Residual Insomnia and Nightmares Postintervention Symptom Reduction Among Veterans Receiving Treatment for Comorbid PTSD and Depressive Symptoms

While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment nonresponse. More specifically, predicting effects of residual insomnia and nightmares on postintervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veterans (N = 232) to evaluate whether residual insomnia and nightmare symptoms remained after treatment completion and, if so, whether these residual insomnia and nightmare symptoms were associated with higher levels of comorbid PTSD and depression at the end of treatment. Participants (ages 21 to 77 years old; 47.0% Black; 61.6% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that residual insomnia was a significant predictor of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Consistent with previous research, greater residual insomnia symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of insomnia during the course of transdiagnostic treatment (e.g., PTSD and depression), leading to several important clinical assessment and treatment implications.     

Deconstructing antenatal depression: What is it that matters for neonatal behavioral functioning?

This prospective study examined the variability within clinical characteristics of antenatal maternal depression and cortisol levels for associations with newborn infant behavior using the Neonatal Behavioral Assessment Scale (NBAS; T.B. Brazelton, 1984 ). Participants were 81 pregnant women at risk for perinatal depression given their histories of depression prior to pregnancy. We took into consideration not only whether the woman experienced antenatal depression but also whether the depression met diagnostic criteria and variability in timing (onset and occurrence) of antenatal depression and symptom severity. Infants of mothers who became depressed during pregnancy scored less optimally on a subset of the NBAS scales, specifically those scales related to infant neuroregulation. Among the clinical characteristics of depression, the fetus' overall exposure to mothers' depression (reflected in the mean) was most often and most strongly associated with NBAS scales. In terms of timing, third‐trimester exposure was significantly related to newborn behavior. The findings are discussed within the S.H. Goodman and I.H. Gotlib ( 1999 ) model for transmission of psychopathology to offspring of depressed mothers.     

The neuropsychological profile in unipolar depression

There is a wealth of empirical data pertaining to the issue of neuropsychological impairment in depression. However, a coherent and comprehensive framework for understanding the disorder remains elusive. This review will briefly consider some of the important issues on which recent research has focused. It would be premature to derive firm conclusions in an area characterized by considerable confusion, so the aim of this review is to highlight the key areas that must be addressed. Three distinct questions are considered. The first concerns the neuropsychological specificity of the deficits associated with depression; whether they represent selective deficits or a more general profile of impairment. The second question is to determine how cognitive deficits might relate to clinical and demographic factors, including symptom severity, hospitalization, medication and ageing. Finally, a comprehensive theory of depression must also relate impairments to neuropathology, and evidence is now available from imaging studies that have attempted to elucidate neural substrates of neuropsychological deficits.     

Perinatal depression influences on infant negative affectivity: Timing,severity, and co-morbid anxiety

Accumulating evidence suggests that antenatal depression predicts infants’ negative affectivity, albeit with variable effect sizes. With a prospective longitudinal design, we sought to explain that variability by addressing questions about timing of the depression across pregnancy and the early postpartum, the role of high symptom levels relative to diagnosed depression, comorbidity with anxiety, and the potential mediating role of neuroendocrine functioning. Primiparous women (n = 77) with histories of depression prior to pregnancy were assessed for cortisol levels monthly beginning by mid-pregnancy. Depression symptom levels and diagnostic status were similarly assessed monthly in pregnancy and also until infants reached three months of age, when mothers completed the Infant Behavior Questionnaire-Revised to measure infant negative affectivity. Antenatal depression symptoms and infant negative affectivity were positively associated (r = .39). Controlling for depression symptom levels in other trimesters, only second trimester depression symptoms predicted higher infant negative affectivity (β = .44). With postpartum depression symptom levels in the model, only antenatal depression symptoms predicted infant negative affectivity (β = .45). In the context of depression, neither antenatal anxiety symptoms nor anxiety disorder diagnosis were associated with infant NA scores. The hypothesized role of elevated maternal cortisol as a mechanism for the association between antenatal depression and infant NA was not supported. Our findings contribute to efforts to more precisely identify infants of perinatally depressed mothers who are at greater risk for elevated negative affectivity, suggesting a window of vulnerability in mid pregnancy and the need for further study of potential mechanisms.     

Temporal Associations Between Posttraumatic Stress Symptoms and Depression in Response to Online Expressive Writing Interventions in a Hispanic Sample

Some expressive writing (EW) interventions targeting posttraumatic stress symptoms (PTSS) may reduce both PTSS and comorbid depression symptoms. The temporal associations between PTSS and depression symptom levels in response to EW interventions are unknown. This study examined the directionality of PTSS and depression symptom levels from baseline to 1-week, 1-month, and 3-month follow-ups of two online EW interventions in a Hispanic sample with diverse trauma experiences. Participants (n = 70) completed either emotion-focused or fact-focused writing for 3 consecutive days online. A manifest autoregressive model with cross-lagged effects and treatment condition was analyzed. All but one first-order autoregressive path were statistically significant, with later PTSS and depression scores significantly predicted by those scores at preceding time points. The cross-lagged effects findings suggest that earlier PTSS levels influenced later depression levels, but earlier depression did not influence later PTSS, demonstrating a unidirectional temporal association. Severe PTSS may hinder EW treatment gains in depression. Superior outcomes for emotion-focused writing relative to fact-focused writing were also found.     

Parental death,depression and beck's theory of cognitive vulnerability: A critical appraisal and suggestions for research

An adequate model of depression should be able to (i) specify the origins of the disorder; (ii) explain the maintenance of depressive behaviour and (iii) result in effective therapy. The adequacy of Beck's cognitive theory of depression has been increasingly questioned (e.g. Alagaratnam, 1984; Alladin, 1985; Bebbington, 1985; Power & Champion (1986); Beidel & Turner (1986); Power (1987) and fundamental questions remain unexplored. In this paper, we focus on the assumption that early parental death results in the development of depressive schemas which constitute a cognitive vulnerability to depression. Bereavement is the most severe psychological trauma most people will encounter in the course of their lives (cf. Parkes & Weiss, 1983). Thus a most stringent test of Beck's hypothesis that depressive schemas are formed in early childhood by loss experiences such as parental death may be conducted by assessing the relationship between adult depression and parental death in childhood. In this paper the evidence will be considered briefly, within the context of Beck's theory of cognitive vulnerability. The specificity of parental loss to depression is questioned. Then, the role of schemas in cognitive theory is explored critically. Problems with Beck's idiosyncratic conceptualisation of depressive schemas are highlighted. A more adequate conceptualisation of the concept of loss is suggested. Finally, suggestions for future research into the origins of depression are offered.     

Validity of the Sluggish Cognitive Tempo Symptom Dimension in Children: Sluggish Cognitive Tempo and ADHD-Inattention as Distinct Symptom Dimensions

This study examined the validity of the sluggish cognitive tempo (SCT) symptom dimension in children. Ten symptom domains were used to define SCT (i.e., (1) daydreams; (2) attention fluctuates; (3) absent-minded; (4) loses train of thought; (5) easily confused; (6) seems drowsy; (7) thinking is slow; (8) slow-moving; (9) low initiative; and (10) easily bored, needs stimulation). Teacher ratings of 366 children (ages 5 to 13 with 56 % girls) along with parent ratings of 703 children (ages 5 to 13 with 55 % girls) indicated that SCT symptom domains one to eight showed convergent validity (i.e., substantial loadings on the SCT factor) and discriminant validity with the ADHD-IN dimension (i.e., higher loadings on the SCT factor than the ADHD-IN factor). Higher scores on this eight-symptom measure of SCT predicted lower levels of academic and social competence even after controlling for ADHD-IN and ADHD-HI. In addition, higher SCT scores still predicted higher anxiety/depression scores after controlling for ADHD-IN and ADHD-HI. Higher SCT scores also predicted lower ADHD-HI scores after controlling for ADHD-IN and anxiety/depression while higher ADHD-IN and anxiety/depression scores predicted higher ADHD-HI scores after controlling for SCT and anxiety/depression or ADHD-IN. SCT also showed a unique negative relationship with ODD while ADHD-IN and anxiety/depression showed unique positive relationships with ODD. This new measure of the SCT dimension was meaningfully independent from the ADHD-IN and anxiety/depression dimensions and suggests that such an SCT dimension may signify a distinct presentation of ADHD or a different (if highly comorbid) disorder altogether.     

The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test’s validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.     

Pertinence clinique en population dépressive d’un médiateur thérapeutique axé sur les ressources personnelles : évaluation par protocole individuel de type arrêt—reprise sur une patiente hospitalisée pour dépression

IntroductionThe low to moderate benefit of current care on optimal functioning in depressed patient encourages the development and evaluation of new interventions in this area.ObjectiveThis study aims at the clinical evaluation by single case of a serious game focused on personal resources in depressed population.MethodThe recommendations of the Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) Statement were respected to design and report the results of this single-case research (Tate et al., 2016). A Withdrawal/Reversal ABA design has been applied to a young patient hospitalized for depression. Each phase contained 3 measurement opportunities spaced 7 to 10 days apart. In intervention phase B, a serious game was introduced in positive psychotherapy workshops without replacing the patient's usual care.ResultsIn the patient, serious game had a clinically significant benefit on depression, psychological well-being and affects. On the other hand, an increase in stress and anxiety levels, as well as a progressive decrease in the feeling of autonomy were also observed.ConclusionSerious game as a therapeutic mediator seems to have demonstrated its effectiveness for the patient. The reduction in depression coupled with the increase in stress and anxiety points out a favourable progression of the patient's problem. Elements specific to the patient's intra-individual problem were highlighted and could shed light on her clinical management.     

Recurrence in major depression: a conceptual analysis

Theory and research on major depression have increasingly assumed a recurrent and chronic disease model. Yet not all people who become depressed suffer recurrences, suggesting that depression is also an acute, time-limited condition. However, few if any risk indicators are available to forecast which of the initially depressed will or will not recur. This prognostic impasse may be a result of problems in conceptualizing the nature of recurrence in depression. In the current paper we first provide a conceptual analysis of the assumptions and theoretical systems that presently structure thinking on recurrence. This analysis reveals key concerns that have distorted views about the long-term course of depression. Second, as a consequence of these theoretical problems we suggest that investigative attention has been biased toward recurrent forms of depression and away from acute, time-limited conditions. Third, an analysis of how these theoretical problems have influenced research practices reveals that an essential comparison group has been omitted from research on recurrence: people with a single lifetime episode of depression. We suggest that this startling omission may explain why so few predictors of recurrence have as yet been found. Finally, we examine the reasons for this oversight, document the validity of depression as an acute, time-limited disorder, and provide suggestions for future research with the goal of discovering early risk indicators for recurrent depression.     

Anxiety and depression and their links with delusions and hallucinations in people with a dual diagnosis of psychosis and substance misuse: a study using data from a randomised controlled trial

Rates of depression and anxiety have been linked to severity and distress associated with positive symptoms in psychosis. There is also tentative evidence to suggest that these concurrent symptoms might be related to delusional and hallucinatory content. Our aim was to assess the cross-sectional associations between anxiety and depression, and hallucination and delusion severity and distress in a sample of 327 people dually diagnosed with psychosis and substance misuse problems. In addition, the relationships between specific symptom content and levels of anxiety and depression were examined. Anxiety was associated with delusion distress and depression with hallucination distress, although neither was related to symptom severity. Auditory commands to harm or kill the self were associated with higher levels of depression. Delusions with themes pertaining to the paranormal, and those with references to celebrities were associated with lower levels of depression. No specific delusion or hallucination content was associated with level of anxiety, when other variables were controlled for. The results demonstrate that anxiety and depression are linked to distinct aspects of psychotic experience, highlighting the need to acknowledge the role of these concurrent symptoms in the context of psychosis. In addition, findings relating to specific types of delusions and hallucinations highlight avenues for further research.     

Improving Attendance and Behavior Change in a Weight Loss Program for Veterans: Feasibility and Acceptability of the HERO Intervention

Psychological distress, such as anxiety, depression, and posttraumatic stress disorder (PTSD), is commonly comorbid with obesity in veterans. The feasibility and acceptability of an integrated cognitive behavioral treatment approach has been tested in nonveteran settings but has yet to be tested among obese veterans with comorbid anxiety, depression, and PTSD. This paper describes such a framework, highlighting a flexible delivery method, transdiagnostic treatment approach, and attention to treatment barriers examined in a prior qualitative assessment. Brief vignettes are used to illustrate clinical decision-making procedures and treatment activities. The feasibility and acceptability as well as potential next steps for research and clinical benefits are also described.     

Sexual Harassment and Posttraumatic Stress Symptoms among Asian and White Women

Sexual harassment is a prevalent problem that has been associated with negative psychological and physical health outcomes. Although sexual harassment has been linked to posttraumatic stress (PTS) symptoms, little is known about how PTS symptoms that arose from sexual harassment experiences might be associated with psychological and physical health. This study examined the associations among sexual harassment, PTS symptoms, and psychological and physical well-being in a sample of Asian and White women. In addition, given the lack of research on sexual harassment among Asian women, we investigated the moderating role of ethnicity. Results indicated that greater sexual harassment frequency and PTS symptom severity predicted more depression, overall psychological distress, and physical symptoms. PTS symptom severity and ethnicity moderated the relationship between sexual harassment frequency and physical symptoms. We discuss the implications of these findings and directions for further research.     

青少年抑郁综合认知模型及其性别差异

Beck抑郁认知理论认为功能失调性态度和自动思维对抑郁的形成和发展有着重要的影响, 但是不同水平的认知因素在青少年抑郁中起什么样的作用还有待于进一步的研究。根据Oei和Kwon (2007)综合认知模型(ICM), 我们假设在青少年负性生活事件和抑郁症状间功能失调性态度是调节变量, 而自动思维是中介变量。研究采用开学初和临近期末间隔近四个月两个时间点的纵向数据搜集方式, 对613名初中生施以青少年生活事件量表(ASLEC)、功能失调性态度问卷(DAS)、自动思维问卷(ATQ)以及流调中心用抑郁量表(CES-D), 然后通过路径分析对模型进行了拟合度和性别差异检验, 结果表明：(1)各变量显著相关(p<0.01), 且各变量间隔四个月两个时间点的分数差异显著(p<0.01); (2)修正后的青少年抑郁综合认知模型较好地拟了数据, 且功能失调性态度与负性生活事件的交互作用对自动思维的影响上女生的路径系数显著大于男生。结论：功能失调性态度在负性生活事件和青少年抑郁症状间起调节作用, 而自动思维从中起到了认知中介的作用, 且该模型性别差异显著。     

Differential Item Functioning of the Symptoms of Major Depression by Race and Ethnicity: An Item Response Theory Analysis

This study examines the psychometric properties, and particularly differential item functioning (DIF) due to racial and ethnic group, of the criteria for a major depressive episode using a large sample (N?=?1,063) of outpatients seeking treatment for mood and anxiety disorders. DIF was evaluated using multiple group confirmatory factor analysis. Item thresholds fell along a continuum with the core features of depressed mood and anhedonia, along with fatigue, being endorsed at lower levels of depression, and change in appetite and suicidal ideation endorsed at more severe levels of depression. Item discriminations, reflecting an item’s ability to discriminate between lower and higher levels of depression, were highest for depressed mood and anhedonia, and lowest for change in appetite and suicidal ideation. When examining model fit among the racial groups we did not find differences in symptom functioning, providing support for the use of these symptoms across diverse groups. This is of particular importance given the paucity of studies examining this question using a semi-structured clinician administered instrument to a clinical sample.     

Social rejection and ADHD in young adults: an analogue experiment

Poor outcomes in ADHD may be related to problematic social functioning and consequences of social rejection. This study examines how ADHD symptom expression affects mood and social rejection. Working from findings in depression that describe maintenance through negative interpersonal interactions, the authors seek to examine this theory's applicability to poor outcomes in ADHD. In a completely randomized design, 130 participants are exposed to one of several videotape segments that include displays of ADHD, depression, and social anxiety. A normal control is also used. All abnormal videotapes are met with greater rejection than the control. Displays of ADHD elicit similar levels of rejection to those elicited by displays of depression. Additionally, ADHD elicits greater levels of hostile mood, whereas depression elicits high levels of depression and fatigue. Implications for an interpersonal theory of vulnerability in ADHD are discussed along with implications for future research, prevention, and intervention.     

Treating PTSD in refugees and asylum seekers within the general health care system. A randomized controlled multicenter study

Objective

There has been uncertainty about whether refugees and asylum seekers with PTSD can be treated effectively in standard psychiatric settings in industrialized countries. In this study, Narrative Exposure Therapy (NET) was compared to Treatment As Usual (TAU) in 11 general psychiatric health care units in Norway. The focus was on changes in symptom severity and in the diagnostic status for PTSD and depression.

Method

Refugees and asylum seekers fulfilling the DSM-IV criteria for PTSD (N = 81) were randomized with an a-priori probability of 2:1 to either NET (N = 51) or TAU (N = 30). The patients were assessed with Clinician Administered PTSD Scale, Hamilton rating scale for depression and the MINI Neuropsychiatric Interview before treatment, and again at one and six months after the completion.

Results

Both NET and TAU gave clinically relevant symptom reduction both in PTSD and in depression. NET gave significantly more symptom reduction compared to TAU as well as significantly more reduction in participants with PTSD diagnoses. No difference in treatment efficacy was found between refugees and asylum seekers.

Conclusions

The study indicated that refugees and asylum seekers can be treated successfully for PTSD and depression in the general psychiatric health care system; NET appeared to be a promising treatment for both groups.

ClinicalTrials.gov registry number

NCT00218959.     

Two Trajectories of Depressive Symptom Reduction Throughout Behavioral Activation Teletherapy Among Underserved,Ethnically Diverse,Primary Care Patients: A VitalSign6 Report

While prior research has investigated trajectories of depressive symptom change throughout psychotherapy, such work has not been conducted exclusively among underserved patients receiving brief Behavioral Activation (BA) teletherapy, intervention modifications that should reduce barriers to therapy initiation and engagement. The current project used cluster analysis to determine discrete groups of symptom change among patients receiving an 8-session BA teletherapy intervention, and analyzed whether demographic and clinical characteristics were associated with group membership. Data from 105 patients referred from charity primary care clinics and receiving at least two therapy sessions were analyzed. Patients were predominantly female and Latina. The 9-item Patient Health Questionnaire (PHQ-9) was the outcome. Two categories were determined: a larger group (N = 61) demonstrating initially less severe symptoms and experiencing a gradual recovery, and a smaller group beginning with more severe symptoms, and experiencing a steeper recovery. In both groups, a majority of participants experienced at least a 5-point drop in depressive symptoms, while in the latter group, a majority of patients achieved depressive symptom remission (PHQ-9 < 5). Monolingual Spanish speakers were more likely to be in the former group, but no other demographic or clinical characteristics were associated with group membership. In both groups, a majority of the symptom reduction occurred by sessions 4–6. Therefore, two categories of depressive symptom change, slow responders and rapid responders, occur among patients receiving a brief BA teletherapy intervention. No demographic differences aside from primary language, nor any clinical characteristics, distinguish group membership, suggesting similar patterns of symptom reduction among a primarily underserved sample.     

Relations among self-reported depressive symptoms in clinic-referred children versus adolescents.

Although there is consensus regarding the existence of childhood depression, disagreement remains as to whether symptoms are developmentally isomorphic. Previous studies focused on developmental differences in symptom levels; analyses of relations among symptoms may be more appropriate, however. Here both approaches were used to compare the Children's Depression Inventory responses from 1,030 clinic-referred children and adolescents. Four of nine symptom categories showed significant developmental differences in their correlations with total score. Externalizing behavior and guilt were more strongly related to depression in children than adolescents; affective symptoms and concerns about the future showed the reverse pattern. Results illustrate the importance of considering relations among symptoms as well as differences in symptom levels when evaluating theoretical claims about developmental differences in the nature of clinical syndromes.     

Cognitive reactivity mediates the relationship between neuroticism and depression

Although neuroticism has long been established as an important risk factor for depression, the mechanisms through which this temperamental predisposition translates into the occurrence of symptoms are still relatively unclear. This study investigated cognitive reactivity, i.e. the ease with which particular patterns of negative thinking are reactivated in response to mild low mood, as a potential mediator. Individuals with (N = 98) and without a previous history of depression (N = 83) who had provided neuroticism scores six years previously were assessed for cognitive reactivity and current symptoms of depression using self-report questionnaires. Tendencies to respond to mild low mood with ruminative thinking mediated the relation between neuroticism and current symptoms of depression in both groups. Reactivation of hopelessness and suicidal thinking occurred as an additional mediator only in those with a history of previous depression. The results suggest that neuroticism predisposes individuals to depression by generally increasing the likelihood of ruminative responses to low mood. In those with a history of depression in the past, neuroticism additionally increases risk of recurrence by facilitating reactivation of previously associated patterns such as suicidal thinking and hopelessness. These findings suggest potential targets for interventions to help preventing the occurrence, or recurrence of depression in those who due to their temperamental predisposition are at an increased risk.