Cognitive impairment often occurs in major depressive disorder (MDD). Studies suggest that these cognitive deficits may be associated with inflammatory biomarkers, but data are limited. Therefore, ...this study aims to investigate the relationship between 48 peripheral blood cytokines and cognitive performance in patients with severe depressive disorder. One hundred consecutive hospitalized adult patients with severe depression who participated in the Depression long-term Augsburg (DELTA) study were included in the present analysis. To test working memory (WM) the Wechsler Adult Intelligence Scale (WAIS) IV and to assess interference control (IC) the Stroop Color and Word Test (SCWT) were performed. The serum concentrations of the biomarkers were measured using the Bio-Plex Pro™ Human Cytokine Screening Panel 1. Multiple linear regression models adjusted for possible confounders were fitted to examine associations. WM was impaired in 11% of the patients. IC was impaired in 1%–3% of the cases depending on the subtest. Eotaxin, IL-1β, IL-4, MCP-1, G-CSF, and PGF-BB were negatively associated with the WM. Eotaxin, IL-1β, IL-4, IL-16, IL-18, MCP-1, G-CSF, SCF, and MIP-1α were negatively associated with IC. None of these associations remained significant after adjustment for multiple testing. The present study identified eotaxin, IL-1β, IL-4, IL-16, IL-18, MCP-1, G-CSF, SCF, PGF-BB and MIP-1α as being associated with cognitive performance. After confirmation of these results in further studies, these cytokines may be potential targets for new treatments.
•At least mild impairment of working memory was found in 33% of patients with severe depression.•Eotaxin, IL-1β, IL-4, MCP-1, G-CSF, and PGF-BB were associated with impaired working memory.•Eotaxin, IL-1β, IL-4, IL-16, IL-18, MCP-1, G-CSF, SCF, and MIP-1α were associated with impaired interference control.
Many studies indicate that men are more reluctant to seek help for mental health problems than women. Traditional ideas of masculinity are often seen as a cause of this phenomenon. However, little is ...known about the diversity of experiences during the processes of help-seeking and service use among men with depression who have already utilized mental health services. This study aims to explore men's experiences and attitudes toward depression, help-seeking, and service use in order to develop gender-sensitive services.
Narrative-biographical interviews were conducted with men treated for depression (
= 12). Interview topics included individual experience with depression, help-seeking behavior, and mental health service use. Transcripts were analyzed using qualitative content analysis.
Before seeking treatment, men's help-seeking behavior was negatively affected by internalized masculine norms. However, findings indicate a change of attitudes toward depression after mental health service use. Men with depression emphasized a salutogenic perspective toward mental health problems and critically reflected on masculine norms. The positive function of men-only groups were described as key for successful service use.
Men with depression reported experiences toward help-seeking and service use on four different levels: (i) attitudes toward depression, (ii) perception of societal views on depression, (iii) experiences within the family context and (iv) experiences with mental health services. Interventions to reduce the stigma of being "unmanly" and to improve men's capacity to cope with being unable to work should be developed. Peer-led men-only groups may increase participants' self-esteem and assist in disclosing weaknesses. In the context of GPs' mediating role, training for health professionals concerning the impact of masculine norms on mental health is recommended.
Abstract
Background
The underestimation of depression among men may result from atypical depression symptoms and male help-seeking behaviour. However, higher suicide rates among men than among women ...indicate a need for gender-specific services for men with depression. In order to develop gender-specific services, it is essential to examine professionals’ attitudes towards men’s depressive symptoms and treatment needs as well as barriers to and facilitators of treatment. This study examined gender-specific treatment needs in male patients and treatment approaches to male patients from a professional perspective.
Methods
Semi-structured face-to-face interviews were conducted with 33 mental health professionals (MHPs) from five German psychiatric institutions. The study assessed the characteristics and attributes of male patients with depression risk factors for the development of depression among men, their condition at the beginning of treatment, male patients’ depressive symptoms, the needs and expectations of male patients, the importance of social networks in a mental health context, and MHPs’ treatment aims and treatment methods. Transcripts were analysed using qualitative content analysis.
Results
The professionals’ reference group of male patients were men who were characterised in accordance with traditional masculinity. Attributes reported as in line with this type of men were late initiations of inpatient treatment after crisis, suicidal ideation or attempted suicide, and high expectations towards treatment duration, success rate in recovery and therapeutic sessions. In contrast, male patients who deviate from these patterns were partially described with reference to female stereotypes. Professionals referred to psychosocial models in their explanations of the causes of depression and provided sociological explanations for the development of masculine ideals among men. The consequences of these for treatment were discussed against the background of normative expectations regarding the male gender. From the professionals’ point of view, psychoeducation and the acceptance of depression (as a widespread mental illness) were the most important goals in mental health treatment.
Conclusions
In order to improve mental health among men, gender-specific services should be offered. Awareness of the role of gender and its implications on mental health treatment should be an integral part of MHPs’ education and their daily implementation of mental health treatment practices.
A traditional male role orientation is considered to increase the risk of depression and preventing men from disclosing symptoms of mental illness and seeking professional help. Less is known about ...the variance of masculinity orientations in men already treated for depression and their role in the treatment process. In this study, patterns of masculinity norms and work role orientations will be identified among men treated for depression. Associations of these patterns with depressive symptoms, stigma and delay in professional help-seeking will be investigated.
In a cross-sectional study, male role orientations (MRNS), work-related attitudes (AVEM), symptoms of mental disorders (PHQ), and attitudes related to stigma of mental illness (DSS) were assessed by standardized methods in a sample of 250 men treated for depression in general medical, psychiatric and psychotherapeutic services. Data were analyzed by means of latent profile analysis (LPA), by multinomial and linear regression models, and by path analysis.
The results of LPA revealed three latent classes of men treated for depression. Men assigned to class one reported a less traditional male role orientation, low professional ambitions and low coping capacities; men assigned to class two reported a traditional masculinity orientation, high professional ambitions but low coping capacities; men assigned to class three reported less traditional masculinity tended orientations, medium professional ambitions and high coping capacities. Men assigned to classes one and two to have more stigmatizing attitudes, longer periods of untreated illness and more severe symptoms of mental disorders, in comparison to men assigned to class three.
Overall, this study reveals that traditional masculinity norms and work-role orientations in men treated for depression are associated with a worse mental health status. Our study results also suggest that a slackening of traditional masculinity norms is associated with improved psychological well-being if it does not coincide with a complete distancing from professional ambitions and a lack of ability to cope with professional stress.
Current approaches to the treatment of schizophrenia have mainly focused on the protein-coding part of the genome; in this context, the roles of microRNAs have received less attention. In the present ...study, we analyze the microRNAome in the blood and postmortem brains of schizophrenia patients, showing that the expression of miR-99b-5p is downregulated in both the prefrontal cortex and blood of patients. Lowering the amount of miR-99b-5p in mice leads to both schizophrenia-like phenotypes and inflammatory processes that are linked to synaptic pruning in microglia. The microglial miR-99b-5p-supressed inflammatory response requires Z-DNA binding protein 1 (Zbp1), which we identify as a novel miR-99b-5p target. Antisense oligonucleotides against Zbp1 ameliorate the pathological effects of miR-99b-5p inhibition. Our findings indicate that a novel miR-99b-5p-Zbp1 pathway in microglia might contribute to the pathogenesis of schizophrenia.
Synopsis
The involvement of microRNAs in the pathogenesis of schizophrenia is not well-understood. This study shows that miR-99b-5p regulates Z-DNA binding protein 1 (Zbp1) to control inflammatory responses in microglia and the development of schizophrenia-like symptoms in mice.
miR-99b-5p is downregulated in the blood and brains of schizophrenia patients.
miR-99b-5p inhibition induces schizophrenia-like phenotypes in mice and microglial inflammation.
Zbp1 is a novel miR-99b-5p target in microglia.
Zbp1 antisense oligos ameliorate the pathological outcomes of decreased miR-99b-5p levels.
Dysregulation of a novel miR-99b-5p-Zbp1 (Z-DNA binding protein 1) pathway in microglia induces inflammatory responses and schizophrenia-like phenotypes in mice.
Purpose
Neighbourhood characteristics are known to be associated with higher rates of hospital admission for psychiatric disorders.
Methods
An ecological study with aggregated data was carried out. ...All cases for schizophrenia and depression in the 42 city districts of Augsburg were identified over a 4-year-period (2006–2009) and neighbourhood variables were obtained. Negative binomial regression adjusted the effects for year of admission and accommodation in inpatient centres.
Results
There was significant association of high unemployment rate, low proportion of working population and high population density with higher rates of admission for schizophrenia. An increase of 1 % in unemployment rate incidence rate ration (IRR) 1.0451, 95 % CI 1.0175–1.0734 was associated with 5 % raise of admission rates for schizophrenia and an increase of 1 % in working population (IRR 0.9793, 95 % CI 0.9605–0.9985) with a decrease of admission rates by 2 %. High proportion of single households and high percentage of persons eligible for social security increased admission rate for depression. Thus 1 % increase in the proportion of single households (IRR 1.0095, 95 % CI 1.0030–1.0162) and of the proportion of persons eligible for social security (IRR 1.0148, 95 % CI 1.0002–1.0297) both independently were associated with an increased rate of admission for depression of 1 %.
Conclusion
Our analysis demonstrated that measures of social isolation in neighbourhoods and social contacts at work influenced admission for schizophrenia and depression: in neighbourhoods with less social contacts and with a higher proportion of persons not working the admission rates increased. The problem of confounding in ecological studies need to be considered.
Mitochondria generate energy through oxidative phosphorylation (OXPHOS). The function of key OXPHOS proteins can be altered by variation in mitochondria-related genes, which may increase the risk of ...mental illness. We investigated the association of mitochondria-related genes and their genetic risk burden with cognitive performance.
We leveraged cross-sectional data from 1320 individuals with a severe psychiatric disorder and 466 neurotypical individuals from the PsyCourse Study. The cognitive tests analyzed were the Trail-Making Test, Verbal Digit Span Test, Digit-Symbol Test, and Multiple Choice Vocabulary Intelligence Test. Association analyses between the cognitive tests, and single-nucleotide polymorphisms (SNPs) mapped to mitochondria-related genes, and their polygenic risk score (PRS) for schizophrenia (SCZ) were performed with PLINK 1.9 and R program.
We found a significant association (FDR-adjusted p < 0.05) in the Cytochrome C Oxidase Assembly Factor 8 (COA8) gene locus of the OXPHOS pathway with the Verbal Digit Span (forward) test. Mitochondrial PRS was not significantly associated with any of the cognitive tests.
Moderate statistical power due to relatively small sample size.
COA8 encodes a poorly characterized mitochondrial protein involved in apoptosis. Here, this gene was associated with the Verbal Digit Span (forward) test, which evaluates short-term memory. Our results warrant replication and may lead to better understanding of cognitive impairment in mental disorders.
•Mitochondria generate energy through oxidative phosphorylation (OXPHOS) pathway.•Variation in mitochondria-related genes can affect key proteins involved in OXPHOS.•The protein COA8 is associated with cognitive performance.•Mitochondrial genetic risk burden has no clear effects on cognitive function.
The German guideline on psychosocial interventions for people with severe mental disorders recommends a broad spectrum of evidence-based treatments. Structured implementation of the associated ...patient version of the guideline is missing to date. The study aims to assess whether structured implementation of a patient guideline improves the empowerment of patients with severe mental disorders, as well as knowledge, attitudes and experiences regarding psychosocial interventions, service use, treatment satisfaction, treatment needs, quality of life and burden of care.
The study is a multicentre, cluster-randomised, controlled study with two parallel groups. Inpatients and day hospital patients (all sexes; 18-65 years) with severe mental disorders will be included. Additionally, relatives of patients with mental disorders (all sexes; ≥ 18 years) will be included. In the experimental group, the patient guideline will be implemented using a multimodal strategy. Participants in the control group will receive treatment as usual but will be made aware of the patient guideline. The primary outcome is the change of empowerment, assessed by using the 'empowerment in the process of psychiatric treatment of patients with affective and schizophrenia disorders' (EPAS) scale. In addition, knowledge, attitudes and experiences regarding psychosocial interventions will be assessed as secondary outcomes, as well as service use, satisfaction with care, patient need and quality of life and participation and social inclusion. For relatives, the perceived burden of care also will be recorded. Results will be analysed using hierarchical linear models. For the health economic evaluation, the incremental cost-utility ratios will be computed using the differences in total costs of illness and the differences in quality-adjusted life years (QALY) between study groups.
The study will be the first to assess the effects of a structured implementation of the patient version of a psychiatric treatment guideline. The study has some limitations regarding the transferability of the results to other patients and other regions. Furthermore, problems with the recruitment of patients and relatives and with the implementation of intervention could occur during the study.
The study is registered in the German Clinical Trials Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00017577 (Date of registration: 23 October 2019.
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