Link between insomnia and perinatal depressive symptoms: A meta‐analysis

Evidence shows the possible link between insomnia and perinatal depressive symptoms. In order to find a convergent quantitative answer, we collected data via the search of Medline, EMBASE and reference tracking, which included nine studies (a total sample of 1,922 women). An aggregate effect size estimate (correlation coefficient) was generated using the comprehensive meta‐analysis software. For the meta‐analytic procedure, a random effects model was set a priori. Moderating factors, including study design, method of assessment of depression, geographical origin of data, publication year, mean age, % married, breastfeeding rate, quality and type of data, % primiparous and history of depression, were examined via categorical or univariate mixed‐effects (method of moments) meta‐regression methods. Heterogeneity and publication bias were examined using standard meta‐analytic approaches. We found a significant, medium‐size relationship between insomnia and perinatal depressive symptoms (point estimate, 0.366; 95% confidence interval [CI], 0.205–0.508; p < 0.001; n = 9) and this was significantly heterogeneous (Q, 118.77; df, 8; p < 0.001; I², 93.26%). The effect size estimate was significant for studies reporting no history of depression (point estimate, 0.364; 95% CI, 0.035–0.622; p < 0.05; n = 5) and for study design. With meta‐regression, no moderating factor (age, marriage rate, breastfeeding rate, pregnancy history or publication year) significantly mediated the effect size estimate. The depression assessment scale used, but not other categorical variables, explained the magnitude of heterogeneity. We found that insomnia during the perinatal period is associated with depressive symptoms, which warrants screening pregnant mothers for insomnia and depression.     

农民工抑郁症状的潜在转变分析

目的:探索农民工抑郁症状的分类及转变,检验人口学变量对抑郁症状的作用及抑郁症状与工作满意度的关系。方法:筛选完整填答2016年(T1)和2018年(T2)中国家庭追踪调查数据库(CFPS)相关量表的1993名农民工,对流调中心用抑郁简版量表(CES-D 8)、工作满意度量表(WSS)填答情况进行潜在转变分析(LTA)。结果:根据CES-D8条目得分将农民工分为低抑郁症状组、积极预期过渡组、消极预期过渡组、高抑郁症状组4组。农民工在T2仍处于T1组的概率依次为38.6%、64.4%、47.3%、47.5%;从T1到T2,低抑郁症状组、积极预期过渡组有39.1%和18.4%的概率向消极预期过渡组转变;高抑郁症状组有25.0%的概率向积极预期过渡组转变。年龄、性别与子女数作为协变量时,处于或转变为消极预期过渡组与高抑郁症状组的发生比(OR)为1.03～2.38;老人数作用下,处于或转变为高抑郁症状组的发生比(OR)为0.59～0.99。方差分析结果发现,抑郁症状越严重组,WSS得分越低。结论:农民工抑郁症状分为4组且多处于或易转变为中高抑郁症状组;高龄、女性、子女数多与老人数少的农民工抑郁症...     

A depressive symptoms responsiveness model for differentiating fatigue from depression in the postpartum period

Summary Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is experienced by most non-depressed women. Health care providers experientially know that not all women who experience postpartum fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they have not yet identified a means for describing or measuring this distinctness. A new model proposing how fatigue may be differentiated from depression after childbirth is presented. The Depressive Symptoms Responsiveness Model proposes that depression-related postpartum fatigue may potentially be differentiated from non-depression-related postpartum fatigue on the basis of whether depressive symptoms abate when fatigue is relieved. The ability to differentiate between fatigue and depression in postpartum women has the potential to improve women’s health through improvements in practice and resource utilization. Furthermore, differentiation may lead to a better understanding of the role of fatigue in postpartum depression. Correspondence: Jennifer J. Runquist, PhD, RN, Assistant Professor, College of Nursing, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201, U.S.A.     

Psychosocial factors influencing low fruit and vegetable consumption

A major national health campaign has recently been initiated to promote consumption of 5 or more servings of fruits and vegetables each day. This paper investigates psychosocial factors related to fruit and vegetable consumption to understand better who might be receptive and who might resist the national 5-A-Day campaign. We studied 405 adult respondents to a random-digit dial telephone survey. Applying the Transtheoretical Model, respondents were classified by stage of readiness to adopt the practice of eating 5 or more fruits and vegetables each day. Logistic regression models were developed for persons consuming 2 or fewer servings daily and for persons in the Precontemplation stage. Education was directly related to fruit and vegetable intake and indirectly related to being in the Precontemplation stage. Males were twice as likely as females to be in the Precontemplation stage and eat fewer than 2 servings a day. Of special interest, respondents with children at home were at greater risk of eating 2 or fewer servings a day than those without children at home (OR=1.63; 95% CI, 1.06–2.52). These results imply that stage of readiness to change should be considered as well as other factors in planning interventions for increasing fruit and vegetable consumption.     

Temperament and character associated with depressive symptoms in women: analysis of two genetically informative samples

Although previous research has explored associations between personality and depressive symptoms, a limited number of studies have assessed the extent to which genetic and environmental influences explain the association. This study investigated how temperament and character were associated with depressive symptoms in 131 pairs of twin and sibling women in early adulthood, as well as 326 pairs of twin women in middle adulthood. Results indicated that genetic influences accounted for a moderate to substantial percentage of the association between these personality features and depressive symptoms, emphasizing the role of genetic influences. Nonshared environmental influences made important contributions to the association between character and depressive symptoms, particularly in the sample of middle‐aged twin women. These findings suggest that unique social experiences and relationships with a partner in adulthood may play an important role in these associations between character and depressive symptoms. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–19, 2009.     

The moderating role of dispositional mindfulness in the associations of morningness-eveningness with depressive and anxiety symptoms

Several studies have shown that eveningness is positively related to both depressive and anxiety symptoms. However, little is known about factors that may play a protective role against the undesirable emotional consequences of evening preference. Thus, in the present study, we explored the moderating effects of dispositional mindfulness on the relationship between morningness-eveningness and the presence of depressive symptoms, as well as between morningness-eveningness and the presence of anxiety symptoms. The study was conducted on a group of 1107 individuals (559 women and 548 men) aged 18–55 years (M = 36.26, SD = 9.89). Consistent with previous findings, eveningness was positively related to the presence of both depressive and anxiety symptoms. The magnitude of these effects decreased with higher dispositional mindfulness. The latter result remained significant when the analogical moderating effects of personality, established in earlier studies, were controlled for in the regression models. This leads to the conclusion that dispositional mindfulness may act as a protective factor against the elevated depressive and anxiety symptoms reported by evening-oriented individuals.     

4～6年级小学生儿童虐待经历与抑郁情绪、睡眠质量的关系

目的:探讨儿童虐待经历与小学生抑郁情绪、睡眠质量的关系。方法:分层抽取重庆市主城3区的9所小学校(重点、普通及农民工小学各3所)的1523名在校4～6年级小学生。运用儿童受虐量表评定小学生的受虐待状况,量表总分中负的分值代表虐待;儿童抑郁自评量表(DSRSC)评定小学生的抑郁情绪,总分≥15分表示有抑郁症状;匹兹堡睡眠质量指数(PSQI)评定小学生的睡眠状况,量表总分>7分表示有睡眠质量问题。共收回有效问卷1417份。结果:小学生虐待、抑郁情绪、睡眠质量问题检出率分别为41.7%、23.2%、26.2%。受虐者的PSQI总分、入睡时间、睡眠时间、睡眠效率、日间功能障碍得分均较非受虐者高(均P<0.05);抑郁者的PSQI总分、入睡时间、睡眠效率得分较无抑郁者高(均P<0.05)。相关分析显示,PSQI总分和抑郁总分与躯体虐待、言语虐待的总分呈负相关(r=-0.06～-0.72,P<0.05);PSQI总分、入睡时间、睡眠效率得分与抑郁总分呈正相关(r=0.13～0.14,P<0.01)。结论:小学生受虐待、抑郁情绪、睡眠质量问题的检出率均较高,且受虐程度特别是躯体虐待、言语虐待程度越严重其情绪和睡眠质量也越差,值得学校和家长高度关注。     

Differential associations of positive and negative expectations with depressive symptoms

Background

Recent research suggests that dysfunctional expectations are a particularly important subtype of cognitions in depression. However, it is unclear whether depressive symptoms are related to the presence of negative expectations, the absence of positive expectations, or both.

Methods

Using hierarchical linear regression analyses, the present study examined the predictive value of positive situation-specific expectations, negative situation-specific expectations, dispositional optimism, and dysfunctional attitudes for depressive symptoms 8 weeks later in a nonclinical sample (N = 157). It also examined whether the relationship between dispositional optimism and dysfunctional attitudes with depressive symptoms is mediated through situational expectations.

Results

Cross-sectionally, depressive symptoms were more strongly associated with the presence of negative expectations than with the absence of positive expectations. In the longitudinal and mediation analyses, none of the cognitive variables had significant associations with depressive symptoms at follow-up beyond the strong influence of baseline depressive symptoms.

Conclusions

The presence of negative expectations was cross-sectionally more strongly associated with depressive symptoms than a lack of positive expectations, presumably due to higher variability in negative expectations in this nonclinical sample. The longitudinal and mediation analyses failed to find significant incremental effects of any of the cognitive variables because baseline depression explained the largest proportion of variance.     

Postnatal women's experiences of management of depressive symptoms: a qualitative study

Background

Postnatal depression is a public health problem requiring intervention. To provide effective care, information is needed on the experiences of those with high levels of depressive symptoms who are offered and accept, or decline, psychological intervention postnatally.

Aim

To provide the first integrated in-depth exploration of postnatal women''s experiences of the identification and management of symptoms of depression and the offer and acceptance of postnatal care by health visitors taking part in the PoNDER trial.

Setting

General practice: primary care within the former Trent regional health authority, England.

Method

Thirty women with 6-week Edinburgh Postnatal Depression Scale (EPDS) scores ≥18 and probable depression completed semi-structured interviews. All women had taken part in the Post-Natal Depression Economic Evaluation and Randomised controlled (PoNDER) trial where intervention group health visitors received training in identification of depressive symptoms and provided psychologically informed sessions based on cognitive-behavioural therapy or person-centred counselling principles.

Results

When accepted, psychological sessions were experienced as positive, effective, and ‘ideal care’. Women approved of using the EPDS but did not understand the health visitor''s role in supporting women. Seeking help and accepting sessions depended on women''s perspectives of their health visitor as an individual.

Conclusion

Women''s experience of their health visitors providing psychological sessions to help with postnatal depressive symptoms is highly positive. Women will better accept support from health visitors if they recognise their role in postnatal depression and find them easy to relate to on personal matters. There is a case for specific enhancement of interpersonal skills in health visiting, or alternatively offering a choice of health visitors to women.     

Stability and individual change in depressive symptoms among mothers raising young children with ASD: maternal and child correlates

Mothers raising children with Autism Spectrum Disorders (ASD) evidence elevated depressive symptoms, but symptom stability has not been examined. Mothers (N=143) of toddlers with ASD (77% boys) were enrolled and assessed when their children were 18 to 33 months old and followed annually for 2 years. Multilevel modeling revealed no significant change in group depressive symptom level, which was in the moderately elevated range (Intercept=13.67; SE=.96). In contrast, there was significant individual variation in change over time. Child problem behaviors and delayed competence, maternal anxiety symptoms and angry/hostile mood, low parenting efficacy and social supports, and coping styles were associated with depression severity. Only maternal anxiety and parenting efficacy predicted individual change. Many mothers do not appear to adapt, supporting the need for early intervention for maternal well-being. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–11, 2009.     

Social support,rural/urban residence,and depressive symptoms among Chinese adults

This study aims to examine the extent to which people are socially integrated and the association between social support and depressive symptoms among Chinese adults, with regard to the moderating effect of the rural or urban residence. The author used data from the China health and longitudinal study (CHARLS), a nationally representative longitudinal survey of the population of adults aged over 45 in China. A total of 16,372 participants were included in this study, and the mean age of the sample was 59.7. Three variables were used to measure participants' social support: family size, proximity of support, and social involvement. The Chinese version of 10-item center for epidemiologic studies depression scale was used as a measurement tool for depressive symptoms. The findings demonstrate that small family size, living with a spouse, frequency of contact with children, and a number of social activities have significant effects on depressive symptoms. For all aspects of social support, the influence on depressive symptoms is not significantly different between urban and rural areas. Family support, especially the support of a spouse is crucial to prevent depression. This study also identifies the vital effect of social activity and encourages the government to improve public services, especially in rural areas.     

Attachment disorganization moderates the effect of maternal postnatal depressive symptoms on infant autonomic functioning

We examined associations of disorganized attachment and maternal depressive symptoms with infant autonomic functioning in 450 infant‐mother dyads enrolled in the Generation R study. Maternal depressive symptoms were measured 2 months postpartum with the Brief Symptom Inventory. At 14 months, we assessed infant attachment with a slightly shortened Strange Situation and measured infant resting heart rate. Respiratory sinus arrhythmia (RSA) was calculated using spectral analysis. Higher levels of maternal postnatal depressive symptoms predicted lower resting RSA in disorganized infants (B = ?0.31, SE = 0.15, p = .04, R² = .05) but not in nondisorganized infants (B = 0.05, SE = 0.06, p = .36). This effect was buffered in disorganized infants with a secondary secure attachment classification. Disorganized infants were more vulnerable to the effect of maternal postnatal depressive symptoms on the physiological stress systems.     

Maternal depressive symptoms,sleep, and odds of spontaneous early birth: implications for racial inequities in birth outcomes

Study ObjectivesDelivery prior to full term affects 37% of US births, including ~400,000 preterm births (<37 weeks) and >1,000,000 early term births (37–38 weeks). Approximately 70% of cases of shortened gestation are spontaneous—without medically-indicated cause. Elucidation of modifiable behavioral factors would have considerable clinical impact.MethodsThis study examined the role of depressive symptoms and sleep quality in predicting the odds of spontaneous shortened gestation among 317 women (135 black, 182 white) who completed psychosocial assessment in mid-pregnancy.ResultsAdjusting for key covariates, black women had 1.89 times higher odds of spontaneous shortened gestation compared to White women (OR [95% CI] = 1.89 [1.01, 3.53], p = 0.046). Women who reported only poor subjective sleep quality (PSQI > 6) or only elevated depressive symptoms (CES-D ≥ 16) exhibited no statistically significant differences in odds of spontaneous shortened gestation compared to those with neither risk factor. However, women with comorbid poor sleep and depressive symptoms exhibited markedly higher odds of spontaneous shortened gestation than those with neither risk factor (39.2% versus 15.7% [OR (95% CI) = 2.69 (1.27, 5.70)], p = 0.01). A higher proportion of black women met criteria for both risk factors (23% of black women versus 11% of white women; p = 0.004), with a lower proportion experiencing neither risk factor (40.7% of black versus 64.3% of white women; p < 0.001).ConclusionsAdditive effects of poor subjective sleep quality and depressive symptoms were observed with markedly higher odds of spontaneous shortened gestation among women with both risk factors. Racial inequities in rates of comorbid exposure corresponded with inequities in shortened gestation. Future empirical studies and intervention efforts should consider the interactive effects of these commonly co-morbid exposures.     

Effects of expressive writing on depressive symptoms—A meta‐analysis

This meta‐analysis addresses the question of whether expressive writing shows an effect on reducing depressive symptoms. It focuses on samples of physically healthy adults with varying degrees of stress but without posttraumatic stress disorder. A total of 39 randomized controlled trials with 64 intervention‐control group comparisons were obtained through keyword search in databases and backward search. Expressive writing did not yield significant long‐term effects on depressive symptoms. However, effects were larger when the number of sessions was higher and when the writing topic was more specific. The results of this meta‐analysis did not support the effectiveness of brief, self‐directed expressive writing as an intervention that decreases depressive symptoms in physically healthy adults with varying degrees of psychological stress. Future research should examine whether longer, more directed writing interventions with additional therapeutic support would lead to different results.     

功能失调性态度对大学生抑郁症状的预测作用

目的:探讨功能失调性态度对大学生抑郁症状发生的预测作用。方法:采用方便取样,选取湖南省长沙市某两所高校大一至大三的学生644名。用功能失调性态度问卷(DAS-A)、流调中心用抑郁量表(CES-D)、学生日常社会和学业事件量表(GASHSS)进行基线评定,用CES-D和GASHSS进行每月1次共6次的追踪测查。采用多层线性模型对数据进行统计分析。结果:功能失调性态度水平对追踪过程中抑郁症状水平的主效应显著(b=1.24,P<0.001),功能失调性态度水平与应激性生活事件水平对追踪过程中抑郁症状水平的交互作用显著(b=0.02,P<0.01),随着生活事件应激强度的增加,其抑郁症状明显增加。结论:功能失调性态度可能是抑郁症状的一个预测因子,高水平功能失调性态度的个体在经历应激性生活事件后更易表现出抑郁症状。