•Add-on exercise therapy reduced depressive symptoms in adolescent inpatients.•Adolescents hospitalized for depression have been shown to be very sedentary.•Exercise is a promising care for the ...physical and mental health of adolescents.•Exercise should be integrated into psychiatric settings for depressed adolescents.
Physical exercise therapy is of proven efficacy in the treatment of adults with depression, but corresponding evidence is lacking in depressed adolescent inpatients. The aim of this study was to document the effect of add-on treatment with structured physical exercise in a clinical population of adolescents hospitalized for depression and anxiety in a psychiatric hospital.
A group of 52 adolescent inpatients was randomly assigned to a physical exercise or control program three to four times per week over a six-week period (20 hours in total). The primary outcome was the Hospital Anxiety Depression Scale (HADS) for evaluation of depression and anxiety symptoms. Secondary outcomes were psychological self-assessments, diagnostic interviews, and physical examinations.
Six participants were lost in each group, leaving 20 inpatients each in the intervention and control groups. A linear mixed model with F-test revealed a significant interaction in favor of physical exercise in reducing the mean depression score (HADS-D) by 3.8 points 95% (CI), range 1.8 to 5.7, compared to a mean reduction score of 0.7 95% (CI), range -0,7 to 2.0 in the control group. No significant interaction was found for anxiety symptoms (HADS-A).
The investigation was limited to the six-week hospital window and the small sample size prevented exploring differences in social characteristics.
Structured physical exercise add-on therapy integrated into the psychiatric hospitalization of adolescents has led to a reduction in their depressive symptoms, demonstrating its effectiveness in the care of adolescent inpatients with depression.
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Enhanced bursting activity of neurons in the lateral habenula (LHb) is essential in driving depression-like behaviours, but the cause of this increase has been unknown. Here, using a high-throughput ...quantitative proteomic screen, we show that an astroglial potassium channel (Kir4.1) is upregulated in the LHb in rat models of depression. Kir4.1 in the LHb shows a distinct pattern of expression on astrocytic membrane processes that wrap tightly around the neuronal soma. Electrophysiology and modelling data show that the level of Kir4.1 on astrocytes tightly regulates the degree of membrane hyperpolarization and the amount of bursting activity of LHb neurons. Astrocyte-specific gain and loss of Kir4.1 in the LHb bidirectionally regulates neuronal bursting and depression-like symptoms. Together, these results show that a glia-neuron interaction at the perisomatic space of LHb is involved in setting the neuronal firing mode in models of a major psychiatric disease. Kir4.1 in the LHb might have potential as a target for treating clinical depression.
This article is part of a Special Issue “Parental Care”. Pregnancy and postpartum are associated with dramatic alterations in steroid and peptide hormones which alter the mothers' hypothalamic ...pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes. Dysregulations in these endocrine axes are related to mood disorders and as such it should not come as a major surprise that pregnancy and the postpartum period can have profound effects on maternal mood. Indeed, pregnancy and postpartum are associated with an increased risk for developing depressive symptoms in women. Postpartum depression affects approximately 10–15% of women and impairs mother–infant interactions that in turn are important for child development. Maternal attachment, sensitivity and parenting style are essential for a healthy maturation of an infant's social, cognitive and behavioral skills and depressed mothers often display less attachment, sensitivity and more harsh or disrupted parenting behaviors, which may contribute to reports of adverse child outcomes in children of depressed mothers. Here we review, in honor of the “father of motherhood”, Jay Rosenblatt, the literature on postnatal depression in the mother and its effect on mother–infant interactions. We will cover clinical and pre-clinical findings highlighting putative neurobiological mechanisms underlying postpartum depression and how they relate to maternal behaviors and infant outcome. We also review animal models that investigate the neurobiology of maternal mood and disrupted maternal care. In particular, we discuss the implications of endogenous and exogenous manipulations of glucocorticoids on maternal care and mood. Lastly we discuss interventions during gestation and postpartum that may improve maternal symptoms and behavior and thus may alter developmental outcome of the offspring.
•Maternal depression includes depression during gestation, early and late postpartum.•Onset of timing of maternal depression influences maternal care and symptoms.•Adrenal, placental, sex and peptide hormones are implicated in maternal depression.•Maternal depression can negatively impact mother–infant interactions.•Interventions should seek to improve both, depressive symptoms and maternal care.
Both mothers and fathers are at risk for experiencing postpartum depressive symptoms shortly after the birth of a child. Previous studies suggest mothers' and fathers' depressive symptoms to be ...interrelated. This study examined bidirectional relations between mothers' and fathers' depressive symptoms across four years postpartum.
Longitudinal data for this study were collected across five waves from 485 mothers and 359 fathers of infants when infants were on average 6 months-old until children were 54 months-old (1-year lags). Mothers and fathers reported on their depressive symptoms using the Center for the Epidemiological Studies Short Depression Scale (CES-D 10). A random intercept cross-lagged panel model (RICLPM) was specified to examine the bidirectional relations between mothers' and fathers' depressive symptoms over time.
At the between-person level, mothers' and fathers' depressive symptoms were positively associated. At the within-person level, unique carry-over effects were found for mothers and fathers in that when reporting higher depressive symptoms than their trait levels, they were more likely to report higher depressive symptoms one year later. Moreover, intermittent cross-lagged effects were observed from mothers' depressive symptoms to fathers' depressive symptoms during toddlerhood.
The sample was not racially or structurally diverse thereby limiting the generalizations of the findings.
After the birth of a child, mothers and fathers are at risk for experiencing chronic depressive symptoms which can have implications for individual, couple and child health. Mothers' depressive symptoms are related to fathers' depressive symptoms over time.
•Mothers' and fathers' depressive symptoms are related across the first four years postpartum.•Carry-over effects were observed for both mothers and fathers.•Intermittent spillover effects were observed from mothers' depressive symptoms to fathers' depressive symptoms one-year later.
Purpose
Depression in patients with breast cancer imposes huge costs to patients, families, and healthcare systems. The present study aimed at evaluating the global prevalence depression among ...patients with breast cancer.
Methods
In this meta-analysis, three electronic databases (PubMed, Web of Science, and Scopus) were searched from 1 January, 2000 until 30 March, 2019. The Hoy tool was used to evaluate the quality of the articles included in the meta-analysis. The search, screening, quality evaluation, and data extraction were carried out by two of the researchers.
Results
Of 47,424 studies, 72 studies performed in 30 countries entered the final stage of analysis. The global prevalence of depression was 32.2%. Specifically, the prevalence of depression was highest in the Eastern Mediterranean region and twice as high in middle-income countries as compared to developed countries.
Conclusions
Regarding the high prevalence of depression in patients with breast cancer, it is vital to carry out screening within standard time periods and offer the necessary emotional support.
Depression is the most common psychiatric disorder worldwide. The burden of disease for depression goes beyond functioning and quality of life and extends to somatic health. Depression has been shown ...to subsequently increase the risk of, for example, cardiovascular, stroke, diabetes and obesity morbidity. These somatic consequences could partly be due to metabolic, immuno-inflammatory, autonomic and hypothalamic-pituitary-adrenal (HPA)-axis dysregulations which have been suggested to be more often present among depressed patients. Evidence linking depression to metabolic syndrome abnormalities indicates that depression is especially associated with its obesity-related components (for example, abdominal obesity and dyslipidemia). In addition, systemic inflammation and hyperactivity of the HPA-axis have been consistently observed among depressed patients. Slightly less consistent observations are for autonomic dysregulation among depressed patients. The heterogeneity of the depression concept seems to play a differentiating role: metabolic syndrome and inflammation up-regulations appear more specific to the atypical depression subtype, whereas hypercortisolemia appears more specific for melancholic depression. This review finishes with potential treatment implications for the downward spiral in which different depressive symptom profiles and biological dysregulations may impact on each other and interact with somatic health decline.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm ...birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond.
We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support.
We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms.
This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.
IMPORTANCE: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions ...that better suit them. OBJECTIVE: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information. DATA SOURCES: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019. STUDY SELECTION: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization. DATA EXTRACTION AND SYNTHESIS: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression. MAIN OUTCOMES AND MEASURES: Patient Health Questionnaire–9 (PHQ-9) scores. RESULTS: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference MD in posttreatment PHQ-9 scores, −0.8; 95% CI, −1.4 to −0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9. CONCLUSIONS AND RELEVANCE: In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.
Data from an extreme-case design involving 971 women who reported symptoms of anxiety and depression after childbirth reveal that the infants of depressed mothers had the lowest social engagement, ...less mature regulatory behaviors and were more negative emotionally at 9 months.
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