Depression and Anxiety最新文献

The escalating global prevalence of type 2 diabetes mellitus (T2DM) and mental disorder (MD) including schizophrenia, bipolar disorder, major depressive disorder, and anxiety highlights the urgency for comprehensive therapeutic strategies. Aerobic exercise (AE) is a viable adjunct therapy, providing significant benefits for individuals dealing with both T2DM and MD. This review consolidates evidence on AE’s role in alleviating the physiological and psychological effects of these comorbid conditions. It delves into the pathophysiological connections between T2DM and various MD, including depression, schizophrenia, anxiety, and bipolar disorder—emphasizing their reciprocal exacerbation. Key neurophysiological mechanisms through which AE confers benefits are explored, including neuroinflammation modulation, brain structure and neuroplasticity enhancement, growth factor expression regulation, and hypothalamic–pituitary–adrenal (HPA)/microbiota–gut–brain (MGB) axis normalization. Clinical results indicate that AE significantly improves both metabolic and psychological parameters in patients with T2DM and MD, providing a substantial argument for integrating AE into comprehensive treatment plans. Future research should aim to establish detailed, personalized exercise prescriptions and explore the long-term benefits of AE in this population. This review underscores the potential of AE to complement existing therapeutic modalities and enhance the management of patients with T2DM and MD.

Background: Trait perseverative cognition (PC) is associated with inflexible autonomic activity and risk for depressive recurrence. However, the identification of dynamic psychophysiological markers of PC that fluctuate within individuals over time could facilitate the passive detection of moments when PC occurs in daily life.

Methods: Using intensively sampled data across 1 week (3x/day) in adults with remitted major depressive disorder (rMDD) and never-depressed controls (CONs), we investigated the utility of monitoring ambulatory autonomic complexity to predict moments of PC engagement in everyday life. Autonomic complexity metrics, including the root mean square of successive difference (RMSSD), indexing vagal control, and sample entropy, indexing signal complexity, were calculated in the 30 min before each measurement of PC to enable time-lagged analyses. Multilevel models examined proximal fluctuations in the mean level and inertia of complexity metrics as predictors of subsequent PC engagement.

Results: Momentary increases in the inertia of sample entropy, but not other metrics, predicted higher levels of subsequent PC in the rMDD group, but not among never-depressed CONs.

Conclusions: The inertia of sample entropy could index autonomic rigidity and serve as a dynamic risk marker for real-world PC in individuals with a history of depression. This could inform the development of technologies to passively detect fluctuations in risk for PC, facilitating real-time interventions to prevent PC and reduce the risk for depressive recurrence.

Background: Reduced brain-derived neurotrophic factor (BDNF) levels have been linked to increased depression risk. While physical exercise is known to alleviate depressive symptoms and elevate BDNF levels, the effects of different exercise modalities and doses, along with their dose–response relationships, remain unclear.

Objective: This study aims to systematically evaluate the effects of various exercise types and doses on BDNF levels in patients with depression through pairwise meta-analysis, network meta-analysis (NMA), and dose–response NMA and to provide personalized exercise prescription recommendations.

Methods: A comprehensive search identified randomized controlled trials (RCTs) examining exercise’s impact on BDNF levels in depression. Pairwise and NMA compared six exercise modalities: continuous aerobic exercise (CAE), resistance exercise (RE), combined aerobic and resistance exercise (AERE), yoga, Qigong, and mindfulness. Dose–response NMA was used to assess the relationships between exercise dose and BDNF levels.

Results: Thirty-six RCTs with 2515 participants were included. The pairwise meta-analysis indicated that all exercise interventions significantly elevated BDNF levels in patients with depression, with AERE, RE, and yoga demonstrating the most substantial effects. NMA rankings suggested that AERE was the most effective intervention, followed by RE, yoga, Qigong, mindfulness, and CAE. Dose–response NMA revealed a positive nonlinear dose–response relationship between total exercise volume and BDNF levels, with an optimal effective dose identified at ~610 METs-min/week. Beyond 1000 metabolic equivalent of tasks (METs)-min/week, increases in BDNF levels appeared to plateau. Moreover, each exercise type had distinct dose–response patterns, with RE and AERE having relatively higher optimal effective dose ranges, while CAE, yoga, Qigong, and mindfulness exhibited lower optimal ranges.

Conclusions: AERE, RE, and yoga are effective interventions for enhancing BDNF levels in patients with depression, with Qigong, mindfulness, and CAE being comparatively less effective. A positive nonlinear dose–response relationship between exercise volume and BDNF levels was observed. Further research is needed to refine dose–response relationships in this population.

Background: During the COVID-19 epidemic, nurses are facing tremendous psychological pressure. However, there is a lack of research on severe depression and its related factors in nurses after COVID-19. This study aimed to compare the prevalence and explore the influencing factors of severe depression among Chinese nurses during and after the COVID-19 pandemic.

Methods: This study recruited 937 frontline nurses during the outbreak and 784 frontline nurses who had participated in the initial recruitment after the pandemic. The self-rating depression scale (SDS), self-rating anxiety scale (SAS), and Pittsburgh Sleep Quality Index (PSQI) were used to assess subjects’ depression, anxiety, and sleep disorders, respectively. Chi-square test, t-test, and binary logistic regression were used to identify factors influencing severe depression. Receiver operating characteristic (ROC) curves were used to assess the predictive value of severe depression-related variables.

Results: The study found that the incidence of severe depression among nurses after the epidemic (4.9%) was significantly higher than that during the epidemic (1.7%). In addition, academic qualifications, health status, frequency of exercise per week, anxiety, and sleep disorders were associated with severe depression among nurses after the COVID-19 epidemic. ROC analyses showed that SAS scores and PSQI scores had good predictive value for nurses’ severe depression after the pandemic.

Conclusions: The prevalence of severe depression among nurses after COVID-19 is higher than that during COVID-19. Nurses continue to face severe psychological stress after the COVID-19 pandemic. Therefore, it is desperately needed for nurses to provide timely psychological support and establish a mental health support system after the COVID-19 epidemic.

Background: Little is known about the mechanism of the relationship between family environment and depressive symptoms in Chinese master’s and PhD students. The objective of this study was to investigate the moderating effect of family support and the mediating effect of psychological resilience on depressive symptoms in a family environment. The differences between master’s and PhD students are also discussed in this study.

Methods: Data for 615 master’s and 78 PhD students were collected using the Family Environment Scale, Depression Self-Rating Scale, Perceived Social Support Scale, and Psychological Resilience Scale in October every year for 3 years from 2021 to 2023. A latent growth curve mediation model was used to examine the potential mediating role of psychological resilience in the relationship between family environment and depressive symptoms over time.

Results: (1) There was a significant positive correlation among family environment, family support, and psychological resilience and a significant negative correlation between these factors and depressive symptoms. (2) Family support moderated the relationship between family environment and depressive symptoms among both master’s and PhD students. (3) Mediation analysis showed that psychological resilience mediated the relationship between family environment and depressive symptoms among master’s students.

Conclusion: Family environment is a significant risk factor for depressive symptoms. This association appears to be moderated by family support and mediated by psychological resilience. It is necessary to design depressive symptom prevention programs that consider the family environment of master’s and PhD students. Therefore, mental health services for this population should consider both family support and psychological resilience.

Background: The prevalence of depression has been increasing sharply. Given the existing treatment gap and the high prevalence of nonresponders to conventional therapies, the potential of complementary medicine becomes clear. The effect of yoga on depression has already been studied, but its efficacy in manifest depressive disorders remains unclear.

Objective: To update and evaluate the current state of evidence for yoga as a therapy option for depressive disorders.

Methods: PubMed/Medline, Cochrane Library, Scopus, PsycINFO, and BASE were searched systematically. Randomized controlled trials (RCTs), including participants with depressive disorders, were eligible. Analyses were conducted for active and passive control groups separately and for subgroups of major depressive disorder (MDD) and mixed samples. The risk of bias was assessed using the Cochrane risk of bias tool 2.0. Primary outcomes were the severity of depression and remission rates, and secondary outcomes were health-related quality of life and adverse events. The quality of evidence was assessed according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE).

Results: Twenty-four studies (n = 1395) were included; of those, 20 studies (n = 1333) were meta-analyzed. Yoga showed a statistically significant short-term effect on depression severity when compared to passive control (standardized mean difference [SMD] = −0.43, 95% confidence interval [CI] = [−0.80; −0.07]) but not when compared to active control (SMD = −0.22, 95% CI  = [−0.67; 0.23]). Regarding remission rates, statistically significant effects were observed when comparing yoga to passive (odds ratio [OR] = 3.20; 95% CI = [1.45; 7.10]) as well as to active control (OR = 2.04; 95% CI = [1.13; 3.69]). No differences on safety outcomes were observed for passive (OR = 1.00, 95% CI = [0.10; 9.98]) as well as for active control (OR  = 0.80, 95% CI = [0.08; 8.09]). The quality of evidence ranged from moderate to very low. Due to the heterogeneity of outcome reporting, no meta-analysis for quality of life was possible.

Conclusion: Yoga is an effective therapy approach for reducing depression severity when compared to passive control and obtains higher remission rates when compared to active and passive controls. Quality of evidence is inconsistent, but given the positive risk–benefit ratio of the intervention and the urge for therapy options for depression, yoga should be considered as a possible treatment option, particularly for MDD patients.

Background: Individuals with a history of childhood neglect may be vulnerable to develop depression, as they may more often use avoidant strategies to cope with the stressors. This study examined (1) whether a history of childhood neglect was associated with higher levels of depressive symptoms and (2) whether avoidant coping behaviors mediated this association.

Methods: In total, N = 2245 German adults (mean age = 41.1 years, age range = 18–82 years, 70.2% female) were recruited from the general population between June and September 2020 during the COVID-19 pandemic. Childhood neglect (Adverse Childhood Experience Questionnaire [ACE]), depressive symptoms (Patient Health Questionnaire [PHQ-9]), and three avoidant coping behaviors (substance use, behavioral disengagement, and self-blame; Brief Coping Orientation to Problems Experienced [COPE]) were assessed. Using structural equation modeling (SEM), we examined the direct pathway from childhood neglect to depressive symptoms in a simultaneous parallel multiple mediation model and the possible mediating paths of avoidant coping behaviors.

Results: Childhood neglect was positively and significantly associated with depressive symptoms (β = 0.24, p < 0.01) while controlling for the presence of childhood abuse. The three avoidant coping behaviors significantly mediated this association (substance use: bias-corrected 95% confidence intervals [BC 95% CI], 0.02, 0.05; behavioral disengagement: BC 95% CI, 0.04, 0.12; and self-blame: BC 95% CI, 0.16, 0.19). Post hoc contrasts between the mediators showed that self-blame had a significantly stronger indirect effect than substance use (BC 95% CI, −0.12, −0.01).

Conclusions: This study provides evidence that avoidant coping behaviors mediate the association between childhood neglect and depressive symptoms in adults. Avoidance coping behaviors may be a promising target for psychological interventions to reduce depressive symptoms.

Background: Depression and anxiety are among the most prevalent psychiatric disorders worldwide, affecting individuals of all ages. The co-occurrence of these disorders often exacerbates their negative health impacts, underscoring the necessity of understanding their comorbid mechanisms.

Methods: This study employed cross-lagged panel networks (CLPNs) to explore the longitudinal associations between depression and anxiety symptoms across three age groups and to compare the respective symptom networks. CLPNs were constructed through cross-temporal associations between different symptoms, reflecting both the pattern of interaction and the significance of specific symptoms in comorbidity. The sample consisted of 1258 adolescents (aged 13–19 years, M = 15.98), 1118 college students (aged 17–24 years, M = 19.94), and 548 older adults (aged 60–101 years, M = 85.19) from China. Depression and anxiety symptoms were assessed using the subscales of the Depression, Anxiety, and Stress Scale Short Version (DASS-21) at two time points over a 6-month period during 2020–2021.

Results: The findings revealed that the prevalence of depression and anxiety in adolescents, college students, and older adults was 25.9%/46.6%, 53.7%/61.5%, and 7.2%/22.5%, respectively. The network structure varied across age groups: adolescents and college students exhibiting a tight interconnection between depression and anxiety symptoms, while older adults showed stronger small-world network characteristics. A key finding across all age groups was the central role of irrational fear. In addition, somatic anxiety symptoms frequently emerged as outcomes of other psychological symptoms.

Conclusion: Depression and anxiety are more pronounced in college students compared to adolescents and older adults. Comparisons of the overall network structure provide insights into the lifelong trajectories of depression and anxiety symptom networks. The centrality of irrational fears and somatization symptoms is emphasized. These results offer guidance for more targeted clinical interventions.

Introduction: Patients with somatic symptom and related disorders (SSRDs) often face diagnostic delays, leading to frustration, unnecessary medical procedures, and excessive costs. This study examines healthcare utilization and costs in the 3 years before diagnosing SSRDs, comparing them to patients with depressive disorders and individuals with no mental disorder using data from the Korean National Health Insurance claims database. The analysis also addresses the influence of medical comorbidities by focusing on patients without them.

Methods: Utilizing Korean nationwide medical claims database covering all South Koreans, we identified individuals aged 15–64 diagnosed with SSRDs between 2015 and 2019. A corresponding group diagnosed with depression served as controls for nonpsychotic mental disorders. We analyzed medical costs and healthcare utilization comparing the SSRDs group to the depression group and the group with no mental disorder using nonparametric tests, including a specific analysis for those with a Charlson Comorbidity Index (CCI) of zero.

Results: The study encompassed 84,223 SSRD patients, 336,919 with depressive disorders, and 269,444 individuals with no mental disorder. Patients with SSRDs had significantly higher healthcare costs and made more frequent use of outpatient and emergency services than both control groups, a pattern consistent even in patients without medical comorbidities.

Conclusion: This large nationwide cohort study confirmed that patients with SSRDs frequently used the healthcare system and incurred considerable costs before their diagnosis. The findings suggest that plans for early recognition and intervention, along with mental health support for this population, are urgently needed to assist them and improve the efficiency of the healthcare system.

Ghrelin is a hormone consisting of 28 amino acids. Growth hormone secretagogue receptor (GHSR) is a receptor for ghrelin, which is expressed in the brain, pituitary gland, and adrenal glands, especially in the hypothalamus. The binding of ghrelin to the receptor 1a subtype mediates most of the biological effects of ghrelin. Ghrelin has a close relationship with the onset of psychosis. Ghrelin can affect the onset of psychosis by regulating neurotransmitters such as dopamine, γ-aminobutyric acid (GABA), and 5-hydroxytryptamine (5-HT) through the hypothalamus–pituitary–adrenal (HPA) axis, brain–gut axis, the mesolimbic dopamine system, and other ways. Ghrelin activates neuropeptide Y (NPY) in the hypothalamic arcuate nucleus (ARC) through the GHSR. Ghrelin binds to neurons in the ventral tegmental area (VTA), where it promotes the activity of dopamine neurons in the nucleus accumbens (NAcs) in a GHSR–dependent way, increasing dopamine levels and the reward system. This article summarized the recent research progress of ghrelin in depression, anxiety, schizophrenia, anorexia nervosa (AN), and bulimia nervosa (BN), and emphasized its potential application for psychiatric disorders treatment.