Risk factors for incidence and persistence of disability in chronic major depression and alcohol use disorders: longitudinal analyses of a population-based study

BackgroundMajor depression and alcohol use disorders are risk factors for incidence of disability. However, it is still unclear whether a chronic course of these health conditions is also prospectively associated with incidence of disability. The aim of the present study was, first, to confirm whether chronic major depression (MD) and alcohol use disorders (AUD) are, respectively, risk factors for persistence and incidence of disability in the general population; and then to analyze the role of help-seeking behavior in the course of disability among respondents with chronic MD and chronic AUD. MethodData from two assessments in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Disability was measured by eight domains of the Short Form 12 Health Survey version 2 (SF-12). Generalized estimating equations and logistic regression models were run to estimate risk factors for persistence and incidence of disability, respectively. ResultsAnalyses conducted on data from the US general population showed that chronic MD was the strongest risk factor for incidence and persistence of disability in the social functioning, emotional role and mental health domains. Chronic AUD were risk factors for incidence and persistence of disability in the vitality, social functioning, and emotional role domains. Within the group of chronic MD, physical comorbidity and help-seeking were associated with persistent disability in most of the SF-12 domains. Help-seeking behavior was also associated with incidence of problems in the mental health domain for the depression group. Regarding the AUD group, comorbidity with physical health problems was a strong risk factor for persistence of disability in all SF-12 domains. Help-seeking behavior was not related to either persistence or incidence of disability in the chronic alcohol group. ConclusionsChronic MD and chronic AUD are independent risk factors for persistence and incidence of disability in the US general population. People with chronic MD seek help for their problems when they experience persistent disability, whereas people with chronic AUD might not seek any help even if they are suffering from persistent disability.<br/

Use of the terms "Wellbeing" and "Quality of Life" in health sciences: A conceptual framework

Background and Objectives: The assessment of wellbeing is a top priority in health sciences. The aim of this paper is to review the history of the concept of wellbeing and “Quality of Life” (QoL), and to understand the theories and assumptions that guided this field in order to provide a conceptual framework that may eventually facilitate the development of a formal synset (grouping of synonyms and semantically similar terms) of health-related wellbeing Methods: The history of the concept of wellbeing and QoL was reviewed in order to provide a conceptual framework. Results: Huge differences exist on the definition of “Wellbeing” and its relationship with QoL, “Happiness” and “Functioning” in the health context. From a dimensional perspective, health related wellbeing could be regarded as an overarching construct characterised by asymmetrical polarity, where “wellbeing” embeds the concept of “ill-being” as “health” incorporates de concept of “disease”. Conclusions: A common conceptual framework of these terms may eventually facilitate the development of a formal synset of health-related wellbeing. This terminological clarification should be part of a new taxonomy of health-related wellbeing based on the International Classification of Functioning, Disability and Health (ICF) framework that may facilitate knowledge transfer across different sectors and semantic interoperability for care management and planningThe research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreement numbers 223071 (COURAGE in Europe) and 282586 (ROAMER), from the Instituto de Salud Carlos III-FIS research grant number PS09/00295, and from the Spanish Ministry of Science and Innovation ACI-Promociona (ACI2009-1010 and ACI- 2011-1080). The study was supported by the Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos II

Coping with COVID: Risk and Resilience Factors for Mental Health in a German Representative Panel Study

The COVID-19 pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare. Methods: In a stratified random sample of the German household population (n=6,684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress (PD; measured via PHQ-4) from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting. Results: PHQ-4 scores in 2020 (M=2.45) and 2021 (M=2.21) were elevated compared to 2019 (M=1.79). Several risk factors (catastrophizing, neuroticism, asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes. Conclusions: We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. Comparison to pre-pandemic data stress the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussedThis project has received funding from the European Union’s Horizon 2020 research and innovation program under Grant Agreement numbers 777084 (DynaMORE) and 101016127 (RESPOND). ‘SOEP-CoV: The Spread of the Coronavirus in Germany: Socio-Economic Factors and Consequences’ was funded by the German Federal Ministry of Education and Research (BMBF). AR was supported by Studienstiftung des deutschen Volkes. HK was supported by the Deutsche Forschungsgemeinschaft (DFG, German Science Foundation) Grants – 415809395, 427279591, and 40965412. The data can be accessed via the research data center of the SOE

The course of depression in late life: A longitudinal perspective

Depression in old age deserves special attention in view of the fact of progressive population ageing, because of the way in which depression and risk factors interact in this period of life and the particularly negative impact of late-life depression on health and quality of life. This editorial aims to provide some insight into longitudinal aspects of depression in old age. Depression may follow varying trajectories (e.g. episode emergence, recurrence) across the lifespan. Late-life depression is not an exception. A symptom-based approach is presented as an appropriate research method to study the predictors and course of affective syndromes in old age. Findings from our studies on depressive symptom trajectories in old age revealed that participants with a course of unremitting elevated symptoms showed the highest levels of loneliness across the trajectory groups and that participants with subclinical symptoms also showed higher levels of loneliness than their counterparts with a minimal-symptom course trajectory. This highlights the need to address loneliness as a way of dealing with depression in old age.This work was supported by the 5-year Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. The ATHLOS project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 635316; Instituto de Salud Carlos III-FIS under grant number PI16/00218; and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)

The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression:a meta-analysis

BACKGROUND: There is growing recognition of the importance of both functioning and quality of life (QoL) outcomes in the treatment of depressive disorders, but the meta-analytic evidence is scarce. The objective of this meta-analysis of randomized controlled trials (RCTs) was to determine the absolute and relative effects of psychotherapy, pharmacotherapy and their combination on functioning and QoL in patients with depression. METHOD: One hundred and fifty-three outcome trials involving 29 879 participants with depressive disorders were identified through database searches in Pubmed, PsycINFO and the Cochrane Central Register of Controlled Trials. RESULTS: Compared to control conditions, psychotherapy and pharmacotherapy yielded small to moderate effect sizes for functioning and QoL, ranging from g = 0.31 to g = 0.43. When compared directly, initial analysis yielded no evidence that one of them was superior. After adjusting for publication bias, psychotherapy was more efficacious than pharmacotherapy (g = 0.21) for QoL. The combination of psychotherapy and medication performed significantly better for both outcomes compared to each treatment alone yielding small effect sizes (g = 0.32 to g = 0.39). Both interventions improved depression symptom severity more than functioning and QoL. CONCLUSION: Despite the small number of comparative trials for some of the analyses, this study reveals that combined treatment is superior, but psychotherapy and pharmacotherapy alone are also efficacious for improving functioning and QoL. The overall relatively modest effects suggest that future tailoring of therapies could be warranted to better meet the needs of individuals with functioning and QoL problems

Research Recommendations for Improving Measurement of Treatment Effectiveness in Depression

Background: Despite the steadily escalating psychological and economic burden of depression, there is a lack of evidence for the effectiveness of available interventions on functioning areas beyond symptomatology. Therefore, the main objective of this study was to give an insight into the current measurement of treatment effectiveness in depression and to provide recommendations for its improvement.Materials and Methods: The study was based on a multi-informant approach, comparing data from a systematic literature review, an expert survey with representatives from clinical practice (130), and qualitative interviews with patients (11) experiencing depression.Results: Current literature places emphasis on symptomatic outcomes and neglects other domains of functioning, whereas clinicians and depressed patients highlight the importance of both. Interpersonal relationships, recreation and daily activities, communication, social participation, work difficulties were identified as being crucial for recovery. Personal factors, neglected by the literature, such as self-efficacy were introduced by experts and patients. Furthermore, clinicians and patients identified a number of differences regarding the areas improved by psychotherapeutic or pharmacological interventions that were not addressed by the pertinent literature.Conclusion: Creation of a new cross-nationally applicable measure of psychosocial functioning, broader remission criteria, report of domain-specific information, and a personalized approach in treatment decision-making are the first crucial steps needed for the improvement of the measurement of treatment effectiveness in depression. A better measurement will facilitate the clinical decision making and answer the escalating burden of depression

Psychotic symptoms are associated with physical health problems independently of a mental disorder diagnosis: Results from the WHO World Health Survey

This study explored whether physical health problems are related to psychotic symptoms independently of a mental disorder diagnosis. A total of 224,254 subjects recruited for the World Health Organization World Health Survey were subdivided into those with both a lifetime diagnosis of psychosis and at least one psychotic symptom in the 12 months prior to the evaluation, those with at least one psychotic symptom in the past 12 months but no lifetime diagnosis of psychosis, and those without psychotic symptoms in the past 12 months and without a lifetime diagnosis of psychosis. The three groups were compared for the presence of medical conditions, health problems, and access to health care. Medical conditions and health problems (angina, asthma, arthritis, tuberculosis, vision or hearing problems, mouth/teeth problems, alcohol consumption, smoking, and accidents), medication consumption, and hospital admissions (but not regular health care visits) were more frequent in individuals with psychotic symptoms but no psychosis diagnosis, compared to those with no symptoms and no diagnosis. The number of medical conditions increased with the number of psychotic symptoms. Given the sample analyzed, this trend seems to be independent from the socio-economic development of the country or the specific health care systemThis work was supported by the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III, CIBERSAM, Madrid Regional Government (S2010/BMD- 2422 AGES), European Union Structural Funds, Fundación Alicia Koplowitz, Fundación Mutua Madrileña, ERA-NET NEURON (Network of European Funding for Neuroscience Research) and theWorld Health Organizatio

Towards a clinical staging for bipolar disorder: defining patient subtypes based on functional outcome.

BACKGROUND: The functional outcome of Bipolar Disorder (BD) is highly variable. This variability has been attributed to multiple demographic, clinical and cognitive factors. The critical next step is to identify combinations of predictors that can be used to specify prognostic subtypes, thus providing a basis for a staging classification in BD. METHODS: Latent Class Analysis was applied to multiple predictors of functional outcome in a sample of 106 remitted adults with BD. RESULTS: We identified two subtypes of patients presenting "good" (n=50; 47.6%) and "poor" (n=56; 52.4%) outcome. Episode density, level of residual depressive symptoms, estimated verbal intelligence and inhibitory control emerged as the most significant predictors of subtype membership at the p<0.05 level. Their odds ratio (OR) and confidence interval (CI) with reference to the "good" outcome group were: episode density (OR=4.622, CI 1.592-13.418), level of residual depressive symptoms (OR=1.543, CI 1.210-1.969), estimated verbal intelligence (OR=0.969; CI 0.945-0.995), and inhibitory control (OR=0.771, CI 0.656-0.907). Age, age of onset and duration of illness were comparable between prognostic groups. LIMITATIONS: The longitudinal stability or evolution of the subtypes was not tested. CONCLUSIONS: Our findings provide the first empirically derived staging classification of BD based on two underlying dimensions, one for illness severity and another for cognitive function. This approach can be further developed by expanding the dimensions included and testing the reproducibility and prospective prognostic value of the emerging classes. Developing a disease staging system for BD will allow individualised treatment planning for patients and selection of more homogeneous patient groups for research purposes