Depression and Anxiety最新文献

The objective of this study was to assess the effectiveness of nonpharmacological interventions in enhancing the mental health and psychosocial outcomes of parents who have experienced perinatal loss, in comparison to active/inactive control groups. It also sought to identify the characteristics and components of effective interventions in the included studies. A comprehensive search was conducted across seven databases from January 2008 to December 2023. The analysis included randomized controlled trials (RCTs) published in English journals and dissertations that reported at least one mental health outcome postintervention for parents with perinatal loss. Twenty-one RCTs were included. The findings demonstrated significant improvements of nonpharmacological interventions in the grief, posttraumatic stress disorder, depression, anxiety, and perceived social support of parents with perinatal loss, with moderate-to-high certainty of evidence. Optimal characteristics of nonpharmacological interventions for parents with perinatal loss were identified to inform future studies, including the intervention approaches (cognitive-based interventions), delivery modalities (face-to-face), and formats (individual-based), and a recommended number of sessions of four or fewer. To validate these findings and explore the process of nonpharmacological interventions in improving health outcomes for parents with perinatal loss from diverse backgrounds, further rigorous RCTs with larger sample sizes and longer follow-up periods are required.

Background. Depression is a disorder that can have a serious impact on functioning and quality of life. Understanding the global, regional, and national epidemiology of depression in working-age populations (15–49 years) is important for informing mental health policies and services. However, up-to-date data have been lacking, especially in developing regions. Methods. This study delved into the prevalence of depression among individuals in the working-age group, specifically those between 15 and 49 years, by analyzing data from the 2019 Global Burden of Disease, Injuries, and Risk Factors Study (GBD). The comprehensive analysis aimed to determine the age-standardized prevalence, incidence, and disability-adjusted life years (DALYs) associated with depression across diverse groups. It considered factors such as geographical regions, age brackets, genders, and sociodemographic indices, spanning a time frame from 1990 to 2019. Results. Globally, the estimated prevalent cases, incident cases, and DALYs for depression increased from 1990 to 2019. Regionally, certain regions like Central Latin America saw rapid increases in age-standardized prevalence and incidence rates over time. By sociodemographic regions, all tiers witnessed rises in incident cases, with high sociodemographic index (SDI) areas having the greatest burden in 2019. Nationally, countries such as India, China, and the United States had the highest total prevalence and incidence in 2019, while nations like Yemen and Angola reported exceptionally high age-standardized rates (ASRs). Peak prevalence risk occurred in the mid-to-late 40s age range. Period effects showed declining risks over time. Earlier birth cohorts, especially before the mid-1960s, faced higher risks than more recent generations. Population growth rather than epidemiological changes appeared to drive increases in disease burden. Conclusion. From 1990 to 2019, the overall trend of depression burden in working-age individuals presents regional and national variations and differs by age, sex, period, and cohort.

Although the benefits of physical activity (PA) on mental well-being are well established, the vulnerability of women during pregnancy and the postpartum period poses challenges in studying the effects of PA on postpartum depression (PPD). This study investigated the association between total and domain-specific PA levels during pregnancy and postpartum depressive symptoms. The study included 105 healthy pregnant women whose PA status was evaluated by the Serbian version of the Physical Activity Questionnaire during Pregnancy (PPAQ-SRB) and their postpartum mental health by the Edinburgh Postnatal Depression Scale. Multivariable logistic regression was used to explore the independent relationship between PPAQ-SRB scores and the prediction of the PPD symptom occurrence. Our analysis revealed that the development of PPD symptomatology was associated with a lower “Total PPAQ-SRB score” (odds ratio (OR) 0.81; 95% confidence interval (CI) [0.70–0.93]; p = 0.03) and “Total Activity score” (OR 0.82; 95% CI [0.71–0.93]; p = 0.03) as well as lower scores of light-intensity PA (OR 0.81; 95% CI [0.69–0.96]; p = 0.013), moderate-intensity PA (OR 0.82; 95% CI [0.71–0.94]; p = 0.005), “Household/care” (OR 0.85; 95% CI [0.73–0.98]; p = 0.028), and “Occupational” activities (OR 0.80; 95% CI [0.78–0.95]; p = 0.012). Lower levels of light-to-moderate-intensity household and occupational activities appeared to increase the risk of PPD, indicating the importance of circumstances under which PA is performed. Hence, our findings indicate that PA during pregnancy can mitigate mood disorders in postpartum mothers. Moreover, reduced participation in light-to-moderate-intensity household and occupational activities seemed to increase the risk of PPD.

Background. One of the most common symptoms in multiple sclerosis (MS) is depression, which causes disruption to daily participation. MS as a degenerative disease causes caregiver strain. The aim of this study is to analyze the influence of depression on the occupational performance of people with MS and to study whether these aspects influence caregiver strain. Materials and Methods. A descriptive cross-sectional observational study was carried out. A total of 124 people with a diagnosis of multiple sclerosis were assessed and administered the Beck Depression Inventory-II, the Canadian Occupational Performance Measure, and the Zarit Caregiver Burden Scale. Results. MS type influences performance, involvement, and caregiver burden. High levels of depression are associated with low levels of participation and performance. The types of MS with the highest caregiver burden are relapsing–remitting and secondary progressive. Conclusions. The type of MS negatively influences occupational performance. Depression and occupational performance are related to caregiver strain. The greater the depressive symptoms, the worse the performance, and the more caregiver strain.

Objective. Depressive symptoms during pregnancy increase the risk for adverse outcomes in women and children. Lower vitamin D levels are suggested to be associated with higher depressive symptoms in nonpregnant populations. We studied if the level of or change in serum of 25-hydroxyvitamin D (25(OH)D) concentration was associated with the levels of depressive symptoms during pregnancy. Methods. The participants of this prospective longitudinal study came from the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) study. The analytic sample comprised 307 women (mean age = 32.5 (range 20.3–44.3)) who reported depressive symptoms concurrently with serum 25(OH)D measurements at a median of 13.0, 19.3, and 27.0 gestational weeks. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Linear and mixed-model regression analyses were used to study the associations. Results. The 25(OH)D levels were not associated with depressive symptoms cross-sectionally (p values > 0.58) or across the three assessment points during pregnancy (B = −0.05; 95% CI, −0.12, 0.01; and p = 0.12). Yet, a higher increase in 25(OH)D during pregnancy was associated with lower levels of depressive symptoms (B = −1.41; 95% CI, −2.75, −0.07; and p = 0.04) but not after adjusting for covariates (p = 0.08). Conclusions. The 25(OH)D levels and depressive symptoms were not associated among pregnant women throughout the pregnancy. However, there is a need for randomized controlled trials to fully exclude the possibility of vitamin D supplementation in the prevention of depression during pregnancy.

This research has suggested a link between major depressive disorder (MDD) and infertility, with interleukin-18 (IL-18) being proposed as a potential mediator due to its connections to both conditions. A Mendelian randomization (MR) approach was utilized in this study, which drew on genetic data from 500,199 European participants studied for MDD, along with additional IL-18 and reproductive health data from the FinnGen consortium and GWAS datasets. Single nucleotide polymorphisms were employed as instrumental variables to examine the causal relationships between MDD, genetically predicted IL-18 levels, and infertility. In our study, bidirectional MR analysis revealed a significant inverse causal relationship between MDD and genetically predicted IL-18 levels, with a higher genetic predisposition to MDD, correlating with reduced IL-18 levels (β: −0.40; 95% confidence interval (CI): −0.69 to −0.11; P = 7.09 × 10⁻³). Additionally, MDD is found to significantly increase the risk of female infertility. Notably, genetically predicted IL-18 levels demonstrated a protective effect against female infertility (odds ratio (OR): 0.92; 95% CI: 0.86–0.98; P = 1.17 × 10⁻²). Mediation analysis indicated that genetically predicted IL-18 levels partially mediated the impact of MDD on female infertility associated with cervical, vaginal, other or unspecified origin, accounting for up to 14.61% of this effect. No evidence of pleiotropy or heterogeneity was detected. The role of genetic predispositions to MDD in influencing genetically predicted IL-18 levels, and subsequently, female infertility, was highlighted by our study, offering insights into the complex interplay between mental health and reproductive biology. These findings contribute to a deeper understanding of the genetic and molecular pathways influencing these conditions, suggesting new directions for research and potential therapeutic interventions.

Despite the presence of individual differences in the depressive symptom change in adults during the COVID-19 pandemic, most studies have investigated population-level changes in depression during the first year of the pandemic. This longitudinal repeated-measurement study obtained 39,259 observations from 4,361 adults assessed nine times over a 24-month period in Norway (March 2020 to March 2022). Using a Latent Change Score Mixture Model to investigate differential change patterns in depressive symptoms, five profiles were identified. Most adults revealed a consistently resilient (42.52%) or predominantly resilient pattern differentiated by an initial shock in symptomatology (13.17%). Another group exhibited consistently high depressive adversities (8.5%). One group showed mild deterioration with small increases in depressive symptomatology compared to onset levels (29.04%), and a second strong deterioration group exhibited clinically severe levels of gained symptoms over time (6.77%). Both deteriorating depressive symptom change patterns predicted the presence of a psychiatric diagnosis and treatment seeking at the end of the study period. Together, the absence of a preexisting psychiatric diagnosis at the onset of the pandemic and severe symptom increases during, combined with reports of psychiatric treatment seeking and diagnosis at the end of the study period, indicated that the strongly deteriorating subgroup represents an additional and newly emerged group of adults struggling with depressive problems. Factors related to general adverse change (lower education levels, lone residence), initial shocks prior to recovery (frequent information seeking, financial and occupational concerns), and resilience and recovery (older age, being in a relationship, physical activity) were identified. Binge drinking and belonging to an ethnic minority were influential predictors of the strongly deteriorating group. All major change patterns in depressive symptoms occurred during the first 3 months of the pandemic, suggesting this period represents a window of sensitivity for the development of long-lasting depressive states versus patterns of recovery and resilience. These findings call for increased vigilance of psychiatric symptoms during the initial phases of infectious disease outbreaks and highlight a specific target period for the implementation of preventive measures.

Objective. To explore the psychological impact of gynecological cancers on middle-aged women in Southwest China and identify the risk factors for moderate to severe depressive symptoms. Methods. This cross-sectional study included 500 patients from Southwest China, divided into two groups: depression (n = 220) and no depression (n = 280). Data on demographics, clinical characteristics, and socioeconomic factors were collected. We developed a logistic regression model to predict depressive symptoms and assessed its accuracy using the area under the receiver operating characteristic curve (AUC). Results. The study cohort consisted of 500 middle-aged and young female cancer patients with a median age of 44 years. Significant predictors of depressive symptoms included younger age, higher economic stress levels, and out-of-pocket medical expenses. A comparative analysis showed that 220 patients exhibited depression symptoms, with these patients being generally younger (median age 41 years) compared to those without depression (median age 47 years, p < 0.001). Economic stress was consistently higher in the depression group across all cancer types. Patients with ovarian cancer had a reduced risk of depression compared to those with cervical cancer. The predictive model demonstrated high accuracy in identifying depression risk, with an AUC of 0.888. Internal validation yielded an average AUC of 0.885, and external validation produced an AUC of 0.872, underscoring the model’s robustness and reliability. These findings emphasize the complex interplay of demographic, socioeconomic, and clinical factors in the psychological well-being of gynecological cancer patients, highlighting the need for tailored psychological and financial support interventions. Conclusion. Gynecological cancer patients in Southwest China experience significant psychological challenges, particularly younger women and those facing economic stress. Our predictive model can aid in early identification of those at risk for depression, emphasizing the importance of holistic care. Interventions should focus on both psychological and financial support to improve patient outcomes.

There is an increased risk for depression and anxiety across the perinatal period (i.e., spanning pregnancy and the first year postpartum); however, limited research has examined elevations in core negative affectivity underlying internalizing disorders more broadly. The current study sought to characterize trajectories of core internalizing problems among both mothers and fathers across the perinatal period and explored whether modifiable risk and protective factors buffered risk for elevated symptoms during this key developmental transition. A community sample of mixed-sex couples (N = 159) completed assessments during pregnancy and at four postpartum timepoints. Using growth mixture modeling, we found that 21.2% of mothers demonstrated clinical elevations in core internalizing symptoms that persisted up to 2 years postpartum. In contrast, 7.8% of fathers demonstrated clinical elevations in core internalizing symptoms across this period, with an additional 29.0% of fathers demonstrating subthreshold symptom elevations. Concerns related to pregnancy and childbirth and paternal (partner) internalizing problems during pregnancy conferred risk for elevated symptoms in mothers, whereas psychological flexibility, emotional intimacy, and the quality of received support were identified as protective factors for fathers. Results highlight the importance of repeated screening for internalizing problems and suggest that promoting a strong interparental relationship is critical for emotional health and well-being across the perinatal period.

Background. Although highly efficacious psychological treatments for posttraumatic stress disorder (PTSD) exist, there is evidence that first-line psychological treatment approaches leave a substantial subgroup of patients still suffering from clinically relevant PTSD symptoms posttreatment. Aims. We aimed to meta-analytically establish the prevalence and predictors of nonresponse to first-line guideline-recommended psychological treatments for PTSD. Materials and Methods. This meta-analysis was preregistered (CRD42023368766). We searched the PTSD Trials Standardized Data Repository, Embase, Medline, PsychINFO, and PTSDpubs. We included randomized controlled trials (RCT), reporting data on nonresponse operationalized by (lack of) symptom reduction in PTSD symptoms at posttreatment of first-line guideline-recommended PTSD treatments for adult patients meeting criteria for a PTSD diagnosis. All studies published by October 10, 2023, were included. Data were extracted by two independent reviewers. We estimated the pooled average nonresponse rates and ORs. Subgroup and metaregression analyses targeting the nonresponse rates served to identify significant predictors. All analyses were conducted using three-level multilevel models. Study quality was assessed using Cochrane’s RoB 2 tool. Results. Eighty six studies with 117 active treatment conditions and 7,894 participants were included in the meta-analysis. The weighted average nonresponse rate was 39.23%, 95% CI (35.08%, 43.53%). Nonresponse was less frequent in the treatment condition compared to the control condition (OR = 0.22). Subgroup analyses and metaregression revealed the type of analysis, population, type of intervention, treatment format, year of publication, age, sex, PTSD symptom severity, comorbid depression, and baseline depression score as significant predictors. The heterogeneity between studies was substantial to considerable (I² = 83.12%). Half of the studies had a high risk of bias. Conclusions. This meta-analysis found that a substantial subgroup of patients suffering from PTSD still showed clinically significant symptoms after having received treatment. Treatment modifications should be considered for specific subgroups of PTSD patients based on predictors found to be associated with nonresponse.