Prenatal marijuana exposure: effect on child depressive symptoms at ten years of age

Studies of the consequences of prenatal marijuana use have reported effects predominantly on the behavioral and cognitive development of the children. Research on other aspects of child neurobehavioral development, such as psychiatric symptomatology, has been limited. This study examines the relations between prenatal marijuana exposure (PME) and child depressive symptoms at 10 years of age. Data are from the 10-year follow-up of 633 mother-child dyads who participated in the Maternal Health Practices and Child Development Project. Maternal prenatal and current substance use, measures of the home environment, demographic status, and psychosocial characteristics were ascertained at prenatal months four and seven, at delivery, and at age 10. At age 10, the children also completed the Children's Depression Inventory (CDI) [M. Kovacs. The Children's Depression Inventory, Multi-Health Systems, Inc., North Tonawanda, NY, (1992).], a self-report measure of current depressive symptoms. Multivariate regressions were used to test trimester-specific effects of marijuana and their associations with the CDI total score, while controlling for significant prenatal predictors and significant current covariates of childhood depression. PME in the first and third trimesters predicted significantly increased levels of depressive symptoms. This finding remained significant after controlling for all identified covariates from both the prenatal period and the current phase at age 10. These findings reflect an association with the level of depressive symptoms rather than a diagnosis of a major depressive disorder. Other significant correlates of depressive symptoms in the children included maternal education, maternal tobacco use (prenatal or current), and the child's composite IQ score. These findings are consistent with recent reports that identify specific areas of the brain and specific brain functions that are associated with PME.     

A decrease in the plasma DHEA to cortisol ratio during smoking abstinence may predict relapse: a preliminary study

Rationale Increases in depressive symptoms during smoking cessation have been associated with risk for relapse. Several studies have linked plasma levels of cortisol and dehydroepiandrosterone (DHEA) or DHEA-sulfate (DHEAS) to depressive symptoms.Objectives To determine whether changes in plasma cortisol, DHEA, or DHEAS levels and emergence of depressive symptoms during smoking cessation are associated with smoking relapse.Materials and methods Subjects were healthy non-medicated men and women, aged 39±12 years, who smoked, on average, 22 cigarettes per day. Depressive symptoms, smoking withdrawal symptoms, and plasma steroid levels were measured before and after 8 days of verified smoking abstinence. Relapse status at day 15 was then determined.Results In the full sample (n=63), there was a trend for changes in depressive symptoms to be associated with relapse. In the subset of 25 subjects with plasma neuroactive steroid data, there was a significant interaction between the change in the plasma DHEA/cortisol ratio from day 0 to day 8 and relapse status at day 15. This ratio was similar before abstinence, but lower at day 8 in relapsed, compared to abstinent, subjects. Changes in the DHEA/cortisol ratio tended to predict changes in depressive symptoms in the women only.Conclusion A decrease in the plasma DHEA/cortisol ratio during 8 days of smoking abstinence was associated with relapse over the following week. Further research is needed to fully characterize sex-specific relationships between abstinence-induced changes in neuroactive steroid levels, depressive or withdrawal symptoms, and relapse. Such research may lead to new interventions for refractory smoking dependence.     

Psychiatric Symptoms,Parental Attachment,and Reasons for Use as Correlates of Heavy Substance Use Among Treatment-Seeking Hispanic Adolescents

In early adolescence, Hispanics self-report higher drug use rates compared to White and African American peers. Among adolescent users, heavy users have more negative behavioral and health consequences. The purpose of this cross-sectional study is to examine whether psychiatric symptoms, parental attachment, and reasons for use predict heavy alcohol and illicit drug use (more than 10 times in the past three months) among Hispanic adolescents. Methods: This study examines baseline data from a study evaluating a family based substance abuse treatment program for Hispanic adolescents. Participants were 14–17 years old (N = 156, 44% female). Adolescent reports on the Diagnostic Interview Schedule for Children Predictive Scales measured psychiatric symptoms of major depressive disorder, attention deficit hyperactivity disorder, conduct disorder, and anxiety. The Personal Experiences Inventory measured type and amount of drug use, as well as perceived social and psychological benefits of drug use. The Inventory of Parent and Peer Attachment measured trust, communication, and alienation between adolescents and their mothers. Logistic regression identified correlates of heavy alcohol use and heavy illicit drug use among Hispanic adolescents. Results: Higher social benefits were associated with increased likelihood of heavy alcohol use. Conduct disorder, higher levels of maternal attachment, lower levels of acculturation, and higher levels of psychological benefits of use were associated with an increased likelihood of heavy illicit drug use. Conclusion: These findings support the assumption that substance use treatment among Hispanic adolescents must be capable of addressing co-occurring psychiatric disorders, familial relationships, and the individual reasons/motivators to use.     

Prenatal cocaine exposure, gender, and adolescent stress response: A prospective longitudinal study

Prenatal cocaine exposure is associated with alterations in arousal regulation in response to stress in young children. However, relations between cocaine exposure and stress response in adolescence have not been examined. We examined salivary cortisol, self-reported emotion, heart rate, and blood pressure (BP) responses to the Trier Social Stress Test (TSST) in 49 prenatally cocaine and other drug exposed (PCE) and 33 non-cocaine-exposed (NCE) adolescents. PCE adolescents had higher cortisol levels before and after stress exposure than NCE adolescents. PCE girls showed an elevated anxiety response to stress (compared to NCE girls) and PCE boys showed a dampened diastolic BP response (compared to NCE boys). Girls showed higher anger response and lower pre-stress systolic BP than boys. Group differences were found controlling for potential confounding variables and were not moderated by caregiver–child relationship quality (although relationship quality predicted HPA axis and anxiety response). The findings suggest that prenatal drug exposure is associated with altered stress response in adolescence and that gender moderates this association.     

Exercise-Associated Changes in the Corticosterone Response to Acute Restraint Stress: Evidence for Increased Adrenal Sensitivity and Reduced Corticosterone Response Duration

Exercise promotes stress resistance and is associated with reduced anxiety and reduced depression in both humans and in animal models. Despite the fact that dysfunction within the hypothalamic pituitary adrenal (HPA) axis is strongly linked to both anxiety and depressive disorders, the evidence is mixed as to how exercise alters the function of the HPA axis. Here we demonstrate that 4 weeks of voluntary wheel running was anxiolytic in C57BL/6J mice and resulted in a shorter time to peak corticosterone (CORT) and a more rapid decay of CORT following restraint stress. Wheel running was also associated with increased adrenal size and elevated CORT following systemic administration of adrenocorticotropic hormone. Finally, the HPA-axis response to peripheral or intracerebroventricular administration of dexamethasone did not suggest that wheel running increases HPA-axis negative feedback through GR-mediated mechanisms. Together these findings suggest that exercise may promote stress resilience in part by insuring a more rapid and shortened HPA response to a stressor thus affecting overall exposure to the potentially negative effects of more sustained HPA-axis activation.     

Substance Use,Anxiety, and Depressive Symptoms Among College Students

Research on college substance use and mental illness is limited and inconsistent. Measures of substance use, and anxiety and depressive symptoms, were completed by 1,316 undergraduates within a major drug transportation corridor. Hierarchical linear regressions were used to test associations between anxious and depressive symptoms and substance use (i.e., alcohol, cannabis, tobacco, cocaine, other amphetamines, sedatives, hallucinogens, and designer drugs). Depressive symptoms were associated with use of cannabis, tobacco, amphetamines, cocaine, sedatives, and hallucinogens. Anxiety symptoms were unrelated to substance use. These findings support the need for education and prevention at universities, emphasizing tobacco, cannabis, and certain “harder” drugs.     

Continued smoking and continued alcohol consumption during early pregnancy distinctively associated with personality

Pregnancy is a unique period to quit smoking and alcohol consumption and although motivated, not all women succeed at this. We investigated the associations of personality with continued smoking and continued alcohol consumption during early pregnancy. In addition, we studied whether antenatal anxiety and depressive symptoms can explain these associations. Two antenatal measurements from the population-based Pregnancy Anxiety and Depression cohort study were used. Pregnant women in their first trimester were recruited via midwifery practices and hospitals. We analyzed a sample of women who continued (n = 101) or quit smoking (n = 254), and a sample of women who continued (n = 110) or quit alcohol consumption (n = 1230). Measures included questions about smoking, alcohol consumption, the NEO-Five Factor Inventory (personality), the State Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. We found associations between continued alcohol consumption and higher levels of openness to experience, and lower levels of conscientiousness (p < 0.05). The association between conscientiousness and continued alcohol consumption was partly explained by both anxiety and depressive symptoms. No associations between personality and continued smoking emerged. This study contributes to the limited literature on personality differences between women who continue and quit smoking and alcohol consumption during early pregnancy. General population studies have not confirmed the association between openness to experience and alcohol consumption which implies that pregnancy is indeed a unique period. Increased insight in how personality influences continued smoking and alcohol consumption during pregnancy can help health professionals to improve lifestyle interventions targeted at pregnant women.     

Gastrointestinal complaints among subjects with depressive symptoms in the general population

Background  Patients with depression have irritable bowel syndrome (IBS) more often than do nondepressed patients, but the comorbidity of depression and gastrointestinal (GI) symptoms in the general population has received little study.
Aim  To study the co-occurrence of depressive and GI symptoms in a general population sample and to assess the rate of health-care utilization particularly for GI reasons among subjects with depressive symptoms.
Methods  A questionnaire containing the Finnish version of the Beck Depression Inventory Short Form and questions covering GI symptoms according to Rome II criteria was mailed to 5000 randomly selected adults.
Results  Response rate was 73%. Prevalence of depressive symptoms was 17% (95% CI: 15.7–18.2). Frequent abdominal pain, diarrhoea, constipation, dyspepsia or IBS were present in 54% of those with depressive symptoms and in 29% of nondepressed controls ( P  < 0.0001). Of those with depressive symptoms, 24% had visited a physician at least once because of abdominal symptoms during the previous year, compared to 13% of controls ( P  < 0.0001).
Conclusions  Depressive symptoms are prevalent in the general population. They are associated with a high rate of GI symptoms, leading to increased use of health-care services and work absenteeism because of abdominal complaints.     

Variation in the Glucocorticoid Receptor Gene at rs41423247 Moderates the Effect of Prenatal Maternal Psychological Symptoms on Child Cortisol Reactivity and Behavior

Prenatal maternal psychopathology affects child development, but some children seem more vulnerable than others. Genetic variance in hypothalamic–pituitary–adrenal axis genes may influence the effect of prenatal maternal psychological symptoms on child emotional and behavioral problems. This hypothesis was tested in the Generation R Study, a population-based cohort from fetal life onward. In total, 1727 children of Northern European descent and their mothers participated in this study and were genotyped for variants in the glucocorticoid receptor (GR) gene (rs6189/rs6190, rs10052957, rs41423247, rs6195, and rs6198) and the FK506-binding protein 5 (FKBP5) gene (rs1360780). Prenatal maternal psychological symptoms were assessed at 20 weeks pregnancy and child behavior was assessed by both parents at 3 years. In a subsample of 331 children, data about cortisol reactivity were available. Based on power calculations, only those genetic variants with sufficient minor allele frequencies (rs41423247, rs10052957, and rs1360780) were included in the interaction analyses. We found that variation in GR at rs41423247 moderates the effect of prenatal maternal psychological symptoms on child emotional and behavioral problems (beta 0.41, SE 0.16, p=0.009). This prenatal interaction effect was independent of mother''s genotype and maternal postnatal psychopathology, and not found for prenatal psychological symptoms of the father. Moreover, the interaction between rs41423247 and prenatal psychological symptoms was also associated with decreased child cortisol reactivity (beta −2.30, p-value 0.05). These findings emphasize the potential effect of prenatal gene–environment interaction, and give insight in possible mechanisms accounting for children''s individual vulnerability to develop emotional and behavioral problems.     

Physiological regulation in cigarette exposed infants: an examination of potential moderators

The primary purpose of this study was to examine pathways from prenatal cigarette exposure to physiological regulation at 2 months of age. Specifically, we explored the possibility that any association between prenatal cigarette exposure and infant physiological regulation was moderated by fetal growth, prenatal or postnatal environmental tobacco smoke (ETS) exposure or maternal depressive symptomatology during pregnancy. We evaluated whether exposed infants who were also exposed to ETS after birth, were small for gestational age (SGA) or had mothers with higher depressive symptoms during pregnancy had the highest levels of physiological dysregulation. Respiratory sinus arrhythmia (RSA) was obtained from 234 (166 exposed and 68 nonexposed) infants during sleep. As expected, cigarette-exposed infants had significantly lower RSA than nonexposed infants. This association was not moderated by prenatal or postnatal ETS exposure, or maternal depressive symptomatology during pregnancy. However, small for gestational age status did moderate this association such that nonexposed infants who were not small for gestational age had a significantly higher RSA than nonexposed small for gestational age infants and exposed infants. These findings provide additional evidence that prenatal cigarette exposure is directly associated with dysregulation during infancy.     

Maternal prenatal state anxiety symptoms and birth weight: A pilot study

Many women suffer from new or worsening anxiety during pregnancy. In this pilot study, we investigated the effect of timing and severity of prenatal state anxiety symptoms on reduced birth weight. We hypothesized that: (1) Women with state anxiety symptoms during mid-gestation would deliver newborns with lower birth weight in comparison to participants with symptoms in early gestation and (2) compared to women with lower anxiety symptoms (< 50^th percentile), women with medium-to-high state anxiety symptoms (> 50^th percentile) would have lower birth weight offspring. The sample consisted of the first 30 pregnant women who agreed to participate in this pilot study. We assessed anxiety symptoms, using the State-Trait Anxiety Inventory during early and mid-gestation. We obtained birth weight from clinical charts. A hierarchical multiple regression showed that, after controlling for covariates, state anxiety symptoms in mid-gestation were associated with lower infant birth weight [F(9, 7) = 20.30, p<.001]. However, birth weight did not differ as a function of the severity of maternal state anxiety [F(1, 23)=.14, p=.71 and F(1, 24)=1.76, p=.20., respectively]. Clearly, our pilot data need replication. Once statistical significance is established with larger samples, it will be informative to examine the clinical significance of those findings.     

State and trait related predictors of serum cortisol to DHEA(S) molar ratios and hormone concentrations in schizophrenia patients.

OBJECTIVE: In previous studies we have demonstrated high serum molar ratios of cortisol to dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS) [together abbreviated DHEA(S)], and the value of both cortisol/DHEA(S) molar ratios for prediction of responsivity to antipsychotic treatment in schizophrenia patients. The present study aimed to examine the contribution of anxiety, and severity of symptoms to the prediction of serum cortisol, DHEA(S) levels and two molar ratios across three examinations. METHOD: Serum concentrations of cortisol and DHEA(S)were examined in 43 schizophrenia inpatients and in 20 age matched healthy controls at baseline, and after 2 and 4 weeks. The Positive and Negative Symptom Scale and the State-Trait Anxiety Inventory scores were used as independent variables for multiple regression analysis. RESULTS: Despite clinical improvement during the study period cortisol/DHEA(S) molar ratios were found persistently elevated as compared to healthy controls. Multiple regression analysis revealed that across three examinations cortisol/DHEA(S) molar ratios negatively associated with trait-anxiety (partial R(2)=7-14%) rather than with negative symptoms (partial R(2)=3-6%). Age and age of onset account for 12.7% for variability of cortisol/DHEAS ratio. Serum cortisol concentrations are predicted by trait and state-anxiety, activation symptoms and daily doses of antipsychotics. A small portion of variability in serum DHEA levels (R(2)=9%) is associated with symptom severity, while DHEAS levels were predicted by age at examination and age of onset. CONCLUSION: Elevated serum cortisol/DHEA(S) molar ratios were attributed to trait-anxiety and age rather than to clinical symptoms. The findings may indicate persistent dysfunction of the hypothalamic-pituitary-adrenal axis that is independent of the patients' clinical state.     

Gender-Specific Association of Galanin Polymorphisms with HPA-Axis Dysregulation, Symptom Severity, and Antidepressant Treatment Response

Galanin (GAL) is an estrogen-inducible neuropeptide, highly expressed in brain regions reported to be involved in regulation of mood and anxiety. GAL possibly has a direct modulatory effect on hypothalamic–pituitary–adrenal (HPA)-axis regulation. Recent data from pharmacological and genetic studies indicate a significant function of GAL in stress-related disorders. By using a tag SNP approach covering the locus encoding preprogalanin (PPGAL), earlier findings of female-specific associations of polymorphisms in this locus with panic disorder were expanded to a larger sample of 268 outpatients with anxiety disorders (ADs). Within a larger sample of 541 inpatients with major depressive disorder (MDD), we then tested associations of one PPGAL tag SNP with specific depression symptom clusters and HPA-axis activity assessed by the combined dexamethasone-suppression/CRH-stimulation test both at inpatient admission and discharge (n=298). Gender specificity as well as dependence of the association on levels of circulating estrogens was analyzed. Genotyping revealed high linkage disequilibrium in the promoter area of the PPGAL gene, which includes several estrogen-response elements. Confirming earlier results, rs948854, tagging this promoter region, was associated with more severe anxiety pathology in female AD patients, but not in males. In premenopausal female MDD patients, the same allele of rs948854 was associated with more severe vegetative but not cognitive depressive symptoms at discharge and worse treatment response on antidepressant medication. Furthermore, this allele was associated with higher HPA-axis activity at admission. No significant case–control associations could be observed. However, because of power limitations of both patient samples, small effects cannot be excluded. The reported associations in independent samples of AD and MDD support an estrogen-dependent function of GAL in pathophysiology of anxiety and depression, affecting response to antidepressant treatment.     

The relationship between adverse events during selective serotonin reuptake inhibitor treatment for major depressive disorder and nonremission in the suicide assessment methodology study

Little is known about the association between antidepressant treatment-emergent adverse events and symptom nonremission in major depressive disorder. The objective of the current analysis was to determine whether particular baseline symptoms or treatment-emergent symptoms (adverse events) during the first 2 weeks are associated with nonremission after 8 weeks of treatment with a selective serotonin reuptake inhibitor (SSRI).Outpatients clinically diagnosed with nonpsychotic major depressive disorder were recruited from 6 primary and 9 psychiatric care sites. Participants (n = 206) were treated with an SSRI antidepressant (citalopram [20-40 mg/d], escitalopram [10-20 mg/d], fluoxetine [20-40 mg/d], paroxetine [20-40 mg/d], paroxetine CR [25-37.5 mg/d], or sertraline [50-150 mg/d]) for 8 weeks. Remission was defined as having a score of 5 or less on the 16-item Quick Inventory of Depressive Symptomatology-Clinician-Rated at week 8, or using last observation carried forward. Adverse events were identified using the 55-item Systematic Assessment for Treatment Emergent Events-Systematic Inquiry completed by participants at baseline and week 2.Findings indicated that the emergence of adverse events of weakness/fatigue, strange feeling, and trouble catching breath/hyperventilation at week 2 were independently associated with lack of remission even after controlling for the potential confounders of baseline depressive severity, anxious symptoms, antidepressant medication, chronic depression, race, burden of general medical comorbidity, and time in study. Hearing/seeing things appeared to have a protective effect. In conclusion, during SSRI treatment, the adverse events of weakness/fatigue, feeling strange, and trouble catching breath/hyperventilation are associated with nonremission, possibly due to lower adherence, early attrition, difficulty increasing the dose, and reduced efficacy.     

The influence of psychiatric comorbidity on the dexamethasone/CRH test in major depression

BackgroundThe outcome of the dexamethasone/corticotropin-releasing-hormone (DEX/CRH) test in depressed patients is heterogeneous. The present study investigated whether comorbidity of anxiety or somatoform disorders might be an explaining factor for this finding.MethodsThe DEX/CRH test was administered in 36 pure major depressive outpatients, 18 major depressive outpatients with a comorbid anxiety and/or somatoform disorder, and 43 healthy controls. Patients were free of psychotropic medication. Group differences in responsivity to the DEX/CRH test were analysed.ResultsDepressive patients with comorbidity showed a significant lower cortisol response compared to pure depressive patients (p = 0.04) and controls (p = 0.003). Group differences between MDD patients with and without comorbidity in cortisol responses disappeared after adjustment for post-DEX cortisol concentrations (p = 0.34).ConclusionsAn enhanced suppression of cortisol to 1.5 mg DEX is present in a subgroup of depressed patients with psychiatric comorbidity. Distinct hypothalamic-pituitary-adrenal (HPA) axis dysfunctions are revealed when comorbidity is taken into account.     

Decreased Hypothalamic Functional Connectivity with Subgenual Cortex in Psychotic Major Depression

Hypothalamus communication with the rest of the brain and peripheral target tissues is critically important for many physiological and psychological functions. These functions include maintaining neuroendocrine circadian rhythms and managing affective processes. The hypothalamus maintains both direct neural connections within the brain and it also controls a variety of neuroendocrine processes that can influence target tissues throughout the body. Dysregulation of the hypothalamic pituitary adrenal axis and hyperactivity of the subgenual cortex are both frequently observed in depression. However, many details of how the hypothalamus, the hypothalamic pituitary adrenal (HPA) axis, and the subgenual cingulate interact with each other are unknown. We hypothesized that resting-state functional connectivity between the hypothalamus and the subgenual cortex would be associated with altered circadian rhythm in patients with depression and depressive symptoms. We also hypothesized that this would be most apparent in patients that have major depression with psychotic symptoms, who typically have the most robust HPA-axis dysregulation. Resting-state functional magnetic resonance imaging (fMRI) scans were collected to observe low-frequency resting-state functional connectivity patterns of the hypothalamus in 39 healthy participants, 39 patients with major depression, and 22 patients with major depression with psychotic symptoms. Hourly overnight measures of cortisol secretion and multiple measures of psychiatric symptom severity were also collected on all. Strong hypothalamic functional connectivity with the subgenual cortex was observed in healthy participants. This connectivity was significantly reduced in patients with psychotic major depression. Increased cortisol secretion during the circadian nadir and reduced connectivity were both associated with symptom severity. Reduced connectivity and high cortisol secretion during the circadian nadir are both useful for explaining a significant amount of variance in symptom severity that occurs between healthy participants and depressed patients. However, only cortisol secretion was useful for explaining the severity of symptoms within the depressed groups. This study suggests that the communication between the hypothalamus and the subgenual cortex is disrupted in patients with major depression with psychotic features. It also suggests that these disruptions are associated with increased symptom severity and may be a cause or a consequence of cortisol dysregulation.     

Is prenatal tobacco exposure a risk factor for early adolescent smoking? A follow-up study

Recent reports indicate a relation between prenatal tobacco exposure (PTE) and offspring smoking. Many of these reports have been retrospective or have not included important variables such as other prenatal substance exposures, maternal and child psycho-social characteristics, mother's current smoking, and friends' smoking. No prior study has examined the timing of PTE. In this prospective study of a birth cohort of 567 14-year-olds, we examined the relation between trimester-specific PTE, offspring smoking, and other correlates of adolescent smoking. Average age of the adolescents was 14.8 years (range: 13.9-16.6 years), 51% were female, 54% were African-American. Data on maternal tobacco and other substance use were collected both prenatally and postnatally, 51% of the mothers were prenatal smokers and 53% smoked when their children were 14 years. PTE in the third trimester significantly predicted offspring smoking (ever/never, smoking level, age of onset) when demographic and other prenatal substances were included in the analyses. PTE remained a significant predictor of the level of adolescent smoking when maternal and child psychological characteristics were added to the model. When more proximal measures of the child's smoking were included in the model, including mother's current smoking and friends' smoking, PTE was no longer significant. Significant predictors of adolescent smoking at age 14 were female gender, Caucasian race, child externalizing behavior, maternal anxiety, and child depressive symptoms. Although direct effects of PTE on offspring smoking behavior have previously been reported from this study and by others, by early-adolescence, this association is not significant after controlling for the more proximal covariates of adolescent smoking such as mother's current smoking and peer smoking.     

Predictors of Current Depressive Symptoms in a Sample of Drug Court Participants

Interviews, completed between March 2000 and November 2002 with Kentucky drug court participants in Lexington and Bowling Green (N = 500), participated in a cross-sectional analysis examining the associations between self-reported, current depressive symptoms and various personal characteristics and experiences from the period before drug court involvement. Depressive symptoms were measured with the Brief Symptom Inventory (BSI), and potential correlates were derived from the Addiction Severity Index (ASI), 1992 version. BSI depression scores indicated minimal-to-moderate symptoms, with a mean individual score of 0.73, on a scale from none (0) to extreme (4) symptom strength. Numerous predictor variables were significantly associated, but multiple regression analysis identified five variables as independent correlates of depressive symptoms: 1) poorer self-rated health, 2) having ever been treated in a hospital for psychological or emotional problems, 3) being troubled by family problems in the 6 months before drug court, 4) having had conflicts with nonfamily others in the 6 months before drug court, and 5) being female. If confirmed by future, prospective research, the five variables found by the multiple regression analysis may be useful in identifying and more adequately treating substance abusers with symptoms of depression.     

Predictors of current depressive symptoms in a sample of drug court participants

Interviews, completed between March 2000 and November 2002 with Kentucky drug court participants in Lexington and Bowling Green (N = 500), participated in a cross-sectional analysis examining the associations between self-reported, current depressive symptoms and various personal characteristics and experiences from the period before drug court involvement. Depressive symptoms were measured with the Brief Symptom Inventory (BSI), and potential correlates were derived from the Addiction Severity Index (ASI), 1992 version. BSI depression scores indicated minimal-to-moderate symptoms, with a mean individual score of 0.73, on a scale from none (0) to extreme (4) symptom strength. Numerous predictor variables were significantly associated, but multiple regression analysis identified five variables as independent correlates of depressive symptoms: 1) poorer self-rated health, 2) having ever been treated in a hospital for psychological or emotional problems, 3) being troubled by family problems in the 6 months before drug court, 4) having had conflicts with nonfamily others in the 6 months before drug court, and 5) being female. If confirmed by future, prospective research, the five variables found by the multiple regression analysis may be useful in identifying and more adequately treating substance abusers with symptoms of depression.     

Electronic cigarette use is associated with depressive symptoms among smokers and former smokers: Cross-sectional and longitudinal findings from the Constances cohort

AimsTo examine the cross-sectional and longitudinal associations between depressive symptoms and electronic cigarette (e-cig) use in a large population-based sample while taking into account smoking status and sociodemographic confounders.MethodsParticipants from the French Constances cohort were included from February 2012 to December 2016. Smoking status, e-cig use (never/ever/current) and nicotine concentration were self-reported. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regressions were used to provide odds ratios (ORs) and 95% confidence intervals (95%CI) of e-cig use according to depressive symptoms, adjusting for age, sex and education.ResultsIn cross-sectional analyses (n = 35,337), depressive symptoms (i.e. a CES-D score ≥ 19) were associated with both ever (OR [95%CI]: 1.67 [1.53–1.82]) and current (1.73 [1.53–1.96]) e-cig use with a dose-dependent relationship (p-trend<0.001). In longitudinal analyses (n = 30,818), depressive symptoms at baseline were associated with current e-cig use at follow-up (2.02 [1.72–2.37]) with a similar dose-dependent relationship. These associations were mainly significant among smokers or former smokers at baseline. Furthermore, among smokers at baseline, depressive symptoms were associated with dual consumption at follow-up (1.58 [1.41–1.77]), whereas among former smokers, they were associated with either smoking only (1.52 [1.34–1.73]) or e-cig use only (2.02 [1.64–2.49]), but not with dual consumption (1.11 [0.73–1.68]) at follow-up. Finally, depressive symptoms were positively associated with nicotine concentration among e-cig users at baseline.ConclusionsDepressive symptoms were positively associated with e-cig use in both cross-sectional and longitudinal analyses with a dose-dependent relationship. In addition, nicotine concentration and depressive symptoms were positively associated.