Stress and Depression

Resveratrol alleviates depressive-like behavior via the activation of SIRT1/NF-κB signaling pathway in microglia

BACKGROUND

Currently, the pathogenesis of depression remains poorly understood, leading to many patients receiving ineffective treatment. Resveratrol has demonstrated beneficial effects in the prevention and treatment of depression. However, it remains unknown whether resveratrol administration can counteract depression-like behaviors by regulating the SIRT1/NF-κB signaling pathway.

METHODOLOGY/PRINCIPAL FINDINGS

Male C57BL/6 mice were randomly assigned to a control group, a depression group, and a resveratrol group. The depression model was established using chronic unpredictable mild stress (CUMS) for 5 weeks. Behavioral tests were conducted to assess depressive-like behaviors. The expression levels of SIRT1 and NF-κB in the hippocampus of mice and BV2 microglial cells were measured. After 5 weeks of modeling, the results indicated that mice in the depression group exhibited significant depressive-like behaviors and inhibited activation of the SIRT1/NF-κB signaling pathway. In contrast, resveratrol administration effectively reversed these changes. Results from in vitro experiments showed that LPS stimulation increased microglial activity and downregulated the SIRT1/NF-κB signaling pathway in microglia; however, resveratrol treatment mitigated these effects.

CONCLUSIONS/SIGNIFICANCE

Our findings suggested that resveratrol can alleviate CUMS-induced depression-like behaviors via the activation of the Sirt1/NF-κB pathway in microglia.

Chronic stress-related behavioral and synaptic changes require caspase-3 activation in the ventral hippocampus of male mice

Although numerous studies have suggested that chronic stress is a major risk factor for major depressive disorder, the process by which stress causes depression is still not fully understood. Previously, we investigated glucocorticoids, which are stress response hormones that activate a synapse-weakening pathway. Therefore, we hypothesized that chronic stress may cause synaptic depression, which could reduce excitability related to emotions. Animals underwent chronic restraint stress (CRS), followed by basal synaptic transmission measurement in hippocampal slices to assess synaptic function. Drugs were infused into the ventral hippocampus via cannulation before behavioral tests, including forced swimming, tail suspension, and sucrose intake tests, which evaluated depressive-like behaviors and anhedonia. The field excitatory postsynaptic potentials (fEPSPs) are reduced by chronic restraint stress (CRS) in the ventral hippocampus. The ventral hippocampi of mice treated with CRS showed low levels of fEPSP after the forced swim test (FST). In the FST and tail suspension test, CRS-induced increases in immobility time were prevented by the acute inhibition of AMPAR internalization by Tat-GluA23y, which also prevented fEPSP reduction. Mice lacking caspase-3 exhibited resilience to CRS-induced increases in immobility time in the FST, as well as changes in the functionality of synaptic AMPAR. Finally, the caspase-3 inhibitor Z-DEVD-FMK rapidly blocked the CRS-induced increase in immobility time in the FST and the CRS-induced decrease in sucrose preference. These findings suggest that chronic stress-related behavioral changes may require caspase-3-dependent alterations in ventral hippocampal synapses.

The effect of fish oil versus krill oil intervention on clinical symptoms and cardiometabolic risk factors in patients with major depressive disorder: A randomized placebo-controlled double-blind trial

BACKGROUND

This study aimed to compare the effects of krill- and fish-oil interventions on clinical symptoms and metabolic risk factors in individuals with MDD.

METHODS

In this randomized study, 57 adults diagnosed with MDD were allocated to receive krill-oil (520 mg EPA + DHA), fish-oil (600 mg EPA + DHA), or a placebo (soybean-oil) daily for 8 weeks. Anthropometric measurements, depression anxiety stress-21 (DASS-21) scale, and Hamilton depression rating scale (HDRS) were performed at baseline and 4 and 8 weeks. In addition, venous blood samples were collected at baseline and post-intervention to evaluate lipid and glycemic profiles, including fasting glucose, HbA1c, cholesterol, triglycerides, LDL-c, and HDL-c levels.SPSS and R Studio software programs were used for statistical analysis.

RESULTS

A total of 50 participants completed the study, with 17 in each intervention group and 16 in the placebo. The mean HDRS scores decreased significantly in both the krill-oil (8.5 ± 1.2) and fish-oil groups (10.0 ± 1.2) compared to the placebo (p < 0.001), indicating clinical symptom improvement. Furthermore, the interaction effect of group-by-time was found to be statistically significant (η2p = 0.273;ptime×group < 0.001). Anxiety and distress scores decreased to similar levels after the post-intervention compared to baseline in krill- and fish-oil groups. Krill- and fish-oil supplementation increased plasma HDL-c and uric acid levels, but the group-by-time interaction effect was only observed at the HDL-c level (η2p = 0.238;ptime×group = 0.002). The mean HbA1c rates and plasma triglyceride levels of krill-oil recipients were lower after the post-intervention.

CONCLUSION

Krill- and fish-oil could be considered as a safe and effective adjuvant treatments for depression. However, there was no evidence of apparent superiority over each other.

Association between red blood cell distribution width-to-albumin ratio and depression: a cross-sectional analysis among US adults, 2011-2018

BACKGROUND

Red blood cell distribution width (RDW)-to-albumin ratio (RAR) is a novel index. Its relationship with depression, a common and complex psychiatric disorder, remains unclear. This study utilized the National Health and Nutrition Examination Survey (NHANES) database to investigate this relationship.

METHODS

Multivariate logistic regression, restricted cubic spline (RCS) regression, receiver operating characteristic (ROC) analysis, and sensitivity analyses were used to examine the relationship between RAR and depression based on NHANES data from 2011-2018. The study also used subgroup analyses and interaction tests to explore whether the relationship was stable across populations.

RESULTS

RAR was positively associated with depression in 18,150 participants aged ≥ 20 years. In fully adjusted models, each one-unit increase in RAR was associated with a 22% increase in the likelihood of depression [1.22 (1.05, 1.41)]. Participants in the highest quartile of RAR had a 30% higher risk of depression than those in the lowest quartile of RAR [1.30 (1.04, 1.63)]. Subgroup analyses revealed that the association between RAR and depression was significantly stronger among men, alcohol-drinking and high-income groups.

CONCLUSIONS

Higher baseline RAR was associated with an increased risk of depression in US adults and was more informative than RDW, albumin, and hemoglobin-to-RDW ratio (HRR). Further large-scale prospective studies are needed to analyze the role of RAR in depression. These findings emphasize that RAR can be a simple, reliable and cost-effective predictor of depression in clinical practice.

Navigating life's challenges: A randomized 6-week online intervention study to enhance resilience in working-age adults

Psychological resilience describes a trainable capacity that allows us to cope with adversity and adapt to stressful life events. This study aimed to investigate the efficacy of a 6-week online resilience intervention in students and working-age individuals. We randomly assigned 174 participants aged between 18 and 54 years (74.1% female) to either an intervention (n = 86, Mage = 24.83, SDage = 5.93) or a wait-list control group (n = 88, Mage = 23.30, SDage = 4.49). The intervention group received a 6-week flexible, asynchronous online resilience training consisting of 12 short videos. We assessed resilience, perceived stress, and worries in both groups. Mixed-ANCOVA results indicated that participants assigned to the intervention group significantly increased their resilience scores (Mdiff = 3.65, p < .001) and reduced negative emotions such as perceived stress (Mdiff = 4.18, p < .001) and worries (Mdiff = 5.09, p < .001). We observed no significant changes in the wait-list control group. The intervention group's ability to enhance resilience through watching two short videos per week supports the idea that resilience is trainable. Online resilience interventions represent a promising opportunity to acquire novel coping strategies in order to strengthen resilience and manage life's upcoming challenges.

Elevated activity of plasma dipeptidyl peptidase 4 upon stress can be targeted to reverse tumor immunosuppression

The interplay between stress-induced metabolic reprogramming and perturbations in the cancer-immune dialogue is a challenging research topic with huge knowledge gaps to fill. In a repeated social defeat model, we discovered that circulating corticosterone, blood glucose, and plasma DPP4 activity were increased in stressed mice. Consistently, three independent cohort studies showed that plasma DPP4 activity was positively correlated with the severity of psychological distress of newly diagnosed cancer patients. Stress-induced surge of glucocorticoid can boost DPP4 activity via glucocorticoid receptor signaling without influencing Dpp4 transcription or the abundance of soluble DPP4. Albeit catalytic inhibition of DPP4 upon stress can't normalize the behavioral pattern and glucocorticoid secretion, it managed to reverse the expansion of circulating neutrophils and monocytes, restored the efficacy of prophylactic tumor vaccine, and augmented the priming of tumor-antigen specific T cells. DPP4 blockade in the context of stress largely enhanced the intratumoral accumulation of CD8+T cells and DCs, cytokine production by CD8+T and NK cells in situ, and tumor antigen presentation in vitro. Proteome profiling of mouse plasma revealed stress-related DPP4-sensitive changes that can be linked to immunological alterations and disturbed protease network. Altogether, elevated DPP4 activity may be targeted in cancer patients with psychiatric comorbidities to boost anti-tumor immunity.

Reward Processing in Mood Disorders and Schizophrenia: A Neurodevelopmental Framework

Major depressive disorder (MDD), bipolar disorder, and schizophrenia involve disruptions in processing rewarding stimuli. In this review, we propose that distinct mechanistic pathways underlie these disruptions in mood disorders versus schizophrenia, and we highlight the importance of understanding these differences for developing personalized treatments. We summarize evidence suggesting that reward processing abnormalities in mood disorders are driven by dysregulated motivational systems; MDD is characterized by blunted responses to reward cues, and bipolar disorder is characterized by heightened responses. In contrast, we argue that reward processing disruptions in schizophrenia do not reflect abnormalities in motivation or hedonic experience; rather, they reflect impairments in the cognitive representation of past and future rewards as well as misdirected attention to irrelevant stimuli. To integrate these findings, we present a neurodevelopmental framework for the onset of mood and psychotic disorders and explore how disruptions in normative brain development contribute to their pathophysiology, timing, and onset. Additionally, we move beyond viewing these conditions as homogeneous disorders and discuss how reward processing profiles may align with specific symptom dimensions.

The efficacy of a stress mindset intervention on psychosocial health and daily stress processes in college students

INTRODUCTION

Although stress is commonly characterized as harmful, interventions promoting adaptive stress mindsets have led to improved physiological, psychological, and behavioral outcomes. Interventions including rehearsal of stress mindset strategies may improve health and functioning.

METHODS

We tested the efficacy of an intervention including an in-person stress mindset seminar and daily rehearsal on psychosocial outcomes and daily stress-related processes over 21 days. Eighty-eight first-year college students were randomized to a stress-is-enhancing condition (SEC) or non-intervention-control (NIC). The SEC attended an interactive seminar providing education about stress physiology and strategies to adopt a more positive stress mindset. Daily dairies recorded stress processes (perceived stress, stress mindset, affect, and daily stressor appraisals) with writing prompts encouraging daily rehearsal of seminar strategies for the SEC.

RESULTS

The intervention produced more adaptive stress mindsets, improved depression and anxiety symptoms, as well as improved daily challenge appraisals and greater perceived ability to cope with stressors, relative to control. No effect was found on daily affect, perceived daily stress, or perceptions of daily stressors as threatening or controllable.

DISCUSSION

These findings further support the efficacy of stress mindset interventions on psychosocial health and adaptive cognitive responses to daily stress and suggest that rehearsal may help maintain effects.

Association between adverse perinatal events and postpartum depressive symptoms in a North American prospective preconception cohort study

BACKGROUND

Identifying risk factors for postpartum depression (PPD) is critical to inform early intervention efforts. This study investigated the impact of adverse perinatal events on PPD.

METHODS

We analyzed data from the Pregnancy Study Online (PRESTO), a North American prospective preconception cohort study. Participants (N = 3559) aged 21-45 years completed questionnaires at preconception, during pregnancy, and postpartum. PPD was assessed at six months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). We fit generalized linear models to estimate risk ratios (RRs) and 95 % confidence intervals (CIs) for the associations of adverse perinatal events (preterm birth; birth size for gestational age; infant birthweight; and NICU admission) with PPD (EPDS score ≥ 13), adjusting for confounders including preconception mental health.

RESULTS

A total of 9.8 % reported PPD. Preterm birth (i.e., <37 weeks gestational age; RR = 1.30; 95 % CI: 0.92, 1.82), particularly spontaneous preterm birth (RR = 1.38; 95 % CI: 0.90, 2.10), very preterm birth (<34 weeks; RR = 1.88; 95 % CI: 1.04, 3.35), very low infant birthweight (i.e., <1500 g; RR = 1.67, 95 % CI: 0.77, 3.60), and NICU admission (RR = 1.15; 95 % CI: 0.86, 1.55) were associated with increased PPD risk. Stratified analyses indicated preterm birth was more strongly associated with PPD among parous participants and participants with a history of mental health diagnoses.

CONCLUSION

Adverse perinatal events were associated with an increased risk of PPD at 6 months postpartum. Early identification and management of depressive symptoms in those who have experienced adverse perinatal events are crucial for improving both parental and infant health outcomes.

Aversion-induced dopamine reductions predict drug-taking and escape behaviors

Dopamine release in the nucleus accumbens core (NAcC) has long been associated with the promotion of motivated behavior. However, inhibited dopamine signaling can increase behavior in certain settings, such as during drug self-administration. While aversive environmental stimuli can reduce dopamine, it is unclear whether such stimuli reliably engage this mechanism in different contexts. Here we compared the physiological and behavioral responses to the same aversive stimulus in different designs to determine if there is uniformity in the manner that aversive stimuli are encoded and promote behavior. NAcC dopamine was measured using fiber photometry in male and female rats during cocaine self-administration sessions in which an acutely aversive 90 dB white noise was intermittently presented. In a separate group of rats, aversion-induced changes in dopamine were measured during an escape design in which operant responses terminated aversive white noise. Aversive white noise significantly reduced NAcC dopamine and increased cocaine self-administration in both male and female rats. The same relationship was observed in the escape design, in which white noise reduced dopamine and promoted the performance of escape behavior. In both designs, the magnitude of the dopamine reduction predicted behavioral performance. While prior research demonstrated that pharmacologically reduced dopamine signaling can promote intake, this report demonstrates that this physiological mechanism is naturally engaged by aversive environmental stimuli and is generalizable to non-drug contexts. These findings illustrate a common physiological signature in response to aversion that may promote both adaptive and maladaptive behavior.

Exploring the longitudinal associations among fear of negative evaluation, self-disgust, and self-injury in Chinese adolescents: Disentangling between- and within-person associations

INTRODUCTION

Nonsuicidal self-injury (NSSI) and suicidal ideation (SI) are widespread mental health concerns among adolescents. As fear of negative evaluation (FNE) and self-disgust are also common psychological phenomena among adolescents, existing research suggests that there may be reciprocal predictive relationships between FNE and NSSI/SI with self-disgust playing a mediating role. This study aimed to investigate the reciprocal relationships between FNE and NSSI, as well as FNE and SI, and the mediating role of self-disgust.

METHOD

Random intercept cross-lagged panel models (RI-CLPMs) were employed. A total of 515 Chinese secondary school students (50.7% boys; baseline Mage = 12.31 years, SD = 0.81) completed self-report questionnaires regarding FNE, self-disgust, NSSI, and SI. The assessment was conducted in four waves, 6 months apart.

RESULTS

The results were as follows: (1) There were bidirectional relations between FNE and NSSI through self-disgust. (2) There was a unidirectional association from FNE to SI via self-disgust.

CONCLUSION

These findings have expanded the theoretical understanding of adolescent NSSI and SI, and highlighted the importance of offering personalized psychological counseling and therapy services at the intrapersonal level for adolescents.

Dynamic alterations of depressive-like behaviors, gut microbiome, and fecal metabolome in social defeat stress mice

Gut microbiome is implicated in the onset and progression of major depressive disorder (MDD), but the dynamic alterations of depressive symptoms, gut microbiome, and fecal metabolome across different stages of stress exposure remain unclear. Here, we modified the chronic social defeat stress (CSDS) model to evaluate mice subjected to social defeat stress for 1, 4, 7, and 10 days. Behavioral tests, 16S rRNA, metagenomics, and fecal metabolomics were conducted to investigate the impact of stress exposure on behaviors, gut microbiota and fecal metabolites. We observed that depressive-like behaviors, such as anhedonia and social avoidance, worsened significantly as stress exposure increased. The microbial composition, function, and fecal metabolites exhibited distinct separations across the different social defeat stress groups. Mediation analysis identified key bacteria, such as Lachnospiraceae_UCG-001 and Bacteroidetes, and fecal metabolites like valeric acid and N-acetylaspartate. In our clinical depression cohort, we confirmed that fecal valeric acid levels, were significantly lower in depressive-like mice and MDD patients, correlating closely with stress exposure and anhedonia in mice. Further analysis of serum and brain metabolites in mice revealed sustained changes of N-acetylaspartate abundance in fecal, serum, and cortical samples following increasing stress exposure. Together, this study elucidated the characteristics of depressive-like behaviors, gut microbiome, and fecal metabolome across various social defeat stress exposure, and identified key bacteria and fecal metabolites potentially involved in modulating social defeat stress response and depressive-like behaviors, providing new insights into the pathogenesis and intervention of depression.

Medial prefrontal glutamate response to acute stress is associated with social subordination in female rhesus macaques

Chronic psychosocial stress is associated with increased risk of psychiatric disorders. Magnetic resonance spectroscopy (MRS) in humans has been used to show that glutamate levels in medial prefrontal cortex (mPFC) following acute stress exposure adapt to recent chronic stress levels. Here, we sought to determine the presence of this glutamate stress response adaptation in rhesus macaques, whose societies are maintained by dominance relationships that are enforced by agonistic interactions and result in chronic stress phenotypes seen in humans. We tested the hypothesis that change in mPFC glutamate after an acute stressor would be moderated by behavioral factors related to social subordination in a manner similar to that previously observed in humans. Seventeen adult female rhesus monkeys (Macaca mulatta, 13-23 yrs.) were observed over ten weeks to collect behavioral data and then received two MRS scans. The first scan occurred after acute stress manipulation involving relocation and isolation. The second control scan occurred after acclimation to the new location. As expected, we found that a behavioral measure of social subordination predicted an adaptive glutamate response such that animals experiencing more submissive behavior asymmetry (a behavioral measure related to social subordination) exhibited an attenuated glutamate response to the acute stressor. These data establish the use of MRS to measure the adaptive glutamate stress in non-human primates and will help further our understanding of the neurobiology of stress adaptation.

Analysis of Program Activities to Develop Forest Therapy Programs for Improving Mental Health: Focusing on Cases in Republic of Korea

This study aims to provide foundational data for developing forest therapy programs to improve mental health conditions by reviewing program development studies, casebooks published by governmental organizations, and existing programs conducted in forest therapy settings and analyzing the status and activities of programs from various disciplines in Korea and abroad. During the collection phase of mental health improvement programs, studies that were not related to depression, anxiety, or stress, or were not relevant to program development, were excluded. Additionally, studies that did not include detailed program plans were omitted from the activity analysis. The literature review focused on academic articles and theses published between 1990 and 2023, identifying 403 relevant studies. Casebooks were collected from three domains, while forest therapy programs were obtained from three forest welfare organizations. These programs were categorized/analyzed based on their general characteristics, structure, and activity content. The findings indicated that research on psychotherapy (forest therapy) programs peaked between 2010 and 2014 (2020 and 2023) in casebooks and field settings. Programs documented in the literature commonly involved 11-20 sessions lasting 60-90 min, whereas casebooks and field programs typically featured fewer than five sessions, each lasting over 180 min. Nineteen purpose-driven and 40 practical activities were identified, providing a theoretical basis for developing forest therapy programs tailored toward alleviating depression, anxiety, and stress. The proposed activities and elements can support the diversification and professionalization of forest therapy programs, fostering more effective and specialized approaches to improve mental health.

Agomelatine Alleviates Depressive-like Behaviors by Suppressing Hippocampal Oxidative Stress in the Chronic Social Defeat Stress Model

Major depressive disorder (MDD) is a common psychiatric disorder characterized by significant mood disturbances and cognitive impairments. Chronic stress, particularly social defeat stress, plays a crucial role in the etiology of depression, with oxidative stress being a pivotal factor in its pathophysiology. Consequently, identifying effective strategies to mitigate oxidative stress and prevent the progression of depression is of paramount importance. Agomelatine, an atypical antidepressant with melatonergic and serotonergic properties, has shown promise in treating MDD due to its unique mechanisms of action. In this study, we aimed to investigate whether agomelatine could ameliorate behavioral deficits in a chronic social defeat stress (CSDS) mouse model. CSDS mice were administered agomelatine (50 mg/kg, intraperitoneally) and exhibited significant reductions in both anxiety-like and depressive-like behaviors in behavioral tests. Further analysis revealed that agomelatine treatment effectively reduced oxidative damage in the hippocampus of CSDS mice. Additionally, agomelatine attenuated mitochondrial dysfunction and restored synaptic plasticity, as evidenced by an increased density of excitatory synapses and enhanced neuronal activity. These findings suggest that agomelatine may exert therapeutic effects by reducing oxidative stress, preserving mitochondrial function, and enhancing synaptic plasticity, providing new insights into its potential as a treatment for chronic social defeat stress-induced depression.

The mediating effects of sleep quality in the relationship between loneliness and depression among middle-aged and older adults

Loneliness has long been recognized as a key predictor of depression in older adults, and both are related to sleep quality. However, to this day, less is known about whether sleep quality mediates their relationship. This study aimed to examine the relationship between loneliness, sleep quality, and depressive symptoms, and to further explore whether sleep quality mediates the relationship between loneliness and depressive symptoms. Using the random cluster sampling method, 1016 permanent residents aged 45 and above in Ankang City, Shaanxi Province were selected. The relationship between loneliness, sleep quality, and depressive symptoms was analyzed using binary logistic regression, and the mediating role of sleep quality between loneliness and depressive symptoms was analyzed using the PROCESS macro in SPSS 25.0 software. The average age of the participants in this study was 60.39 ± 8.50. Regression analyses showed that individuals with loneliness (OR 7.161, 95%CI: 4.889-10.490, P < 0.001) and those with poor sleep quality (OR 4.777, 95%CI: 3.301-6.913, P < 0.001) were more likely to experience depressive symptoms than individuals without loneliness and with good sleep quality. This study also found a significant mediating effect of sleep quality between loneliness and depressive symptoms [effect value = 0.066, bootstrap 95% CI: (0.037, 0.093)] with an effect size of 13.31%. Loneliness may lead to reduced sleep quality in individuals, which in turn may lead to or exacerbate depressive symptoms. Therefore, this study highlights the importance of assessing and improving sleep quality in lonely people.

Psychometric Properties of the Depression Anxiety Stress Scales (DASS-42 and DASS-21) in Patients with Hematologic Malignancies

Background/Objectives: Patients with hematologic malignancies undergo prolonged, intensive treatments involving frequent hospitalizations and experience debilitating side effects. Consequently, they are at increased risk of developing symptoms of depression, anxiety, and stress, which can undermine their quality of life. However, there is a scarcity of instruments validated for the simultaneous assessment of depression, anxiety, and stress within hematologic cancer populations. The aim of this study is to examine the construct validity, convergent and discriminant validity, and reliability of the Depression Anxiety Stress Scales (DASS-42 and DASS-21) among hematologic cancer patients. Methods: We collected data from 452 hematologic cancer patients across three studies. Results: Confirmatory factor analyses indicated that the theoretical correlated three-factor model and bifactor model for DASS-42 and DASS-21 responses were sufficient to explain the underlying factor structure of the scales in hematologic cancer patients. However, the bifactor model for DASS-42 and DASS-21 fit better with the data compared to the theoretical correlated three-factor model. In addition, we found the correlated three-factor model and the bifactor structure to exhibit scalar measurement invariance across gender for DASS-42 and DASS-21. DASS-42 and DASS-21 subscales demonstrated weak to strong negative correlations with measures of psychological well-being (happiness, well-being, life satisfaction) and strong positive correlations with measures of similar constructs (depression, anxiety, and stress), thereby supporting their convergent and discriminant validity with theoretically and empirically expected correlations with external criteria. The reliability analyses demonstrated that both DASS-42 and DASS-21 subscales exhibited strong internal consistency and test-retest reliability when assessing symptoms of depression, anxiety, and stress among patients with hematologic malignancies. Moreover, the item-scale convergent and discriminant validity analyses demonstrated that items exhibited higher corrected item-total correlations with their intended subscales than with other subscales across the DASS-42 and DASS-21, providing evidence for the distinct measurement properties of each subscale. Conclusions: The findings suggest that the DASS-42 and DASS-21 are psychometrically robust instruments for use in Turkish hematologic cancer patients.

Is secondhand smoke exposure associated with depressive symptoms among secondary school students in Malaysia? Findings from a national school-based study

INTRODUCTION

Numerous studies have shown that secondhand smoke (SHS) is harmful to human health. Thus, the purpose of this study was to look into the relationship between exposure to SHS and depression among secondary-school students in Malaysia.

METHODS

We derived the data from the Malaysian National Health and Morbidity Survey 2017: Adolescents Health Survey (NHMS 2017: AHS). We examined the association between SHS exposure and depression in 24497 secondary school students. Descriptive and multivariable logistic regression analyses were performed.

RESULTS

The study revealed that 42% of the students were exposed to SHS during the last seven days. Depression symptoms were associated with SHS exposure (AOR=1.16; 95% CI: 1.07-1.25) after adjusting for possible confounding effects of other independent variables, including age, gender, ethnicity, smoking status of respondents, marital status of parents, physically being bullied, and physical and verbal abuse.

CONCLUSIONS

To prevent and control school-going adolescents' exposure to SHS, health education and smoking cessation among those who have close contact with adolescents should be enhanced. In addition, promoting more smoke-free areas, including houses and public places, should be intensified among secondary school students in Malaysia as they transition to adulthood.

Stress reactivity moderates the association between stressful life events and depressive symptoms in adolescents: Results from a population-based study

BACKGROUND

A large body of evidence links stressful life events with depression. However, little is understood about the role of perceived impact in this association.

METHODS

We performed regression analysis to investigate whether self-reported stress reactivity (derived by regressing the impact-weighted life event score on the unweighted score) moderated the association between stressful life events and depressive symptoms in adolescents from the Avon Longitudinal Study of Parents and Children cohort (n = 4791), controlling for age at outcome, sex, ethnicity, and maternal education. Depressive symptoms were assessed using the self-report Short Mood and Feelings Questionnaire (score range 0-26) at 16 years of age. Adolescents also reported on their exposure to 23 possible stressful life events since age 12 and their impact, which were used to define stress reactivity groups using a residual regression approach.

RESULTS

We identified a moderating effect of stress reactivity. Adolescents with high stress reactivity showed a stronger association between the number of stressful life events and depressive symptoms than adolescents with low (b = 0.32, 95 % CI = 0.13, 0.50, p < 0.001) or typical (b = 0.44, 95 % CI = 0.28, 0.60, p < 0.001) stress reactivity.

LIMITATIONS

Limitations include the use of retrospective life event measures and limited generalisability of findings to other population-based, high-risk, or clinical samples.

CONCLUSIONS

When resources are limited, interventions should prioritise individuals with high stress reactivity who have experienced multiple stressful life events, as these individuals may be at greater risk for depression.

Non-Pharmacological Interventions for Managing the Symptoms of Depression in Women with Breast Cancer: A Literature Review of Clinical Trials

Symptoms of depression represent a significant burden to patients with breast cancer, not only because of the psychological stress associated with their diagnosis, but also because of the adverse effects of its treatment. We reviewed the clinical trials examining the management of the symptoms of depression in breast cancer patients through different non-pharmacological interventions in different databases (PubMed, Embase, Scopus, and the American Psychological Association). Cognitive behavioural therapy, interpersonal psychotherapy or psychodynamic psychotherapy, as well as acceptance and commitment therapy have been effective in improving symptoms of depression in cancer patients with moderate to severe symptoms. Physical exercise, yoga, mindfulness, and support groups have been shown to benefit patients with mild depressive symptoms. These interventions not only showed positive results in interventions in women with breast cancer in terms of the symptoms of depression, but also highlighted their benefits for comorbid anxiety, stress, and poor sleep quality; moreover, it is suggested that these interventions should be leveraged to manage mental health issues in breast cancer patients. The molecular effects of these interventions, such as the reduction in inflammatory cytokines and cortisol levels, have seldom been reported and need further studies.

The relationship between resilience and mental health: mobile phone dependence and its differences across levels of parent-child conflict among left-behind adolescents: a cross-sectional network analysis

BACKGROUND

Mobile phone dependence and mental health problems have become increasingly prominent among left-behind adolescents in China. In recent years, some studies have focused on the important role of parent-child relationship and psychological resilience. Therefore, this study aims to explore the multidimensional relationships among resilience, mental health, and mobile phone dependence among left-behind adolescents, and to assess the impact of parent-child conflict level on these relationships.

METHODS

The Brief Symptom Inventory (BSI-18), the Chinese version of the Mobile Phone Addiction Index (MPAI), the Resilience Scale for Children and Adolescents (RSCA), and the Parent-Child Conflict Scale were used to investigate 2,100 left-behind adolescents in Sichuan Province, and R was run to make network analysis and network comparison.

RESULTS

(1) A structurally stable network relationship exists between left-behind adolescents' resilience, mental health, and mobile phone dependence; (2) BSI3 (Anxiety) is the most important node of the network model, followed by MPAI1 (the inability to control cravings subscale); (3) MPAI1 (the inability to control cravings subscale) and RSCA4 (family support) are key to connect resilience, mental health, and smartphone addiction in the study sample; (4) There was a significant difference in the network structure between the high- and low-level groups of parent-child conflict, no significant difference in the global strength of the network, and a significant difference in the centrality of strength and the centrality of bridge strength.

CONCLUSIONS

Chinese left-behind adolescents' resilience and mental health, mobile phone dependence are both independent and interact with each other to some extent. Specifically, high centrality dimensions such as anxiety, the inability to control cravings, and family support can be prioritised for intervention in related treatments, or reducing parent-child conflict and enhancing resilience to mitigate mobile phone dependence among left-behind adolescents, thus improving their mental health.

Heterogeneities of Site-Specific N-Glycosylation in the Hippocampus of Depression-like Behavior Models in Mice Induced by Acute Stress and Chronic Stress

It is well established that acute and chronic stress contributes to the onset and progression of depression, but the underlying mechanisms have not been elucidated. Here an integrated N-glycoproteomic and proteomic analysis was performed to investigate heterogeneities of glycoprotein and site-specific glycosylation between the hippocampi of control, acute stress-affected (AS), and chronic mild stress-affected (CMS) mice. 1063 unique intact N-glycopeptides, 116 N-glycan compositions, and 512 glycosylation sites were identified. CMS and AS had significant effects on glycosylation. CMS reduced multiantenna glycosylation (N8H8 and N6H5F1S1) more strongly, while AS reduced multiantenna glycosylation (N5H3F1) more strongly. CMS inhibited high-mannose synthesis with high polymerization (N2H9 and N2H8), while AS inhibited high-mannose synthesis with low polymerization (N2H6, H2H5). Furthermore, 26 and 39 glycosylation-related genes (GRGs) were identified in the AS and CMS groups, separately. Functional enrichment analysis for GRGs in the AS and CMS groups exhibited that the up-regulated functions were leading edge membrane and cell adhesion molecule binding; meanwhile, the down-regulated functions were cAMP signaling pathways. Finally, tSNE analysis based on ScRNA-seq revealed that core GRGs were highly expressed in astrocytes. All of these findings improve our understanding of glycosylation in stress-related depression, providing valuable data resources for depression pathogenesis exploration and novel therapeutic target discovery.

Irritability and stress: Prospective, bidirectional relationships in adolescence

BACKGROUND

Irritability is a transdiagnostic risk factor for psychopathology and interpersonal problems in youth. However, there is little research on the role of life stress in irritability. The association between stress and irritability may be bidirectional, with irritability leading to stress exposure and stress aggravating irritability. Moreover, it is conceivable that there are sex differences in these relationships. Therefore, we examined the prospective, bidirectional relationships between irritability and stressful life events in a sample of adolescents while considering the role of biological sex.

METHODS

We tested multi-group path models investigating bidirectional associations of irritability with dependent and independent episodic stressors in a community sample of 520 adolescents (52.1 % male) across ages 12, 15, and 18.

RESULTS

All models had acceptable fit. For males, dependent stress at age 12 predicted irritability at age 15, which in turn predicted more stress at age 18. For females, irritability at age 12 predicted dependent stress at age 15, which in turn predicted more irritability at age 18. For independent events in males, irritability at age 15 predicted stress at age 18. For females, independent stress at age 12 predicted irritability at age 15, which in turn predicted more stress at age 18.

CONCLUSION

There are significant bidirectional relationships between irritability and episodic stressors, although the relationships varied depending on youth's age, sex, and role in contributing to stressor occurrence.

The minor allele of the serotonin transporter gene variant rs4251417 is associated with increased resilience in soldiers experiencing acute stress during survival training: preliminary findings

BACKGROUND

Variation in cognitive, emotional and physical performance in response to stress is attributable to environmental and genetic factors. Ability to adapt to stress is resilience.

OBJECTIVES

This study investigated genetic factors associated with resilience in soldiers exposed to severe stress due to intense physical and mental demands at Survive, Evade, Resist and Escape school, a unique environment to study acute stress and resiliency in real-world circumstances.

DESIGN

A preliminary correlational study was conducted to identify genetic markers for resilience to stress.

METHODS

Mood state, resiliency and dissociative state of 73 soldiers were assessed using: Connor-Davidson Resilience Scale (CD-RISC); Profile of Mood States (POMS); and Clinician-Administered Dissociative States Scale (CADSS). Change scores for resilience-related stress markers were computed; 116 single nucleotide polymorphisms (SNPs) associated with stress, depression, anxiety, sleep, or psychiatric disorders were assessed.

RESULTS

A significant association between change in CD-RISC score and SNP rs4251417, present in an intron of SLC6A4, the serotonin transporter gene, was observed.

CONCLUSIONS

Individuals with the minor allele of SNP rs4251417 had a greater positive change in CD-RISC, indicating increased self-assessed resilience. This study suggests the minor allele of SNP rs4251417 of SLC6A4 is associated with resilience when individuals are exposed to high stress.

Measuring behavioral responses to a social stressor: Does the Social Performance Rating Scale have utility beyond social anxiety disorder?

The observer-rated Social Performance Rating Scale (SPRS) indexes anxious behaviors exhibited in social contexts. Although the SPRS has been used almost exclusively to study social anxiety disorder (SAD), other emotional disorders are also characterized by heightened responses to social stressors, hinting that the SPRS could serve as a transdiagnostic state measure of behavioral anxiety. To explore this possibility, adults with generalized anxiety disorder or major depressive disorder (n = 105) and adults with no psychopathology (n = 35) delivered a speech to a committee of mock behavioral experts. Behavioral anxiety observed during the speech was rated using the SPRS, then examined in relation to clinical and state measures of anxiety and depression. Contrary to our hypotheses, behavioral anxiety was not associated with clinician- or self-rated anxiety or depression severity. Instead, behavioral anxiety was heightened among individuals who specifically fear and avoid public speaking; who perceived the speech task to be more stressful; and who reported more emotional distress, somatic hyperarousal, and anxious and pessimistic thoughts at the time of the speech. The SPRS is a valid measure of anxious behavior in the many individuals, with and without SAD, who experience acute anxiety in social-evaluative contexts. As behavioral measures are resource-intensive to collect, research is needed to establish whether the SPRS predicts anxious behavior and functional impairment in real-world settings, over and above easier-to-obtain self-report measures.

Stress sensitivity in women with a history of recurrent versus first-episode major depression

Approximately 50 % of people who recover from an initial episode of major depressive disorder (MDD) experience a recurrence, and the risk for recurrence increases with each additional episode. Consistent with the stress sensitization model, there is evidence that whereas initial MDD onsets are often preceded by major negative life events, recurrences are often triggered by more minor events. However, it is unclear whether this is due to increased frequency of minor life events, increased reactivity to these events, or both. The current study examined these questions in a community sample of 227 adult women with a history of recurrent MDD (rMDD, n = 77), first-episode MDD (fMDD, n = 38), or no history of MDD (n = 112). Women were assessed at baseline and every six months for two years (5 assessments total). Throughout the follow-up, major and minor life events were assessed using contextual threat interviews and depressive symptoms were assessed using a self-report questionnaire. Regarding event frequency, minor events were more common than major events, and the rMDD group experienced more negative events overall (both major and minor) than the never depressed group but not the fMDD group. Regarding stress reactivity, results of linear mixed modeling revealed that whereas all three groups exhibited similar increases in depressive symptoms following major events, only women in the rMDD group experienced significant increases in depressive symptoms following minor events. These findings show that not only are women with rMDD living in more stressful contexts, but they are also more reactive to minor stressors, increasing risk for future depression.

CB1 receptor signaling: Linking neuroplasticity, neuronal types, and mental health outcomes

The endocannabinoid system (ECS) is crucial in the pathophysiology of mental disorders. Historically, cannabis has been utilized for centuries to mitigate symptoms of anxiety and depression; however, the precise role of cannabinoids in these conditions has only recently garnered extensive research attention. Despite the growing body of literature on the ECS and its association with mental health, several critical questions remain unresolved. This review primarily focuses on cannabinoid CB1 receptors (CB1R), providing an examination of their regulatory roles in states related to mental disorders. Evidence suggests that CB1R distribution occurs among various neuronal types, astrocytes, and subcellular membranes across multiple brain regions, potentially exhibiting both analogous and antagonistic effects. Additionally, various forms of stress have been shown to produce divergent impacts on CB1R signaling pathways. Furthermore, numerous CB1R agonists demonstrate biphasic, dose-dependent effects on anxiety and depression; specifically, low doses may exert anxiolytic effects, while higher doses can induce anxiogenic responses, a phenomenon observed in both rodent models and human studies. We also discuss the diverse underlying mechanisms that mediate these effects. We anticipate that this review will yield valuable insights into the role of CB1R in mental disorders and provide a framework for future research endeavors on CB1R and the ECS. This knowledge may ultimately inform therapeutic strategies aimed at alleviating symptoms associated with mental health conditions.

Mathematical modeling and optimal control of depression dynamics influenced by saboteurs

Depression disorder affects millions globally, characterized by symptoms such as profound sadness, loss of interest in activities, and disruptions in eating and sleeping patterns. Understanding depression within the context of chronic pain is essential for developing effective management and intervention strategies. This study utilizes mathematical modeling to analyze depression trends using empirical data from Spain spanning from 2011 to 2022. Our depression model incorporates distinct compartments for primary and secondary depressed populations, along with a category for individuals categorized as saboteurs, who may actively influence the depression prevalence. We calculated the basic reproduction number [Formula: see text] and identified four equilibrium points and evaluated their stability. Additionally, sensitivity analysis was conducted to assess the impact of [Formula: see text] on depression prevalence. Furthermore, optimal control strategies were explored for the model. These strategies aim to improve treatment adherence, encourage doctor consultations, promote self-medication practices, and enhance recovery rates, ultimately aiming to reduce spread of depressive disorders and associated mortality. Data fitting was conducted using Python, and simulations were carried out in MATLAB to ensure rigorous validation of the model.

Resting-state fMRI reveals altered functional connectivity associated with resilience and susceptibility to chronic social defeat stress in mouse brain

Chronic stress is a causal antecedent condition for major depressive disorder and associates with altered patterns of neural connectivity. There are nevertheless important individual differences in susceptibility to chronic stress. How functional connectivity (FC) amongst interconnected, depression-related brain regions associates with resilience and susceptibility to chronic stress is largely unknown. We used resting-state functional magnetic resonance imaging (rs-fMRI) to examine FC between established depression-related regions in susceptible (SUS) and resilient (RES) adult mice following chronic social defeat stress (CSDS). Seed-seed FC analysis revealed that the ventral dentate gyrus (vDG) exhibited the greatest number of FC group differences with other stress-related limbic brain regions. SUS mice showed greater FC between the vDG and subcortical regions compared to both control (CON) or RES groups. Whole brain vDG seed-voxel analysis supported seed-seed findings in SUS mice but also indicated significantly decreased FC between the vDG and anterior cingulate area compared to CON mice. Interestingly, RES mice exhibited enhanced FC between the vDG and anterior cingulate area compared to SUS mice. Moreover, RES mice showed greater FC between the infralimbic prefrontal cortex and the nucleus accumbens shell compared to CON mice. These findings indicate unique differences in FC patterns in phenotypically distinct SUS and RES mice that could represent a neurobiological basis for depression, anxiety, and negative-coping behaviors that are associated with exposure to chronic stress.

Non-pharmacological therapeutic paradigms in stress-induced depression: from novel therapeutic perspective with focus on cell-based strategies

Major depressive disorder (MDD) is considered a psychiatric disorder and have a relationship with stressful events. Although the common therapeutic approaches against MDD are diverse, a large number of patients do not present an adequate response to antidepressant treatments. On the other hand, effective non-pharmacological treatments for MDD and their tolerability are addressed. Several affective treatments for MDD are used but non-pharmacological strategies for decreasing the common depression-related drugs side effects have been focused recently. However, the potential of extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs), microRNAs (miRNAs) as cell-based therapeutic paradigms, besides other non-pharmacological strategies including mitochondrial transfer, plasma, transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and exercise therapy needs to further study. This review explores the therapeutic potential of cell-based therapeutic non-pharmacological paradigms for MDD treatment. In addition, plasma therapy, mitotherapy, and exercise therapy in several in vitro and in vivo conditions in experimental disease models along with tDCS and TMS will be discussed as novel non-pharmacological promising therapeutic approaches.

Cumulative effects of stress-sensitivity factors on depressive symptoms and suicide risk: A prospective study

BACKGROUND

Sensitivity to stress is essential in the onset, clinical symptoms, course, and prognosis of major depressive disorder (MDD). Meanwhile, it was unclear how variously classified but connected stress-sensitivity variables affect MDD. We hypothesize that high-level trait- and state-related stress-sensitivity factors may have different cumulative effects on the clinical symptoms and follow-up outcomes of MDD.

AIM

To investigate how stress-sensitivity factors added up and affected MDD clinical symptoms and follow-up results.

METHODS

In this prospective study, 281 MDD patients were enrolled from a tertiary care setting. High-level stress-sensitivity factors were classified as trait anxiety, state anxiety, perceived stress, and neuroticism, with a total score in the top quartile of the research cohort. The cumulative effects of stress-sensitivity factors on cognitive dysfunction, disability and functional impairment, suicide risk, and depressive and anxiety symptoms were examined using an analysis of variance with linear trend analysis. Correlations were investigated further using multiple regression analysis.

RESULTS

Regarding high-level stress-sensitivity factors, 53.40% of patients had at least one at baseline, and 29.61% had two or more. Four high-level stress-sensitivity components had significant cumulative impacts on MDD symptoms at baseline (all P < 0.001). Perceived stress predicted the greatest effect sizes of state-related factors on depressive symptoms (partial η 2 = 0.153; standardized β = 0.195; P < 0.05). The follow-up outcomes were significantly impacted only by the high-level trait-related components, mainly when it came to depressive symptoms and suicide risk, which were predicted by trait anxiety and neuroticism, respectively (partial η 2 = 0.204 and 0.156; standardized β = 0.247 and 0.392; P < 0.05).

CONCLUSION

To enhance outcomes of MDD and lower the suicide risk, screening for stress-sensitivity factors and considering multifaceted measures, mainly focusing on trait-related ones, should be addressed clinically.

Neuronal stress-coping mechanisms in postpartum females

Animals exhibit a wide range of stress responses aimed at restoring homeostasis and promoting adaptation. In response to stress, they employ coping mechanisms to maintain physiological balance. Dysregulated stress-coping strategies have been associated with mental disorders, including depression, anxiety, and post-traumatic stress disorder. Understanding the neuronal mechanisms that regulate stress-coping is critical for elucidating normal physiological responses and addressing the pathological processes underlying these disorders. Stress responses are influenced by sex and life stage, with notable variability in the prevalence and severity of mental disorders based on these factors. Stress-coping mechanisms are pivotal in determining the vulnerability or resilience of an individual to stress. Thus, identifying differences in stress-coping strategies between sexes and across life stages is essential for advancing prevention and treatment strategies for stress-related mental disorders. This review explores the neuronal mechanisms underlying stress responses, emphasizing the distinct stress-coping strategies utilized by postpartum females. Highlighting these differences underscores the need for targeted prevention and treatment approaches that consider sex- and life stage-specific variations in stress-coping mechanisms.

AMPA receptor diffusional trapping machinery as an early therapeutic target in neurodegenerative and neuropsychiatric disorders

Over the past two decades, there has been a growing recognition of the physiological importance and pathological implications surrounding the surface diffusion of AMPA receptors (AMPARs) and their diffusional trapping at synapses. AMPAR surface diffusion entails the thermally powered random Brownian lateral movement of these receptors within the plasma membrane, facilitating dynamic exchanges between synaptic and extrasynaptic compartments. This process also enables the activity-dependent diffusional trapping and accumulation of AMPARs at synapses through transient binding to synaptic anchoring slots. Recent research highlights the critical role of synaptic recruitment of AMPARs via diffusional trapping in fundamental neural processes such as the development of the early phases of long-term potentiation (LTP), contextual fear memory, memory consolidation, and sensory input-induced cortical remapping. Furthermore, studies underscore that regulation of AMPAR diffusional trapping is altered across various neurological disease models, including Huntington's disease (HD), Alzheimer's disease (AD), and stress-related disorders like depression. Notably, pharmacological interventions aimed at correcting deficits in AMPAR diffusional trapping have demonstrated efficacy in restoring synapse numbers, LTP, and memory functions in these diverse disease models, despite their distinct pathogenic mechanisms. This review provides current insights into the molecular mechanisms underlying the dysregulation of AMPAR diffusional trapping, emphasizing its role as a converging point for multiple pathological signaling pathways. We propose that targeting AMPAR diffusional trapping represents a promising early therapeutic strategy to mitigate synaptic plasticity and memory deficits in a spectrum of brain disorders, encompassing but not limited to HD, AD, and stress-related conditions. This approach underscores an integrated therapeutic target amidst the complexity of these neurodegenerative and neuropsychiatric diseases.

Stress, Anxiety and Depressive Symptoms, Burnout and Insomnia Among Greek Nurses One Year After the End of the Pandemic: A Moderated Chain Mediation Model

Background/Objectives: Several studies have reported alarming rates of mental health issues and sleep problems among nurses even in the post-pandemic era. The objective was to investigate the prevalence of stress, anxiety and depressive symptoms, burnout and insomnia among nurses in Greece one year after the end of the pandemic and to construct a mediation model evaluating the impact of stress on insomnia, the chain mediating roles of depressive symptoms and burnout, as well as the moderating role of anxiety symptoms in the model. Methods: This cross-sectional study was conducted online in July 2024 and included 380 hospital nurses who completed the Depression Anxiety Stress Scale (DASS-21), the Copenhagen Burnout Inventory (CBI) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of stress, anxiety and depressive symptoms, burnout and insomnia were 33.9% with 95% confidence interval (CI): [0.292, 0.390], 33.3% (95% CI: [0.284, 0.381]), 35% (95% CI: [0.302, 0.400]), 46.8% (95% CI: [0.399, 0.502]) and 56.1% (95% CI: [0.509, 0.611]), respectively. Multiple regression analysis indicated that the Depression subscale of the DASS-21 explained 40.6% of the variance in the AIS, while an additional 7.6% was explained by the CBI and another 1.3% rate by the Stress subscale of the DASS-21. Mediation analysis revealed that stress affected insomnia both directly and indirectly through the chain mediating roles of depressive symptoms and burnout. Anxiety symptoms moderated the chain mediation path by enhancing the negative impact of stress on depressive symptoms. Conclusions: The proposed moderated chain mediation model introduces certain factors influencing insomnia and explains how changes in any one of these factors effectuate changes in the other factors, offering insights for individualized interventions.

Socioeconomic factors and sex effects of postpartum maternal depression on offspring internalizing symptoms: a systematic review and meta-analysis

BACKGROUND

Postpartum maternal depression and socioeconomic factors are established risk factors for the mental health of offspring. It has been consistently unclear as to whether female or male offspring are more vulnerable to the effects of postpartum maternal depression at different stages of the child's life course. To determine whether the characteristics of postpartum maternal depression with a history of prenatal depression influence sex differences in offspring internalizing symptoms across childhood and adolescence, socioeconomic factors should be considered.

METHODS

We systematically searched PubMed, Embase, PsycINFO, CNKI, and SinoMed databases from inception to November 28, 2023, and selected longitudinal cohort studies that quantified sex differences in internalizing symptoms of children and adolescents. Pooled standardized mean differences (SMDs) were calculated using random-effects models. ROBINS-E tool was used to rate the quality of evidence.

RESULTS

Twenty-eight studies were eligible between 1997 and 2023, including 24,022 mother-child dyads. Sex-difference trajectories of offspring internalizing symptoms were identified after exposure to postpartum maternal depression, ranging from a lack of significant sex differences in childhood to a higher prevalence observed among girls than boys in adolescence (SMD, 0.25, 95% CI, 0.13-0.38). Economic income and maternal education affected the associations between the magnitude and concurrent recurrence of postpartum depression and significant sex differences in adolescent internalizing symptoms, respectively. After adjusting for socioeconomic factors, early nonconcurrent recurrence of postpartum depression was associated with greater odds of internalizing symptoms among adolescent girls than among boys (β = 0.03, 95% CI, 0.01-0.06); however, there was no statistical significance after adjusting for prenatal depression.

CONCLUSIONS

Socioeconomic factors differentially impacted the association between postpartum maternal depression and significant sex differences in adolescent internalizing symptoms. Independent of socioeconomic factors and prenatal depression, postpartum maternal depression was not associated with significant sex differences in adolescent internalizing symptoms. Therefore, the significant sex effects of postpartum maternal depression are more likely due to complex interactions between maternal depression and the intrauterine and postpartum environments that shape offspring sex-difference trajectories, with consequences occurring for later internalizing symptoms in adolescence.

TRIAL REGISTRATION

PROSPERO, CRD42022301445.

Economic evaluation of resilience training for medical students: A cohort state-transition model

BACKGROUND

Resilience training shows moderate effect in combatting burnout, yet little is known about its cost-effectiveness. This study analyzes the cost-effectiveness of offering resilience training to medical students with elevated stress from a Dutch university medical center (payer) perspective compared to mental health support as usual.

METHODS

We constructed a state-transition cohort (Markov) model to estimate quality-adjusted lifeyears and associated costs of offering resilience training to a cohort of 410 first-year medical students over a 6-year timeframe. Utility values were obtained through baseline data from the DEcrease STress through RESilience training for Students (DESTRESS) study. Data on transition probabilities and the effect of resilience training were based on the best available literature. We resampled all data to generate 10,000 simulations of incremental costs and effects in a probabilistic analysis.

RESULTS

On average students gained 0.15 QALYs (95%CI 0.09, 0.20) at a cost-saving of €1076 (95%CI 412, 2008), making resilience training the dominant strategy. These savings resulted from an assumed reduction in study delay due to a reduction in symptoms of stress and burnout. For every euro the university invests in resilience training, we estimatea return of investment of €2.79.

CONCLUSIONS

This study provides evidence that offering resilience training to medical students is cost-effective and cost-saving.

Plasma proteomic signature of chronic psychosocial stress in mice

Chronic stress significantly impacts both physical and mental wellbeing, increasing risk of cardiovascular disease, immune dysregulation, and psychiatric conditions such as depression and anxiety disorders. The plasma proteome is a valuable source of biomarkers of health and disease, but the limited number of studies exploring the potential of the plasma proteome as a biomarker for stress-related disorders underscores the importance of further investigation of the effects of chronic stress on the plasma proteome. The aim of this study was to examine the effect of a 5-week chronic psychosocial stress paradigm on the plasma proteome in mice and to determine if any affected proteins correlated with stress-induced changes in behaviour and physiology, and thus might represent biomarkers of negative impacts of chronic stress. Using LC-MS/MS proteomic analysis, 38 proteins in the mouse plasma proteome were identified to be affected by chronic psychosocial stress. Functional analysis revealed that these proteins clustered into biological functions including inflammatory response, regulation of the immune response, complement and coagulation cascades, lipid metabolic process, and high-density lipoprotein particles. Correlation analyses of the identified proteins with stress-induced behavioral or physiological changes stress revealed significant correlations between stress-induced anxiety-like behaviour and Phosphatidylinositol-glycan-specific phospholipase D, Complement C2, Epidermal growth factor receptor, Prosaposin, Actin-related protein 2/3 complex subunit 1B, Maltase-glucoamylase, Mannosyl-oligosaccharide 1,2-alpha-mannosidase IA and Fibrinogen-like protein 1. Chronic psychosocial stress blunted acute stress-induced corticosterone release, and this correlated with abundance of Pyrethroid hydrolase Ces2a; N-fatty-acyl-amino acid synthase/hydrolase Pm20d1, Mannosyl-oligosaccharide 1,2-alpha-mannosidase IA, Alpha-2-macroglobulin-P and L-selectin. Finally, stress-induced reductions in both brown and epididymal fat correlated with Phosphatidylinositol-glycan-specific phospholipase D, Complement C2, Epidermal growth factor receptor, Kininogen-1, Apolipoprotein M, Angiopoietin-related protein 3, Proprotein convertase subtilisin/kexin type 9, and Lipopolysaccharide-binding protein. These findings demonstrate that chronic psychosocial stress induces alterations in plasma proteins implicated in key biological processes and pathways related to stress response, immune function, and lipid metabolic regulation. Further investigation into these proteins may provide new avenues for identification of biomarkers or mediators of stress-induced pathology.

State rumination links major life stressors to acute stressor cortisol response in healthy adults

Experiencing major life stressors is associated with negative health outcomes, yet the mechanisms are not fully understood. Major stressors are threatening, discrete events that can have lingering consequences on emotional and cognitive processes. This can lead to maladaptive coping strategies, such as rumination, that compromise the ability to handle subsequent stressors and disrupt the hypothalamic-pituitary-adrenal (HPA) axis response. Based on the Perseverative Cognition Hypothesis, it was hypothesized that greater exposure to major stressors would be associated with greater rumination during a laboratory stressor, which, in turn, would predict higher cortisol reactivity and peak and delayed recovery. Participants were 211 healthy adults (Mage = 30.2, SD = 10.9, range = 18 - 55) who underwent the Trier Social Stress Test and self-reported rates of major stressors in the past 12 months and stress-related state rumination. Two-piece growth curve modeling with landmark registration was used to calculate peak salivary cortisol levels along with cortisol reactivity and recovery slopes to capture individual differences in the trajectory of cortisol response. Results showed that state rumination significantly mediated the link between more major stressors and elevated peak cortisol levels as well as steeper reactivity and recovery slopes. Interpersonal stressors and non-interpersonal stressors showed similar associations to cortisol response via state rumination. This study enhances our understanding of how stress contributes to HPA axis dysregulation by connecting major stressors with acute stressors, pointing at stress-induced rumination as a plausible mechanism.

Preliminary findings on the association between maternal salivary and hair cortisol and the mother-infant-interaction during the early postpartum period

Maternal capabilities to engage in sensitive caregiving are important for infant development and mother-infant-interaction, however, can be negatively affected by cortisol due to a stress response. Previous research suggested that cortisol possibly impairs cognitive functions important for caregiving behavior, which potentially leads to less maternal sensitivity. However, studies investigating the influence of cortisol using endocrine parameters on the mother-infant-interaction during the early postpartum are lacking. In the current study, fifty-nine mother-infant-dyads participated in a laboratory face-to-face still-face (FFSF) observation when infants were 4 months of age. Maternal and infant positive, negative and matched behavior during the FFSF was microanalytically coded. Cortisol concentrations were obtained using hair and saliva samples. For salivary cortisol, the area under the curve with respect to ground (AUCG) was calculated using two saliva samples obtained after arrival and after the FFSF. Multiple block-wise hierarchical linear regression models were conducted to incorporate potential confounding factors (maternal age, parity, infant gestational age, infant sex) in a first step and, then, test for the association of hair and salivary cortisol with maternal and infant positive, negative and dyadic behavior in a second step. For both it was hypothesized that cortisol assessed in hair and saliva is negatively associated with positive and matched mother-infant-interaction, and positively associated with negative mother-infant-interaction. It could be shown that salivary but not hair cortisol as well as infant gestational age and infant sex related significantly to infant positive and negative affect as well as matched behavior during the reunion phase of the FFSF. Maternal positive affect was unrelated to any of the variables. The results are discussed in regard to the importance of maternal cortisol levels over a longer period of time and more acute situational levels for the mother-infant-interaction as well as the relevance of included confounding factors.

Relationship Between Stressful Life Events and Depression Among Adolescents: The Mediating Roles of Subcomponents of Executive Function

Stressful life events are important risk factors in the development of adolescent depression. Executive function is significant in the stress-depression link. However, it is not clear whether there is a specific effect for subcomponents of executive function (working memory, inhibition, and shifting). Therefore, the present study recruited 213 adolescents (mean age (Mage) = 15.19 years, SD = 1.27, range = 12.00-18.00 years, and 53.00% girls) and measured their perceived stress using the questionnaire of the Adolescent Self-Rating Life Events Checklist, working memory ability by two-back tasks, inhibition ability by Stroop tasks, and shifting ability by Wisconsin Card-Sorting tasks. Results showed that stressful life events positively correlated with adolescents' depression, while stressful life events negatively linked with working memory and inhibition. Depression was negatively associated with working memory and inhibition. No significant correlation was found between shifting and either stressful life events or depression. Mediation analyses revealed that working memory and inhibition mediated the link between stressful life events and adolescent depression, while shifting did not show a mediating effect. Our findings provide further evidence for the precise effect of executive function in the stress-depression link, implicating that different subcomponents should be considered to provide targeted intervention to alleviate adolescents' depressive symptoms.

The Mediating Role of Avoidant Personality Disorder Features in the Relationship Between Stressful Life Events and Depression Among First-Year University Students

Purpose

Stressful life events are risk factors of depression. To explore whether the avoidant personality disorder (AVPD) features play a mediating role between stressful life events (SLEs) and depression among Chinese first-year university students.

Methods

The cross-sectional study was conducted from April to October 2018. The participants were the freshmen selected from Jining Medical University and Weifang Medical University (n=7390) in Shandong Province in China. Depression was assessed by the Beck Depression Inventory-II, AVPD were measured by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). The data were processed and analyzed by SPSS24.0 software, Pearson correlation analysis and PROCESS3.3 program intermediary analysis. The method of Bootstrap was adopted to determine whether the AVPD features act as mediating factors in the association between the NLEs and depression.

Results

A total of 34.68% of the participants reported one to three AVPD features, and 18.15% reported four to seven AVPD features. AVPD features (r=0.384, P<0.05) and the SLEs (r=0.309, P<0.05) were positively related to the risk of depression, respectively. AVPD features play a partial mediating effect on the relationship between SLEs and depression (the effect value is 0.133, P < 0.01; 32.28% of the total effect).

Limitation

There might be recall bias in this cross-sectional study.

Conclusion

AVPD features are prevalent among Chinese university students. AVPD features displayed the mediation effect on depression related to stressful life events. Psychological interventions for depression in college students should focus not only on stress but on individual personality traits and cognitive mode. Care-givers, teachers, and health professionals should pay more attention to the early identification of the AVPD features among university students.

Subjective and objective stress during body exposure: a comparison of adolescents with anorexia nervosa versus high body dissatisfaction

Objective

Body dissatisfaction (BD) is a risk factor for the development of an eating disorder (ED) and a negative predictor for treatment outcome in adolescents with anorexia nervosa (AN). As a clinical core symptom and a relevant maintaining factor of AN, body image disturbance and BD are highly relevant target variables for therapeutic interventions. Body exposure (BE) was found as being effective for reducing BD in adolescents with EDs and high BD. However, the underlying mechanisms of BE are still not clear, with habituation processes being discussed as one possible mechanism.

Methods

Affective and neurobiological processes during a four-session computer-based BE intervention were investigated. Within a controlled design comparing adolescents with AN (n = 34) vs. adolescent patients with high BD (n = 17) but without a diagnosed ED, subjective (stress ratings; 11-point Likert scale) and objective (salivary cortisol and alpha-amylase [sAA]) stress measures were assessed at four time points at each exposure session (start, +10 min, +30 min/end, +60 min/recovery). ED and depressive psychopathology were assessed via self-rating questionnaires.

Results

A between-session habituation effect was found for subjective stress ratings and sAA levels with decreasing scores throughout the four sessions. A within-session habituation was found for cortisol levels. Higher psychopathology was associated with subjective stress ratings. There were no group differences between AN and BD regarding ED psychopathology or subjective or objective stress measures. Subjective and objective stress measures were mainly not associated with each other.

Conclusions

Habituation processes were found for subjective and objective stress, which might enhance motivation to continue BE interventions and thus increase their impact. BD seems to be a transdiagnostic phenomenon with BE as a successful intervention independent of psychiatric diagnosis. Current findings should be validated in larger samples, and the hypothesis of a transdiagnostic BD should be investigated in future research.

Exploring the correlations between social support, resilience, well-being, and mental health variables among youth in border areas of Jammu and Kashmir

BACKGROUND

The border areas of Jammu and Kashmir have long been affected by conflict, potentially impacting the mental health of youth. Understanding the relationships between social health factors and mental health outcomes in these regions is crucial for developing effective interventions.

AIM

This study aims to investigate the correlations between social health factors (social support, resilience, and well-being) and mental health outcomes (stress, anxiety, and depression) among youth living in the border areas of Jammu and Kashmir.

METHODS

A sample of 300 individuals aged 18 to 25 years was recruited, with 150 participants from the Line of Control (LoC) border in Rajouri district and 150 from the International Border (IB) in Jammu district. Participants completed six standardized measures: the Resilience Scale, the Multidimensional Scale of Perceived Social Support (MSPSS), the Patient Health Questionnaire-9 (PHQ-9), the WHO-5 Well-Being Index, the Perceived Stress Scale (PSS), and the Generalized Anxiety Disorder-7 (GAD-7). Pearson Correlation was computed with statistical significance at p < .05.

RESULTS

Significant positive correlations were found between social support, resilience, and well-being in both IB and LoC groups. Depression was positively correlated with anxiety in both groups. However, stress was positively correlated with depression and anxiety only in the LoC group.

CONCLUSION

These findings highlight the importance of social health factors in maintaining mental well-being among youth in conflict-affected regions. The study suggests that interventions targeting social support, resilience, and well-being may effectively promote mental health in these areas. Additionally, the results underscore the need for context-specific approaches in addressing mental health challenges in different conflict-affected environments.

Automated classification of stress and relaxation responses in major depressive disorder, panic disorder, and healthy participants via heart rate variability

Background

Stress is a significant risk factor for psychiatric disorders such as major depressive disorder (MDD) and panic disorder (PD). This highlights the need for advanced stress-monitoring technologies to improve treatment. Stress affects the autonomic nervous system, which can be evaluated via heart rate variability (HRV). While machine learning has enabled automated stress detection via HRV in healthy individuals, its application in psychiatric patients remains underexplored. This study evaluated the feasibility of using machine-learning algorithms to detect stress automatically in MDD and PD patients, as well as healthy controls (HCs), based on HRV features.

Methods

The study included 147 participants (MDD: 41, PD: 47, HC: 59) who visited the laboratory up to five times over 12 weeks. HRV data were collected during stress and relaxation tasks, with 20 HRV features extracted. Random forest and multilayer perceptron classifiers were applied to distinguish between the stress and relaxation tasks. Feature importance was analyzed using SHapley Additive exPlanations, and differences in HRV between the tasks (ΔHRV) were compared across groups. The impact of personalized longitudinal scaling on classification accuracy was also assessed.

Results

Random forest classification accuracies were 0.67 for MDD, 0.69 for PD, and 0.73 for HCs, indicating higher accuracy in the HC group. Longitudinal scaling improved accuracies to 0.94 for MDD, 0.90 for PD, and 0.96 for HCs, suggesting its potential in monitoring patients' conditions using HRV. The HC group demonstrated greater ΔHRV fluctuation in a larger number of and more significant features than the patient groups, potentially contributing to higher accuracy. Multilayer perceptron models provided consistent results with random forest, confirming the robustness of the findings.

Conclusion

This study demonstrated that differentiating between stress and relaxation was more challenging in the PD and MDD groups than in the HC group, underscoring the potential of HRV metrics as stress biomarkers. Psychiatric patients exhibited altered autonomic responses, which may influence their stress reactivity. This indicates the need for a tailored approach to stress monitoring in these patient groups. Additionally, we emphasized the significance of longitudinal scaling in enhancing classification accuracy, which can be utilized to develop personalized monitoring technologies for psychiatric patients.

Psychobiological Stress Response Profiles in Current and Remitted Depression: A Person-Centered, Multisystem Approach

Background

A dysregulated stress response, including exaggerated affective reactivity and abnormal hypothalamic-pituitary-adrenal axis responsivity, has been implicated in the etiology, maintenance, and relapse of major depressive disorder (MDD). Among adolescents, discordant affective and physiological stress response profiles have been linked to negative affective outcomes and increased risk for psychopathology. Whether these findings extend to adults with varying degree of MDD risk is unclear, as are possible links to various risk factors.

Methods

We used a person-centered, multisystem approach in a sample of 119 unmedicated adults with current or remitted MDD and individuals without past MDD to evaluate psychobiological stress response profiles. Multitrajectory modeling was applied to positive affect, negative affect, and salivary cortisol (CORT) levels in response to the Maastricht Acute Stress Test.

Results

Analyses identified 4 within-person profiles, 1 typical, termed normative (n = 32, 26.9%) and 3 atypical: CORT hyperreactivity affective stability (n = 17, 14.3%), CORT hyporeactivity affective reactivity 1 (n = 45, 37.8%), and CORT hyporeactivity affective reactivity 2 (n = 25, 21.0%). While validating the assumption of a normative profile and increased risk for psychopathology in non-normative stress response profiles, coherent associations emerged between stress response profiles and clinical status, depression severity, anhedonia, perceived stress, childhood adversity, and reports of well-being, suggesting increased risk for psychopathology for individuals with a hyperreactive or discordant hyporeactive stress response profile.

Conclusions

This work advances our understanding of stress response mechanisms in MDD and underscores the potential of targeted interventions to enhance resilience and reduce psychopathology based on individual stress response profiles.

Polygene by environment interactions predicting depressive outcomes

Depression is a major public health problem with a continued need to uncover its etiology. Current models of depression contend that gene-by-environment (G × E) interactions influence depression risk, and further, that depression is polygenic. Thus, recent models have emphasized two polygenic approaches: a hypothesis-driven multilocus genetic profile score (MGPS; "MGPS × E") and a polygenic risk score (PRS; "PRS × E") derived from genome-wide association studies (GWAS). This review for the first time synthesizes current knowledge on polygene by environment "P × E" interaction research predicting primarily depression-related outcomes, and in brief, neurobiological outcomes. The "environment" of focus in this project is stressful life events. It further discusses findings in the context of differential susceptibility and diathesis-stress theories-two major theories guiding G × E work. This synthesis indicates that, within the MGPS literature, polygenic scores based on the serotonin system, the HPA axis, or across multiple systems, interact with environmental stress exposure to predict outcomes at multiple levels of analyses and most consistently align with differential susceptibility theory. Depressive outcomes are the most studied, but neuroendocrine, and neuroimaging findings are observed as well. By contrast, vast methodological differences between GWAS-based PRS studies contribute to mixed findings that yield inconclusive results.

Depression, anxiety and stress in taxi drivers: a systematic review of the literature

PURPOSE

Mental health is a global public health challenge, with mental disorders being a major cause of morbidity. Particularly, taxi drivers face unique challenges related to long working hours, economic instability, and hazardous working conditions. To summarise the existing scientific literature on mental disorders in taxi drivers and identify associated variables.

METHODS

PubMed, Scopus and Web of Science databases were examined from inception to April 2024 following the PRISMA guidelines. Two authors independently selected original studies. We included observational studies published in English or Spanish or Portuguese, which assessed the mental health of taxi drivers. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute (NHBLI) was used to assess the quality of the articles.

RESULTS

From an initial pool of 618 studies, eleven met the inclusion criteria and were included in the present systematic review. The findings indicate a considerable prevalence of mental health issues among taxi drivers in comparison to the general population. The prevalence of depression ranged from 14.3 to 60.5% and were driven by a number of factors, including perceived mental strain, lack of respect from operators, a stressful personal life, insufficient sleep, poor working conditions, work-family conflict and low work engagement. Anxiety was reported by 24.1-47% of drivers, with a lack of sufficient sleep being identified as a primary contributing factor. The prevalence of stress ranged from 19 to 55%, with key contributing factors including discrimination, smoking, limited language proficiency, sleep disorders and younger age. Furthermore, 33% of drivers displayed elevated levels of psychological distress, frequently linked to traumatic experiences and occupational hazards.

CONCLUSIONS

Rates of depression, anxiety, stress and psychological distress are higher in taxi drivers than in general population, therefore prevention strategies should target this group.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023360073.

Phenomena of hypo- and hyperconnectivity in basal ganglia-thalamo-cortical circuits linked to major depression: a 7T fMRI study

Major depressive disorder (MDD) typically manifests itself in depressed affect, anhedonia, low energy, and additional symptoms. Despite its high global prevalence, its pathophysiology still gives rise to questions. Current research places alterations in functional connectivity among MDD's most promising biomarkers. However, given the heterogeneity of previous findings, the use of higher-resolution imaging techniques, like ultra-high field (UHF) fMRI (≥7 Tesla, 7T), may offer greater specificity in delineating fundamental impairments. In this study, 7T UHF fMRI scans were conducted on 31 MDD patients and 27 age-gender matched healthy controls to exploratorily contrast cerebral resting-state functional connectivity patterns between both groups. The CONN toolbox was used to generate functional network connectivity (FNC) analysis based on the region of interest (ROI)-to-ROI correlations in order to enable the identification of clusters of significantly different connections. Correction for multiple comparisons was implemented at the cluster level using a false discovery rate (FDR). The analysis revealed three significant clusters differentiating MDD patients and healthy controls. In Clusters 1 and 2, MDD patients exhibited between-network hypoconnectivity in basal ganglia-cortical pathways as well as hyperconnectivity in thalamo-cortical pathways, including several individual ROI-to-ROI connections. In Cluster 3, they showed increased occipital interhemispheric within-network connectivity. These findings suggest that alterations in basal ganglia-thalamo-cortical circuits play a substantial role in the pathophysiology of MDD. Furthermore, they indicate potential MDD-related deficits relating to a combination of perception (vision, audition, and somatosensation) as well as more complex functions, especially social-emotional processing, modulation, and regulation. It is anticipated that these findings might further inform more accurate clinical procedures for addressing MDD.

Personalized Depression Prevention Reduces Dependent Stressors Among Adolescents: Results from a Randomized Controlled Trial

OBJECTIVE

Depression and stressors both increase during adolescence. The stress generation model posits that depression symptoms and associated impairment contribute to the generation of dependent stressors. Adolescent depression prevention programs have been shown to reduce the risk of depression. Recently, risk-informed personalization approaches have been adopted to enhance the efficacy of depression prevention, and preliminary evidence supports the beneficial effects of personalized prevention on depression symptoms. Given the close association between depression and stress, we examined the hypothesis that personalized depression prevention programs would reduce adolescents' experience of dependent stressors (interpersonal and non-interpersonal) over longitudinal follow-up.

METHOD

The present study included 204 adolescents (56% girls, 29% racial minority) who were randomized to receive either a cognitive-behavioral or an interpersonal prevention program. Youth were categorized as high or low on cognitive and interpersonal risk using a previously established risk classification system. Half of the adolescents received a prevention program that matched their risk profile (e.g., high cognitive risk randomized to cognitive-behavioral prevention); half received a mismatched program (e.g., high interpersonal risk randomized to cognitive-behavioral prevention). Exposure to dependent and independent stressors was assessed repeatedly over an 18-month follow-up period.

RESULTS

Matched adolescents reported fewer dependent stressors during the post-intervention follow-up period (d = .46, p = .002) and from baseline through 18-months post-intervention (d = .35, p = .02) compared to mismatched youth. As expected, there were no differences between matched and mismatched youth on the experience of independent stressors.

CONCLUSIONS

These findings further highlight the potential of personalized approaches to depression prevention and demonstrate benefits that go beyond depression symptom reduction.

Associations Between the Neural Stress Response and Symptoms of Anxiety and Depression

Anxiety and depression disorders show high prevalence rates, and stress is a significant risk factor for both. However, studies investigating the interplay between anxiety, depression, and stress regulation in the brain are scarce. The present manuscript included 124 law students from the LawSTRESS project. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), and psychosocial stress was induced with the imaging stress paradigm ScanSTRESS. Anxiety, but not depression scores, were significantly related to neural stress responses in a striato-limbic cluster. Moreover, relative to women, men showed stronger associations between anxiety scores and activation in striatal and temporal clusters. A bifactor model of the HADS suggested a general factor characterized by tension, nervousness, and cheerlessness, which was associated with activation changes in a similar but more circumscribed cluster than anxiety. In the LawSTRESS project, the HADS was assessed at five sampling points (1 year, 3 months, 1 week prior exam, 1 week, and 1 month thereafter), and thus an exploratory trajectory analysis could be performed. It confirmed the relationship between anxiety scores and striatal stress responses at baseline but revealed no predictive value of the neural measure across the sampling points. Our results suggest that-in healthy young participants-neural acute psychosocial stress responses in striato-limbic structures are associated with anxiety, supporting the assumption that these regions are related to individual differences in vulnerability to stress-related disorders. A correlation with depression scores could not be found, and possible explanations are discussed.