Individual and neighborhood characteristics as predictors of depression symptom response

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149361/1/hesr13127_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149361/2/hesr13127.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149361/3/hesr13127-sup-0001-Authormatrix.pd

A Cross-Methodological Investigation of Emotional Reactivity in Major Depression

Major depressive disorder (MDD) is primarily characterized by prevalent sadness and anhedonia. Laboratory studies find that depression is characterized by reduced reactivity across emotional contexts, while a few studies using naturalistic designs find that depressed people show normative reactivity to negative life events and mood brightening in response to positive events. The current study was an investigation of emotional reactivity in depression through the use of experimental and naturalistic designs. This allowed for an investigation of sources of lab-life discrepancies in emotional functioning in depression, including negative affect (NA) regulation. We examined experiential reactivity across contexts and types of stimuli in 41 currently depressed (MDD) and 33 healthy controls. Results showed that overall, our groups were largely indistinguishable in NA and PA reactivity magnitude across contexts and types of stimuli, with some exceptions. When looking at sadness reactivity specifically, despite higher sadness at baseline, MDDs reported in the lab similar decreases in sadness to a humorous film as controls. In daily life, MDDs reported larger decreases in sadness in response to positive daily events, yet indistinguishable reactivity to a structured humorous film relative to controls. Analyses using HLM showed that NA response to the happy film in the acceptance condition was marginally predictive of overall NA in daily life but not of NA reactivity to positive events. Findings suggest group differences in emotional reactivity vary across contexts and stimuli, however these variations are dependent on specificity of emotion. Current results possibly highlight increased flexibility during experience of positive events in daily life in depression. Acceptance of NA may have implications for the experience of overall negative mood in depression

A retrospective and prospective comparison of Hungarian children who have one or two episodes of depression

Early onset depression is associated with high recurrence rates later in life. Recurrent depressive episodes during childhood may be particularly problematic, if additional episodes have a scarring effect that hinders healthy development. Distinguishing between first onsets and recurrences has been useful in understanding adult depression. This distinction has seldom been examined in pediatric depression, in part because it is difficult to enroll adequate samples of children with recurrent depression. We conducted archival analyses of carefully-diagnosed pediatric probands with depression first onset between ages of 4 and 12. Probands who reported one depressive episode (N = 435) were compared with probands who reported two depression episodes (N = 115) on clinical (treatment, comorbidities), psychosocial (negative life events (NLEs), parental psychopathology) and emotion regulation measures. Based on previous findings in older adolescents and adults, we hypothesized that probands with two MDEs will have higher comorbidity, parental psychopathology, more NLEs, and higher maladaptive emotion regulation scale scores than probands with one MDE. Surprisingly, probands with one and two MDEs were indistinguishable on psychological and pharmacological treatment variables. As expected, probands with two MDEs had lower age of first onset, higher maladaptive emotion regulation scores, higher rates of comorbid anxiety and reported more NLEs than probands with one MDE. Probands with two MDEs also spent a longer total time in episode; group differences remained after controlling for time spent depressed. Distinguishing between first onsets and recurrences is meaningful in pediatric depression

Perspectives on the Management of Vascular Depression

“Mr. A,” an 80-year-old married man, presents for his first psychiatric evaluation. He arrives punctually, carrying a manila folder containing documents summarizing his medication history and previous surgical procedures. He reports that this outpatient visit was initiated by a referral from his primary care physician after his wife expressed concern that her husband appeared to be depressed. Mr. A denies any previous mental health problems, history of psychotropic medication use, or history of therapy. He reports a period of bereavement after the death of his first wife at age 40 but states that he recovered over time without intervention. He remarried 17 years ago and describes his wife as supportive. He previously worked in an executive position that required substantial travel overseas. The development of angina on these trips ultimately resulted in the placement of multiple cardiac stents, and he retired 12 years ago because of health concerns. He has been less active since retirement, and he states that he has no hobbies. He reports that he still ruminates a great deal about events that occurred during his career. When asked about depressive symptoms, Mr. A does not agree that he is depressed and questions the need for the referral. He admits to feeling socially detached, with a loss of interest and lack of motivation, and states, “I know that I should get out more, but I can’t ever get past the first step.” While he denies feeling overtly sad, he reports feeling irritable at times toward his family, which he finds troubling. According to his wife, Mr. A’s irritability is increasing in frequency and tends to arise without substantive provocation. His sleep is suboptimal, with frequent nighttime awakening due to nocturia, and difficulty returning to sleep. His appetite is adequate, but his weight has been slowly increasing, which he attributes to his sedentary lifestyle. He feels his memory is “okay,” noting that he occasionally has trouble finding the right word to use and that it is harder for him to focus when reading or paying the bills. He reports that his energy is low, and he blames this symptom on his cardiologist’s prescriptions for lisinopril and metoprolol. Overall, he ascribes his difficulties to increased medical problems over the past decade and a corresponding increase in medications. These medications now include atorvastatin for hypercholesterolemia and glipizide for type 2 diabetes in addition to antihypertensives, clopidogrel, and aspirin. He denies feelings of hopelessness and helplessness, but he reports that he sometimes feels discouraged at the change in his ability to function relative to his earlier years. He denies suicidal ideation but casually admits to worries that in the future he could become a burden if he experiences another serious cardiac event. A comprehensive interview was conducted to assess not only Mr. A’s current symptoms but also factors contributing to his social isolation. During the interview, Mr. A identified some activities that he may take up, including a return to working out in a gym. He noted that when he was young, he was quite conscientious about attending a gym, but this activity was sidelined during his executive years. He was receptive to the idea of restarting a regular workout program and had a senior discount for a gym membership in his neighborhood. A comprehensive review of his sleep-wake cycle suggested that he tended to spend a lot of time at the computer in the evening, out of boredom. He was advised to reduce exposure to light in the evening and begin taking melatonin at bedtime to help stabilize his day-night cycle and increase the restfulness of his sleep. Additional management included the initiation of sertraline, at 25 mg every morning initially, increasing to 50 mg with a plan to further titrate the dosage if well tolerated and needed. He was instructed to focus on positive health behaviors, including resuming regular physical activity, engaging more with his wife’s community activities, and maintaining a healthy diet. He was advised to focus on finding meaningful activities, and he was cautioned to avoid the expectation that medications alone would resolve his symptoms. Mr. A’s wife actively supported the treatment plan, offering to provide assistance in observing his irritability, sleep, and daily activities. Over the following months, Mr. A was able to see improvement in his motivation and was able to resume some remodeling projects. Ultimately, he was able to maintain a regular gym schedule, which, together with melatonin, resulted in improved sleep and well-being

Sleep Quality in Healthy and Mood-disordered Persons Predicts Daily Life Emotional Reactivity

Disordered sleep has been linked to impaired emotional functioning in healthy and depressed individuals. Little is known, however, about how chronic sleep problems influence emotional reactivity in everyday life. Participants with major or minor unipolar depressive disorder (n = 60) and healthy controls (n = 35) reported on sleep and emotional responses to daily life events using a computerised Experience Sampling Method. We examined whether impaired sleep quality influenced emotional reactivity to daily events, and if this relationship was altered by unipolar mood disorders. Among healthy individuals, sleep difficulties were associated with enhanced negative affect (NA) to unpleasant events and a dulled response to neutral events. However, among mood-disordered persons, sleep difficulties were associated with higher NA across all types of everyday life events. Impaired sleep quality differentially affects daily life emotional reactions as a function of depression

Optimal Well-Being After Major Depression

Can people achieve optimal well-being and thrive after major depression? Contemporary epidemiology dismisses this possibility, viewing depression as a recurrent, burdensome condition with a bleak prognosis. To estimate the prevalence of thriving after depression in United States adults, we used data from the Midlife Development in the United States study. To count as thriving after depression, a person had to exhibit no evidence of major depression and had to exceed cutoffs across nine facets of psychological well-being that characterize the top 25% of U.S. nondepressed adults. Overall, nearly 10% of adults with study-documented depression were thriving 10 years later. The phenomenon of thriving after depression has implications for how the prognosis of depression is conceptualized and for how mental health professionals communicate with patients. Knowing what makes thriving outcomes possible offers new leverage points to help reduce the global burden of depression

The Value of Extracting Clinician-Recorded Affect for Advancing Clinical Research on Depression: Proof-of-Concept Study Applying Natural Language Processing to Electronic Health Records

BackgroundAffective characteristics are associated with depression severity, course, and prognosis. Patients’ affect captured by clinicians during sessions may provide a rich source of information that more naturally aligns with the depression course and patient-desired depression outcomes. ObjectiveIn this paper, we propose an information extraction vocabulary used to pilot the feasibility and reliability of identifying clinician-recorded patient affective states in clinical notes from electronic health records. MethodsAffect and mood were annotated in 147 clinical notes of 109 patients by 2 independent coders across 3 pilots. Intercoder discrepancies were settled by a third coder. This reference annotation set was used to test a proof-of-concept natural language processing (NLP) system using a named entity recognition approach. ResultsConcepts were frequently addressed in templated format and free text in clinical notes. Annotated data demonstrated that affective characteristics were identified in 87.8% (129/147) of the notes, while mood was identified in 97.3% (143/147) of the notes. The intercoder reliability was consistently good across the pilots (interannotator agreement [IAA] >70%). The final NLP system showed good reliability with the final reference annotation set (mood IAA=85.8%; affect IAA=80.9%). ConclusionsAffect and mood can be reliably identified in clinician reports and are good targets for NLP. We discuss several next steps to expand on this proof of concept and the value of this research for depression clinical research

Respiratory Sinus Arrhythmia Reactivity to a Sad Film Predicts Depression Symptom Improvement and Symptomatic Trajectory

Respiratory sinus arrhythmia (RSA) reactivity, an index of cardiac vagal tone, has been linked to self-regulation and the severity and course of depression (Rottenberg, 2007). Although initial data supports the proposition that RSA withdrawal during a sad film is a specific predictor of depression course (Fraguas, 2007; Rottenberg, 2005), the robustness and specificity of this finding are unclear. To provide a stronger test, RSA reactivity to three emotion films (happy, sad, fear) and to a more robust stressor, a speech task, were examined in currently depressed individuals (n = 37), who were assessed for their degree of symptomatic improvement over 30 weeks. Robust RSA reactivity to the sad film uniquely predicted overall symptom improvement over 30 weeks. RSA reactivity to both sad and stressful stimuli predicted the speed and maintenance of symptomatic improvement. The current analyses provide the most robust support to date that RSA withdrawal to sad stimuli (but not stressful) has specificity in predicting the overall symptomatic improvement. In contrast, RSA reactivity to negative stimuli (both sad and stressful) predicted the trajectory of depression course. Patients\u27 engagement with sad stimuli may be an important sign to attend to in therapeutic settings

Multisite Agricultural Veterans Affairs Farming and Recovery Mental Health Services (VA FARMS) Pilot Program: Protocol for a Responsive Mixed Methods Evaluation Study

BackgroundVeterans Affairs Farming and Recovery Mental Health Services (VA FARMS) is an innovative pilot program to provide supportive resources for veterans with interests in agricultural vocations. Implemented at 10 pilot sites, VA FARMS will provide mental health services and resources for veterans while supporting training in gardening and agriculture. As each pilot site project has unique goals, outreach strategies, and implementation efforts based on the local environment and veteran population, evaluating the pilot program provides a unique challenge for evaluators. This paper describes the protocol to evaluate VA FARMS, which was specifically designed to enable site variation by providing both site-specific and cross-site understanding of site implementation processes and outcomes. ObjectiveThe objectives of this paper are to (1) describe the protocol used for evaluating VA FARMS, as an innovative Department of Veterans Affairs (VA) agriculturally based, mental health, and employment pilot program serving veterans at 10 pilot sites across the Veterans Health Administration enterprise; and (2) provide guidance to other evaluators assessing innovative programs. MethodsThis evaluation uses the context, inputs, process, product (CIPP) model, which evaluates a program’s content and implementation to identify strengths and areas for improvement. Data collection will use a concurrent mixed methods approach. Quantitative data collection will involve quarterly program surveys, as well as three individual veteran participant surveys administered upon the veteran’s entrance and exit of the pilot program and 3 months postexit. Quantitative data will include baseline descriptive statistics and follow-up statistics on veteran health care utilization, health care status, and agriculture employment status. Qualitative data collection will include participant observation at each pilot site, and interviews with participants, staff, and community stakeholders. Qualitative data will provide insights about pilot program implementation processes, veterans’ experiences, and short-term participation outcomes. ResultsEvaluation efforts began in December 2018 and are ongoing. Between October 2018 and September 2020, 494 veterans had enrolled in VA FARMS and 1326 veterans were reached through program activities such as demonstrations, informational presentations, and town-hall discussions. A total of 1623 community members and 655 VA employees were similarly reached by VA FARMS programming during that time. Data were collected between October 2018 and September 2020 in the form of 336 veteran surveys, 30 veteran interviews, 27 staff interviews, and 11 community partner interviews. Data analysis is expected to be completed by October 2022. ConclusionsThis evaluation protocol will provide guidance to other evaluators assessing innovative programs. In its application to the VA FARMS pilot, the evaluation aims to add to existing literature on nature-based therapies and the rehabilitation outcomes of agricultural training programs for veterans. Results will provide programmatic insights on the implementation of pilot programs, along with needed improvements and modifications for the future expansion of VA FARMS and other veteran-focused agricultural programs. International Registered Report Identifier (IRRID)DERR1-10.2196/4049