Journal of Affective Disorders

Editorial Board

2012-06-01

Coping strategies and psychological morbidity in family carers of people with dementia: A systematic review and meta-analysis

Ryan Li, Claudia Cooper, Jonathan Bradley, Amanda Shulman, Gill Livingston — 2012-06-01

Abstract: Background: Carers for people with dementia experience high levels of anxiety and depression. Coping style has been associated with carer anxiety and depression.Method: We systematically reviewed studies examining the relationships between coping and anxiety or depression among carers of people with dementia. We rated study validity using standardised checklists. We calculated weighted mean correlations (WMC) for the relationships between coping and psychological morbidity, using random effects meta-analyses.Results: We included 35 studies. Dysfunctional coping correlated with higher levels of anxiety (WMC=0.39, 95% CI 0.28–0.50; N=688) and depression (0.46, 0.36–0.56; N=1428) cross-sectionally, and with depression 6 and 12months later (0.32, 0.10–0.54; N=143). Emotional support and acceptance-based coping correlated with less anxiety (−0.22, 95% CI −0.26 to −0.18; N=628) and depression (−0.20, −0.28 to −0.11; N=848) cross-sectionally; and predicted anxiety and depression a year later in the only study to measure this. Solution-focused coping did not correlate significantly with psychological morbidity.Limitations: Just over a quarter of the identified studies provided extractable data for meta-analysis, including only two longitudinal studies.Conclusions: There is good evidence that using more dysfunctional, and less emotional support and acceptance-based coping styles are associated with more anxiety and depression cross-sectionally, and there is preliminary evidence from longitudinal studies that they predict this morbidity. Our findings would support the development of psychological interventions for carers that aim to modify coping style.

Association between bipolar I disorder and the L55M and Q192R polymorphisms of the paraoxonase 1 (PON1) gene

2012-06-01

Abstract: Background: The purpose of this work was to study the association between the PON1 L55M and Q192R polymorphisms and bipolar I disorder in Tunisian patients and to explore their relation to the sociodemographic, clinical and therapeutic characteristics of this disease.Patients and methods: Our study included 109 patients with bipolar I disorder and 110 controls aged 39.4±11.8 and 37.3±9.2years, respectively. L55M and Q192R of the PON1 gene polymorphisms were determined by multiplex polymerase chain reaction.Results: Significant difference was detected in the distribution of the genotype frequencies of L55M and Q192R polymorphisms (χ²=6.32, df=2, p=0.04; χ²=10.15, df=2, p=0.006 respectively) between patients and controls. We noted significant association between bipolar I disorder and QR and RR genotypes (OR 2.06, CI 95% 1.10–3.84, p=0.02; OR 1.72, CI 95% 1.07–2.75, p=0.02 respectively) and between this disease and LM and MM genotypes (OR 2.22, CI 95% 1.19–4.15, p=0.012; OR 3.04, CI 95% 1.60–5.77, p=0.01 respectively). There were no significant differences in gender, age at onset, illness episode and treatment among all genotypes. However, Q192R polymorphism was significantly associated with age and patients with RR genotype were the youngest.Conclusion: Bipolar I disorder was significantly associated with L55M and Q192R polymorphisms, suggesting that these polymorphisms may play a role for development of bipolar I disorder. There was no significant association between the clinical and therapeutic characteristics of this population and these polymorphisms. Further studies are required to clarify the implication of these polymorphisms in the pathophysiology of bipolar I disorder.

Affective temperaments in general population: A review and combined analysis from national studies

Gustavo H. Vázquez, Leonardo Tondo, Lorenzo Mazzarini, Xenia Gonda — 2012-06-01

Abstract: Background: The aim of this study was to investigate the characteristics of affective temperaments in general non-clinical population in different countriesMethod: We performed a detailed search of published studies (one unpublished) investigating affective temperaments in non-clinical populations by administering the Temperament Evaluation of Memphis, Paris and San Diego Auto-questionnaire (TEMPS-A) in its 110-items version. We have included a total of six studies published from different countries (Argentina, Germany, Hungary, Korea, Lebanon, and Portugal) and one unpublished with preliminary data from Spain. We analyzed the combined data from the collected studies.Results: We found significant gender differences, with men scoring higher in irritable and hyperthymic, and women in anxious, depressive and cyclothymic temperaments. Age had a significant effect in women with depressive temperament. Correlations among temperament scores have shown positive associations between depressive and anxious, and cyclothymic and irritable.Conclusions: There was a similarity in gender differences and the association between different affective temperaments. Our results indicate that affective temperaments show both universal and distinctive characteristics.Limitation: The sample populations in different countries were not homogeneous for age and socio-economic composition. In the Korean study of Kang et al. the version of the TEMPS was not validated.

Evolution of perinatal depressive symptoms from pregnancy to two years postpartum in a low-risk sample: The MATQUID cohort

A.L. Sutter-Dallay, O. Cosnefroy, E. Glatigny-Dallay, H. Verdoux, N. Rascle — 2012-06-01

Abstract: Background: Few studies have explored the evolution of perinatal depressive symptoms (PNDS) throughout the perinatal period.Aims: To evaluate in a low-risk sample, whether different evolutive profiles of PNDS exist from pregnancy to 2-years postpartum, and whether the subgroups differ regarding psychopathological and demographic characteristics.Methods: In a prospective, longitudinal study from 8months pregnancy to 2years postpartum, repeated measures of PNDS using the CES-D were performed on a sample of 579 women at low-risk for PNDS. First, semiparametric mixture models were used to identify groups of women with distinct trajectories of PNDS. Second, multinomial logistic regressions were used to identify risk factors for each group.Results: Four distinct trajectories of PNDS evolution were found: (i) 72% of the women never presented with clinically significant depressive symptoms; (ii) 4% presented with depressive symptoms only during the postnatal period; (iii) 21% presented with depressive symptoms throughout the follow-up period, with a higher intensity during pregnancy; (iv) 3% presented with stable highly intense symptoms throughout the follow-up period. Psychosocial risk factors for PNDS were mainly identified in the patients of the third group, with an influence of socio-economical variables and anxiety traits.Limitations: The main limitations of the present study are the small size of the sample and the low level of risk for PNDS, so the results cannot be extrapolated to all types of populations.Conclusion: Different subtypes of evolutionary profiles of PNDS are found in a low-risk sample, and are associated with different profiles of risk factors.

Mechanisms underlying REBT in mood disordered patients: Predicting depression from the hybrid model of learning

Chris J. Jackson, Zahra Izadikah, Tian P.S. Oei — 2012-06-01

Abstract: Background: Jackson's (2005, 2008a) hybrid model of learning identifies a number of learning mechanisms that lead to the emergence and maintenance of the balance between rationality and irrationality. We test a general hypothesis that Jackson's model will predict depressive symptoms, such that poor learning is related to depression. We draw comparisons between Jackson's model and Ellis' (2004) Rational Emotive Behavior Therapy and Theory (REBT) and thereby provide a set of testable learning mechanisms potentially underlying REBT.Methods and results: Results from 80 patients diagnosed with depression completed the learning styles profiler (LSP; Jackson, 2005) and two measures of depression. Results provide support for the proposed model of learning and further evidence that low rationality is a key predictor of depression.Conclusions: We conclude that the hybrid model of learning has the potential to explain some of the learning and cognitive processes related to the development and maintenance of irrational beliefs and depression.

A longitudinal evaluation of religiosity and psychosocial determinants of suicidal behaviors among a population-based sample in the United States

2012-06-01

Abstract: Background: Relationships among religiosity and other psychosocial factors in determining suicidal behaviors in adolescence and in emerging adulthood have been inconclusive. We sought to investigate prospective relationships among religiosity, psychosocial factors and suicidal behaviors using a nationally representative sample of adolescents emerging into adulthood.Method: Analysis was based on 9412 respondents from four waves of National Longitudinal Study of Adolescent Health. A Generalized Estimating Equation (GEE) procedure was used to fit a series of models on the response variable (suicidal behaviors) and a set of psychosocial and religiosity predictors taking into account the correlated structure of the datasets.Results: Analyses showed that adolescent suicidality and religious activity participation showed significant declines over time. Using multinomial logistic regression we found that females showed statistically significant risks of suicidal behaviors, but this effect declined in adulthood. In adjusted models, baseline attendance of a church weekly was associated with 42% reduction (95% Confidence Interval: 0.35–0.98) of suicide ideation in Wave III. Across all waves, low support from fathers (compared with mothers) consistently explained variability in suicidal behaviors among genders emerging into adulthood.Limitations: Accurate measurement of religiosity is psychometrically challenging.Conclusions: The findings of the study indicate that religious activity participation is associated with reduced suicidal behaviors among adolescents but this effect declines during emerging adulthood. Psychosocial supports particularly from fathers' have an enduring impact on reduced suicidal behaviors among adolescents and emerging adults. Prevention, identification and evaluation of disorders of suicidality need a careful assessment of underlying mental pain (psyache) to reduce the likelihood of aggravated suicide.

Long term follow up of suicide in a clinically depressed community sample

Wendy Thomson — 2012-06-01

Abstract: Background: The purpose of this study was to examine how sex differences in suicide rates unfolded in a long-term follow up of patients who had been diagnosed with major depression.Method: Patients who were diagnosed with major depression in the Chichester/Salisbury Catchment Area Study were followed for 49years. Recorded deaths from suicide were compared with rates that were predicted from historical data on suicide mortality rates from 1960 onwards.Findings: An overall suicide rate of 3.4% was found in the present sample. Sixteen women and three men died from suicide. Women's suicide rates were significantly higher than the level predicted based on general population trends. Men showed a barely non-significant trend in the same direction. The diagnosis of clinical depression was associated more strongly with increased risk for suicide among women compared with men. Of the female suicides, 13 had been diagnosed with endogenous depression.Conclusions: While suicide rates are significantly higher for men in the general population, and for depressed patients of both sexes, the depression may be a particularly strong predictor of suicide risk among women.Limitations: The dataset does not provide information about processes that mediate the relationship between depression and suicide mortality.

Functional connectivity in the cognitive control network and the default mode network in late-life depression

2012-06-01

Abstract: Background: Abnormalities have been identified in the Cognitive Control Network (CCN) and the Default Mode Network (DMN) during episodes of late-life depression. This study examined whether functional connectivity at rest (FC) within these networks characterizes late-life depression and predicts antidepressant response.Methods: 26 non-demented, non-MCI older adults were studied. Of these, 16 had major depression and 10 had no psychopathology. Depressed patients were treated with escitalopram (target dose 20mg) for 12weeks after a 2-week placebo phase. Resting state time series was determined prior to treatment. FC within the CCN was determined by placing seeds in the dACC and the DLPFC bilaterally. FC within the DMN was assessed from a seed placed in the posterior cingulate.Results: Low resting FC within the CCN and high resting FC within the DMN distinguished depressed from normal elderly subjects. Beyond this “double dissociation”, low resting FC within the CCN predicted low remission rate and persistence of depressive symptoms and signs, apathy, and dysexecutive behavior after treatment with escitalopram. In contrast, resting FC within the DMN was correlated with pessimism but did not predict treatment response.Conclusions: If confirmed, these findings may serve as a signature of the brain's functional topography characterizing late-life depression and sustaining its symptoms. By identifying the network abnormalities underlying biologically meaningful characteristics (apathy, dysexecutive behavior, pessimism) and sustaining late-life depression, these findings can provide a novel target on which new somatic and psychosocial treatments can be tested.

Peeking into the minds of troubled adolescents: The utility of polysomnography sleep studies in an inpatient psychiatric unit

Azmeh Shahid, Arash Khairandish, Bojana Gladanac, Colin Shapiro — 2012-06-01

Abstract: Background: Sleep problems are commonly associated with the primary diagnostic criteria for many psychiatric disorders. Evidence suggests sleep disturbances may precede development of psychiatric disorders and the severity of psychopathology reflects the severity of sleep problems. Polysomnography (PSG) sleep studies in child and adolescent psychiatric populations, a particularly at risk group, has considerable value but has been more elusive requiring further investigation.Methods: We performed a retrospective chart review of PSG sleep studies and psychiatrist evaluations of 106 adolescents aged 7–16 admitted to an involuntary adolescent psychiatric inpatient facility.Results: Less than 5% of cases had mild/no sleep problems. Hyperarousal hallmarked this population, and severity of sleep disturbances trends with the severity of psychopathology. Inpatients with multiple psychiatric disorders had greater frequencies of insomnia, decreased sleep efficiency, and arousals from SWS (p<0.05). Inpatient's with self-harm behavior more frequently had elevated sleep onset latency (SOL), reduced efficiency, reduced SWS (p<0.05), increased REM, and reduced REM latency compared to inpatients with dysthymia and/or depression.Limitations: Lacking an a priori hypothesis, this study was explorative and uncontrolled for factors such as medications. This notwithstanding however, analysis indicates the majority of inpatients were taking cocktails that “should” alleviate sleep symptoms suggesting greater associations may prevail in unmedicated populations.Conclusions: This study attests to the potential clinical utility of PSG sleep studies in the management of adolescent psychiatric disorders and contributes to the body of evidence reputing the intimate connection between sleep problems and the development and perpetuation of psychopathology with public health implications.

Amygdala response and functional connectivity during emotion regulation: A study of 14 depressed adolescents

2012-06-01

Abstract: Background: Ineffective emotion regulation and abnormal amygdala activation have each been found in adolescent-onset major depressive disorder. However, amygdala activation during emotion regulation has not been studied in adolescent-onset major depressive disorder.Method: Fourteen unmedicated adolescents diagnosed with current depression without comorbid psychiatric disorders and fourteen well-matched controls ages 13 to 17years underwent an emotional regulation task during functional magnetic resonance imaging. During this task, participants viewed negatively-valence images and were asked to notice how they were feeling without trying to change it and maintain their emotional reaction (“Maintain”) or to interpret the image in such a way as minimize their emotional response (“Reduce”).Results: Imaging analyses demonstrated that adolescents with depression showed: (1) greater right amygdala activation during the maintain condition relative to controls, (2) less connectivity during the maintain condition between the amygdala and both the insula and medial prefrontal cortex than controls, and (3) a significant positive correlation between amygdala-seeded connectivities during maintenance of emotion and psychosocial functioning.Limitations: The current study is a cross-sectional comparison and longitudinal investigations with larger sample sizes are needed to examine the association between amygdala reactivity and emotion regulation over time in adolescent MDD.Conclusions: During the maintain condition, adolescents with depression showed a heightened amygdala response and less reciprocal activation in brain regions that may modulate the amygdala. A poorly modulated, overreactive amygdala may contribute to poor emotion regulation.

A hierarchy of distress and invariant item ordering in the General Health Questionnaire-12

F. Doyle, R. Watson, K. Morgan, O. McBride — 2012-06-01

Abstract: Background: Invariant item ordering (IIO) is defined as the extent to which items have the same ordering (in terms of item difficulty/severity — i.e. demonstrating whether items are difficult [rare] or less difficult [common]) for each respondent who completes a scale. IIO is therefore crucial for establishing a scale hierarchy that is replicable across samples, but no research has demonstrated IIO in scales of psychological distress. We aimed to determine if a hierarchy of distress with IIO exists in a large general population sample who completed a scale measuring distress.Methods: Data from 4107 participants who completed the 12-item General Health Questionnaire (GHQ-12) from the Northern Ireland Health and Social Wellbeing Survey 2005–6 were analysed. Mokken scaling was used to determine the dimensionality and hierarchy of the GHQ-12, and items were investigated for IIO.Results: All items of the GHQ-12 formed a single, strong unidimensional scale (H=0.58). IIO was found for six of the 12 items (H-trans=0.55), and these symptoms reflected the following hierarchy: anhedonia, concentration, participation, coping, decision-making and worthlessness.Limitations: The cross-sectional analysis needs replication.Conclusions: The GHQ-12 showed a hierarchy of distress, but IIO is only demonstrated for six of the items, and the scale could therefore be shortened. Adopting brief, hierarchical scales with IIO may be beneficial in both clinical and research contexts.

Bipolar depression: Clinical correlates of receiving antidepressants

2012-06-01

Abstract: Background: The efficacy and tolerability of antidepressants (ADs) to treat or avoid episodes of depression in bipolar disorder (BPD) patients as well as reasons for using them remain unresolved.Methods: We analyzed patient-characteristics and outcomes of episodes of acute major depression among 290 adult, DSM-IV BPD patients (71% type-I, 52% women) at the Hospital Clinic of Barcelona; 80% were given an AD and 20% were not; 80% of both groups also received mood-stabilizers. We evaluated factors associated with AD-treatment using bivariate analyses and multiple logistic-regression modeling.Results: Factors associated with AD-use by multivariate modeling ranked: [a] more years ill, [b] depressive first-lifetime episode, [c] more depressions/year, [d] melancholic index episode, and [e] less affective illness in first-degree relatives. Within 8weeks, depression improved by ≥50%, less often among BPD patients given an AD (64.4%; 38.6% without switching into hypo/mania) than not (82.1%; 78.6% without switching).Conclusions: Use of ADs to treat acute BP-depression was very common and associated with a more severe clinical history. Mood-switching was prevalent with AD-treatment even with mood-stabilizers present.

Personal stigma, problem appraisal and perceived need for professional help in currently untreated depressed persons

2012-06-01

Abstract: Background: The role of stigma in help-seeking for depression is unclear. We hypothesize that in persons experiencing symptoms of depression, personal stigmatizing attitudes impair appraisal of the present condition as mental health problem and thus reduce the perceived need for professional help.Methods: We recruited a sample of 25 currently untreated depressed persons from the general population using local newspaper articles and emails that listed symptoms of depression avoiding the term “depression” or any other potentially stigma-associated term. We elicited personal stigmatizing attitudes, appraisal of the present problem as mental health problem, and perceived need for any medical or therapeutic help.Results: In linear regression analyses controlling for depression severity and previous help-seeking, high personal stigma was related to lower problem appraisal (beta, −0.38; p<0.05) and to lower perceived need (beta, −0.59, p<0.01). Lower problem appraisal was associated with lower perceived need. Regressing need on both problem appraisal and stigma reduced the direct influence of stigma on need, indicating a partial mediation of this relationship by problem appraisal.Limitations: Our small sample prohibited the use of path models.Conclusions: Personal stigmatizing attitudes in persons suffering from a depressive syndrome pose an important barrier to help, impairing appraisal of depressive symptoms as potential mental health problem and decreasing perceived need for professional help.

Is processing speed a valid cognitive endophenotype for bipolar disorder?

2012-06-01

Abstract: Objectives: The current study investigated whether a single brief cognitive assessment, processing speed, could be considered as a valid endophenotype for bipolar disorder (BD).Methods: Processing speed was assessed using the Digit Symbol Test (DST) in 53 euthymic BD probands (BD-P), 50 unaffected first-degree relatives (UFDR) and 60 unrelated healthy controls (HC).Results: Euthymic BD-P and the UFDR were significantly more impaired on DST performance even after controlling for demography and current mood symptoms (effect sizes 0.89 and 0.52). Clinically significant performance impairment was present in about 30% BD-P and 25% UFDR.Limitations: Pharmacotherapy was not controlled for.Conclusions: Processing speed, as measured with the DST, is a brief reliable measure that could be used in clinical assessments of at risk populations. Our findings support the hypothesis that processing speed may be a valid endophenotype, highly specific for differentiating both euthymic BD-P and UFDR, from HC.