Depression Research and Treatment The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Leukocyte Gene Expression in Patients with Medication Refractory Depression before and after Treatment with ECT or Isoflurane Anesthesia: A Pilot Study Sun, 13 Apr 2014 16:33:47 +0000 Objective. To evaluate leukocyte gene expression for 9 selected genes (mRNAs) as biological markers in patients with medication refractory depression before and after treatment with ECT or isoflurane anesthesia (ISO). Methods. In a substudy of a nonrandomized open-label trial comparing effects of ECT to ISO therapy, blood samples were obtained before and after treatment from 22 patients with refractory depression, and leukocyte mRNA was assessed by quantitative PCR. Patients’ mRNAs were also compared to 17 healthy controls. Results. Relative to controls, patients before treatment showed significantly higher IL10 and DBI and lower ADRA2A and ASIC3 mRNA (). Both ECT and ISO induced significant decreases after treatment in 4 genes: IL10, NR3C1, DRD4, and Sult1A1. After treatment, patients’ DBI, ASIC3, and ADRA2A mRNA remained dysregulated. Conclusion. Significant differences from controls and/or significant changes after ECT or ISO treatment were observed for 7 of the 9 mRNAs studied. Decreased expression of 4 genes after effective treatment with either ECT or ISO suggests possible overlap of underlying mechanisms. Three genes showing dysregulation before and after treatment may be trait-like biomarkers of medication refractory depression. Gene expression for these patients has the potential to facilitate diagnosis, clarify pathophysiology, and identify potential biomarkers for treatment effects. E. Iacob, S. C. Tadler, K. C. Light, H. R. Weeks, K. W. Smith, A. T. White, R. W. Hughen, T. A. VanHaitsma, L. A. Bushnell, and A. R. Light Copyright © 2014 E. Iacob et al. All rights reserved. Participating in Online Mental Health Interventions: Who Is Most Likely to Sign Up and Why? Wed, 02 Apr 2014 14:15:24 +0000 Internet-based interventions are increasingly recognized as effective in the treatment and prevention of mental disorders. However, little research has investigated who is most likely to participate in intervention trials. This study examined the characteristics of individuals interested in participating in an online intervention to improve emotional well-being and prevent or reduce the symptoms of depression, factors reported to encourage or discourage participation, and preferences for different intervention types. The study comprised 4761 Australians participating in a survey on emotional health. Comparisons are made between those who expressed an interest in participating in the trial and those who were not. Compared to those who declined to participate, interested participants were more likely older, females, separated/divorced, and highly educated, have reported current or past history of depression, report higher depressive symptoms, and have low personal stigma. Despite the flexibility of online interventions, finding time to participate was the major barrier to engagement. Financial compensation was the most commonly suggested strategy for encouraging participation. An increased understanding of factors associated with nonparticipation may inform the design of future e-mental health intervention trials. Importantly, consideration needs to be given to the competing time pressures of potential participants, in balance with the desired study design. Dimity A. Crisp and Kathleen M. Griffiths Copyright © 2014 Dimity A. Crisp and Kathleen M. Griffiths. All rights reserved. The Validity and Reliability of the Sinhala Translation of the Patient Health Questionnaire (PHQ-9) and PHQ-2 Screener Thu, 27 Mar 2014 07:46:06 +0000 The Patient Health Questionnaire (PHQ-9) was adapted and translated into Sinhala. Sample consisted of 75 participants diagnosed with MDD according to DSM-IV criteria and 75 gender matched controls. Concurrent validity was assessed by correlating total score of PHQ-9 with that of Centre for Epidemiological Studies Depression Scale (CESD). The Structured Clinical Interview for DSM-IV (SCID-II) conducted by a psychiatrist was the gold standard. Mean age of the sample was 33.0 years. There were 91 females (60.7%). There was significant difference in the mean PHQ-9 scores between cases (14.71) and controls (2.55) (). The specificity of the categorical algorithm was 0.97; the sensitivity was 0.58. Receiver operating characteristic (ROC) analysis found that cut-off score of ≥10 had sensitivity of 0.75 and specificity of 0.97. The area under the curve (AOC) was 0.93. The sensitivity of the two-item screener (PHQ-2) was 0.80 and the specificity was 0.97. Cronbach’s alpha was 0.90. The PHQ-9 is a valid and reliable instrument for diagnosing MDD in a non-Western population. The threshold algorithm is recommended for screening rather than the categorical algorithm. The PHQ-2 screener has good sensitivity and specificity and is recommended as a quick screening instrument. Raveen Hanwella, Shakya Ekanayake, and Varuni A. de Silva Copyright © 2014 Raveen Hanwella et al. All rights reserved. A Preliminary Study on the Relationship between Platelet Serotonin Transporter Functionality, Depression, and Fatigue in Patients with Untreated Chronic Hepatitis C Thu, 20 Mar 2014 13:20:27 +0000 Objective and Methods. Although the interaction between fatigue and depression in patients with chronic hepatitis C infection (HCV) has been recognized, the biological correlates of this observation have yet to be reported. We addressed this issue by examining serotonin transporter- (SERT-) driven [14C]-serotonin uptake rate (SUR) and serotonin content in platelets of 65 untreated HCV patients and 65 healthy control subjects (HCS). All patients completed report questionnaires for fatigue, depression, and general psychopathology. Structured interviews were conducted by a board-certified psychiatrist. Results. Whereas 36 of the patients experienced fatigue of moderate-to-severe intensity, only 16 reported symptoms of depression (BDI score > 10). Mean SUR in patients with depressive symptoms was significantly higher relative to the HCS, corresponding to a large Cohen’s effect size of (95% ). Patients who rated their fatigue to have a marked impact on mood and activity displayed a moderate relationship between the BDI score and SUR (, , ), which becomes stronger after controlling for age, gender, and thrombocytopenia (, ). In the univariate analysis, high fatigue interference score, thrombocytopenia, and high SUR were all significant predictors of depression. Conclusions. High SERT activity could be implicated in the expression of depressive symptoms especially in a subgroup of HCV patients who are feeling fatigue as markedly distressing. Leonora Franke, Eric Therstappen, Beate Schlosser, Michael Biermer, Thomas Berg, Martin Schäfer, Petra Arck, Ralf Uebelhack, and Astrid Friebe Copyright © 2014 Leonora Franke et al. All rights reserved. Psychosocial Functioning in Depressive Patients: A Comparative Study between Major Depressive Disorder and Bipolar Affective Disorder Thu, 13 Mar 2014 11:07:34 +0000 Introduction. Major depressive disorder (MDD) and bipolar affective disorder (BAD) are among the leading causes of disability. These are often associated with widespread impairments in all domains of functioning including relational, occupational, and social. The main aim of the study was to examine and compare nature and extent of psychosocial impairment of patients with MDD and BAD during depressive phase. Methodology. 96 patients (48 in MDD group and 48 in BAD group) were included in the study. Patients were recruited in depressive phase (moderate to severe depression). Patients having age outside 18–45 years, psychotic symptoms, mental retardation, and current comorbid medical or axis-1 psychiatric disorder were excluded. Psychosocial functioning was assessed using Range of Impaired Functioning Tool (LIFE-RIFT). Results. Domains of work, interpersonal relationship, life satisfaction, and recreation were all affected in both groups, but the groups showed significant difference in global psychosocial functioning score only () with BAD group showing more severe impairment. Conclusion. Bipolar depression causes higher global psychosocial impairment than unipolar depression. Shubham Mehta, Pankaj Kumar Mittal, and Mukesh Kumar Swami Copyright © 2014 Shubham Mehta et al. All rights reserved. An Overview of Depression among Transgender Women Thu, 13 Mar 2014 08:39:25 +0000 Rates of depression are higher in transgender women than in the general population, warranting an understanding of the variables related to depression in this group. Results of the literature review of depression in transgender women reveal several variables influencing depression, including social support, violence, sex work, and gender identity. The theoretical constructs of minority stress, coping, and identity control theory are explored in terms of how they may predict depression in transgender women. Depression and depressive symptoms have been used to predict high-risk sexual behaviors with mixed results. The implications of the findings on treating depression in transgender women include taking into account the stress of transition and the importance of supportive peers and family. Future studies should explore a model of depression and high-risk behaviors in transgender women. Beth Hoffman Copyright © 2014 Beth Hoffman. All rights reserved. Exploring Personality Features in Patients with Affective Disorders and History of Suicide Attempts: A Comparative Study with Their Parents and Control Subjects Sun, 02 Mar 2014 13:31:01 +0000 Personality traits are important candidate predictors of suicidal behavior. Several studies have reported an association between personality/temperament traits and suicidal behavior, suggesting personality traits as intermediary phenotypes related to suicidal behavior. Thus, it is possible that suicide attempts can be accounted for by increased familial rates of risk personality traits. The aim of this work was to evaluate personality traits in affective disorder patients with attempted suicide and to compare them with the personality trait scores of their parents. In addition, ITC scores in the two groups were compared with a healthy control sample. The patients evaluated met the DSM-IV criteria for major depression disorder or dysthymia and had a documented history of suicide attempts. Psychiatric diagnoses of patients and parents were done according to the SCID-I and the personality was assessed using the Temperament and Character Inventory. We analyzed 49 suicide attempt subjects and their parents () and 89 control subjects. We observed that temperament and character dimensions were similar between patients and their parents (). In particular, we observed that high HA and low P, SD, and CO were shared among families. Our study is the first to report that the personality traits of affective disorder patients with a history of attempted suicide are shared between patients and their parents. Beatriz Camarena, Ana Fresán, and Emmanuel Sarmiento Copyright © 2014 Beatriz Camarena et al. All rights reserved. Depression and Psychological Trauma: An Overview Integrating Current Research and Specific Evidence of Studies in the Treatment of Depression in Public Mental Health Services in Chile Mon, 17 Feb 2014 13:48:01 +0000 In the last two decades, different research has demonstrated the high prevalence of childhood trauma, including sexual abuse, among depressive women. These findings are associated with a complex, severe, and chronic psychopathology. This can be explained considering the neurobiological changes secondary to early trauma that can provoke a neuroendocrine failure to compensate in response to challenge. It suggests the existence of a distinguishable clinical-neurobiological subtype of depression as a function of childhood trauma that requires specific treatments. Among women with depression and early trauma receiving treatment in a public mental health service in Chile, it was demonstrated that a brief outpatient intervention (that screened for and focused on childhood trauma and helped patients to understand current psychosocial difficulties as a repetition of past trauma) was effective in reducing psychiatric symptoms and improving interpersonal relationships. However, in this population, this intervention did not prevent posttraumatic stress disorder secondary to the extreme earthquake that occurred in February 2010. Therefore in adults with depression and early trauma, it is necessary to evaluate prolonged multimodal treatments that integrate pharmacotherapy, social support, and interpersonal psychotherapies with trauma focused interventions (specific interventions for specific traumas). Verónica Vitriol, Alfredo Cancino, Kristina Weil, Carolina Salgado, Maria Andrea Asenjo, and Soledad Potthoff Copyright © 2014 Verónica Vitriol et al. All rights reserved. The Relationship between Negative Affect and Reported Cognitive Failures Tue, 11 Feb 2014 09:58:35 +0000 The purpose of this study was to expand our understanding of the range of negative affect associated with reported problems with everyday functions and activities, measured by the cognitive failures questionnaire (CFQ). Evidence from previous research indicates that individuals meeting criteria for mood disorders, such as major depression or seasonal affective disorder, experience cognitive deficits in memory and attention that can lead to problems with everyday activities reported in the CFQ. The Positive and Negative Affect Scale (PANAS) was used to assess potential correlations with a wider range of negative emotions. Findings for a sample of 129 college students revealed that negative affective experiences were significantly correlated with failures of memory and attention on the CFQ (fear = .41, hostility = .38, sadness = .28, and guilt = .43). Conversely, positive affect was negatively correlated with distractibility (). Additional affective scales on the PANAS (e.g., shyness and fatigue) were also associated with higher reports of cognitive failures. The results provide converging evidence of a relationship between negative affective experiences and reported frequency of problems on the cognitive failures questionnaire. Tabitha W. Payne and Michael A. Schnapp Copyright © 2014 Tabitha W. Payne and Michael A. Schnapp. All rights reserved. Assessing Depression in Cardiac Patients: What Measures Should Be Considered? Thu, 06 Feb 2014 11:59:10 +0000 It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients’ wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS), the Cognitive Behavioural Assessment Hospital Form (CBA-H), the Beck Depression Inventory (BDI), the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9), the Depression Interview and Structured Hamilton (DISH), the Hamilton Rating Scale for Depression (HAM-D/HRSD), and the Composite International Diagnostic Interview (CIDI). Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients. M. Ceccarini, G. M. Manzoni, and G. Castelnuovo Copyright © 2014 M. Ceccarini et al. All rights reserved. The Prevalence and Risk Factors of Paternal Depression from the Antenatal to the Postpartum Period and the Relationships between Antenatal and Postpartum Depression among Fathers in Hong Kong Tue, 28 Jan 2014 08:34:58 +0000 Introduction. Despite the fact that maternal perinatal mental health problems have been extensively studied and addressed to be a significant health problem, the literature on paternal perinatal mental health problems is relatively scarce. The present study aims at determining the prevalence of paternal perinatal depression and identifying the risk factors and the relationship between antenatal and postpartum depression. Methodology. 622 expectant fathers were recruited from regional maternal clinics. The expectant fathers were assessed using standardized and validated psychological instruments on 3 time points including early pregnancy, late pregnancy, and six weeks postpartum. Results. Results showed that a significant proportion of expectant fathers manifested depressive symptoms during the perinatal period. Paternal antenatal depression could significantly predict higher level of paternal postpartum depression. Psychosocial risk factors were consistently associated with paternal depression in different time points. Conclusions. The present study points to the need for greater research and clinical attention to paternal depression given that it is a highly prevalent problem and could be detrimental to their spouse and children development. The present findings contribute to theoretical basis of the prevalence and risk factors of paternal perinatal depression and have implications of the design of effective identification, prevention, and interventions of these clinical problems. Y. W. Koh, C. Y. Chui, C. S. K. Tang, and A. M. Lee Copyright © 2014 Y. W. Koh et al. All rights reserved. Remission from Depression among Adults with Arthritis: A 12-Year Followup of a Population-Based Study Mon, 27 Jan 2014 12:12:20 +0000 Individuals with arthritis are vulnerable to depression. In this study, we calculated time to remission from depression in a representative community-based sample of depressed Canadians with arthritis who were followed for 12 years. We conducted secondary analysis of a longitudinal panel study, the National Population Health Survey, which was begun in 1994/95 and has included biennial assessment of depression since that time. Our analysis focused on a total of 216 respondents with arthritis who were depressed at baseline. The mean time to remission from depression was calculated using the Kaplan-Meier procedure and compared across categories of each of the potential predictors. The percentage of those no longer screening positive for depression was calculated at two years after baseline. At two years after baseline, 71% of the sample had achieved remission from depression. Time to remission was significantly longer for those depressed adults who were under the age of 55, those who reported more chronic pain at baseline, those with comorbid migraine, and those who experienced childhood physical abuse or parental addictions. These findings highlight the importance of screening for these factors to improve the targeting of interventions to depressed patients with arthritis. Esme Fuller-Thomson, Marla Battiston, Tahany M. Gadalla, Yael Shaked, and Ferrah Raza Copyright © 2014 Esme Fuller-Thomson et al. All rights reserved. Stresses and Disability in Depression across Gender Tue, 21 Jan 2014 09:15:32 +0000 Depression, though generally episodic, results in lasting disability, distress, and burden. Rising prevalence of depression and suicide in the context of epidemiological transition demands more attention to social dimensions like gender related stresses, dysfunction, and their role in outcome of depression. Cross-sectional and follow-up assessment of men and women with depression at a psychiatric tertiary centre was undertaken to compare their illness characteristics including suicidal ideation, stresses, and functioning on GAF, SOFAS, and GARF scales (). We reassessed the patients on HDRS-17 after 6 weeks of treatment. Paired t-test and chi-square test of significance were used to compare the two groups, both before and after treatment. Interpersonal and marital stresses were reported more commonly by women () and financial stresses by men () though relational functioning was equally impaired in both. Women had suffered stresses for significantly longer duration (). Men had more impairment in social and occupational functioning compared to females (). History of suicide attempts was significantly associated with more severe depression and lower levels of functioning in case of females with untreated depression. Significant cross-gender differences in stresses, their duration, and types of dysfunction mandate focusing on these aspects over and above the criterion-based diagnosis. Sharmishtha S. Deshpande, Bhalchandra Kalmegh, Poonam N. Patil, Madhav R. Ghate, Sanjeev Sarmukaddam, and Vasudeo P. Paralikar Copyright © 2014 Sharmishtha S. Deshpande et al. All rights reserved. Does Duloxetine Improve Cognitive Function Independently of Its Antidepressant Effect in Patients with Major Depressive Disorder and Subjective Reports of Cognitive Dysfunction? Sun, 19 Jan 2014 07:41:52 +0000 Introduction. Cognitive deficits are commonly reported by patients with major depressive disorder (MDD). Duloxetine, a dual serotonin/noradrenaline reuptake inhibitor, may improve cognitive deficits in MDD. It is unclear if cognitive improvements occur independently of antidepressant effects with standard antidepressant medications. Methods. Thirty participants with MDD who endorsed cognitive deficits at screening received 12-week duloxetine treatment. Twenty-one participants completed treatment and baseline and posttreatment cognitive testing. The Cambridge Neuropsychological Test Automated Battery was used to assess the following cognitive domains: attention, visual memory, executive function/set shifting and working memory, executive function/spatial planning, decision making and response control, and verbal learning and memory. Results. Completers showed significant cognitive improvements across several domains on tasks assessing psychomotor function and mental processing speed, with additional improvements in visual and verbal learning and memory, and affective decision making and response control. Overall significance tests for executive function tasks were also significant, although individual tasks were not, perhaps due to the small sample size. Most notably, cognitive improvements were observed independently of symptom reduction on all domains except verbal learning and memory. Conclusions. Patients reporting baseline cognitive deficits achieved cognitive improvements with duloxetine treatment, most of which were independent of symptomatic improvement. This trial is registered with NCT00933439. Tracy L. Greer, Prabha Sunderajan, Bruce D. Grannemann, Benji T. Kurian, and Madhukar H. Trivedi Copyright © 2014 Tracy L. Greer et al. All rights reserved. Sedative Drug Use among King Saud University Medical Students: A Cross-Sectional Sampling Study Tue, 14 Jan 2014 12:48:48 +0000 Introduction. Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Saudi Arabia. The aim of this study was to evaluate the prevalence and factors associated with sedative drug use among medical students in Saudi Arabia. Materials and Methods. A cross-sectional convenience sampling study gathered data by anonymous questionnaire from students enrolled at the King Saud University College of Medicine in 2011. The questionnaires collected data regarding social and demographic variables, sleep patterns, and the use of stimulant and sedative drugs since enrollment. Sedatives were defined as any pharmaceutical preparations that induce sleep. Results and Discussion. Of the 729 students who returned questionnaires, 17.0% reported sedative drug use at some time since enrollment. Higher academic year, lower grade point average, regular exercise, fewer hours of sleep per day, poorer quality of sleep, and the presence of sleeping disorders were found to be significantly associated with sedative drug use. Conclusions. Further study is required to increase our understanding of sedative drug use patterns in this relatively high-risk group, as such understanding will help in the development of early intervention programs. Ahmed A. Al-Sayed, Abdualltef H. Al-Rashoudi, Abdulrhman A. Al-Eisa, Abdullah M. Addar, Abdullah H. Al-Hargan, Albaraa A. Al-Jerian, Abdullah A. Al-Omair, Ahmed I. Al-Sheddi, Hussam I. Al-Nowaiser, Omar A. Al-Kathiri, and Abdullah H. Al-Hassan Copyright © 2014 Ahmed A. Al-Sayed et al. All rights reserved. Personality Pathology Predicts Outcomes in a Treatment-Seeking Sample with Bipolar I Disorder Thu, 02 Jan 2014 12:30:18 +0000 We conducted a secondary analysis of data from a clinical trial to explore the relationship between degree of personality disorder (PD) pathology (i.e., number of subthreshold and threshold PD symptoms) and mood and functioning outcomes in Bipolar I Disorder (BD-I). Ninety-two participants completed baseline mood and functioning assessments and then underwent 4 months of treatment for an index manic, mixed, or depressed phase acute episode. Additional assessments occurred over a 28-month follow-up period. PD pathology did not predict psychosocial functioning or manic symptoms at 4 or 28 months. However, it did predict depressive symptoms at both timepoints, as well as percent time symptomatic. Clusters A and C pathology were most strongly associated with depression. Our findings fit with the literature highlighting the negative repercussions of PD pathology on a range of outcomes in mood disorders. This study builds upon previous research, which has largely focused on major depression and which has primarily taken a categorical approach to examining PD pathology in BD. Susan J. Wenze, Brandon A. Gaudiano, Lauren M. Weinstock, and Ivan W. Miller Copyright © 2014 Susan J. Wenze et al. All rights reserved. Suicidal Career in Severe Depression among Long-Term Survivors: In a Followup after 37–53 Years Suicide Attempts Appeared to End Long before Depression Mon, 23 Dec 2013 10:13:21 +0000 Objective. To describe the suicidal career in the long-term course of severe depression. Subjects and Method. Seventy-five former in-patients were interviewed by telephone about course of depression and suicide attempts 37–53 years after index admission. Medical records were read in many cases. Results. 29 subjects had attempted suicide, 13 repeated, 10 made severe, and 13 violent attempts. The risk of suicide attempt decreased by 10% for every decade spent depressed. Suicide attempts were made early in course of depression, and more time was spent depressed after suicide attempts than before. Conclusions. A healing process of the suicidal career, which may occur long before the end of the last depressive episode (sometimes decades), is proposed. Lisa Crona, Alexander Mossberg, and Louise Brådvik Copyright © 2013 Lisa Crona et al. All rights reserved. Temperament, Character, and Depressive Symptoms during Pregnancy: A Study of a Japanese Population Sun, 22 Dec 2013 14:53:30 +0000 Background. To examine the effects of temperament and character domains on depression during pregnancy. Methods. We examined 601 pregnant women using a questionnaire that included the Edinburgh Postnatal Depression Scale (EPDS), the Temperament and Character Inventory (TCI), and demographic variables. Results. In a hierarchical regression analysis, severity of depression during pregnancy was predicted by the women’s negative response towards the current pregnancy, low self-directedness, and high harm avoidance, persistence, and self-transcendence. Conclusion. Depression during pregnancy is predicted by personality traits as well as women’s negative attitudes towards the current pregnancy. Mariko Minatani, Sachiko Kita, Yukiko Ohashi, Toshinori Kitamura, Megumi Haruna, Kyoko Sakanashi, and Tomoko Tanaka Copyright © 2013 Mariko Minatani et al. All rights reserved. Factors Affecting Non-Adherence among Patients Diagnosed with Unipolar Depression in a Psychiatric Department of a Tertiary Hospital in Kolkata, India Wed, 04 Dec 2013 14:39:23 +0000 Non-adherence to depression treatment is a common clinical problem globally. However, limited research is available from India. This cross-sectional study aimed to assess non-adherence to prescribed treatment among patients with unipolar depression at a psychiatric out-patient department (OPD) of a tertiary hospital in Kolkata, India. The Morisky Medication Adherence Scale (MMAS) was used and a questionnaire designed by the Principal Investigator (PI) was administered. A total of 239 patients with unipolar depression were interviewed of whom 66.9% (160) were non-adherent and 33.1% (79) were adherent to treatment. The difference was significant (Fisher’s Exact ). Women were nearly three times at a higher risk of being non-adherent compared to men (OR 2.7; 95% CI 1.0–7.1). The non-adherent group compared to the adherent group was significantly more likely to consume extra medicines than the recommended amount (OR 2.8; 95% CI 1.1–7.3) and had lower internal locus of control (LOC) (OR 4.5; 95% CI 2.4–8.3). Adherence to prescribed treatment in an out-patient clinical setting was a problem among patients with unipolar depression. Suitable interventions on individuals with the above mentioned attributes are required in India and in similar settings where non-adherence to depression therapy is an important public health problem. Sohini Banerjee and Ravi Prasad Varma Copyright © 2013 Sohini Banerjee and Ravi Prasad Varma. All rights reserved. The Effect of Short-Term Aerobic Exercise on Depression and Body Image in Iranian Women Thu, 21 Nov 2013 08:05:36 +0000 The purpose of this study was to determine the effect of short-term aerobic exercise on depression symptoms and body image attitudes among Iranian women. In this quasiexperimental study, 82 females were assigned to experimental group (aerobic exercise group, ) or control group (waiting list, ) and evaluated by Beck Depression Inventory-second edition (BDI-II) and Multidimensional Body Self-Relation Questionnaire (MBSRQ), respectively. The experimental group received four-week aerobic exercise program, and control group had been asked to wait for the next four weeks. Results of this study confirmed the significant decrease in depression symptoms at the experimental group compared to control group . For the body image dependent variables, significant improvement was also found in appearance evaluation, appearance orientation, health orientation, and illness orientation in aerobic exercise group . Sareh Zarshenas, Parsa Houshvar, and Ali Tahmasebi Copyright © 2013 Sareh Zarshenas et al. All rights reserved. Mental Health Outcomes in US Children and Adolescents Born Prematurely or with Low Birthweight Tue, 12 Nov 2013 15:17:50 +0000 We examined the effects of prematurity (37 weeks of gestation) and low birthweight (2500 g) on mental health outcomes among US children aged 2–17 years. The 2011-2012 National Survey of Children’s Health ( = 95,677) was used to estimate prevalence of parent-reported mental health problems in children. Prevalence of mental disorders was 22.9% among children born prematurely, 28.7% among very-low-birth-weight (1500 g) children, and 18.9% among moderately low-birth-weight (1500–2499 g) children, compared with 15.5% in the general child population. Compared to those born full term, children born prematurely had 61% higher adjusted odds of serious emotional/behavioral problems, 33% higher odds of depression, and 58% higher odds of anxiety. Children born prematurely had 2.3 times higher odds of autism/ASD, 2.9 times higher odds of development delay, and 2.7 times higher odds of intellectual disability than term children. Very-low-birth-weight children had 3.2 times higher odds of autism/ASD, 1.7 times higher odds of ADD/ADHD, 5.4 times higher odds of development delay, and 4.4 times higher odds of intellectual disability than normal-birth-weight children. Social factors were significant predictors of mental disorders in both premature/low-birth-weight and term/normal-birth-weight children. Neurodevelopmental conditions accounted for the relationship between prematurity and depression/anxiety/conduct problems. Prematurity and low birthweight are significant risk factors for mental health problems among children. Gopal K. Singh, Mary Kay Kenney, Reem M. Ghandour, Michael D. Kogan, and Michael C. Lu Copyright © 2013 Gopal K. Singh et al. All rights reserved. The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People Sun, 10 Nov 2013 09:40:26 +0000 Objective. To evaluate the effect of an early vocational-orientated eclectic intervention on beck depression inventory (BDI) scores compared to treatment as usual in first ever depressive episode among employed people. Design. A randomized controlled trial comparing the rehabilitative intervention and the conventional treatment. Subjects. The subjects came from occupational health care units. Methods. Employees were sent to a rehabilitation center after being screened for depression using the BDI. They were diagnosed using the structured clinical interview for DSM-IV. The participating subjects () were randomized into intervention and control groups. The intervention group received eclectic early depression intervention treatment () and the control group was treated in the conventional way (). They were followed for one year. Results. The mean decrease in BDI scores within the intervention group was from 20.8 to 11.6 and within the control group from 19.3 to 10.8. BDI score decreased by 10 or more points in 64% of the participants in the intervention group and in 53% of the control group (). Conclusions. There was some evidence that early eclectic intervention in first ever episode depression may be more effective than conventional treatments among working age people in employment. Tero Raiskila, Sanna Blanco Sequeiros, Jorma Kiuttu, Marja-Liisa Kauhanen, Kristian Läksy, Kirsi Vainiemi, Annamari Tuulio-Henriksson, Helinä Hakko, Matti Joukamaa, and Juha Veijola Copyright © 2013 Tero Raiskila et al. All rights reserved. Migraine and Despair: Factors Associated with Depression and Suicidal Ideation among Canadian Migraineurs in a Population-Based Study Sun, 13 Oct 2013 15:13:03 +0000 This study sought to (1) investigate the association between migraine and both depression and suicidal ideation and (2) to identify the factors independently associated with each of these mental health problems among Canadian men and women with migraine. Data were analyzed from the 2005 Canadian Community Health Survey (CCHS). Presence of migraine was assessed by self-report of a health professional diagnosis. Current depression was measured using the CIDI-SF, and suicidal ideation was based on a question about serious consideration of suicide at any point during the respondent's lifetime. Migraineurs were found to have elevated odds of depression (men: OR = 2.02; 95% CI = 1.70, 2.41; women: OR = 1.89; 95% CI = 1.71, 2.10) and suicidal ideation (men: OR = 1.70; 95% CI = 1.55, 1.96; women: OR = 1.72; 95% CI = 1.59, 1.86) even when adjusting for sociodemographic variables and disability status. The odds of depression and suicidal ideation were higher among both genders of migraineurs who were younger, unmarried and had more activity limitations; associations with poverty and race depended on gender and whether the focus was on depression or suicidal ideation. While screening for depression is already recommended for those with migraine, this research helps identify which migraineurs may require more immediate attention, including those who are younger, unmarried, and experiencing limitations in their activities. Esme Fuller-Thomson, Meghan Schrumm, and Sarah Brennenstuhl Copyright © 2013 Esme Fuller-Thomson et al. All rights reserved. Prevalence of Depression among University Students: A Systematic Review and Meta-Analysis Study Wed, 25 Sep 2013 18:07:00 +0000 Introduction. Depression is one of the four major diseases in the world and is the most common cause of disability from diseases. The aim of this study is to estimate the prevalence of depression among Iranian university students using meta-analysis method. Materials and Methods. Keyword depression was searched in electronic databases such as PubMed, Scopus, MAGIran, Medlib, and SID. Data was analyzed using meta-analysis (random-effects model). Heterogeneity of studies was assessed using the index. Data was analyzed using STATA software Ver.10. Results. In 35 studies conducted in Iran from 1995 to 2012 with sample size of 9743, prevalence of depression in the university students was estimated to be 33% (95% CI: 32–34). The prevalence of depression among boys was estimated to be 28% (95% CI: 26–30), among girls 23% (95% CI: 22–24), single students 39% (95% CI: 37–41), and married students 20% (95% CI: 17–24). Metaregression model showed that the trend of depression among Iranian students was flat. Conclusions. On the whole, depression is common in university students with no preponderance between males and females and in single students is higher than married ones. Diana Sarokhani, Ali Delpisheh, Yousef Veisani, Mohamad Taher Sarokhani, Rohollah Esmaeli Manesh, and Kourosh Sayehmiri Copyright © 2013 Diana Sarokhani et al. All rights reserved. A Low-Cost Point-of-Care Testing System for Psychomotor Symptoms of Depression Affecting Standing Balance: A Preliminary Study in India Tue, 24 Sep 2013 10:26:19 +0000 The World Health Organization estimated that major depression is the fourth most significant cause of disability worldwide for people aged 65 and older, where depressed older adults reported decreased independence, poor health, poor quality of life, functional decline, disability, and increased chronic medical problems. Therefore, the objectives of this study were (1) to develop a low-cost point-of-care testing system for psychomotor symptoms of depression and (2) to evaluate the system in community dwelling elderly in India. The preliminary results from the cross-sectional study showed a significant negative linear correlation between balance and depression. Here, monitoring quantitative electroencephalography along with the center of pressure for cued response time during functional reach tasks may provide insights into the psychomotor symptoms of depression where average slope of the Theta-Alpha power ratio versus average slope of baseline-normalized response time may be a candidate biomarker, which remains to be evaluated in our future clinical studies. Once validated, the biomarker can be used for monitoring the outcome of a comprehensive therapy program in conjunction with pharmacological interventions. Furthermore, the frequency of falls can be monitored with a mobile phone-based application where the propensity of falls during the periods of psychomotor symptoms of depression can be investigated further. Arindam Dutta, Robins Kumar, Suruchi Malhotra, Sanjay Chugh, Alakananda Banerjee, and Anirban Dutta Copyright © 2013 Arindam Dutta et al. All rights reserved. Cognitive Vulnerabilities and Depression in Young Adults: An ROC Curves Analysis Thu, 22 Aug 2013 12:03:55 +0000 Objectives and Methods. The aim of the present study was to evaluate, by means of receiver operating characteristic (ROC) curves, whether cognitive vulnerabilities (CV), as measured by three well-known instruments (the Beck Hopelessness Scale, BHS; the Life Orientation Test-Revised, LOT-R; and the Attitudes Toward Self-Revised, ATS-R), independently discriminate between subjects with different severities of depression. Participants were 467 young adults (336 females and 131 males), recruited from the general population. The subjects were also administered the Beck Depression Inventory-II (BDI-II). Results. Four first-order (BHS Optimism/Low Standard; BHS Pessimism; Generalized Self-Criticism; and LOT Optimism) and two higher-order factors (Pessimism/Negative Attitudes Toward Self, Optimism) were extracted using Principal Axis Factoring analysis. Although all first-order and second-order factors were able to discriminate individuals with different depression severities, the Pessimism factor had the best performance in discriminating individuals with moderate to severe depression from those with lower depression severity. Conclusion. In the screening of young adults at risk of depression, clinicians have to pay particular attention to the expression of pessimism about the future. Michela Balsamo, Claudio Imperatori, Maria Rita Sergi, Martino Belvederi Murri, Massimo Continisio, Antonino Tamburello, Marco Innamorati, and Aristide Saggino Copyright © 2013 Michela Balsamo et al. All rights reserved. Symptom Profile and Severity in a Sample of Nigerians with Psychotic versus Nonpsychotic Major Depression Wed, 21 Aug 2013 13:50:59 +0000 The therapeutic strategies in managing patients with psychotic major depression (PMD) differ from those with non-psychotic major depression (NMD), because of differences in clinical profile and outcome. However, there is underrecognition of psychotic symptoms in depressed patients. Previous studies in Western population suggest that certain symptom patterns, apart from psychosis which may be concealed, can facilitate the discrimination of PMD from NMD. These studies may have limited applicability to sub-Saharan Africa due to cross-cultural differences in the phenomenology of depression. This study compared the rates and severity of depressive symptoms in outpatients with PMD () and NMD () using the Structured Clinical Interview for Depression (SCID) and Hamilton Depression Rating Scale (HAM-D). Patients with PMD had statistically significantly higher rates of suicidal ideation, suicidal attempt, psychomotor agitation, insomnia, and reduced appetite. Patients with NMD were more likely to manifest psychomotor retardation and somatic symptoms. PMD was associated with greater symptom severity. On logistic regression analysis, suicidal ideation, psychomotor disturbances, insomnia, and somatic symptoms were predictive of diagnostic status. The presence of these symptoms clusters may increase the suspicion of occult psychosis in patients with depression, thereby informing appropriate intervention strategies. Increase Ibukun Adeosun and Oyetayo Jeje Copyright © 2013 Increase Ibukun Adeosun and Oyetayo Jeje. All rights reserved. Socioeconomic, Psychiatric and Materiality Determinants and Risk of Postpartum Depression in Border City of Ilam, Western Iran Wed, 24 Jul 2013 09:19:09 +0000 Background. Postpartum depression (PPD) is considered as one of the mood disturbances occurring during 2-3 months after delivery. The present study aimed to determine the prevalence of PPD and its associated risk factors in border city of Ilam, western Iran. Methods. Through a descriptive cross-sectional study in 2011, overall, 197 women who attended Obstetrics & Gynecology clinics postpartumly in the border city of Ilam, western Iran, were randomly recruited. A standard questionnaire that was completed by a trained midwife through face to face interviews was used for data gathering. Results. Mean age ± standard deviations was 27.9 ± 5.2 years. Prevalence of PPD was estimated to be 34.8% (95% CI: 27.7–41.7). A significant difference was observed among depression scores before and after delivery (). Type of delivery (), low socioeconomic status (), and women having low educational level () were the most important significant risk factors associated with PPD. The regression analysis showed that employed mothers compared to housekeepers were more at risk for PPD (adjusted OR = 2.01, 95% CI: 1.22–2.28, ). Conclusions. Prevalence of PPD in western Iran was slightly higher than the corresponding rate from either national or international reports. Pegah Taherifard, Ali Delpisheh, Ramin Shirali, Abdorrahim Afkhamzadeh, and Yousef Veisani Copyright © 2013 Pegah Taherifard et al. All rights reserved. Sleep Difficulties Are Correlated with Emotional Problems following Loss and Residual Symptoms of Effective Prolonged Grief Disorder Treatment Sun, 14 Jul 2013 10:11:05 +0000 There is preliminary evidence that poor sleep quality is associated with emotional problems following loss, including symptoms of prolonged grief disorder (PGD) and depression. We conducted two studies to improve existing knowledge about the role of sleep difficulties in recovery from loss. Study 1 that relied on self-reported data from a heterogeneous sample of 177 bereaved individuals replicated prior findings of a linkage between increased sleep difficulties and increased PGD severity. This study also suggested that sleep difficulties are more strongly associated with depression than with PGD. In Study 2, we examined whether prior evidence that sleep complaints are a residual symptom of PGD treatment could be replicated in a sample of 43 bereaved individuals who underwent cognitive behavioural therapy for PGD. Outcomes showed that, although sleep difficulties declined significantly during this cognitive behavioural therapy, after this therapy, over half of all patients still had sleep difficulties above the average sleep difficulties observed in the general Dutch population. Paul A. Boelen and Jaap Lancee Copyright © 2013 Paul A. Boelen and Jaap Lancee. All rights reserved. Trends of Postpartum Depression in Iran: A Systematic Review and Meta-Analysis Tue, 09 Jul 2013 09:19:42 +0000 Background. Postpartum depression (PPD) is a serious mental health disorder affecting 13% of women in developed communities. The present study reviews available epidemiological publications on PPD-related aspects in Iranian women to help policy makers and health workers to design preventative strategies and further researches. Materials and Methods. A systematic review was constructed based on the computerized literature valid database. The 95% confidence intervals were calculated by random effects models. Metaregression was introduced to explore and explain heterogeneity between studies. Data manipulation and statistical analyses were performed using Stata 11. Results. Overall, 41 studies met the inclusion criteria. The pooled prevalence of PPD in Iran was 25.3% (95% CI: 22.7%–27.9%). Amongst subgroups of unwanted delivery, illiterate, housewives, and having history of depression the prevalence was 43.4% (35.6–51.1), 31.6% (18.1–45.0), 30.7% (25.2–36.3), and 45.2% (35.4–53.1), respectively. Conclusions. Interventions that would specifically target women with a prior history of depression, illiterates, housewives, or women with unwanted pregnancies could be helpful to decrease the prevalence of postpartum depression in Iran. Yousef Veisani, Ali Delpisheh, Kourosh Sayehmiri, and Shahab Rezaeian Copyright © 2013 Yousef Veisani et al. All rights reserved.