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Athira KV, Bandopadhyay S, Samudrala PK, Naidu VGM, Lahkar M, Chakravarty S. An Overview of the Heterogeneity of Major Depressive Disorder: Current Knowledge and Future Prospective. Curr Neuropharmacol 2020; 18:168-187. [PMID: 31573890 PMCID: PMC7327947 DOI: 10.2174/1570159x17666191001142934] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 08/05/2019] [Accepted: 09/27/2019] [Indexed: 02/08/2023] Open
Abstract
Major depressive disorder (MDD) is estimated to impose maximum debilitating effects on the society by 2030, with its critical effects on health, functioning, quality of life and concomitant high levels of morbidity and mortality. Yet, the disease is inadequately understood, diagnosed and treated. Moreover, with the recent drastic rise in the pace of life, stress has materialized as one of the most potent environmental factors for depression. In this scenario, it is important to understand the modern pathogenetic hypotheses and mechanisms, and possibly try to shift from the traditional approaches in depression therapy. These include the elaboration of pathophysiological changes in heterogeneous systems such as genetic, epigenetic, serotonergic, noradrenergic, gamma-aminobutyric acid, glutamatergic and endocannabinoid systems, neurotrophic factors, HPA axis, immune system as well as cellular stress mechanisms. These components interact with each other in a complex matrix and further elucidation of their mechanism and cascade pathways are needed. This might aid in the identification of MDD subtypes as well as the development of sophisticated biomarkers. Further, characterization might also aid in developing multitargeted therapies that hold much promise as compared to the conventional monoamine based treatment. New candidate pharmacons, refined psychotherapeutic modalities, advanced neuro-surgical and imaging techniques as well as the implementation of pharmacokinetic, pharmacogenetic prescribing guidelines constitute the emerging expanses of MDD treatment.
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Affiliation(s)
- Kaipuzha Venu Athira
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Guwahati, 781125, Assam, India.,Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad 500007, India.,Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, 682 041, Kerala, India
| | - Sikta Bandopadhyay
- Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad 500007, India
| | - Pavan Kumar Samudrala
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Guwahati, 781125, Assam, India
| | - V G M Naidu
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Guwahati, 781125, Assam, India
| | - Mangala Lahkar
- Department of Pharmacology, Gauhati Medical College, Guwahati, 781032, Assam, India
| | - Sumana Chakravarty
- Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad 500007, India
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Hedén L, Berglund M, Gillsjö C. Effects of the Intervention "Reflective STRENGTH-Giving Dialogues" for Older Adults Living with Long-Term Pain: A Pilot Study. J Aging Res 2020; 2020:7597524. [PMID: 32953174 PMCID: PMC7481915 DOI: 10.1155/2020/7597524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Long-term musculoskeletal pain is a major, often undertreated, disabling health problem among an increasing number of older adults. Reflective STRENGTH-giving dialogues (STRENGTH) may be a tool to support older adults living with long-term pain. The main aim of this pilot study was to investigate the immediate and longitudinal effect of the intervention STRENGTH on levels of pain, wellbeing, occurrence of depression symptoms, and sense of coherence (SOC) among community-dwelling older adults suffering from musculoskeletal pain compared to a control group. METHODS The study was semiexperimental with an intervention group and a control group. The effect of a single STRENGTH intervention was reported on the Numeric Rating Scale (NRS) regarding pain and wellbeing. To evaluate the longitudinal effect of STRENGTH, using the Brief Pain Inventory-Short Form (BPI-SF), the Geriatric Depression Scale-20 (GDS-20), SOC-13 at baseline (T1), and six months after the intervention/no intervention (T2), a total of 30 older adults, aged 72 to 97 years (Mdn 86 years), were included consecutively and fulfilled the intervention series (n = 18) or untreated controls (n = 12). RESULTS The intervention with STRENGTH decreases pain (NRS 6 Mdn versus NRS 4 Mdn, p < 0.001) and increases wellbeing (NRS 7 Mdn versus NRS 8 Mdn, p < 0.001). After a six-month study period with STRENGTH, no longitudinal effect difference was found compared to baseline. Compared to the control group, there was an increasing trend between decreased pain level and increased SOC level for STRENGTH intervention. CONCLUSIONS This pilot study supports STRENGTH's effect as a pain-alleviating model that provides a decrease in pain levels and an increase of wellbeing in older adults with long-term pain. STRENGTH dialogues could be a useful intervention to provide individually holistic care in older adults living with long-term pain.
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Affiliation(s)
- Lena Hedén
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Mia Berglund
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Catharina Gillsjö
- School of Health Sciences, University of Skövde, Skövde, Sweden
- College of Nursing, University of Rhode Island, South Kingstown, RI, USA
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Page GG, Corwin EJ, Dorsey SG, Redeker NS, McCloskey DJ, Austin JK, Guthrie BJ, Moore SM, Barton D, Kim MT, Docherty SL, Waldrop-Valverde D, Bailey DE, Schiffman RF, Starkweather A, Ward TM, Bakken S, Hickey KT, Renn CL, Grady P. Biomarkers as Common Data Elements for Symptom and Self-Management Science. J Nurs Scholarsh 2018; 50:276-286. [PMID: 29575635 DOI: 10.1111/jnu.12378] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Biomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a "minimum set" of biomarkers for consideration as CDEs in symptom and self-management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance. DESIGN AND METHODS From May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and self-management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and self-management science are proposed along with implications for future research and use of CDEs in these areas. FINDINGS The recommended minimum set of biomarker CDEs include pro- and anti-inflammatory cytokines, a hypothalamic-pituitary-adrenal axis marker, cortisol, the neuropeptide brain-derived neurotrophic factor, and DNA polymorphisms. CONCLUSIONS It is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and self-management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and self-management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and self-management science. CLINICAL RELEVANCE The use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and self-management science.
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Affiliation(s)
- Gayle G Page
- Nu Beta, Professor and Independence Foundation Chair in Nursing Education, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Elizabeth J Corwin
- Alpha Epsilon, Professor and Associate Dean for Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Susan G Dorsey
- Pi, Professor and Chair, Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD, USA
| | - Nancy S Redeker
- Delta Mu, Beatrice Renfield Term Professor of Nursing, Professor, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT
| | - Donna Jo McCloskey
- Clinical Advisor, Contractor, National Institute of Nursing Research, NIH, Bethesda, MD, USA
| | - Joan K Austin
- Alpha, Distinguished Professor Emerita, Indiana University School of Nursing, Indianapolis, IN and National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Barbara J Guthrie
- Professor, Director of the PhD Program, Northeastern University, Boston, MA, USA
| | - Shirley M Moore
- Delta Xi, Edward J. and Louise Mellen Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Debra Barton
- Mary Lou Willard French Professor of Oncology Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Miyong T Kim
- Epsilon Theta, Professor, Associate Vice President for Community Health Engagement, University of Texas at Austin, Austin, TX, USA
| | - Sharron L Docherty
- Iota Omicron, Associate Professor, School of Nursing; Associate Professor, Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Drenna Waldrop-Valverde
- Associate Professor and Assistant Dean for Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donald E Bailey
- Beta Epsilon and Theta Iota, Associate Professor, Duke University, Durham, NC, USA
| | - Rachel F Schiffman
- Alpha Chi and Eta Nu, Professor and Associate Dean for Research, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Teresa M Ward
- Psi-at-Large, Associate Professor, University of Washington School of Nursing, Seattle, WA, USA
| | - Suzanne Bakken
- Alpha Eta, The Alumni Professor of Nursing and Professor of Biomedical Informatics Director, Columbia University, New York, NY, USA
| | - Kathleen T Hickey
- Alpha Eta, Professor of Nursing at Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Cynthia L Renn
- Pi, Associate Professor Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD, USA
| | - Patricia Grady
- Tau, Director, National Institute of Nursing Research, National Institutes or Health, Bethesda, MD, USA
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Salt E, Crofford LJ, Segerstrom S. The Mediating and Moderating Effect of Volunteering on Pain and Depression, Life Purpose, Well-Being, and Physical Activity. Pain Manag Nurs 2017; 18:243-249. [PMID: 28601476 DOI: 10.1016/j.pmn.2017.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
To improve function and quality of life in patients with chronic pain, a prevalent and costly condition, an understanding of the relationships among well-being, physical activity, depression, and life purpose with pain is needed. Because of the role loss experienced by people with chronic pain, activities such as volunteering could have an important role in improving health and well-being. In one study, chronic pain patients who participated in volunteer activities reported both decreased pain and "a sense of purpose." The aim of this study is to test the relationships among pain and well-being, physical activity, depression, and life purpose and then to determine if volunteering activities mediated or moderated these relationships. This observational study was conducted in a large university setting in Kentucky and used a sample of 200 women older than age 50. We found that people with higher pain were more depressed and had lower life purpose and well-being. People who volunteered less had more pain, lower perceived life purpose, more depressive symptoms, and decreased physical activity. Volunteer activities did have a significant mediating effect on the relationship between pain and depression; approximately 9% of the relationship between pain and depression can be accounted for by volunteering. Moderation by volunteering was found between pain and life purpose. We identified important relationships among pain, volunteering, and health outcomes and found that volunteering has a role in improving depressive symptoms and life purpose in women with pain.
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Affiliation(s)
- Elizabeth Salt
- University of Kentucky, College of Nursing, Lexington, Kentucky.
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Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, March L. Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health. THE GERONTOLOGIST 2017; 56 Suppl 2:S243-55. [PMID: 26994264 DOI: 10.1093/geront/gnw002] [Citation(s) in RCA: 360] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Persistent pain, impaired mobility and function, and reduced quality of life and mental well-being are the most common experiences associated with musculoskeletal conditions, of which there are more than 150 types. The prevalence and impact of musculoskeletal conditions increase with aging. A profound burden of musculoskeletal disease exists in developed and developing nations. Notably, this burden far exceeds service capacity. Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. Globally, there is an emphasis on maintaining an active lifestyle to reduce the impacts of obesity, cardiovascular conditions, cancer, osteoporosis, and diabetes in older people. Painful musculoskeletal conditions, however, profoundly limit the ability of people to make these lifestyle changes. A strong relationship exists between painful musculoskeletal conditions and a reduced capacity to engage in physical activity resulting in functional decline, frailty, reduced well-being, and loss of independence. Multilevel strategies and approaches to care that adopt a whole person approach are needed to address the impact of impaired musculoskeletal health and its sequelae. Effective strategies are available to address the impact of musculoskeletal conditions; some are of low cost (e.g., primary care-based interventions) but others are expensive and, as such, are usually only feasible for developed nations. In developing nations, it is crucial that any reform or development initiatives, including research, must adhere to the principles of development effectiveness to avoid doing harm to the health systems in these settings.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. Arthritis and Osteoporosis Victoria, Caulfield South, Melbourne, Australia.
| | - Marita J Cross
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital Department of Rheumatology, St Leonards, New South Wales, Australia
| | - Damian G Hoy
- School of Population Health, University of Queensland, Herston, Brisbane, Australia. Secretariat of the Pacific Community, Public Health Division, Noumea, New Caledonia
| | - Lídia Sànchez-Riera
- Institut d'Investigació, Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Department Reumatologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fiona M Blyth
- Concord Clinical School, University of Sydney and Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, New South Wales, Australia
| | - Anthony D Woolf
- Bone and Joint Research Office, The Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - Lyn March
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital Department of Rheumatology, St Leonards, New South Wales, Australia
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Stubbs B, Koyanagi A, Thompson T, Veronese N, Carvalho AF, Solomi M, Mugisha J, Schofield P, Cosco T, Wilson N, Vancampfort D. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry 2016; 43:63-70. [PMID: 27796261 DOI: 10.1016/j.genhosppsych.2016.09.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Back pain (BP) is a leading cause of global disability. However, population-based studies investigating its impact on mental health outcomes are lacking, particularly among low- and middle-income countries (LMICs). Thus, the primary aims of this study were to: (1) determine the epidemiology of BP in 43 LMICs; (2) explore the relationship between BP and mental health (depression spectrum, psychosis spectrum, anxiety, sleep disturbances and stress). METHODS Data on 190,593 community-dwelling adults aged ≥18 years from the World Health Survey (WHS) 2002-2004 were analyzed. The presence of past-12 month psychotic symptoms and depression was established using questions from the Composite International Diagnostic Interview. Anxiety, sleep problems, stress sensitivity, and any BP or chronic BP (CBP) during the previous 30 days were also self-reported. Multivariable logistic regression analyses were undertaken. RESULTS The overall prevalence of any BP and CBP were 35.1% and 6.9% respectively. Significant associations with any BP were observed for subsyndromal depression [OR (odds ratio)=2.21], brief depressive episode (OR=2.64), depressive episode (OR=2.88), psychosis diagnosis with symptoms (OR=2.05), anxiety (OR=2.12), sleep disturbance (OR=2.37) and the continuous variable of stress sensitivity. Associations were generally more pronounced for chronic BP. CONCLUSION Our data establish that BP is associated with elevated mental health comorbidity in LMICs. Integrated interventions that address back pain and metal health comorbidities might be an important next step to tackle this considerable burden.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom.
| | - Ai Koyanagi
- Research and Development Unit, ParcSanitariSant Joan de Déu, Universitat de Barcelona, FundacióSant Joan de Déu, Dr. Antoni Pujadas, 42, SantBoi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de InvestigaciónBiomédicaen Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Nicola Veronese
- Geriatrics Division, Department of Medicine-DIMED, University of Padova, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Andre F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Marco Solomi
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy
| | - James Mugisha
- Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Theodore Cosco
- MRC Unit for Lifelong Health & Ageing, University College London, 33 Bedford Place, London WC1B 5JU, United Kingdom
| | - Nicky Wilson
- Physiotherapy Service, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
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Netz Y, Zijlstra W. EURAPA moves to open access: Research trends and challenges in physical activity in old age. Eur Rev Aging Phys Act 2015; 12:1. [PMID: 26865865 PMCID: PMC4743859 DOI: 10.1186/s11556-015-0149-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 08/25/2015] [Indexed: 01/04/2023] Open
Affiliation(s)
- Yael Netz
- The European Group for Research into Elderly and Physical Activity, Wingate College, Wingate Institute, Netanya, 4290200 Israel
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University, Cologne, 50933 Germany
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