Depression and Anxiety最新文献

Sleep disturbances, including insomnia and trauma-related nightmares (TRNs), are the core symptoms of post-traumatic stress disorder (PTSD) in military personnel. Furthermore these nocturnal manifestations are directly related to the persistence of daytime PTSD symptoms and are known to exacerbate comorbid conditions such as depression, suicidality, and daytime impairments. This prospective study examined the variability of PTSD-related sleep disruptions and its relationship to symptom severity using ecological recordings over several nights. One hundred thirty PTSD-diagnosed service members and 65 healthy military controls recorded sleep data at home for five nights using a polysomnographic headband to measure total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency index (SEI), and sleep stages. PTSD severity and comorbid symptoms were assessed by clinical evaluations. Compared to controls, PTSD participants had higher SOL and WASO (+14.1 min and +9.1 min, p < 0.001, respectively), reduced SEI (−6.6%, p  < 0.001), and lower N3 and rapid eye movement (REM) sleep durations. In addition, night-to-night variability (NNV) in SOL and WASO was higher in the PTSD group. The sleep fragmentation index (FI)—and more specifically non-REM (NREM) sleep fragmentation—was significantly correlated with PTSD severity, particularly the intrusive and avoidance symptoms clusters in the PCL-5 score. The results highlight the need for customized multinight assessments to study sleep variability in military patients with combat-related PTSD, in order to advance therapeutic strategies for military populations.

Trial Registration: ClinicalTrials.gov Identifier: NCT04581850

Background: Depression is a primary public health challenge that affects individuals of all ages. This study aims to reveal information on spatial and temporal changes in depression by describing temporal trend differences, regional differences, and gender differences.

Materials and Methods: Utilizing data from the Global Burden of Disease Study 2021 (GBD2021) from 1990 to 2021, we outlined the prevalence and burden of depression among 204 countries in 21 regions, including age and sex disparities, and explored the correlation between depressive burden and the sociodemographic index (SDI). The age-standardized rates of prevalence (ASPR), disability-adjusted life years (DALYs, age-standardized DALY rate, ASDR), and estimated annual percentage change (EAPC) were employed to evaluate the global burden of depression.

Results: Our study revealed a greater than 1.8-fold increase in prevalent cases and DALYs for global depressive disorder from 1990 to 2021. Globally, the age-standardized rates (ASRs) slightly declined, with a 1.32% decrease in the ASPR and a 1.84% decrease in the ASDR from 1990 to 2019. The main decline occurred from 2005 to 2010 (4.86% decrease in the ASPR and 6.09% decrease in the ASDR), with the majority of the contributions occurring in the low-middle-SDI and low-SDI regions. The global ASPR and ASDR experienced astonishing jumps from 2019 to 2021, resulting in increases of nearly 11% in the ASPR and 13% in the ASDR. Notably, the ASPR and ASDR of depression decreased in females but increased in males from 1990 to 2019 and reversed thereafter. From 1990 to 2021, among the 21 regions, the EAPCs in most regions were >0, with the only exceptional decline occurring in East Asia in the ASPR −0.06 [95% Cl:−0.10 to −0.03]) and ASDR −0.09 [95% Cl:−0.13 to −0.05]). Compared with those in other regions, the ASPR (0.42 [95% Cl: 0.34–0.49]) and ASDR (0.53 [95% Cl: 0.46–0.61]) were greater in high-income North America. Among the five SDI regions, the largest increases in ASPR (0.25 [95% Cl: 0.21–0.30]) and ASDR (0.31 [95% Cl: 0.26–0.37]) occurred in the high-SDI region, with the majority of the contributions occurring from 2019 to 2021. Worldwide, a decreasing trend and significant associations between the ASPR and the SDI (R = −0.22, p = 0.0013) and between the ASDR and the SDI (R = −0.28, p < 0.001) were observed.

Conclusion: Depression remains a serious challenge worldwide. The trends in depression burden varied across regions and groups. A vibrant socioeconomic environment could have a positive impact on the disease burden. Mental health should be incorporated into public health preparedness and emergency plans in practical ways on the basis of the national conditions of each country.

Social anxiety disorder (SAD) is associated with persistent fear of negative evaluation (FNE) and fear of positive evaluation (FPE), which play critical roles in the development and maintenance of anxiety symptoms. However, it remains unclear how FNE and FPE contribute to the common and different symptoms of social anxiety. In this review, we tried to elucidate the shared and distinct mechanisms underlying fear of evaluation and clarify the impact of FNE and FPE on social anxiety by integrating the theories, external expressions, and internal mechanisms. First, FNE and FPE share evolutionary functions but have distinct motivations for maintaining social role stability. Second, FNE and FPE share similar emotions and avoidance behaviors but contribute to distinct comorbid symptoms in SAD, including eating disorders and alcohol abuse. Third, FNE and FPE share emotional and social pain circuits but have different dysfunctions in the prefrontal, cingulate, and reward brain regions, which are associated with rejection sensitivity and anhedonia features. Overall, this review sheds light on the cognitive and neural mechanisms of SAD based on fear of evaluation, highlighting both the shared and distinctive aspects of FNE and FPE. These insights have important implications for the development of effective interventions for social anxiety.

Background: Preliminary evidence suggests that mental health problems can transmit within adolescent peer social groups. However, prior studies have primarily quantified exposure by counting peers with mental health problems, which cannot precisely reflect the group level density of already affected peers. Moreover, existing evidence predominantly focused on transmission associated with exposure to severe cases, neglecting the more widely prevalent mild-to-moderate cases. Therefore, we explored whether and in what condition exposure to mild-to-moderate cases should be considered along with severe cases in the transmission of mental health problems.

Methods: We analyzed data from a mental health monitoring project involving 20 middle schools in Guangdong, China, encompassing all students in 449 classes. The risks of adolescents reporting worse depressive and anxiety symptoms associated with exposure to classmates with severe symptoms or mild-to-severe symptoms were explored through three-level mixed-effect multiple Poisson regression models, adjusted for random effects at classroom and school levels.

Findings: Among the 19,058 participants (48.3% girls), 5651 (29.6%) reported depression problems and 6464 (33.9%) reported anxiety problems. Higher risks of adolescents reporting worse depressive and anxiety symptoms were significantly associated with exposure to classmates with any severity of symptoms when considering the percentage of these classmates in the classroom (IRR ranged between 1.01 and 1.02). Conversely, having greater number of classmates with severe symptoms was significantly associated with higher risk of reporting worse symptoms (IRR ranged between 1.03 and 1.09) regardless of proportion of these classmates.

Interpretation: Our findings indicated that in group level mental health transmission, the level of exposure should be interpreted with consideration of group density rather than mere number of already affected peers. Moreover, mental health problems can transmit beyond exposure to peers with severe symptoms, thereby facilitating more effective risk screening and prevention of mental health problem transmission in adolescents. This approach is imperative, given the substantial prevalence of mild-to-moderate mental health symptoms among adolescents.

Background: Subclinical hypothyroidism (SCH) is a mild impairment of thyroid function. The prevalence of SCH is significantly higher in the major depressive disorder (MDD) population than in the general population, but the risk factors and relationships are not apparent. The occurrence of SCH is influenced by age and medication. Therefore, our study was to investigate the prevalence and risk factors of SCH in young and middle-aged groupstotal of patients with first-episode and drug-naive (FEDN) MDD.

Methods: A total of 1717 FEDN MDD patients were divided into a younger group (18–45 years) and a middle-aged group (>45 years). The Hamilton Depression Scale (HAMD) was used to assess patients’ depression symptoms. Serum thyroid function and lipid level parameters were measured. A self-administered questionnaire collected other clinical and demographic data.

Results: The prevalence of SCH in middle-aged MDD patients was 66.9%. Middle-aged patients had a longer duration of illness, a later age of onset, a higher proportion of female patients, and a lower level of education. Further logistic regression indicated that serum total cholestrol (TC) and high-density lipoprotein cholesterol (HDL-C) levels, as well as overweight and obesity, were significantly associated with SCH in both groups; however, low-density lipoprotein cholesterol (LDL-C) was an independent risk factor associated with SCH in the middle-aged group.

Conclusions: Our results suggest that the prevalence of SCH is higher in middle-aged MDD patients than in younger patients and that long-term more severe depression, high TC and HDL-C levels, and abnormal body weight may influence the occurrence of SCH. Physicians should pay more attention to LDL-C levels in middle-aged patients with FEDN MDD.

Background: Late-life depression has serious public health implications due to its impact on healthcare systems and the economy. As the prevalence of depression tends to change over time across populations, continuous disease surveillance is warranted to inform evidence-based preventive interventions. The well-being of the Singapore elderly (WiSE) is the second study in the series that looked at the prevalence and correlates of depression in a multiethnic population in Singapore.

Methods: This single-phase and comprehensive cross-sectional study employed stage 1 diagnosis of geriatric mental state-automated geriatric examination for computer-assisted taxonomy (GMS-AGECAT) to capture depression and subsyndromal depression.

Results: The prevalence of depression and subsyndromal depression was 4.4% and 11.9%, respectively, compared to 3.7% and 13.4% in 2013 (p = 0.425). Indians, those who were divorced and had below primary education had higher odds of depression (2.2, 3.6, and 4.2 times, respectively). Depression was associated with severe disability, loneliness, suicidal ideations, poor life satisfaction, health status, and social connections.

Conclusion: Despite a decade of preventive efforts for the population, there has not been any decrease in the prevalence of depression. There needs to be continued efforts to strengthen prevention, detection, and access to care of those with depression. A multiprong community–based preventive strategy focusing on social as well as health factors is needed to promote social connections, reduce loneliness, and promote the overall wellbeing of the elderly.

Background: This study aims to explore the relationship between birth interval and prevalence of depression among postmenopausal women with two deliveries in the United States.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) were used, which spanned the years 2005–2018 and is publicly accessible. We utilized weighted multivariable logistic regression analysis, restricted cubic splines (RCS), and subgroup analysis to examine the relationship between the prevalence of depression in postmenopausal women with only two deliveries and the age at first birth (AFB), age at last birth (ALB), and birth interval (the difference between ALB and AFB).

Results: A total of 2375 postmenopausal women with only two deliveries were included in the study, and 271 (11.4%) had depression. RCS models showed that AFB and ALB were U-shaped curves associated with the prevalence of depression. Additionally, the birth interval was roughly L-shaped curve correlated with the risk of depression.

Conclusions: Both early and late childbearing, as well as short birth intervals, may contribute to mental health challenges in this demographic. These findings suggest that women with both early and late childbearing, as well as those with short birth intervals, may face a higher risk of depression during their postmenopausal years. This underscores the importance of targeted mental health screening and support for these groups.

Objective: Appetite changes are a significant clinical feature of depression, with circadian rhythms disruption being a crucial mechanism in depression. However, the specific role of eating rhythms in depression remains unclear. This study aimed to assess the relationship between energy intake rhythmicity and depressive symptoms.

Methods: A total of 34,974 noninstitutionalized individuals were recruited from the National Health and Nutrition Examination Survey. To investigate the relationship between 24-h energy intake and depressive symptoms, covariate-adjusted sample-weighted regressions were employed. The study analyzed various aspects of energy intake rhythmicity, including the proportion of energy intake from non-meals and meal times, as well as the proportion of energy intake across meals and various time periods (morning, midday, afternoon, evening, night, and overnight).

Results: A high proportion of energy intake from non-meals (adjusted odds ratio [OR] = 1.11, 95% confidence interval [CI]: 1.08–1.15) was associated with higher depressive symptoms. The proportion of breakfast energy intake in total daily energy intake was nonlinearly associated with depressive symptoms. In participants with a breakfast energy intake below 20%, the prevalence of depressive symptoms decreased by 15% (adjusted OR = 0.85, 95% CI: 0.75–0.96) per each 10% increment in the proportion of breakfast energy intake. A U-shaped relationship was identified between the timing of the day’s last energy intake and depressive symptoms, with the lowest prevalence occurring at 7:48 PM (before 7:48 PM: adjusted [OR = 0.96, 95% CI: 0.94–0.98]; after 7:48 PM: adjusted [OR = 1.11, 95% CI: 1.03–1.20]).

Conclusions: Among adults in the United States, the proportion of energy consumed from non-meals was associated with higher depressive symptoms. Adequate energy intake at breakfast and moderate end-times of energy intake were linked to reduced depressive symptoms. These results may contribute to designing of future studies on dietary rhythm interventions for managing depression.

Background: The objective of the current study was to evaluate the trend and risk factors of antenatal depression (AD) among Chinese women in the third trimester of pregnancy, taking into account the impact of multiple fertility policy adjustments and economic development in China.

Method: A repeated cross-sectional study design was used. A total of 3404 pregnant women at 30–42 weeks’ gestation were recruited from the two largest maternity hospitals in Zhejiang Province, China, between 2016 and 2021.

Results: The prevalence of AD among women in their third trimester of pregnancy had significantly increased from 31.8% to 60.6% (p  < 0.001) from 2016 to 2021. Pregnant women aged between 18 and 24 years reported the highest prevalence of AD. Those aged between 25 and 34 years (odds ratio [OR], 0.788; 95% confidence interval [CI]: 0.630–0.985), with a better self-reported health status (OR, 0.929; 95% CI: 0.922–0.936) and higher perceived social support (OR, 0.948; 95% CI: 0.940–0.955), reported a lower prevalence of AD. Pregnant women who were housewives (OR, 1.399; 95% CI: 1.078–1.817), had an introverted personality (OR, 1.324; 95% CI: 1.119–1.568), and had experienced an unplanned pregnancy (OR, 1.303; 95% CI: 1.098–1.547) reported a higher prevalence of AD.

Conclusions: The significant increase in the prevalence of AD from 2016 to 2021 has caused concern in society. To improve the aforementioned situation, it is imperative to implement further initiatives to address the challenges faced by pregnant women, especially those who are housewives, have introverted personalities, and have experienced unplanned pregnancies.

Background: Major depressive disorder (MDD) is a leading cause of disability worldwide. The pathophysiology of MDD remains unclear, which limits the development of treatments for MDD. Recently, epoxide hydrolase 2 (EPHX2) has been found to be associated with MDD. Our previous study revealed an association between EPHX2 expression and suicide. However, the effect of EPHX2 on the prognosis of MDD and suicide remains unclear. Previous studies have found that impulsivity at baseline can be a significant predictor of clinical improvement in patients with MDD. Therefore, we inferred that EPHX2 could be associated with the treatment effect of MDD, and impulsivity could mediate the effect of EPHX2 on the treatment effect of MDD.

Methods: This naturalistic prospective study included 117 participants with MDD, who were assessed, using clinical questionnaires, cognitive function, and treatment information, at baseline, 2 weeks, and 1, 2, and 3 months. A linear mixed-effects model was used to investigate longitudinal changes in the severity of symptoms, risk of suicide, and cognitive function.

Results: The interactive effects of impulsivity and EPHX2 polymorphisms on the risk of suicide (measured by the Columbia-Suicide Severity Rating Scale) were significantly different for rs11288636, rs68012435, and rs11288636. The interactive effects between polymorphisms and time on depression severity (measured by the Hamilton Depression Scale-24) were significantly different and including after adjustment for the total impulsivity score.

Conclusions: This study suggests that EPHX2 polymorphisms are associated with the prognosis of MDD, and impulsivity could be a critical factor for the change in suicide risk among different EPHX2 genotypes.

Trial Registration: ClinicalTrials.gov identifier: NCT05575713