Suicidal risk and executive functions in major depressive disorder: a study protocol

Global, regional, and national temporal trends in prevalence for depressive disorders in older adults, 1990-2019: An age-period-cohort analysis based on the global burden of disease study 2019

As a severe public health issue, depressive disorders (DD) has caused an increasingly burden of disease, especially in the older adults. To provide an overview and in-depth analysis of temporal trends in prevalence of DD in older adults at global, regional, and national levels over the last 30 years. Here, an age-period-cohort model was adopted to analyze age, period, and cohort effects. We showed that the global prevalence of DD in older adults was increasing. The net drift of the global prevalence of DD was showing an increasing trend in 78 countries, while local drift showing a declining trend in all age groups in high sociodemographic index (SDI) region. Additionally, period and cohort effects exhibited different patterns across regions. Over time, the declining trend was most significant in high SDI regions, while this trend was most significant in middle SDI region. Interestingly, those aged 60-64 years to 70-74 years was increasing globally, while age group aged 75-79 years to 95-99 years was on declining. In high, high-middle, and low SDI regions, individuals born early face higher risks than those born late, while the opposite results were observed in low-middle SDI region. Overall, our findings offer a insight global perspective for studying the temporal trends of DD prevalence, supplementing our evidence and understanding of DD epidemiology, and identifying gaps in DD prevention, management, and intervention plans in different aspects.

CB1 receptor mediates anesthetic drug ketamine‑induced neuroprotection against glutamate in HT22 cells

The anesthetic drug, ketamine (KTM) has been shown to induce therapeutic effects against major depressive disorder (MDD), however the related underlying mechanisms remain unclear. In the present study, HT22 neuronal cells were treated with glutamate to imitate oxidative stress injury in MDD, and it was hypothesized that the cannabinoid type 1 (CB1) receptor mediates KTM-induced neuroprotection via ameliorating mitochondrial function in glutamate-treated neuronal cells. Compared with the control, glutamate decreased cell viability and intracellular antioxidants, including glutathione (GSH), catalase and superoxide dismutase 2 levels, and inhibited mitochondrial function simultaneously. Moreover, glutamate increased lactate dehydrogenase release, cellular apoptosis level, cleaved caspase-3 expression and intracellular oxidants, such as reactive oxygen species, oxidized GSH and mitochondrial superoxide in the cells. The presence of KTM, however, significantly decreased the glutamate-induced oxidative stress injury, ameliorated the antioxidant/oxidant levels in the cells, enhanced mitochondrial function and upregulated CB1 receptor expression (P<0.05). Co-administration of the CB1 receptor antagonist AM251 markedly abolished the KTM-induced cytoprotective effects and ameliorations of antioxidant/oxidant levels and mitochondrial function, and also reversed CB1 upregulation (P<0.05). These observations indicated that KTM decreases the oxidative stress injury caused by glutamate in HT22 neuronal cells, and the neuroprotective effects may be mediated by the CB1 receptor.

Association between cognitive functioning and lifetime suicidal ideation among Chinese older adults: the mediating effect of depression

PURPOSE

Existing evidence indicates an association between cognitive functioning and both geriatric depression and suicidality, with mixed evidence regarding the direction of the relationship between cognitive functioning and aspects of geriatric lifetime suicidal ideation. This study aims to examine the relationship between cognitive functioning, depression, and suicide ideation and to explore the intermediary role of depression between cognitive functioning and suicidal ideation in the older adults.

METHODS

A multi-stage random cluster sampling method was used to collect a sample of 3896 individuals aged 60 and above. Descriptive statistics of the sample data were analyzed using one-way ANOVA, and then the correlation between variables was obtained by binary logistic regression analysis. SPSS macro program PROCESS V3.5 was used to test the mediating role of depression in the relationship between cognitive function and lifetime suicidal ideation.

RESULTS

The prevalence of lifetime suicidal ideation among older adults was 3.9%. Lifetime suicidal ideation was associated with depression (OR = 1.308, P < 0.001) but was not significantly correlated with cognitive function (OR = 0.972, P > 0.05). The relationship between cognitive function and depression was also supported in this study (β = - 0.0841, P < 0.001). Depression completely mediated the relationship between cognitive function and lifetime suicidal ideation.

CONCLUSION

There was no significant correlation between cognitive impairment in older adults and a heightened risk of lifetime suicidal ideation. However, this relationship was completely mediated by depression. It is crucial to prevent the onset of depression among older adults with cognitive impairment, as depression is strongly linked to lifetime suicidal ideation.

Global, regional, and national trends in incidence of depression among women, 1990-2019: An analysis of the global burden of disease study

Depression is a common mental disorder and more women are affected by depression than men. In this study, we aimed to analyze the trends in the incidence of depression among women from 1990 to 2019 and their associations with sociodemographic and universal health coverage indices based on data from the Global Burden of Disease study 2019. It was observed that while the incidence rate of depression among women decreased by an average of 0.35% per year at the global level, the incidence rate increased at the regional level for the high sociodemographic index region by an average of 0.39% per year from 1990 to 2019. And the global downward trend in incidence rate from 1990 to 2019 was contributed by the downward trend from 2000 to 2009. In Spearman correlation analyzes at the level of country/territory, a negative correlation between the estimated annual percentage change in the incidence rate and the universal health coverage index was found (ρ=-0.15).

Validation and application of the Chinese version of the Columbia-Suicide Severity Rating Scale: Suicidality and cognitive deficits in patients with major depressive disorder

BACKGROUND

Depression is a significant risk factor for death by suicide. Additionally, patients with depression who have neurocognitive dysfunction are at a higher risk of exhibiting suicidal behaviors. We aimed to validate the Chinese version of the Columbia Suicide Severity Rating Scale (C-SSRS) and then employ it to examine the association between suicidality and cognitive deficits in patients with Major Depressive Disorder (MDD).

METHODS

Data from 456 patients with MDD who underwent baseline assessment and 3-month follow-up were used for psychometric validation of the C-SSRS. 430 patients were divided into a mild cognitive impairment group (N = 390) and a severe cognitive impairment group (N = 40) using cluster analysis and compared with healthy controls. The relationship between C-SSRS scores and the degree of cognitive impairment was analyzed.

RESULTS

1) The Chinese version of C-SSRS demonstrated good internal consistency (Cronbach's alpha = 0.884/0.842), convergent and divergent validity. 2) The severity of suicidal ideation (SI), the intensity of SI, and the lifetime history of suicide attempts were significant independent predictors of short-term suicide attempts. 3) Higher worst-point lifetime SI severity and intensity scores in patients with MDD were significantly associated with severe cognitive impairment.

LIMITATIONS

The analysis of cognition and suicide was based on cross-sectional studies. Hence, changes in SI and cognitive function over time could not be analyzed.

CONCLUSIONS

The Chinese C-SSRS is a reliable and valid assessment tool for suicidal ideation and behavior in patients with depression. Suicidal ideation in patients with MDD is associated with cognitive dysfunction. These findings provide a reference for suicide prevention in patients with depression.

Potential mechanisms of action of resveratrol in prevention and therapy for mental disorders

There is a growing body of evidence about the potential of diet and nutrients to improve the population's mental health and the treatment of psychiatric disorders. Some studies have suggested that resveratrol has therapeutic properties in mental disorders, such as major depressive disorder, bipolar disorder, Alzheimer's disease, and autism. In addition, resveratrol is known to induce several benefits modulated by multiple synergistic pathways, which control oxidative stress, inflammation, and cell death. This review collects the currently available data from animal and human studies and discusses the potential mechanisms of action of resveratrol in prevention and therapy for psychiatric disorders.

Executive functions in non-suicidal self-injury comorbid first-episode and drug-naïve depression among adolescents

Executive functions(EFs) may be associated with the emergence of non-suicidal self-injury(NSSI) due to their role as behavior controllers. EFs includes three core cognitive processes: inhibitory control, working memory, and cognitive flexibility(i.e. the ability to selectively alter cognitive strategies to generate appropriate behavior in the changing environment). This study aimed to systematically explore the three core EFs in depressed adolescents with NSSI. The data was obtained from the baseline data of the Chinese adolescent depression Cohort. The adolescents underwent cognitive assessments to yield domain-specific scores in EFs using the Digit Span Backward test(DSB), the Stroop Color-word interference test- color-word condition(Stroop-CW), and the Wisconsin Card Sorting tests(WCST). The significant differences in WCST scores were found between the NSSI group and the non-NSSI group. NSSI frequency was moderately positively correlated with total errors and negatively correlated with the number of categories completed. The number of categories completed in the "≥200″ NSSI frequency group was significantly lower than that in the "≤10″ NSSI group. The current findings suggested that depressed adolescents who had engaged in NSSI have poorer cognitive flexibility performance compared to adolescents without NSSI. As the frequency of NSSI increased, cognitive flexibility might become worse. These results provide evidence of a connection between executive dysfunctions and NSSI in depressed adolescents.

The 3'UTR VNTR SLC6A3 Genetic Variant and Major Depressive Disorder: A Systematic Review

Major Depressive Disorder (MDD) is a disabling and particularly persistent mental disorder that is considered to be a priority public health problem. The active human dopamine transporter (DAT), which is encoded by the SLC6A3 gene, regulates the dopamine concentration in the synaptic cleft. In this sense, this neurotransmitter is primordial in modulating human emotions. This systematic review aims to verify the SLC6A3 (DAT1) 3'UTR VNTR (rs28363170) gene variant's SS (9R/9R) genotype and S (9R) allele frequency fluctuation and its influence on the modulation of pharmacotherapy in MDD. For this purpose, we searched different databases, and after applying the eligibility criteria, six articles were selected. Studies have shown an association between the SS (9R/9R) genotypic and S (9R) allelic presence with the risk of developing MDD, in addition to influencing the decrease in response to antidepressant therapy. However, despite the findings, disagreements were observed between other studies. For this reason, further studies with the SLC6A3 3'UTR VNTR (rs28363170) variant in different populations are necessary to understand this polymorphism's role in the onset of this disease.

Executive Functions and Public Health: A Narrative Review

Executive functions (EFs) skills are necessary for regulating the thoughts, emotions, and actions which are associated with many aspects of daily functioning. Executive dysfunction (EDFs) is present in a wide range of mental disorders. New study indicates that EFs may predict health behavior and make it easier to engage in a variety of healthy activities. In this narrative review, EFs and public health are briefly discussed. In general, 133 articles met the inclusion criteria (published 2018-2023) which were reviewed. EFs affect the mental and physical health. Besides individual problems, people with mental problems have heavy costs to society. Mental health cannot be considered separately from general health. Consequently, preventive and therapeutic approaches to mental health should be considered not only at the level of the whole society, but also at the global level.

Factors associated with objective and subjective cognitive impairment in Chinese patients with acute major depressive disorder

BACKGROUND

Patients diagnosed withmajor depressive disorder (MDD) usually experience impaired cognitive functioning, which might negatively impact their clinical and functional outcomes. This study aimed to investigate the association of specific clinical factors with cognitive dysfunction in a group of MDD patients.

METHODS

A total of 75 subjects diagnosed with recurrent MDD were evaluated during the acute stage. Their cognitive functions were assessed using the THINC-integrated tool (THINC-it) for attention/alertness, processing speed, executive function, and working memory. Clinical psychiatric evaluations, such as the Hamilton Anxiety Scale (HAM-A), the Young Mania Rating Scale (YMRS), the Hamilton Depression Scale (HAM-D), and the Pittsburgh Sleep Quality Index(PSQI), were used to assess patients' levels of anxiety, depression and sleeping problems. The investigated clinical variables were age, years of education, age at onset, number of depressive episodes, disease duration, presence of depressive and anxiety symptoms, sleep problems, and number of hospitalizations.

RESULTS

The results revealed that significant differences were observed between the two groups in the THINC-it total scores, Spotter, Codebreaker, Trails, and PDQ-5-D scores (P < 0.001). The THINC-it total scores, Spotter, Codebreaker, Trails, and Symbol Check were significantly associated with age and age at onset(P < 0.01). In addition, regression analysis found that years of education was positively associated with the Codebreaker total scores (P < 0.05). the THINC-it total scores, Symbol Check, Trails, and Codebreaker were correlated with the HAM-D total scores(P < 0.05). Additionally, the THINC-it total scores, Symbol Check, PDQ-5-D and Codebreaker significantly correlated with the PSQI total scores (P < 0.05).

CONCLUSION

We found a significant statistical association between almost all cognitive domains and different clinical aspects in depressive disorder, such asage, age at onset, severity of depression, years of education, and sleep problems. Additionally, education was shown to be a protective factor against processing speed impairments. Special considerations of these factors might help outline better management strategies to improve cognitive functions in MDD patients.

Longitudinal associations between executive function impairments and suicide risk in patients with major depressive disorder: A 1-year follow-up study

Impaired executive function (EF) is a key feature of patients with major depressive disorder (MDD) that several studies have linked to suicidal ideation and suicide attempts. This is the first longitudinal study to examine the association between impaired EF and suicide risk in adult patients with MDD. Longitudinal prospective study with 3 assessment points: baseline, 6 and 12 months. The Columbia-Suicide Severity Rating Scale (C-SSRS) was used to assess suicidality. The Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to assess EF. The association between EF impairments and suicidality was analyzed using mixed-effects models. Out of 167 eligible outpatients, 104 were included in the study. Of these, 72 were re-evaluated at 6 months and 60 at 12 months, obtaining 225 complete observations of the EF. Impaired decision-making and risk-taking behavior were associated with suicidal ideation. Difficulty in impulse control was related to suicidal ideation and to greater severity of suicidal ideation. Impaired spatial planning and working memory was linked to suicide attempts. Our results add to previous literature that the association between EF impairments and suicidality is maintained over the long term, supporting it as a longitudinal risk factor and a possible neurocognitive marker of suicide in patients with MDD.

Association of adenosine triphosphate-related genes to major depression and suicidal behavior: Cognition as a potential mediator

BACKGROUND

Soluble epoxide hydrolase (sEH, encoded by EPHX2) and P2X2 (a subtype of ATP receptors) may mediate the antidepressant-like effects of ATP. We sought to determine whether polymorphisms and mRNA expression of EPHX2 and P2X2 are associated with depression and suicidal behavior and how cognition may mediate such associations.

METHOD

We examined 83 single nucleotide polymorphisms (SNPs) of EPHX2 and P2X2. Subjects were MDD suicide attempters (N = 143), MDD non-suicide attempters (N = 248), and healthy volunteers (HV, N = 110). Data on demographics, depression severity, and suicide attempts were collected. Participants completed a set of cognitive tasks. Polymorphisms were genotyped using MALDI-TOF MS within the MassARRAY system. The expression of mRNA was measured using real-time polymerase chain reaction (RT-PCR).

RESULTS

Cognitive function was a significant mediator (p = 0.006) of the genetic effect on depression. Allele C of rs202059124 was associated with depression risk (OR = 11.57, 95%CI: 2.33-209.87, p = 0.0181). A significant relationship was found between P2X2 mRNA expression and depression (OR = 0.68, 95%CI: 0.49-0.94, p = 0.0199). One haploblock (rs9331942 and rs2279590) was associated with suicide attempts: subjects with haplotype GC (frequency = 19.8 %, p = 0.017) and AT (frequency = 35.2 %, p < 0.001) had a lower rate of suicide attempts.

CONCLUSIONS

Our results confirmed that cognitive impairment plays a role in the effect of rs9331949 on depression. Moreover, we confirmed a relationship between P2X2, EPHX2, and MDD in humans and presented preliminary haplotype-based evidence that implicates EPHX2 in suicide.

LIMITATIONS

The main limitation of this study is the limited sample size. More comprehensive and multi-domain cognition tasks and different assessment measures are required in further study.

Fusion of pain avoidance and the contingent negative variation induced by punitive condition predict suicide ideation in a college population

This study examined behavioral and ERP features involved in pain processing as predictors of suicide ideation. Twenty-seven depressed undergraduates with high suicide ideation (HSI), 23 depressed undergraduates with low suicide ideation (LSI), and 32 healthy controls (HCs) completed the clinical Scales. The amplitudes of LPP, P2, P3, CNV, FRN, power in the beta, theta, and delta bands in the SAID task were multimodal EEG features. A machine learning algorithm known as support vector machine was used to select optimal feature sets for predicting pain avoidance, depression, and suicide ideation. The accuracy of suicide ideation classification was significantly higher for multimodal features (78.16%) which pain avoidance ranked the first and the CNV ranked the fifth than a single ERP feature model (66.62%). Pain avoidance emerged as the most optimal feature of suicide ideation classification than depression. And the CNV elicited by punitive cues may be a biomarker in suicide ideation. Pain avoidance and its related EEG components may improve the efficacy of suicide ideation classification as compared to depression.

Dementia knowledge among physiotherapists in Nigeria

BACKGROUND

With the growing population of older adults in Nigeria comes a simultaneous rise in the incidence of dementia in the country. Adequate knowledge of dementia is needed to effectively administer interventions for persons living with dementia. Physiotherapy is one of the professions providing care for people with dementia. The aim of this study was to evaluate the knowledge of dementia among physiotherapists in Nigeria.

METHODS

An online survey method was used to collect data from the sample population of practicing physiotherapists in Nigeria. Data was collected using the 21-item Dementia Knowledge Assessment Tool Version Two (DKAT2) and the respondents also provided some demographic information. Mann Whitney test, Kruskal Wallis test and Spearman's rho correlation were used to test for association between the DKAT2 scores and the demographic variables and this association was further explored with multiple linear regression analysis.

RESULTS

A total number of 223 physiotherapists participated in this study. The findings of the study show that there is limited knowledge of dementia among the physiotherapists. Number of years of professional experience and specialty groups predicted significantly higher knowledge scores.

CONCLUSION

The knowledge deficits found among physiotherapists in Nigeria indicate that older adults living with dementia might not be receiving the best evidence-based physiotherapy treatments for their condition. This research therefore advocates for an educational intervention to be carried out within the physiotherapy profession in order to improve the quality of services rendered to their patients.

Persistent Ventral Anterior Cingulate Cortex and Resolved Amygdala Hyper-responses to Negative Outcomes After Depression Remission: A Combined Cross-sectional and Longitudinal Study

BACKGROUND

Major depressive disorder (MDD) is a highly prevalent mood disorder affecting more than 300 million people worldwide. Biased processing of negative information and neural hyper-responses to negative events are hallmarks of depression. This study combined cross-sectional and longitudinal experiments to explore both persistent and resolved neural hyper-responses to negative outcomes from risky decision making in patients with current MDD (cMDD) and remitted MDD (rMDD).

METHODS

A total of 264 subjects participated in the cross-sectional study, including 117 patients with medication-naïve, first-episode current depression; 45 patients with rMDD with only 1 episode of depression; and 102 healthy control subjects. Participants completed a modified balloon analog risk task during functional magnetic resonance imaging. In the longitudinal arm of the study, 42 patients with cMDD were followed and 26 patients with rMDD were studied again after 8 weeks of antidepressant treatment.

RESULTS

Patients with cMDD showed hyper-responses to loss outcomes in multiple limbic regions including the amygdala and ventral anterior cingulate cortex (vACC). Amygdala but not vACC hyperactivity correlated with depression scores in patients with cMDD. Furthermore, amygdala hyperactivity resolved while vACC hyperactivity persisted in patients with rMDD in both cross-sectional and longitudinal studies.

CONCLUSIONS

These findings provide consistent evidence supporting differential patterns of amygdala and vACC hyper-responses to negative outcomes during depression remission. Amygdala hyperactivity may be a symptomatic and state-dependent marker of depressive neural responses, while vACC hyperactivity may reflect a persistent and state-independent effect of depression on brain function. These findings offer new insights into the neural underpinnings of depression remission and prevention of depression recurrence.

Associations between abnormal spontaneous neural activity and clinical variables, eye movements, and event-related potential indicators in major depressive disorder

Background

This study aimed to investigate the correlations between abnormal spontaneous neural activity measured with fractional amplitude of low-frequency fluctuations (fALFF) and clinical variables, eye movements, and event-related potential indicators in patients with major depressive disorder (MDD).

Methods

We recruited 42 patients with MDD and 42 healthy controls (HCs) and collected their clinical variables, eye movement, event-related potential, and resting-state functional magnetic resonance imaging (rs-fMRI) data. The fALFF, support vector machine (SVM), and correlation analysis were used to analyze the data.

Results

The results of the study showed that the fALFF values of the sensorimotor network, including the right middle temporal gyrus, right cerebellar Crus2, left occipital gyrus, and left middle temporal gyrus, were significantly higher compared to HCs. Correlation analysis showed that the abnormal fALFF value of the right cerebellar Crus2 was inversely correlated with the active coping scores of the Simplified Coping Style Questionnaire in the patients (r = -0.307, p = 0.048). No correlation was observed between abnormal fALFF values and other clinical symptoms, neuropsychological tests, eye movements, and event-related potential-related indicators in patients with MDD. fALFF values in the left middle temporal gyrus could be used to distinguish patients with MDD from HCs with an accuracy of 78.57%.

Conclusions

Patients with MDD exhibited enhanced spontaneous neural activity in the sensorimotor network. No associations were found between abnormal spontaneous neural activity and clinical variables, eye movements, and event-related potential related indicators in MDD.

Can circadian rhythm predict changes in neurocognitive functioning in bipolar disorder: protocol of a 12-month longitudinal cohort study based on research domain criteria

Introduction: Bipolar disorder (BD) is a prevalent and disabling mental disorder characterized by disrupted circadian rhythms and impaired neurocognitive features, both of which fall under the major domains of Research Domain Criteria (RDoC). However, there is limited evidence regarding the interaction between circadian rhythms and long-term neurocognitive functioning. Therefore, this longitudinal cohort study protocol aims to explore whether circadian rhythm can predict changes in neurocognitive functioning over time in patients with BD.Methods: This study adopts a longitudinal cohort design, aiming to recruit 100 BD patients in either depressive or remitted states. Participants will undergo evaluations from clinical, circadian rhythm, and neurocognitive perspectives at baseline, 6-month, and 12-month follow-ups, involving questionnaires, actigraphy, and computed neurocognitive tests. We will examine both cross-sectional and longitudinal associations between participants' circadian rhythm patterns and neurocognitive functioning. Statistical analyses will employ Spearman correlation and mixed regression models.Discussion: We anticipate that circadian rhythms may serve as predictors of neurocognitive functioning changes. The findings of this study could offer supplementary insights into BD pathophysiology, potential treatment targets, and prediction.Trial Registration: This study has been registered with the Chinese Clinical Trial Registry under the registration code ChiCTR2200064922 on 21st October 2022.

A graph theory neuroimaging approach to distinguish the depression of bipolar disorder from major depressive disorder in adolescents and young adults

BACKGROUND

Markers to differentiate depressions of bipolar disorder (BD-Dep) from depressions of major depressive disorder (MDD-Dep), and for more targeted treatments, are critically needed to decrease current high rates of misdiagnosis that can lead to ineffective or potentially deleterious treatments. Distinguishing, and specifically treating the depressions, during the adolescent/young adult epoch is especially important to decrease illness progression and improve prognosis, and suicide, as it is the epoch when suicide thoughts and behaviors often emerge. With differences in functional connectivity patterns reported when BD-Dep and MDD-Dep have been studied separately, this study used a graph theory approach aimed to identify functional connectivity differences in their direct comparison.

METHODS

Functional magnetic resonance imaging whole-brain functional connectivity (Intrinsic Connectivity Distribution, ICD) measures were compared across adolescents/young adults with BD-Dep (n = 28), MDD-Dep (n = 20) and HC (n = 111). Follow-up seed-based connectivity was conducted on regions of significant ICD differences. Relationships with demographic and clinical measures were assessed.

RESULTS

Compared to the HC group, both the BD-Dep and MDD-Dep groups exhibited left-sided frontal, insular, and medial temporal ICD increases. The BD-Dep group had additional right-sided ICD increases in frontal, basal ganglia, and fusiform areas. In seed-based analyses, the BD-Dep group exhibited increased interhemispheric functional connectivity between frontal areas not seen in the MDD-Dep group.

LIMITATIONS

Modest sample size; medications not studied systematically.

CONCLUSIONS

This study supports bilateral and interhemispheric functional dysconnectivity as features of BD-Dep that may differentiate it from MDD-Dep in adolescents/young adults and serve as a target for early diagnosis and treatment strategies.

Alpha-beta decoupling relevant to inhibition deficits leads to suicide attempt in major depressive disorder

BACKGROUND

One devastating outcome of major depressive disorder (MDD) is high suicidality, especially for patients with suicide attempt (SA). Evidence indicated that SA may be strongly associated with inhibitory control deficits. We hypothesized that the inhibition function deficits of patient with SA might be underpinned by abnormal neuronal oscillations.

METHODS

Our study recruited 111 subjects including 74 patients and 37 controls, who performed a GO/NOGO task during magnetoencephalography recording. Time-frequency-representations and phase-amplitude-coupling were measured for the brain circuits involved in the inhibitory function. Phase-slope-indexes were calculated between regions to determine the direction of power flow.

RESULTS

Significant increased reaction time and decreased judgment accuracy were observed in SA group. During the perception stage of GO task (approximately 125 ms), SA group manifested elevated alpha power in ventral prefrontal cortex (VPFC) and attenuated beta power in dorsal anterior cingulate (dACC) compared with other groups (p < 0.01). In the processing stage of NOGO task (approximately 300 ms), they showed decreased beta power in VPFC and increased alpha power in dACC (p < 0.01). Alpha-beta decoupling during both tasks was observed in SA group. Furthermore, the decoupling from VPFC to dACC under NOGO tasks was significantly correlated with suicide risk level.

LIMITATIONS

The number of participants was relatively small, and psychological elements were not involved in current study.

CONCLUSION

Dysregulated oscillatory activities of dACC and VPFC suggested deficits in execution and inhibition functions triggering high suicide risks. The alpha-beta decoupling from VPFC to dACC could be served as a neuro-electrophysiological biomarker for identifying potential suicide risk.

Spatial analysis and modelling of depression relative to social vulnerability index across the United States

According to the Substance Abuse and Mental Health Services Administration, about 21 million adults in the US experience a major depressive episode. Depression is considered a primary risk factor for suicide. In the US, about 19.5% of adults are reported to be experiencing a depressive disorder, leading to over 45,000 deaths (14.0 deaths per 100,000) due to suicides. To our knowledge, no previous spatial analysis study of depression relative to the social vulnerability index has been performed across the nation. In this study, county-level depression prevalence and indicators were compiled. We analysed the geospatial distribution of depression prevalence based on ordinary least squares, geographically weighted regression, and multiscale geographically weighted regression models. Our findings indicated that the multiscale model could explain over 86% of the local variance of depression prevalence across the US based on per capita income, age 65 and older, belonging to a minority group (predominantly negative impacts), and disability (mainly positive effect). This study can provide valuable insights for public health professionals and policymakers to address depression disparities.

Risk factors for suicidal attempt in patients with the melancholic subtype of depressive disorder: Implication for nursing care

The incidence of suicide in patients with depressive order is much higher than other population. We aimed to evaluate the current status and risk of suicidal attempt in patients with the melancholic subtype of depressive disorder, to provide evidence for the clinical management and nursing care of depressive disorder. Patients diagnosed as the melancholic subtype of depressive disorder and treated in our hospital from June 1, 2018 to August 31, 2021 were included. The characteristics of included patients were collected and analyzed. Pearson correlation analysis and logistic regression analysis with odd ratio and 95% confidence interval were conducted to analyze the influencing factors of suicidal attempt in patients with the melancholic subtype of depressive disorder. A total of 446 patients with melancholic subtype of depressive disorder were included, the incidence of suicidal attempt was 18.83%. Pearson correlation analysis indicated that gender (R = 0.611), alcohol drinking (R = 0.719), living situation (R = 0.812), number of previous admission to hospital (R = 0.547), sleep disorder (R = 0.612) and frequent depressive episodes (R = 0.559) were all correlated with the suicidal attempt in patients with melancholic subtype of depressive disorder (all P < 0.05). Logistic regression analysis showed that female (OR 3.115, 95%CI 2.493-3.906), alcohol drinking(OR 1.946, 95%CI 1.684-2.763), living alone (OR 2.401, 95%CI 1.915-3.008), number of previous admission to hospital ≥ 3 (OR 2.342, 95%CI 1.601-2.742), sleep disorder (OR 1.821, 95%CI 1.328-2.215) and frequent depressive episodes (OR 3.128, 95%CI 2.421-3.779) were the independent risk factors of suicidal attempt (all P < 0.05). Suicidal attempt is common in the patients with melancholic subtype of depressive disorder, and there are many related risk factors for suicidal attempt in patients with the melancholic subtype of depressive disorder.

Treatment-resistant depression and major depression with suicide risk-The cost of illness and burden of disease

Introduction

Treatment-Resistant Depression (TRD) and Major Depression with Suicide Risk (MDSR) are types of depression with relevant effects on the health of the population and a potentially significant economic impact. This study estimates the burden of disease and the costs of illness attributed to Treatment-Resistant Depression and Major Depression with Suicide Risk in Portugal.

Methods

The disease burden for adults was quantified in 2017 using the Disability-Adjusted Life Years (DALYs) lost. Direct costs related to the health care system and indirect costs were estimated for 2017, with indirect costs resulting from the reduction in productivity. Estimates were based on multiple sources of information, including the National Epidemiological Study on Mental Health, the Hospital Morbidity Database, data from the Portuguese National Statistics Institute on population and causes of death, official data on wages, statistics on the pharmaceutical market, and qualified opinions of experts.

Results

The estimated prevalence of TRD, MDSR, and both types of depression combined was 79.4 thousand, 52.5 thousand, and 11.3 thousand patients, respectively. The disease burden (DALY) due to the disability generated by TRD alone, MDSR alone, and the joint prevalence was 25.2 thousand, 21 thousand, and 4.5 thousand, respectively, totaling 50.7 thousand DALYs. The disease burden due to premature death by suicide was 15.6 thousand DALYs. The estimated total disease burden was 66.3 thousand DALYs. In 2017, the annual direct costs with TRD and MDSR were estimated at € 30.8 million, with the most important components being medical appointments and medication. The estimated indirect costs were much higher than the direct costs. Adding work productivity losses due to reduced employment, absenteeism, presenteeism, and premature death, a total cost of € 1.1 billion was obtained.

Conclusions

Although TRD and MDSR represent relatively small direct costs for the health system, they have a relevant disease burden and extremely substantial productivity costs for the Portuguese economy and society, making TRD and MDSR priority areas for achieving health gains.

Self-reported depression and anxiety among COPD patients. A case-control study

BACKGROUND

Anxiety and depression are the most prevalent mental disorders worldwide. However, the exact mechanisms linking chronic obstructive pulmonary disease (COPD) with depression and anxiety have not been identified.

OBJECTIVES

To compare self-reported depression and anxiety among patients diagnosed with COPD in relation to healthy controls.

DESIGN AND SETTING

Case control study at a public hospital institution in Spain.

METHODS

We designed a case-control study. Patients were recruited using a consecutive sampling method from a single institution. Two groups were created: COPD and healthy controls. Data on medical history and demographic background were collected from the medical records. Self-reported depression levels were assessed using Beck's depression inventory (BDI). Self-reported anxiety was measured using the State-trait anxiety inventory (STAI).

RESULTS

Fifty-two patients with COPD and fifty healthy patients were included in this study. BDI scores were higher for COPD patients (10.23 ± 6.26) than in the control group (5.2 ± 6.56). STAI-state scores were higher for COPD patients (41.85 ± 12.55) than for controls (34.88 ± 9.25). STAI-trait scores were higher for COPD patients (41.42 ± 10.01) than for controls (34.62 ± 9.19).

CONCLUSIONS

This study showed that there were higher levels of depression and anxiety among COPD patients than among healthy controls.

Factors of suicidal behavior among inpatients with major depressive disorder: A retrospective case series

OBJECTIVE

Previous studies indicate that more than half of those who died by suicide had a depressive disorder. When discussing the factors associated to suicidal behavior (SB) among patients with major depressive disorder (MDD), sociocultural contexts should also be carefully considered. This case series study explored the factors correlated to SB among MDD patients in Beijing, China.

METHODS

The patient information sheets were retrieved from an electronic database that comprised patient medical information. Three forms of binary logistic regression equations were conducted to explore the factors associated to SB among patients with MDD. For the inconsistent variables produced by the three regression models, the propensity score matching (PSM) analysis was done for further verification.

RESULTS

In this retrospective study, 1,091 depressed cases were enrolled. The difference between the SB group and non-SB group in gender, impulsivity, the severity of depression, history of major mental trauma, and family history of suicide were statistically significant in univariate comparisons (P < 0.05); the binary logistic regression analysis and the PSM analysis showed that female gender, history of major mental trauma, impulsivity, family history of suicide and severity of depression were factors correlated to SB among patients with MDD (odds ratios >1).

CONCLUSIONS

Female gender, the history of major mental trauma, impulsivity, the severity of depression, and family history of suicide were independently associated with the appearance of SB among MDD patients in Beijing, China. Inevitably, these findings should be viewed with particular caution due to the inherent drawbacks of a retrospective nature. More prospective longitudinal research should be conducted to examine those dynamic alterations in the corresponding confounders.

Nutritional therapy can reduce the burden of depression management in low income countries: A review

Depression is a serious mental and mood disorder with global health and economic burden. This burden may be overwhelming in low income countries, although there are insufficient data. Most antidepressant formulations are predicated on the monoamine, neuroendocrine and neuro-inflammation hypotheses, with little or no cognizance to other neurochemicals altered in depression. A nutritional strategy with or without conventional antidepressants is recommended, as nutrition plays vital roles in the onset, severity and duration of depression, with poor nutrition contributing to its pathogenesis. This review discusses nutritional potentials of utilizing omega-3 fatty acids, proteins, vitamins, minerals and herbs or their phytochemicals in the management of depression with the aim of reducing depression burden. Literature search of empirical data in books and journals in data bases including but not limited to PubMed, Scopus, Science Direct, Web of Science and Google Scholar that might contain discussions of sampling were sought, their full text obtained, and searched for relevant content to determine eligibility. Omega-3 fatty and amino acids had significant positive anti-depression outcomes, while vitamins and minerals although essential, enhanced omega-3 fatty and amino acids activities. Some herbs either as whole extracts or their phytochemicals/metabolites had significant positive anti-depression efficacy. Nutrition through the application of necessary food classes or herbs as well as their phytochemicals, may go a long way to effectively manage depression. This therefore will provide inexpensive, natural, and non-invasive therapeutic means with reduced adverse effects that can also be applied alongside clinical management. This nutritional strategy should be given more attention in research, assessment and treatment for those with depression and other mental illness in low income countries, especially in Africa.

The burden of caring for adults with depression and suicidal ideation in five large European countries: analysis from the 2020 National Health and Wellness Survey

BACKGROUND

Suicidal ideation (SI) affects approximately 30-40% of those with major depressive disorder (MDD). To date, studies have examined the substantial humanistic and economic burden to caregivers of persons with MDD, however little is known of the impact of caring for persons with MDD when SI is present. This study examined the additional burden imposed on caregivers for persons with unipolar depression and SI in five major European countries.

METHODS

A retrospective, cross-sectional analysis was conducted in five European countries using 2020 Europe National Health Wellness Survey (France, Germany, Italy, Spain and the United Kingdom) to compare differences in health and economic outcomes between caregivers of adults with unipolar depression and SI (CAUD-SI) and caregivers of adults with unipolar depression without SI (CAUD-nSI). The outcomes assessed included health-related quality of life (HRQoL; Medical Outcomes Study Short Form [SF-12v2]), health status (Short-Form 6 Dimension [SF-6D], EuroQol 5-Dimension 5-Level [EQ-5D-5L]), Work productivity and activity impairment (WPAI) and healthcare resource utilization (HRU). Linear mixed models and generalized linear mixed models adjusted for covariates were used to compare the two groups on outcomes of interest.

RESULTS

Of 62,319 respondents, 0.89% (n = 554) were CAUD-SI and 1.34% (n = 837) were CAUD-nSI. In adjusted models, CAUD-SI reported greater humanistic burden than CAUD-nSI, with lower HRQoL (PCS: 42.7 vs. 45.0, p < 0.001 and MCS: 37.5 vs. 38.9, p = 0.007) and health status (SF-6D: 0.57 vs 0.60, p < 0.001 and EQ-5D-5L: 0.58 vs 0.66, p < 001). CAUD-SI respondents reported significantly higher economic burden than CAUD-nSI respondents for WPAI (percent activity impairment: 64.9% vs. 52.5%, p = 0.026) and HRU (provider visits: 10.0 vs. 7.9, p < 0.001, emergency room visits: 1.49 vs. 0.73, p < 0.001 and hospitalizations: 1.03 vs. 0.52, p < 0.001).

CONCLUSION

In five European countries, caregivers of adults with depression and SI experience additional humanistic and economic burden than caregivers of adults with depression and no SI. Distinguishing caregiver groupings and their unique burden provide important insights for providing targeted support and interventions for both the patient and caregiver.

Prevalence of Major Depressive Disorder and Correlates of Thoughts of Death, Suicidal Behaviour, and Death by Suicide in the Geriatric Population-A General Review of Literature

Background: There has been an increase in deaths by suicide in old age in the last decade. Depression and suicide in the elderly, 60 years and above, is a major global public health concern. Determining the prevalence of depression, and correlates of death by suicide in the geriatric population, is an important first step toward addressing this public health concern. This literature review aims to determine the prevalence of major depressive disorders and the correlates of death by suicide in the geriatric population. Methods: This general review of the literature was performed using relevant search terms to determine both the prevalence of depression and the correlates of death by suicide among the geriatric population. Databases such as MEDLINE, PsycINFO, CINAHL, and PubMed were searched. Relevant and current articles were extracted, reviewed, and analyzed. The elderly population was defined as individuals 60 years and above. Only full texts articles in English were reviewed. Findings: The prevalence estimates of major depressive disorder in the elderly ranged from 5.37 to 56%. Adults aged 60 years and older have a high risk of depression that exposes them to suicide. Moreover, elderly women are more likely to experience depression than elderly men, but successful suicide is more common in men. Depression and other mental health conditions (schizophrenia, anxiety disorders) and perceived stress were found to be predictors of suicide in the elderly. Other predictors included physical illnesses such as malignancies, financial constraints, cuckoldry, and sexual dysfunction, and also social factors like living alone triggers depressive symptoms and increases suicidal risk in the elderly. Hanging was found to be the most common method of death by suicide for both sexes. While elderly women preferred poisoning, elderly men in Western countries preferred firearms. Differences in gender, the aging process and social issues were also contributing factors to methods used for suicide. Conclusions: Depression and debilitating physical illnesses were identified as significant contributors to suicide risk in the elderly population, and emphasis should be placed on identifying these factors early and treating them. Recognizing and addressing factors that predict suicide in the elderly will help to improve the mental wellbeing of the elderly.

Decision-making in suicidal behavior: A systematic review and meta-analysis

Impaired decision-making (DM) is well-known in suicidal behavior (SB). We aimed to review the evidence on DM and its mediating factors in SB and perform a meta-analysis on DM assessed using the Iowa Gambling Task (IGT). We conducted a search on databases of papers published on DM and SB up to 2020: 46 studies were included in the systematic review, and 18 in the meta-analysis. For meta-analysis, we compared DM performance between suicide attempters (SAs) and patients (PCs) or healthy controls (HCs). The systematic review showed that SAs have greater difficulties in all DM domains. The meta-analysis found worse IGT performance among SAs in comparison with PCs and HCs. A meta-regression did not find differences for age, gender, psychiatric disorder, and clinical status. Our findings indicate that SAs exhibited deficits in DM under conditions of risk though not ambiguity. Worse DM was independent of age, gender, psychiatric disorder, and suggested that DM impairment could be considered a cognitive trait of suicidal vulnerability, a risk factor and an attribute of SAs.

Neurocognitive Functioning in Adolescents at Risk for Suicidal Behaviors

Today, little is still known about the neurocognitive functioning of the individual at risk for suicide in a relevant developmental stage like adolescence. Thus, the main goal of the present work was to analyze the neurocognitive performance of adolescents at high risk for suicide. A total of 1509 adolescents from a stratified random cluster sampling were selected. Adolescents at risk for suicidal behaviors included 83 participants. A comparison group of 83 participants matched by age and gender was also randomly selected from the sample. The Paykel Suicide Scale (PSS) and the University of Pennsylvania Computerized Neurocognitive Battery for children (included 14 tasks assessing five neurobehavioral domains: executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed) were used. Adolescents at risk for suicide revealed statistically significant impairments across different neurocognitive domains including complex cognition, episodic memory and social cognition. No significant differences were found for Sensorimotor and Executive Function domains. Results found in the present study contribute relevant information about the nature of the neurocognitive impairments associated with suicide and add information in order to deeper comprehend the tentative etiology of suicide thoughts and attempts in adolescents with the aim to establish preventive treatments.

Worldwide prevalence of suicide attempt in pregnant and postpartum women: a meta-analysis of observational studies

PURPOSE

Past suicide attempts (SA) are a major contributor to suicide. The prevalence of SA in pregnant and postpartum women varied significantly across studies. Therefore, this meta-analysis was conducted to examine the prevalence of SA and its mediating factors in this population.

METHODS

Relevant articles published in PubMed, EMBASE, Web of Science, PsycINFO, Medline complete, Chinese National Knowledge Infrastructure database (CNKI), Chinese Wanfang and Chongqing VIP database were systematically searched from inception to March 28, 2019. Titles, abstracts and full texts were reviewed independently by three researchers. Studies were included if they reported data on SA prevalence or provided relevant data that enabled the calculation of SA prevalence. Data were extracted by two researchers and checked by one senior researcher. The random-effects model was used to analyze data by the CMA 2.0 and Stata 12.0, with the high degree of statistical heterogeneity present. The primary outcomes were prevalence of SA with 95% CI during pregnancy and during the first-year postpartum.

RESULTS

Fourteen studies covering 6,406,245 pregnant and postpartum women were included. The pooled prevalence of SA was 680 per 100,000 (95% confidence interval 0.10-4.69%) during pregnancy and 210 per 100,000 (95% confidence interval 0.01-3.21%) during the first-year postpartum. Data source was significantly associated with prevalence of SA in the subgroup analysis (pregnancy, p < 0.001; the first-year postpartum, p = 0.013).

CONCLUSION

The prevalence of SA is not high in pregnant and postpartum women. Due to the potential loss of life and negative impact of SA on health outcomes, however, careful screening and effective preventive measures should be implemented for this population.

Validity and reliability of Kessler Psychological Distress Scale for Brazilian elderly: a cross-sectional study

OBJECTIVE

to verify the validity and reliability of the Psychological Distress Scale for screening mental distress.

METHODS

a cross-sectional study with 75 elderly people. Psychological Distress scale and Self Reporting Questionnaire were used. Criterion validity was verified using Spearman's correlation and diagnostic accuracy measures. Cronbach's alpha coefficient was used to investigate reliability.

RESULTS

the total internal consistency of the Psychological Distress Scale was α=0.844. Concurrent validity between this instrument and the Self Reporting Questionnaire was ρ=0.722 (p<0.001). The best cut-off point for screening mental distress among elderly people was a total score greater than 14, with sensitivity equal to 75.47% and specificity equal to 85.0%.

CONCLUSIONS

the scale was robust for screening mental distress, given its high reliability, in terms of homogeneity, and adequate criterion validity, whose best cut-off point for screening was a score greater than 14.

Clinical Quest for Associated Cognitive Impairment in Major Depressed Patients

Patients diagnosed with unipolar disorder usually experience impaired cognitive functioning during an acute depressive episode. The purpose of the current study was to investigate the association of specific clinical factors with cognitive dysfunction in a group of major depressed patients. 65 subjects diagnosed with recurrent major depressive disorder were evaluated during an acute episode. The cognitive functions were assessed with neuropsychological tests for attention and processing speed, memory, verbal fluency, psychomotor speed and executive functions. Hamilton Depression Rating Scale - 17 items was used to quantify the severity of depression. Clinical variables consisted in age at onset, number of previous depressive episodes, presence of psychotic symptoms or suicide attempts. The group had a mean age of 48.48 years, with predominance of females, with a history of 5.43 episodes and associated psychotic symptoms (23.1%) and suicide attempts (20%). Cognitive domains for which we found significant results (p < 0.05) were executive functions and attention, being associated with the number of previous depressive episodes. Psychomotor speed was significantly associated with the severity of depression. Also, patients with psychotic symptoms obtained altered results for psychomotor speed and verbal memory. For almost all cognitive domains we found significant statistical association with different clinical aspects, such as number of depressive episodes, severity of depression, presence of psychotic symptoms and suicide attempts. Since each of them had an influence over cognition, further studies involving larger samples are necessary to establish if there is a direct relationship between cognitive impairment and clinical variables.

Prevalence of and factors associated with depression among hill tribe individuals aged 30 years and over in Thailand

BACKGROUND

Depression is a silent health problem that can lead to severe and sometimes fatal outcomes if individuals are not diagnosed and treated properly; this is particularly true in populations with limited education, low economic status and several barriers to accessing health services, such as the hill tribe people in Thailand.

METHODS

This cross-sectional study aimed to explore the prevalence of and factors associated with depression among hill tribe individuals aged 30 years and over. A validated questionnaire and the Patient Health Questionnaire-9 (PHQ-9) were used for data collection in an interview format in a private and confidential room. Logistic regression was used to detect the associations of variables with depression at a significance level of α = 0.05.

RESULTS

A total of 2,552 participants were recruited for the analysis; 65.9% were females, 79.9% were married, 35.8% were aged 50 years and over, and 54.2% were Buddhist. The majority were uneducated (76.7%), were agriculturalists (48.4%), and had a low family income (71.2%). The overall prevalence of depression was 12.0%. In the multivariate analysis, eight variables were found to be significantly associated with depression among hill tribe adults aged 30 years and over in Thailand. Being female, 50 years or older, married, and Christian; living with a relative; smoking; using opium; and having moderate and high stress levels were associated with depression.

CONCLUSION

Effective public health interventions should be considered to reduce the burden of depression in the hill tribe population by focusing on individuals who are female, 50 years or older, married, Christian, and stressed and those who abuse substances.