a potential explanation for this phenomenon, that suicide attempts may leave a residual psychological scar that heightens risk for future attempts. This possibility is evaluated against two alternatives: (i) risk for first and subsequent suicide attempts is accounted for by a shared diathesis pre-existing the first lifetime attempt, and (ii) different rates of developmental decline in risk factors account for differences in prospective number of attempts. In this discussion, a formalized conceptual framework of psychological scarring is presented, along with considerations of particular relevance to its study. Finally, the clinical implications of determining the processes underlying the association between suicide attempts and heightened risk for recurrence are discussed.

Predictors of depression relapse and recurrence after cognitive behavioural therapy: a systematic review and meta-analysis

BACKGROUND

Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and longer-term recurrence.

AIM

This systematic review and meta-analysis aimed to identify factors associated with an increased risk of relapse and/or recurrence (RR) after CBT for depression.

METHOD

We reviewed 13 relevant papers, of which a small set of unique samples were eligible for meta-analysis (k = 5, N = 369). Twenty-six predictor variables were identified and grouped into seven categories: residual depressive symptoms; prior episodes of depression; cognitive reactivity; stressful life events; personality factors; clinical and diagnostic factors; demographics.

RESULTS

Meta-analyses indicated that residual depressive symptoms (r = 0.34 [0.10, 0.54], p = .01) and prior episodes (r = 0.19 [0.07, 0.30], p = .002) were statistically significant predictors of RR, but cognitive reactivity was not (r = 0.18 [-0.02, 0.36], p = .08). Other variables lacked replicated findings. On average, 33.4% of patients experienced RR after CBT.

CONCLUSIONS

Patients with the above risk factors could be offered evidence-based continuation-phase interventions to enhance the longer-term effectiveness of CBT.

The Impact of Stress and Major Depressive Disorder on Hippocampal and Medial Prefrontal Cortex Morphology

Volumetric reductions in the hippocampus and medial prefrontal cortex (mPFC) are among the most well-documented neural abnormalities in major depressive disorder (MDD). Hippocampal and mPFC structural reductions have been specifically tied to MDD illness progression markers, including greater number of major depressive episodes (MDEs), longer illness duration, and nonremission/treatment resistance. Chronic stress plays a critical role in the development of hippocampal and mPFC deficits, with some studies suggesting that these deficits occur irrespective of MDE occurrence. However, preclinical and human research also points to other stress-mediated neurotoxic processes, including enhanced inflammation and neurotransmitter disturbances, which may require the presence of an MDE and contribute to further brain structural decline as the illness advances. Specifically, hypothalamic-pituitary-adrenal axis dysfunction, enhanced inflammation and oxidative stress, and neurotransmitter abnormalities (e.g., serotonin, glutamate, gamma-aminobutyric acid) likely interact to facilitate illness progression in MDD. Congruent with stress sensitization models of MDD, with each consecutive MDE it may take lower levels of stress to trigger these neurotoxic pathways, leading to more pronounced brain volumetric reductions. Given that stress and MDD have overlapping and distinct influences on neurobiological pathways implicated in hippocampal and mPFC structural decline, further work is needed to clarify which precise mechanisms ultimately contribute to MDD development and maintenance.

Cognitive and attentional vulnerability to depression in youth: A review

Although depressive disorders are among the most common disorders in youth, highly efficacious treatments for childhood affective disorders are lacking. There is significant need to better understand the factors that contribute to the development and maintenance of depression in youth so that treatments can be targeted at optimal mechanisms. The aim of the current paper was to synthesize research on cognitive and neurobiological factors associated with youth depression, guided by De Raedt and Koster's model (2010) for vulnerability to depression in adults. Consistent with model predictions, there is evidence that attentional impairments are greatest in the context of negative information, relative to positive or neutral information, and some evidence that attentional deficits are associated with rumination in depressed youth. However, we found little evidence for the model's assumption that attentional bias is an etiological and maintenance factor for depression. There are several other model predictions that require additional study as current data are lacking. Overall, De Raedt and Koster's (2010) integrative cognitive and biological framework has tremendous potential to move the field forward in understanding the development of depression in youth. Additional longitudinal studies incorporating measures across biological and cognitive levels of analysis are needed.

Sex differences in major depression and comorbidity of cardiometabolic disorders: impact of prenatal stress and immune exposures

Major depressive disorder topped ischemic heart disease as the number one cause of disability worldwide in 2012, and women have twice the risk of men. Further, the comorbidity of depression and cardiometabolic disorders will be one of the primary causes of disability worldwide by 2020, with women at twice the risk. Thus, understanding the sex-dependent comorbidities has public health consequences worldwide. We propose here that sex differences in MDD-cardiometabolic comorbidity originate, in part, from pathogenic processes initiated in fetal development that involve sex differences in shared pathophysiology between the brain, the vascular system, the CNS control of the heart and associated hormonal, immune, and metabolic physiology. Pathways implicate neurotrophic and angiogenic growth factors, gonadal hormone receptors, and neurotransmitters such as gamma amino butyric acid (GABA) on neuronal and vascular development of HPA axis regions, such as the paraventricular nucleus (PVN), in addition to blood pressure, in part through the renin-angiotensin system, and insulin and glucose metabolism. We show that the same prenatal exposures have consequences for sex differences across multiple organ systems that, in part, share common pathophysiology. Thus, we believe that applying a sex differences lens to understanding shared biologic substrates underlying these comorbidities will provide novel insights into the development of sex-dependent therapeutics. Further, taking a lifespan perspective beginning in fetal development provides the opportunity to target abnormalities early in the natural history of these disorders in a sex-dependent way.

Past-year relational victimization is associated with a blunted neural response to rewards in emerging adults

Anhedonia is associated with multiple forms of psychopathology, yet relatively, little is known about how anhedonia develops. Emerging evidence suggests that anhedonia is the result of interactions between life stress and the brain's reward systems, and that social stress, in particular, may drive these processes. One potent form of social stress is peer victimization, but very little research has focused on peer victimization beyond adolescence, and even less has examined the associations between peer victimization and neural response to rewards. The present study sought to identify associations between past-year history of peer victimization and neural response to rewards in emerging adults (N = 61). Relational and physical forms of victimization were assessed separately since these distinct types of social stress have different trajectories across development and different associations with psychopathology. Reward sensitivity was indexed with the event-related potential component known as the reward positivity, which was elicited using a forced-choice monetary reward guessing task. Results demonstrated that past-year relational, but not physical, victimization was associated with a blunted neural response to rewards. These findings provide insight into one potential mechanism in the etiology of anhedonia, which may, in turn, help us to better identify pathways to multiple psychopathologies.

The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders

Sleep reactivity is the trait-like degree to which stress exposure disrupts sleep, resulting in difficulty falling and staying asleep. Individuals with highly reactive sleep systems experience drastic deterioration of sleep when stressed, whereas those with low sleep reactivity proceed largely unperturbed during stress. Research shows that genetics, familial history of insomnia, female gender and environmental stress influence how the sleep system responds to stress. Further work has identified neurobiological underpinnings for sleep reactivity involving disrupted cortical networks and dysregulation in the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Sleep reactivity is most pathologically and clinically pertinent when in excess, such that high sleep reactivity predicts risk for future insomnia disorder, with early evidence suggesting high sleep reactivity corresponds to severe insomnia phenotypes (sleep onset insomnia and short sleep insomnia). High sleep reactivity is also linked to risk of shift-work disorder, depression and anxiety. Importantly, stress-related worry and rumination may exploit sensitive sleep systems, thereby augmenting the pathogenicity of sleep reactivity. With the development of cost-effective assessment of sleep reactivity, we can now identify individuals at risk of future insomnia, shift-work disorder and mental illness, thus identifying a target population for preventive intervention. Given that insomniacs with high sleep reactivity tend to present with severe insomnia phenotypes, patient sleep reactivity may inform triaging to different levels of treatment. Future research on sleep reactivity is needed to clarify its neurobiology, characterize its long-term prospective associations with insomnia and shift-work disorder phenotypes, and establish its prognostic value for mental illness and other non-sleep disorders.

Prospective prediction of first lifetime onset of suicidal ideation in a national study of substance users

Suicide rates have increased over the past several decades. Prior research has evaluated risk factors for suicidal behavior, but much of this work does not adequately differentiate between risk factors for suicidal ideation (SI) and suicide attempts, nor does it differentiate between first-onset SI and recurrent ideation. This study seeks to identify risk factors for first-onset SI among a high-risk group: individuals receiving treatment for substance use disorders. Data were drawn from the National Treatment Improvement Evaluation Study, a prospective study examining the impact of addiction treatment programs. Patients with no lifetime history of suicide attempts or ideation (n = 2560) were assessed at baseline and one year later for prospectively-occurring SI. Sociodemographic variables, mental health indices, interpersonal factors, and substance use severity indicators were evaluated as prospective predictors of first-onset SI in linear regression models. Current mental health problems (OR = 1.54, 95% CI = 1.19-2.01), current substance use problems (OR = 1.33, 95% CI = 1.04-1.70), and difficulty accessing treatment for substance use problems (OR = 1.90, 95% CI = 1.16-3.11) emerged as significant predictors of first-onset SI in a multivariate analysis, suggesting that individuals with current mental health or substance use related symptoms are among the most at risk for developing SI. Difficulty obtaining treatment remained significant, highlighting the importance of treatment accessibility. Future clinical work and research would benefit by addressing these issues, potentially by focusing on mental health treatment in substance abuse programs and evaluating barriers to treatment.

The association between the number of previous episodes and modifiable vulnerability factors in remitted patients with recurrent depression

Objective

Remitted patients with a history of several previous major depressive episodes have a higher risk of relapse/recurrence than patients with fewer previous episodes, and the probability of another episode increases progressively with each successive episode. This study examines the association between the number of previous episodes and modifiable vulnerability factors in remitted patients with recurrent depression.

Methods

Patients with recurrent depression (DSM-IV-diagnosed) who were in remission (N = 214) were recruited between September 2011 and July 2016. The association was examined between the number of previous episodes and the following factors: i.e. interpersonal functioning, daily stress, sense of mastery, coping and dysfunctional beliefs.

Results

A history of more previous episodes was associated with higher levels of interpersonal problems (P < .001), daily stress (P = .04) and a lower sense of mastery (P = .05). Interpersonal problems were most strongly associated with more previous episodes in a Generalized Linear Regression model. In the domain of interpersonal problems, the subscales that showed the strongest relationship were domineering/controlling, vindictive/self-centred, socially inhibited and self-sacrificing.

Conclusions

Patients with a history of more depressive episodes reported higher levels of interpersonal problems, daily stress and a lower sense of mastery. Future studies should examine these factors in a longitudinal cohort and look at whether the effect of interventions to prevent relapse can be explained by targeting these psychological factors.

Trial registration

Netherlands Trial Register: 2599.

Loneliness effects on personality

Individuals feel lonely when they perceive a discrepancy between their desired and their actually experienced quantity and quality of social relationships. Prior research has demonstrated the importance of loneliness for various health-related aspects. In the present article, we extend the existing literature on loneliness by investigating its role for predicting personality traits and their development from late adolescence to early midlife. Using data from a representative German sample ( N = 12,402) sampling individuals from three different birth cohorts, we found loneliness to predict the levels of all Big Five traits except openness five years later. The effects of loneliness on the development of neuroticism and extraversion reached statistical significance but were only marginal in terms of effect size. Furthermore, we found that a self-regulatory focus geared to the prevention of negative events mediated the effects of loneliness on later levels of the Big Five.

Cognitive Vulnerability and Stress for Emotional and Behavioral Problems in Children and Adolescents: A Longitudinal Study

The present study investigated Beck's cognitive diathesis-stress theory (1967, 1987) for the prediction of emotional and behavioral problems in childhood. The study included 218 participants aged 10 to 16 years (M = 12.38, SD = 1.16) who underwent two evaluations with an interval of 8.4 months between them. In the first evaluation, sample was divided according to the participants' cognitive vulnerability (vulnerable, moderate, resilient) and in the second, by their experience of stressful events in recent months (low risk, moderate risk, high risk). The groups were compared by variation in the intensity of the symptoms over time. Results showed that high-risk cognitively vulnerable children had increased externalizing symptoms and children with moderate and high cognitive vulnerability had increased internalizing symptoms at Time 2. These results suggest the importance of considering dysfunctional cognitions and the existence of a certain level of stressful events for the development of psychopathology in childhood.

Functioning before and after a major depressive episode: pre-existing vulnerability or scar? A prospective three-wave population-based study

BACKGROUND

The vulnerability hypothesis suggests that impairments after remission of depressive episodes reflect a pre-existing vulnerability, while the scar hypothesis proposes that depression leaves residual impairments that confer risk of subsequent episodes. We prospectively examined vulnerability and scar effects in mental and physical functioning in a representative Dutch population sample.

METHODS

Three waves were used from the Netherlands Mental Health Survey and Incidence Study-2, a population-based study with a 6-years follow-up. Mental and physical functioning were assessed with the Medical Outcomes Study Short Form (SF-36). Major depressive disorder (MDD) was assessed with the Composite International Diagnostic Interview 3.0. Vulnerability effects were examined by comparing healthy controls (n = 2826) with individuals who developed a first-onset depressive episode during first follow-up but did not have a lifetime diagnosis of MDD at baseline (n = 181). Scarring effects were examined by comparing pre- and post-morbid functioning in individuals who developed a depressive episode after baseline that was remitted at the third wave (n = 108).

RESULTS

Both mental (B = -5.4, s.e. = 0.9, p < 0.001) and physical functioning (B = -8.2, s.e. = 1.1, p < 0.001) at baseline were lower in individuals who developed a first depressive episode after baseline compared with healthy controls. This effect was most pronounced in people who developed a severe episode. No firm evidence of scarring in mental or physical functioning was found. In unadjusted analyses, physical functioning was still lowered post-morbidly (B = -5.1, s.e. = 2.1, p = 0.014), but this effect disappeared in adjusted analyses.

CONCLUSIONS

Functional impairments after remission of depression seem to reflect a pre-existing vulnerability rather than a scar.

Association between Perceived Stressfulness of Stressful Life Events and the Suicidal Risk in Chinese Patients with Major Depressive Disorder

Background

Patients with major depressive disorder (MDD) usually have high risk of suicidality. Few studies have investigated the effects of stressful life events (SLEs) on the risk of suicide in Chinese patients who have developed MDD. This study aimed to investigate the impact of SLEs on suicidal risk in Chinese patients with MDD.

Methods

In total, 1029 patients with MDD were included from nine psychiatric hospitals to evaluate the impact of SLEs on suicidal risk. Patients fulfilling the Mini-International Neuropsychiatric Interview (MINI) criteria for MDD were included in the study. Patients were excluded if they had lifetime or current diagnoses of psychotic disorder, bipolar disorder, and alcohol or substance dependence. Depressive symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17). The suicidal risk of MDD patients was determined by the suicide risk module of MINI. SLEs were assessed by the Life Events Scale.

Results

No gender difference was found for suicidal risk in MDD patients. Patients with suicidal risk had younger ages, lower education levels, more drinking behavior, and lower marriage rate, and fewer people had child and more severe depressive symptoms than nonsuicidal risk group. High-level perceived stressfulness (HPS) and number of SLEs that patients were exposed to were significantly greater in patients with suicidal risk than patients without. In multivariate logistic analysis, HPS of SLEs (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.16-2.05, P = 0.003) and depressive symptoms (OR = 1.08, 95% CI: 1.05-1.11, P < 0.001) were associated with suicidal risk even after adjustment of gender, age, marriage, drinking behavior, and childless.

Conclusions

HPS of SLEs is associated with suicide risk in Chinese patients with MDD. Further suicide prevention programs targeting this risk factor are needed.

Trial Registration

ClinicalTrials.gov: NCT02023567; https://clinicaltrials.gov/ct2/show/NCT02023567?term=NCT02023567&rank=1.

All for One and One for All: Mental Disorders in One Dimension

In both child and adult psychiatry, empirical evidence has now accrued to suggest that a single dimension is able to measure a person's liability to mental disorder, comorbidity among disorders, persistence of disorders over time, and severity of symptoms. This single dimension of general psychopathology has been termed "p," because it conceptually parallels a dimension already familiar to behavioral scientists and clinicians: the "g" factor of general intelligence. As the g dimension reflects low to high mental ability, the p dimension represents low to high psychopathology severity, with thought disorder at the extreme. The dimension of p unites all disorders. It influences present/absent status on hundreds of psychiatric symptoms, which modern nosological systems typically aggregate into dozens of distinct diagnoses, which in turn aggregate into three overarching domains, namely, the externalizing, internalizing, and psychotic experience domains, which finally aggregate into one dimension of psychopathology from low to high: p. Studies show that the higher a person scores on p, the worse that person fares on measures of family history of psychiatric illness, brain function, childhood developmental history, and adult life impairment. A dimension of p may help account for ubiquitous nonspecificity in psychiatry: multiple disorders share the same risk factors and biomarkers and often respond to the same therapies. Here, the authors summarize the history of the unidimensional idea, review modern research into p, demystify statistical models, articulate some implications of p for prevention and clinical practice, and outline a transdiagnostic research agenda. [AJP AT 175: Remembering Our Past As We Envision Our Future October 1910: A Study of Association in Insanity Grace Helen Kent and A.J. Rosanoff: "No sharp distinction can be drawn between mental health and mental disease; a large collection of material shows a gradual and not an abrupt transition from the normal state to pathological states."(Am J Psychiatry 1910; 67(2):317-390 )].

Adolescent oxytocin response to stress and its behavioral and endocrine correlates

Oxytocin (OXT) shows anxiolytic and stress-reducing effects, but salivary OXT response to laboratory-induced stress has only been assessed in one study in healthy adults. The present study aimed at extending these findings by assessing salivary OXT stress reactivity in healthy adolescents (aged 11-18) compared to a control condition. A higher salivary OXT response to stress compared to the control condition was expected. In addition, the association between OXT, cortisol (CORT) and psychological reactivity patterns was explored. Psychosocial stress was induced using the Trier Social Stress Test (TSST; 13 males, 15 females), while the Control-TSST (14 males, 15 females) served as a non-stress control condition. Salivary OXT increased in response to the TSST with a peak at +1 and decline at +10 min after stress. Baseline OXT correlated negatively with experienced anxiety and insecurity, while both correlated positively with OXT reactivity. OXT and CORT increase as well as OXT increase and CORT recovery were positively correlated. Results indicate that salivary OXT in response to the TSST is a valid method to assess biological effects of laboratory-induced stress also in adolescents. Due to a rapid increase and decline, salivary OXT needs to be assessed directly after stress exposure. Given the interplay of OXT with affective symptoms and CORT response, the combined measure of salivary OXT and CORT reactivity adds to studying stress reactivity in typically developing and clinical samples.

How resilience is strengthened by exposure to stressors: the systematic self-reflection model of resilience strengthening

BACKGROUND

Exposure to demands is normally considered to drain resources and threaten wellbeing. However, studies have indicated a resilience-strengthening role for stressors.

OBJECTIVES

This paper introduces a unifying model, including five testable hypotheses regarding how resilience can be strengthened progressively via exposure to life-stressors.

METHODS

We review and synthesize relevant scholarship that underpins the Systematic Self-Reflection model of resilience-strengthening.

RESULTS

The model highlights the importance of a specific meta-cognitive skill (self-reflection on one's initial stressor response) as a mechanism for strengthening resilience. The Systematic Self-Reflection model uniquely proposes five self-reflective practices critical in the on-going adaptation of three resilient capacities: (1) coping resources, (2) usage of coping and emotional regulatory repertoire, and (3) resilient beliefs. The self-reflective process is proposed to strengthen a person's resilience by developing insight into their already-present capacities, the limitations of these capacities, and by stimulating the search for person-driven alternative approaches.

CONCLUSION

This model extends the existing scholarship by proposing how the experience of stressors and adversity may have resilience-strengthening opportunities. The implication of this model is that engaging with stressors can have positive consequences for longer-term healthy emotional development if scaffolded in adaptive reflective practices.

Risk factors for relapse and recurrence of depression in adults and how they operate: A four-phase systematic review and meta-synthesis

PURPOSE

To review and synthesise prognostic indices that predict subsequent risk, prescriptive indices that moderate treatment response, and mechanisms that underlie each with respect to relapse and recurrence of depression in adults.

RESULTS AND CONCLUSIONS

Childhood maltreatment, post-treatment residual symptoms, and a history of recurrence emerged as strong prognostic indicators of risk and each could be used prescriptively to indicate who benefits most from continued or prophylactic treatment. Targeting prognostic indices or their "down-stream" consequences will be particularly beneficial because each is either a cause or a consequence of the causal mechanisms underlying risk of recurrence. The cognitive and neural mechanisms that underlie the prognostic indices are likely addressed by the effects of treatments that are moderated by the prescriptive factors. For example, psychosocial interventions that target the consequences of childhood maltreatment, extending pharmacotherapy or adapting psychological therapies to deal with residual symptoms, or using cognitive or mindfulness-based therapies for those with prior histories of recurrence. Future research that focuses on understanding causal pathways that link childhood maltreatment, or cognitive diatheses, to dysfunction in the neocortical and limbic pathways that process affective information and facilitate cognitive control, might result in more enduring effects of treatments for depression.

The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features

There is tremendous recent interest in chronic traumatic encephalopathy (CTE) in former collision sport athletes, civilians, and military veterans. This critical review places important recent research results into a historical context. In 2015, preliminary consensus criteria were developed for defining the neuropathology of CTE, which substantially narrowed the pathology previously reported to be characteristic. There are no agreed upon clinical criteria for diagnosis, although sets of criteria have been proposed for research purposes. A prevailing theory is that CTE is an inexorably progressive neurodegenerative disease within the molecular classification of the tauopathies. However, historical and recent evidence suggests that CTE, as it is presented in the literature, might not be pathologically or clinically progressive in a substantial percentage of people. At present, it is not known whether the emergence, course, or severity of clinical symptoms can be predicted by specific combinations of neuropathologies, thresholds for accumulation of pathology, or regional distributions of pathologies. More research is needed to determine the extent to which the neuropathology ascribed to long-term effects of neurotrauma is static, progressive, or both. Disambiguating the pathology from the broad array of clinical features that have been reported in recent studies might facilitate and accelerate research- and improve understanding of CTE.

Resting frontal brain asymmetry is linked to future depressive symptoms in women

This longitudinal pilot study examined whether baseline resting frontal electroencephalographic (EEG) asymmetry correlates with depressive symptoms during the most impaired two-week period in the following year. Current-source-density (CSD) transformed resting frontal EEG asymmetry, severity of depression symptoms (Beck Depression Inventory - II), and stress (indexed by negative life events; NLE) were recorded in never-depressed young adults with no current DSM-IV diagnosis (38 women, 16 men) at baseline. One year later, depression symptoms and NLEs experienced during the interim were assessed. Individuals who reported greater interim NLEs also endorsed interim higher depression symptoms, a pattern that replicated when first accounting for baseline stress and depression. For women, higher depression reported at follow-up was linked to lower left than right frontal EEG activity at baseline, a pattern that replicated when first accounting for depressive symptoms at baseline. Despite the modest sample size of the present analysis, findings are consistent with prior reports of sex differences in patterns of brain laterality and support the idea that CSD-referenced EEG asymmetry may be a risk marker for future depression in previously healthy young women.