There is controversy about whether psychotherapies are effective in the treatment of subclinical depression, defined by clinically relevant depressive symptoms in the absence of a major depressive ...disorder.
To examine whether psychotherapies are effective in reducing depressive symptoms, reduce the risk of developing major depressive disorder and have comparable effects to psychological treatment of major depression.
We conducted a meta-analysis of 18 studies comparing a psychological treatment of subclinical depression with a control group.
The target groups, therapies and characteristics of the included studies differed considerably from each other, and the quality of many studies was not optimal. Psychotherapies did have a small to moderate effect on depressive symptoms against care as usual at the post-test assessment (g = 0.35, 95% CI 0.23-0.47; NNT = 5, 95% CI 4-8) and significantly reduced the incidence of major depressive episodes at 6 months (RR = 0.61) and possibly at 12 months (RR = 0.74). The effects were significantly smaller than those of psychotherapy for major depressive disorder and could be accounted for by non-specific effects of treatment.
Psychotherapy may be effective in the treatment of subclinical depression and reduce the incidence of major depression, but more high-quality research is needed.
•This is the first systematic review and meta-analysis based on longitudinal studies analysing mental disorders and psychiatric comorbidity on suicidal behaviour among young people.•Mental disorders ...increase the risk for suicide attempts in young people.•In particular affective disorders predicted suicide attempts in young people.•Mental disorders and comorbidity are strong predictors of suicide behavior.
Suicide is the second leading cause of death for young people. Objective: To assess mental disorders as risk factors for suicidal behaviour among adolescents and young adults including population-based longitudinal studies.
We conducted a systematic literature review. Bibliographic searches undertaken in five international databases and grey literature sources until January 2017 yielded a total of 26,883 potential papers. 1701 full-text articles were assessed for eligibility of which 1677 were excluded because they did not meet our eligibility criteria. Separate meta-analyses were conducted for each outcome (suicide death and suicide attempts). Odds ratio (OR) and 95% confidence intervals (95%CI) and beta coefficients and standard errors were calculated.
24 studies were finally included involving 25,354 participants (12–26 years). The presence of any mental disorder was associated with higher risk of suicide death (OR = 10.83, 95%CI = 4.69–25.00) and suicide attempt (OR = 3.56; 95%CI 2.24–5.67). When considering suicidal attempt as the outcome, only affective disorders (OR = 1.54; 95%CI = 1.21–1.96) were significant. Finally, the results revealed that psychiatric comorbidity was a primary risk factor for suicide attempts.
Data were obtained from studies with heterogeneous diagnostic assessments of mental disorders. Nine case-control studies were included and some data were collected in students, not in general population.
Mental disorders and comorbidity are strong predictors of suicide behaviour in young people. Detection and management of the affective disorders as well as their psychiatric comorbidity could be a crucial strategy to prevent suicidality in this age group.
•This research update effectiveness data to telephone-delivered psychotherapy.•It is the first that determine adherence to telephone-administered psychotherapy.•Telephone-delivered psychotherapy ...shows beneficial effects on depression compared to control conditions.•There is no evidence that it is less effective compared to active comparators.•Telephone-delivered psychotherapy shows an adequate treatment adherence.
The aim of this systematic review was to evaluate the effectiveness of telephone-administered psychotherapy for depression in adults when compared to control conditions or other active treatments, and to determine adherence to telephone-administered psychotherapy.
A bibliographic search was conducted in MEDLINE, Embase, PsycINFO, the Cochrane library, and a number of sources of grey literature. We included randomised controlled trials (RCTs) examining the impact of telephone-administered psychotherapy on depressive symptomatology. Two reviewers independently screened citations, extracted the relevant data, and assessed risk of bias using Cochrane tools. Random effects meta-analyses were used to determine the average effect of the interventions on depressive symptomatology: main analysis including randomised trials only, and several exploratory subgroup and sensitivity analyses.
We identified ten trials. Telephone-administered psychotherapy showed beneficial effects on depression severity when compared to control conditions ((standardized mean difference SMD= −0.85 (95% CI −1.56 to −0.15)). When compared to active comparators, the meta-analysis showed a non-significant small effect size (SMD= −0.18 (95% CI −0.45 to 0.09)), in favour of telephone-administered psychotherapy. Total weighted mean adherence was 73%.
Some of the included studies presented a small sample size. Due to variations in time points follow-ups among the studies, it was not possible to determine long term post intervention effects.
Available evidence suggests that telephone-delivered psychotherapy may be an effective strategy to reduce depression symptoms when compared to control conditions, and shows an adequate treatment adherence. Future research is needed to determine its cost-effectiveness and long-term effects.
Edge artificial intelligence (AI) is receiving a tremendous amount of interest from the machine learning community due to the ever-increasing popularization of the Internet of Things (IoT). ...Unfortunately, the incorporation of AI characteristics to edge computing devices presents the drawbacks of being power and area hungry for typical deep learning techniques such as convolutional neural networks (CNNs). In this work, we propose a power-and-area efficient architecture based on the exploitation of the correlation phenomenon in stochastic computing (SC) systems. The proposed architecture solves the challenges that a CNN implementation with SC (SC-CNN) may present, such as the high resources used in binary-to-stochastic conversion, the inaccuracy produced by undesired correlation between signals, and the complexity of the stochastic maximum function implementation. To prove that our architecture meets the requirements of edge intelligence realization, we embed a fully parallel CNN in a single field-programmable gate array (FPGA) chip. The results obtained showed a better performance than traditional binary logic and other SC implementations. In addition, we performed a full VLSI synthesis of the proposed design, showing that it presents better overall characteristics than other recently published VLSI architectures.
To assess the accuracy of WMH-ICS online screening scales for evaluating four common mental disorders (Major Depressive EpisodeMDE, Mania/HypomaniaM/H, Panic DisorderPD, Generalized Anxiety ...DisorderGAD) and suicidal thoughts and behaviorsSTB used in the UNIVERSAL project.
Clinical diagnostic reappraisal was carried out on a subsample of the UNIVERSAL project, a longitudinal online survey of first year Spanish students (18-24 years old), part of the WHO World Mental Health-International College Student (WMH-ICS) initiative. Lifetime and 12-month prevalence of MDE, M/H, PD, GAD and STB were assessed with the Composite International Diagnostic Interview-Screening Scales CIDI-SC, the Self-Injurious Thoughts and Behaviors Interview SITBI and the Columbia-Suicide Severity Rating Scale C-SSRS. Trained clinical psychologists, blinded to responses in the initial survey, administered via telephone the Mini-International Neuropsychiatric Interview MINI. Measures of diagnostic accuracy and McNemar χ2 test were calculated. Sensitivity analyses were conducted to maximize diagnostic capacity.
A total of 287 students were included in the clinical reappraisal study. For 12-month and lifetime mood disorders, sensitivity/specificity were 67%/88.6% and 65%/73.3%, respectively. For 12-month and lifetime anxiety disorders, these were 76.8%/86.5% and 59.6%/71.1%, and for 12-month and lifetime STB, 75.9%/94.8% and 87.2%/86.3%. For 12-month and lifetime mood disorders, anxiety disorders and STB, positive predictive values were in the range of 18.1-55.1% and negative predictive values 90.2-99.0%; likelihood ratios positive were in the range of 2.1-14.6 and likelihood ratios negative 0.1-0.6. All outcomes showed adequate areas under the curve AUCs (AUC>0.7), except M/H and PD (AUC = 0.6). Post hoc analyses to select optimal diagnostic thresholds led to improved concordance for all diagnoses (AUCs>0.8).
The WMS-ICS survey showed reasonable concordance with the MINI telephone interviews performed by mental health professionals, when utilizing optimized cut-off scores. The current study provides initial evidence that the WMS-ICS survey might be useful for screening purposes.
To assess sociodemographic, clinical and treatment factors as well as depression outcome in a large representative clinical sample of psychiatric depressive outpatients and to determine if ...melancholic and atypical depression can be differentiated from residual non-melancholic depressive conditions.
A prospective, naturalistic, multicentre, nationwide epidemiological study of 1455 depressive outpatients was undertaken. Severity of depressive symptoms was assessed by the Hamilton Depression Rating Scale (HDRS) and the Self Rated Inventory of Depressive Symptomatology (IDS-SR(30)). IDS-SR(30) defines melancholic and atypical depression according to DSM-IV criteria. Assessments were carried out after 6-8 weeks of antidepressant treatment and after 14-20 weeks of continuation treatment.
Melancholic patients (16.2%) were more severely depressed, had more depressive episodes and shorter episode duration than atypical (24.7%) and non-melancholic patients. Atypical depressive patients showed higher rates of co-morbid anxiety disorders and substance abuse. Melancholic patients showed lower rates of remission.
Our study supports a different clinical pattern and treatment outcome for melancholic and atypical depression subtypes.
•A simple three-zone model reproduces the major feats of the Earth's energy budget.•The model assumes that the latitudinal heat transport is maximized.•We forecast past, present and future conditions ...for different albedo and greenhouse factors.•Current trends in albedo and greenhouse lead to maximum warming at high latitudes.•These trends compete setting the temperature of other latitudes.
The large uncertainties in the forecasting of future global climatic conditions endorse the need of developing simple yet credible predicting tools. Here we propose a three-zone steady-state radiative model that maximizes latitudinal heat fluxes and considers the potential effect of the Earth's declination. The model is formulated as a set of five equations and six unknowns (zonal temperatures and widths, and the latitudinal heat transport) that requires specifying the reflected (albedo) and back-to-Earth (greenhouse) radiation fractions and obliges turning the low-latitude temperature into an additional parameter. The results do depend on the Earth declination, with changes of 0.5/1.5 K in the intermediate/high zones, which is interpreted as potentially affecting the greenhouse and high-latitude albedo coefficients. Therefore, we focus on identifying the effects of changes in these parameters – properly selected to represent last-glacial-maximum, modern and end-of the-century conditions. The main change is a large rise of the high-latitude temperature, favored both by a decrease in the high-latitude albedo and an increase in the greenhouse factor. For the other variables, the temporal changes in albedo and greenhouse gases compete among them, resulting in one trend from glacial to modern times and a reversal between preindustrial times and the end of the 21st century (currently a warming-narrowing of the intermediate region and the widening of both the low- and high-latitude zones); however, we note that an increase in the low-latitude temperature would tend to alleviate these changes. Despite its simplicity, the model leads to realistic global trends, becoming a useful simple tool for exploring the sensitivity of the Earth's heat distribution to changes in radiative fluxes and endorsing the validity of the maximum latitudinal-heat-transport premise.
The management of schizophrenia is evolving towards a more comprehensive model based on functional recovery. The concept of functional recovery goes beyond clinical remission and encompasses multiple ...aspects of the patient's life, making it difficult to settle on a definition and to develop reliable assessment criteria. In this consensus process based on a panel of experts in schizophrenia, we aimed to provide useful insights on functional recovery and its involvement in clinical practice and clinical research.
After a literature review of functional recovery in schizophrenia, a scientific committee of 8 members prepared a 75-item questionnaire, including 6 sections: (I) the concept of functional recovery (9 items), (II) assessment of functional recovery (23 items), (III) factors influencing functional recovery (16 items), (IV) psychosocial interventions and functional recovery (8 items), (V) pharmacological treatment and functional recovery (14 items), and (VI) the perspective of patients and their relatives on functional recovery (5 items). The questionnaire was sent to a panel of 53 experts, who rated each item on a 9-point Likert scale. Consensus was achieved in a 2-round Delphi dynamics, using the median (interquartile range) scores to consider consensus in either agreement (scores 7-9) or disagreement (scores 1-3). Items not achieving consensus in the first round were sent back to the experts for a second consideration.
After the two recursive rounds, consensus was achieved in 64 items (85.3%): 61 items (81.3%) in agreement and 3 (4.0%) in disagreement, all of them from section II (assessment of functional recovery). Items not reaching consensus were related to the concepts of functional recovery (1 item, 1.3%), functional assessment (5 items, 6.7%), factors influencing functional recovery (3 items, 4.0%), and psychosocial interventions (2 items, 5.6%).
Despite the lack of a well-defined concept of functional recovery, we identified a trend towards a common archetype of the definition and factors associated with functional recovery, as well as its applicability in clinical practice and clinical research.
Reservoir computing (RC) is a powerful machine learning methodology well suited for time-series processing. The hardware implementation of RC systems (HRC) may extend the utility of this neural ...approach to solve real-life problems for which software solutions are not satisfactory. Nevertheless, the implementation of massive parallel-connected reservoir networks is costly in terms of circuit area and power, mainly due to the requirement of implementing synapse multipliers that increase gate count to prohibitive values. Most HRC systems present in the literature solve this area problem by sequencializing the processes, thus loosing the expected fault-tolerance and low latency of fully parallel-connected HRCs. Therefore, the development of new methodologies to implement fully parallel HRC systems is of high interest to many computational intelligence applications requiring quick responses. In this article, we propose a compact hardware implementation for Echo-State Networks (an specific type of reservoir) that reduces the area cost by simplifying the synapses and using linear piece-wise activation functions for neurons. The proposed design is synthesized in a Field-Programmable Gate Array and evaluated for different time-series prediction tasks. Without compromising the overall accuracy, the proposed approach achieves a significant saving in terms of power and hardware when compared with recently published implementations. This technique pave the way for the low-power implementation of fully parallel reservoir networks containing thousands of neurons in a single integrated circuit.
Suicide is a serious public health concern. Depression is the main gateway to suicidal behavior. The already established relationship between depression and suicidal risk should now focus on the ...investigation of more specific factors: recent studies have suggested an association between vulnerability to suicidal behavior and neurocognitive alterations, a nuclear symptom of depression. This project aims to identify alterations in the Executive Functions (EF) of patients suffering a first depressive episode that might constitute a risk factor for suicidal ideation, suicidal attempts and suicide, to allow for more adequate suicide prevention.
Prospective longitudinal design involving two groups (first depressive episodes with and without alterations in their EF) and four repeated measures (0, 6, 12 and 24 months). The estimated minimum sample size is 216 subjects. The variables and measurement instruments will include socio-demographic variables, clinical variables (age of illness onset, family and personal antecedents, psychopathological and medical comorbidity, suicidal ideation, suicide attempts and completed suicides, severity of depression, including melancholic or atypical, remission of the depressive episode), and neuropsychological variables (EF and decision-making processes evaluated through the Cambridge Neuropsychological Test Automated Battery (CANTAB)).
First and foremost, the identification of clinical and neuropsychological risk factors associated with suicidal behavior will open the possibility to prevent such behavior in patients with a first depressive episode in the context of clinical practice. Secondly, interventions aimed at cognitive impairment (in particular: EF) derived from the study may be incorporated into strategies for the prevention of suicidal behavior. Finally, impaired neurocognitive function (even in early stages) could become an identifiable endophenotype or "marker" in clinical and neurobiological studies about suicidal behavior in depressive patients.
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