Understanding Sociobehavioral Mitigators of Depressive Symptoms among U.S. Young Adults

This study drew upon an ecological system framework to examine a model focusing on the interrelationship among depressive symptoms, sense of mastery, moderate-to-vigorous physical activity (MVPA), religiosity, and relations with parents and romantic partners among U.S. young adults aged 24 to 34. Cross-sectional data from the National Longitudinal Study of Adolescent Health (N = 4,982), obtained in 2008 and 2009, were analyzed using structural equation modeling techniques. The associations of MVPA, relations with parents, and relations with romantic partner to depressive symptoms were mediated through mastery. Relations with one's romantic partner were a stronger predictor of depressive symptoms than relations with parents, while the influence of religiosity on relations with romantic partner was largely mediated by relations with parents. The results highlight the sociobehavioral buffers of depressive symptoms that are peculiar to young adulthood. Further intervention research in preventing and treating depressive symptoms should consider incorporating the sociobehavioral factors that are tailored to the specific age group.     

Depressive Symptoms Among Older Adults: Long-Term Reduction After a Physical Activity Intervention

We examined the effects of two physical activity modes on depressive symptoms over a 5-year period among older adults and change in physical self-esteem as a mediator of changes in depressive symptoms. Formerly sedentary, older adults (N = 174) were randomly assigned into 6-month conditions of either walking or low-intensity resistance/flexibility training. Depressive symptoms and physical self-esteem were measured before and after the 6-month intervention, and 12 and 60 months after intervention initiation. Depressive symptoms scores were decreased immediately after the intervention, followed by a sustained reduction for 12 and 60 months after intervention initiation; there was no differential pattern of change between the physical activity modes. Change in physical self-esteem predicted change in depressive symptoms. This study supports the effectiveness of an exercise intervention for the sustained reduction of depressive symptoms among sedentary older adults and physical self-esteem as a potential mediator of this effect.     

Internet-Based Treatment for Adults with Depressive Symptoms: Randomized Controlled Trial

Background

Many depressed people do not receive help for their symptoms, and there are various barriers that impede help-seeking. The Internet may offer interesting alternatives for reaching and helping people with depression. Depression can be treated effectively with Internet-based cognitive behavioral therapy (CBT), but a short intervention based on problem solving therapy (PST) could constitute a worthwhile alternative to CBT.

Objective

In this study we evaluated the effectiveness of Internet-based CBT and Internet-based PST in comparison to a waiting list control group (WL), and we determined the differences between the two treatments.

Methods

We conducted a 3-arm randomized controlled trial to compare CBT, PST, and WL. The main inclusion criterion was presence of depressive symptoms (≥ 16 on the Center for Epidemiological Studies Depression scale). CBT and PST consisted of eight and five weekly lessons respectively. Participants were supported by email. Self-report measures of depression, anxiety, and quality of life were completed at pretest and after 5, 8, and 12 weeks.

Results

A total of 263 participants were randomized to the three conditions (CBT: n=88; PST: n=88; WL: n=87). Of the 263 participants, 184 (70%) completed questionnaires after 5 weeks, 173 (66%) after 8 weeks, and 151 (57%) after 12 weeks. Between-group effect sizes for depressive symptoms were 0.54 for CBT after 8 weeks (95% confidence interval (CI): 0.25 - 0.84) and 0.47 for PST after 5 weeks (95% CI: 0.17 - 0.77). These effects were further improved at 12 weeks (CBT: 0.69, 95% CI: 0.41 - 0.98; PST: 0.65, 95% CI: 0.36 - 0.95). For anxiety, effect sizes were also at a medium level. Effect sizes for quality of life were low. The number of participants showing clinically significant change at 12 weeks was significantly higher for CBT (n = 34, 38.6%) and PST (n = 30, 34.1%), compared to WL (n = 0).

Conclusions

Both Internet-based treatments are effective in reducing depressive symptoms, although the effect of PST is realized more quickly.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 16823487; http://www.controlled-trials.com/ISRCTN16823487/16823487 (Archived by WebCite at http://www.webcitation.org/5cQsOj7xf).     

Depressive Symptoms and Sleep Disturbance in Adults with Histories of Childhood Abuse

Abstract

Depressive symptoms including sleep disturbance are clinically apparent in many patients with histories of childhood abuse. This study investigated the nature and severity of depressive symptoms, sleep disturbance, and trauma-related symptoms in a group of female participants with abuse histories, as compared to a non-abused group of female participants with major depression. Sixty (60) participants with a history of childhood abuse and 13 participants with major depression completed several self-report instruments which examine past life experiences, depressive symptoms, post-traumatic symptoms, dissociative symptoms, and sleep problems. To control for differences in background characteristics, a subset of participants with abuse histories were matched to and compared with the 13 depressed participants. Both the abused and depressed groups showed high levels of depressive symptoms, but there were no significant differences between the groups. The abused group had significantly more intrusive post-traumatic symptoms, more dissociative symptoms, and were more likely to be afraid of falling asleep and more anxious upon mid-sleep awakening. Severity of depressive symptoms in the abused group was correlated with severity of intrusive post-traumatic symptomatology. The investigators conclude that symptoms of major depression in some patients with abuse histories may have a post-traumatic etiology, especially since intrusive reexperi-encing of past trauma may produce severe dysphoria and hopelessness. The nature of sleep disturbance in patients with abuse histories may be a clinical tool to identify patients whose depressive symptoms may be post-traumatic in origin.     

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.     

产后抑郁症患者的述情障碍与抑郁症状的相关分析

目的探讨产后抑郁症患者的述情障碍与抑郁症状的相关性。方法采用汉密尔顿抑郁量表17项版本(HAMD-17)和多伦多述情障碍量表20项(TAS-20)对60例产后抑郁症患者和60例健康产妇进行评定。结果①产后抑郁症组患者TAS-20总分及3个因子分评分显著高于对照组,差异有统计学意义(t=31.294,21.450,10.006,26.053;P<0.01;);②TAS-20总分及3个因子分与HAMD-17总分、焦虑/躯体化因子(Hf1)、体重因子(Hf2)、认知障碍因子(Hf3)、阻滞因子(Hf4)呈显著正相关(r=0.273～0.638,P<0.01或0.05);睡眠障碍因子(Hf5)与TAS-20总分和3个因子分相关均不显著(r=-0.141～0.030,P>0.05)。结论产后抑郁症患者存在着明显的述情障碍;述情障碍与抑郁症状的严重程度呈显著正相关,产后抑郁症患者的述情障碍与抑郁症状相互影响;有述情障碍的产后抑郁症患者的功能性躯体不适症状更突出。     

合肥市小学生抑郁症状及相关因素分析

目的:了解小学生抑郁症状现况,探讨可能的相关影响因素。方法:采用儿童抑郁量表(CDI)及自编问卷对合肥市2078名小学生进行抑郁症状及其生活方式、社会支持等情况调查。结果:小学生抑郁症状检出率为11.9%,男生检出率高于女生(13.6%/9.6%,χ2=7.01,P<0.01)。早上起床感觉不好、晚上睡觉时间迟及睡眠不好者出现抑郁症状的危险性是没有该情况者的2倍,有节食行为与一周吃早饭天数<3天可使抑郁症状发生的危险性增加1.5倍。学校生活状况,父母支持、伙伴支持及老师支持是降低抑郁症状发生的保护因素,各得分每增加1分,发生抑郁的危险性可降低约1/2。结论:建立良好的学校、家庭、伙伴等社会支持环境,培养良好的生活与学习习惯,有利于降低小学生抑郁症状的发生。     

依赖、自我批评人格特质与抑郁症状的关系

目的:了解依赖、自我批评与抑郁患者的抑郁程度和不同抑郁症状之间的关系。方法:对290例抑郁障碍病人进行流调中心用抑郁量表(CES-D)和抑郁体验问卷(DEQ)的测量。结果:①高依赖高自我批评者的CES-D总分及抑郁的躯体症状、抑郁情绪因子分显著高于低依赖低自我批评抑郁障碍患者(P<0.05);②依赖、自我批评与CES-D总分、抑郁的躯体症状、抑郁情绪症状的相关均具有统计学意义(r在0.203～0.297之间);③自我批评因子对CES-D总分、抑郁情绪症状有显著的回归效应;自我批评因子对男性抑郁患者的躯体症状有显著的回归效应,依赖因子对女性抑郁患者的躯体症状有显著的回归效应。结论:依赖、自我批评因子与抑郁障碍患者的抑郁程度、躯体症状、抑郁情绪症状存在低度相关;相对于依赖因子,自我批评因子能更稳定地预测抑郁患者的抑郁症状。     

Independent and Combined Associations of Physical Activity and Sedentary Behavior with Depressive Symptoms Among Japanese Adults

Background

Associations between levels of sedentary behavior and depressive symptoms independently and in combination with different levels of physical activity remain unclear.

Purpose

This study aimed to examine independent and combined associations of physical activity (PA) and sedentary behavior (SB) with depressive symptoms among Japanese adults.

Method

An Internet-based survey collected data on depression levels (Center for Epidemiologic Studies Depression Scale), self-reported time spent in PA and SB (Japanese short version of the International Physical Activity Questionnaire), and sociodemographic variables from 2,914 adults in 2009. Binary logistic regression analyses were conducted to examine the odds ratios (ORs) for being depressed (depression scores ≥16) according to independent PA levels (none, insufficient, sufficient), SB levels (low, moderate, high), and nine combinations of PA and SB categories.

Results

After adjusting for potential confounders, sufficient PA level was found to be related to lower risk of depressive symptoms independently (OR?=?0.61), whereas no significant associations were observed between SB levels and depression. In the combined associations, adults in the sufficient PA/high SB (OR?=?0.44), sufficient PA/moderate SB (OR?=?0.56), and sufficient PA/low SB (OR?=?0.57) categories were significantly less likely to have depressive symptoms in comparison with the no PA/high SB category.

Conclusion

Meeting physical activity recommendations is associated with a lower risk of depressive symptoms, regardless of time spent in total sedentary behavior. These results suggest that promoting physical activity may be an effective strategy against depressive symptoms among Japanese adults.

     

抑郁性神经症功能失调状况与临床症状的关系

目的：探讨抑郁性神经症患者的功能失调状况是属于素质性的,还是一种状态依从性的变量。方法：应用功能失调状况评定量表（ＤＳＡ）测评了９０例抑郁性精神症患者,并以９０正常人作对照。另外,将抑郁性神经症的ＤＡＳ总分和因子分与症状自评量表（ＳＣＬ－９０）的总分及因子分进行了相关分析。结果：抑郁性精神症的ＤＡＳ总分及因子分均明显高于正常人;ＤＡＳ得分与ＳＣＬ－９０评分之间的分析提示绝大部分变量间呈现密切正相关     

抑郁性障碍患者的症状表现与认知情绪调节方式的关系

目的:探讨抑郁性障碍患者的症状表现特征及其与认知情绪调节方式之间的关系。方法:采用结构式临床访谈、认知情绪调节问卷对301例抑郁性障碍患者进行调查。结果:①抑郁性障碍患者最常见的躯体症状是心慌(72.43%)、疲劳(70.76%)、胸闷(65.78%)及失眠(64.45%),最常见的情感症状是情绪低落(92.03%)、焦虑(87.04%)、紧张(71.43%)及兴趣减退(62.46%)。②认知情绪调节方式中的积极重新关注和积极重新评价与躯体症状表现数目呈显著负相关(r=-0.233,r=-0.141),沉思和灾难化与躯体症状表现数目呈显著正相关(r=0.224,r=0.207);积极重新关注和积极重新评价与情感症状表现数目呈显著负相关(r=-0.126,r=-0.145),自我责备、沉思和灾难化与情感症状表现数目呈显著正相关(r=0.131,r=0.211,r=0.320)。③躯体症状组患者在接受、沉思、灾难化及责备他人等消极认知策略上的得分显著高于情感症状组患者。结论:抑郁性障碍患者的认知情绪调节方式与症状表现有关。     

Religiousness and Depressive Symptoms Among Adolescents

Examined the relations between depressive symptoms and (a) 3 standard indicators of religiousness and (b) a potentially more age-specific indicator in a sample of 744 adolescents (M age = 13.06 years, SD = 0.45). Adolescents completed the Children's Depression Inventory (CDI) and the Brief Multidimensional Measure of Religiousness/Spirituality. Results indicate that several dimensions of religiousness are associated with lower levels of depressive symptoms (i.e., attendance, self-ranking, and positive interpersonal religious experience), whereas negative interpersonal religious experience was associated with higher levels. These relations were not moderated by sex or ethnicity. Interpersonal religious experience had a stronger relation with depressive symptoms than did the standard dimensions of religiousness. The importance of social support during adolescence and future directions for this relatively new area of research are discussed.     

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.     

不同家庭互动类型儿童的自陈抑郁症状、应付方式比较

目的:探讨家庭互动类型与儿童自陈抑郁症状和应付方式的关系.方法:在本横断面研究设计中,采用随机整群取样方法,在南宁市区、郊区225所小学中随机抽取10所小学,对五、六年级的2113名学生(年龄12～13岁)完成调查,根据家庭互动问卷评分将家庭互动分为监督组、纪律组、养育组和冲突组4种类型,用儿童自陈抑郁症状条目评定抑郁症状,应付方式问卷评定应付方式.结果:女生的抑郁得分(10.5±2.7)略高于男生(10.1±2.6)(P<0.01),4种家庭互动类型(监督组、纪律组、养育组和冲突组)的比例分别是29.7%、13.4%、41.0%和15.9%,纪律组和冲突组儿童的抑郁症状总分[(12.0±2.7)、(11.8±2.6)]及消极应付方式得分[(1.3±0.5)、(1.2±0.5)]高于监督组和养育组[抑郁分:(10.5±2.6)、(9.7±2.6);消极应付方式分:(1.2±0.6)、(1.1±0.6 )(均P<0.001)],而积极应付方式得分低于监督组和养育组[(1.3±0.6)、(1.3±0.6)vs.(1.5±0.5)、(1.7±0.5),P<0.001].结论:纪律组或冲突组的儿童抑郁症状较多,常采用消极应付方式,养育组则反之.     

Early Trauma and Relationships among Recent Stress,Depressive Symptoms,Anxiety Symptoms,and Suicidal Ideation in Korean Women

BackgroundEvidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history.MethodsUsing data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET.ResultsStructural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively.ConclusionTailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.     

学龄儿童的抑郁

３２２名１０～１２岁小学五、六年级学生填写了Ｂｕｌｅｖｕｅ抑郁量表（ＢＩＤ）。抑郁症状的出现率３．４％～１１．５％，有自杀观念者５．９％。自杀观念与总分、心境恶劣、自卑和自杀、攻击性行为和社会交往４个因子的相关程度最高。３２２人中１０人（３．１％）为抑郁症检出者，临床表现与成人抑郁症相似，其中８人有自杀观念。结果提示抑郁情绪、自杀观念、抑郁症在学龄儿童中的出现率较高，应加强预防和治疗。     

合肥市和深圳市小学生抑郁症状及其影响因素比较

目的:比较合肥市和深圳市小学生抑郁症状流行状况,探讨不同地区小学生抑郁症状的影响因素.方法:采用儿童抑郁量表对两市3224名小学生抑郁症状进行评定,问卷调查小学生家庭、学校和同伴社会支持水平及一般人口学特征.结果:合肥市小学生抑郁症状检出率为11.9%,高于深圳市的8.2%(x2=10.37,P=0.001);合肥市、深圳市有抑郁症状小学生的社会支持各维度得分及总分均低于无抑郁症状小学生(合肥市有无抑郁症状小学生父母支持、学校支持、同伴支持得分及总分分别为3.6±1.6/5.0±0.9、2.1±0.9/2.6±0.8、3.2±1.5/4.4±1.0、8.9±2.9/12.0±1.8,均P＜0.001;深圳市有无抑郁症状小学生父母支持、学校支持、同伴支持得分及总分分别为3.4±1.8/4.9±0.7、2.2±1.2/2.9±0.8、3.4±1.5/4.4±0.9、9.0±2.7/12.3±1.6,均P＜0.001);合肥市小学生父母支持每增加1分可使抑郁症状发生的危险下降50%,学校支持与同伴支持得分每增加1分,小学生抑郁症状危险性可降低30%～40%;深圳市父母、学校和同伴支持得分每增加1分,小学生抑郁症状危险性可下降50%左右.结论:大约10%的小学生存在抑郁症状,改善小学生父母、学校和同伴支持,可望降低小学生抑郁症状发生的危险性.