| 1. |
- Ekeblad, Annika, et al.
(författare)
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Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic
- 2016
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Ingår i: Depression and anxiety (Print). - : WILEY-BLACKWELL. - 1091-4269 .- 1520-6394. ; 33:12, s. 1090-1098
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundInterpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. MethodsNinety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. ResultsIPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score amp;lt;10). The dropout rate was significantly higher in CBT (40%; 19/47) compared to IPT (19%; 8/43). Statistically controlling for antidepressant medication use did not change the results. ConclusionsIPT was noninferior to CBT in a sample of depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity.
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| 2. |
- Halonen, Jaana, et al.
(författare)
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Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood—The 1987 Finnish Birth Cohort
- 2019
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Ingår i: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 36:4, s. 305-312
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Tidskriftsartikel (refereegranskat)abstract
- Background: Parental mental disorders have been shown to predict offspring's mental health problems. We examined whether pathways from parental mental disorders to offspring's psychiatric work disability in early adulthood are mediated through offspring's mental disorders and social disadvantage in adolescence.Methods: Study population consisted of the 1987 Finnish Birth Cohort. Data on parents’ psychiatric care or work disability due to mental diagnosis between 1987 and 2000 and the cohort participants’ health and social factors between 2001 and 2005 were derived from administrative national registers. From 2006 through 2015, 52,182 cohort participants were followed for admittance of psychiatric work disability due to depressive or anxiety disorders. First, we applied a pathway analysis to examine the occurrence of each path. We then used mediation analysis to assess the proportion of association between parental mental disorders and work disability mediated by offspring's health and social disadvantage.Results: The pathway model indicated that the association from parental mental disorders to offspring's work disability due to depressive or anxiety disorder is through mental disorders and social disadvantage in adolescence. Odds Ratio for the total effect of parental mental disorders on offspring's psychiatric work disability was 1.85 (95% confidence interval [CI] 1.46–2.34) in the model including offspring's mental disorders that mediated this association by 35%. Corresponding results were 1.86 (95% CI 1.47–2.35) and 28% for social disadvantage in adolescence.Conclusions: These findings suggest that intergenerational determination of work disability due to mental disorders could be addressed by actions supporting mental health and social circumstances in adolescence.
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| 3. |
- Holmquist, Sofie, et al.
(författare)
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Low physical activity as a key differentiating factor in the potential high-risk profile for depressive symptoms in older adults
- 2017
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Ingår i: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 34:9, s. 817-825
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The identification of potential high-risk groups for depression is of importance. The purpose of the present study was to identify high-risk profiles for depressive symptoms in older individuals, with a focus on functional performance.METHODS: The population-based Healthy Ageing Initiative included 2,084 community-dwelling individuals (49% women) aged 70. Explorative cluster analysis was used to group participants according to functional performance level, using measures of basic mobility skills, gait variability, and grip strength. Intercluster differences in depressive symptoms (measured by the Geriatric Depression Scale [GDS]-15), physical activity (PA; measured objectively with the ActiGraph GT3X+), and a rich set of covariates were examined.RESULTS: The cluster analysis yielded a seven-cluster solution. One potential high-risk cluster was identified, with overrepresentation of individuals with GDS scores >5 (15.1 vs. 2.7% expected; relative risk = 6.99, P < .001); the prevalence of depressive symptoms was significantly lower in the other clusters (all P < .01). The potential high-risk cluster had significant overrepresentations of obese individuals (39.7 vs. 17.4% expected) and those with type 2 diabetes (24.7 vs. 8.5% expected), and underrepresentation of individuals who fulfilled the World Health Organization's PA recommendations (15.6 vs. 59.1% expected; all P < .01), as well as low levels of functional performance.CONCLUSIONS: The present study provided a potential high-risk profile for depressive symptoms among elderly community-dwelling individuals, which included low levels functional performance combined with low levels of PA. Including PA in medical screening of the elderly may aid in identification of potential high-risk individuals for depressive symptoms.
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| 4. |
- Iliadis, Stavros I, et al.
(författare)
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Mid-pregnancy corticotropin-releasing hormone levels in association with postpartum depressive symptoms
- 2016
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Ingår i: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 33:11, s. 1023-1030
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Tidskriftsartikel (refereegranskat)abstract
- Background: Peripartum depression is a common cause of pregnancy and postpartum related morbidity. The production of corticotropin-releasing hormone (CRH) from the placenta alters the profile of hypothalamus-pituitary-adrenal axis hormones and may be associated with postpartum depression. The purpose of this study was to assess, in non-depressed pregnant women, the possible association between CRH levels in pregnancy and depressive symptoms postpartum.Methods: A questionnaire containing demographic data and the Edinburgh Postnatal Depression Scale was filled in gestational weeks 17 and 32, and six weeks postpartum. Blood samples were collected in week 17 for assessment of CRH. A logistic regression model was constructed, using postpartum Edinburgh Postnatal Depression Scale score as the dependent variable and log transformed CRH levels as the independent variable. Confounding factors were included in the model. Sub-analyses after exclusion of study subjects with preterm birth, small for gestational age newborns, and women on corticosteroids were performed.Results: 535 women without depressive symptoms during pregnancy were included. Logistic regression showed an association between high CRH levels in gestational week 17 and postpartum depressive symptoms, before and after controlling for several confounders (unadjusted Odds Ratio = 1.11; 95% CI 1.01 – 1.22, adjusted Odds Ratio = 1.13; 95% CI 1.02 – 1.26, per 0.1 unit increase in log corticotropin-releasing hormone). Exclusion of women with preterm birth and newborns small for gestational age as well as women who used inhalation corticosteroids during pregnancy did not alter the results.Conclusions: This study suggests an association between high CRH levels in gestational week 17 and the development of postpartum depressive symptoms, among women without depressive symptoms during pregnancy.
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| 5. |
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| 6. |
- Morina, N., et al.
(författare)
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The impact of enhancing perceived self-efficacy in torture survivors
- 2018
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Ingår i: Depression and anxiety (Print). - : Blackwell Publishing Inc.. - 1091-4269 .- 1520-6394. ; 35:1, s. 58-64
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Tidskriftsartikel (refereegranskat)abstract
- Background: Perceived self-efficacy (SE) is an important factor underlying psychological well-being. Refugees suffer many experiences that can compromise SE. This study tested the impact of enhancing perceived SE on coping with trauma reminders and distress tolerance in tortured refugees. Methods: Torture survivors (N = 40) were administered a positive SE induction in which they retrieved mastery-related autobiographical memories, or a non-SE (NSE) induction, and then viewed trauma-related images. Participants rated their distress following presentation of each image. Participants then completed a frustration-inducing mirror-tracing task to index distress tolerance. Results: Participants in the SE condition reported less distress and negative affect, and improved coping in relation to viewing the trauma-related images than those in the NSE condition. The SE induction also led to greater persistence with the mirror-tracing task than the NSE induction. Conclusions: These findings provide initial evidence that promoting SE in tortured refugees can assist with managing distress from trauma reminders, and promoting greater distress tolerance. Enhancing perceived SE in tortured refugees may increase their capacity to tolerate distress during therapy, and may be a useful means to improve treatment response. © 2017 Wiley Periodicals, Inc.
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| 7. |
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| 8. |
- Price, Rebecca B., et al.
(författare)
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Less is more : Patient-level meta-analysis reveals paradoxical dose-response effects of a computer-based social anxiety intervention targeting attentional bias
- 2017
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Ingår i: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 34:12, s. 1106-1115
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Forskningsöversikt (refereegranskat)abstract
- Background: The past decade of research has seen considerable interest in computer-based approaches designed to directly target cognitive mechanisms of anxiety, such as attention bias modification (ABM).Methods: By pooling patient-level datasets from randomized controlled trials of ABM that utilized a dot-probe training procedure, we assessed the impact of training "dose" on relevant outcomes among a pooled sample of 693 socially anxious adults.Results: A paradoxical effect of the number of training trials administered was observed for both posttraining social anxiety symptoms and behavioral attentional bias (AB) toward threat (the target mechanism of ABM). Studies administering a large (>1,280) number of training trials showed no benefit of ABM over control conditions, while those administering fewer training trials showed significant benefit for ABM in reducing social anxiety (P = .02). These moderating effects of dose were not better explained by other examined variables and previously identified moderators, including patient age, training setting (laboratory vs. home), or type of anxiety assessment (clinician vs. self-report).Conclusions: Findings inform the optimal dosing for future dot-probe style ABM applications in both research and clinical settings, and suggest several novel avenues for further research.
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| 9. |
- Renna, Megan E., et al.
(författare)
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The association between anxiety, traumatic stress, and obsessive-compulsive disorders and chronic inflammation : A systematic review and meta-analysis
- 2018
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Ingår i: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 35:11, s. 1081-1094
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Tidskriftsartikel (refereegranskat)abstract
- Background Methods Anxiety is characterized by prolonged preparation for real or perceived threat. This may manifest both as psychological and physiological activation, ultimately leading to greater risk for poor health. Chronic inflammation may play an integral role in this relationship, given the influential role that it has in chronic illness. The aim of this meta-analysis is to examine levels of chronic inflammation, measured by inflammatory cytokines and C-reactive protein, in people with anxiety disorders, PTSD (posttraumatic stress disorder), or obsessive-compulsive disorder compared to healthy controls. Several moderating variables, including specific diagnosis and depression comorbidity, were also assessed. Seventy six full-text articles were screened for eligibility with 41 studies ultimately included in analysis. Results Conclusions Results demonstrated a significant overall difference between healthy controls (HCs) and people with anxiety disorders in pro-inflammatory cytokines (P = 0.013, Hedge's g = -0.39), which appears to be largely driven by interleukin-1 beta (IL-1 beta; P = 0.009, Hedge's g = -0.50), IL-6 (P < 0.001, Hedge's g = -0.93), and tumor necrosis factor-alpha (P = 0.030, Hedge's g = -0.56). Moderation analyses revealed a moderating effect of diagnosis (P = 0.050), as only individuals with PTSD demonstrated differences in inflammation between HCs (P = 0.004, Hedge's g = -0.68). These data demonstrate the association between inflammatory dysregulation and diagnoses associated with chronic, impactful, and severe anxiety and provides insight into the way that anxiety, and in particular PTSD, is related to certain inflammatory markers. In doing so, these findings may provide an initial step in disentangling the relationship between anxiety and basic health processes.
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| 10. |
- Sigström, Robert, 1982, et al.
(författare)
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Nine-year follow-up of specific phobia in a population sample of older people
- 2016
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Ingår i: Depression and Anxiety. - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 33:4, s. 339-46
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little is known about the long-term course of specific phobia (SP) in the general population. We examined the prevalence and course of SP and subthreshold fears in an older population followed over 9 years. METHOD: A psychiatric examination was performed in a population-based sample of 558 70-year-olds, among whom 303 dementia-free survivors were followed up at both ages 75 and 79. Fears were rated with respect to level of anxiety and social or other consequences. DSM-IV SP was diagnosed when fears were associated with prominent anxiety and had social or other consequences. All other fears were labeled subthreshold fears. RESULTS: The prevalence of SP declined from 9.9% at age 70 to 4.0% at age 79. The reason was that the prevalence of fears associated with prominent anxiety (mandatory in the diagnosis) decreased whereas the prevalence of fears that gave social or other consequences remained stable. A total of 14.5% of the population had SP at least once during the study. Among these, 11.4% had SP and 65.9% had specific fear at all three examinations. CONCLUSION: The prevalence of fears associated with prominent anxiety decreased with age, resulting in an overall decline in the prevalence of SP. SP seems to be a fluctuating disorder, and in most cases an exacerbation of chronic subthreshold fears.
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| 11. |
- Silverman, Michael E., et al.
(författare)
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The risk factors for postpartum depression : A population-based study
- 2017
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Ingår i: Depression and anxiety (Print). - Hoboken, USA : John Wiley & Sons. - 1091-4269 .- 1520-6394. ; 34:2, s. 178-187
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Tidskriftsartikel (refereegranskat)abstract
- Background: Postpartum depression (PPD) can result in negative personal and child developmental outcomes. Only a few large population-based studies of PPD have used clinical diagnoses of depression and no study has examined how a maternal depression history interacts with known risk factors. The objective of this study was to examine the impact of a depression history on PPD and pre- and perinatal risk factors.Methods: A nationwide prospective cohort study of all women with live singleton births in Sweden from 1997 through 2008 was conducted. Relative risk (RR) of clinical depression within the first year postpartum and two-sided 95% confidence intervals were estimated.Results: The RR of PPD in women with a history of depression was estimated at 21.03 (confidence interval: 19.72-22.42), compared to those without. Among all women, PPD risk increased with advanced age (1.25 (1.13-1.37)) and gestational diabetes (1.70 (1.36-2.13)). Among women with a history of depression, pregestational diabetes (1.49 (1.01-2.21)) and mild preterm delivery also increased risk (1.20 (1.06-1.36)). Among women with no depression history, young age (2.14 (1.79-2.57)), undergoing instrument-assisted (1.23 (1.09-1.38)) or cesarean (1.64(1.07-2.50)) delivery, and moderate preterm delivery increased risk (1.36 (1.05-1.75)). Rates of PPD decreased considerably after the first postpartum month (RR = 0.27).Conclusions: In the largest population-based study to date, the risk of PPD was more than 20 times higher for women with a depression history, compared to women without. Gestational diabetes was independently associated with a modestly increased PPD risk. Maternal depression history also had a modifying effect on pre- and perinatal PPD risk factors.
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| 12. |
- Strauss, Timmy, et al.
(författare)
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Touch aversion in patients with interpersonal traumatization
- 2019
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Ingår i: Depression and anxiety (Print). - : WILEY. - 1091-4269 .- 1520-6394. ; 36:7, s. 635-646
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Tidskriftsartikel (refereegranskat)abstract
- Background Interpersonal touch is a key aspect of human interaction and a usually very comforting experience. For patients suffering from posttraumatic stress disorders (PTSD) caused by interpersonal traumatization, such touch is affectively ambiguous. Methods In two studies, we investigated the experience and neural processing of various types of interpersonal and impersonal touch in patients as compared with healthy controls. Results Patients strongly disliked show, interpersonal skin-to-skin stroking, while controls appreciated this kind of touch. No group differences were observed for ratings of impersonal touch. Similarly, the neural activation differed between groups for interpersonal, but not for impersonal touch. The interpersonal touch aversion in patients was accompanied by enhanced blood-oxygen-level-dependent response in the superior temporal gyrus and by a pronounced reduction of response in the hippocampus. This reduction was significantly correlated to symptoms of negative alterations and arousal within the patients. Conclusion We interpret the hippocampal suppression as an attempt to control traumatic memories, evoked by interpersonal touch. This mechanism may maintain the aversion of interpersonal touch in patients with interpersonal trauma-related PTSD.
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