Familial Risk Factors in Relation to Recurrent Depression Among Former Adolescent Psychiatric Inpatients

Systematic Review and Meta-Analysis: Predictors of Relapsing, Recurrent, and Chronic Depression in Young People

OBJECTIVE

Youth depression disrupts the social and vocational transition into adulthood. Most depression burden is caused by recurring or chronic episodes. Identifying young people at risk for relapsing, recurring, or chronic depression is critical. We systematically reviewed and meta-analyzed the literature on prognostic factors for relapsing, recurrent, and chronic depression in young people.

METHOD

We searched the literature up (MEDLINE, PsycINFO, CINAHL, Embase, CENTRAL, WHO ICTRP, ClinicalTrials.gov, bioRxiv, MedRxiv) to March 6, 2024, and included cohort studies and randomized trials that assessed any prognostic factor for relapse, recurrence, or chronicity of depression in young people (aged 10-25 years at baseline) with a minimum of a 3-month follow-up. We assessed individual study risk of bias using the QUIPS tool and the certainty of evidence via the GRADE approach. We conducted random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment when 3 or more estimates on the same prognostic factor were available. Qualitative synthesis was conducted to identify promising prognostic factors that could not be meta-analyzed.

RESULTS

A total of 76 reports of 46 studies (unique cohorts or trials) were included that tested 388 unique prognostic factors in 7,488 young people experiencing depression. The majority of the reports were at high risk of bias (87%). We conducted 22 meta-analyses on unadjusted, and 7 on adjusted, prognostic factors of a poor course trajectory (ie, combined relapse, recurrence, and chronicity). Female sex (adjusted; odds ratio [95% CI] = 1.49 [1.15, 1.93], p = .003), higher severity of depressive symptoms (unadjusted; standardized mean difference [95% CI] = 0.53 [0.33, 0.73], p < .001), lower global functioning (unadjusted; standardized mean difference [95% CI] = -0.35 [-0.60, -0.10], p = .005), more suicidal thoughts and behaviors (unadjusted; standardized mean difference [95% CI] = 0.52 [0.03, 1.01], p = .045), and longer sleep-onset latency (unadjusted; mean difference [95% CI] = 6.96 [1.48, 12.44] minutes, p = .013) at baseline predicted a poor course trajectory of depression. The certainty of the evidence was overall very low to moderate. Promising prognostic factors that could not be meta-analyzed included relational/interpersonal factors (friend relationships and family relationships/structure).

CONCLUSION

Our findings demonstrate the prognostic value of demographic and clinical factors for poor course trajectories of depression in young people. More research is needed to confirm the potential value of relational/interpersonal factors in predicting poor depression course. Limitations of the literature include the high risk of bias of included studies, which indicates that future studies should include large sample sizes and wider diversity of prognostic markers (eg, genetic and neurobiological) in multivariable models. The critical next step is to combine the identified prognostic factors and to evaluate their clinical value in identifying individuals at risk for a poor course trajectory of depression during youth, a life stage in which most of the disability and burden attributable to depression can be averted.

STUDY PREREGISTRATION INFORMATION

Prognostic factors for relapsing, recurrent or chronic depression in youth: a systematic review with meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023458646.

Parental mental disorders and ages of onset of severe mental disorders in offspring: A nationwide family-link study

OBJECTIVE

The current study used a retrospective study design to investigate the association between age of onset of severe mental disorders in offspring and the likelihood of diagnoses of parental mental disorder.

METHOD

We enrolled 212,333 people with severe mental disorder, including schizophrenia, bipolar disorder (BD), or major depressive disorder (MDD) and 2,123,329 controls matched for age, sex, and demographics from the National Health Insurance Database of Taiwan. Poisson regression models were used to examine the likelihood of diagnoses of five mental disorders in their parents compared to the parents of the controls (reported as odds ratio (OR) with 95% confidence interval), including schizophrenia, BD, MDD, alcohol use disorder (AUD), and substance use disorder (SUD). The study cohort was classified into child-onset, adolescent-onset, and adult-onset groups according to the onset of severe mental disorders in the offspring.

RESULT

The parents of people with child-, adolescent-, and adult-onset schizophrenia (OR range: 1.73-9.08, all p < 0.05) or BD (OR range: 1.97-8.17, all p < 0.05) were more likely to be diagnosed with schizophrenia, BD, MDD, AUD, and substance use disorder (SUD) than controls except for AUD in the child-onset group. However, the parents of people with child-, adolescent-, and adult-onset depressive disorder were more likely to be diagnosed with schizophrenia, BD, MDD, AUD, and SUD (OR range: 1.82-4.76, all p < 0.05) than controls. Sub-analyses stratified by sex showed different patterns of associations between parental mental disorders and offspring mental disorders.

CONCLUSION

No matter when the severe mental disorder of the offsprings occurred at different onset stages, their parents had a higher likelihood of being diagnosed with schizophrenia, BD, MDD, AUD, and SUD.

Constipation among workers with depression/anxiety: a retrospective study using a claims database and survey data in Japan

OBJECTIVES

To investigate the prevalence, associated factors, treatment status and burden of constipation in workers with depression or anxiety.

STUDY DESIGN

This was a retrospective observational study using a pre-existing database.

SETTING

Claims data from October to November 2022 and data from the survey conducted in November 2022 were extracted from the database.

PARTICIPANTS

This study included self-reported workers who completed the survey, after excluding those with major mental disorders diagnosed as distinct from depression or anxiety and constipation due to organic diseases identified by International Classification of Diseases (ICD-10) codes.

OUTCOME MEASURES

The subjects were divided into three groups: treated depression/anxiety, untreated depression/anxiety and no depression/anxiety. The prevalence of constipation, factors associated with constipation and medications prescribed for constipation were analysed. Work productivity and quality of life (QOL) were compared between three subgroups based on constipation status: treated constipation, untreated constipation and no constipation subgroup.

RESULTS

Of the 18 585 respondents in the analysis population, 950 respondents (5.1%) were classified into the treated depression/anxiety group, 6035 respondents (32.5%) into the untreated depression/anxiety group and the remaining respondents into the no depression/anxiety group (11 600 (62.4%)). The prevalence of constipation was 22.5% in the treated group, 22.3% in the untreated group and 10.4% in the no depression/anxiety group, respectively. Depression and anxiety severity were independently associated with an increased risk of constipation. In all groups, the most commonly prescribed drug class was osmotic laxatives. Work productivity and QOL tended to indicate a greater burden in the untreated constipation subgroup than in the treated or no constipation subgroups.

CONCLUSIONS

The prevalence of constipation was twice as high if workers had depression/anxiety. Considering that the comorbidity of constipation with mental disorders may increase multiple burdens, appropriate medical interventions are required to treat both mental (depression/anxiety) and physical (constipation) conditions. This should be widely recognised by physicians and employers.

Factors Associated with Depression among Working-Age Household Heads in Korea: A Cross-Sectional Household Study

BACKGROUND

Depression is a mental disorder common worldwide. This study determined the relationships between demographics, health status, household parameters, and depression rates among working-age household heads.

METHODS

We analyzed data from the Korea Welfare Panel Study Survey conducted in 2020. The 11-item version of the Center for Epidemiologic Studies Depression Scale was used to assess depression. Bivariate analyses and a multiple logistic regression model were used to evaluate the influence of these factors on depression among household heads.

RESULTS

The overall prevalence of depression among working-age household heads was 11.69% (19.83% of females and 9.58% of males). The relative risk of depression was 1.71 times higher among the unemployed than among wage earners and 2.18 times higher among those with low income than among those with general income. The relative risk of depression was 3.23 times higher in those with poor health status than in those with good health, and 2.45 times more in those with severe disabilities than in those without disabilities. The rate of depression decreased with education level, number of family members, and presence of children but increased with the presence of the disabled or elderly.

CONCLUSION

This study provides a comprehensive overview of depression among working-age household heads and identifies factors strongly associated with depression. These findings may have implications for policymakers to reduce the burden on and improve the quality of life of household heads.

Prevalence and correlates of internalizing and externalizing mental health problems among in-school adolescents in eastern Ethiopia: a cross-sectional study

Adolescent's mental health issues are a major social burden and a significant public health issue, but they have not received enough attention in Ethiopia. Therefore, this study aimed to determine the prevalence and correlates of internalizing and externalizing mental health problems among in-school adolescents in the Harari region, eastern Ethiopia. A cross-sectional study was conducted among 3227 in-school adolescents. Multistage sampling was used to select schools and eligible students to participate in the study. A guided, self-administered strength and difficulty questionnaire measured mental health problems. Data were double-entered, validated, and cleaned using EpiData 3.1 and analyzed using STATA version 17. Ordinal logistic regression analysis was performed to estimate the adjusted odds ratio between mental health problems and their correlates. Statistical significance was set at p-value < 0.05. The magnitudes of mental health problems among in-school adolescents by subscale was 24.17% (95% CI 22.72; 25.67) for internalizing and 11.93% (95% CI 10.85; 13.09) for externalizing problems. A high internalizing problem score was associated with females, rural residents, alcohol users, attending public schools, those bullied at school, and those in the lowest wealth index. Likewise, the likelihood of a high externalizing problem score was high among alcohol users, adolescents whose fathers are uneducated, rural, and bullied at school. The study suggests that mental health problems are prevalent among in-school adolescents in Ethiopia, especially internalizing problems. The study also identifies several risk factors associated with internalizing and externalizing problems, such as wealth index, school types, alcohol use, bullying, and rural residence. These factors may indicate the need for more mental health awareness and support programs for adolescents in Ethiopia. This highlights that schools and communities should prioritize mental health awareness and support programs for adolescents. These programs should be tailored to address the specific needs of the population, such as rural residents, those in the lowest wealth index, and those who have experienced bullying.

Family and Academic Stress and Their Impact on Students' Depression Level and Academic Performance

Current research examines the impact of academic and familial stress on students' depression levels and the subsequent impact on their academic performance based on Lazarus' cognitive appraisal theory of stress. The non-probability convenience sampling technique has been used to collect data from undergraduate and postgraduate students using a modified questionnaire with a five-point Likert scale. This study used the SEM method to examine the link between stress, depression, and academic performance. It was confirmed that academic and family stress leads to depression among students, negatively affecting their academic performance and learning outcomes. This research provides valuable information to parents, educators, and other stakeholders concerned about their childrens' education and performance.

COVID-19: A Source of Stress and Depression Among University Students and Poor Academic Performance

Current research examines how COVID-19 has impacted the daily life of students, specifically personal and academic aspects. The authors investigated the role of academic and family stress caused by COVID-19 on students' depression levels and the subsequent impact on their academic performance based on Lazarus' cognitive appraisal theory of stress. The non-probability convenience sampling technique has been used to collect data from undergraduate and postgraduate students using a modified questionnaire with a five-point Likert scale. This study used structural equation modeling to examine the link between stress, depression, and academic performance during COVID-19. It was confirmed that educational and family stress significantly leads to depression among students, negatively affecting their academic performance and learning outcomes. This research provides valuable information to parents, educators, and other stakeholders concerned about their children's education and performance.