社会支持调节青少年应激与抑郁症状的追踪研究

目的:了解社会支持对青少年应激与抑郁症状的调节作用。方法:618名在校高中生在完成了包含负性生活事件、社会支持和抑郁症状在内的首次测评后,每隔三个月完成一次包含负性生活事件和抑郁症状在内的追踪测评,在为期一年的时间内共完成4次追踪测评,采用多层线性模型对数据进行分析。结果:父母支持对青少年抑郁症状预测的主效应显著,父母支持与应激水平共同预测青少年抑郁症状的交互作用则不显著;同伴支持对青少年抑郁症状预测的主效应不显著,同伴支持与应激水平共同预测青少年抑郁症状的交互作用显著。结论:父母支持影响青少年抑郁的发生,同伴支持能有效缓冲应激事件给青少年抑郁症状带来的不良影响。     

Maternal Depression,Parenting, and Youth Depressive Symptoms: Mediation and Moderation in a Short-Term Longitudinal Study

Although multiple studies find that offspring of depressed mothers are at risk for depressive disorders, there is uncertainty about the specific mechanisms that are at work—particularly with respect to modifiable factors that might be targeted for early intervention. The present work examines that parenting behaviors may operate as mediators, moderators, or independent influences on the development of youth depressive symptoms. One hundred one mothers and their early adolescent children participated in positive and negative interaction tasks. Maternal and youth self-reports of youth depressive symptoms were collected at baseline, 9-month, and 18-month assessments. Maternal history of depression was significantly associated with maternal-reported, but not youth self-reported, depressive symptomatology. Maternal positive and negative interaction behaviors in positive contexts were associated with higher youth self-reported depressive symptoms. Maternal positive interaction behaviors in positive contexts and maternal negative interactive behaviors in conflict contexts were associated with higher youth self-reported depressive symptoms. We found no evidence for maternal interaction behaviors serving as a mediator and little evidence of maternal interaction behaviors serving as a moderator of the relationship between maternal and offspring depression. Low maternal positive engagement tended to be more consistently associated with maternal- and self-reported youth depressive symptoms. The present findings suggest that characteristics of mother–child interactions that are associated with youth depressive symptomatology are pertinent to youth with and without a mother with a history of depression.     

Harsh Parenting and Serotonin Transporter and BDNF Val66Met Polymorphisms as Predictors of Adolescent Depressive Symptoms

Depressive symptoms are prevalent and rise during adolescence. The present study is a prospective investigation of environmental and genetic factors that contribute to the growth in depressive symptoms and the frequency of heightened symptoms during adolescence. Participants included 206 mother–father–adolescent triads (M age at Time 1 = 13.06 years, SD = .51, 52% female). Harsh parenting was observationally assessed during a family conflict paradigm. DNA was extracted from saliva samples and genotyped for the 5-HTTLPR and BDNF Val66Met polymorphisms. Adolescents provide self-reports of depressive symptoms annually across early adolescence. The results reveal Gene × Environment interactions as predictors of adolescent depressive symptom trajectories in the context of harsh parenting as an environmental risk factor. A BDNF Val66Met × Harsh Parenting interaction predicted the rise in depressive symptoms across a 3-year period, whereas a 5-HTTLPR × Harsh Parenting interaction predicted greater frequency in elevated depressive symptoms. The findings highlight the importance of unique genetic and environmental influences in the development and course of heightened depressive symptoms during adolescence.     

母亲抑郁与青少年认知重评的关系:教养方式的中介作用

目的:考察母亲抑郁、母亲教养方式(关切-引导,温暖)与青少年认知重评之间的关系。方法:采用流调中心用抑郁量表,教养方式问卷和情绪调节量表,测量了1212对青少年双生子及其母亲。结果:①母亲抑郁和青少年认知重评显著负相关,母亲教养方式和青少年认知重评显著正相关,母亲抑郁和教养方式显著负相关。②母亲抑郁与青少年认知重评之间的相关可以由母亲教养方式完全介导。结论:母亲抑郁通过其教养方式影响青少年认知重评。     

Recognition of Depressive Symptoms by Physicians

OBJECTIVE:

To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners.

INTRODUCTION:

MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms.

METHODS:

A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies.

RESULTS:

The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4–76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2–99.4%).

DISCUSSION:

Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms.

CONCLUSIONS:

Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms.     

功能性躯体症状的母系代际传递性:家庭教养方式的作用

目的:考察功能性躯体症状(FSS)的母系代际传递性,家庭教养方式对儿童FSS的影响,以及家庭教养方式在代际传递过程中所起到的作用。方法:使用儿童躯体化量表、简式父母教养方式问卷和症状自评量表对539名青少年及其母亲进行问卷调查。结果:①本研究中青少年在过去3个月中躯体化症状的发生率为29.4%;②母亲过度保护、父亲拒绝对儿童FSS有正向预测作用,父亲的过度保护对儿童FSS有负向预测作用;③FSS的母系代际传递性显著;④母亲过度保护对FSS的母系代际传递具有部分中介作用;⑤父亲教养方式不能调节FSS的母系代际传递性。结论:儿童FSS存在母系代际传递性,不良的家庭教养方式会催化儿童FSS的发生,儿童FSS的母系传递部分通过母亲过度保护的教养方式实现。     

Interactions Between Genotype and Depressive Symptoms on Obesity

Depression and Genetic variation in serotonin and monoamine transmission have both been associated with body mass index (BMI), but their interaction effects are not well understood. We examined the interaction between depressive symptoms and functional polymorphisms of serotonin transporter (SLC6A4) and monoamine oxidase A (MAOA) on categories of BMI. Participants were from the National Longitudinal Study of Adolescent Health. Multiple logistic regression was used to investigate interactions between candidate genes and depression on risk of obesity (BMI ≥ 30) or overweight + obese combined (BMI ≥ 25). Males with an MAOA active allele with high depressive symptoms were at decreased risk of obesity (OR 0.22; 95% CI 0.06–0.78) and overweight + obesity (OR 0.48; 95% CI 0.26–0.89). No similar effect was observed among females. These findings highlight that the obesity–depression relationship may vary as a function of gender and genetic polymorphism, and suggest the need for further study. Handling editor: Tatiana Foroud.     

Depressive Symptoms in a Sample of Women Following Perinatal Loss

Objective:The aim of the study is to identify variables associated with depressive symptoms among women shortly after perinatal loss.Method:Respondents who agreed to participate in the study were interviewed, and sociodemographic data were obtained from them. The Hospital Anxiety and Depression Scale and the Edinburgh Postnatal Depression Scale (EDPS) were thereafter administered on each respondent.Results:Respondents with perinatal loss had high rate of depressive symptoms (52% on EDPS), the rate was significantly higher, when compared with the control group (c²= 10.16, P=0.001). Factors significantly associated with depressive symptoms included previous perinatal losses, poor support from husband and occurrence of antenatal complications.Conclusion:Depressive reaction following perinatal loss is very common. Programs need to be designed to help these women cope with their loss and to reduce subsequent psychological morbidity.     

伴抑郁症状的精神分裂症临床分析

目的 了解精神分裂症的抑郁症状临床特征。方法 对76例件抑郁症状的精神分裂症,140例不伴抑郁症状的精神分裂症进行临床对照分析。结果 抑郁症状在精神分裂症中颇为普遍,抑郁症状与精神病性症状关系密切,抑郁症状与复发率、住院时间、自杀有关;与性别、年龄、精神疾病总痛程比较,差异均无显著性;加用与不加用抗抑郁剂比较,在治疗起效时间、症状改善时间方面的差异均有非常显著性(P<0.01)。结论 对伴抑郁症状的精神分裂患者治疗上加用抗抑郁剂是缩短疗程的有效途径。     

独生子女首发抑郁症患者父母焦虑状况的调查分析

目的探讨独生子女首发抑郁症患者父母的焦虑状况。方法对独生子女抑郁症患者父母和正常独生子女父母各58人采用焦虑自评量表（SA S）及自制一般状况调查表进行调查,并对比分析。结果独生子女抑郁症患者父母双方的因子得分均高于正常对照父母,部分因子差异具有统计学意义（t=1.73~1.99,P均〈0.05）,;研究组母亲和父亲焦虑评分比较无显著性差异（t=-1.40~1.66,P均〉0.05）。结论独生子女首发抑郁症患者父母存在不同程度的焦虑情绪,应及时有效地对其父母进行心理干预。     

Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial

Background

Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms before sick leave via the Internet could be beneficial and cost saving.

Objective

In this study, we developed and tested the effectiveness of a Web-based guided self-help course for employees with depressive symptoms. We report on the posttreatment effectiveness of the intervention.

Methods

This study is a two-arm randomized controlled trial comparing a Web-based guided self-help course to care as usual (CAU). We recruited employees from 6 different companies via the companies’ intranet and posters. The main inclusion criterion was elevated depressive symptoms as measured by a score of ≥16 on the Center for Epidemiological Studies Depression scale (CES-D). The intervention (Happy@Work) was based on problem-solving treatment and cognitive therapy and consisted of 6 weekly lessons. Participants were asked to submit their weekly assignment via the website after completion. They subsequently received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), anxiety measured by the Hospital Anxiety and Depression Scale (HADS), burnout measured by the Maslach Burnout Inventory (MBI), and work performance measured by the Health and Work Performance Questionnaire (HPQ; secondary outcomes) were completed at baseline and at posttreatment.

Results

A total of 231 employees were randomized to either the intervention group (n=116) or CAU (n=115).The posttreatment assessment was completed by 171 (74.0%) participants. Both the intervention and the CAU group showed significant improvements in the primary outcome of depressive symptoms, but no differences between the conditions was found (d=0.16, 95% CI –0.10 to 0.41, P=.29). Significant but small effects in favor of the intervention group were found for anxiety symptoms (d=0.16, 95% CI –0.09 to 0.42, P=.04) and exhaustion (d=0.17, 95% CI –0.09 to 0.43, P=.02).

Conclusions

This study showed that a Web-based guided self-help course for employees with depressive symptoms was not more effective in reducing depressive symptoms among employees than CAU. Large improvements in depressive symptoms in the CAU group were unforeseen and potential explanations are discussed.     

度洛西汀治疗伴疼痛症状的女性抑郁症的疗效

目的研究度洛西汀对伴疼痛症状女性抑郁症患者的疗效及安全性。方法用度洛西汀治疗57例伴疼痛症状的女性抑郁症患者,治疗6周,采用汉密尔顿抑郁量表(HAMD)17项版本、医学结局研究用疼痛量表(MOSPM)和不良反应量表(TESS)评定疗效及不良反应。结果 HAMD、MOSPM总分在治疗1周末下降,与治疗前评分比较有统计学意义(t=2.74,P<0.05;t=2.62,P<0.01),治疗6周末评分与治疗前比较有统计学意义(t=13.22,10.52;P<0.01)。患者的抑郁及躯体疼痛症状均较治疗前明显减轻,疼痛症状的疗效为77.4%、抑郁症状的疗效为83.6%,不良反应轻。结论度洛西汀能明显改善伴疼痛症状的女性抑郁症患者的抑郁、疼痛症状,疗效明显、不良反应轻、依从性好。     

青少年抑郁情绪和违纪行为的共存——孰因孰果?

目的:采用交叉滞后模型探讨青少年抑郁情绪和违纪行为共存的机制.方法:886名青春早期(11-13岁)和580名青春中期(14-16岁)的青少年参加了三轮追踪测量,其中男生的比例分别为50％和46.2％.采用流调中心抑郁量表(CES-D)和行为问题问卷(YSR)来测量青少年的抑郁情绪和违纪行为.结果:对于男生来说,在青春发展早期,违纪行为显著预测抑郁情绪的产生,支持失败模型理论;在青春发展中期,抑郁情绪显著预测违纪行为的产生,支持释放模型理论.对于女生来说,违纪行为和抑郁情绪相互影响,不存在发展阶段的差异.结论:抑郁情绪和违纪行为的关系存在性别差异.     

Self-Efficacy as a Psychological Moderator of Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue and a variety of somatic symptoms. Few studies have examined psychological aspects of CFS. In the present study, self-efficacy is shown to be a significant predictor of CFS symptoms beyond the variance accounted for by demographic variables and distress. Further psychological CFS research is encouraged by (1)identifying dimensions that are salient in the experience and study of CFS, (2) providing preliminary psychometric data for measures of those dimensions, and (3)identifying psychological variables that serve as moderators of the experience of CFS.     

Discrimination and Depressive Symptoms Among Black American Men: Moderated-Mediation Effects of Ethnicity and Self-Esteem

Discrimination is related to depression and poor self-esteem among Black men. Poorer self-esteem is also associated with depression. However, there is limited research identifying how self-esteem may mediate the associations between discrimination and depressive symptoms for disparate ethnic groups of Black men. The purpose of this study was to examine ethnic groups as a moderator of the mediating effects of self-esteem on the relationship between discrimination and depressive symptoms among a nationally representative sample of African American (n = 1201) and Afro-Caribbean American men (n = 545) in the National Survey of American Life. Due to cultural socialization differences, we hypothesized that self-esteem would mediate the associations between discrimination and depressive symptoms only for African American men, but not Afro-Caribbean American men. Moderated-mediation regression analyses indicated that the conditional indirect effects of discrimination on depressive symptoms through self-esteem were significant for African American men, but not for Afro-Caribbean men. Our results highlight important ethnic differences among Black men.