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Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry 2024; 23:58-90. [PMID: 38214615 PMCID: PMC10786006 DOI: 10.1002/wps.21160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.
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Affiliation(s)
| | - Deidre M Anglin
- City College, City University of New York, New York, NY, USA
- Graduate Center, City University of New York, New York, NY, USA
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Praveetha Patalay
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Thomas Steare
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Talen Wright
- Division of Psychiatry, University College London, London, UK
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Scholten W, ten Have M, van Geel C, van Balkom A, de Graaf R, Batelaan N. Recurrence of anxiety disorders and its predictors in the general population. Psychol Med 2023; 53:1334-1342. [PMID: 34294172 PMCID: PMC10009370 DOI: 10.1017/s0033291721002877] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/19/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anxiety disorders frequently recur in clinical populations, but the risk of recurrence of anxiety disorders is largely unknown in the general population. In this study, recurrence of anxiety and its predictors were studied in a large cohort of the adult general population. METHODS Baseline, 3-year and 6-year follow-up data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Respondents (N = 468) who had been in remission for at least a year prior to baseline were included. Recurrence was assessed at 3 and 6 years after baseline, using the Composite International Diagnostic Interview version 3.0. Cumulative recurrence rates were estimated using the number of years since remission of the last anxiety disorder. Furthermore, Cox regression analyses were conducted to investigate predictors of recurrence, using a broad range of putative predictors. RESULTS The estimated cumulative recurrence rate was 2.1% at 1 year, 6.6% at 5 years, 10.6% at 10 years, and 16.2% at 20 years. Univariate regression analyses predicted a shorter time to recurrence for several variables, of which younger age at interview, parental psychopathology, neuroticism and a current depressive disorder remained significant in the, age and gender-adjusted, multivariable regression analysis. CONCLUSIONS Recurrence of anxiety disorders in the general population is common and the risk of recurrence extends over a lengthy period of time. In clinical practice, alertness to recurrence, monitoring of symptoms, and quick access to health care in case of recurrence are needed.
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Affiliation(s)
- Willemijn Scholten
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Carmen van Geel
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Anton van Balkom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Neeltje Batelaan
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
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Freund J, Buntrock C, Braun L, Thielecke J, Baumeister H, Berking M, Ebert DD, Titzler I. Digital prevention of depression for farmers? A qualitative study on participants' experiences regarding determinants of acceptance and satisfaction with a tailored guided internet intervention program. Internet Interv 2022; 29:100566. [PMID: 36039069 PMCID: PMC9418375 DOI: 10.1016/j.invent.2022.100566] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Farmers, forest workers and gardeners have a higher risk of developing depression compared to other occupational populations. As part of the German pilot project "With us in balance", the potential of six guided internet- and mobile-based interventions (IMIs) to prevent depression among their insurants is examined. The IMI program is tailored to various risk factors of depression, individual symptoms, and needs. Although IMIs have been shown to be effective in reducing depressive symptoms, there is little qualitative research about the acceptance of digital preventive IMIs. The aim of this qualitative study is to gain insights into participants' experiences with the guided IMIs by focusing on determinants for acceptance and satisfaction. METHODS Semi-structured interviews were conducted with 22/171 (13 %) intervention group (IG) participants of a randomized controlled trial. The interview guide was developed based on theoretical models of user acceptance (Unified Theory of Acceptance and Use of Technology) and patient satisfaction (evaluation model, discrepancy theory). The interviews were evaluated independently by two coders performing a deductive-inductive content analysis and attaining a substantial level of agreement (K = 0.73). RESULTS The qualitative analysis revealed 71 determinants for acceptance and satisfaction across ten dimensions: performance expectancy, organisation, e-coach, usability, training content and structure, training usage, training outcome, financing, social influence, and behavioural intention. The most frequently identified drivers for the IMI use include "location independence", "positive relationship to the e-coach" (each n = 19, 86 %), "personal e-coach guidance", "expertise of the e-coach", "target group specific adaptation" (each n = 18, 82 %), "flexibility", "high willingness for renewed participation" (each n = 17, 77 %), "fast and easy availability", "training of health enhancing attitudes and behaviours" and "content with figurative expressions" (each n = 16, 73 %). DISCUSSION The qualitative findings predominantly suggest the acceptance of and satisfaction with the IMI program for the prevention of depression in famers and related lines of work. Many identified positive drivers are related to the e-coach guidance, which emphasizes its importance in the preventive setting from the perspective of the participants. Nevertheless, some negative aspects have been identified which help to understand potential weaknesses of the IMI program. Participants indicated different needs in terms of IMI content and usage, which points towards the potential benefit of individualisation. The possibility of being able to use IMIs anonymously, flexibly and independently of location might be highly relevant for this specific target group.
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Affiliation(s)
- Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
- Corresponding author at: Friedrich-Alexander-University of Erlangen-Nürnberg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Nägelsbachstraße 25a, 91052 Erlangen, Germany.
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Lina Braun
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- Faculty TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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Lee JY, Stewart R, Kang HJ, Kim JW, Jhon M, Kim SW, Shin IS, Kim JM. Childhood Abuse, Social Support, and Long-Term Pharmacological Treatment Outcomes in Patients With Depressive Disorders. Front Psychiatry 2022; 13:803639. [PMID: 35185652 PMCID: PMC8847738 DOI: 10.3389/fpsyt.2022.803639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study was performed to investigate the roles of childhood abuse and social support in predicting short- and long-term pharmacological treatment outcomes in outpatients with depressive disorders in a naturalistic 1-year prospective design. METHODS Patients were recruited at a university hospital in South Korea between March 2012 and April 2017. Subjects with stepwise pharmacotherapy (switching, augmentation, combination, and mixture of these approaches) included 1246 patients at 12-week points in the acute treatment response and 1,015 patients at 12-months in the long-term treatment response. Remission was defined as Hamilton Depression Rating Scale score ≤ 7. Exposure to three types of childhood abuse (physical, emotional, and sexual) before the age of 16 and perceived social support were assessed at baseline. RESULTS Individual associations of childhood abuse were associated with poorer treatment outcomes in the 12-month long-term phase, and no significant individual associations were found for social support level with any period outcome. In combination, any child abuse, emotional abuse, and physical abuse were significantly associated with long-term 12-month remission rate in the presence of higher level of social support after adjustment with significant interaction terms. However, no significant interactions were found with sexual abuse. CONCLUSION Synergistic interactive effects of child abuse and social support levels on treatment outcomes in depressive patients were found during long-term pharmacotherapy. Thus, depressed patients with a history of childhood abuse may require specialized clinical approaches, including social support, to enhance the long-term treatment outcomes.
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Affiliation(s)
- Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea
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Peitz D, Kersjes C, Thom J, Hoelling H, Mauz E. Indicators for Public Mental Health: A Scoping Review. Front Public Health 2021; 9:714497. [PMID: 34646802 PMCID: PMC8502920 DOI: 10.3389/fpubh.2021.714497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
Background: To monitor population mental health, the identification of relevant indicators is pivotal. This scoping review provides a comprehensive overview of current indicators representing the various fields of public mental health core topics. It was conducted as a first step to build up a Mental Health Surveillance for Germany. Methods: We conducted a systematic MEDLINE search via PubMed. This search was supplemented by an extensive examination of the websites of relevant national as well as international institutions in the context of public mental health and an additional internet search via Google. To structure the data, an expert-based focus group identified superordinate topics most relevant to public mental health to which the identified indicators could be assigned to. Finally, the indicator set was screened for duplicates and appropriate content to arrive at a final set. Results: Within the various search strategies, we identified 13.811 records. Of these records, a total of 365 records were processed for indicator extraction. The extracted indicators were then assigned to 14 topics most relevant to public mental health as identified by the expert-based focus group. After the exclusion of duplicates and those indicators not meeting criteria of specificity and target group, the final set consisted of 192 indicators. Conclusion: The presented indicator set provides guidance in the field of current concepts in public mental health monitoring. As a comprehensive compilation, it may serve as basis for future surveillance efforts, which can be adjusted and condensed depending on the particular monitoring focus. Our work provides insights into established indicators included in former surveillance work as well as recent, not yet included indicators reflecting current developments in the field. Since our compilation mainly concludes indicators related to mental health in adults, it should be complemented with indicators specific to children and adolescents. Furthermore, our review revealed that indicators on mental health promotion and prevention are underrepresented in current literature of public mental health and should hence be focused on within future research and surveillance.
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Affiliation(s)
- Diana Peitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christina Kersjes
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Thom
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Heike Hoelling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Elvira Mauz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Tibi L, Asher S, van Oppen P, van Balkom AJLM, Eikelenboom M, Visser HA, Penninx BW, Anholt GE. The correlates of social phobia in OCD: Findings from a large clinical sample. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:312-332. [PMID: 33870535 DOI: 10.1111/bjc.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder, often complicated with comorbidities. Social phobia (SP) is the most frequent co-occurring anxiety disorder in OCD, associated with increased clinical severity. However, no study had examined the relevance of interpersonal processes in this comorbidity, which are at the core of SP. This study characterized the clinical (i.e., symptom profile, age of onset, chronicity, and comorbidity), vulnerability (i.e., childhood trauma, negative life events), and interpersonal (attachment style, expressed emotion, and social support) correlates of comorbid SP in a large sample of OCD patients. METHODS We analysed the data of 382 OCD patients participating in the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. We examined the correlates of SP in OCD using self-report questionnaires and structured clinical interviews. In addition, data of 312 non-OCD SP patients were drawn from the Netherlands Study of Depression and Anxiety (NESDA), to compare the age of onset of SP between groups. Descriptive univariate analyses were followed by backward stepwise logistic regression analyses. RESULTS Social phobia was present among approximately 20% of OCD patients. Social phobia in OCD was associated with increased depression severity and decreased ratings of secure attachment style. Among OCD patients, SP had a significantly earlier age onset as compared to SP in non-OCD patients. CONCLUSION Social phobia in OCD might render a vulnerable clinical picture, characterized with early onset of SP symptoms, insecure attachment style, and increased depressive symptoms. Future studies should use prospective designs to better understand the nature of comorbid SP in OCD. PRACTITIONER POINTS Approximately one fifth of OCD patients were diagnosed with comorbid social phobia in a large representative clinical sample. OCD patients with comorbid social phobia presented with a vulnerable clinical picture, characterized with increased depression severity and decreased ratings of secure attachment style. Social phobia in OCD was associated with an earlier AOO as compared to the AOO of social phobia without OCD. The findings are limited by a cross-sectional design; thus, causality could not be assessed. Research is needed to further examine the mechanisms of comorbid social phobia in OCD.
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Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sapir Asher
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Patricia van Oppen
- Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Merijn Eikelenboom
- Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Henny A Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal, Ermelo, The Netherlands
| | - Brenda W Penninx
- Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Shah JL, Scott J, McGorry PD, Cross SP, Keshavan MS, Nelson B, Wood SJ, Marwaha S, Yung AR, Scott EM, Öngür D, Conus P, Henry C, Hickie IB. Transdiagnostic clinical staging in youth mental health: a first international consensus statement. World Psychiatry 2020; 19:233-242. [PMID: 32394576 PMCID: PMC7215079 DOI: 10.1002/wps.20745] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Recognizing that current frameworks for classification and treatment in psychiatry are inadequate, particularly for use in young people and early intervention services, transdiagnostic clinical staging models have gained prominence. These models aim to identify where individuals lie along a continuum of illness, to improve treatment selection and to better understand patterns of illness continuity, discontinuity and aetiopathogenesis. All of these factors are particularly relevant to help-seeking and mental health needs experienced during the peak age range of onset, namely the adolescent and young adult developmental periods (i.e., ages 12-25 years). To date, progressive stages in transdiagnostic models have typically been defined by traditional symptom sets that distinguish "sub-threshold" from "threshold-level" disorders, even though both require clinical assessment and potential interventions. Here, we argue that staging models must go beyond illness progression to capture additional dimensions of illness extension as evidenced by emergence of mental or physical comorbidity/complexity or a marked change in a linked biological construct. To develop further consensus in this nascent field, we articulate principles and assumptions underpinning transdiagnostic clinical staging in youth mental health, how these models can be operationalized, and the implications of these arguments for research and development of new service systems. We then propose an agenda for the coming decade, including knowledge gaps, the need for multi-stakeholder input, and a collaborative international process for advancing both science and implementation.
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Affiliation(s)
- Jai L. Shah
- Prevention and Early Intervention Program for Psychosis (PEPP‐Montreal)Douglas Mental Health University InstituteMontrealQCCanada,ACCESS Open MindsDouglas Mental Health University InstituteMontrealQCCanada,Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Jan Scott
- Institute of NeuroscienceUniversity of NewcastleNewcastle upon TyneUK,Brain and Mind CentreUniversity of SydneySydneyNSWAustralia,Diderot UniversityParisFrance,Norwegian University of Science and TechnologyTrondheimNorway
| | - Patrick D. McGorry
- Orygen, The National Centre of Excellence in Youth Mental HealthMelbourneVICAustralia,Centre for Youth Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | | | - Matcheri S. Keshavan
- Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMAUSA
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental HealthMelbourneVICAustralia,Centre for Youth Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Stephen J. Wood
- Orygen, The National Centre of Excellence in Youth Mental HealthMelbourneVICAustralia,Centre for Youth Mental HealthUniversity of MelbourneMelbourneVICAustralia,School of PsychologyUniversity of BirminghamBirminghamUK
| | - Steven Marwaha
- Institute for Mental HealthUniversity of BirminghamBirminghamUK
| | - Alison R. Yung
- Orygen, The National Centre of Excellence in Youth Mental HealthMelbourneVICAustralia,Centre for Youth Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Elizabeth M. Scott
- Brain and Mind CentreUniversity of SydneySydneyNSWAustralia,School of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - Dost Öngür
- Psychotic Disorders Division, McLean HospitalHarvard Medical SchoolBostonMAUSA
| | - Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Department of PsychiatryLausanne University HospitalLausanneSwitzerland
| | - Chantal Henry
- Perception and Memory Unit, Institut Pasteur, UMR3571Centre National de la Recherche Scientifique (CNRS)ParisFrance,Université de ParisParisFrance,Department of Psychiatry, Service Hospitalo‐UniversitaireGHU Paris Psychiatrie & NeurosciencesParisFrance
| | - Ian B. Hickie
- Brain and Mind CentreUniversity of SydneySydneyNSWAustralia
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Tibi L, van Oppen P, van Balkom AJLM, Eikelenboom M, Hendriks GJ, Anholt GE. Childhood trauma and attachment style predict the four-year course of obsessive compulsive disorder: Findings from the Netherlands obsessive compulsive disorder study. J Affect Disord 2020; 264:206-214. [PMID: 32056752 DOI: 10.1016/j.jad.2019.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/08/2019] [Accepted: 12/19/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder where most patients do not reach full symptomatic remission. Identifying predictors of course can improve patients' care by informing clinicians on prognosis and enhancing treatment strategies. Several predictors associated with improved outcome of OCD were identified. However, research focused mainly on clinical, illness-related predictors of the course of OCD. This study examined the contribution of environmental and interpersonal predictors on the long-term outcome of OCD, in addition to the previously identified clinical indicators. METHODS We used the baseline, two and four-year data of 382 adult OCD patients participating in the naturalistic cohort study of the Netherlands Obsessive Compulsive Disorder Association (NOCDA). Remission was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Predictors of outcome were assessed at baseline, via clinician-rated and self-report instruments. RESULTS Remission at two and at four-year follow-up ranged from 11% to 26%. Early age of onset and the presence of childhood trauma predicted a worse four-year course. Secure attachment style emerged as a protective predictor of improved outcome. LIMITATIONS The naturalistic design of our study did not enable a systematic estimation the effect of treatments received during the follow-up period. Furthermore, age of onset and childhood trauma were assessed retrospectively, which may contribute to recall bias. CONCLUSION Results coincide with previous prediction research and stress the importance of adaptive interpersonal functioning in the course of OCD. Clinical implications and future research directions are discussed.
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Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Merijn Eikelenboom
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Gert-Jan Hendriks
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, the Netherlands; Institute of Integrated Mental Health Care "Pro Persona," "Overwaal" Centre of Expertise for Anxiety Disorders OCD and PTSD Nijmegen, the Netherlands; Radboud University Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Bartolomei J, Baeriswyl-Cottin R, Framorando D, Zanello A, Bacchetta JP, Herrmann F, Sentissi O. Personality Factors and Attachment Styles as Predictors of the Therapeutic Efficacy of a Short-Term Ambulatory Intervention for Depression. J Psychiatr Pract 2020; 26:3-16. [PMID: 31913965 DOI: 10.1097/pra.0000000000000442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Several studies have shown a significant positive impact of intensive short-term ambulatory psychiatric interventions for depression. However, data on outcomes related to factors that are predictive of the efficacy of these interventions in terms of remission or response to treatment remain scarce. The goal of this naturalistic prospective study was to identify factors, including Big Five Inventory personality traits and attachment style, that are predictive of the efficacy of crisis interventions (CIns) in major depressive disorder. METHODS The study included 234 adult outpatients with major depressive disorder who completed all assessments in a study of a short-term intensive ambulatory CIn. In this study, we evaluated sociodemographic factors, and scores on the Global Assessment of Functioning Scale, the Big Five Inventory personality assessment, the Montgomery-Åsberg Depression Rating Scale, and the Adult Attachment Scale. RESULTS Mean scores on the Montgomery-Åsberg Depression Rating Scale decreased significantly from 26.3 (SD=9.0) at admission to 10.6 (SD=8.1) at the end of the CIn (t=23.9; P<0.001); 99 patients (42%) experienced remission, 151 patients (65%) were considered treatment responders, and 98 patients (42%) both responded to treatment and experienced remission. Results of multivariate regression analysis showed that education level and family intervention were associated with response to treatment. Neuroticism traits were related to a lower rate of response to treatment. The dependency dimension attachment style had a positive impact on response to treatment. CONCLUSIONS Neuroticism traits can predict clinical outcomes after a short-term intensive psychiatric intervention for depression. Results of family interviews, education level, and Global Assessment of Functioning scores should also be taken into account in predicting clinical outcomes.
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Affiliation(s)
- Javier Bartolomei
- BARTOLOMEI, ZANELLO, and BACCHETTA: Adult Psychiatric Division, Crisis Intervention Centre of Cappi Paquis, Hôpitaux Universitaires de Genève, Geneva, Switzerland; BAERISWYL-COTTIN and FRAMORANDO: Adult Psychiatric Division, Crisis Intervention Centre of Cappi Servette, Hôpitaux Universitaires de Genève, Geneva, Switzerland; HERRMANN: Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, and Hôpital des Trois-Chêne, Hôpitaux Universitaires de Genève, Geneva, Switzerland; SENTISSI: Department of Mental Health and Psychiatry, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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10
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Thurston RC, Carson MY, Koenen KC, Chang Y, Matthews KA, von Känel R, Jennings JR. The relationship of trauma exposure to heart rate variability during wake and sleep in midlife women. Psychophysiology 2019; 57:e13514. [PMID: 31850525 DOI: 10.1111/psyp.13514] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/19/2019] [Accepted: 11/24/2019] [Indexed: 11/28/2022]
Abstract
Traumatic experiences are common and linked to cardiovascular disease (CVD) risk, yet the mechanisms underlying these relationships is less well understood. Few studies have examined trauma exposure and its relation to autonomic influence over cardiac function, a potential pathway linking trauma exposure to CVD risk. Investigating autonomic influence over cardiac function during both wake and sleep is critical, given particular links of sleep autonomic function to cardiovascular health. Among midlife women, we tested whether trauma exposure would be related to lower high frequency heart rate variability (HF-HRV), an index of vagal influence over cardiac function, during wake and sleep. Three hundred and one nonsmoking midlife women completed physical measures, a 24-hr electrocardiogram, actigraphy sleep measurement, and questionnaires about trauma (Brief Trauma Questionnaire), childhood abuse (Child Trauma Questionnaire [CTQ]), mood, demographics, and medical/psychiatric history. Relations between trauma and HF-HRV were assessed in linear mixed effects models adjusting for covariates (age, race, education, body mass index, blood pressure, psychiatric history, medication use, sleep, mood, childhood abuse history). Results indicated that most women had experienced trauma. Any trauma exposure as well as a greater number of traumatic experiences were associated with lower HF-HRV during wake and particularly during sleep. Relations were not accounted for by covariates. Among midlife women, trauma exposure was related to lower HF-HRV during wake and sleep. Trauma may have an important impact on vagal influence over the heart, particularly during sleep. Decreased vagal influence over cardiac function may be a key mechanism by which trauma is associated with CVD risk.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Y Carson
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Richard Jennings
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
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11
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Sherwood L, Hegarty S, Vallières F, Hyland P, Murphy J, Fitzgerald G, Reid T. Identifying the Key Risk Factors for Adverse Psychological Outcomes Among Police Officers: A Systematic Literature Review. J Trauma Stress 2019; 32:688-700. [PMID: 31553502 DOI: 10.1002/jts.22431] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 12/18/2022]
Abstract
It is well established that police work is highly stressful; however, a paucity of evidence limits our knowledge and understanding of the factors that may lead to, compromise, and/or compound psychological distress for this unique population. To address this lack, the current systematic review was conducted to reveal the individual, organizational, and operational risk factors that have been identified in the research literature to date and their associations with depression, anxiety, posttraumatic stress disorder (PTSD), and burnout. We performed searches on literature published between January 2008 and January 2018 and identified a total of 20 studies that met our inclusion criteria. The results indicated that individual factors, including high levels of neuroticism, low social support, and engaging in passive or avoidant coping strategies, were associated with adverse psychological outcomes. This review identified low social support from colleagues as the most common risk factor linked to adverse psychological outcomes. Other organizational risk factors associated with such outcomes included high work demands, low resources, and low reward. This article demonstrates that individual, organizational, and operational factors all impact the negative psychological outcomes of police officers to some degree. In particular, the current review suggests that certain negative psychological outcomes are likely a result of a combination of risk factors across the three domains of risk, highlighting the necessity to observe psychological risk of police in a more comprehensive way.
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Affiliation(s)
- Larissa Sherwood
- Centre for Global Health, School of Psychology, Trinity College Dublin
| | - Siobhan Hegarty
- Centre for Global Health, School of Psychology, Trinity College Dublin
| | | | | | - Jamie Murphy
- Psychology Research Institute, School of Psychology, Ulster University
| | | | - Tracey Reid
- Collaborative Network for Training and Excellence in Psychotraumatology
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12
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Bosman RC, Ten Have M, de Graaf R, Muntingh AD, van Balkom AJ, Batelaan NM. Prevalence and course of subthreshold anxiety disorder in the general population: A three-year follow-up study. J Affect Disord 2019; 247:105-113. [PMID: 30660019 DOI: 10.1016/j.jad.2019.01.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/07/2018] [Accepted: 01/13/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study examined the prevalence, course and risk indicators of subthreshold anxiety disorder to determine the necessity and possible risk indicators for interventions. METHODS Data were derived from the 'Netherlands Mental Health Survey and Incidence Study-2' (NEMESIS-2), a psychiatric epidemiological cohort study among the general population (n = 4528). This study assessed prevalence, characteristics, and three-year course of subthreshold anxiety disorder (n = 521) in adults, and compared them to a no anxiety group (n = 3832) and an anxiety disorder group (n = 175). Risk indicators for persistent and progressive subthreshold anxiety disorder were also explored, including socio-demographics, vulnerability factors, psychopathology, physical health and functioning. RESULTS The three-year prevalence of subthreshold anxiety disorder was 11.4%. At three-year follow-up, 57.3% had improved, 29.0% had persistent subthreshold anxiety disorder and 13.8% had progressed to a full-blown anxiety disorder. Prevalence, characteristics and course of subthreshold anxiety disorder were in between both comparison groups. Risk indicators for persistent course partly overlapped with those for progressive course and included vulnerability and psychopathological factors, and diminished functioning. LIMITATIONS Course analysis were restricted to the development of anxiety disorders, other mental disorders were not assessed. Moreover, due to the naturalistic design of the study the impact of treatment on course cannot be assessed. CONCLUSIONS Subthreshold anxiety disorder is relatively prevalent and at three-year follow-up a substantial part of respondents experienced persistent symptoms or had progressed into an anxiety disorder. Risk indicators like reduced functioning may help to identify these persons for (preventative) treatment and hence reduce functional limitations and disease burden.
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Affiliation(s)
- Renske C Bosman
- Department of Psychiatry, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction (Trimbos Instituut), Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos Instituut), Utrecht, The Netherlands
| | - Anna Dt Muntingh
- Department of Psychiatry, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Anton Jlm van Balkom
- Department of Psychiatry, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
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13
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Bennik EC, Jeronimus BF, Aan Het Rot M. The relation between empathy and depressive symptoms in a Dutch population sample. J Affect Disord 2019; 242:48-51. [PMID: 30173062 DOI: 10.1016/j.jad.2018.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/25/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Impairments in social functioning are common in individuals with (sub)clinical levels of depression. One possible underlying mechanism of this relationship is low empathy. The present study examined linear and non-linear associations between empathy and depressive symptoms, and whether these associations were moderated by gender. METHODS Using the Empathy Quotient scale, cognitive and affective empathy were assessed using a large convenience sample from the general Dutch population (N = 3076). Depressive symptoms were indexed by the Depression, Anxiety and Stress Scale (DASS) and the Quick Inventory of Depressive Symptomatology (QIDS-SR16). RESULTS Low cognitive empathy was associated with more depressive symptoms. There was a weak positive relation between affective empathy and depressive symptoms, indexed by the QIDS rather than the DASS. LIMITATIONS Generalizing results to the general population remains difficult with a convenience sample. Self-reported data may be affected by social-desirability or sex-stereotypical reporting biases. CONCLUSIONS Our results support a linear relationship between cognitive empathy and symptoms of depression. There was some evidence for non-linear associations and a moderating role of gender, but these patterns were not observed across all types of analysis.
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Affiliation(s)
- Elise C Bennik
- Department of Psychology, University of Groningen, The Netherlands.
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14
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van der Wal SJ, Bienvenu OJ, Romanoski AJ, Eaton WW, Nestadt G, Samuels J. Longitudinal relationships between personality disorder dimensions and depression in a community sample. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.npbr.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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van Oudheusden LJB, Eikelenboom M, van Megen HJGM, Visser HAD, Schruers K, Hendriks GJ, van der Wee N, Hoogendoorn AW, van Oppen P, van Balkom AJLM. Chronic obsessive-compulsive disorder: prognostic factors. Psychol Med 2018; 48:2213-2222. [PMID: 29310732 DOI: 10.1017/s0033291717003701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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 The course of illness in obsessive-compulsive disorder (OCD) varies significantly between patients. Little is known about factors predicting a chronic course of illness. The aim of this study is to identify factors involved in inducing and in maintaining chronicity in OCD. METHODS The present study is embedded within the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, an ongoing multicenter naturalistic cohort study designed to identify predictors of long-term course and outcome in OCD. For this study, 270 subjects with a current diagnosis of OCD were included. Chronicity status at 2-year follow-up was regressed on a selection of baseline predictors related to OCD, to comorbidity and to stress and support. RESULTS Psychotrauma [odds ratio (OR) 1.98, confidence interval (CI) 1.22-3.22, p = 0.006], recent negative life events (OR 1.42, CI 1.01-2.01, p = 0.043), and presence of a partner (OR 0.28, CI 0.09-0.85, p = 0.025) influenced the risk of becoming chronic. Longer illness duration (OR 1.46, CI 1.08-1.96, p = 0.013) and higher illness severity (OR 1.09, CI 1.03-1.16, p = 0.003) increased the risk of remaining chronic. CONCLUSIONS External influences increase the risk of becoming chronic, whereas the factors involved in maintaining chronicity are illness-related. As the latter are potentially difficult to modify, treatment should be devoted to prevent chronicity from occurring in the first place. Therapeutic strategies aimed at alleviating stress and at boosting social support might aid in achieving this goal.
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Affiliation(s)
- Lucas J B van Oudheusden
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| | - Harold J G M van Megen
- Innova Research Centre, Mental Health Care Institute GGZ Centraal,Ermelo,The Netherlands
| | - Henny A D Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal,Ermelo,The Netherlands
| | - Koen Schruers
- Research School for Mental Health and Neuroscience, Maastricht University and Mondriaan Academic Anxiety Center,Maastricht,The Netherlands
| | - Gert-Jan Hendriks
- Department of Psychiatry,Center for Anxiety Disorders 'Overwaal', Institute for Integrated Mental Health Care Pro Persona, Behavioural Science Institute, Radboud University, Radboud University Medical Center,Nijmegen,the Netherlands
| | - Nic van der Wee
- Department of Psychiatry,Leiden Center for Brain and Cognition and Leiden Center for Translational Neuroscience, Leiden University Medical Center,Leiden,the Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
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Visram S, Smith S, Connor N, Greig G, Scorer C. Examining associations between health, wellbeing and social capital: findings from a survey developed and conducted using participatory action research. JOURNAL OF PUBLIC MENTAL HEALTH 2018. [DOI: 10.1108/jpmh-09-2017-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to employ innovative methods to examine the associations between personal wellbeing, self-rated health and various aspects of social capital within a socio-economically disadvantaged town in northern England.
Design/methodology/approach
A survey was developed and administered with input from local stakeholders (including residents), using a participatory action research (PAR) approach. In total, 11 lay interviewers were trained to pilot and deliver the final survey, which was completed either in person or online. In total, 233 valid surveys were returned.
Findings
Respondents were aged between 17 and 87 years (mean 47.3, SD 17.4), 65.7 per cent were female and 46.2 per cent identified themselves as having a longstanding illness, disability or infirmity. Overall, respondents reported lower levels of personal wellbeing and social capital in comparison with UK averages, although free-text responses highlighted a strong sense of community spirit and pride in the town. Low wellbeing was strongly associated with poor health, social isolation and neighbourhood factors such as perceived lack of community safety and trust.
Research limitations/implications
PAR appears to be an acceptable approach in generating estimates of population characteristics associated with personal wellbeing.
Practical implications
The findings of this study may be used by policymakers to design services and interventions to better meet the needs of communities characterised by indicators of poor health and wellbeing.
Originality/value
This work constitutes part of a global trend to measure personal and societal wellbeing. A novel methodology has been used to examine the factors that influence wellbeing at a neighbourhood level.
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17
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Klein NS, Holtman GA, Bockting CLH, Heymans MW, Burger H. Development and validation of a clinical prediction tool to estimate the individual risk of depressive relapse or recurrence in individuals with recurrent depression. J Psychiatr Res 2018; 104:1-7. [PMID: 29908389 DOI: 10.1016/j.jpsychires.2018.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/27/2018] [Accepted: 06/08/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Many studies examined predictors of depressive relapse/recurrence but no simple tool based on well-established risk factors is available that estimates the risk within an individual. We developed and validated such a prediction tool in remitted recurrently depressed individuals. METHODS The tool was developed using data (n = 235) from a pragmatic randomised controlled trial in remitted recurrently depressed participants and externally validated using data (n = 209) from a similar randomised controlled trial of remitted recurrently depressed participants using maintenance antidepressants. Cox regression was used with time to relapse/recurrence within 2 years as outcome and well-established risk factors as predictors. Performance measures and absolute risk scores were calculated, a practically applicable risk score was created, and the tool was externally validated. RESULTS The 2-year cumulative proportion relapse/recurrence was 46.2% in the validation dataset. The tool included number of previous depressive episodes, residual depressive symptoms, severity of the last depressive episode, and treatment. The C-statistic and calibration slope were 0.56 and 0.81 respectively. The tool stratified participants into relapse/recurrence risk classes of 37%, 55%, and 72%. The C-statistic and calibration slope in the external validation were 0.59 and 0.56 respectively, and Kaplan Meier curves showed that the tool could differentiate between risk classes. CONCLUSIONS This is the first study that developed a simple prediction tool based on well-established risk factors of depressive relapse/recurrence, estimating the individual risk. Since the overall performance of the model was poor, more studies are needed to enhance the performance before recommending implementation into clinical practice.
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Affiliation(s)
- Nicola S Klein
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands; Top Referent Traumacentrum, GGZ Drenthe, Altingerweg 1, 9411 PA Beilen, The Netherlands
| | - Gea A Holtman
- Department of General Practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Claudi L H Bockting
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands; Department of Psychiatry, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, PO Box 7057, Amsterdam, The Netherlands
| | - Huibert Burger
- Department of General Practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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18
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Struijs SY, Lamers F, Spinhoven P, van der Does W, Penninx BWJH. The predictive specificity of psychological vulnerability markers for the course of affective disorders. J Psychiatr Res 2018; 103:10-17. [PMID: 29758471 DOI: 10.1016/j.jpsychires.2018.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/05/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
High scores on markers of psychological vulnerability have been associated with a worse course of affective disorders. However, little is known about the specificity of those associations in predicting the course of different depressive and anxiety disorders. We examined the impact of psychological vulnerability on the short- and long-term course of depressive and anxiety disorders. Participants from the Netherlands Study of Depression and Anxiety with a current diagnosis of depression or anxiety (n = 1256) were reassessed after 2 and 6 years. Diagnostic status and chronic duration (>85% of the time) of symptoms were the outcomes. Predictors were neuroticism, extraversion, locus of control, cognitive reactivity (rumination and hopelessness reactivity), worry and anxiety sensitivity. High neuroticism, low extraversion and external locus of control predicted chronicity of various affective disorders. Rumination, however, predicted chronicity of depressive but not anxiety disorders. Worry specifically predicted chronicity of GAD and anxiety sensitivity predicted chronicity of panic disorder and social anxiety disorder. These patterns were present both at short-term and at long-term, without losing predictive accuracy. Psychological vulnerabilities that are theoretically specific to certain disorders indeed selectively predict the course of these disorders. General markers of vulnerability predicted the course of multiple affective disorders. This pattern of results supports the notion of specific as well as transdiagnostic predictors of the course of affective disorders and is consistent with hierarchical models of psychopathology.
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Affiliation(s)
- Sascha Y Struijs
- Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Center, 1081 HJ Amsterdam, The Netherlands.
| | - Femke Lamers
- Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Center, 1081 HJ Amsterdam, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, 2333 AK Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, 2333 ZA, The Netherlands
| | - Willem van der Does
- Institute of Psychology, Leiden University, 2333 AK Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, 2333 ZA, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health Research Institute, VU University Medical Center, 1081 HJ Amsterdam, The Netherlands
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Goldstein BL, Kotov R, Perlman G, Watson D, Klein DN. Trait and facet-level predictors of first-onset depressive and anxiety disorders in a community sample of adolescent girls. Psychol Med 2018; 48:1282-1290. [PMID: 28929975 DOI: 10.1017/s0033291717002719] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Individual differences in neuroticism, extraversion, and conscientiousness are associated with, and may predict onset of, internalizing disorders. These general traits can be parsed into facets, but there is a surprising paucity of research on facet risk for internalizing disorders. We examined general traits and facets of neuroticism, extraversion, and conscientiousness in predicting first onsets of depressive and anxiety disorders. METHODS A community sample of 550 adolescent females completed general and facet-level personality measures and diagnostic interviews. Interviews were re-administered 18 months later. RESULTS First onsets of depressive disorders were predicted by neuroticism, extraversion, and conscientiousness. Facets predicting first onset of depression included depressivity (neuroticism facet) and lower positive emotionality and sociability (extraversion facets). First onsets of generalized anxiety disorder (GAD) were predicted by neuroticism, and particularly the facet of anxiousness. First onsets of social phobia were predicted at the facet level by anxiousness. First onsets of specific phobia were predicted by neuroticism, low conscientiousness, and all neuroticism facets. In multivariate analyses, first onsets of depression were uniquely predicted by depressivity, and onsets of GAD and social phobia were uniquely predicted by anxiousness over and above the general trait of neuroticism. CONCLUSIONS General traits predict first onsets of depressive and anxiety disorders. In addition, more specific associations are evident at the facet level. Facets can refine our understanding of the links between personality and psychopathology risk, and provide finer-grained targets for personality-informed interventions.
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Affiliation(s)
| | - Roman Kotov
- Department of Psychiatry,Stony Brook University,Stony Brook, NY,USA
| | - Greg Perlman
- Department of Psychiatry,Stony Brook University,Stony Brook, NY,USA
| | - David Watson
- Department of Psychology,University of Notre Dame,Notre Dame, IN,USA
| | - Daniel N Klein
- Department of Psychology,Stony Brook University,Stony Brook,NY,USA
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20
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Skapinakis P, Caldwell D, Hollingworth W, Bryden P, Fineberg N, Salkovskis P, Welton N, Baxter H, Kessler D, Churchill R, Lewis G. A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults. Health Technol Assess 2018; 20:1-392. [PMID: 27306503 DOI: 10.3310/hta20430] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition. OBJECTIVES To determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults. DATA SOURCES We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers, which includes trials from routine searches of all the major databases. Searches were conducted from inception to 31 December 2014. REVIEW METHODS We undertook a systematic review and network meta-analysis (NMA) of the clinical effectiveness and acceptability of available treatments. Outcomes for effectiveness included mean differences in the total scores of the Yale-Brown Obsessive-Compulsive Scale or its children's version and total dropouts for acceptability. For the cost-effectiveness analysis, we developed a probabilistic model informed by the results of the NMA. All analyses were performed using OpenBUGS version 3.2.3 (members of OpenBUGS Project Management Group; see www.openbugs.net ). RESULTS We included 86 randomised controlled trials (RCTs) in our systematic review. In the NMA we included 71 RCTs (54 in adults and 17 in children and adolescents) for effectiveness and 71 for acceptability (53 in adults and 18 in children and adolescents), comprising 7643 and 7942 randomised patients available for analysis, respectively. In general, the studies were of medium quality. The results of the NMA showed that in adults all selective serotonin reuptake inhibitors (SSRIs) and clomipramine had greater effects than drug placebo. There were no differences between SSRIs, and a trend for clomipramine to be more effective did not reach statistical significance. All active psychological therapies had greater effects than drug placebo. Behavioural therapy (BT) and cognitive therapy (CT) had greater effects than psychological placebo, but cognitive-behavioural therapy (CBT) did not. BT and CT, but not CBT, had greater effects than medications, but there are considerable uncertainty and methodological limitations that should be taken into account. In children and adolescents, CBT and BT had greater effects than drug placebo, but differences compared with psychological placebo did not reach statistical significance. SSRIs as a class showed a trend for superiority over drug placebo, but the difference did not reach statistical significance. However, the superiority of some individual drugs (fluoxetine, sertraline) was marginally statistically significant. Regarding acceptability, all interventions except clomipramine had good tolerability. In adults, CT and BT had the highest probability of being most cost-effective at conventional National Institute for Health and Care Excellence thresholds. In children and adolescents, CBT or CBT combined with a SSRI were more likely to be cost-effective. The results are uncertain and sensitive to assumptions about treatment effect and the exclusion of trials at high risk of bias. LIMITATIONS The majority of psychological trials included patients who were taking medications. There were few studies in children and adolescents. CONCLUSIONS In adults, psychological interventions, clomipramine, SSRIs or combinations of these are all effective, whereas in children and adolescents, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be effective. Future RCTs should improve their design, in particular for psychotherapy or combined interventions. STUDY REGISTRATION The study is registered as PROSPERO CRD42012002441. FUNDING DETAILS The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Peter Bryden
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Naomi Fineberg
- University of Hertfordshire and Hertfordshire Partnerships Mental Health Trust, Hatfield, UK
| | | | - Nicky Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Baxter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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Colvin A, Richardson GA, Cyranowski JM, Youk A, Bromberger JT. The role of family history of depression and the menopausal transition in the development of major depression in midlife women: Study of women's health across the nation mental health study (SWAN MHS). Depress Anxiety 2017; 34:826-835. [PMID: 28489293 PMCID: PMC5585035 DOI: 10.1002/da.22651] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/13/2017] [Accepted: 04/21/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study evaluated whether family history of depression predicts major depression in midlife women above and beyond static risk factors (such as personal history of depression prior to midlife) and risks that may change dynamically across midlife (such as menopausal, psychosocial, and health profiles). METHODS Participants were 303 African American and Caucasian women (42-52 years at baseline) recruited into the Study of Women's Health across the Nation (SWAN) Mental Health Study (MHS) in Pittsburgh. Major depression was assessed annually with Structured Clinical Interviews for DSM-IV. Family mental health history was collected at the ninth or tenth annual follow-up. Random effects logistic regression was used to assess the relationship between family history of depression and midlife depression, controlling for baseline sociodemographic characteristics and time-varying risk factors. RESULTS Family history of depression was associated with midlife depression after adjusting for participant's history of major depression prior to midlife, trait anxiety and baseline age, and time-varying menopausal status, body mass index, very upsetting life events, and chronic difficulties (OR = 2.24, 95% CI = 1.17-4.29, P = .02). Higher odds of major depression were found when women were late perimenopausal or postmenopausal relative to when they were premenopausal or early perimenopausal (OR = 3.01, 95% CI = 1.76-5.15, P < .0001). However, menopausal status was only associated with major depression among women without a family history. CONCLUSIONS Family history of depression predicts major depression in midlife women independent of the menopausal transition and other time-varying covariates. Notably, the menopausal transition was associated with increased risk only among women without a family history of depression.
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Affiliation(s)
- Alicia Colvin
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Gale A. Richardson
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Ada Youk
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Joyce T. Bromberger
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA,Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Veltman EM, Lamers F, Comijs HC, de Waal MWM, Stek ML, van der Mast RC, Rhebergen D. Depressive subtypes in an elderly cohort identified using latent class analysis. J Affect Disord 2017; 218:123-130. [PMID: 28472702 DOI: 10.1016/j.jad.2017.04.059] [Citation(s) in RCA: 31] [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: 12/16/2016] [Revised: 03/14/2017] [Accepted: 04/24/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clinical findings indicate heterogeneity of depressive disorders, stressing the importance of subtyping depression for research and clinical care. Subtypes of the common late life depression are however seldom studied. Data-driven methods may help provide a more empirically-based classification of late-life depression. METHODS Data were used from the Netherlands Study of Depression in Older People (NESDO) derived from 359 persons, aged 60 years or older, with a current diagnosis of major depressive disorder. Latent class analysis (LCA) was used to identify subtypes of depression, using ten CIDI-based depression items. Classes were then characterized using various sociodemographic and clinical characteristics. RESULTS The most prevalent class, as identified by LCA, was a moderate-severe class (prevalence 46.5%), followed by a severe melancholic class (prevalence 38.4%), and a severe atypical class (prevalence 15.0%). The strongest distinguishing features between the three classes were appetite and weight and, to a lesser extent, psychomotor symptoms and loss of interest. Compared with the melancholic class, the severe atypical class had the highest prevalence of females, the lowest mean age, the highest BMI, and highest prevalence of both cardiovascular disease, and metabolic syndrome. LIMITATIONS The strongest distinguishing symptoms, appetite and weight, could be correlated. Further, only longitudinal studies could demonstrate whether the identified classes are stable on the long term. DISCUSSION In older persons with depressive disorders, three distinct subtypes were identified, similar to subtypes found in younger adults. The strongest distinguishing features were appetite and weight; moreover, classes differed strongly on prevalence of metabolic syndrome and cardiovascular disease. These findings suggest differences in the involvement of metabolic pathways across classes, which should be considered when investigating the pathogenesis and (eventually) treatment of depression in older persons.
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Affiliation(s)
- E M Veltman
- Department of Psychiatry, Leiden University Medical Center, The Netherlands.
| | - F Lamers
- GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - H C Comijs
- GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - M W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands
| | - M L Stek
- GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R C van der Mast
- Department of Psychiatry, Leiden University Medical Center, The Netherlands; Department of Psychiatry, CAPRI-University of Antwerp, Belgium
| | - D Rhebergen
- GGZ inGeest/Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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van Ditzhuijzen J, Ten Have M, de Graaf R, van Nijnatten CHCJ, Vollebergh WAM. Correlates of Common Mental Disorders Among Dutch Women Who Have Had an Abortion: A Longitudinal Cohort Study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2017; 49:123-131. [PMID: 28453924 DOI: 10.1363/psrh.12028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 05/20/2023]
Abstract
CONTEXT Credible research has not found any evidence that abortion causes mental disorders. It is not known, however, whether abortion-specific risk indicators and other variables are associated with the incidence or recurrence of mental disorders after abortion. METHODS As part of a prospective cohort study conducted in the Netherlands, 325 women were interviewed between April 2010 and January 2011, between 20 and 40 days after having an abortion; 264 were followed up an average of 2.7 years later. Associations between selected baseline variables and postabortion incident or recurrent mental disorders among the 199 women at risk were investigated using bivariate and multivariate logistic regression analyses. RESULTS Thirty-two percent of women at risk of an incident or recurrent mental disorder experienced one after the abortion. In multivariate analyses, no abortion-related variables (e.g., history of multiple abortions, second-trimester abortion, preabortion decision difficulty or uncertainty, and postabortion negative emotions) were associated with experience of any postabortion incident or recurrent mental disorders. The outcome was positively associated with having conceived within an unstable relationship (odds ratio, 3.0), number of negative life events in the past year (1.4) and having a history of mental disorders (2.4). CONCLUSIONS Correlates of postabortion mental disorders were variables that have been identified as general risk factors for mental disorders, which supports the idea that abortion does not pose specific risks to future mental health. Future research should investigate in what way unstable relationships, adverse life events and psychiatric history affect postabortion mental health.
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Affiliation(s)
- Jenneke van Ditzhuijzen
- research scientist and lecturer, Department of Interdisciplinary Social Sciences, Utrecht University, the Netherlands
| | - Margreet Ten Have
- senior scientist, the Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht
| | - Ron de Graaf
- senior scientist, the Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht
| | | | - Wilma A M Vollebergh
- professor, Department of Interdisciplinary Social Sciences, Utrecht University, the Netherlands
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24
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Hengartner MP, van der Linden D, Bohleber L, von Wyl A. Big Five Personality Traits and the General Factor of Personality as Moderators of Stress and Coping Reactions Following an Emergency Alarm on a Swiss University Campus. Stress Health 2017; 33:35-44. [PMID: 26877146 DOI: 10.1002/smi.2671] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 12/15/2022]
Abstract
We conducted an online survey including 306 participants aged 18-64 years to assess the general factor of personality (GFP) and Big Five personality traits in relation to individual stress and coping reactions following a shooting emergency alarm at a Swiss university campus. Although the emergency eventually turned out to be a false alarm, various witnesses showed pronounced distress owing to a vast police operation. The GFP structure was replicated using two alternative modelling approaches. Neuroticism related substantially to acute fear and traumatic distress as well as to more enduring maladaptive coping. Agreeableness was negatively associated with the coping strategy of medication use, whereas both agreeableness and conscientiousness related positively to social activity following the emergency. The GFP related moderately to peri-traumatic distress and showed a substantial negative association with medication use and a strong positive association with social activity. In conclusion, both the GFP and Big Five traits significantly moderate stress responses following a stressful life event. The GFP predominantly relates to socially adaptive coping, whereas in particular neuroticism accounts for acute stress reactions such as fear and traumatic distress. These findings support the notion that personality influences how persons react in the face of adversity. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
| | | | - Laura Bohleber
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
| | - Agnes von Wyl
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
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25
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Markkula N, Marola N, Nieminen T, Koskinen S, Saarni SI, Härkänen T, Suvisaari J. Predictors of new-onset depressive disorders - Results from the longitudinal Finnish Health 2011 Study. J Affect Disord 2017; 208:255-264. [PMID: 27792971 DOI: 10.1016/j.jad.2016.08.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/23/2016] [Accepted: 08/27/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Identifying risk factors for depression is important for understanding etiological mechanisms and targeting preventive efforts. No prior studies have compared risk factors of dysthymia and major depressive disorder (MDD) in a longitudinal setting. METHODS Predictors of new-onset MDD and dysthymia were examined in a longitudinal general population study (Health 2000 and 2011 Surveys, BRIF8901). 4057 persons free of depressive disorders at baseline were followed up for 11 years. DSM-IV MDD and dysthymia were diagnosed with the Composite International Diagnostic Interview. RESULTS 126 persons (4.4%, 95%CI 3.6-5.2) were diagnosed with MDD or dysthymia at follow-up. Predictors of new-onset depressive disorders were younger age (adjusted OR 0.97, 95%CI 0.95-0.99 per year), female gender (aOR 1.46, 95%CI 1.01-2.12), multiple childhood adversities (aOR 1.76, 95%CI 1.10-2.83), low trust dimension of social capital (aOR 0.58, 95%CI 0.36-0.96 for high trust), baseline anxiety disorder (aOR 2.75, 95%CI 1.36-5.56), and baseline depressive symptoms (aOR 1.65, 95%CI 1.04-2.61 for moderate and aOR 2.49, 95%CI 1.20-5.17 for severe symptoms). Risk factors for MDD were younger age, female gender, anxiety disorder and depressive symptoms, whereas younger age, multiple childhood adversities, low trust, and having 1-2 somatic diseases predicted dysthymia. LIMITATIONS We only had one follow-up point at eleven years, and did not collect information on the subjects' health during the follow-up period. CONCLUSIONS Persons with subclinical depressive symptoms, anxiety disorders, low trust, and multiple childhood adversities have a higher risk of depressive disorders. Predictors of MDD and dysthymia appear to differ. This information can be used to target preventive efforts and guide social policies.
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Affiliation(s)
- Niina Markkula
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland; Universidad del Desarrollo, Santiago, Chile.
| | - Niko Marola
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland
| | | | - Seppo Koskinen
- National Institute for Health and Welfare, Department of Health, Functional Capacity and Welfare, Helsinki, Finland
| | - Samuli I Saarni
- Turku University Hospital and the University of Turku, Turku, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, Department of Health, Functional Capacity and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland
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26
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Joshi S, Mooney SJ, Rundle AG, Quinn JW, Beard JR, Cerdá M. Pathways from neighborhood poverty to depression among older adults. Health Place 2017; 43:138-143. [PMID: 28049071 PMCID: PMC5285438 DOI: 10.1016/j.healthplace.2016.12.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022]
Abstract
The pathways through which neighborhood poverty can affect resident depression are still unknown. We investigated mechanisms through which neighborhood poverty may influence depression among older adults. Participants were drawn from the New York City Neighborhood and Mental Health in the Elderly Study II, a 3-wave study of adults aged 65-75 (n=3,497) at baseline. Neighborhood poverty and homicide were associated with depressive symptoms at follow-up waves (RR:1.20, 95%CI: 1.05, 1.36; RR: 1.09, 95%CI: 1.02, 1.17, respectively). Homicide accounted for 30% of the effect of neighborhood poverty on depressive symptoms. Neighborhood exposure to violence may be a key mechanism through which neighborhood poverty influences depression among older adults.
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Affiliation(s)
- Spruha Joshi
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Minneapolis, MN 55455, USA
| | - Stephen J Mooney
- Department of Epidemiology, Columbia University, 722 W 168th St, New York, NY 10032, USA
| | - Andrew G Rundle
- Department of Epidemiology, Columbia University, 722 W 168th St, New York, NY 10032, USA
| | - James W Quinn
- Department of Epidemiology, Columbia University, 722 W 168th St, New York, NY 10032, USA
| | - John R Beard
- School of Public Health, University of Sydney, Edward Ford Building (A27), Fisher Road, NSW 2006, Australia
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA 95817, USA.
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27
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Hengartner MP, Yamanaka-Altenstein M. Personality, Psychopathology, and Psychotherapy: A Pre-specified Analysis Protocol for Confirmatory Research on Personality-Psychopathology Associations in Psychotherapy Outpatients. Front Psychiatry 2017; 8:9. [PMID: 28203209 PMCID: PMC5285345 DOI: 10.3389/fpsyt.2017.00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/13/2017] [Indexed: 12/02/2022] Open
Abstract
The role of personality trait variation in psychopathology and its influence on the outcome of psychotherapy is a burgeoning field. However, thus far most findings were based on controlled clinical trials that may only poorly represent real-world clinical settings due to highly selective samples mostly restricted to patients with major depression undergoing antidepressive medication. Focusing on personality and psychopathology in a representative naturalistic sample of psychotherapy patients is therefore worthwhile. Moreover, up to date hardly any confirmatory research has been conducted in this field. Strictly confirmatory research implies two major requirements: firstly, specific hypotheses, including expected effect sizes and statistical approaches to data analysis, must be detailed prior to inspection of the data, and secondly, corresponding protocols have to be published online and freely available. Here, we introduce a longitudinal naturalistic study aimed at examining, firstly, the prospective impact of baseline personality traits on the outcome of psychotherapy over a 6-month observation period; secondly, the stability and change in personality traits over time; thirdly, the association between longitudinal change in psychopathology and personality; fourthly, the agreement between self-reports and informant rating of personality; and fifthly, the predictive validity of personality self-reports compared to corresponding informant ratings. For it, we comprehensively state a priori hypotheses, predict the expected effect sizes and detail the statistical analyses that we intend to conduct to test these predictions. Such a stringent confirmatory design increases the transparency and objectivity of psychopathological research, which is necessary to reduce the rate of false-positive findings and to increase the yield of scientific research.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences , Zurich , Switzerland
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28
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Bowen RC, Dong LY, Peters EM, Baetz M, Balbuena L. Mood Instability Is a Precursor of Relationship and Marital Difficulties: Results from Prospective Data from the British Health and Lifestyle Surveys. Front Psychiatry 2017; 8:276. [PMID: 29375402 PMCID: PMC5770655 DOI: 10.3389/fpsyt.2017.00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/24/2017] [Indexed: 11/13/2022] Open
Abstract
The DSM system implies that affective instability is caused by reactivity to interpersonal events. We used the British Health and Lifestyle Survey that surveyed community residents in 1984 and again in 1991 to study competing hypotheses: that mood instability (MI) leads to interpersonal difficulties or vice versa. We analyzed data from 5,352 persons who participated in both waves of the survey. Factor analysis of the Eysenck Personality Inventory neuroticism scale was used to derive a 4-item scale for MI. We used depression measures that were previously derived by factor analyzing the General Health Questionnaire. We tested the competing hypotheses by regressing variables at follow-up against baseline variables. The results showed that MI in 1984 clearly predicted the development of interpersonal problems in 1991. After adjusting for depression, depression becomes the main predictor of spousal difficulties, but MI remains a predictor of interpersonal difficulties with family and friends. Attempts to investigate the reverse hypothesis were ambiguous. The clinical implication is that when MI and interpersonal problems are reported, the MI should be treated first, or at least concurrently.
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29
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Fleury MJ, Grenier G, Bamvita JM, Perreault M, Caron J. Typology of individuals with substance dependence based on a Montreal longitudinal catchment area study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:405-19. [PMID: 25124748 DOI: 10.1007/s10488-014-0581-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study sought to develop a typology of individuals with substance dependence (ISD) based on a longitudinal survey (n = 2,434) and 121 ISD. The latter were divided into three groups: newly abstinent individuals, chronic dependents and acute dependents. Individuals' typology was developed by cluster analysis. Newly abstinent individuals had fewer emotional problems and mental disorders in the previous 12 months. Four classes of ISD were identified, labelled respectively "chronic multi-substance consumption and mental disorders comorbidities," "multi-substance consumption," "alcohol and marijuana consumption" and "alcohol consumption only." Strategies adapted to each of these profiles could be promoted for more effective treatment.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada,
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Thielen FW, Ten Have M, de Graaf R, Cuijpers P, Beekman A, Evers S, Smit F. Long-term economic consequences of child maltreatment: a population-based study. Eur Child Adolesc Psychiatry 2016; 25:1297-1305. [PMID: 27154047 DOI: 10.1007/s00787-016-0850-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
Child maltreatment is prognostically associated with long-term detrimental consequences for mental health. These consequences are reflected in higher costs due to health service utilization and productivity losses in adulthood. An above-average sense of mastery can have protective effects in the pathogenesis of mental disorders and thus potentially cushion adverse impacts of maltreatment. This should be reflected in lower costs in individuals with a history of child maltreatment and a high sense of mastery. The aims of the study were to prognostically estimate the excess costs of health service uptake and productivity losses in adults with a history of child maltreatment and to evaluate how mastery may act as an effect modifier. Data were used on 5618 individuals participating in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). We focussed on measures of child maltreatment (emotional neglect, physical, psychological and sexual abuse) and economic costs owing to health-care uptake and productivity losses when people with a history of abuse have grown into adulthood. We evaluated how mastery acted as an effect modifier. Estimates were adjusted for demographics and parental psychopathology. Post-stratification weights were used to account for initial non-response and dropout. Due to the non-normal distribution of the costs data, sample errors, 95 % confidence intervals, and p values were calculated using non-parametric bootstrapping (1000 replications). Exposure to child maltreatment occurs frequently (6.9-24.8 %) and is associated with substantial excess costs in adulthood. To illustrate, adjusted annual excess costs attributable to emotional neglect are €1,360 (95 % CI: 615-215) per adult. Mastery showed a significant effect on these figures: annual costs were €1,608 in those with a low sense of mastery, but only €474 in those with a firmer sense of mastery. Child maltreatment has profound mental health consequences and is associated with staggering long-term economic costs, rendering lack of action very costly. Our data lends credibility to the hypothesis that mastery may help to cushion the adverse consequences of child maltreatment. Further research on mastery may help to ameliorate individual burden and in addition offer some economic benefits.
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Affiliation(s)
- Frederick W Thielen
- Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands.,Department of Health Services Research, Maastricht University, Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Margreet Ten Have
- Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - Ron de Graaf
- Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry, VU University Medical Centre, Amsterdam, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands
| | - Silvia Evers
- Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands.,Department of Health Services Research, Maastricht University, Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Filip Smit
- Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, P.O. Box 725, 3500 AS, Utrecht, The Netherlands. .,Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands. .,Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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31
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Jeronimus BF, Kotov R, Riese H, Ormel J. Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants. Psychol Med 2016; 46:2883-2906. [PMID: 27523506 DOI: 10.1017/s0033291716001653] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory. METHOD This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants. RESULTS The results showed large unadjusted prospective associations between neuroticism and symptoms/diagnosis of anxiety, depression, and non-specific mental distress (d = 0.50-0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10-0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03-0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short (<4 year) than long (⩾4 years) follow-up intervals, suggesting a substantial decay of the association with increasing time intervals. Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect. CONCLUSION High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.
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Affiliation(s)
- B F Jeronimus
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE),Groningen,The Netherlands
| | - R Kotov
- Department of Psychiatry,Stony Brook University,NY,USA
| | - H Riese
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE),Groningen,The Netherlands
| | - J Ormel
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE),Groningen,The Netherlands
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The natural course of elevated levels of depressive symptoms in patients with vascular disease over eight years of follow-up. The SMART-Medea study. J Affect Disord 2016; 202:95-101. [PMID: 27259081 DOI: 10.1016/j.jad.2016.05.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/22/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with cardiovascular disease have an increased risk for depression, and depression predicts poor prognosis in these patients, but the long-term course of depression is not known. We studied the natural course of elevated levels of depressive symptoms in patients with cardiovascular disease over eight years follow-up. METHODS Within the Second Manifestations of ARTerial disease - Memory, depression and aging (SMART-Medea) study, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) in 690 patients (62±10 years) at baseline and bi-annually during 8 years follow-up. Natural course was described for symptom severity and course type (never, single episode, intermittent, and chronic) based on the cut-off point of ≥6 on the PHQ-9. Using multinomial regression analysis (reference: never depressed) we estimated age- and sex-adjusted odds ratios (OR) for the associations of demographic factors and vascular disease categories with course type. RESULTS Of the 690 patients, 60% was never depressed, 10% had a single episode, 19% had an intermittent and 11% a chronic course of depression. Increased risk for chronic course was observed for women (OR=3.42; 95% CI=1.98-5.90), those with younger age (OR=3.20; 95% CI=1.73-5.94), and for patients with cerebrovascular disease when compared to patients with coronary artery disease (OR=2.50; 95% CI=1.31-4.78). LIMITATIONS No information was available on clinical diagnosed major depressive disorder and/or clinical events during follow-up. CONCLUSIONS In patients with cardiovascular disease, an intermittent or chronic course of elevated levels of depressive symptoms is very common. Patients with cardiovascular disease may require more careful clinical monitoring and management of depressive symptoms.
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Mangold DL, Veraza R, Kinkler L, Kinney NA. Neuroticism Predicts Acculturative Stress in Mexican American College Students. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986307302167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuroticism is a risk factor for mood and anxiety disorders and a strong predictor of subjective stress in non-Hispanics. This study examined neuroticism as a predictor of subjective acculturative stress in 122 Mexican American college students. Neuroticism was measured using the Revised Neuroticism Extroversion Openness Personality Inventory (NEO-PI-R), and acculturative stress was measured using the Hispanic Stress Inventory (HSI). Results of hierarchical regression analyses showed that overall neuroticism and the facets of depression, vulnerability, and anger and/or hostility significantly predicted acculturative stress. The association between neuroticism and greater subjective psychosocial stress can now be extended to acculturative stress for a subgroup of Mexican Americans. Findings support and extend previous work from the authors' laboratory suggesting that neuroticism modulates the relationship between exposure to culturally specific stress and risk for certain mood and anxiety disorders.
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The reliability and validity of the Japanese version of the Temperament and Personality Questionnaire for patients with non-melancholic depression. J Affect Disord 2016; 198:237-41. [PMID: 27039286 DOI: 10.1016/j.jad.2016.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/09/2016] [Accepted: 03/09/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Parker et al. (2006) proposed a new approach to classify specific sub-types of non-melancholic depression caused by various stress factors and premorbid personality styles: the Temperament and Personality Questionnaire (T&P). The current study aim was to develop the Japanese version of the T&P and evaluate its reliability and validity. METHODS We studied 114 patients with non-melancholic depression. Reliability was assessed using the test-retest method. Convergent validity of the T&P was compared with the clinician ratings of each patient for the eight personality traits. We also assessed the impact of depressive state on the T&P. RESULTS The test-retest intraclass correlation coefficients among eight constructs of the T&P ranged from 0.77 to 0.89, indicating good-to-excellent reliability. Anxious Worrying (rho=0.29), Perfectionism (rho=0.17), Personal Reserve (rho=0.18), Irritability (rho=0.38), and Social Avoidance (rho=0.32) showed adequate levels of convergent validity; Rejection Sensitivity (rho=0.16), Self-criticism (rho=-0.02), and Self-focus (rho=0.07) showed relatively weak convergent validity. Perfectionism (rho=-0.06), Social Avoidance (rho=0.17), Anxious Worrying (rho=0.40), Personal Reserve (rho=0.30), Irritability (rho=0.28), Rejection Sensitivity (rho=0.35), Self-criticism (rho=0.49), and Self-focus (rho=0.24) showed minimal sensitivity to mood state effects. LIMITATIONS Only one site was used. While a Likert scale was used, the clinician-rated personality trait measure had not been validated. CONCLUSIONS The J-T&P is a reliable and valid measure for assessing temperament and personality in Japanese patients with non-melancholic depression.
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Huang V, Peck K, Mallya S, Lupien SJ, Fiocco AJ. Subjective Sleep Quality as a Possible Mediator in the Relationship between Personality Traits and Depressive Symptoms in Middle-Aged Adults. PLoS One 2016; 11:e0157238. [PMID: 27285159 PMCID: PMC4902234 DOI: 10.1371/journal.pone.0157238] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/26/2016] [Indexed: 02/04/2023] Open
Abstract
This study explored the mediating role of sleep in the relationship between personality traits and depressive symptoms in a group of community-dwelling men and women (Mage = 57.92, SD = 4.00). Participants completed the short form NEO Five Factor Inventory (NEO-FFI), Pittsburgh Sleep Quality Index (PSQI), and the Center for Epidemiologic Studies Depression Scale (CES-D). High neuroticism and low conscientiousness was associated with poor sleep, as well as greater depressive symptom severity. Partial indirect mediation effects were found between personality traits (i.e., neuroticism and conscientiousness) and depressive symptoms through self-report sleep measures. An alternative model was also explored, entering depression as the mediator; however a smaller portion of the variance was explained by this model, compared with the hypothesized model. The current study provides preliminary information regarding the mechanisms that influence the relationship between personality traits, sleep, and depression among a group of community-dwelling middle-aged adults. Implications and future directions are discussed.
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Affiliation(s)
- Vivian Huang
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Katlyn Peck
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Sasha Mallya
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Sonia J. Lupien
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandra J. Fiocco
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
- * E-mail:
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Lukat J, Becker ES, Lavallee KL, van der Veld WM, Margraf J. Predictors of Incidence, Remission and Relapse of Axis I Mental Disorders in Young Women: A Transdiagnostic Approach. Clin Psychol Psychother 2016; 24:322-331. [PMID: 27256536 DOI: 10.1002/cpp.2026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/30/2016] [Accepted: 05/01/2016] [Indexed: 11/07/2022]
Abstract
An understanding of etiological and maintaining factors of mental disorders is essential for the treatment of mental disorders, as well as mental health promotion and protection. The present study examines predictors of the incidence, remission and relapse of a wide range of Axis I mental disorders, using data from the Dresden Predictor Study. A sample of 1394 young German women completed questionnaires evaluating psychological factors (positive mental health, self-efficacy, life satisfaction, neuroticism, psychopathology and dysfunctional attitudes) and global assessment of functioning, as well as structured diagnostic interviews assessing incidence and change (remission, relapse) in mental disorders. Predictors were analysed using a multivariate logistic regression model. Significant factors for incidence of mental disorders included neuroticism and global functioning. A remitting course of mental disorders was predicted by positive mental health, self-efficacy and global assessment of functioning. Relapse was significantly predicted by neuroticism and dysfunctional attitudes. Results imply that mental health promotion is particularly important for women with high neuroticism and low functioning, as they tend to be at risk for incidence. Mental disorder treatment may benefit from strengthening positive mental health and functioning, as these factors promote remission. Relapse-prevention may benefit from attention to neuroticism and dysfunctional attitudes in order to reduce the likelihood of relapse. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Incidence of mental disorders in young women was predicted by neuroticism and low global functioning. There seems to be a need for preventive interventions addressing high neuroticism and low global functioning. Remission in young women was predicted by positive mental health. It may be helpful to include resource-based interventions, which can strengthen or support general positive mental health. Relapse in young women was predicted by two negative psychological factors: high neuroticism and reporting many dysfunctional attitudes. Psychotherapy addressing the characteristics and behaviour of neurotic patients might be beneficial. Interventions should also focus on addressing and changing dysfunctional attitudes.
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Affiliation(s)
- Justina Lukat
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
| | - Kristen L Lavallee
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany.,Department of Psychology, University of Basel, Switzerland
| | | | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
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Tseng CC, Hu LY, Liu ME, Yang AC, Shen CC, Tsai SJ. Risk of depressive disorders following sudden sensorineural hearing loss: A nationwide population-based retrospective cohort study. J Affect Disord 2016; 197:94-9. [PMID: 26985740 DOI: 10.1016/j.jad.2016.03.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/15/2016] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sudden sensorineural hearing loss (SSNHL) occurs as an unexplained, rapid loss of hearing that can cause significant stress in the affected individual. This study aims to assess the risk of depressive disorders in SSNHL patients. METHODS From the National Health Insurance Research Database (NHIRD) in Taiwan, we identified new SSNHL patients diagnosed by an otolaryngologist between January 01, 2000, and December 31, 2008. A control group was composed of individuals who had never suffered from SSNHL. A total of 1717 SSNHL patients and 6868 individuals without SSNHL who were matched by sex, age and index date were followed until December 31, 2009, unless otherwise diagnosed with depressive disorders by a psychiatrist or deceased. RESULTS The results found that after adjusting for patients' age, sex, comorbidities, urbanization, and monthly income, SSNHL patients are 2.17 times more at risk (95% confidence interval [CI], 1.51-3.08, p<.001) for depressive disorders then control patients, especially in younger age groups (<60 years old). CONCLUSIONS Our study indicated an increased risk of developing depressive disorders in patients with SSNHL, particularly for younger patients. Symptoms of depression should be regularly evaluated in patients with SSNHL.
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Affiliation(s)
- Chih-Chieh Tseng
- Department of Psychiatry, Beitou branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mu-En Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Albert C Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Che Shen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
| | - Shih-Jen Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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Hengartner MP, Ajdacic-Gross V, Wyss C, Angst J, Rössler W. Relationship between personality and psychopathology in a longitudinal community study: a test of the predisposition model. Psychol Med 2016; 46:1693-1705. [PMID: 26979285 DOI: 10.1017/s0033291716000210] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Mounting evidence supports the notion that personality is crucial in the aetiopathology of common mental disorders, but studies that allow for aetiological conclusions are lacking. The aim of the present study was thus to provide a test of the predisposition model. METHOD We analysed data from the Zurich Cohort Study, a 30-year longitudinal epidemiological community study of an adult cohort (n = 591) from 1979 to 2008. Personality was assessed in 1988 with an established personality questionnaire, and psychopathology through seven semi-structured interviews between 1979 and 2008. RESULTS On the basis of personality assessment from 1988, used as predictor of subsequent psychopathology (1993-2008), while adjusting for sex and prior mental disorders (1979-1988), neuroticism related significantly with future major depression episodes [odds ratio (OR) = 1.41], anxiety disorders (OR = 1.32) and depression treatment use (OR = 1.41). When participants with a past 10-year history (i.e. 1979-1988) of either major depression, anxiety disorder or depression treatment use were excluded, neuroticism in 1988 still significantly predicted first incidence (i.e. 1993-2008) of major depression episodes (OR = 1.53) and depression treatment use (OR = 1.84). CONCLUSIONS The present study provides compelling evidence that the personality trait of neuroticism constitutes an independent risk factor for subsequent major depression episodes and use of respective professional treatments, which serves as a proxy for particularly severe and impairing depression episodes. We therefore advocate that personality traits could provide clinically useful prognostic information when considered carefully.
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Affiliation(s)
- M P Hengartner
- Department of Applied Psychology,Zurich University of Applied Sciences,Zurich,Switzerland
| | - V Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics,University of Zurich,Zurich,Switzerland
| | - C Wyss
- Department of Psychiatry, Psychotherapy and Psychosomatics,University of Zurich,Zurich,Switzerland
| | - J Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics,University of Zurich,Zurich,Switzerland
| | - W Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics,University of Zurich,Zurich,Switzerland
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Hengartner MP, Kawohl W, Haker H, Rössler W, Ajdacic-Gross V. Big Five personality traits may inform public health policy and preventive medicine: Evidence from a cross-sectional and a prospective longitudinal epidemiologic study in a Swiss community. J Psychosom Res 2016; 84:44-51. [PMID: 27095158 DOI: 10.1016/j.jpsychores.2016.03.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Some evidence documents the importance of personality assessments for health research and practise. However, no study has opted to test whether a short self-report personality inventory may comprehensively inform health policy. METHODS Data were taken from a population-based epidemiologic survey in Zurich, Switzerland, conducted from 2010-2012. A short form of the Big Five Inventory was completed by n=1155 participants (54.4% women; mean age=29.6 years), while health-related outcomes were taken from a comprehensive semi-structured clinical interview. A convenience subsample averaging n=171 participants additionally provided laboratory measures and n=133 were subsequently followed-up at least once over a maximal period of 6 months. RESULTS Personality traits, in particular high neuroticism and low conscientiousness, related significantly to poor environmental resources such as low social support (R(2)=0.071), health-impairing behaviours such as cannabis use (R(2)=0.071), and psychopathology, including negative affect (R(2)=0.269) and various mental disorders (R(2)=0.060-0.195). The proportion of total variance explained was R(2)=0.339 in persons with three or more mental disorders. Personality significantly related to some laboratory measures including total cholesterol (R(2)=0.095) and C-Reactive Protein (R(2)=0.062). Finally, personality prospectively predicted global psychopathological distress and vegetative symptoms over a 6-month observation period. CONCLUSIONS Personality relates consistently to poor socio-environmental resources, health-impairing behaviours and psychopathology. We also found some evidence for an association with metabolic and immune functions that are assumed to influence health. A short personality inventory could provide valuable information for preventive medicine when used as a means to screen entire populations for distinct risk exposure, in particular with respect to psychopathology.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Switzerland.
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland
| | - Helene Haker
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland
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Conway CC, Craske MG, Zinbarg RE, Mineka S. PATHOLOGICAL PERSONALITY TRAITS AND THE NATURALISTIC COURSE OF INTERNALIZING DISORDERS AMONG HIGH-RISK YOUNG ADULTS. Depress Anxiety 2016; 33:84-93. [PMID: 26344411 PMCID: PMC4701643 DOI: 10.1002/da.22404] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/18/2015] [Accepted: 07/18/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A personality disorder diagnosis signals a negative prognosis for depressive and anxiety disorders, but the precise abnormal personality traits that determine the temporal course of internalizing psychopathology are unknown. In the present study, we examined prospective associations between abnormal personality traits and the onset and recurrence of internalizing disorders. METHODS A sample of 371 young adults at high risk for internalizing problems completed the Schedule for Nonadaptive and Adaptive Personality-Second Edition--a measure of 12 abnormal personality traits and three temperament dimensions (i.e., Negative Temperament, Positive Temperament, Disinhibition vs. Control)--and underwent annual diagnostic interviews over 4 years of follow-up. RESULTS In multivariate survival analyses, Negative Temperament was a robust predictor of both new onsets and recurrences of internalizing disorder. Further, the Dependency and Self-Harm abnormal personality dimensions emerged as independent predictors of new onsets and recurrences, respectively, of internalizing disorders after statistically adjusting for variation in temperament. CONCLUSIONS Our findings suggest that abnormal personality traits and temperament dimensions have complementary effects on the trajectory of internalizing pathology during young adulthood. In assessment and treatment settings, targeting the abnormal personality and temperament dimensions with the greatest prognostic value stands to improve the early detection of enduring internalizing psychopathology.
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Affiliation(s)
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA,The Family Institute at Northwestern University, Evanston, IL, USA
| | - Susan Mineka
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Design and Recruitment for a Randomized Controlled Trial of Problem-Solving Therapy to Prevent Depression among Older Adults with Need for Supportive Services. Am J Geriatr Psychiatry 2016; 24:94-102. [PMID: 26706911 PMCID: PMC4706765 DOI: 10.1016/j.jagp.2015.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Addressing subthreshold depression (indicated prevention) and vulnerabilities that increase the risk of major depression or anxiety disorders (selective prevention) is important for protecting mental health in old age. The Depression-Agency Based Collaborative (Dep-ABC) is a prevention trial involving older adults recruited from aging services sites (home care agencies, senior housing, senior centers) who meet criteria for subthreshold depression and disability. Therefore, the authors examine the effectiveness of partnerships with aging services sites for recruiting at-risk older adults, the quality of recruitment and acceptability of the Dep-ABC assessment and intervention, and the baseline status of participants. METHODS Dep-ABC is a single-blind randomized controlled prevention trial set in aging services settings but with centralized screening, randomization, in-home assessments, and follow-up. Its intervention arm involves six to eight sessions of problem-solving therapy, in which older adults aged 60+ learn to break down problems that affect well-being and develop strategies to address them. We examined participation rates to assess quality of recruitment across sites and level of disability according to service use. RESULTS Dep-ABC randomized 104 participants, 68.4% of eligible older adults. Screening using self-reported disability successfully netted a sample in which 74% received home care agency services, with remaining participants similarly impaired in structured self-reports of impairment and on observed performance tests. CONCLUSION Direct outreach to aging services providers is an effective way to identify older adults with service needs at high risk of major depression. Problem-solving therapy is acceptable to this population and can be added to current services.
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Premorbid risk factors for major depressive disorder: are they associated with early onset and recurrent course? Dev Psychopathol 2015; 26:1477-93. [PMID: 25422974 DOI: 10.1017/s0954579414001151] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Premorbid risk for major depressive disorder (MDD) and predictors of an earlier onset and recurrent course were examined in two studies in a large, community-based sample of parents and offspring, prospectively assessed from late childhood into adulthood. In Study 1 (N = 2,764 offspring and their parents), parental psychiatric status, offspring personality at age 11, and age 11 offspring internalizing and externalizing symptoms predicted the subsequent development of MDD, as did poor quality parent-child relationships, poor academic functioning, early pubertal development, and childhood maltreatment by age 11. Parental MDD and adult antisocial behavior, offspring negative emotionality and disconstraint, externalizing symptoms, and childhood maltreatment predicted an earlier onset of MDD, after accounting for course; lower positive emotionality, trait anxiety, and childhood maltreatment predicted recurrent MDD, after accounting for age of onset. In Study 2 (N = 7,146), we examined molecular genetic risk for MDD by extending recent reports of associations with glutamatergic system genes. We failed to confirm associations with MDD using either individual single nucleotide polymorphism based tests or gene-based analyses. Overall, results speak to the pervasiveness of risk for MDD, as well as specific risk for early onset MDD; risk for recurrent MDD appears to be largely a function of its often earlier onset.
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Toma A, Hamer M, Shankar A. Associations between neighborhood perceptions and mental well-being among older adults. Health Place 2015; 34:46-53. [DOI: 10.1016/j.healthplace.2015.03.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/16/2015] [Accepted: 03/24/2015] [Indexed: 11/16/2022]
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Bromberger JT, Schott L, Kravitz HM, Joffe H. Risk factors for major depression during midlife among a community sample of women with and without prior major depression: are they the same or different? Psychol Med 2015; 45:1653-1664. [PMID: 25417760 PMCID: PMC4414245 DOI: 10.1017/s0033291714002773] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Women's vulnerability for a first lifetime-onset of major depressive disorder (MDD) during midlife is substantial. It is unclear whether risk factors differ for first lifetime-onset and recurrent MDD. Identifying these risk factors can provide more focused depression screening and earlier intervention. This study aims to evaluate whether lifetime psychiatric and health histories, personality traits, menopausal status and factors that vary over time, e.g. symptoms, are independent risk factors for first-onset or recurrent MDD across 13 annual follow-ups. METHOD Four hundred and forty-three women, aged 42-52 years, enrolled in the Study of Women's Health Across the Nation in Pittsburgh and participated in the Mental Health Study. Psychiatric interviews obtained information on lifetime psychiatric disorders at baseline and on occurrences of MDD episodes annually. Psychosocial and health-related data were collected annually. Cox multivariable analyses were conducted separately for women with and without a MDD history at baseline. RESULTS Women without lifetime MDD at baseline had a lower risk of developing MDD during midlife than those with a prior MDD history (28% v. 59%) and their risk profiles differed. Health conditions prior to baseline and during follow-ups perception of functioning (ps < 0.05) and vasomotor symptoms (VMS) (p = 0.08) were risk factors for first lifetime-onset MDD. Being peri- and post-menopausal, psychological symptoms and a prior anxiety disorder were predominant risk factors for MDD recurrence. CONCLUSIONS The menopausal transition warrants attention as a period of vulnerability to MDD recurrence, while health factors and VMS should be considered important risk factors for first lifetime-onset of MDD during midlife.
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Affiliation(s)
- J. T. Bromberger
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - L. Schott
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - H. M. Kravitz
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - H. Joffe
- Department of Psychiatry, Brigham and Women’s Hospital and Dana Farber Cancer Institute/Harvard Medical School, Boston, MA, USA
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Abstract
A vast body of literature has revealed that dysregulation of the hypothalamic-pituitary-adrenal (HPA) stress axis is associated with etiology of major depressive disorder (MDD). There are many ways that the dysregulation of the HPA axis can be assessed: by sampling diurnal basal secretion and/or in response to a stress task, pharmacological challenge, and awakening. Here, we focus on the association between cortisol awakening response (CAR), as one index of HPA axis function, and MDD, given that the nature of this association is particularly unclear. Indeed, in the following selective review, we attempt to reconcile sometimes-divergent evidence of the role of CAR in the pathway to depression. We first examine association of CAR with psychological factors that have been linked with increased vulnerability to develop depression. Then, we summarize the findings regarding the CAR profile in those with current depression, and evaluate evidence for the role of CAR following depression resolution and continued vulnerability. Finally, we showcase longitudinal studies showing the role of CAR in predicting depression onset and recurrence. Overall, the studies reveal an important, but complex, association between CAR and vulnerability to depression.
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Affiliation(s)
- Katarina Dedovic
- Department of Psychiatry, Douglas Hospital Research Centre, Montreal, QC, Canada ; Social and Affective Neuroscience Laboratory, University of California, Los Angeles, CA, USA
| | - Janice Ngiam
- Department of Psychology, McGill University, Montreal, QC, Canada
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van Zoonen K, Buntrock C, Ebert DD, Smit F, Reynolds CF, Beekman ATF, Cuijpers P. Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. Int J Epidemiol 2014; 43:318-29. [PMID: 24760873 DOI: 10.1093/ije/dyt175] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depressive disorders are highly prevalent, have a detrimental impact on the quality of life of patients and their relatives and are associated with increased mortality rates, high levels of service use and substantial economic costs. Current treatments are estimated to only reduce about one-third of the disease burden of depressive disorders. Prevention may be an alternative strategy to further reduce the disease burden of depression. METHODS We conducted a meta-analysis of randomized controlled trials examining the effects of preventive interventions in participants with no diagnosed depression at baseline on the incidence of diagnosed depressive disorders at follow-up. We identified 32 studies that met our inclusion criteria. RESULTS We found that the relative risk of developing a depressive disorder was incidence rate ratio = 0.79 (95% confidence interval: 0.69-0.91), indicating a 21% decrease in incidence in prevention groups in comparison with control groups. Heterogeneity was low (I(2) = 24%). The number needed to treat (NNT) to prevent one new case of depressive disorder was 20. Sensitivity analyses revealed no differences between type of prevention (e.g. selective, indicated or universal) nor between type of intervention (e.g. cognitive behavioural therapy, interpersonal psychotherapy or other). However, data on NNT did show differences. CONCLUSIONS Prevention of depression seems feasible and may, in addition to treatment, be an effective way to delay or prevent the onset of depressive disorders. Preventing or delaying these disorders may contribute to the further reduction of the disease burden and the economic costs associated with depressive disorders.
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Affiliation(s)
- Kim van Zoonen
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands, Leuphana University Innovation Incubator, Division Health Trainings Online, Lüneburg, Germany, Philips University, Department of Psychology, Clinical Psychology and Psychotherapy, Marburg, Germany, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands, Department of Epidemiology and Biostastics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA and Department of Psychiatry and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
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Huang LC, Tsai KJ, Wang HK, Sung PS, Wu MH, Hung KW, Lin SH. Prevalence, incidence, and comorbidity of clinically diagnosed obsessive-compulsive disorder in Taiwan: a national population-based study. Psychiatry Res 2014; 220:335-41. [PMID: 25169892 DOI: 10.1016/j.psychres.2014.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/06/2014] [Accepted: 08/09/2014] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder significant in intrusive thoughts and compensation repetitive behaviors. Few studies have reported on this condition Asia. This study estimated the prevalence, incidence and psychiatric comorbidities of OCD in Taiwan. We identified study subjects for 2000-2008 with a principal diagnosis of OCD according to the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic criteria by using National Health Research Institute database. These patients received either outpatient or inpatient care for their condition. Rates were directly age- and sex-adjusted to the 2004 Taiwan population distribution. The estimated mean annual incidence was 27.57 per 10(5) inhabitants and the one year prevalence was 65.05 per 10(5) inhabitants. Incidence and prevalence increased with age, peaking at age 18-24 years in males and at 35-44 years in females. About 53% of adults (≥18 years) and 48% of child and adolescent patients (6-17 years) had one or more comorbid psychiatric conditions. The most common comorbid diagnosis was depressive disorders for both adult and child-adolescent patients. We found a lower prevalence and incidence of clinically diagnosed OCD than that of community studies. Many Asian patients with OCD also had various psychiatric comorbidities, a clinically relevant finding.
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Affiliation(s)
- Li-Chung Huang
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Kuang Wang
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Pi-Shan Sung
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Hsiu Wu
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Kuo-Wei Hung
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Yuan׳s General Hospital, Kaohsiung, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
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Blanco C, Okuda M, Wang S, Liu SM, Olfson M. Testing the drug substitution switching-addictions hypothesis. A prospective study in a nationally representative sample. JAMA Psychiatry 2014; 71:1246-53. [PMID: 25208305 PMCID: PMC4797944 DOI: 10.1001/jamapsychiatry.2014.1206] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management. OBJECTIVE To determine whether remission from an SUD increases the risk of onset of a new SUD after a 3-year follow-up compared with lack of remission from an SUD and whether sociodemographic characteristics and psychiatric disorders, including personality disorders, independently predict a new-onset SUD. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study where data were drawn from a nationally representative sample of 34 653 adults from the National Epidemiologic Survey on Alcohol and Related Conditions. Participants were interviewed twice, 3 years apart (wave 1, 2001-2002; wave 2, 2004-2005). MAIN OUTCOMES AND MEASURES We compared new-onset SUDs among individuals with at least 1 current SUD at wave 1 who did not remit from any SUDs at wave 2 (n = 3275) and among individuals with at least 1 current SUD at wave 1 who remitted at wave 2 (n = 2741). RESULTS Approximately one-fifth (n = 2741) of the total sample had developed a new-onset SUD at the wave 2 assessment. Individuals who remitted from 1 SUD during this period were significantly less likely than those who did not remit to develop a new SUD (13.1% vs 27.2%, P < .001). Results were robust to sample specification. An exception was that remission from a drug use disorder increased the odds of a new SUD (odds ratio [OR] = 1.46; 95% CI, 1.11-1.92). However, after adjusting for the number of SUDs at baseline, remission from drug use disorders decreased the odds of a new-onset SUD (OR = 0.66; 95% CI, 0.46-0.95) whereas the number of baseline SUDs increased those odds (OR=1.68; 95% CI, 1.43-1.98). Being male, younger in age, never married, having an earlier age at substance use onset, and psychiatric comorbidity significantly increased the odds of a new-onset SUD during the follow-up period. CONCLUSIONS AND RELEVANCE As compared with those who do not remit from an SUD, remitters have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution but rather is associated with a lower risk of new SUD onsets.
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Affiliation(s)
- Carlos Blanco
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Mayumi Okuda
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Shuai Wang
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Shang-Min Liu
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
| | - Mark Olfson
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York
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Voltas N, Hernández-Martínez C, Arija V, Aparicio E, Canals J. A prospective study of paediatric obsessive-compulsive symptomatology in a Spanish community sample. Child Psychiatry Hum Dev 2014; 45:377-87. [PMID: 24077908 DOI: 10.1007/s10578-013-0408-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The obsessive-compulsive manifestations course was assessed with the Leyton obsessional inventory-child version survey (LOI-CV) in a 3-year prospective study, using a non-clinical sample. From an initial sample of 1,514 school-age children who underwent symptoms screening for obsessive-compulsive, anxiety and depression, 562 subjects (risk group/without risk group) were re-assessed in the 2nd phase and 242 subjects were monitored after 3 years. LOI-CV scores significantly decreased over time independently of age and gender. The prevalence, persistence and incidence for two levels of severity of obsessive–compulsive manifestations ranged between 4.8-30.4%, 9.3-28.4% and 1.1-14.4%, respectively. 34.6-64.5% of obsessive-compulsive symptomatology was predicted by anxiety, depressive and obsessive-compulsive symptoms. For the obsessiveness (less severe form of obsessive-compulsive manifestations), the depressive symptoms were not predictors. Gender and socioeconomic status were not related with obsessive-compulsive manifestations. These data support a substantial continuity of the obsessive-compulsive manifestations and the existence of different levels of severity within the obsessive-compulsive spectrum.
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Colvin A, Richardson GA, Cyranowski JM, Youk A, Bromberger JT. Does family history of depression predict major depression in midlife women? Study of Women's Health Across the Nation Mental Health Study (SWAN MHS). Arch Womens Ment Health 2014; 17:269-78. [PMID: 24952069 PMCID: PMC4120816 DOI: 10.1007/s00737-014-0433-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/11/2014] [Indexed: 11/29/2022]
Abstract
This study aims to determine whether family history of depression predicts major depression in midlife women independent of psychosocial and health profiles at midlife. Participants were 303 African American and Caucasian women (42-52 years at baseline) recruited into the Study of Women's Health Across the Nation (SWAN) and the Women's Mental Health Study (MHS) in Pittsburgh. Major depression was assessed annually with the Structured Clinical Interview for DSM-IV. Family mental health history was collected at the ninth or tenth follow-up. Multivariable logistic regression was used to determine whether family history of depression predicted major depression in midlife, adjusting for covariates. The odds of experiencing major depression during the study were three times greater for those with a family history than for those without a family history (OR = 3.22, 95% CI = 1.95-5.31). Family history predicted depression (OR = 2.67, 95% CI = 1.50-4.78) after adjusting for lifetime history of depression, age, trait anxiety, chronic medical conditions, and stressful life events. In analyses stratified by lifetime history of depression, family history significantly predicted depression only among women with a lifetime history of depression. Family history of depression predicts major depression in midlife women generally, but particularly in those with a lifetime history of depression prior to midlife.
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Affiliation(s)
- Alicia Colvin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
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