Comparing age at onset of major depression and other psychiatric disorders by birth cohorts in five US community populations

Prevalence and Correlates of Substance Use Among Youth Living with HIV in Fishing Communities in Uganda

Alcohol and drug use (ADU) poses a significant barrier to optimal HIV treatment outcomes for adolescents and youths living with HIV (AYLHIV). We aimed to investigate the prevalence and correlates of ADU among ALHIV in Ugandan fishing communities, areas characterized by high HIV and poverty rates. AYLHIV aged 18-24, who knew they were HIV-positive, were selected from six HIV clinics. Substance use was determined through self-report in the last 12 months and urine tests for illicit substances. Utilizing a socioecological framework, the study structured variables into a hierarchical logistic regression analysis to understand the multi-layered factors influencing ADU. Self-reported past 12 months substance use was 42%, and 18.5% of participants had a positive urine test for one or more substances, with alcohol, benzodiazepines, and marijuana being the most commonly used. With the addition of individual-level socio-demographics, indicators of mental health functioning, interpersonal relationships, and community factors, the logistic regression analysis revealed greater exposure to adverse childhood experiences increased the odds of substance use (Odds Ratio [OR] = 1.24; 95% Confidence Interval [CI]: 1.03-1.55). Additionally, exposure to alcohol advertisements at community events significantly raised the odds of substance use (OR = 3.55; 95% CI: 1.43-8.83). The results underscore the high prevalence among AYLHIV and emphasize the need for comprehensive interventions targeting individual (e.g., life skills education and mental health supports), interpersonal (e.g., peer support and family-based interventions), community (e.g., community engagement programs, restricted alcohol advertisements and illicit drug access), and policies (e.g., integrated care models and a national drug use strategy), to address ADU.

Neuropeptide Y gene variants and Agreeableness: interaction effect with the birth cohort and the serotonin transporter promoter polymorphism

OBJECTIVE

Neuropeptide Y (NPY) is a powerful regulator of anxious states, including social anxiety, but evidence from human genetic studies is limited. Associations of common gene variants with behaviour have been described as subject to birth cohort effects, especially if the behaviour is socially motivated. This study aimed to examine the association of NPY rs16147 and rs5574 with personality traits in highly representative samples of two birth cohorts of young adults, the samples having been formed during a period of rapid societal transition.

METHODS

Both birth cohorts (original n = 1238) of the Estonian Children Personality Behaviour and Health Study (ECPBHS) self-reported personality traits of the five-factor model at 25 years of age.

RESULTS

A significant interaction effect of the NPY rs16147 and rs5574 and birth cohort on Agreeableness was found. The T/T genotype of NPY rs16147 resulted in low Agreeableness in the older cohort (born 1983) and in high Agreeableness in the younger cohort (born 1989). The C/C genotype of NPY rs5574 was associated with higher Agreeableness in the younger but not in the older cohort. In the NPY rs16147 T/T homozygotes, the deviations from average in Agreeableness within the birth cohort were dependent on the serotonin transporter promoter polymorphism.

CONCLUSIONS

The association between the NPY gene variants and a personality domain reflecting social desirability is subject to change qualitatively in times of rapid societal changes, serving as an example of the relationship between the plasticity genes and environment. The underlying mechanism may involve the development of the serotonergic system.

Assessing the Feasibility of Economic Approaches to Prevent Substance Abuse Among Adolescents: Protocol for a Mixed Methods Study

BACKGROUND

Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them.

OBJECTIVE

We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda's fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them.

METHODS

This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group).

RESULTS

Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024.

CONCLUSIONS

Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/46486.

The Impact of COVID-19 Related Distress on Antenatal Depression in Australia

Globally, the impact of COVID-19 on mental health has been significant. Pregnant women are known to be a vulnerable population in relation to mental health. In Australia, there was an unprecedented demand during the pandemic for mental health services, including services for pregnant women. Maternal mental health has unique and enduring features that can significantly shape a child's overall development and poor maternal mental health can have considerable social and economic costs. This cross-sectional study evaluated symptoms of antenatal depression and COVID-19-related distress in a sample of two hundred and sixty-nine pregnant women residing in Australia aged between 20 and 43 (M = 31.79, SD = 4.58), as part of a larger study. Social media advertising was used to recruit participants between September 2020 and November 2021. Prevalence rates for antenatal depression were found to be higher in this study (16.4%) compared with previous Australian prevalence rates (7%). COVID-19 distress in relation to having a baby during a COVID-19 outbreak significantly predicted symptoms of antenatal depression, B = 1.46, p < 0.001. Results from this study suggest that mothers and families may have increased mental health vulnerabilities as a consequence of the pandemic for some time yet.

Risk factors associated with postpartum depression in a high-risk maternity clinic: a cross-sectional study

BACKGROUND

The aim of this study was to evaluate obstetric, epidemiological and social factors related to postpartum depression (PPD) and investigate possible risk factors related to this disorder, in puerperal women who had their childbirth and were referred to the High-Risk Outpatient Clinic.

METHODS

A cross-sectional study from August-December/2019 was carried out. One hundred seventy-one puerperal women were analyzed by filling out an epidemiological questionnaire and the Edinburgh Postpartum Depression Scale (EPDS) Form. Scores ≥10 were considered positive. Research on risk factors for postpartum depression was carried out.

RESULTS

29.8% of mothers had a score related with PPD. Breastfeeding without complication is protective against PPD (P=0.002 and χ²=12.533). In contrast, not having a planned pregnancy (P=0.0175, χ²=5.717), having depression at any stage of life (P=0.013, χ²=6.237), depression during pregnancy (P≤0.0001, χ²=46.201) or having a family history of depression (P=0.001, χ²=10.527), are factors associated with the development of PPD. Moreover, just having depression during pregnancy was found to be a significant risk factor for the occurrence of PPD, increasing the risk of developing this pathology by 12 times (OR=12.891).

CONCLUSIONS

Depression during pregnancy is an important risk factor for the development of PPD. This can easily be detected using the Edinburgh Postpartum Depression Scale and treated in a timely manner.

Reinforcement-based responsiveness, depression, and anhedonia: A multi-method investigation of intergenerational risk

Offspring of depressed parents are at an increased risk for depression. Reward- and punishment-based systems might be mechanisms linking maternal outcomes to offspring depression and anhedonia. The current study was designed to investigate the intergenerational relations between maternal markers of reward and punishment responsiveness and their offspring's depression and anhedonia in a community sample of 40 mother (mean age = 44.5; SD = 6.82) and adolescent (mean age = 14.73; SD = 1.25; 52.5% female) dyads. Maternal markers of reward and punishment responsiveness were captured using self-report, behavioral, and neurophysiological methods, and self-reported depression and anhedonia symptoms were used as outcomes among the adolescent offspring. Maternal self-reported reward responsiveness and punishment learning rates were differentially associated with depression across male and female offspring. Regarding anhedonia, maternal punishment learning rate was positively related to adolescent anhedonia regardless of offspring biological sex. Maternal reward learning rate was also positively associated with anhedonia among male offspring. In general, low concurrence across self-report, behavioral, and neurophysiological markers of reward and punishment responsiveness was found. The results from the current study suggest that learning-rates on reinforcement-based behavioral tasks may be important objective markers to consider when evaluating intergenerational risk.

Psychiatric Disorder Incidence Among Adolescents and Young Adults Aged 15-39 With Cancer: Population-Based Cohort

BACKGROUND

Adolescent and young adult (AYA) cancer survivors face physical and psychological sequelae related to having cancer decades after treatment completion. It is unclear if AYA cancer survivors are at increased risk for late psychiatric disorders.

METHODS

We used the Alberta AYA Cancer Survivor Study that includes 5-year survivors of cancer diagnosed at age 15-39 years during 1991 to 2013. The primary outcome was incidence of psychiatric disorder (composite outcome) including anxiety, depressive, trauma- and stressor-related, psychotic, and substance use disorders that were identified using coding algorithms for administrative health databases. A validated coding algorithm identified people who experienced a suicide attempt or event of self-harm. Secondary outcomes were incidences of diagnoses by type of psychiatric disorder.

RESULTS

Among 12 116 AYA 5-year cancer survivors (n = 4634 [38%] males; n = 7482 [62%] females), 7426 (61%; n = 2406 [32%] males; n = 5020 [68%] females) were diagnosed with at least 1 of 5 psychiatric disorders occurring at least 3 years after cancer diagnosis. Survivors of all cancer types were most often diagnosed with anxiety (males: 39.0%, 95% confidence interval [CI] = 37.6% to 40.4%; females: 54.5%, 95% CI = 53.3% to 55.6%), depressive (males: 32.7%, 95% CI = 31.3% to 34.0%; females: 47.0%, 95% CI = 45.8% to 48.1%), and trauma- and stressor-related disorders (males: 13.5%, 95% CI =12.5% to 14.5%; females: 22.5%, 95% CI = 21.6% to 23.5%).

CONCLUSIONS

Anxiety, depressive, and trauma- and stressor-related disorders are common among 5-year survivors of AYA cancer. Primary, secondary, or tertiary preventive strategies for AYAs diagnosed with cancer, particularly at an early age, are needed to mitigate risk of potentially severe outcomes because of psychiatric disorders.

Maternal major depression disorder misclassification errors: Remedies for valid individual- and population-level inference

Individual and population level inference about risk and burden of MDD, particularly maternal MDD, is often made using case-finding tools that are imperfect and prone to misclassification error (i.e. false positives and negatives). These errors or biases are rarely accounted for and lead to inappropriate clinical decisions, inefficient allocation of scarce resources, and poor planning of maternal MDD prevention and treatment interventions. The argument that the use of existing maternal MDD case-finding instruments results in misclassification errors is not new; in fact, it has been argued for decades, but by and large its implications and particularly how to correct for these errors for valid inference is unexplored. Correction of the estimates of maternal MDD prevalence, case-finding tool sensitivity and specificity is possible and should be done to inform valid individual and population-level inferences.

Exploring valence bias as a metric for frontoamygdalar connectivity and depressive symptoms in childhood

Negativity bias is a core feature of depression that is associated with dysfunctional frontoamygdalar connectivity; this pathway is associated with emotion regulation and sensitive to neurobiological change during puberty. We used a valence bias task (ratings of emotional ambiguity) as a potential early indicator of depression risk and differences in frontoamygdalar connectivity. Previous work using this task demonstrated that children normatively have a negative bias that attenuates with maturation. Here, we test the hypothesis that persistence of this negativity bias as maturation ensues may reveal differences in emotion regulation development, and may be associated with increased risk for depression. In children aged 6-13 years, we tested the moderating role of puberty on relationships between valence bias, depressive symptoms, and frontoamygdalar connectivity. A negative bias was associated with increased depressive symptoms for those at more advanced pubertal stages (within this sample) and less regulatory frontoamygdalar connectivity, whereas a more positive bias was associated with more regulatory connectivity patterns. These data suggest that with maturation, individual differences in positivity biases and associated emotion regulation circuitry confer a differential risk for depression. Longitudinal work is necessary to determine the directionality of these effects and explore the influence of early life events.

Association Analysis Between Catechol-O-Methyltransferase Expression and Cognitive Function in Patients with Schizophrenia, Bipolar Disorder, or Major Depression

INTRODUCTION

Schizophrenia, bipolar disorder (BD), and major depressive disorder are three common mental disorders. Although their diagnosis and treatment differ, they partially overlap.

METHODS

To explore the similarities and characteristics of these three psychiatric diseases, an intelligence quotient (IQ) assessment was performed to evaluate cognitive deficits. Relative catechol-O-methyltransferase (COMT) expression in peripheral blood mononuclear cells was examined in all three groups compared with healthy controls (HCs).

RESULTS

The results indicated that patients with any of the three psychiatric diseases presented IQ deficits, and that the first-episode schizophrenia (FES) group had even lower cognitive function than the other two groups. The relative COMT expression decreased in the FES group and increased in the BD group compared with the HC group. The correlation analysis of COMT expression level and IQ scores showed a positive correlation between relative COMT expression and full-scale IQ in the HC group. However, this correlation disappeared in all three psychiatric diseases studied.

CONCLUSION

In conclusion, this cross-disease strategy provided important clues to explain lower IQ scores and dysregulated COMT expression among three common mental illnesses.

Predicting the risk of depression among adolescents in Nepal using a model developed in Brazil: the IDEA Project

The burden of adolescent depression is high in low- and middle-income countries (LMICs), yet research into prevention is lacking. Development and validation of models to predict individualized risk of depression among adolescents in LMICs is rare but crucial to ensure appropriate targeting of preventive interventions. We assessed the ability of a model developed in Brazil, a middle-income country, to predict depression in an existing culturally different adolescent cohort from Nepal, a low-income country with a large youth population with high rates of depression. Data were utilized from the longitudinal study of 258 former child soldiers matched with 258 war-affected civilian adolescents in Nepal. Prediction modelling techniques were employed to predict individualized risk of depression at age 18 or older in the Nepali cohort using a penalized logistic regression model. Following a priori exclusions for prior depression and age, 55 child soldiers and 71 war-affected civilians were included in the final analysis. The model was well calibrated, had good overall performance, and achieved good discrimination between depressed and non-depressed individuals with an area under the curve (AUC) of 0.73 (bootstrap-corrected 95% confidence interval 0.62-0.83). The Brazilian model comprising seven matching sociodemographic predictors, was able to stratify individualized risk of depression in a Nepali adolescent cohort. Further testing of the model's performance in larger socio-culturally diverse samples in other geographical regions should be attempted to test the model's wider generalizability.

Child maltreatment and mental health problems in 30-year-old adults: A birth cohort study

Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer with limited data at 30-year follow-up. This was a prospective record-linkage analysis to examine whether notified and/or substantiated child maltreatment was associated with adverse psychological outcomes in early adulthood when participants were 30 years old. We used data from 2861 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exposure to suspected child maltreatment was measured by linkage with state child protection data. The primary outcomes were DSM-IV diagnoses derived from the Composite International Diagnostic Interview-Auto version (CIDI). There were child abuse notifications on 171 participants, of which 103 were substantiated. The most common notifications were for physical abuse (n=96) followed by emotional abuse and neglect (n=80 each). There were 63 notifications of sexual abuse. Of those completing the CIDI at follow-up, 257 participants (9%) reported a depressive disorder, 703 (25%) an anxiety disorder and 138 (5%) PTSD. After adjustment for potential confounders, there were variations in the long-term effects of different types of abuse with physical abuse having a stronger association with depression, and sexual abuse with PTSD. Both emotional abuse and neglect were associated to varying degrees with depression, anxiety and PTSD. Substantiated abuse or multiple forms of abuse had generally the worst outcomes.

Influence of birth cohort on age of onset cluster analysis in bipolar I disorder

Purpose:

Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.

Methods:

The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.

Results:

There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.

Conclusion:

These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Secular trends in the age at onset of bipolar I disorder - Support for birth cohort effects from interational, multi-centre clinical observational studies

OBJECTIVE

To examine any association of birth decade, sex and exposure to alcohol and/or substance use disorders (ASUD) with age at onset (AAO) of bipolar I disorder (BD-I).

METHODS

Using data from a representative clinical sample of 3896 BD-I cases recruited from 14 European countries, we examined AAO distributions in individuals born in consecutive birth decades. Cumulative probabilities with Mantel-Cox log-rank tests, pairwise comparisons and Odds Ratios (OR) with 95% confidence intervals (95% CI) were employed to analyze AAO according to birth decade, sex, and presence or absence of an ASUD.

RESULTS

In the total sample, median AAO of BD-I decreased from about 41 years for those born in the 1930s to about 26 years for those born in the 1960s. In a sub-sample of 1247 individuals (selected to minimize confounding), AAO significantly decreased for males and females born in each consecutive decade between 1930 and 50 (OR: 0.65; 95% CI: 0.51, 0.81), and for cases with an ASUD as compared to without (OR: 0.77, 95% CI: 0.69, 0.87). The best fitting regression model identified an independent effect for each birth decade and an interaction between ASUD status and sex, with a consistently earlier AAO in males with an ASUD (OR: 0.79: 95% CI: 0.70, 0.91).

CONCLUSIONS

In BD-I cases diagnosed according to internationally recognized criteria and recruited to pan-European clinical observational studies, the AAO distributions are compatible with a birth cohort effect. A potentially modifiable risk factor, namely ASUD status, was associated with the observed reduction in AAO, especially in males.

The Role of Family Routines in the Intergenerational Transmission of Depressive Symptoms between Parents and their Adolescent Children

Whereas previous research on environmental factors implicated in the intergenerational transmission of depression has tended to focus on the role of parenting quality (e.g., harshness), the current study sought to assess whether structural aspects of families may contribute to depression-relevant affective and immune processes in youths. Specifically, the present study examined the role of family routines in linking parental depressive symptoms to youth emotion regulation, a depression-relevant marker of low-grade inflammation, and depressive symptoms in youths. 261 parent-adolescent dyads reported on their own depressive symptoms, family routines, and youths' emotion regulation abilities. In addition, peripheral blood was drawn from youths to assess levels of the proinflammatory cytokine interleukin 6 (IL-6). Path analyses provided support for a model in which parental depressive symptoms related to fewer family routines, which in turn were associated with higher IL-6 and depressive symptoms in youths as well as marginally associated with worse youth emotion regulation. Moreover, family routines were found to statistically account for part of the association between parent- and youth- depressive symptoms. Together, these results suggest that family routines may represent an additional facet of the family environment that can potentially contribute to the intergenerational transmission of depressive symptoms.

Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta-Analysis

OBJECTIVES

To compare the diagnostic accuracy of depression case finding tools with a criterion standard in the outpatient setting among adults with dementia.

DESIGN

Systematic review and meta-analysis.

SETTING

Studies of older outpatients with dementia.

PARTICIPANTS

Elderly outpatients (clinic and long-term care) with dementia (N = 3,035).

MEASUREMENTS

Prevalence of major depression and diagnostic accuracy measures including sensitivity, specificity, and likelihood ratios.

RESULTS

From the 11,539 citations, 20 studies were included for qualitative synthesis and 15 for a meta-analysis. Tools included were the Montgomery Åsberg Depression Rating Scale, Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS), Center for Epidemiologic Studies Depression Scale (CES-D), Hamilton Depression Rating Scale (HDRS), Single Question, Nijmegen Observer-Rated Depression Scale, and Even Briefer Assessment Scale-Depression. The pooled prevalence of depression in individuals with dementia was 30.3% (95% CI = 22.1-38.5). The average age was 75.2 (95% CI = 71.7-78.7), and mean Mini-Mental State Examination scores ranged from 11.2 to 24. The diagnostic accuracy of the individual tools was pooled for the best-reported cutoffs and for each cutoff, if available. The CSDD had a sensitivity of 0.84 (95% CI = 0.73-0.91) and a specificity of 0.80 (95% CI = 0.65-0.90), the 30-item GDS (GDS-30) had a sensitivity of 0.62 (95% CI = 0.45-0.76) and a specificity 0.81 (95% CI = 0.75-0.85), and the HDRS had a sensitivity of 0.86 (95% CI = 0.63-0.96) and a specificity of 0.84 (95% CI = 0.76-0.90). Summary statistics for all tools across best-reported cutoffs had significant heterogeneity.

CONCLUSION

There are many validated tools for the detection of depression in individuals with dementia. Tools that incorporate a physician interview with patient and collateral histories, the CSDD and HDRS, have higher sensitivities, which would ensure fewer false-negatives.

Identifying depression among adolescents using three key questions: a validation study in primary care

BACKGROUND

Depression in adolescents is a serious psychiatric illness. GPs play an important role in identifying adolescents with depression and those at risk of developing depression. Few validated tools are suitable for identifying adolescent depression in general practice.

AIM

To determine if three verbally asked key questions are valid for identifying depression in adolescents.

DESIGN AND SETTING

A cross-sectional, general practice multicentre, validation study was conducted in Oslo, Norway, and Aarhus, Denmark.

METHOD

A total of 294 adolescents answered three verbally asked key questions followed by a Composite International Diagnostic Interview (CIDI) for psychiatric diagnosis. Inclusion criteria were age (14-16 years) and fluency in the Norwegian or Danish language. The primary outcome was ROC curve statistics in terms of sensitivity and specificity, predictive values, and likelihood ratios of the three key questions. Secondary outcomes were Loevinger's H, Cronbach's α, and prevalence of depression.

RESULTS

The three key questions met the criteria for construct and criterion validity for detecting depression among the adolescents. ROC curve statistics for the three key questions demonstrated an AUC of 0.79 for the answer 'yes' to either screening question and of 0.73 for the answer 'yes' to the help question. The positive predictive value was 31% and the negative predictive value was 97%.

CONCLUSION

The three key questions are useful for identifying depression in adolescents in primary health care.

Testing for Plausibly Causal Links Between Parental Bereavement and Child Socio-Emotional and Academic Outcomes: A Propensity-Score Matching Model

The extant literature on parentally bereaved children has focused almost exclusively on the presence of negative mental health and socio-emotional outcomes among these children. However, findings from this literature have been equivocal. While some authors have found support for the presence of higher levels of internalizing and externalizing problems or mental health problems among this population, others have not found such a relationship. Additionally, study designs in this body of literature have limited both the internal and external validity of the research on parentally bereaved children. The present study seeks to address these issues of internal and external validity by utilizing propensity-score matching analyses to make plausibly causal inferences about the relationship between bereavement and internalizing and externalizing problems among children from a nearly nationally representative sample. This study also extends examination of the influence of parental bereavement to other domains of child development: namely, to academic outcomes. Findings suggest a lack of support for causal relationships between parental bereavement and either socio-emotional or academic outcomes among U.S. children. The plausibility of assumptions necessary to draw causal inferences is discussed.

Is age of onset associated with severity, prognosis, and clinical features in bipolar disorder? A meta-analytic review

OBJECTIVES

To identify clinical characteristics and adverse outcomes associated with an earlier age of onset of bipolar disorder.

METHODS

A comprehensive search yielded 15 empirical papers comparing clinical presentation and outcomes in individuals with bipolar disorder grouped according to age of onset (total N=7370). The following variables were examined to determine odds ratios (ORs) and 95% confidence intervals (CIs): presence of Axis I comorbidity, rapid cycling, psychotic symptoms, mixed episodes (DSM-IV), lifetime suicide attempts, lifetime alcohol and substance abuse, symptom severity, and treatment delay.

RESULTS

Early age of onset was found to be associated with longer delay to treatment (Hedges' g=0.39, P=.001), greater severity of depression (Hedges' g=0.42, P<.001), and higher levels of comorbid anxiety (OR=2.34, P<.001) and substance use (OR=1.80, P<.001). Surprisingly, no association was found between early age of onset and clinical characteristics such as psychotic symptoms or mixed episodes as defined by DSM-IV.

CONCLUSIONS

Earlier age of onset of bipolar disorder is associated with factors that can negatively impact long-term outcomes such as increased comorbidity. However, no association was found between early onset and indicators of severity or treatment resistance such as psychotic symptoms. Clinical features found to have the strongest relationship with early age of onset were those potentially amenable to pharmacological and psychological treatment. Results highlight the importance of early identification and provide potential areas of focus for the development of early intervention in bipolar disorder.

Depressive Disorders Related to Female Reproductive Transitions

Depression is rapidly becoming a major health concern. Recent estimates rank it as the fourth leading cause of disease burden worldwide, and its incidence is steadily increasing. Women have a risk of experiencing depressive illnesses that is twice that of men. Women with depression also typically experience greater functional impairment. The incidence of depression dramatically increases during the reproductive years, which correspond to ages 25 to 44 years. During this time frame, women may experience several reproductive milestones or transitional events such as menarche, the menstrual cycle, pregnancy, infertility, miscarriage, and perimenopause/menopause. These transitions evoke neuroendocrinologic changes that appear to influence the risk for depressive episodes. Common disorders associated with these hormonal fluctuations include premenstrual dysphoric disorder, postpartum depression, and depression in the perimenopausal transition. Although the specific pathophysiologic association is still unclear, evidence supports that these reproductive transitions influence the risk of depression in women.

ASSOCIATION BETWEEN SOCIAL MEDIA USE AND DEPRESSION AMONG U.S. YOUNG ADULTS

BACKGROUND

Social media (SM) use is increasing among U.S. young adults, and its association with mental well-being remains unclear. This study assessed the association between SM use and depression in a nationally representative sample of young adults.

METHODS

We surveyed 1,787 adults ages 19 to 32 about SM use and depression. Participants were recruited via random digit dialing and address-based sampling. SM use was assessed by self-reported total time per day spent on SM, visits per week, and a global frequency score based on the Pew Internet Research Questionnaire. Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Scale Short Form. Chi-squared tests and ordered logistic regressions were performed with sample weights.

RESULTS

The weighted sample was 50.3% female and 57.5% White. Compared to those in the lowest quartile of total time per day spent on SM, participants in the highest quartile had significantly increased odds of depression (AOR = 1.66, 95% CI = 1.14-2.42) after controlling for all covariates. Compared with those in the lowest quartile, individuals in the highest quartile of SM site visits per week and those with a higher global frequency score had significantly increased odds of depression (AOR = 2.74, 95% CI = 1.86-4.04; AOR = 3.05, 95% CI = 2.03-4.59, respectively). All associations between independent variables and depression had strong, linear, dose-response trends. Results were robust to all sensitivity analyses.

CONCLUSIONS

SM use was significantly associated with increased depression. Given the proliferation of SM, identifying the mechanisms and direction of this association is critical for informing interventions that address SM use and depression.

Creatine target engagement with brain bioenergetics: a dose-ranging phosphorus-31 magnetic resonance spectroscopy study of adolescent females with SSRI-resistant depression

Major depressive disorder (MDD) often begins during adolescence and is projected to become the leading cause of global disease burden by the year 2030. Yet, approximately 40 % of depressed adolescents fail to respond to standard antidepressant treatment with a selective serotonin reuptake inhibitor (SSRI). Converging evidence suggests that depression is related to brain mitochondrial dysfunction. Our previous studies of MDD in adult and adolescent females suggest that augmentation of SSRI pharmacotherapy with creatine monohydrate (CM) may improve MDD outcomes. Neuroimaging with phosphorus-31 magnetic resonance spectroscopy (³¹P-MRS) can measure the high-energy phosphorus metabolites in vivo that reflect mitochondrial function. These include phosphocreatine (PCr), a substrate for the creatine kinase reaction that produces adenosine triphosphate. As part of the National Institute of Mental Health’s experimental medicine initiative, we conducted a placebo-controlled dose-ranging study of adjunctive CM for adolescent females with SSRI-resistant MDD. Participants were randomized to receive placebo or CM 2, 4 or 10 g daily for 8 weeks. Pre- and post-treatment ³¹P-MRS scans were used to measure frontal lobe PCr, to assess CM’s target engagement with cerebral energy metabolism. Mean frontal lobe PCr increased by 4.6, 4.1 and 9.1 % in the 2, 4 and 10 g groups, respectively; in the placebo group, PCr fell by 0.7 %. There was no group difference in adverse events, weight gain or serum creatinine. Regression analysis of PCr and depression scores across the entire sample showed that frontal lobe PCr was inversely correlated with depression scores (p = 0.02). These results suggest that CM achieves target engagement with brain bioenergetics and that the target is correlated with a clinical signal. Further study of CM as a treatment for adolescent females with SSRI-resistant MDD is warranted.

The Price of Perspective Taking: Child Depressive Symptoms Interact with Parental Empathy to Predict Immune Functioning in Parents

Parental empathy is generally held as a positive characteristic; however, might there be contexts in which parental empathy is actually harmful? The present study examined whether adolescents' depressive symptoms might have immunologic costs for more empathic parents. One hundred forty three parents and their children completed self-report measures of empathy and depressive symptoms, respectively. One year later, production of four pro-inflammatory cytokines in parents' blood was measured in response to in vitro exposure to a bacterial product. Significant interactions across all inflammatory markers emerged, such that parents who were higher in empathy showed greater inflammatory cytokine production if their children also reported high levels of depressive symptoms, but lower cytokine production if their children reported low levels of symptoms. Less empathic parents showed the opposite pattern. These results provide support for the hypothesis that parents high in empathy may be especially sensitive physiologically to their children's psychopathologic symptoms.

Brain-behavior relationships in the experience and regulation of negative emotion in healthy children: implications for risk for childhood depression

Structural and functional alterations in a variety of brain regions have been associated with depression and risk for depression across the life span. A majority of these regions are associated with emotion reactivity and/or regulation. However, it is generally unclear what mechanistic role these alterations play in the etiology of depression. A first step toward understanding this is to characterize the relationships between variation in brain structure/function and individual differences in depression severity and related processes, particularly emotion regulation. To this end, the current study examines how brain structure and function predict concurrent and longitudinal measures of depression symptomology and emotion regulation skills in psychiatrically healthy school-age children (N = 60). Specifically, we found that smaller hippocampus volumes and greater responses to sad faces in emotion reactivity regions predict increased depressive symptoms at the time of scan, whereas larger amygdala volumes, smaller insula volumes, and greater responses in emotion reactivity regions predict decreased emotion regulation skills. In addition, larger insula volumes predict improvements in emotion regulation skills even after accounting for emotion regulation at the time of scan. Understanding brain-behavior relationships in psychiatrically healthy samples, especially early in development, will help inform normative developmental trajectories and neural alterations in depression and other affective pathology.

Measuring symptoms and diagnosing mental disorders in the elderly community: the test-retest reliability of the CIDI65

Prevalence findings for the elderly are artificially low, most likely due to insufficient consideration of age-related cognitive abilities in diagnostic interviews.

AIMS

(1) To describe the rationale for the development of an age-adapted Composite International Diagnostic Interview (CIDI65+) for use in a European project (MentDis_ICF65+). (2) To examine its test-retest reliability.

METHODS

Based on substantive pilot work the CIDI standard questions were shortened, broken down into shorter subsets and combined with sensitization questions and dimensional measures. Test-retest was determined in N = 68 subjects aged 60-79 years via two independent examinations by clinical interviewers using kappa (sensitivity, specificity) for categorical and intraclass correlation (ICC) coefficients for dimensional measures.

RESULTS

Test-retest reliability was good for any mental disorder (κ = 0.63), major depression (κ = 0.55), anxiety (κ = 0.62, range = 0.30-0.78), substance (κ = 0.77, range = 0.71-0.82), obsessive-compulsive disorder (κ = 1.00) and most core symptoms/syndromes (κ range = 0.48-1.00). Agreement for some disorders (i.e. somatoform/pain) attenuated, partly due to time lapse effects. ICC for age of onset, recency, quantity, frequency and duration questions ranged between κ = 0.60-0.90. Dimensional agreement measures were not consistently higher.

CONCLUSION

The age-adapted CIDI65+ is reliable for assessing most mental disorders, distress, impairment and time-related information in the elderly, prompting the need to examine validity.

Annual research review: Secular trends in child and adolescent mental health

BACKGROUND

Child and adolescent mental health problems are common, associated with wide-ranging functional impairments, and show substantial continuities into adult life. It is therefore important to understand the extent to which the prevalence of mental health problems has changed over time, and to identify reasons behind any trends in mental health.

SCOPE AND METHODOLOGY

This review evaluates evidence on whether the population prevalence of child and adolescent mental health problems has changed. The primary focus of the review is on epidemiological cross-cohort comparisons identified by a systematic search of the literature (using the Web of Knowledge database).

FINDINGS

Clinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.

Treatment of nonpsychotic major depression during pregnancy: patient safety and challenges

In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use.

Taking time seriously: a call to action in mental health research

Sociological research on mental health focuses on a multitude of dynamic processes, including changes in psychological symptoms or the onset of a mental disorder, the course and outcome of mental health problems, and the associations of mental health with a wide variety of time-varying social risk and protective factors. I argue that scholars studying mental health have, thus far, only scratched the surface of the temporal dynamics upon which mental health and illness rest. Two broad research issues are reviewed to illustrate important temporal issues that have been neglected or understudied in mental health research: (1) specific dimensions of temporality, which focus on dynamic processes at the individual level, and (2) the age-period-cohort model, which focuses on mental health at the population level. Priority topics for future research that takes time seriously are recommended.

Age, period, and cohort effects in psychological distress in the United States and Canada

Although treatment utilization for depression and anxiety symptoms has increased substantially in the United States and elsewhere, it remains unclear whether the underlying population distribution of psychological distress is changing over time. We estimated age, period, and cohort effects using data from 2 countries over more than 20 years, including National Health Interview Surveys from 1997 to 2010 (n = 447,058) and Canadian Community Health Surveys from 2000 to 2007 (n = 125,306). Psychological distress was measured with the Kessler Psychological Distress Scale. By period, both countries showed the highest levels of psychological distress in 2001 and the lowest levels in 2007. By age, psychological distress was highest in adolescence and during the late 40s and early 50s. By cohort, Canadian Community Health Survey results indicated a decreasing cohort effect among those born in 1922-1925 through 1935-1939 (β = -0.36, 95% confidence interval: -0.45, -0.27) and then a continuously increasing cohort effect during the remainder of the 20th century through 1989-1992 (β = 0.49, 95% confidence interval: 0.38, 0.61). The National Health Interview Survey data captured earlier-born cohorts and indicated an increased cohort effect for the earliest born (for 1912-1914, β = 0.44, 95% confidence interval: 0.26, 0.61). In sum, individuals in the oldest and more recently born birth cohorts have higher mean psychological distress symptoms compared with those born in midcentury, underscoring the importance of a broad, population-level lens for conceptualizing mental health.

Detection and Treatment of Long-Chain Omega-3 Fatty Acid Deficiency in Adolescents with SSRI-Resistant Major Depressive Disorder

Residual depressive symptoms are commonly observed in adolescents with major depressive disorder (MDD) following treatment with selective serotonin reuptake inhibitors (SSRIs). This study combined a case-control analysis and an open-label fish oil (FO) trial to investigate the relationship between long-chain omega-3 (LCn-3) fatty acid status and residual depressive symptoms in SSRI-resistant adolescent MDD patients. Baseline erythrocyte docosahexaenoic acid (DHA)(-28%, p=0.0003), but not eicosapentaenoic acid (EPA)(-18%, p=0.2), was significantly lower in patients (n=20) compared with healthy controls (n=20). Patients receiving 10-week low-dose (2.4 g/d, n=7) and high-dose (16.2 g/d, n=7) FO exhibited significant increases in erythrocyte EPA and DHA composition. In the intent-to-treat sample, depressive symptoms decreased significantly in the high-dose group (n=7, -40%, p<0.0001), and there was a trend in the low-dose group (n=10, -20%, p=0.06). Symptom remission was observed in 40% of patients in the low-dose group and 100% of patients in the high-dose group. There were no significant changes in vital signs and adverse events were rated as mild or moderate in severity. These preliminary findings demonstrate that adolescents with SSRI-resistant depression exhibit robust DHA deficits, and suggest that adjunctive FO supplementation is well-tolerated and effective for increasing LCn-3 fatty acid status and augmenting SSRI antidepressant effects.

The mutual influences between depressed Macaca fascicularis mothers and their infants

Objective

To assess the influence of infant rearing on the behavior of depressed adult female Macaca fascicularis and the influence of depressed infant-rearing adult female Macaca fascicularis on their infants in a free enclosure environment.

Methods

Here, 20 depressed subjects and then 20 healthy subjects were randomly selected from a total population of 1007 adult female Macaca fascicularis subjects. Four depressed subjects and eight healthy subjects were rearing infants. By focal observation, three trained observers video-recorded the selected subjects over a total observational period of 560 hours. The video footage was analyzed by qualified blinded analysts that coded the raw footage into quantitative behavioral data (i.e., durations of 53 pre-defined behavioral items across 12 behavioral categories) for statistical analysis.

Results

Between infant-rearing and non-rearing healthy subjects, ten differential behaviors distributed across five behavioral categories were identified. Between infant-rearing and non-rearing depressed subjects, nine behaviors distributed across five behavioral categories were identified. Between infant-rearing healthy and infant-rearing depressed subjects, fifteen behaviors distributed across six behavioral categories were identified.

Conclusion

Infant-rearing depressed adult female Macaca fascicularis subjects may have a worse psychological status as compared to non-rearing depressed counterparts. Infant rearing may negatively influence depressed Macaca fascicularis mothers. Infant-rearing depressed subjects were less adequate at raising infants as compared to infant-rearing healthy subjects. Thus, maternal depression in this macaque species may negatively impact infatile development, which is consistent with previous findings in humans.

The bipolar spectrum: diagnostic and pharmacologic considerations

Bipolar disorder represents a clinically challenging, episodic, lifelong medical illness that is both disabling and dangerous to the patient and is associated with a high risk of suicide. The prognosis for bipolar patients is likely to worsen with delays in accurate diagnosis and treatment as time is allowed for more extensive complications and morbidity to accrue and for alcohol or other substance use comorbidity to complicate the course of the illness. Physicians face several challenges when diagnosing bipolar disorder, including overlapping symptomatology and comorbidity with other disorders, as well as the somewhat restrictive and categorical approach taken by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the International Statistical Classification of Diseases, 10th Revision (ICD-10) diagnostic criteria. As a result, bipolar disorder is frequently unrecognized and misdiagnosed with considerable clinical and prognostic consequences for the patient. The accuracy of diagnosis of bipolar disorder could be improved through the introduction of a refined procedure for the identification and evaluation of a broader range of symptoms, and by careful attention to the presence of subthreshold symptomatology. A conceptual shift toward acceptance of a 'spectrum' model of bipolar disorder and the development of appropriate clinical diagnostic tools should assist physicians in differentiating bipolar disorder from other Axis I, Axis II, and personality disorders, as well as ensuring early diagnosis and therapeutic intervention.

Omega-3 fatty acids influence mood in healthy and depressed individuals

Depression is one of the most prevalent disorders in the United States, and rates of depression are higher for women than men. Despite their widespread use, drugs used in the treatment of depression are only moderately more effective than placebo in treating the disorder. Effective treatment of perinatal depression is of particular concern as treatment can influence both the mother and the developing child. Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation may reduce symptoms of major depressive disorder and perinatal depression. The aim of the present review was to evaluate epidemiological studies examining PUFA intake and depressive symptoms in the general population, as well as double-blind, placebo-controlled trials assessing the influence of n-3 PUFA in healthy individuals and those with depression; specific consideration was given to perinatal depression and potential gender differences in the relationship. Although there is some evidence to suggest that n-3 PUFA intake is associated with reduced depressive symptoms, particularly in females, these results are generally limited to epidemiological studies, whereas results from randomized controlled trials are mixed.

Housing and home-leaving experiences of young adults with psychotic disorders: a comparative qualitative study

Housing stability is a key component of rehabilitation for individuals with severe mental illnesses but remains a challenge for mental health service providers, particularly with young adults experiencing early mental health difficulties. The aim of this study is to explore perceptions of housing and home-leaving processes among young adults with emerging psychotic disorders and to compare it to the perceptions of young adults without psychotic disorders. A qualitative, grounded theory based, multiple case study was conducted among 52 adults aged 18-30 years old. Two core categories emerged in relation with perception of housing: choice/control over the residential environment, and housing opportunities over time. Difference between the groups include more coerced home-leaving for young adults with first-episode psychosis and low levels of choice, control and opportunities for a sub-group of participants living in group homes. The housing situation of young adults is analyzed and discussed from a systemic perspective.

Psychological correlates of decision-making during prenatal diagnosis: a prospective study

OBJECTIVE

Decision-making during prenatal diagnosis has not been extensively studied. We aimed to determine psychological correlates and level of decisional conflict following prenatal diagnosis.

METHOD

A total of 159 pregnant women were consecutively enrolled. All participants completed three questionnaires (the Hospital Anxiety and Depression scale, the Berlin Social Support scales and the Decisional Conflict scale) at three time points (T1 - waiting period between prenatal testing and disclosure of the results; T2 - decision phase within 3 days from test result disclosure; T3 - digestion period within 3 weeks from disclosure).

RESULTS

Women with fetal anomaly who terminate pregnancy were significantly more anxious and depressed than controls at each time point. Additionally, women with a normal fetus who terminate pregnancy presented higher level of anxiety and depression compared with controls at T2. Women who terminated pregnancy showed increased uncertainty scores at T2 and T3. Anxious and depressed individuals at T2 (decision period) were more uncertain about their choice at T3 compared to women with normal levels of anxiety and depression.

CONCLUSION

The decision to terminate pregnancy, irrespective of test results, may determine emotional distress and psychiatric morbidity. Women who were anxious and depressed at decision appeared to be more uncertain about their choices as time passed by. A careful assessment of women during prenatal diagnosis should be useful to identify women who may benefit from psychological support.

Transitions to adulthood in first-episode psychosis: a comparative study

AIM

The first aim of this study is to compare attainment of five markers of transition to adulthood between young adults with first-episode psychosis and young adults without any psychopathology. The second aim is to examine if the association between age group and transition to adulthood is similar for individuals who experience first-episode psychosis versus those who do not.

METHODS

Participants were 50 young adults with first-episode schizophrenia aged between 18 and 30 years old, and 50 volunteers without any psychopathology matched for sex and age. Participants were assessed with the Quality of Life Scale and a questionnaire on markers of transition to adulthood.

RESULTS

Significant differences appear between the groups for three of the five markers of transition to adulthood, namely: residential/financial independence, educational attainment and involvement in a romantic relationship. The effect of age on several markers is significant for the comparison group only.

CONCLUSION

Rehabilitation interventions should be informed by a developmental perspective on community functioning for young adults with first-episode schizophrenia. Vocational rehabilitation should be extended to focus more extensively on supported education and not only on supported employment, and interventions targeting residential independence should be granted more attention.

Role of Long-Chain Omega-3 Fatty Acids in Psychiatric Practice

Nutrition plays a minor role in psychiatric practice which is currently dominated by a pharmacological treatment algorithm. An accumulating body of evidence has implicated deficits in the dietary essential long-chain omega-3 (LCn-3) fatty acids, eicosapenaenoic acid (EPA) and docosahexaenoic acid (DHA), in the pathophysiology of several major psychiatric disorders. LCn-3 fatty acids have an established long-term safety record in the general population, and existing evidence suggests that increasing LCn-3 fatty acid status may reduce the risk for cardiovascular disease morbidity and mortality. LCn-3 fatty acid supplementation has been shown to augment the therapeutic efficacy of antidepressant, mood-stabilizer, and second generation antipsychotic medications, and may additionally mitigate adverse cardiometabolic side-effects. Preliminary evidence also suggests that LCn-3 fatty acid supplementation may be efficacious as monotherapy for primary and early secondary prevention and for perinatal symptoms. The overall cost-benefit ratio endorses the incorporation of LCn-3 fatty acids into psychiatric treatment algorithms. The recent availability of laboratory facilities that specialize in determining blood LCn-3 fatty acid status and emerging evidence-based consensus guidelines regarding safe and efficacious LCn-3 fatty acid dose ranges provide the infrastructure necessary for implementation. This article outlines the rationale for incorporating LCn-3 fatty acid treatment into psychiatric practice.

Elevated immune-inflammatory signaling in mood disorders: a new therapeutic target?

Converging translational evidence has implicated elevated immune-inflammatory signaling activity in the pathoetiology of mood disorders, including major depressive disorder and bipolar disorder. This is supported in part by cross-sectional evidence for increased levels of proinflammatory eicosanoids, cytokines and acute-phase proteins during mood episodes, and prospective longitudinal evidence for the emergence of mood symptoms in response to chronic immune-inflammatory activation. In addition, mood-stabilizer and atypical antipsychotic medications downregulate initial components of the immune-inflammatory signaling pathway, and adjunctive treatment with anti-inflammatory agents augment the therapeutic efficacy of antidepressant, mood stabilizer and atypical antipsychotic medications. Potential pathogenic mechanisms linked with elevated immune-inflammatory signaling include perturbations in central serotonin neurotransmission and progressive white matter pathology. Both heritable genetic factors and environmental factors including dietary fatty-acid composition may act in concert to sustain elevated immune-inflammatory signaling. Collectively, these data suggest that elevated immune-inflammatory signaling is a mechanism that is relevant to the pathoetiology of mood disorders, and may therefore represent a new therapeutic target for the development of more effective treatments.

Physical activity during pregnancy and postpartum depressive symptoms

OBJECTIVE

to examine the associations between total and domain-specific moderate-to-vigorous physical activity (MVPA) during pregnancy and postpartum depressive symptoms.

DESIGN

a prospective cohort study.

PARTICIPANTS

data were obtained from 652 women recruited from prenatal clinics at University of North Carolina Hospitals during 2001-2005 for the Pregnancy, Infection, and Nutrition (PIN) Postpartum Study.

MEASUREMENTS

MVPA measured at 17-22 and 27-30 weeks' gestation was investigated as a predictor of depressive symptoms assessed with the Edinburgh Postnatal Depression Scale at 3 months postpartum.

FINDINGS

total MVPA was not associated with depressive symptoms when using either 17-22 weeks' gestation or 27-30 weeks' gestation MVPA measures. In general, there were minimal associations for domain-specific MVPA. The direction of associations between depressive symptoms and work, adult and child care, and outdoor household MVPAs differed by time of measurement.

KEY CONCLUSIONS

the association between physical activity and postpartum depressive symptoms may differ with the timing of assessment. Additional studies (i.e. with a larger sample of women or a sample of at-risk women) following women throughout pregnancy and postpartum are needed to explore differences in the influence of physical activity on depressive symptoms.

IMPLICATIONS FOR PRACTICE

assessment of potential risk factors for elevated depressive symptoms, such as participation levels in different types of physical activity, throughout pregnancy may assist in determining who may be susceptible to postpartum depression.

Treatment of depression associated with the menstrual cycle: premenstrual dysphoria, postpartum depression, and the perimenopause

Several forms of depression are unique to women because of their apparent association with changes in gonadal hormones, which in turn modulate neuroregulatory systems associated with mood and behavior. This review examines the evaluation and treatment of depression that occurs premenstrually, postpartum, or in the perimenopause on the basis of current literature. The serotonergic antidepressants consistently show efficacy for severe premenstrual syndromes (PMSs) and premenstrual dysphoric disorder (PMDD), and are the first-line treatment for these disorders. The use of antidepressants for postpartum depression is compromised by concerns for effects in the infants of breast-feeding mothers, but increasing evidence suggests the relative safety of the antidepressant medications, and the risk calculation should be made on an individual basis. Estradiol may be effective for postpartum depression and for moderate-to-severe major depression in the perimenopause. In spite of its frequent use, progesterone is not effective for the mood and behavioral symptoms of PMS/PMDD, postpartum depression, or perimenopausal depressive symptoms.

Common and unique risk factors and comorbidity for 12-month mood and anxiety disorders among Canadians

OBJECTIVE

To explore the common and unique risk factors for mood and anxiety disorders. What sociodemographic, psychological, and physical risk factors are associated with mood and anxiety disorders and their comorbidities? What is the impact of multiple risk factors?

METHOD

Data from the Canadian Community Health Survey: Mental Health and Well-Being were analyzed. Appropriate sampling weights and bootstrap variance estimation were employed. Multiple logistic regression was used to estimate odds ratios and confidence intervals.

RESULTS

The annual prevalence of any mood disorder was 5.2%, and of any anxiety disorder 4.7%. Major depressive episode was the most prevalent mood and anxiety disorder (4.8%), followed by social phobia, panic disorder, mania, and agoraphobia. Among people with mood and anxiety disorders, 22.4% had 2 or more disorders. Risk factors common to mood and anxiety disorders were being young, having lower household income, being unmarried, experiencing greater stress, having poorer mental health, and having a medical condition. Unique risk factors were found: major depressive episode and social phobia were associated with being born in Canada; panic disorder was associated with being Caucasian; lower education was associated with panic and agoraphobia; and poor physical health was associated with mania and agoraphobia. People who were young, unmarried, not fully employed, and had a medical condition, greater stress, poorer self-rated mental health, and dissatisfaction with life, were more likely to have a comorbid mood and (or) anxiety disorder. As the number of common risk factors increases, the probability of having mood and anxiety disorders also increases.

CONCLUSIONS

Common and unique risk factors exist for mood and anxiety disorders. Risk factors are additive in increasing the likelihood of disease.

Regulation of mRNA expression encoding chaperone and co-chaperone proteins of the glucocorticoid receptor in peripheral blood: association with depressive symptoms during pregnancy

BACKGROUND

Major depressive disorder during pregnancy associates with potentially detrimental consequences for mother and child. The current study examined peripheral blood gene expression as a potential biomarker for prenatal depressive symptoms.

METHOD

Maternal RNA from whole blood, plasma and the Beck Depression Inventory were collected longitudinally from preconception through the third trimester of pregnancy in 106 women with a lifetime history of mood or anxiety disorders. The expression of 16 genes in whole blood involved in glucorticoid receptor (GR) signaling was assessed using real-time polymerase chain reaction. In parallel, plasma concentrations of progesterone, estradiol and cortisol were measured. Finally, we assessed ex vivo GR sensitivity in peripheral blood cells from a subset of 29 women.

RESULTS

mRNA expression of a number of GR-complex regulating genes was up-regulated over pregnancy. Women with depressive symptoms showed significantly smaller increases in mRNA expression of four of these genes - FKBP5, BAG1, NCOA1 and PPID. Ex vivo stimulation assays showed that GR sensitivity diminished with progression of pregnancy and increasing maternal depressive symptoms. Plasma concentrations of gonadal steroids and cortisol did not differ over pregnancy between women with and without clinically relevant depressive symptoms.

CONCLUSIONS

The presence of prenatal depressive symptoms appears to be associated with altered regulation of GR sensitivity. Peripheral expression of GR co-chaperone genes may serve as a biomarker for risk of developing depressive symptoms during pregnancy. The presence of such biomarkers, if confirmed, could be utilized in treatment planning for women with a psychiatric history.

Pre-adult onset and patterns of suicidality in patients with a history of recurrent depression

BACKGROUND

This report assesses the association between age of onset of major depression and later suicidality in a sample of 276 recurrently depressed patients recruited for the Oxford/Bangor Staying Well after Depression (SWAD) Trial, and interviewed when in remission.

METHODS

The study enrolled adult patients with a history of at least three episodes of non-psychotic major depressive disorder from primary care and psychiatric care practices and through community advertisements. At study entry, all participants estimated the age of their first onset of a major depressive episode and completed both self-report and interview-based assessments of past and current suicidal ideation and behavior. Participants were divided into pre-adult and adult onset groups using a cut-off age of 18.

RESULTS

Forty-eight percent of the sample reported a pre-adult age of onset. Pre-adult age of onset was significantly associated with suicidality, both from self-report and from interviewer assessment even when adjusting for differences in age, gender, employment status, length of the disorder and early adversity.

LIMITATIONS

Relevant variables were all assessed through retrospective reports.

CONCLUSIONS

Pre-adult age of onset is closely associated with risk for and severity of later suicidality, replicating, in a sample of patients assessed when in remission, findings from studies that assessed patients when currently depressed. The association of pre-adult age of onset with suicidality is not due to differences in sociodemographic variables, length of the disorder and early adversity.

The simplified Edinburgh Postnatal Depression Scale (EPDS) for antenatal depression: is it a valid measure for pre-screening?

The identification of antenatal depression is critical but poorly conducted. The aim of this study was to construct a simplified depression survey scale and to verify its efficacy as a pre-screening for antenatal depression. A total of 494 pregnant women in the third trimester of gestation who had received antenatal care at Seoul St. Mary's Hospital from July 2009 to June 2010 were included. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire was completed by them. The subjects were randomly divided into two groups: 250 of training set and 244 of validation set. We designed a simplified questionnaire comprising two items of EPDS using the training set. We then validated its efficacy with the training set and reaffirmed the results with the validation set. The sum of item 5 (scare or panic) and item 8 (sadness or misery) explained 75.5% of the total score of the EPDS (AUC = 0.947). Using a score of 3 as a cut-off value of the simplified scale, sensitivity was 92.4% and specificity was 86.3%. The positive and negative predictive values were 56.2% and 98.4%, retrospectively. This study suggests that the simplified EPDS can be an efficient instrument to rule out depression during pregnancy.

Birth cohort effects and gender differences in alcohol epidemiology: a review and synthesis

BACKGROUND

Alcohol consumption has demonstrated substantial temporal trends, with some evidence suggesting strong birth cohort effects. The identification of at-risk birth cohorts can inform the interpretation of alcohol trends across age, time, and demographic characteristics such as gender. The present literature review has 2 objectives. First, we conduct a cross-national review of the literature on birth cohort differences in alcohol consumption, disorder, and mortality. Second, we determine the consistency of evidence for birth cohort effects on gender differences.

METHODS

A search was conducted and key data on population characteristics, presence and direction of cohort effects, and interactions with gender compiled. Thirty-one articles were included.

RESULTS

Evidence suggests that younger birth cohorts in North America, especially those born after World War II, are more likely than older cohorts to engage in heavy episodic drinking and develop alcohol disorders, but this cohort effect is not found in Australia and western Europe. Cross-nationally, substantial evidence indicates that women in younger cohorts are at especially high risk for heavy episodic drinking and alcohol disorders.

DISCUSSION

Younger birth cohorts in North America and Europe are engaging in more episodic and problem drinking. The gender gap in alcohol problems is narrowing in many countries, suggesting shifting social norms surrounding gender and alcohol consumption. These trends suggest that public health efforts to specifically target heavy drinking in women are necessary.

Prevalence and clinical course of depression: a review

Depression is one of the leading causes of disease worldwide. Historically conceived as either a disease of the mind or of the brain, treatment options followed this aetiology. Current diagnostic assessment of depression is based on descriptions of symptoms, their presence and magnitude over time. Epidemiological studies demonstrate that depressive disorders are highly prevalent: displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. These studies have deepened our understanding of the course of depression; remission, recovery, relapse and recurrence. An illustration of recovery rates has begun to demonstrate the complexity of the nature and course of depression. The majority recovers; however, recovery may not be permanent and future episodes carry the threat of chronicity. A key variable influencing rates of recovery, relapse, and recurrence is the presence of medical or psychiatric comorbid illnesses. The review considers the literature on Major Depression beginning with a brief historical overview, its classification, and a synthesis of the current knowledge regarding prevalence and course.