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Kist JD, Vrijsen JN, Mulders PCR, van Eijndhoven PFP, Tendolkar I, Collard RM. Transdiagnostic psychiatry: Symptom profiles and their direct and indirect relationship with well-being. J Psychiatr Res 2023; 161:218-227. [PMID: 36940627 DOI: 10.1016/j.jpsychires.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/02/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Heterogeneity and comorbidity in psychiatric disorders are common, however, little is known about the impact on well-being and the role of functional limitations. We aimed to identify transdiagnostic psychiatric symptom profiles and to study their association with well-being and the mediating role of functional limitations in a naturalistic psychiatric patient group. METHODS We used four disorder-specific questionnaires to assess symptom severity within a sample of 448 psychiatric patients with stress-related and/or neurodevelopmental disorders and 101 healthy controls. Using both exploratory and confirmatory factor analyses we identified transdiagnostic symptom profiles, which we entered into a linear regression analysis to assess their association with well-being and the mediating role of functional limitations in this association. RESULTS We identified eight transdiagnostic symptom profiles, covering mood, self-image, anxiety, agitation, empathy, non-social interest, hyperactivity and cognitive focus. Mood and self-image showed the strongest association with well-being in both patients and controls, while self-image also showed the highest transdiagnostic value. Functional limitations were significantly associated with well-being and fully mediated the relationship between cognitive focus and well-being. LIMITATIONS The participant sample consisted of a naturalistic group of out-patients. While this strengthens the ecological validity and transdiagnostic perspective of this study, the patients with a single neurodevelopmental disorder were underrepresented. CONCLUSION Transdiagnostic symptom profiles are valuable in understanding what reduces well-being in psychiatric populations, thereby opening new avenues for functionally meaningful interventions.
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Affiliation(s)
- J D Kist
- Radboudumc, Department of Psychiatry, Nijmegen, 6525, GA, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, 6525, EN, the Netherlands.
| | - J N Vrijsen
- Radboudumc, Department of Psychiatry, Nijmegen, 6525, GA, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, 6525, EN, the Netherlands; Pro Persona Mental Health Care, Depression Expertise Centre, Nijmegen, 6525, DX, the Netherlands
| | - P C R Mulders
- Radboudumc, Department of Psychiatry, Nijmegen, 6525, GA, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, 6525, EN, the Netherlands
| | - P F P van Eijndhoven
- Radboudumc, Department of Psychiatry, Nijmegen, 6525, GA, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, 6525, EN, the Netherlands
| | - I Tendolkar
- Radboudumc, Department of Psychiatry, Nijmegen, 6525, GA, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, 6525, EN, the Netherlands
| | - R M Collard
- Radboudumc, Department of Psychiatry, Nijmegen, 6525, GA, the Netherlands
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Chahar Mahali S, Beshai S, Wolfe WL. The associations of dispositional mindfulness, self-compassion, and reappraisal with symptoms of depression and anxiety among a sample of Indigenous students in Canada. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:872-880. [PMID: 31995461 DOI: 10.1080/07448481.2020.1711764] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
ObjectiveDepression and anxiety are major concerns among students. Unfortunately, there are disparities between the mental health of majority culture students (White; Judeo-Christian) and that of Indigenous students. Although mindfulness, self-compassion, and reappraisal are correlated with symptoms of psychopathology among White students, these relationships have never been examined among Indigenous students. Participants: Undergraduate Indigenous students recruited from a Canadian institution. Methods: We administered self-report measures of depression, anxiety, dispositional mindfulness, self-compassion, and emotion regulation strategies (cognitive reappraisal and emotional suppression). Results: 37.5% (n = 33) and 40.9% (n = 36) reported significant symptoms of depression or anxiety, respectively. Dispositional mindfulness and self-compassion were negatively and strongly associated with depression symptoms (r = -.58 and r = -.58, respectively). Further, both constructs were also negatively and strongly associated with anxiety symptoms (r = -.55 and r = -.53, respectively). We also found a negative correlation between reappraisal and depression and anxiety symptoms. Conclusions: Mindfulness, self-compassion, and reappraisal are associated with depression and anxiety symptoms among this sample of Indigenous students.
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Affiliation(s)
| | - Shadi Beshai
- Department of Psychology, University of Regina, Regina, Canada
| | - Whitney L Wolfe
- Aboriginal Student Centre, University of Regina, Regina, Canada
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3
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Social Media and Depression Symptoms: a Meta-Analysis. Res Child Adolesc Psychopathol 2021; 49:241-253. [PMID: 33404948 DOI: 10.1007/s10802-020-00715-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/22/2022]
Abstract
Social Networking Sites (SNS) have close to 3 billion users worldwide. Recently, however, SNS have come under media scrutiny for their potential association with depression. Two previous meta-analyses failed to find evidence for a robust concurrent association between SNS use and depression symptoms. However, these analyses focused primarily on the time spent using SNS. The current meta-analysis is the first to consider the multi-dimensional nature of SNS use, and examines separately the quantitative associations of depression symptoms to SNS use in three types of SNS studies examining three distinct constructs of SNS use: time spent using SNS, intensity of SNS use, and problematic SNS use. Sixty-two studies (N = 451, 229) met inclusion criteria. Depression symptoms were significantly, but weakly, associated with time spent using SNS (r = 0.11) and intensity of SNS use (r = 0.09). However, the association of depression symptoms to problematic SNS use was moderate (r = 0.29), was significantly higher than for time spent using SNS (Qbetween = 35.85, p < 0.001) or intensity of SNS use (Qbetween = 13.95, p < 0.001), and was not significantly moderated by age, gender, year of study publication, or mode of recruitment. These results suggest that future research examining causal models of the relation of SNS use and depression, as well as research on intervention and prevention, should focus in more detail on individuals who are engaging in a pattern of problematic SNS use.
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Riegler C, Wiedmann S, Rücker V, Teismann H, Berger K, Störk S, Vieta E, Faller H, Baune BT, Heuschmann PU. A Self-administered Version of the Functioning Assessment Short Test for Use in Population-based Studies: A Pilot Study. Clin Pract Epidemiol Ment Health 2020; 16:192-203. [PMID: 33088336 PMCID: PMC7539537 DOI: 10.2174/1745017902016010192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 11/22/2022]
Abstract
Background: The Functioning Assessment Short Test (FAST) is an interviewer-administered scale assessing functional impairment originally developed for psychiatric patients. Objectives: To adapt the FAST for the general population, we developed a self-administered version of the scale and assessed its properties in a pilot study. Methods: The original FAST scale was translated into German via forward and backward translation. Afterwards, we adjusted the scale for self-administered application and inquired participants from two ongoing studies in Germany, ‘STAAB’ (Würzburg) and ‘BiDirect’ (Münster), both recruiting subjects from the general population across a wide age range (STAAB: 30-79 years, BiDirect: 35-65 years). To assess reliability, agreement of self-assessment with proxy-assessment by partners was measured via intraclass correlation coefficient (ICC) over the FAST score. Construct validity was estimated by conducting correlations with validated scales of depression (PHQ-9), anxiety (GAD-7), and health-related quality of life (SF-12) and regression analyses using these scales besides potentially disabling comorbidities (e.g. Chronic Back Pain (CBP)). Results: Participants (n=54) had a median age of 57.0 years (quartiles: 49.8, 65.3), 46.3% were female. Reliability was moderate: ICC 0.50 (95% CI 0.46-0.54). The FAST score significantly correlated with PHQ-9, GAD-7, and the mental sub-scale of SF-12. In univariable linear regression, all three scales and chronic back pain explained variance of the FAST score. In multivariable analysis, only CBP and the SF-12 remained significant predictors. Conclusion: The German self-administered version of the FAST yielded moderate psychometric properties in this pilot study, indicating its applicability to assess functional impairment in the general population.
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Affiliation(s)
- Christoph Riegler
- Institute for Clinical Epidemiology und Biometry, University of Würzburg, Würzburg, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin), Berlin, Germany
| | - Silke Wiedmann
- Institute for Clinical Epidemiology und Biometry, University of Würzburg, Würzburg, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin, Germany
| | - Viktoria Rücker
- Institute for Clinical Epidemiology und Biometry, University of Würzburg, Würzburg, Germany
| | - Henning Teismann
- Institute for Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Klaus Berger
- Institute for Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Eduard Vieta
- Bipolar and Depressive Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Peter U Heuschmann
- Institute for Clinical Epidemiology und Biometry, University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Clinical Trial Center Würzburg, University of Würzburg, Würzburg, Germany
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5
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Iancu SC, Wong YM, Rhebergen D, van Balkom AJLM, Batelaan NM. Long-term disability in major depressive disorder: a 6-year follow-up study. Psychol Med 2020; 50:1644-1652. [PMID: 31284881 DOI: 10.1017/s0033291719001612] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) represents a leading cause of disability. This study examines the course of disability in patients with chronic, recurrent and remitting MDD compared to healthy controls and identifies predictors of disability in remitting MDD. METHODS We included 914 participants from the Netherlands Study of Depression and Anxiety (NESDA). DSM-IV MDD and WHO DAS II disability were assessed at baseline and at 2, 4 and 6 years. Six-year total and domain-specific disability were analysed and compared in participants with chronic (n = 57), recurrent (n = 120), remitting (n = 127) MDD and in healthy controls (n = 430). Predictors of residual disability were identified using linear regression analysis. RESULTS At baseline, most disability was found in chronic MDD, followed by recurrent MDD, remitting MDD and healthy controls. Across diagnostic groups, most disability was found in household activities, interpersonal functioning, participation in society and cognition. A chronic course was associated with chronic disability. Symptom remission was associated with a decrease in disability, but some disability remained. In remitting MDD, higher residual disability was predicted by older age, more severe avoidance symptoms, higher disability at baseline and late symptom remission. Severity of residual disability correlated with the severity of residual depressive symptoms. CONCLUSIONS Symptomatic remission is a prerequisite for improvements in disability. However, disability persists despite symptom remission. Therefore, treatment of MDD should include an explicit focus on disability, especially on the more complex domains. To this end, treatments should promote behavioural activation and address subthreshold depressive symptoms in patients with remitted MDD.
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Affiliation(s)
- Sorana C Iancu
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute and GGZ inGeest, Amsterdam, The Netherlands
| | - Yak Mee Wong
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Didi Rhebergen
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute and GGZ inGeest, Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute and GGZ inGeest, Amsterdam, The Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute and GGZ inGeest, Amsterdam, The Netherlands
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Wassink-Vossen S, Collard RM, Wardenaar KJ, Verhaak PF, Rhebergen D, Naarding P, Voshaar RCO. Trajectories and determinants of functional limitations in late-life
depression: A 2-year prospective cohort study. Eur Psychiatry 2020; 62:90-96. [DOI: 10.1016/j.eurpsy.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background:
In mental health research, functional recovery is increasingly
valued as an important outcome in addition to symptomatic
remission.
Methods:
Course types of functional limitations among depressed older
patients and its relation with symptomatic remission were explored in a
naturalistic cohort study (Netherlands Study of Depression in Older
persons). 378 depressed older patients (≥60 years) and 132 non-depressed
persons were included. Depressive disorders were assessed with Composite
International Diagnostic Interview at baseline and two-year follow-up.
Functional limitations were assessed every 6 months with the World
Health Organization Disability Assessment II.
Results:
Depressed patients had more functional limitations compared to their
non-depressed counterparts. Growth Mixture Modeling among depressed
patients identified two trajectories of functional limitations, both
starting at a high disability level. The largest subgroup (81.2%) was
characterized by a course of high disability levels over time. The
smaller subgroup (18.8%) had an improving course (functional recovery).
After two years, the main predictor of functional recovery was the
remission of depression. Among symptomatic remitted patients, female
sex, higher level of education, higher gait speed, and less severe
depression were associated with no functional recovery. Non-remitted
patients without functional recovery were characterized by the presence
of more chronic somatic diseases, a lower sense of mastery, and a higher
level of anxiety.
Conclusions:
1 in 5 depressed older patients have a course with functional
recovery. Combining functional and symptomatic recovery points to a
subgroup of older patients that might profit from more rigorous
psychiatric treatment targeted at psychiatric comorbidity and a group of
frail depressed older patients that might profit from integrated
geriatric rehabilitation.
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7
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Hess CW, Karter J, Cosgrove L, Hayden L. Evidence-based practice: a comparison of International Clinical Practice Guidelines and current research on physical activity for mild to moderate depression. Transl Behav Med 2019; 9:703-710. [PMID: 30321410 DOI: 10.1093/tbm/iby092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In 2016, the U.S. Preventive Services Task Force recommended routine depression screening for individuals aged 13 and above. Questionnaire-based screening will likely increase treatment in patients with milder symptoms. Although professional groups who develop clinical practice guidelines recognize the importance of considering the risks and benefits of interventions, no official mandate exists for a stepped-care approach. Physical activity warrants increased consideration in guidelines, given the optimal risk/benefit profile and the increasing evidence of efficacy for the treatment and prevention of depression. The aim of the current study was to evaluate clinical practice guidelines for the treatment of major depressive disorder, specifically the recommendation of physical activity and adherence to a stepped-care approach. Authors searched three databases to identify treatment guidelines for depression. Guidelines were reviewed on the following domains regarding recommendation of physical activity: (a) front-line intervention, (b) explicit but not front-line recommendation, (c) inexplicit recommendation, (d) no mention, (e) adherence to a stepped-care approach, and (f) presentation of empirical support for their recommendation. Seventeen guidelines met inclusion criteria. Four guidelines recommended physical activity as a front-line intervention, two did not mention physical activity, eleven made some mention of physical activity, seven presented evidence to support their recommendation, and seven employed a stepped-care approach. The majority of guidelines did not use a stepped-care approach and varied greatly in their inclusion of physical activity as a recommended intervention for mild to moderate depression. Implications for practice, research, and policy are discussed.
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Affiliation(s)
- Courtney Wynne Hess
- Department of Counseling & School Psychology, University of Massachusetts, Boston, MA, USA
| | - Justin Karter
- Department of Counseling & School Psychology, University of Massachusetts, Boston, MA, USA
| | - Lisa Cosgrove
- Department of Counseling & School Psychology, University of Massachusetts, Boston, MA, USA
| | - Laura Hayden
- Department of Counseling & School Psychology, University of Massachusetts, Boston, MA, USA
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8
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Scheffers M, van Duijn MAJ, Beldman M, Bosscher RJ, van Busschbach JT, Schoevers RA. Body attitude, body satisfaction and body awareness in a clinical group of depressed patients: An observational study on the associations with depression severity and the influence of treatment. J Affect Disord 2019; 242:22-28. [PMID: 30170235 DOI: 10.1016/j.jad.2018.08.074] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/30/2018] [Accepted: 08/12/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Apart from changes in mood and cognition, depressive disorders are also characterized by changes in body experience, changes that largely influence daily functioning and aggravate distress. In order to gain more insight into this important issue, three domains of body experience - body attitude, body satisfaction and body awareness - and their associations with symptom severity of depression were studied pre- and post-treatment in a clinical sample of depressed patients in a multidisciplinary setting. METHODS Body attitude (Dresden Body Image Questionnaire), body satisfaction (Body Cathexis Scale), body awareness (Somatic Awareness Questionnaire) and severity of depressive symptoms (Inventory of Depressive Symptomatology) were measured. Differences between pre-treatment and post-treatment scores were studied with paired t-tests. Associations between body experience and depression were analysed with Pearson correlations and partial correlations. RESULTS At the start of treatment, patients scored significantly lower than a healthy comparison sample on body attitude and body satisfaction, but not on body awareness. After treatment, depression scores decreased with large effect sizes, scores for body attitude and body satisfaction increased with medium effect sizes and body awareness scores increased slightly. Medium pre-treatment and strong post-treatment associations were found between depression severity and body attitude and between depression severity and body satisfaction. LIMITATIONS The design does not allow to draw causal conclusions. Because of the multidisciplinary treatment no information is available on the specific contribution of interventions targeting body experience. CONCLUSIONS The study provides evidence for medium to strong associations in clinically depressed patients between body attitude, body satisfaction and depression.
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Affiliation(s)
- M Scheffers
- School of Human Movement and Education,Windesheim University of Applied Sciences, Campus 2-6, Zwolle, CA 8017, The Netherlands.
| | - M A J van Duijn
- Department of Sociology, University of Groningen, Groningen, The Netherlands
| | - M Beldman
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, The Netherlands
| | - R J Bosscher
- School of Human Movement and Education,Windesheim University of Applied Sciences, Campus 2-6, Zwolle, CA 8017, The Netherlands
| | - J T van Busschbach
- School of Human Movement and Education,Windesheim University of Applied Sciences, Campus 2-6, Zwolle, CA 8017, The Netherlands; Rob Giel Research center (RGOc), University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands
| | - R A Schoevers
- Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center for Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands
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Tuithof M, Ten Have M, van Dorsselaer S, Kleinjan M, Beekman A, de Graaf R. Course of subthreshold depression into a depressive disorder and its risk factors. J Affect Disord 2018; 241:206-215. [PMID: 30130686 DOI: 10.1016/j.jad.2018.08.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/17/2018] [Accepted: 08/07/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Information on the natural course of subthreshold depression and risk factors for the development of a full-blown depressive disorder in the general population is scarce. This information is crucial to understand the development of depression and to advance indicated depression prevention. METHODS Using longitudinal data from a representative population-based study (the Netherlands Mental Health Survey and Incidence Study-2) we assessed 3-year course of subthreshold depression (depressive symptoms causing clinically significant distress for at least 2 weeks, or for 3 days per month for a year; n = 120), compared to an asymptomatic group (n = 4111) and a depressive disorder group (major depression or dysthymia; n = 294). Next, risk factors for the development of a depressive disorder among adults with subthreshold depression were determined. RESULTS Twelve percent of the subthreshold cases developed a full-blown depressive disorder during 3-year follow-up. Risk factors were lower social support, having recurrent short episodes of depressive symptomatology, remitted and current anxiety disorder, remitted substance use disorder, lifetime suicide thoughts, a chronic physical disorder and diminished mental and physical functioning. LIMITATIONS The number of subjects with subthreshold depression that developed a depressive disorder was small. This limits the possibility to detect significant risk factors. CONCLUSION Only a minority of the subthreshold cases developed a full-blown depressive disorder over three years. This shows that subthreshold depression does not, by itself, carry an a priori risk to warrant focusing indicated prevention. The identified risk factors could help to detect those subthreshold cases in whom depression prevention is economically and practically viable.
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Affiliation(s)
- Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | | | - Marloes Kleinjan
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Utrecht University, Utrecht, The Netherlands
| | | | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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I Did OK, but Did I Like It? Using Ecological Momentary Assessment to Examine Perceptions of Social Interactions Associated With Severity of Social Anxiety and Depression. Behav Ther 2018; 49:866-880. [PMID: 30316486 DOI: 10.1016/j.beth.2018.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/21/2018] [Accepted: 07/30/2018] [Indexed: 12/29/2022]
Abstract
Socially anxious and depressed individuals tend to evaluate their social interactions negatively, but little is known about the specific real-time contributors to these negative perceptions. The current study examined how affect ratings during social interactions predict later perceptions of those interactions, and whether this differs by social anxiety and depression severity. Undergraduate participants (N = 60) responded to a smartphone application that prompted participants to answer short questions about their current affect and social context up to 6 times a day for 2 weeks. At the end of each day, participants answered questions about their perceptions of their social interactions from that day. Results indicated that the link between negative affective experiences reported during social interactions and the end-of-day report of enjoyment (but not effectiveness) of those experiences was more negative when social anxiety was more severe. The link between negative affective experiences rated during social interactions and the end-of-day report of effectiveness (but not enjoyment) during those social encounters was more negative when depression was more severe. These findings demonstrate the importance of examining self-perceptions of social interactions based both on the extent to which individuals think that they met the objective demands of an interaction (i.e., effectiveness, mastery) and the extent to which they liked or disliked that interaction (i.e., enjoyment, pleasure). These findings also highlight how real-time assessments of daily social interactions may reveal the key experiences that contribute to negative self-evaluations across disorders, potentially identifying critical targets for therapy.
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11
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Collard RM, Wassink-Vossen S, Schene AH, Naarding P, Verhaak P, Oude Voshaar RC, Comijs HC. Symptomatic and functional recovery in depression in later life. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1071-1079. [PMID: 29923072 PMCID: PMC6182497 DOI: 10.1007/s00127-018-1540-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Functional limitations give an indication of the total impact of diseases, such as depression, on individuals health and recovery. This study examines the change in several domains of functioning over 2 years in older persons depressed at baseline (non-remitted group and remitted group after 2 years) and in a non-depressed comparison group. METHODS Data were used from a cohort study (Netherlands Study of Depression in Older persons [NESDO]) consisting of depressed older persons ≥ 60 years (N = 378) and a non-depressed comparison group (N = 132) with 2 years of follow-up (attrition rate 24%). Functional limitations (outcome) were assessed with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire every 6 months. Total scores and domain scores were used. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at 2-year follow-up. Severity of depression (predictor) was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals. RESULTS Linear mixed models showed that the level of functional limitations differed between the three groups during 2 years of follow-up. The non-remitted group had the highest level of functional limitations during 2 years, followed by the remitted group. Stable low levels of functional limitations were found for the non-depressed group. Remission from depression was accompanied by improvements in functioning, however, compared to the non-depressed comparison group significant functional limitations remained. Higher severity of depression appeared as risk factor for a declining course of functioning, especially the social aspects of functioning. METHODOLOGICAL CONSIDERATIONS Participants that were more severely depressed and more functionally impaired at baseline had higher attrition rates than the participants that were included in the analytical sample. CONCLUSION This study showed that depression in later life has long-term debilitating effects on functioning, enduring even after remission from depression. This implies that depression treatment in later life should aim broader than just symptomatic recovery, but also include functional recovery.
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Affiliation(s)
- Rose M Collard
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul Naarding
- Department of Old-age Psychiatry, GGNet, Apeldoorn, Zutphen, The Netherlands
| | - Peter Verhaak
- Department General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
| | - Richard C Oude Voshaar
- University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Hannie C Comijs
- GGZinGeest, Amsterdam, The Netherlands
- Department Psychiatry/Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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12
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Mall S, Mortier P, Taljaard L, Roos J, Stein DJ, Lochner C. The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university. BMC Psychiatry 2018. [PMID: 29523199 PMCID: PMC5845179 DOI: 10.1186/s12888-017-1583-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND College students are at risk of depression. This risk may be increased by the experience of childhood adversity and/or recent stressors. This study examined the association between reported experiences of childhood adversity, recent stressors and depression during the last 12 months in a cohort of South African university students. METHODS Six hundred and eighty-six first year students at Stellenbosch University in South Africa completed a health-focused e-survey that included items on childhood adversity, recent stressors and mood. Individual and population attributable risk proportions (PARP) between experiences of childhood adversity and 12-month stressful experiences and 12-month depression were estimated using multivariate binomial logistic regression analysis. RESULTS About one in six students reported depression during the last 12 months. Being a victim of bullying and emotional abuse or emotional neglect during childhood were the strongest predictors of depression in the past year at both individual and population level. With regard to recent stressors, a romantic partner being unfaithful, serious ongoing arguments or break-ups with some other close friend or family member and a sexual or gender identity crisis were the strongest predictors of depression. The predictor effect of recent stressors was significantly reduced in the final model that adjusted for the type and number of childhood traumatic experiences. At a population level, academic stress, serious ongoing arguments or break-ups with a close friend or family member, and serious betrayal by someone close were the variables that yielded the highest PARP. CONCLUSIONS Our findings suggest a significant relationship between early adversity, recent stressors, and depression here and throughout, consistent with the broader literature on predictors of depression. This study contributes to the limited data on college students' mental health in low and middle income countries including on the African continent. The findings provide information on the population level effect sizes of trauma as a risk factor for depression, as well as on the relationship between specific recent stressors and depression in college students.
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Affiliation(s)
- Sumaya Mall
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. .,Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Philippe Mortier
- Research Group Psychiatry, Department of Neurosciences, KU Leuven, Belgium
| | - Lian Taljaard
- 0000 0001 2214 904Xgrid.11956.3aMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa ,Mental Health Information Centre of Southern Africa, Stellenbosch, South Africa
| | - Janine Roos
- Mental Health Information Centre of Southern Africa, Stellenbosch, South Africa
| | - Dan J. Stein
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa ,0000 0001 2214 904Xgrid.11956.3aMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Christine Lochner
- 0000 0001 2214 904Xgrid.11956.3aMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
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14
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Wesołowska K, Elovainio M, Hintsa T, Jokela M, Pulkki-Råback L, Pitkänen N, Lipsanen J, Tukiainen J, Lyytikäinen LP, Lehtimäki T, Juonala M, Raitakari O, Keltikangas-Järvinen L. Fasting Glucose and the Risk of Depressive Symptoms: Instrumental-Variable Regression in the Cardiovascular Risk in Young Finns Study. Int J Behav Med 2017; 24:901-907. [PMID: 28779468 DOI: 10.1007/s12529-017-9639-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Type 2 diabetes (T2D) has been associated with depressive symptoms, but the causal direction of this association and the underlying mechanisms, such as increased glucose levels, remain unclear. We used instrumental-variable regression with a genetic instrument (Mendelian randomization) to examine a causal role of increased glucose concentrations in the development of depressive symptoms. METHOD Data were from the population-based Cardiovascular Risk in Young Finns Study (n = 1217). Depressive symptoms were assessed in 2012 using a modified Beck Depression Inventory (BDI-I). Fasting glucose was measured concurrently with depressive symptoms. A genetic risk score for fasting glucose (with 35 single nucleotide polymorphisms) was used as an instrumental variable for glucose. RESULTS Glucose was not associated with depressive symptoms in the standard linear regression (B = -0.04, 95% CI [-0.12, 0.04], p = .34), but the instrumental-variable regression showed an inverse association between glucose and depressive symptoms (B = -0.43, 95% CI [-0.79, -0.07], p = .020). The difference between the estimates of standard linear regression and instrumental-variable regression was significant (p = .026) CONCLUSION: Our results suggest that the association between T2D and depressive symptoms is unlikely to be caused by increased glucose concentrations. It seems possible that T2D might be linked to depressive symptoms due to low glucose levels.
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Affiliation(s)
- Karolina Wesołowska
- Institute of Behavioral Sciences, University of Helsinki, P.O. Box 9, (Siltavuorenpenger 1 A), 00014, Helsinki, Finland.
| | - Marko Elovainio
- Institute of Behavioral Sciences, University of Helsinki, P.O. Box 9, (Siltavuorenpenger 1 A), 00014, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Taina Hintsa
- Institute of Behavioral Sciences, University of Helsinki, P.O. Box 9, (Siltavuorenpenger 1 A), 00014, Helsinki, Finland
| | - Markus Jokela
- Institute of Behavioral Sciences, University of Helsinki, P.O. Box 9, (Siltavuorenpenger 1 A), 00014, Helsinki, Finland
| | - Laura Pulkki-Råback
- Institute of Behavioral Sciences and Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
| | - Niina Pitkänen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jari Lipsanen
- Institute of Behavioral Sciences, University of Helsinki, P.O. Box 9, (Siltavuorenpenger 1 A), 00014, Helsinki, Finland
| | | | - Leo-Pekka Lyytikäinen
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
| | - Terho Lehtimäki
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Olli Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Liisa Keltikangas-Järvinen
- Institute of Behavioral Sciences, University of Helsinki, P.O. Box 9, (Siltavuorenpenger 1 A), 00014, Helsinki, Finland
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Abstract
Relatively little theory or research has addressed the mediating processes through which depressive symptoms lead to impairment. To conceptualize the nature of impairment in depression, we conducted semistructured interviews of 18 psychiatric patients experiencing depressive symptoms about how their depressive symptoms create impairment. Interviews were audio recorded and transcribed, and thematic analysis methods were used to identify content areas and themes. Three content areas were identified: domains of impairment (types of behavior that are impaired), experience of impairment (nature and severity of impairment), and pathways to impairment (processes connecting symptoms to impairment). Pathways included direct connections between symptom and impairment, as well as indirect pathways mediated by other symptoms and by cognitive responses to symptoms. Patients' examples of the impairment phenomena are presented. In addition, patterns of association were observed between particular pathways and symptom type (vegetative versus cognitive/affective). Increased understanding of clients' explanations for impairment may improve clinical intervention and assessments.
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Reichenberger J, Wiggert N, Agroskin D, Wilhelm FH, Blechert J. No praise, please: Depressive symptoms, reactivity to positive social interaction, and fear of positive evaluation. J Behav Ther Exp Psychiatry 2017; 54:186-194. [PMID: 27575634 DOI: 10.1016/j.jbtep.2016.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 08/06/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Depression is characterized by depressed mood and loss of interest or pleasure. Resulting alterations in emotional reactivity have been explained by three different accounts: 'positive attenuation', 'negative potentiation', and 'emotion context insensitivity'. Despite the importance of depression-related emotional alteration in social interactions, research with naturalistic interpersonal stimuli is scarce and underlying mechanisms largely unknown. METHODS Hence, the present study examined subjective emotional reactivity to brief negative, positive, and neutral social-evaluative videos as a function of depressive symptoms in an adult sample (N = 84). Fear of positive evaluation (FPE) and fear of negative evaluation (FNE), often conceptualized as cognitive components of social anxiety, were examined as possible mediators. RESULTS Results revealed that more depression symptoms were related to diminished pleasantness responses to both positive and neutral videos. When considering all three video conditions simultaneously, only responses to positive videos remained significantly related to depression scores, supporting the 'positive attenuation' account. Moreover, FPE was found to uniquely mediate the relationship between depressive symptoms and pleasantness responses to positive videos. CONCLUSIONS Results indicate that emotional reactivity to positive interpersonal stimuli is relevant for theoretical and clinical considerations of depression. This research underlines the importance of FPE not only for understanding social anxiety but also depression.
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Affiliation(s)
- Julia Reichenberger
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria; Department of Psychology, University of Salzburg, Salzburg, Austria.
| | - Nicole Wiggert
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria; Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Dmitrij Agroskin
- Division of Social Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Frank H Wilhelm
- Department of Psychology, Division of Clinical Psychology, Health Psychology and Psychotherapy, University of Salzburg, Salzburg, Austria
| | - Jens Blechert
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria; Department of Psychology, University of Salzburg, Salzburg, Austria
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Tang F, Wang G, Lian Y. Association between anxiety and metabolic syndrome: A systematic review and meta-analysis of epidemiological studies. Psychoneuroendocrinology 2017; 77:112-121. [PMID: 28027497 DOI: 10.1016/j.psyneuen.2016.11.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/11/2016] [Accepted: 11/18/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Epidemiological studies have repeatedly investigated the association between anxiety and metabolic syndrome (MetS). However, the results have been inconsistent. We performed a meta-analysis of observational studies to summarize the evidence regarding the relation of anxiety and MetS risk. METHODS We performed a systematic literature search of all studies published in PubMed and EMBASE from its inception to June 2016. Cross-sectional and cohort studies that reported an association between the two conditions in adults were included. Data on prevalence, incidence, unadjusted or adjusted odds ratio (OR), and 95% CI were extracted or provided independently by the authors. Random effects model was used to report the pooled OR. The I2 statistic was used to assess heterogeneity. Egger's test and Begger's test were used to evaluate the publication bias. RESULTS The search yielded 18 cross-sectional studies and two cohort studies. The pooled finding from cross-sectional studies showed that anxiety had a significant positive association with MetS (OR 1.07, 95% CI 1.01-1.12), with moderate heterogeneity (I2=45.7%, P=0.018). Findings from two cohort studies indicated that the association between anxiety and MetS was insignificant. CONCLUSION Our results suggest that there is an association between anxiety and MetS. In individuals with MetS anxiety should be detected and managed. Further prospective studies are needed to explore the bidirectional association between anxiety and MetS.
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Affiliation(s)
- Fang Tang
- Health Management Center, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China
| | - Gangpu Wang
- Department of General Surgery, The Fourth Hospital of Jinan City, Jinan, China
| | - Ying Lian
- Department of Case Administration, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China.
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18
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An actigraphy study investigating sleep in bipolar I patients, unaffected siblings and controls. J Affect Disord 2017; 208:248-254. [PMID: 27792970 PMCID: PMC5154955 DOI: 10.1016/j.jad.2016.08.076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/16/2016] [Accepted: 08/21/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Disturbances in sleep and waking patterns are highly prevalent during mood episodes in bipolar disorder. The question remains whether these disturbances persist during phases of euthymia and whether they are heritable traits of bipolar disorder. The current study investigates objective sleep measures in a large sample of bipolar I patients, non-affected siblings and controls. METHODS A total of 107 bipolar disorder I patients, 74 non-affected siblings, and 80 controls were included. Sleep was measured with actigraphy over the course of 14 days. Seven sleep parameters were analyzed for group differences and their relationship with age at onset, number of episodes and psychotic symptoms using linear mixed model analysis to account for family dependencies. RESULTS Patients had a longer sleep duration and later time of sleep offset compared to the non-affected siblings but these differences were entirely attributable to differences in mood symptoms. We found no difference between patients and controls or siblings and controls when the analyses were restricted to euthymic patients. None of the bipolar illness characteristics were associated with sleep. LIMITATIONS Medication use was not taken into account which may have influenced our findings and controls were younger compared to non-affected siblings. CONCLUSIONS In the largest study to date, our findings suggest that recovered bipolar I patients and their siblings do not experience clinically significant sleep disturbances. Sleep disturbances are primarily a reflection of current mood state, but are unrelated to the course of the disorder.
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Spinhoven P, Batelaan N, Rhebergen D, van Balkom A, Schoevers R, Penninx BW. Prediction of 6-yr symptom course trajectories of anxiety disorders by diagnostic, clinical and psychological variables. J Anxiety Disord 2016; 44:92-101. [PMID: 27842240 DOI: 10.1016/j.janxdis.2016.10.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/31/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022]
Abstract
This study aimed to identify course trajectories of anxiety disorder using a data-driven method and to determine the incremental predictive value of clinical and psychological variables over and above diagnostic categories. 703 patients with DSM-IV panic disorder with or without agoraphobia, agoraphobia, social phobia, or generalized anxiety disorder were selected from a prospective cohort study. Latent Growth Mixture Modeling was conducted, based on symptoms of anxiety and avoidance as assessed with the Life Chart Interview covering a 6-year time period. In 44% of the participants symptoms of anxiety and avoidance improved, in 24% remained stable, in 25% slightly increased, and in 7% severely increased. Identified course trajectories were predicted by baseline DSM-IV anxiety categories, clinical variables (i.e., severity and duration and level of disability) and psychological predictors (i.e., neuroticism, extraversion, anxiety sensitivity, worry, and rumination). Clinical variables better predicted unfavorable course trajectories than psychological predictors, over and above diagnostic categories.
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Affiliation(s)
- Philip Spinhoven
- Institute of Psychology, Leiden University and Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - Neeltje Batelaan
- Department of Psychiatry/EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Didi Rhebergen
- Department of Psychiatry/EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Anton van Balkom
- Department of Psychiatry/EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Robert Schoevers
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands.
| | - Brenda W Penninx
- Department of Psychiatry/EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Zhou T, Li X, Pei Y, Gao J, Kong J. Internet-based cognitive behavioural therapy for subthreshold depression: a systematic review and meta-analysis. BMC Psychiatry 2016; 16:356. [PMID: 27769266 PMCID: PMC5073460 DOI: 10.1186/s12888-016-1061-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/04/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Subthreshold depression has a considerable impact on individuals' subjective well-being and psychosocial functioning and is a predictor of major depressive disorder. Internet-based cognitive behavioural treatments (iCBTs) have been used to reduce the symptoms of subthreshold depression. This meta-analysis aims to systematically review evidence indicating the efficacy of iCBT programs on the improvement of depressive symptoms in this population. METHODS Articles published from January 2005 to July 2016 were searched in the following databases: Medline, PubMed, Web of Science, ScienceDirect, PsycArticles and the Cochrane Central Register of Controlled Trials. Only randomized controlled trials comparing the efficacy of iCBT programs with control groups for participants with subthreshold depression were selected. Both quantitative and qualitative analyses were conducted to examine the efficacy of iCBT interventions. RESULTS Tenarticles from 8 randomized controlled trials were identified in this systematic review. The results suggested that iCBT programs had a superior efficacy compared to results from a non-active control group at the post-intervention stage (SMD = - 0.28, CI [- 0.42, - 0.14]; I2 = 49 %). However, evidence on the long-term efficacy of iCBT programs is still insufficient and needs further exploration. CONCLUSION There has been substantial evidence that iCBT intervention has a superior short-term efficacy compared to the results of control groups, while its long-term efficacy of iCBT for subthreshold depressive symptoms is inconclusive and must be examined in further research. TRIAL REGISTRATION The protocol of this review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), Protocol No. CRD42015023390 .
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Affiliation(s)
- Ting Zhou
- School of Management, Beijing University of Chinese Medicine, #11 North Three-Ring Road East, Chaoyang District, Beijing, China 100029
| | - Xue Li
- School of Management, Beijing University of Chinese Medicine, #11 North Three-Ring Road East, Chaoyang District, Beijing, China 100029
| | - Ye Pei
- School of Management, Beijing University of Chinese Medicine, #11 North Three-Ring Road East, Chaoyang District, Beijing, China 100029
| | - Jianan Gao
- School of Management, Beijing University of Chinese Medicine, #11 North Three-Ring Road East, Chaoyang District, Beijing, China 100029
| | - Junhui Kong
- School of Management, Beijing University of Chinese Medicine, #11 North Three-Ring Road East, Chaoyang District, Beijing, China, 100029.
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Kaseva K, Rosenström T, Hintsa T, Pulkki-Råback L, Tammelin T, Lipsanen J, Yang X, Hintsanen M, Hakulinen C, Pahkala K, Hirvensalo M, Hutri-Kähönen N, Raitakari OT, Keltikangas-Järvinen L. Trajectories of Physical Activity Predict the Onset of Depressive Symptoms but Not Their Progression: A Prospective Cohort Study. JOURNAL OF SPORTS MEDICINE (HINDAWI PUBLISHING CORPORATION) 2016; 2016:8947375. [PMID: 27795983 PMCID: PMC5067320 DOI: 10.1155/2016/8947375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 12/26/2022]
Abstract
This prospective, community-based study examined trajectories of physical activity from childhood to adulthood and whether these trajectories contributed to depressive symptoms in adulthood to a greater degree than adulthood physical activity. Participants (n = 3596) were from the ongoing Cardiovascular Risk in Young Finns Study which started in 1980. Depressive symptoms were measured with Beck Depression Inventory (BDI-II) in 2012, and physical activity was assessed from 1980 to 2011 with self-reports. Analyses were adjusted for age, sex, childhood negative emotionality, socioeconomic factors, previous depressive symptoms, social support, body mass index, and smoking status (1980-2007). Highly, moderately, and lightly physically active trajectory groups were identified. Highly active participants reported lower levels of depressive symptoms compared to lightly active ones (p < 0.001) and compared to moderately active ones (p = 0.001). Moderately active participants had less symptoms than lightly active ones (p < 0.001). High levels of adulthood physical activity associated with lower levels of depressive symptoms (p < 0.001). The findings did not withstand adjustment for previous depressive symptoms (p > 0.05). Lifelong physical activity trajectories or adulthood physical activity was not associated with the progression of depressive symptoms in adulthood. Thus, physical activity history does not contribute to the progression of the depressive symptoms to a greater degree than adulthood physical activity.
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Affiliation(s)
- Kaisa Kaseva
- Unit of Personality, Work and Health Psychology, Institute of Behavioral Sciences, P.O. Box 9, University of Helsinki, 00014 Helsinki, Finland
| | - Tom Rosenström
- Unit of Personality, Work and Health Psychology, Institute of Behavioral Sciences, P.O. Box 9, University of Helsinki, 00014 Helsinki, Finland
| | - Taina Hintsa
- Unit of Personality, Work and Health Psychology, Institute of Behavioral Sciences, P.O. Box 9, University of Helsinki, 00014 Helsinki, Finland
| | - Laura Pulkki-Råback
- Unit of Personality, Work and Health Psychology, Institute of Behavioral Sciences, P.O. Box 9, University of Helsinki, 00014 Helsinki, Finland
- Helsinki Collegium for Advanced Studies, Fabianinkatu 24, P.O. Box 4, University of Helsinki, 00014 Helsinki, Finland
| | - Tuija Tammelin
- LIKES, Research Center for Sport and Health Sciences, Rautpohjankatu 8, 40700 Jyväskylä, Finland
| | - Jari Lipsanen
- Unit of Personality, Work and Health Psychology, Institute of Behavioral Sciences, P.O. Box 9, University of Helsinki, 00014 Helsinki, Finland
| | - Xiaolin Yang
- LIKES, Research Center for Sport and Health Sciences, Rautpohjankatu 8, 40700 Jyväskylä, Finland
| | - Mirka Hintsanen
- Unit of Personality, Work and Health Psychology, Institute of Behavioral Sciences, P.O. Box 9, University of Helsinki, 00014 Helsinki, Finland
- Unit of Psychology, University of Oulu, P.O. Box 8000, 90014 Oulu, Finland
| | - Christian Hakulinen
- Unit of Personality, Work and Health Psychology, Institute of Behavioral Sciences, P.O. Box 9, University of Helsinki, 00014 Helsinki, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, Kiinamyllynkatu 10, University of Turku, 20520 Turku, Finland
- Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Physical Activity and Health, Kiinamyllynkatu 10, University of Turku, 20520 Turku, Finland
| | - Mirja Hirvensalo
- Department of Sport Sciences, P.O. Box 35 (L), University of Jyväskylä, 40014 Jyväskylä, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, P.O. Box 2000, University of Tampere and Tampere University Hospital, 33521 Tampere, Finland
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, Kiinamyllynkatu 10, University of Turku, 20520 Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kiinamyllynkatu 4-8, Turku University Hospital, 20520 Turku, Finland
| | - Liisa Keltikangas-Järvinen
- Unit of Personality, Work and Health Psychology, Institute of Behavioral Sciences, P.O. Box 9, University of Helsinki, 00014 Helsinki, Finland
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Chinneck A, Mackinnon SP, Stewart SH. Investigating Possible Reciprocal Relations Between Depressive and Problem Gambling Symptoms in Emerging Adults. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:93-101. [PMID: 27253700 PMCID: PMC4784238 DOI: 10.1177/0706743715625934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Previous cross-sectional research has shown that depression and problem gambling co-occur. Longitudinal research, however, allows for a better determination of directionality, as behavioural changes in gambling involvement can be more reliably studied over time. Our study assesses symptoms of depression and problem gambling across 4 waves and addresses whether their relation is directional (with one reliably preceding the other), bidirectional, or pathoplastic. METHOD As part of the Manitoba Longitudinal Study of Young Adults, prospective data were collected on Canadian young adults' (Wave 1: n = 679, 51.8% female, aged 18 to 20 years) depressive symptoms, involvement in gambling, and risky gambling behaviour. Recruitment and the first cycle of data collection (Wave 1) took place in fall 2007. Three additional waves of data collection then occurred in 12- to 18-month intervals: fall 2008, spring 2010, and spring 2011. The Problem Gambling Severity Index and the Composite International Diagnostic Interview-Short Form were administered through telephone interview at each wave. RESULTS Bivariate growth curves showed that depressive and problem gambling symptoms were positively correlated at Wave 1, Wave 2, and Wave 4. Neither disorder was found to be a risk factor for the other, and depression and problem gambling were not pathoplastically related (that is, increases in one did not result in increases in the other over time, and vice versa). CONCLUSIONS While depression and problem gambling are related, their co-occurrence may be better explained not by depressive- or gambling-related risk, but by the presence of a common underlying factor (such as substance abuse).
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Affiliation(s)
- Annie Chinneck
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia
| | - Sean P Mackinnon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia
| | - Sherry H Stewart
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia
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Balbuena L, Bowen R, Baetz M, Marwaha S. Mood Instability and Irritability as Core Symptoms of Major Depression: An Exploration Using Rasch Analysis. Front Psychiatry 2016; 7:174. [PMID: 27833568 PMCID: PMC5080527 DOI: 10.3389/fpsyt.2016.00174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/04/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mood instability (MI) and irritability are related to depression but are not considered core symptoms. Instruments typically code clusters of symptoms that are used to define syndromic depression, but the place of MI and irritability has been under-investigated. Whether they are core symptoms can be examined using Rasch analysis. METHOD We used the UK Psychiatric Morbidity Survey 2000 data (n = 8,338) to determine whether the nine ICD/DSM symptoms, plus MI and irritability, constitute a valid depression scale. Rasch analysis was used, a method concerned with ensuring that items constitute a robust scale and tests whether the count of symptoms reflects an underlying interval-level measure. Two random samples of 500 were drawn, serving as calibration and validation samples. As part of the analysis, we examined whether the candidate symptoms were unidimensional, followed a Guttman pattern, were locally independent, invariant with respect to age and sex, and reliably distinguished different levels of depression severity. RESULTS A subset of five symptoms (sad, no interest, sleep, cognition, suicidal ideas) together with mood instability and irritability satisfactorily fits the Rasch model. However, these seven symptoms do not separate clinically depressed persons from the rest of the population with adequate reliability (Cronbach α = 0.58; Person Separation Index = 0.35), but could serve as a basis for scale development. Likewise, the original nine DSM depression symptoms failed to achieve satisfactory reliability (Cronbach α = 0.67; Person Separation Index = 0.51). LIMITATIONS The time frame over which symptoms were experienced varied, and some required recall over the last year. Symptoms other than those examined here might also be core depression symptoms. CONCLUSION Mood instability and irritability are candidate core symptoms of the depressive syndrome and should be part of its clinical assessment.
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Affiliation(s)
- Lloyd Balbuena
- Psychiatry, University of Saskatchewan , Saskatoon, SK , Canada
| | - Rudy Bowen
- Psychiatry, University of Saskatchewan , Saskatoon, SK , Canada
| | - Marilyn Baetz
- Psychiatry, University of Saskatchewan , Saskatoon, SK , Canada
| | - Steven Marwaha
- Mental Health and Wellbeing, Warwick Medical School , Coventry , UK
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Dedovic K, Giebl S, Duchesne A, Lue SD, Andrews J, Efanov S, Engert V, Beaudry T, Baldwin MW, Pruessner JC. Psychological, endocrine, and neural correlates of attentional bias in subclinical depression. ANXIETY STRESS AND COPING 2015; 29:479-96. [DOI: 10.1080/10615806.2015.1101457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Katarina Dedovic
- Douglas Institute Research Centre, McGill University, Boulevard Lasalle Verdun, QC, Canada
- Social and Affective Neuroscience Laboratory, University of California, Los Angeles, CA, USA
| | - Saskia Giebl
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Annie Duchesne
- Douglas Institute Research Centre, McGill University, Boulevard Lasalle Verdun, QC, Canada
- Department of Biology, Bishop's University, Sherbrooke, QC, Canada
| | - Sonja D. Lue
- Douglas Institute Research Centre, McGill University, Boulevard Lasalle Verdun, QC, Canada
| | - Julie Andrews
- Douglas Institute Research Centre, McGill University, Boulevard Lasalle Verdun, QC, Canada
| | - Simona Efanov
- Douglas Institute Research Centre, McGill University, Boulevard Lasalle Verdun, QC, Canada
| | - Veronika Engert
- Douglas Institute Research Centre, McGill University, Boulevard Lasalle Verdun, QC, Canada
- Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Thomas Beaudry
- McGill Centre for studies in Aging, McGill University, Verdun, Québec, Canada
| | | | - Jens C. Pruessner
- Douglas Institute Research Centre, McGill University, Boulevard Lasalle Verdun, QC, Canada
- McGill Centre for studies in Aging, McGill University, Verdun, Québec, Canada
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Nieman DH, McGorry PD. Detection and treatment of at-risk mental state for developing a first psychosis: making up the balance. Lancet Psychiatry 2015; 2:825-34. [PMID: 26360901 DOI: 10.1016/s2215-0366(15)00221-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/02/2015] [Accepted: 05/01/2015] [Indexed: 12/26/2022]
Abstract
The at-risk mental state (ARMS) has been substantially researched and used as the basis for new clinical settings and strategies over the past two decades. However, it has also caused controversy and intense debate. In this Review, we assess available evidence and propose future directions. Accumulating research suggests that a blend of clinical staging and profiling, which naturally incorporates ARMS, might be a better guide for treatment of patients in different stages of psychiatric illness than the categorical DSM and ICD systems. Furthermore, clinical staging, with its emphasis on balancing risks and benefits, could help to prevent premature treatment or overtreatment with psychotropic drugs. Meta-analyses and reviews show that treatment of ARMS leads to a significant reduction in transition rate to a first psychosis. The debate about stigma associated with ARMS is based on scarce published work. The few studies that have been done suggest that stigma (including self-stigma) arises largely from negative societal views on psychiatric disorders and, depending on the setting and approach, not from engagement in treatment for ARMS per se. The evidence base suggests that definition of ARMS is an important step in implementation of clinical staging and profiling in psychiatry. However, more research across traditional diagnostic boundaries is needed to refine these clinical phenotypes and link them to biomarkers with the goal of personalised stepwise care. Health-system reform is overdue and a parallel process to support this approach is needed, which is similar to how physical forms of non-communicable disease are treated.
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Affiliation(s)
- Dorien H Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
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Topuzoğlu A, Binbay T, Ulaş H, Elbi H, Tanık FA, Zağlı N, Alptekin K. The epidemiology of major depressive disorder and subthreshold depression in Izmir, Turkey: Prevalence, socioeconomic differences, impairment and help-seeking. J Affect Disord 2015; 181:78-86. [PMID: 25933098 DOI: 10.1016/j.jad.2015.04.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Subclinical and clinical depression is common, widely distributed in the general population, and usually associated with role impairment and help-seeking. Reliable information at the population level is needed to estimate the disease burden of depression and associated care needs in Turkey. METHOD The cross-sectional study aimed to assess the prevalence of subthreshold (SubD) and clinical major depressive disorder (MDD) in Izmir, Turkey. In the 5242 eligible households, a total of 4011 individuals were successfully interviewed, yielding a response rate of 76.5%. Prevalence estimates of MDD and SubD depression were formed by using the responses to the questions of the CIDI section E. Short Form 36 (SF-36) to assess health status and functional impairments in eight scaled scores during the last four weeks. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, as well as prescribed medicines and any hospitalization. RESULTS The one year prevalence estimate for CIDI/DSM IV MDD was 8.2% (95% CI, 7.4-9.1). Less educated, low income, uninsured, low SES, unemployed/disabled and housewives, slum area residents had higher one year MDD prevalence. Determined prevalence of help seeking from mental health services of SubD and MDD cases were 23.6%, 30.6% respectively. Only 24.8% of clinically depressive patients received minimally adequate treatment. LIMITATIONS Cross sectional design. CONCLUSION Higher MDD prevalence correlates with younger ages, female gender, unemployment, less education, lower monthly income, lower SES and uninsurance. Help seeking from mental health services were low. There are treatment gap and impairment in depressive group.
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Affiliation(s)
- Ahmet Topuzoğlu
- Dokuz Eylul University, Department of Psychiatry, Izmir, Turkey.
| | - Tolga Binbay
- Dokuz Eylul University, Department of Psychiatry, Izmir, Turkey
| | - Halis Ulaş
- Dokuz Eylul University, School of Medicine, Department of Psychiatry, Izmir, Turkey
| | - Hayriye Elbi
- Ege University, School of Medicine, Department of Psychiatry, Izmir, Turkey
| | - Feride Aksu Tanık
- Ege University, School of Medicine, Department of Public Health, Izmir, Turkey
| | - Nesli Zağlı
- Ege University, Department of Psychiatry, Izmir, Turkey
| | - Köksal Alptekin
- Dokuz Eylul University, Department of Psychiatry, Izmir, Turkey
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Elovainio M, Pulkki-Råback L, Hakulinen C, Ferrie JE, Jokela M, Hintsanen M, Raitakari OT, Keltikangas-Järvinen L. Childhood and adolescence risk factors and development of depressive symptoms: the 32-year prospective Young Finns follow-up study. J Epidemiol Community Health 2015; 69:1109-17. [DOI: 10.1136/jech-2014-205352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/29/2015] [Indexed: 11/04/2022]
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Abstract
The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are related to symptom chronicity. This study evaluated interpersonal pathoplasticity in a range of depressive presentations. We examined archival data collected from 407 participants who met criteria for major depressive disorder (MDD), dysthymic disorder (DD), or subthreshold depression (sD). Latent profile analysis (LPA) identified 5 interpersonal subtypes (vindictive, intrusive, socially avoidant, exploitable, and cold). Apart from gender, the subtypes did not differ significantly on demographic characteristics, psychiatric comorbidity, or self-report depression severity. Socially avoidant participants were more likely to meet criteria for a clinical depression diagnosis (MDD or DD), whereas vindictive participants were more likely to have sD. Our results indicate that interpersonal problems could account for heterogeneity observed in depression.
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Affiliation(s)
- Sarah Simon
- Department of Psychology, Long Island University–Brooklyn Campus
| | - Nicole M. Cain
- Department of Psychology, Long Island University–Brooklyn Campus
| | - Lisa Wallner Samstag
- Department of Psychology, Long Island University–Brooklyn Campus
- Beth Israel Medical Center
| | - Kevin B. Meehan
- Department of Psychology, Long Island University–Brooklyn Campus
| | - J. Christopher Muran
- Beth Israel Medical Center
- Derner Institute of Advanced Psychological Studies, Adelphi University
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30
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Elovainio M, Jokela M, Rosenström T, Pulkki-Råbäck L, Hakulinen C, Josefsson K, Hintsanen M, Hintsa T, Raitakari OT, Keltikangas-Järvinen L. Temperament and depressive symptoms: what is the direction of the association? J Affect Disord 2015; 170:203-12. [PMID: 25254618 DOI: 10.1016/j.jad.2014.08.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Temperament characteristics have been suggested to be associated with mental health outcomes, especially depression, but the direction of the association is unknown. In this study, we tested whether temperament characteristics, as defined by the Buss-Plomin adulthood emotionality-activity-sociability (EAS) temperament model, predict depressive symptoms or whether depressive symptoms predict changes in temperament characteristics. METHODS Participants comprised a population-based sample of 719 men and 1020 women from the Young Finns study aged 20-35 years at baseline in 1997 and who responded to repeated surveys of temperament and depressive symptoms in four study phases from 1997 to 2012. The associations were tested using linear regression models, repeated cross-lagged structural equation models, parallel latent growth curve models and two-dimensional continuous-time state space model (Exact Discrete Model). RESULTS Both low sociability (β=-0.12, p<0.001) and high negative emotionality (β=0.34, p<0.001) predicted subsequent increased depressive symptoms, whereas earlier depressive symptoms predicted increased negative emotionality (β=0.50, p<0.001), but not low sociability. LIMITATIONS The depressive symptoms scale applied may not be used for measuring clinically recognized depression. CONCLUSIONS Our findings suggest that the direction of the association is from low sociability to depressive symptoms rather than the reverse, but the association between negative emotionality and depressive symptoms seems to be reciprocal.
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Yi Z, Fang Y. Are subsyndromal symptomatic depression and major depressive disorder distinct disorders? SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 24:286-7. [PMID: 25328353 PMCID: PMC4198878 DOI: 10.3969/j.issn.1002-0829.2012.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Zhenghui Yi
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Brütt AL, Schulz H, Andreas S. Psychometric properties of an instrument to measure activities and participation according to the ICF concept in patients with mental disorders. Disabil Rehabil 2014; 37:259-67. [PMID: 24833419 DOI: 10.3109/09638288.2014.918189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The International Classification of Functioning, Disability and Health (ICF) conceptualizes the bio-psycho-social model of health and illness, but cannot be used as an assessment instrument in routine care. The objective of this study was to psychometrically test a self-report instrument for measuring activities and social participation (ICF-Mental-A&P) of psychotherapy patients. METHODS For the psychometric evaluation of the ICF-Mental-A&P, participants completed a questionnaire on symptoms, interpersonal problems and quality of life at admission and at discharge of in-patient treatment. A consecutive sample of 2256 patients diagnosed with at least one mental disorder was recruited from eight in-patient units in Germany. RESULTS After item selection, the ICF-Mental-A&P contained 31 items comprising six subscales examined by confirmatory factor analysis. Subscales had acceptable internal consistency (α = 0.78-0.90) and test-retest correlations (r = 0.71-0.86). There were several expected correlations (r ≥ 0.6) between ICF-Mental-A&P scores and measures of symptoms and interpersonal problems. CONCLUSIONS Findings suggest that the ICF-Mental-A&P is a comprehensive, reliable measure of activities and participation according to the ICF concept for patients with mental disorders. It may therefore be an important instrument in clinical practice and could help to determine and evaluate functioning-related and patient-focused treatment outcomes.
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Affiliation(s)
- Anna Levke Brütt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf , Hamburg , Germany and
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Rosenström T, Jylhä P, Robert Cloninger C, Hintsanen M, Elovainio M, Mantere O, Pulkki-Råback L, Riihimäki K, Vuorilehto M, Keltikangas-Järvinen L, Isometsä E. Temperament and character traits predict future burden of depression. J Affect Disord 2014; 158:139-47. [PMID: 24655778 DOI: 10.1016/j.jad.2014.01.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Personality traits are associated with depressive symptoms and psychiatric disorders. Evidence for their value in predicting accumulation of future dysphoric episodes or clinical depression in long-term follow-up is limited, however. METHODS Within a 15-year longitudinal study of a general-population cohort (N=751), depressive symptoms were measured at four time points using Beck׳s Depression Inventory. In addition, 93 primary care patients with DSM-IV depressive disorders and 151 with bipolar disorder, diagnosed with SCID-I/P interviews, were followed for five and 1.5 years with life-chart methodology, respectively. Generalized linear regression models were used to predict future number of dysphoric episodes and total duration of major depressive episodes. Baseline personality was measured by the Temperament and Character Inventory (TCI). RESULTS In the general-population sample, one s.d. lower Self-directedness predicted 7.6-fold number of future dysphoric episodes; for comparison, one s.d. higher baseline depressive symptoms increased the episode rate 4.5-fold. High Harm-avoidance and low Cooperativeness also implied elevated dysphoria rates. Generally, personality traits were poor predictors of depression for specific time points, and in clinical populations. Low Persistence predicted 7.5% of the variance in the future accumulated depression in bipolar patients, however. LIMITATIONS Degree of recall bias in life charts, limitations of statistical power in the clinical samples, and 21-79% sample attrition (corrective imputations were performed). CONCLUSION TCI predicts future burden of dysphoric episodes in the general population, but is a weak predictor of depression outcome in heterogeneous clinical samples. Measures of personality appear more useful in detecting risk for depression than in clinical prediction.
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Affiliation(s)
- Tom Rosenström
- IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland.
| | - Pekka Jylhä
- Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
| | - C Robert Cloninger
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Mirka Hintsanen
- IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland; Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
| | - Marko Elovainio
- IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Outi Mantere
- Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Laura Pulkki-Råback
- IBS, Unit of Personality, Work and Health Psychology, University of Helsinki, Helsinki, Finland
| | - Kirsi Riihimäki
- Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland
| | - Maria Vuorilehto
- Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | | | - Erkki Isometsä
- Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
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Shoval G, Shmulewitz D, Wall MM, Aharonovich E, Spivak B, Weizman A, Hasin D. Alcohol dependence and suicide-related ideation/behaviors in an Israeli household sample, with and without major depression. Alcohol Clin Exp Res 2013; 38:820-5. [PMID: 24117756 DOI: 10.1111/acer.12290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide-related ideation and behaviors (SRIB) are associated with both alcohol disorders and major depressive disorder (MDD). The objective of this study was to evaluate the relationship of alcohol dependence (AD) and major depression to the risk for lifetime SRIB. METHODS Data from a community-based sample of 1,237 adult Israeli lifetime drinkers assessed with reliable diagnostic measures were analyzed using logistic regression. RESULTS Lifetime SRIB was reported in 4.7% and was more prevalent among participants with AD (9.0%) than among those without AD (4.1%); p-value = 0.01. Although both AD and major depression were associated with SRIB (AD: OR 2.2, 95% CI 1.1 to 4.4; MDD: OR 11.4, 95% CI = 6.4 to 20.4), joint analysis showed that AD without MDD increased risk for SRIB as compared to those without AD or MDD (OR 3.1, 95% CI 1.1 to 9.1), but AD did not increase risk among those with MDD (OR 1.1, 95% CI 0.4 to 2.7). Among those with AD, the severity of subclinical depressive symptoms was associated with increased SRIB. CONCLUSIONS These findings show that AD increases risk for SRIB among individuals without a history of major depression. Suicidal tendencies may be undetected and underdiagnosed in this group because of the absence of major depression and therefore left untreated. These findings should be considered when adopting suicide prevention or treatment strategies for this high-risk subpopulation.
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Affiliation(s)
- Gal Shoval
- Geha Mental Health Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wesselhoeft R, Sørensen MJ, Heiervang ER, Bilenberg N. Subthreshold depression in children and adolescents - a systematic review. J Affect Disord 2013; 151:7-22. [PMID: 23856281 DOI: 10.1016/j.jad.2013.06.010] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Depressive disorders are disabling conditions striking at all ages. In adults, subthreshold depression (SD) is viewed as being on a continuum with major depressive disorder (MDD). Whether this holds for children and adolescents, is still unclear. We performed the first systematic review of SD in subjects below 18 years, in order to explore if childhood SD and MDD share causal pathways, phenomenology and outcomes, supporting a dimensional view. METHODS A critical systematic review in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. A review protocol was developed a priori, and all reports were assessed by two reviewers. RESULTS The literature search generated 941 eligible references and 24 studies were included. Although diagnostic criteria for SD showed great variability, similarities for SD and MDD were striking. Both were common conditions with similar risk factor patterns. Clinical characteristics in both groups were depressed mood, suicidal ideation and high comorbidity. Outcomes were almost equally poor, with increased psychiatric morbidity and health service use. SD intervention studies showed promising results. LIMITATIONS Reports with data on SD not reported in keywords or abstract may have been missed by the search strategy. CONCLUSION A dimensional view of depressive disorders is also supported in children and adolescents, suggesting SD to be a precursor to MDD. Although SD is a somewhat milder condition than MDD, it has severe outcomes with psychopathology and impairment. There is a need of identifying cost-efficient and longlasting interventions in order to prevent development of early SD into MDD.
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Affiliation(s)
- Rikke Wesselhoeft
- Department of Child and Adolescent Mental Health Odense, Research Unit (University Function), Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark.
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36
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Dedovic K, Duchesne A, Engert V, Lue SD, Andrews J, Efanov SI, Beaudry T, Pruessner JC. Psychological, endocrine and neural responses to social evaluation in subclinical depression. Soc Cogn Affect Neurosci 2013; 9:1632-44. [PMID: 24078020 DOI: 10.1093/scan/nst151] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This study aimed to identify vulnerability patterns in psychological, physiological and neural responses to mild psychosocial challenge in a population that is at a direct risk of developing depression, but who has not as yet succumbed to the full clinical syndrome. A group of healthy and a group of subclinically depressed participants underwent a modified Montreal Imaging Stress task (MIST), a mild neuroimaging psychosocial task and completed state self-esteem and mood measures. Cortisol levels were assessed throughout the session. All participants showed a decrease in performance self-esteem levels following the MIST. Yet, the decline in performance self-esteem levels was associated with increased levels of anxiety and confusion in the healthy group, but increased levels of depression in the subclinical group, following the MIST. The subclinical group showed overall lower cortisol levels compared with the healthy group. The degree of change in activity in the subgenual anterior cingulate cortex in response to negative evaluation was associated with increased levels of depression in the whole sample. Findings suggest that even in response to a mild psychosocial challenge, those individuals vulnerable to depression already show important maladaptive response patterns at psychological and neural levels. The findings point to important targets for future interventions.
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Affiliation(s)
- Katarina Dedovic
- Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada
| | - Annie Duchesne
- Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada
| | - Veronika Engert
- Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada
| | - Sonja Damika Lue
- Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada
| | - Julie Andrews
- Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada
| | - Simona I Efanov
- Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada
| | - Thomas Beaudry
- Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada
| | - Jens C Pruessner
- Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada Social and Affective Neuroscience Laboratory, Psychology Department, University of California, Los Angeles, CA 90095, USA, Douglas Mental Health University Institute, Integrated Program in Neuroscience, Department of Psychiatry, McGill University, Montreal, QC H4H 1R2, Canada, Maxplanck Institute, 04103 Leipzig, Germany, American School of professional Psychology, Washington, DC 22209, USA, and McGill Centre for Studies in Aging, Faculty of Medicine, McGill University, Montreal, QC H4H 1R2, Canada
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Karsten J, Penninx BWJH, Verboom CE, Nolen WA, Hartman CA. Course and risk factors of functional impairment in subthreshold depression and anxiety. Depress Anxiety 2013; 30:386-94. [PMID: 23165799 DOI: 10.1002/da.22021] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/18/2012] [Accepted: 10/13/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although persons with subthreshold depression or anxiety are known to be at risk for full-syndromal disorders, little is known about their functioning over time. In this study, we investigate the functional impairment of persons with subthreshold depression or anxiety over time, compared to that of controls. Furthermore, we evaluate which illness, personal, and environmental risk factors influence its course. METHODS Data come from the Netherlands Study of Depression and Anxiety (N = 1,266, aged 18-65). Linear mixed models were used to identify predictors of functional impairment at baseline, 1-, and 2-year follow-up. Risk factors were evaluated in their overall effect on functioning and on change in functioning over time, and whether they differed for respondents with and without subthreshold depression or anxiety. RESULTS Functional impairment in subthreshold respondents improved over time, but remained much higher than in controls. Prior anxiety disorder, high neuroticism, low conscientiousness, more somatic conditions, and more childhood trauma all predicted greater functional impairment. Older age predicted lower functioning only in subthreshold respondents, while the effect of neuroticism was stronger in subthreshold respondents relative to controls. CONCLUSIONS Functional impairment in subthreshold respondents improved over time, but remained elevated compared to that of controls. Given continuously elevated levels of impairment, preventive interventions should be focused on persons with subthreshold symptoms; in particular those with prior anxiety disorder, high neuroticism, low conscientiousness, somatic conditions, or childhood trauma.
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Affiliation(s)
- Julie Karsten
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Uher R, Rutter M. Basing psychiatric classification on scientific foundation: problems and prospects. Int Rev Psychiatry 2012; 24:591-605. [PMID: 23244614 DOI: 10.3109/09540261.2012.721346] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
To examine whether and how the classification of mental disorders can be based on research, we evaluate the relevance of psychiatric science to the major questions in classification. We conclude that most studies cannot inform the validity of diagnostic categories because they are constrained by the classification through a top-down diagnostic approach. Analyses of relationships between diagnostic categories suggest that most interdiagnostic boundaries in current classifications lack validity. Likewise, genetic studies show that the susceptibility to mental illness is at most partly disorder-specific. Neuroimaging research is uninformative due to unsystematic single-diagnosis studies, use of super-healthy controls, and publication bias. Treatment research suggests moderate specificity in several areas of psychopathology (e.g. lithium for bipolar disorder), but lack of specificity is the rule (e.g. the broad indications of serotonin-reuptake inhibitors). In summary, evidence from multiple lines of research converges to indicate that current classifications contain excessively large numbers of categories of limited validity. Dimensional classification will not solve the problem because the number of dimensions is as uncertain as the number of categories. Psychiatric research should discard the assumption that current classification is valid. Instead of diagnosis-specific investigations, studies of unselected groups assessed with bottom-up approaches are needed to advance psychiatry.
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Affiliation(s)
- Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Rodríguez MR, Nuevo R, Chatterji S, Ayuso-Mateos JL. Definitions and factors associated with subthreshold depressive conditions: a systematic review. BMC Psychiatry 2012; 12:181. [PMID: 23110575 PMCID: PMC3539957 DOI: 10.1186/1471-244x-12-181] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 09/28/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Subthreshold depressive disorders (minor and subthrehold depression) have been defined in a wide range of forms, varying on the number of symptoms and duration required. Disability associated with these conditions has also been reported. Our aim was to review the different definitions and to determine factors associated with these conditions in order to clarify the nosological implications of these disorders. METHODS A Medline search was conducted of the published literature between January 2001 and September 2011. Bibliographies of the retrieved papers were also analysed. RESULTS There is a wide heterogeneity in the definition and diagnostic criteria of minor and subthreshold depression. Minor depression was defined according to DSM-IV criteria. Regarding subthreshold depression, also called subclinical depression or subsyndromal symptomatic depression, between 2 and 5 depressive symptoms were required for the diagnosis, and a minimum duration of 2 weeks. Significant impairment associated with subthreshold depressive conditions, as well as comorbidity with other mental disorders, has been described. CONCLUSIONS Depression as a disorder is better explained as a spectrum rather than as a collection of discrete categories. Minor and subthreshold depression are common conditions and patients falling below the diagnostic threshold experience significant difficulties in functioning and a negative impact on their quality of life. Current diagnostic systems need to reexamine the thresholds for depressive disorders and distinguish them from ordinary feelings of sadness.
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Affiliation(s)
- Mar Rivas Rodríguez
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain,Department of Psychiatry, Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
| | - Roberto Nuevo
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain,Department of Psychiatry, Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
| | - Somnath Chatterji
- Department of Health Statistics and Informatics, World Health Organization, Avenue Appia 20, Geneva 27, CH 1211, Switzerland
| | - José Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain,Department of Psychiatry, Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain,Hospital Universitario de La Princesa, C./Diego de León 62, Madrid, 28006, Spain
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40
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Fountoulakis KN, Lekka E, Kouidi E, Chouvarda I, Deligiannis A, Maglaveras N. Development of the Global Disability Scale (Glo.Di.S): preliminary results. Ann Gen Psychiatry 2012; 11:14. [PMID: 22594786 PMCID: PMC3434028 DOI: 10.1186/1744-859x-11-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/24/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The assessment of functioning and disability is an important part of the clinical evaluation, since it measures disease burden and reflects the effectiveness of therapeutic planning and interventions. The aim of the current study was to develop such a self-report instrument on the basis of a review of the literature, and compatible with the WHO approach. MATERIAL AND METHODS The review of the literature led to the development of the Global Disability Scale (Glo.Di.S) with 25 items assessing different aspects of disability. The study sample included 728 persons from vulnerable populations (homeless, jobless, very low income, single parent families etc.; (29.12% males and 70.88% females; aged 55.96 ± 15.22 years). The protocol included also the STAI and the CES-D. The statistical analysis included factor analysis item analysis and ANCOVA. RESULTS The factor analysis revealed the presence of 4 factors explaining 71% of total variance (Everyday functioning, Social and interpersonal functioning, Severity and Mental disability). Chronbach's alpha for the whole scale was 0.95 and for subscales were 0.74-0.94. DISCUSSION The results of the current study suggest that the Glo.Di.S. has the potential to serve as a reliable and valid tool for assessing functioning and disability. Further research is needed to prove that it could be useful across countries, populations and diseases, and whether it provides data that are culturally meaningful and comparable. It can be used in surveys and in clinical research settings and it can generate information of use in evaluating health needs and the effectiveness of interventions to reduce disability and improve health.
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Affiliation(s)
- Konstantinos N Fountoulakis
- Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Pylaia 55535, Greece.
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Fitzgerald ME, Roy K, Anderson EE, Letiecq BL. The Effect of Depressive Symptoms on Low-Income Men in Responsible Fathering Programs. ACTA ACUST UNITED AC 2012. [DOI: 10.3149/fth.1001.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yi Z, Li Z, Yu S, Yuan C, Hong W, Wang Z, Cui J, Shi T, Fang Y. Blood-based gene expression profiles models for classification of subsyndromal symptomatic depression and major depressive disorder. PLoS One 2012; 7:e31283. [PMID: 22348066 PMCID: PMC3278427 DOI: 10.1371/journal.pone.0031283] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 01/05/2012] [Indexed: 12/28/2022] Open
Abstract
Subsyndromal symptomatic depression (SSD) is a subtype of subthreshold depressive and also lead to significant psychosocial functional impairment as same as major depressive disorder (MDD). Several studies have suggested that SSD is a transitory phenomena in the depression spectrum and is thus considered a subtype of depression. However, the pathophysioloy of depression remain largely obscure and studies on SSD are limited. The present study compared the expression profile and made the classification with the leukocytes by using whole-genome cRNA microarrays among drug-free first-episode subjects with SSD, MDD, and matched controls (8 subjects in each group). Support vector machines (SVMs) were utilized for training and testing on candidate signature expression profiles from signature selection step. Firstly, we identified 63 differentially expressed SSD signatures in contrast to control (P< = 5.0E-4) and 30 differentially expressed MDD signatures in contrast to control, respectively. Then, 123 gene signatures were identified with significantly differential expression level between SSD and MDD. Secondly, in order to conduct priority selection for biomarkers for SSD and MDD together, we selected top gene signatures from each group of pair-wise comparison results, and merged the signatures together to generate better profiles used for clearly classify SSD and MDD sets in the same time. In details, we tried different combination of signatures from the three pair-wise compartmental results and finally determined 48 gene expression signatures with 100% accuracy. Our finding suggested that SSD and MDD did not exhibit the same expressed genome signature with peripheral blood leukocyte, and blood cell–derived RNA of these 48 gene models may have significant value for performing diagnostic functions and classifying SSD, MDD, and healthy controls.
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Affiliation(s)
- Zhenghui Yi
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zezhi Li
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shunying Yu
- Department of Genetics, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengmei Yuan
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Hong
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zuowei Wang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Cui
- The Center for Bioinformatics and Institute of Biomedical Sciences, The College of Life Sciences, East China Normal University, Shanghai, China
| | - Tieliu Shi
- The Center for Bioinformatics and Institute of Biomedical Sciences, The College of Life Sciences, East China Normal University, Shanghai, China
- Shanghai Information Center for Life Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
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Aschbacher K, Epel E, Wolkowitz OM, Prather AA, Puterman E, Dhabhar FS. Maintenance of a positive outlook during acute stress protects against pro-inflammatory reactivity and future depressive symptoms. Brain Behav Immun 2012; 26:346-52. [PMID: 22119400 PMCID: PMC4030538 DOI: 10.1016/j.bbi.2011.10.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/18/2011] [Accepted: 10/28/2011] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Cognitive and affective responses to acute stress influence pro-inflammatory cytokine reactivity, and peripheral cytokines (particularly interleukin-1 beta (IL-1β)), can act on the brain to promote depressive symptoms. It is unknown whether acute stress-induced changes in positive affect and cognitions (POS) and pro-inflammatory reactivity predict future depressive symptoms. We examined acute stress responses among women, to determine prospective predictors of depressive symptoms. HYPOTHESES (1) Stress-induced decreases in POS will be associated with stress-related increases in circulating IL-1β. (2) Acute stress-induced decreases in POS and increases in IL-1β reactivity will predict increases in depressive symptoms 1 year later. Thirty-five post-menopausal women were exposed to acute stress with the Trier Social Stress Task (TSST) and provided blood samples under resting conditions and 30 min after the conclusion of the TSST, which were assayed for IL-1β. IL-1β reactivity was quantified as post minus pre-TSST. Failure to maintain POS was quantified as the decrease in POS during the TSST. Change in depressive symptoms from the study baseline to the following year was determined. Greater acute stress-induced declines in POS were significantly associated with increased IL-1β reactivity (p≤.02), which significantly predicted increases in depressive symptoms over the following year (p<.01), controlling for age, body mass index, chronic stress, antidepressant use and baseline depressive symptoms. IL-1β reactivity was a significant mediator of the relationship between POS decline and future increases in depressive symptoms (p=.04). Difficulty maintaining positivity under stress and heightened pro-inflammatory reactivity may be markers and/or mechanisms of risk for future increases in depressive symptoms.
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Affiliation(s)
- K Aschbacher
- Department of Psychiatry, School of Medicine, University of California San Francisco, CA 94143-0848, USA.
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Gili M, Luciano JV, Bauzá N, Aguado J, Serrano MJ, Armengol S, Roca M. Psychometric properties of the IDS-SR30 for the assessment of depressive symptoms in Spanish population. BMC Med Res Methodol 2011; 11:131. [PMID: 21936925 PMCID: PMC3188477 DOI: 10.1186/1471-2288-11-131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 09/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the high prevalence of depression, it is clinically relevant to improve the early identification and assessment of depressive episodes. The main objective of the present study was to examine the psychometric properties of the IDS-SR30 (Self-rated Inventory of Depressive Symptomatology) in a large Spanish sample of depressive patients. METHODS This prospective, naturalistic, multicenter, nationwide epidemiological study conducted in Spain included 1595 adult patients (65.3% females) with a DSM-IV Major Depressive Disorder (MDD. IDS-SR30 and the Hamilton Depression Rating Scale (HDRS, 21 items)were administered to the sample. Data was collected during 2 routine visits. The second assessment was carried out after 10 ± 2 weeks after first assessment. RESULTS The IDS-SR30 showed good internal consistency (α = 0.94) and high item total correlations (≥ 0.50) were found in 70% of the items. The convergent validity was 0.85. Results of the principal component analysis (PCA) and confirmatory factor analyses (CFA) showed that a three factor model (labelled mood/cognition, anxiety/somatic and sleep) is adequate for the current sample. CONCLUSIONS The Spanish version of the IDS-SR30 seems a reliable, valid and useful tool for measuring depression symptomatology in Spanish population.
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Affiliation(s)
- Margalida Gili
- Institut Universitari d'Investigació en Ciències de la Salut, University of Balearic Islands, Cra, de Valldemossa, Palma de Mallorca 07122, Spain.
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Rivas M, Nuevo R, Ayuso-Mateos JL. Depresión subclínica en España: prevalencia e impacto sobre la salud. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:144-9. [DOI: 10.1016/j.rpsm.2011.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/19/2011] [Accepted: 05/23/2011] [Indexed: 11/25/2022]
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Karsten J, Hartman CA, Smit JH, Zitman FG, Beekman ATF, Cuijpers P, van der Does AJW, Ormel J, Nolen WA, Penninx BWJH. Psychiatric history and subthreshold symptoms as predictors of the occurrence of depressive or anxiety disorder within 2 years. Br J Psychiatry 2011; 198:206-12. [PMID: 21357879 DOI: 10.1192/bjp.bp.110.080572] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Past episodes of depressive or anxiety disorders and subthreshold symptoms have both been reported to predict the occurrence of depressive or anxiety disorders. It is unclear to what extent the two factors interact or predict these disorders independently. AIMS To examine the extent to which history, subthreshold symptoms and their combination predict the occurrence of depressive (major depressive disorder, dysthymia) or anxiety disorders (social phobia, panic disorder, agoraphobia, generalised anxiety disorder) over a 2-year period. METHOD This was a prospective cohort study with 1167 participants: the Netherlands Study of Depression and Anxiety. Anxiety and depressive disorders were determined with the Composite International Diagnostic Interview, subthreshold symptoms were determined with the Inventory of Depressive Symptomatology-Self Report and the Beck Anxiety Inventory. RESULTS Occurrence of depressive disorder was best predicted by a combination of a history of depression and subthreshold symptoms, followed by either one alone. Occurrence of anxiety disorder was best predicted by both a combination of a history of anxiety disorder and subthreshold symptoms and a combination of a history of depression and subthreshold symptoms, followed by any subthreshold symptoms or a history of any disorder alone. CONCLUSIONS A history and subthreshold symptoms independently predicted the subsequent occurrence of depressive or anxiety disorder. Together these two characteristics provide reasonable discriminative value. Whereas anxiety predicted the occurrence of an anxiety disorder only, depression predicted the occurrence of both depressive and anxiety disorders.
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Affiliation(s)
- Julie Karsten
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, The Netherlands.
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Karsten J, Nolen WA, Penninx BWJH, Hartman CA. Subthreshold anxiety better defined by symptom self-report than by diagnostic interview. J Affect Disord 2011; 129:236-43. [PMID: 20956020 DOI: 10.1016/j.jad.2010.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/07/2010] [Accepted: 09/07/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is no consensus on how to define subthreshold anxiety. Based on functional impairment, we aim to evaluate the use of a diagnostic instrument and an anxiety severity questionnaire to derive an empirical cut-off for defining clinically relevant, subthreshold anxiety. METHODS Our sample consisted of 1788 subjects without full-syndromal anxiety disorders from the Netherlands Study of Depression and Anxiety (NESDA). We used ANCOVA to compare the Composite International Diagnostic Interview (CIDI) and the Beck Anxiety Inventory (BAI) in their association with functional impairment, measured by the World Health Organization Disability Assessment Schedule (WHODAS II). The BAI was selected over the Fear Questionnaire (FQ) and the Penn State Worry Questionnaire (PSWQ) for its highest associations with anxiety disorders. ROC analysis determined the percentage of functionally impaired with subthreshold anxiety based on found cut-offs. RESULTS The CIDI was very modestly associated with functional impairment, possibly because of skip rules, wording or scoring, while the BAI was highly correlated to functional impairment. A score of 11 on the BAI defined clinically relevant subthreshold anxiety. This cut-off identified 36.0% of the most functionally impaired as having subthreshold anxiety. LIMITATIONS No "natural" cut-off on the BAI for determining subthreshold anxiety could be determined. The cut-off point of 11, based on a large effect size relative to normal anxiety, thus remains somewhat arbitrary. CONCLUSIONS The questionnaire BAI is more suitable than the interview CIDI to measure clinically relevant, subthreshold anxiety. The BAI score of 11 appeared to be the most appropriate cut-off for identifying clinically relevant subthreshold anxiety.
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Affiliation(s)
- J Karsten
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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