Modifiable risk factors predicting major depressive disorder at four year follow-up: a decision tree approach

BACKGROUND: Relative to physical health conditions such as cardiovascular disease, little is known about risk factors that predict the prevalence of depression. The present study investigates the expected effects of a reduction of these risks over time, using the decision tree method favoured in assessing cardiovascular disease risk. METHODS: The PATH through Life cohort was used for the study, comprising 2,105 20-24 year olds, 2,323 40-44 year olds and 2,177 60-64 year olds sampled from the community in the Canberra region, Australia. A decision tree methodology was used to predict the presence of major depressive disorder after four years of follow-up. The decision tree was compared with a logistic regression analysis using ROC curves. RESULTS: The decision tree was found to distinguish and delineate a wide range of risk profiles. Previous depressive symptoms were most highly predictive of depression after four years, however, modifiable risk factors such as substance use and employment status played significant roles in assessing the risk of depression. The decision tree was found to have better sensitivity and specificity than a logistic regression using identical predictors. CONCLUSION: The decision tree method was useful in assessing the risk of major depressive disorder over four years. Application of the model to the development of a predictive tool for tailored interventions is discussed

The relationship between cognition and mortality in a community sample of older adults

Cognitive performance has previously been shown to be associated with time to death in a broad range of studies. There are multiple perspectives that have been used to better understand this relationship, including identifying the types of cognitive abilities that predict mortality, investigating potential mechanisms that might explain the relationship, examining whether level of ability or changes in ability are responsible for the association, assessing evidence of terminal decline and exploring patterns of late-life decline. It is also important to rule out the confounding of the relationship between cognition and time to death by other factors such as mental health. Five research articles investigated multiple aspects of the relationship between cognition and mortality using the Canberra Longitudinal Study cohort, a sample of 896 community-dweIIing Australians aged 70 and older. Findings suggested that fluid inteIIigence was a better predictor of mortality than crystaIIised inteIIigence. While socioeconomic status, health behaviours and health status accounted for some of the variance in the relationship, certain domains of cognitive ability including processing speed and global ability had an independent effect on mortality. Using unbiased estimates of cognitive change, it was found that initial cognitive performance was a better predictor of mortality, particularly cardiovascular mortality, than the rate of change in ability. However, there was evidence of terminal decline in the sample, with decline accelerating two-to four-fold, beginning 6-8 years prior to death across various abilities. Although education modified the time course of terminal decline, the effects were not consistent with the predictions of the cognitive reserve hypothesis. Age-related decline in ability could not be attributed to common biological constraints, as little evidence was found for late-life dedifferentiation of abilities after accounting for dementia. FinaIIy, depression and anxiety had no significant association with mortality after accounting for physical health, indicating that the cognition-mortality relationship did not result from confounding by mental health status. Overall, late-life cognitive performance appears to be related to mortality partly because it reflects life-long outcomes from a range of health behaviours, disease states, educational experience and socioeconomic background. In addition, pathological events including dementia and cardiovascular changes may contribute to the decline of cognitive performance that occurs in proximity to death. However, beyond these influences, there is an aspect of cognitive ability that is independently predictive of mortality

E-Health interventions for suicide prevention

Many people at risk of suicide do not seek help before an attempt, and do not remain connected to health services following an attempt. E-health interventions are now being considered as a means to identify at-risk individuals, offer self-help through web interventions or to deliver proactive interventions in response to individuals' posts on social media. In this article, we examine research studies which focus on these three aspects of suicide and the internet: the use of online screening for suicide, the effectiveness of e-health interventions aimed to manage suicidal thoughts, and newer studies which aim to proactively intervene when individuals at risk of suicide are identified by their social media postings. We conclude that online screening may have a role, although there is a need for additional robust controlled research to establish whether suicide screening can effectively reduce suicide-related outcomes, and in what settings online screening might be most effective. The effectiveness of Internet interventions may be increased if these interventions are designed to specifically target suicidal thoughts, rather than associated conditions such as depression. The evidence for the use of intervention practices using social media is possible, although validity, feasibility and implementation remains highly uncertain.Philip J. Batterham is supported by NHMRC fellowship 1035262. Helen Christensen is supported by NHMRC Fellowship 1056964

Commentary on Snowdon: ‘The Journal’s concerns about suicide’

Suicide deaths, along with suicidal thoughts and behaviours, place an extensive burden on individuals, with broader impact across the community.The author is supported by National Health and Medical Research Council fellowship 108331

Detecting suicidality on Twitter

Twitter is increasingly investigated as a means of detecting mental health status, including depression and suicidality, in the population. However, validated and reliable methods are not yet fully established. This study aimed to examine whether the level of concern for a suicide-related post on Twitter could be determined based solely on the content of the post, as judged by human coders and then replicated by machine learning. From 18th February 2014 to 23rd April 2014, Twitter was monitored for a series of suicide-related phrases and terms using the public Application Program Interface (API). Matching tweets were stored in a data annotation tool developed by the Commonwealth Scientific and Industrial Research Organisation (CSIRO). During this time, 14,701 suicide-related tweets were collected: 14% were randomly (n = 2000) selected and divided into two equal sets (Set A and B) for coding by human researchers. Overall, 14% of suicide-related tweets were classified as ‘strongly concerning’, with the majority coded as ‘possibly concerning’ (56%) and the remainder (29%) considered ‘safe to ignore’. The overall agreement rate among the human coders was 76% (average κ = 0.55). Machine learning processes were subsequently applied to assess whether a ‘strongly concerning’ tweet could be identified automatically. The computer classifier correctly identified 80% of ‘strongly concerning’ tweets and showed increasing gains in accuracy; however, future improvements are necessary as a plateau was not reached as the amount of data increased. The current study demonstrated that it is possible to distinguish the level of concern among suicide-related tweets, using both human coders and an automatic machine classifier. Importantly, the machine classifier replicated the accuracy of the human coders. The findings confirmed that Twitter is used by individuals to express suicidality and that such posts evoked a level of concern that warranted further investigation. However, the predictive power for actual suicidal behaviour is not yet known and the findings do not directly identify targets for intervention.This project was supported in part by funding from the NSW Mental Health Commission and the NHMRC John Cade Fellowship 1056964. PJB and ALC are supported by the NHMRC Early Career Fellowships 1035262 and 1013199

Anxiety Symptoms as Precursors of Major Depression and Suicidal Ideation

Background Relative to depression symptoms, the role of anxiety symptoms in the development of depression and suicidal ideation has not been well established. This study aimed to identify the anxiety and depression symptoms that confer the greatest amount of risk for depression and suicidal ideation at the population level. Method The PATH through Life study is an Australian community-based longitudinal cohort study of 7,485 younger, middle-aged, and older adults. Adjusted population attributable risk (PAR) for incident depression and suicidal ideation after 4 years was assessed for 18 symptoms of anxiety and depression. Results Anxiety symptoms contributed greater risk overall to both depression (45%) and suicidal ideation (23%) incidence than depression symptoms (35% and 16%, respectively). Anxiety symptoms had largest PARs among younger age groups. Conclusions Prevention programs for depression and suicide should aim to reduce anxiety symptoms in addition to depression symptoms, and target individuals reporting symptoms such as worrying or irritability. (C) 2013 Wiley Periodicals, Inc

The Development and Validation of the Thwarted Belongingness Scale (TBS) for Interpersonal Suicide Risk

Thwarted belongingness (TB) has been identified as a risk factor for the development of suicide ideation. However, measures for assessing this construct are currently limited. The present study aimed to develop and validate a new self-report measure for thwarted belongingness (TBS) against the Interpersonal Needs Questionnaire Thwarted Belongingness sub-scale (INQ TB; Van Orden et al. 2012), and provide a comparative test of the Interpersonal Psychological Theory of Suicide (IPTS; Joiner 2005). A 42-item pool underwent refinement via three consecutive stages: (1) expert feedback, (2) item selection study using a sample of community-dwelling Australian adults (Study 1, N = 284), and (3) validation study and test of IPTS predictions in a larger sample of community-dwelling Australian adults (Study 2, N = 747). Exploratory and confirmatory factor analyses supported the uni-dimensionality of the TBS. Item response theory analysis indicated that the TBS captured more information over a slightly narrower range than the INQ TB. Preliminary support was provided for the IPTS ideation prediction when using the TBS and INQ TB. The TBS may provide enhanced identification of TB in individuals who display moderate to high levels of this interpersonal risk factor. However, further development of additional interpersonal measures is needed to ascertain the role of TB in relation to interpersonal suicide risk and how to best approach its conceptualisation and measurement.This research is supported by an Australian Government Research Training Program (RTP) Scholarship. PJB and ALC are supported by National Health and Medical Research Council (NHMRC) fellowships 1083311 and 112254

A systematic review of the predictions of the Interpersonal-Psychological Theory of Suicidal Behavior

CONTEXT Since the development of the Interpersonal Psychological Theory (IPTS; Joiner, 2005), a growing body of literature has emerged testing different aspects of the theory across a range of populations. OBJECTIVE The aim of this review was to identify support for the IPTS, and critical gaps in the evidence base, by systematically reviewing current evidence testing the effects of thwarted belongingness, perceived burdensomeness, and acquired capability on suicide ideation and attempt. METHODS PsycInfo and PubMed databases were electronically searched for articles published between January 2005 and July 2015. Articles were included if they directly assessed the IPTS constructs as predictors of suicidal ideation or suicide attempt. RESULTS Fifty-eight articles reporting on 66 studies were identified. Contrary to expectations, the studies provided mixed evidence across the theory's main predictions. The effect of perceived burdensomeness on suicide ideation was the most tested and supported relationship. The theory's other predictions, particularly in terms of critical interaction effects, were less strongly supported. CONCLUSIONS Future research focused on expanding the availability of valid measurement approaches for the interpersonal risk factors, and further elaborating upon their mixed relationships with suicide ideation and attempt across multiple populations is important to advance theoretical and clinical progress in the field

Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of Generalised Anxiety Disorder

BACKGROUND Generalised Anxiety Disorder (GAD) is a highly prevalent psychiatric disorder. Effective prevention in young adulthood has the potential to reduce the prevalence of the disorder, to reduce disability and lower the costs of the disorder to the community. The present trial (the WebGAD trial) aims to evaluate the effectiveness of an evidence-based online prevention website for GAD. METHODS/DESIGN The principal clinical question under investigation is the effectiveness of an online GAD intervention (E-couch) using a community-based sample. We examine whether the effect of the intervention can be maximised by either human support, in the form of telephone calls, or by automated support through emails. The primary outcome will be a reduction in symptoms on the GAD-7 in the active arms relative to the non active intervention arms. DISCUSSION The WebGAD trial will be the first to evaluate the use of an internet-based cognitive behavioural therapy (CBT) program contrasted with a credible control condition for the prevention of GAD and the first formal RCT evaluation of a web-based program for GAD using community recruitment. In general, internet-based CBT programs have been shown to be effective for the treatment of other anxiety disorders such as Post Traumatic Stress Disorder, Social Phobia, Panic Disorder and stress in clinical trials; however there is no evidence for the use of internet CBT in the prevention of GAD. Given the severe shortage of therapists identified in Australia and overseas, and the low rates of treatment seeking in those with a mental illness, the successful implementation of this protocol has important practical outcomes. If found to be effective, WebGAD will provide those experiencing GAD with an easily accessible, free, evidence-based prevention tool which can be promoted and disseminated immediately

Preferences for Internet-Based Mental Health Interventions in an Adult Online Sample: Findings From an Online Community Survey

BACKGROUND: Despite extensive evidence that Internet interventions are effective in treating mental health problems, uptake of Internet programs is suboptimal. It may be possible to make Internet interventions more accessible and acceptable through better understanding of community preferences for delivery of online programs. OBJECTIVE: This study aimed to assess community preferences for components, duration, frequency, modality, and setting of Internet interventions for mental health problems. METHODS: A community-based online sample of 438 Australian adults was recruited using social media advertising and administered an online survey on preferences for delivery of Internet interventions, along with scales assessing potential correlates of these preferences. RESULTS: Participants reported a preference for briefer sessions, although they recognized a trade-off between duration and frequency of delivery. No clear preference for the modality of delivery emerged, although a clear majority preferred tailored programs. Participants preferred to access programs through a computer rather than a mobile device. Although most participants reported that they would seek help for a mental health problem, more participants had a preference for face-to-face sources only than online programs only. Younger, female, and more educated participants were significantly more likely to prefer Internet delivery. CONCLUSIONS: Adults in the community have a preference for Internet interventions with short modules that are tailored to individual needs. Individuals who are reluctant to seek face-to-face help may also avoid Internet interventions, suggesting that better implementation of existing Internet programs requires increasing acceptance of Internet interventions and identifying specific subgroups who may be resistant to seeking help.PJB and ALC are supported by National Health and Medical Research Council (NHMRC) Fellowships 1083311 and 1122544. The study was partially funded by a grant from AFFIRM, the Australian Foundation for Mental Health Research, and the John James Memorial Foundation