EEG sleep in adolescents with major depression: the role of suicidality and inpatient status

All night sleep EEG recordings were performed for three consecutive nights in 27 adolescents with a diagnosis of major depressive disorder (MDD) and 30 normal adolescent controls. Group comparisons between the entire MDD group and the normal controls revealed no significant diagnostic group differences for any of the major sleep variables. Analyses within subgroups of MDD adolescents, however, revealed heterogeneity of EEG sleep findings in association with suicidality and inpatient status. The findings of this study suggest that the discrepancies among the EEG sleep studies in adolescent MDD may be accounted for by the relative proportions of inpatients, suicidality, or bipolarity within the MDD sample being studied.     

Postpartum depression, suicidality, and mother-infant interactions

To date, few studies have examined suicidality in women with postpartum depression. Reports of suicidal ideation in postpartum women have varied (Lindahl et al. Arch Womens Ment Health 8:77–87, 2005), and no known studies have examined the relationship between suicidality and mother-infant interactions. This study utilizes baseline data from a multi-method evaluation of a home-based psychotherapy for women with postpartum depression and their infants to examine the phenomenon of suicidality and its relationship to maternal mood, perceptions, and mother-infant interactions. Overall, women in this clinical sample (n = 32) had wide ranging levels of suicidal thinking. When divided into low and high groups, the mothers with high suicidality experienced greater mood disturbances, cognitive distortions, and severity of postpartum symptomotology. They also had lower maternal self-esteem, more negative perceptions of the mother-infant relationship, and greater parenting stress. During observer-rated mother-infant interactions, women with high suicidality were less sensitive and responsive to their infants’ cues, and their infants demonstrated less positive affect and involvement with their mothers. Implications for clinical practice and future research directions are discussed.     

Guilt,fear, submission,and empathy in depression

BACKGROUND: This study compares self-focused motivations (fear of negative evaluation, social comparison, and fear of envy) and other-focused motivations (empathy and interpersonal guilt) in submissive behavior and depression. METHODS: The Beck Depression Inventory, Submissive Behavior Scale, Fear of Negative Evaluation Scale, Social Comparison Scale, Interpersonal Guilt Questionnaire, and Interpersonal Reactivity Inventory were administered to 50 patients hospitalized for depression and 52 students. RESULTS: Depressed patients were significantly higher in survivor guilt, omnipotent responsibility guilt, submissive behavior, fear of negative evaluation, fear of envy, and empathic distress, and lower in social comparison. LIMITATIONS: This research was limited in that it was a correlational study. CONCLUSIONS: This study suggests that altruistic concern about others may be an important factor in depression and submissive behavior. Evolutionary implications of these findings are discussed.     

The relation of religious belief and practices, depression, and hopelessness in persons with clinical depression

Religious belief and practices have been associated with lower levels of depression in persons dealing with stressful situations. In this study, researchers examined this relationship in 271 persons diagnosed with clinical depression. It was hypothesized that religious belief and practices would be associated with lower depression and that this relationship would be mediated by hopelessness. Religious belief, but not religious behavior, was a significant predictor of lower levels of hopelessness and depression beyond demographic variables. Through the relation of religious belief to lower levels of hopelessness, religious belief was indirectly related to less depression. There was also a small direct positive association of belief with depression, pointing to the complexity of the role belief plays for religious persons. Further study is needed for a better understanding of different ways religion affects depressed persons.     

Familial aggregation for conduct disorder symptomatology: the role of genes, marital discord and family adaptability

BACKGROUND: There is extensive evidence of statistical associations between family discord/ maladaptation and antisocial behaviour in the children, but questions remain on the extent to which the psychopathological risks are genetically or environmentally mediated. METHODS: Twin pairs (N = 1,350), aged 8 to 16 years, in the general population-based Virginia Twin Study of Adolescent Behavioral Development were assessed using the Child and Adolescent Psychiatric Assessment interview administered separately to both twins and both parents. Structured interviews for parental lifetime psychiatric disorders were also administered to the mothers and fathers. Maternal reports on Olsson's Family Adaptability and Cohesiveness questionnaire and the Dyadic Adjustment Scale were used as indices of the family environment. A path analytical model based on an extended twin-family design was used to test hypotheses about parent offspring similarity for conduct disorder symptomatology. RESULTS: Family discord and maladaptation, which intercorrelated at 0.63, were associated with a roughly two-fold increase in risk for conduct disorder symptomatology. When parental conduct disorder was included in the model the environmental mediation effect for family maladaptation remained, but that for family discord was lost. CONCLUSION: It is concluded that there is true environmental mediation from family maladaptation, operating as a shared effect, which accounts for 3.5 % of the phenotypic variance. The assumptions underlying this genetic research strategy are made explicit, together with its strengths and limitations.     

Suicide at 50 years of age and older: perceived physical illness, family discord and financial strain

BACKGROUND: Mental disorders amplify suicide risk across the lifecourse, but most people with mental disorder do not take their own lives. Few controlled studies have examined the contribution of stressors to suicide risk. METHOD: A case-control design was used to compare 86 suicides and 86 controls aged 50 years and older, matched on age, gender, race and county of residence. Structured interviews were conducted with proxy respondents for suicides and controls. RESULTS: Perceived physical illness, family discord and employment change amplified suicide risk after controlling for sociodemographic covariates and mental disorders that developed > or = 1 year prior to death/interview. Only the effect of physical illness (OR 6.24, 95% CI 1.28-51.284) persisted after controlling for all active mental disorders. CONCLUSIONS: Interventions to decrease the likelihood of financial stress and to help families manage discord and severe physical illness may effectively reduce suicides among middle-aged and older adults.     

Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals.

Two versions of cognitive-behavioral therapy (CBT), one with religious content (RCT) and one with standard protocol (NRCT), were used to treat 19-20 religious patients each. Fifty-nine religious patients who met the Research Diagnostic Criteria for nonpsychotic, nonbipolar depression were treated in 18-20 1-hr sessions over 3 months. Religious and nonreligious therapists were used in each CBT group. Pastoral counseling (PCT) treatment-as-usual and waiting-list control (WLC) conditions each contained 10-11 patients. RCT and PCT patients reported significantly lower posttreatment depression and adjustment scores than did either the NRCT or the WLC condition. The CBT difference was due largely to superior performance of the nonreligious therapists (with dissimilar values to the patients) in the RCT over the NRCT condition. Improvement in the three treatment conditions was equal at 3-month and 2-year follow-ups and greater than posttreatment WLC improvement levels.     

Interdependencies among interparental discord and parenting practices: the role of adult vulnerability and relationship perturbations

We examined the nature and directionality of associations between interparental discord and parenting practices in a sample of 227 mothers and fathers of kindergarten children over two measurement waves spaced 1 year apart. Cross-lagged models indicated that associations between interparental discord and maternal and paternal parenting practices (i.e., acceptance, discipline) were generally negligible with one exception: interparental discord at Time 1 predicted decreases in maternal acceptance from Time 1 to Time 2. However, consistent with the family systems conceptualization of the family as an open system, prospective associations among interparental and parent-child subsystems varied significantly as a function of parental depressive symptoms, interparental relationship insecurity, and child-rearing disagreements. The moderating role of adult characteristics commonly varied across the type of adult vulnerability (e.g., depressive symptoms, interparental relationship insecurity, child-rearing disagreements), dimension of parenting practices (e.g., maternal and paternal acceptance and inconsistent discipline), and the directionality of the paths between interparental and parent-child subsystems.     

Evolved mechanisms in depression: the role and interaction of attachment and social rank in depression

Evolved mechanisms underpinning attachment and social rank behavior may be the basis for some forms of major depression, especially those associated with chronic stress. We note the heterogeneity of depression, but suggest that some of its core symptoms, such as behavioral withdrawal, low self-esteem and anhedonia, may have evolved in order to regulate behavior and mood and convey sensitivity to threats and safety. Focusing on the evolved mental mechanisms for attachment and social rank helps to make sense of (1) depression's common early vulnerability factors (e.g., attachment disruptions, neglect and abuse), (2) the triggering events (e.g., loss of close relationships, being defeated and/or trapped in low socially rewarding or hostile environments), and (3) the psychological preoccupations of depressed people (e.g., sense of unlovableness, self as inferior and a failure). This focus offers clues as to how these two systems interact and on how to intervene.     

Pathways to suicidality across ethnic groups in Canadian adults: the possible role of social stress

BACKGROUND: Ethnicity is an important determinant of mental health outcomes including suicidality (i.e. suicidal ideation and suicide attempt). Understanding ethnic differences in the pathways to suicidality is important for suicide prevention efforts in ethnically diverse populations. These pathways can be conceptualized within a social stress framework. METHOD: The study examines ethnic differences in the pathways to suicidality in Canada within a social stress framework. Using data from the Canadian Community Health Survey Cycle 1.1 (CCHS 1.1) and path analysis, we examined the hypotheses that variations in (1) socio-economic status (SES), (2) sense of community belonging (SCB), (3) SES and SCB combined, and (4) SES, SCB and clinical factors combined can explain ethnic differences in suicidality. RESULTS: Francophone whites and Aboriginals were more likely to report suicidality compared to Anglophone whites whereas visible minorities and Foreign-born whites were least likely. Disadvantages in income, income and education, income and its combined effect with depression and alcohol dependence/abuse led to high rates even among the low-risk visible minority group. Indirect pathways for Asians differed from that of Blacks and South Asians, specifically through SCB. With the exception of SCB, Aboriginals were most disadvantaged, which exacerbated their risk for suicidality. However, their strong SCB buffered the risk for suicidality across pathways. Disadvantages in education, income and SCB were associated with the high risk for suicidality in Francophone whites. CONCLUSIONS: Francophone whites and Aboriginals had higher odds of suicidality compared to Anglophone whites; however, some pathways differed, indicating the need for targeted program planning and prevention efforts.     

Toward an understanding of the role of notochordal cells in the adult intervertebral disc: From discord to accord

The goal of this mini‐review is to address the long standing argument that the pathogenesis of disc disease is due to the loss and/or the replacement of the notochordal cells by other cell types. We contend that, although cells of different size and morphology exist, there is no strong evidence to support the view that the nucleus pulposus contains cells of distinct lineages. Based on lineage mapping studies and studies of other notochordal markers, we hypothesize that in all animals, including human, nucleus pulposus retains notochordal cells throughout life. Moreover, all cells including chondrocyte‐like cells are derived from notochordal precursors, and variations in morphology and size are representative of different stages of maturation, and or, function. Thus, the most critical choice for a suitable animal model should relate more to the anatomical and mechanical characteristics of the motion segment than concerns of cell loss and replacement by non‐notochordal cells. Developmental Dynamics 239:2141–2148, 2010. © 2010 Wiley‐Liss, Inc.     

Food insecurity and its association with co-occurring postnatal depression,hazardous drinking,and suicidality among women in peri-urban South Africa

Background

Although the public health impacts of food insecurity and depression on both maternal and child health are extensive, no studies have investigated the associations between food insecurity and postnatal depression or suicidality.

Methods

We interviewed 249 women three months after they had given birth and assessed food insecurity, postnatal depression symptom severity, suicide risk, and hazardous drinking. Multivariable Poisson regression models with robust standard errors were used to estimate the impact of food insecurity on psychosocial outcomes.

Results

Food insecurity, probable depression, and hazardous drinking were highly prevalent and co-occurring. More than half of the women (149 [59.8%]) were severely food insecure, 79 (31.7%) women met screening criteria for probable depression, and 39 (15.7%) women met screening criteria for hazardous drinking. Nineteen (7.6%) women had significant suicidality, of whom 7 (2.8%) were classified as high risk. Each additional point on the food insecurity scale was associated with increased risks of probable depression (adjusted risk ratio [ARR], 1.05; 95% CI, 1.02–1.07), hazardous drinking (ARR, 1.04; 95% CI, 1.00–1.09), and suicidality (ARR, 1.12; 95% CI, 1.02–1.23). Evaluated at the means of the covariates, these estimated associations were large in magnitude.

Limitations

The study is limited by lack of data on formal DSM-IV diagnoses of major depressive disorder, potential sample selection bias, and inability to assess the causal impact of food insecurity.

Conclusion

Food insecurity is strongly associated with postnatal depression, hazardous drinking, and suicidality. Programmes promoting food security for new may enhance overall psychological well-being in addition to improving nutritional status.     

The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality

BACKGROUND: The global burden and large diagnostic and therapeutic deficits associated with depressive disorders call for intervention programs. The aim of the Nuremberg Alliance against Depression (NAD) is to establish and to assess the effectiveness of a four-level intervention program for improving the care of patients with depression. METHOD: A 2-year intervention program was performed in Nuremberg (480000 inhabitants) at four levels: training of family doctors and support through different methods; a public relations campaign informing about depression; cooperation with community facilitators (teachers, priests, local media, etc.); and support for self-help activities as well as for high-risk groups. The effects of the 2-year intervention on the number of suicidal acts (completed suicides plus suicide attempts, main outcome criterion) were evaluated with respect to a 1-year baseline and a control region (Wuerzburg, 270,000 inhabitants). RESULTS: Compared to the control region, a reduction in frequency of suicidal acts was observed in Nuremberg during the 2-year intervention (2001 v. 2000: -19.4%; p< or =0.082; 2002 v. 2000: -24%, p< or =0.004). Considering suicide attempts only (secondary outcome criterion), the same effect was found (2001 v. 2000: -18.3%, p< or =0.023; 2002 v. 2000: -26.5%, p<0.001). The reduction was most noticeable for high-risk methods (e.g. hanging, jumping, shooting). Concerning completed suicides, there were no significant differences compared to the control region. CONCLUSIONS: The NAD appeared to be effective in reducing suicidality. It provides a concept as well as many methods that are currently being implemented in several other intervention regions in Germany and in other countries.     

Shame, Guilt and Penance in the Psychoanalyst: The Therapist's Superego in Psychoanalysis

In his daily work, guilt and shame and, consequently, punishment and penance do not pass over the psychoanalyst unobtrusively even if the ‘ideal’ basic psychoanalytic attitude demands that he/she be above this kind of human triviality. After all, through his own training analysis and through education he can be (or become) conscious of feelings contrary to the high psychoanalytic expectations of the person behind the couch: to listen patiently, not to react emotionally or aspire after direct gratification, be always understanding and unselfish, never offended, always aiming at insight and, in the end, to make himself redundant. That is the ideal, but what is it like in reality? There is obviously a field of tension, caused not only by one's personal impediments, including one's personal motives to choose this profession, but also evoked by the conventions within one's professional group as a socially defined professional superego. How tolerant are psychoanalysts of each other, is this much aspired inner awareness, for example, actually facilitated or rather impeded, owing to the rigidity of the rules? In any case, the personal superego and especially the ego ideal, in psychoanalysis partly transposed to a professional superego and a professional ideal image, play an important part and contribute to the ultimate result. Inner awareness still seems to be the main thing.     

Cognitive reserve and mortality in dementia: the role of cognition, functional ability and depression

OBJECTIVE: This study examined whether dementia patients with greater cognitive reserve had increased mortality rates, and whether this association was different across strata of cognition, functional ability and depression. METHODS: In the community-based Amsterdam Study of the Elderly, 261 non-institutionalized dementia patients, identified using the Geriatric Mental State Schedule (GMS), were followed for an average of 55.5 months after which mortality data were obtained. Cognitive reserve was indicated by years of education and pre-morbid intelligence (measured using the Dutch Adult Reading Test). Cognition, functional ability and depression were indicated by Mini-Mental State scores, ADL and IADL measurements and GMS depressive syndrome, respectively. RESULTS: During the follow-up 146 persons (55.9%) died. Cox regression analyses showed that more highly educated dementia patients had higher mortality rates, only if they had low MMSE scores or if they had a concurrent depression. Pre-morbid intelligence was associated with a higher mortality rate, independent of cognition, but this association was much stronger among patients with depression. The positive association between education or intelligence and mortality was not modified by functional disabilities. CONCLUSIONS: The results suggest that dementia patients with greater cognitive reserve have increased mortality rates, only if the disease has progressed to such an extent that clinical symptoms are more severe. In this respect, the reserve hypothesis needs a modification. Depression in dementia patients with greater cognitive reserve may reflect a subgroup of patients with poor prognosis.     

The relationship of religious variables to death depression and death anxiety

The present research explored the relationship of religious variables to death anxiety and death depression in 200 persons from the general population in what is apparently the first study to correlate religious variables with death depression. Persons with lower death depression had greater strength of conviction, greater belief in afterlife, and were less likely to say that the most important aspect of religion is that it offers the possibility of life after death. Persons with less death anxiety were found to have greater strength of conviction. The findings were discussed in relationship to previous research that has suggested that religious belief is associated more closely with death anxiety level than is religious practice.