Prenatal depression effects on early development: A review

This review of recent research on prenatal depression suggests that it is a strong predictor of postpartum depression and is more common than postpartum depression. Prenatal depression has been associated with excessive activity and growth delays in the fetus as well as prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate. Infants of depressed mothers have difficult temperament, and later in development attentional, emotional and behavioral problems have been noted during childhood and adolescence, as well as chronic illnesses in adulthood. Several variables have confounded the effects of prenatal depression including comorbid anxiety and anger as well as stressful life events. Potential mediating variables are low prenatal maternal dopamine and serotonin levels and elevated cortisol and norepinephrine. The associated intrauterine artery resistance may limit blood flow, oxygen and nutrients to the fetus. Some studies also suggest the heritability of developmental problems for the children of prenatally depressed mothers, including ADHD and antisocial behavior. Multivariate, longitudinal research is needed to disentangle these confounding and mediating variables.     

Prenatal depression effects and interventions: A review

This review covers research on the negative effects of prenatal depression and cortisol on fetal growth, prematurity and low birthweight. Although prenatal depression and cortisol were typically measured at around 20 weeks gestation, other research suggests the stability of depression and cortisol levels across pregnancy. Women with Dysthymia as compared to Major Depression Disorder had higher cortisol levels, and their newborns had lower gestational age and birthweight. The cortisol effects in these studies were unfortunately confounded by low serotonin and low dopamine levels which in themselves could contribute to non-optimal pregnancy outcomes. The negative effects of depression and cortisol were also potentially confounded by comorbid anxiety, by demographic factors including younger age, less education and lower SES of the mothers and by the absence of a partner or a partner who was unhappy about the pregnancy or a partner who was depressed. Substance use (especially caffeine use) was still another risk factor. All of these problems including prenatal depression, elevated cortisol, prematurity and low birthweight and even postpartum depression have been reduced by prenatal massage therapy provided by the women's partners. Massage therapy combined with group interpersonal psychotherapy was also effective for reducing depression and cortisol levels. Several limitations of these studies were noted and suggestions for future research included exploring other predictor variables like progesterone/estriol ratios, immune factors and genetic determinants. Further research is needed both on the potential use of cortisol as a screening measure and the use of other therapies that might reduce prenatal depression and cortisol in the women and prematurity and low birthweight in their infants.     

Double Depression in Men: Does It Exist?

Differences between male veterans diagnosed with major depression alone and male veterans diagnosed with both major depression and dysthymia (double depression) were investigated. Assessment instruments included the Structured Clinical Interview for DSM-III-R, the Beck Depression Inventory (BDI), and the Symptom Checklist-90-R (SCL-90-R). Consistent with prior literature, it was hypothesized that male veterans diagnosed with both major depression and dysthymia display more severe depressive symptomatology and other forms of psychopathology than male veterans diagnosed with major depression alone. Results did not corroborate these hypotheses. Patients with double depression (n = 17) yielded BDI and SCL-90-R scores which did not differ significantly from those of patients with major depression alone (n = 14). Our results call into question the existence of double depression among men, a disorder whose existence has been demonstrated primarily among women.     

Prenatal paternal depression

Prenatal depressive symptoms, anxiety, anger and daily hassles were investigated in 156 depressed and non-depressed pregnant women and their depressed and non-depressed partners (fathers-to-be). Depressed versus non-depressed fathers had higher depression, anxiety and daily hassles scores. Although the pregnant women in general had lower anxiety, anger and daily hassles scores than the men, the scores on the measures for depressed fathers and depressed mothers did not differ. Paternal depression appeared to have less effect than maternal depression on their partners’ scores. However, the similarity between the scores of depressed mothers and depressed fathers highlights the importance of screening for depression in fathers-to-be as well as mothers-to-be during pregnancy.     

Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): validity of the distinction

The nosology of chronic depression has become increasingly complex since the publication of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), but there are few data available to evaluate the validity of the distinctions between the subtypes of chronic depression. The validity of the distinction between DSM-III-R chronic major depression (CMD) and major depression superimposed on dysthymia (double depression, DD) was examined. Participants were 635 patients with chronic depression in a 12-week trial of antidepressant medications. Patients with CMD, DD, and a 3rd group with a chronic major depressive episode superimposed on dysthymia (DD/CMD) were compared on demographic and clinical characteristics, family history, and response to treatment. Few differences were evident, although the depression of patients with DD/CMD tended to be more severe.     

Moderating effects of the valence of social interaction on the dysfunctional consequences of perseverative cognition: an ecological study in major depression and social anxiety disorder

Background and Objectives: Major depression disorder (MDD) and social anxiety disorder (SAD) are characterized by the use of perseverative cognition (PC) as a dysfunctional coping strategy. We sought to investigate the dysfunctional physiological and psychological consequences of PC and how the valence of social interactions moderates such consequences in these psychopathological conditions.

Design/Methods: The study combined 24-hour heart rate variability (HRV) and ecological momentary assessments in 48 individuals with MDD, SAD, and sex-matched controls.

Results: In all participants, PC was associated with mood worsening and reduced ability of the parasympathetic nervous system, mainly the vagus, to inhibit sympathetic arousal (i.e., reduced HRV). Individuals with SAD had the highest frequency of daily PC, while those with MDD reported that PC interfered more with their ongoing activities. In SAD, daily PC was associated with significantly lower HRV after negative social interactions. Individuals with MDD reported higher levels of sadness during PC irrespective of the valence of the preceding social interaction but higher levels of anxiety and efforts to inhibit PC following positive interactions.

Conclusions: Results highlight the need to account for important moderators like the valence of social interaction when looking at the physiological consequences of maladaptive emotion regulation strategies.     

Prenatal depression effects on the fetus and newborn: a review

A review of research on prenatal depression effects on the fetus and newborn suggests that they experience prenatal, perinatal and postnatal complications. Fetal activity is elevated, prenatal growth is delayed, and prematurity and low birthweight occur more often. Newborns of depressed mothers then show a biochemical/physiological profile that mimics their mothers' prenatal biochemical/physiological profile including elevated cortisol, lower levels of dopamine and serotonin, greater relative right frontal EEG activation and lower vagal tone. Elevated prenatal maternal cortisol is the strongest predictor of these neonatal outcomes. Moderate pressure massage can alleviate these effects including reducing prematurity.     

Exposure to the Chinese famine in early life and depression in adulthood

We aimed to investigate whether exposure to the Chinese famine (1959–1961) in early life was associated with depression in adulthood. We included 17,505 participants from the China health and retirement longitudinal study (CHARLS). Participants were classified into indirect and direct exposure groups. And the directly exposure groups including prenatal, childhood, adolescence/adult exposure groups. Depression was diagnosed by Center for Epidemiological Studies Depression Scale-10 (CES-D) score. Multivariate logistic regression model was used to calculate the odd ratios (ORs) and 95% confidence intervals (CIs) of depression. In women, prenatal, childhood, adolescence/adult exposure groups had higher depression risk than indirect exposure group (OR = 1.46, 1.40, and 1.67, respectively). However, there was no significant association between famine exposure and depression among men. Exposure to famine during prenatal (OR: 1.48; 95% CI: 1.07–2.06), childhood (OR: 1.47; 95% CI: 1.13–1.91), and adolescence/adult (OR: 1.63; 95% CI: 1.24–2.15) period were associated with depression among subjects living in rural, but not those living in urban. Exposure to the Chinese famine in early life had sex and area-specific associations with depression.     

Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants

Although maternal attachment is an important predictor of infant attachment security and other developmental outcomes, little is known about the formation of maternal attachment in the first few months of the infant's life, particularly among ethnic minority mothers. The current study examined the predictors of postpartum maternal attachment in a sample of 217 Latina women enrolled in a perinatal depression prevention trial. Mothers’ attachment to their infants was measured at 6-8 weeks postpartum using the Maternal Postnatal Attachment Scale. A variety of predictors of early attachment were explored including: depressive symptoms during pregnancy, pregnancy intention, feelings about the pregnancy, and the quality of the partner relationship. The strongest predictor of lower maternal attachment was depressive symptoms late in pregnancy; pregnancy intention was marginally predictive of attachment, with lower scores being associated with unwanted pregnancies. The study fills a critical gap in our understanding of the role of depressive symptoms during pregnancy in shaping mothers’ early attachment to their infants.     

Transient versus enduring depression among alcoholics in inpatient treatment

The purposes of this study are (1) to determine the incidence of significant clinical depression among alcoholics at treatment intake at a Veterans Medical Center, (2) to subdivide alcoholics who show significant clinical depression into enduring and transient depressive subgroups, and (3) to identify demographic and psychometric variables useful in discriminating between these two subgroups. Results indicate that of the 60% of VA inpatient alcoholics who showed evidence of significant clinical depression at intake, approximately equal numbers met criteria for inclusion in transient and enduring depressive subgroups. Patients with enduring and transient depression, as defined in this study, were differentiated on the basis of age, drinking pattern, and selected scales from two psychometric instruments which measure depression, confused and disorganized thinking, and an avoidant personality style. These findings may be useful in assisting clinicians in differentiating between alcoholic patients with transitory depression associated with alcohol consumption and/or withdrawal and alcoholic patients with more serious and enduring depression, which may require additional pharmacologic and/or psychotherapeutic intervention.     

Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression

Internet-delivered psychological treatment of major depression has been investigated in several trials, but the role of personalized treatment is less investigated. Studies suggest that guidance is important and that automated computerized programmes without therapist support are less effective. Individualized e-mail therapy for depression has not been studied in a controlled trial. Eighty-eight individuals with major depression were randomized to two different forms of Internet-delivered cognitive behaviour therapy (CBT), or to a waiting-list control group. One form of Internet treatment consisted of guided self-help, with weekly modules and homework assignments. Standard CBT components were presented and brief support was provided during the treatment. The other group received e-mail therapy, which was tailored and did not use the self-help texts i.e., all e-mails were written for the unique patient. Both treatments lasted for 8 weeks. In the guided self-help 93% completed (27/29) and in the e-mail therapy 96% (29/30) completed the posttreatment assessment. Results showed significant symptom reductions in both treatment groups with moderate to large effect sizes. At posttreatment 34.5% of the guided self-help group and 30% of the e-mail therapy group reached the criteria of high-end-state functioning (Beck Depression Inventory score below 9). At six-month follow-up the corresponding figures were 47.4% and 43.3%. Overall, the difference between guided self-help and e-mail therapy was small, but in favour of the latter. These findings indicate that both guided self-help and individualized e-mail therapy can be effective.     

Anxiety and depression: toward overlapping and distinctive features

ABSTRACT

This Special Issue of Cognition and Emotion addresses one of the cardinal concerns of affective science, which is overlapping and distinctive features of anxiety and depression. A central finding in the study of anxiety and depression is that they are moderately highly correlated with each other. This leads us to the question: What is behind this co-occurrence? Possible explanations relate to poor discriminant validity of measures; both emotional states are associated with negative affect; stressful life events; impaired cognitive processes; they share a common biological/genetic diathesis. However, despite a set of common (nonspecific) features, anxiety and depression are clearly not identical emotional states. Differences between them might be best viewed, for example, through their heterogeneous and multi-layered nature, adaptive functions and relations with regulatory processes, positive affect, and motivation or complex cognitive processes. In this introduction we consider several approaches (e.g. functional approach; tripartite model and content-specificity hypothesis) to which most research in this Special Issue is relevant. In addition, we have asked contributors to this Special Issue to indicate how their own studies on comparisons between anxiety and depression and models on anxiety and depression move this area of research to more mature science with applicability.     

Information processing in patients with first episode major depression

Hammar, Å., Kildal, A. B. & Schmid, M. (2012). Information processing in patients with first episode major depression. Scandinavian Journal of Psychology 53, 445–449. Few studies have investigated cognitive functioning in a group of patients experiencing a first episode of depression. The aim of this study was to investigate how patients diagnosed with a first episode of depression perform in effortful and non‐effortful information processing compared to healthy controls. An experimental paradigm based on a visual search test was applied. Thirty‐one patients and thirty‐one healthy controls were included in the study. All patients experienced a severe level of symptom load at the time of testing. Results showed no significant differences between groups under any of the conditions. Findings in the present study indicate that patients with a first episode of depression perform equally to healthy controls in tasks requiring visual attention in both effortful and non‐effortful information processing.     

The effects of humor and depression labels on reactions to social comments

Humor is generally considered to facilitate social relationships, whereas depression has been related to difficulties in relationships. This study investigated the effects of labeling social comments as humorous, as well as labeling the presenter of the comments as feeling depressed, on recipients' reactions to these comments. To this end, 350 university students were presented with vignettes describing four styles of comments (i.e., affiliative, self-enhancing, self-defeating, and aggressive) made by a casual acquaintance. Participants were randomly assigned to one of four conditions. These conditions varied in terms of whether the four styles of comments were described as humorous or not, and whether the acquaintance making the comments was described as feeling depressed or not. Findings indicated that humor led to more positive reactions. Labeling the acquaintance as depressed led to more negative reactions than when the acquaintance was labeled non-depressed, particularly when the comments were self-defeating. Interestingly, when the acquaintance was described as feeling depressed, affiliative comments made in a humorous fashion led to more positive reactions than did non-humorous affiliative comments. These findings are discussed in terms of the effects of humor and depression on interpersonal interactions.     

Dissociating effects of subclinical anxiety and depression on cognitive control

Even at subclinical levels, anxiety and depression are associated with impaired cognitive control. It is unclear, though, to what extent these deficits reflect a common underlying dysfunction. Using a non-affective hybrid masked prime-Simon task, we obtained several measures of within- and between- trial inhibitory behavioral control in 80 young, healthy volunteers, together with measures of their anxiety and depression levels. Neither depression nor anxiety affected low-level within-trial control, or any of the between-trial control measures. However, increased levels of depression, but not of anxiety, were associated with impaired high-level within-trial control (increased Simon effect). Results indicate that depression, but not anxiety, impairs voluntary online response-control mechanisms independent of affective content.     

Neuropsychological effects of stress on social phobia with and without comorbid depression

BACKGROUND: The influence of stress on neuropsychological functioning was assessed in socially phobic (SP), comorbid socially phobic/major depression (CM), and asymptomatic control subjects (AC) under baseline and stressor conditions. METHODS: Subjects were 33 clinically diagnosed undergraduates aged 18 to 41 years. Neuropsychological measures included the Trail Making Test, Wisconsin Card Sorting Test (WCST), Spatial Span, and Digit Span administered during a baseline condition and a psychosocial stress condition (videotaping). RESULTS: Spatial Span scores were reduced for SP during stress, improved for AC, and showed no change for CM. TMT B times showed an interaction effect, with completion time improving significantly less for SP than for AC and CM during stress. Analyses of the normative data for WCST total errors indicated that AC and CM improved significantly during stress, while SP performance declined during stress. CONCLUSIONS: The present findings suggest that comorbid depressed versus non-depressed SP subjects respond uniquely to stress in terms of their neuropsychological functioning and self-reported mood and experiences; generalized social phobia may be associated with spatial working memory disturbance during social stress. Therefore, situations involving potential social and personal evaluation (e.g., examinations or presentations) may have a significant impact on the neuropsychological functioning of SP individuals.     

Enduring cognitive dysfunction in unipolar major depression: A test–retest study using the Stroop paradigm

Hammar, Å., Sørensen, L., Årdal, G., Oedegaard, K.J., Kroken, R., Roness, A. & Lund, A. (2009). Enduring cognitive dysfunction in unipolar major depression: A test–retest study using the Stroop‐paradigm. Scandinavian Journal of Psychology. The aim of the study was to investigate automatic and effortful information processing with the Stroop paradigm in a long term perspective in patients with major depressive disorder (MDD). Patients were tested at two test occasions: at inclusion with a Hamilton Depression Rating Scale (HDRS) score >18, and after 6 months, when most patients had experienced symptom reduction. The Stroop paradigm is considered to measure aspects of attention and executive functioning and consists of three conditions/cards: naming the color of the patches (Color), reading of the color‐words (Word) and naming the ink color of color‐words (Color‐Word). The Color‐Word condition is proved to be the most cognitive demanding task and requires the proband to actively suppress interference and is therefore considered to require more effortful information processing, whereas naming the color of the patches and reading the color‐words are expected to be more automatic and less cognitive demanding. A homogenous group of 19 patients with unipolar recurrent MDD according to DSM‐IV and a HDRS score of >18 were included in the study. A control group was individually matched for age, gender and level of education. Depressed patients performed equal to the control group on the Color and Word cards at both test occasions. However, the patients were impaired compared with the control group on the Color‐Word card task at both test occasions. Thus, the depressed patients showed no improvement of effortful attention/executive performance as a function of symptom reduction. The results indicate that the depressed patients showed impaired cognitive performance on cognitive demanding tasks when symptomatic and that this impairment prevailed after 6 months, despite significant improvement in their depressive symptoms.     

An investigation of the effects of comorbid Axis II pathology on outcome of inpatient treatment for unipolar depression

DSM-based research on comorbidity has suggested thatdepression andpersonality disorder frequently occur together and that the combination of syndromes is associated with a poor response to treatment for depression. The present study was designed to explore the effect of comorbid Axis II pathology for a sample of 45 inpatients who received treatment for major depression. Both categorical and dimensional ratings of personality disorder were used in the statistical analysis. Positive categorical diagnosis of Cluster C (anxious-avoidant) disorder, as well as higher dimensional rating of Cluster A (odd-eccentric) pathology, was predictive of a poor response to treatment (p<.05), as measured by change in pre-post clinical ratings on the Montgomery-Asberg Depression Rating Scale. These results were construed as indicative of a significant Axis II comorbidity effect in the context of an inpatient, multimodal treatment setting for depression. The results also spotlight the influence of techniques of measurement in determining the outcome of statistical analysis.     

Gender differences in the development of depression

The present study attempted to examine possible gender differences in the vulnerability to depression, specifically with regard to eliciting factors, marital status, age of onset, season of hospitalization, and type of treatment. The records of all patients (67 women and 34 men), treated during 1991 for major depression, dysthymia, or depression NOS at a psychiatric hospital in Southeastern Sweden were examined, and placed in empirically derived categories regarding eliciting factors.
The results indicated significant gender differences with regard to eliciting factors, marital status, and age. The eliciting factor in female depression was most commonly "threat to social bonds" whereas in male depression it was "threat to self esteem" or "threat to self respect". Married women were more prone to depression than were married men, as were men living alone compared to women living alone. Women above 60 years of age were significantly more prone to depression than were men of this age group. The results were discussed from two theoretical perspectives: gender role theory and gender-specific developmental theory.     

Hormonal sensitivity of preterm versus full-term infants to the effects of maternal depression

Comparisons were made of differences in the hormonal sensitivity of preterm versus full-term infants to maternal depression, as reflected in children's cortisol levels. In Study 1 (N=25), a comparison was made between preterm versus healthy full-term children. In Study 2 (N=80), a comparison was made between preterm infants and full-term infants with mild or moderate medical problems. Preterm infants were found to be highly reactive to maternal depression (as measured by the Beck Depression Inventory). That is, they demonstrated higher cortisol levels when paired with depressed mothers and lower cortisol levels when paired with non-depressed mothers. No equivalent effects were found for children who were full-term, even when they had experienced other medical problems at birth. It was concluded that premature infants are exceptionally sensitive to the "emotional climate" in their home environment. As a result, they may manifest very different hormonal outcomes--with implications for their later development.