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Concept: Leonard Cohen

171

BACKGROUND: There is a significant treatment gap for patients with depression. A third of sufferers never seek help, and the vast majority of those who do only do so after considerable delay. Little is understood regarding poor help-seeking rates amongst people with depression, with existing research mainly focussed on the impact of barriers to treatment. The current study explored psychological factors affecting help-seeking behaviour in clinically depressed individuals. METHODS: Semi-structured interviews were conducted with 20 current or previously clinically depressed participants who either had or had not sought professional help. Thematic analysis was used to analyse results. RESULTS: The onset of depressive symptoms created conflict with participants' identity and personal goals. Delays in seeking help were primarily attributed to the desire to protect identity and goals from the threat of depressive symptoms. Participants used avoidance strategies to reduce the perceived threat of depressive symptoms on identity. These strategies interfered with help-seeking. Help-seeking was only undertaken once participants reached a point of acceptance and began to make concessions in their identity and goals, at which time they reduced their use of avoidance. CONCLUSIONS: Difficulties resolving conflict between identity and depressive symptoms may account for significant delays in seeking help for depression. The results have implications for predicting health behaviour and improving treatment uptake for depression, and may inform existing help-seeking models.

Concepts: Cognitive behavioral therapy, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, Dysthymia, Types of psychological depression, Suicide, Leonard Cohen

64

It has been reported that gut probiotics play a major role in the bidirectional communication between the gut and the brain. Probiotics may be essential to people with depression, which remains a global health challenge, as depression is a metabolic brain disorder. However, the efficacy of probiotics for depression is controversial. This study aimed to systematically review the existing evidence on the effect of probiotics-based interventions on depression. Randomized, controlled trials, identified through screening multiple databases and grey literature, were included in the meta-analysis. The meta-analysis was performed using Review Manager 5.3 software using a fixed-effects model. The meta-analysis showed that probiotics significantly decreased the depression scale score (MD (depressive disorder) = -0.30, 95% CI (-0.51–0.09), p = 0.005) in the subjects. Probiotics had an effect on both the healthy population (MD = -0.25, 95% CI (-0.47–0.03), p = 0.03) and patients with major depressive disorder (MDD) (MD = -0.73, 95% CI (-1.37–0.09), p = 0.03). Probiotics had an effect on the population aged under 60 (MD = -0.43, 95% CI (-0.72–0.13), p = 0.005), while it had no effect on people aged over 65 (MD = -0.18, 95% CI (-0.47-0.11), p = 0.22). This is the first systematic review and meta-analysis with the goal of determining the effect of probiotics on depression. We found that probiotics were associated with a significant reduction in depression, underscoring the need for additional research on this potential preventive strategy for depression.

Concepts: Randomized controlled trial, Human brain, Hippocampus, Life expectancy, Major depressive disorder, Dysthymia, Leonard Cohen

33

Guided by concepts from a relational developmental perspective, this study examined intra- and interpersonal associations between self-esteem and depressive symptoms in a sample of 1,407 couples surveyed annually across 6 years in the Panel Analysis of Intimate Relations and Family Dynamics (pairfam) study. Autoregressive cross-lagged model results demonstrated that self-esteem predicted future depressive symptoms for male partners at all times, replicating the vulnerability model for men (low self-esteem is a risk factor for future depression). Additionally, a cross-partner association emerged between symptoms of depression: Higher depressive symptoms in one partner were associated with higher levels of depression in the other partner one year later. Finally, supportive dyadic coping, the support that partners reported providing to one another in times of stress, was tested as a potential interpersonal mediator of pathways between self-esteem and depression. Female partners' higher initial levels of self-esteem predicted male partners' subsequent reports of increased supportive dyadic coping, which, in turn, predicted higher self-esteem and fewer symptoms of depression among female partners in the future. Male partners' initially higher symptoms of depression predicted less frequent supportive dyadic coping subsequently reported by female partners, which was associated with increased feelings of depression in the future. Couple relations represent an important contextual factor that may be implicated in the developmental pathways connecting self-esteem and symptoms of depression. (PsycINFO Database Record

Concepts: Time, Future, Forecasting, Intimate relationship, Leonard Cohen

29

Prospection, the mental representation of possible futures, is usually adaptive. When it goes awry, however, it disrupts emotion and motivation. A negative view of the future is typically seen as one symptom of depression, but we suggest that such negative prospection is the core causal element of depression. Here, we describe the empirical evidence supporting this framework, and we explore the implications for clinical interventions.

Concepts: Psychology, Future, The Core, Leonard Cohen

4

Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support.

Concepts: Health care provider, Psychology, Illness, Mental disorder, Asia, Mood disorder, Mental health professional, Leonard Cohen

4

BACKGROUND: When challenged with information about the future, healthy participants show an optimistically biased updating pattern, taking desirable information more into account than undesirable information. However, it is unknown how patients suffering from major depressive disorder (MDD), who express pervasive pessimistic beliefs, update their beliefs when receiving information about their future. Here we tested whether an optimistically biased information processing pattern found in healthy individuals is absent in MDD patients. Method MDD patients (n = 18; 13 medicated; eight with co-morbid anxiety disorder) and healthy controls (n = 19) estimated their personal probability of experiencing 70 adverse life events. After each estimate participants were presented with the average probability of the event occurring to a person living in the same sociocultural environment. This information could be desirable (i.e. average probability better than expected) or undesirable (i.e. average probability worse than expected). To assess how desirable versus undesirable information influenced beliefs, participants estimated their personal probability of experiencing the 70 events a second time. RESULTS: Healthy controls showed an optimistic bias in updating, that is they changed their beliefs more toward desirable versus undesirable information. Overall, this optimistic bias was absent in MDD patients. Symptom severity correlated with biased updating: more severely depressed individuals showed a more pessimistic updating pattern. Furthermore, MDD patients estimated the probability of experiencing adverse life events as higher than healthy controls. CONCLUSIONS: Our findings raise the intriguing possibility that optimistically biased updating of expectations about one’s personal future is associated with mental health.

Concepts: Mental disorder, Selective serotonin reuptake inhibitor, Major depressive disorder, Seasonal affective disorder, Primary care, Depression, Types of psychological depression, Leonard Cohen

2

To examine the overall effect of individual depression prevention programs on future likelihood of depressive disorder and reduction in depressive symptoms. In addition, we have investigated whether Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT) and other therapeutic techniques may modify this effectiveness.

Concepts: Psychology, Cognitive behavioral therapy, Schizophrenia, Major depressive disorder, Dysthymia, Interpersonal psychotherapy, Leonard Cohen

2

Pharmacological modulation of metabotropic glutamate receptor 5 (mGluR5) is of marked interest as a novel therapeutic mechanism to treat schizophrenia and major depression. However, the status of mGluR5 in the pathophysiology of these disorders remains unknown.

Concepts: Medicine, Receptor, Metabotropic glutamate receptor, Mental disorder, Metabotropic receptor, Schizophrenia, Suicide, Leonard Cohen

2

Objective. The main hypothesis, and the objective of the study, was to test if the participants allocated to the treatment group would show a larger reduction in depressive symptoms than those in the control group. Methods. This study was a randomized nine week trial of an Internet-administered treatment based on guided physical exercise for Major Depressive Disorder (MDD). A total of 48 participants with mild to moderate depression, diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders, were randomized either to a treatment intervention or to a waiting-list control group. The main outcome measure for depression was the Beck Depression Inventory-II (BDI-II), and physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). The treatment program consisted of nine text modules, and included therapist guidance on a weekly basis. Results. The results showed significant reductions of depressive symptoms in the treatment group compared to the control group, with a moderate between-group effect size (Cohen’s d = 0.67; 95% confidence interval: 0.09-1.25). No difference was found between the groups with regards to increase of physical activity level. For the treatment group, the reduction in depressive symptoms persisted at six months follow-up. Conclusions. Physical activity as a treatment for depression can be delivered in the form of guided Internet-based self-help. Trial Registration. The trial was registered at ClinicalTrials.gov (NCT01573130).

Concepts: Cognitive behavioral therapy, Bipolar disorder, Major depressive disorder, Dysthymia, Depression, Treatment for depression, Leonard Cohen

1

Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs).

Concepts: Epidemiology, Life expectancy, Cognitive behavioral therapy, Major depressive disorder, Seasonal affective disorder, Dysthymia, Mental status examination, Leonard Cohen