Ansiedad frente a exámenes, un tipo de ansiedad fóbica que se presenta en el contexto académico / Test anxiety, a type of phobic anxiety that occurs in the academic context

Experimentar ansiedad frente a exámenes desencadena una respuesta emocional acompañada de cambios fisiológicos que el estudiante siente ante una situación percibida como amenazante, específicamente ante una evaluación, examen escrito u oral; actualmente, se la cataloga dentro de las fobias específicas. El individuo que busca evitar o eludir dicho escenario cae en la conducta de procrastinación. Esto afecta su rendimiento académico y acarrea consecuencias graves de salud mental, el estudiante comienza a percibirse afectado en su autovalia, autoestima y en su ambiente social, que muchas veces lo lleva a contraer trastorno depresivo e ideación suicida. El presente artículo es un estudio de revisión bibliográfica y su objetivo fue describir la experiencia de la. ansiedad frente a exámenes como fobia específica situacional, las consecuencias de dicho padecimiento, su comorbilidad con otros trastornos psicológicos y los tratamientos disponibles. Fueron analizados y comparados unos 26 artículos científicos, basados en ensayos controlados de manera aleatoria, otros son estudios controlados de caso único, publicados en importantes revistas electrónicas de impacto. La búsqueda se realizó utilizando las palabras clave. Como conclusión, se destacó la importancia del conocimiento de esta patología, a fin de realizar un diagnóstico precoz y prevención en psicoterapia, evitando así un mayor deterioro en la salud mental de los estudiantes. No obstante, es necesaria la realización de más investigación controlada al respecto.

Experiencing test anxiety triggers an emotional response accompanied by physiological changes that the student feels in a situation perceived as threatening, specifically in the face of an evaluation, written or oral exam; Currently, it is classified as a specific phobia. The individual who seeks to avoid or avoid this scenario falls into procrastination behavior. This affects their academic performance and has serious mental health consequences. The student begins to feel affected in his or her self-worth, self-esteem, and social environment, which often leads him or her to contract a depressive disorder and suicidal ideation. This article is a bibliographic review study regarding experiencing test anxiety as a situational specific phobia, the consequences of said condition, its comorbidity with other psychological disorders and the available treatments. Some 26 scientific articles were analyzed and compared, based on randomized controlled trials, others are controlled single case studies, published in important impact electronic journals. The search was carried out using keywords. In conclusion, the importance of knowledge of this pathology was highlighted, in order to make an early diagnosis and prevention in psychotherapy, thus avoiding further deterioration in the mental health of students. However, more controlled research is needed in this regard.

Influence of personality traits， resilience and coping style on the efficacy of sertraline treatment in female adolescents with first-episode depressive disorder / 四川精神卫生

BackgroundDepressive disorders are prevalence among adolescents， with a higher incidence in females compared to males， often accompanied by more severe depressive symptoms. Sertraline is commonly prescribed for adolescent depressive disorder， however， its efficacy is only evident in certain patients. Currently， there is limited research on predicting the therapeutic efficacy of sertraline in female adolescents with depressive disorder. ObjectiveTo explore the relationship between personality traits， psychological resilience， coping style and the clinical efficacy of sertraline treatment in female adolescents with first-episode depressive disorder， in order to provide references for the treatment of this population. MethodsA total of 112 female adolescent patients with first-episode depressive disorder， meeting the diagnostic criteria of the International Classification of Diseases （tenth edition） （ICD-10）， and undergoing a 4-week treatment regimen with sertraline， were selected from the Second People's Hospital of Guizhou Province from February 2019 to January 2021.General demographic questionnaire， NEO Five-Factor Inventory （NEO-FFI）， Resilience Scale for Chinese Adolescents （RSCA）， Coping Style Scale for Middle School Students （CSSMSS）， Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale-17 item （HAMD-17） were used for assessment. Logistic regression analysis was used to investigate the factors influencing the clinical efficacy of sertraline in the treatment of female adolescents with first-episode depressive disorder. ResultsNeuroticism （β=-0.115， 95% CI： 0.807~0.984） could negatively predicted the therapeutic efficacy of sertraline in female adolescents with first-episode depressive disorder， whereas agreeableness （β=0.129， 95% CI： 1.025~1.264） and RSCA score （β=0.062， 95% CI： 1.004~1.128） could positively predict its therapeutic efficacy. ConclusionHigh neuroticism， low agreeableness and low psychological resilience may be the risk factors for the poor therapeutic effect of sertraline in the treatment of female adolescents with first-episode depressive disorder. ［Funded by 2019 Guiyang Science and Technology Program （number， Zhuke Contract ［2019］9-3-1）］

Study of discrepancy in subjective and objective cognitive function in patients with depressive disorder / 四川精神卫生

BackgroundThere exist differences in the subjective and objective cognitive functions of patients with depressive disorder， ane there are limited research on influencing factors of such phenomenon currently. ObjectiveTo explore the differences in subjective and objective cognitive function in patients with depressive disorder as well as influencing factors， and to provide references for further understanding of cognitive impairment in patients with depressive disorder. MethodsA total of 77 patients with depressive disorder who received outpatient or inpatient treatment in the Fourth People's Hospital of Chengdu from January 13， 2022 to December 11， 2023 were selected for the study. These patients also met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders， fifth edition（DSM-5）. Various tools were employed to assess patients in this study： Montgomery-Asberg Depression Rating Scale （MADRS） for the depressive symptoms， Perceived Deficits Questionnaire for Depression （PDQ-D） and Chinese Version of Brief Neurocognitive Test Battery （C-BCT） for the subjective and objective cognitive function， Sheehan Disability Scale （SDS） for the social function， and Clinical Global Impression-Severity of Illness（CGI-SI） for the severity of patient's condition. Pearson correlation analysis was used to examine the correlation of subjective and objective cognitive function and their differences with age， years of education， MADRS total score， SDS total score， and CGI-SI score. Multiple linear regression was used to explore the influencing factors of the differences between subjective and objective cognitive function. ResultsThere was a statistically significant difference in the total PDQ-D scores and the difference of subjective and objective cognitive function （D value） between depressive patients with and without medication （t=-4.228， -2.392， P<0.05 or 0.01）. There was no statistically significant correlation in subjective and objective cognitive function in patients with depressive disorder （r=-0.148， P>0.05）. Negative correlations can be observed between the PDQ-D total score and age or years of education （r=-0.333， -0.369， P<0.01）. The PDQ-D total score was positively correlated with MADRS total score， SDS total score and CGI-SI score （r=0.487， 0.637， 0.434， P<0.01）. D value was negatively correlated with age and years of education （r=-0.411， -0.362， P<0.01）， while positively correlated with MADRS total score， SDS total score and CGI-SI score （r=0.259， 0.468， 0.299， P<0.05 or 0.01）. Age （β=-0.328， P<0.01） and SDS total score （β=0.409， P<0.01） were two predictive factors for D value. ConclusionThe difference between subjective and objective cognitive function among patients with depressive disorder is related to several factors including age， years of education， severity of symptoms and impairment of social function. ［Funded by Surface Project of National Natural Science Foundation of China （number， 62173069）； Technological Innovation 2030-Major Project of "Brain Science and Brain-Like Research" （number， 2022ZD0211700）； Key R&D Support Program and Major Application Demonstration Project of Chengdu Science and Technology Bureau （number， 2022-YF09-00023-SN）］

Risk Factors of Depression Screened by Two-Sample Mendelian Randomization Analysis: A Systematic Review / 生物医学与环境科学（英文）

OBJECTIVE@#This study explored the potentially modifiable factors for depression and major depressive disorder (MDD) from the MR-Base database and further evaluated the associations between drug targets with MDD.@*METHODS@#We analyzed two-sample of Mendelian randomization (2SMR) using genetic variant depression ( n = 113,154) and MDD ( n = 208,811) from Genome-Wide Association Studies (GWAS). Separate calculations were performed with modifiable risk factors from MR-Base for 1,001 genomes. The MR analysis was performed by screening drug targets with MDD in the DrugBank database to explore the therapeutic targets for MDD. Inverse variance weighted (IVW), fixed-effect inverse variance weighted (FE-IVW), MR-Egger, weighted median, and weighted mode were used for complementary calculation.@*RESULTS@#The potential causal relationship between modifiable risk factors and depression contained 459 results for depression and 424 for MDD. Also, the associations between drug targets and MDD showed that SLC6A4, GRIN2A, GRIN2C, SCN10A, and IL1B expression are associated with an increased risk of depression. In contrast, ADRB1, CHRNA3, HTR3A, GSTP1, and GABRG2 genes are candidate protective factors against depression.@*CONCLUSION@#This study identified the risk factors causally associated with depression and MDD, and estimated 10 drug targets with significant impact on MDD, providing essential information for formulating strategies to prevent and treat depression.

Higher IL-6 and IL-4 plasma levels in depressed elderly women are influenced by diabetes mellitus

Abstract Objective This study aimed at investigating a set of peripheral cytokines in elderly female patients with MDD, comparing them to controls, and assessing the potential influence of clinical comorbidities on inflammatory markers. Methods Twenty-five elderly female patients diagnosed with MDD and 19 age-matched female controls were enrolled on this study. Plasma levels of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-γ and tumor necrosis factor (TNF)-α were evaluated with commercially-available assays. Results Elderly female patients with MDD exhibited higher plasma IL-6 and IL-4 levels when compared to controls. In a logistic regression model taking cytokine levels, comorbidities, and age into account, only type 2 diabetes mellitus (DM2) remained associated with MDD. Conclusion Diabetes influences the association between MDD and higher levels of cytokines in elderly female patients. Future studies should take this evidence into account in order to mitigate confounding factors.

Ansiedade e Depressão: rastreio entre profissionais da estratégia de saúde da família na Amazônia / Anxiety and Depression: screening among family health strategy professionals in the Amazon / Ansiedad y Depresión: tamizaje entre profesionales de estrategias de salud familiar en la Amazonía

Objetivo: realizar rastreamento de depressão e transtorno de ansiedade generalizada entre profissionais da Estratégia de Saúde da Família em um município no interior da Amazônia. Método:estudo transversal desenvolvido com 63 profissionais atuantes em 12 equipes de ESF na cidade de Santarém, Pará, Brasil. Foram utilizadas ferramentas validadas e adaptadas transculturalmente: o Patient ́s Health Questionaire ­9 e o Generalizes Anxiety Disorder ­7. Os dados foram analisados a partir de ferramentas da estatística descritiva (frequências absolutas e relativas) a partir do software Microsoft Excel 2018. Resultados:Houve predomínio de indivíduos do sexo feminino, na idade de 40 a 44 anos e raça/cor pardo. O estado civil predominante foi casado, a categoria profissional mais representada na amostra foram os agentes comunitários de saúde e o a maioria dos participantes possuía nível superior completo. 57.1% tiveram rastreamento positivo para depressão e 42.1% para ansiedade. Conclusão:Observou-se elevada frequência de ansiedade e depressão entre os profissionais incluídos na amostra. Nossos dados reforçam a necessidade de ações preventivas na área de saúde mental visando reduzir os impactos dos fatores de risco. Além disso, é fundamental a realização de grandes estudos voltados à investigação dos fatores associados à saúde mental dos trabalhadores da saúde no Brasil

Objective: To screen for depression and generalized anxiety disorder among Family Health Strategy professionals in a municipality in the interior of the Amazon. Method:A cross-sectional study was carried out with 63 professionals working in 12 FHS teams in the city of Santarém, Pará, Brazil. Cross-culturally adapted and validated tools were used: the Patient's Health Questionnaire -9 and the Generalized Anxiety Disorder -7. The data was analyzed using descriptive statistics tools (absolute and relative frequencies)using Microsoft Excel 2018 software. Results:There was a predominance of females, aged between 40 and 44 and of brown race/color. The predominant marital status was married, the most represented professional category in the sample were community health agents and the majority of participants had completed higher education. 57.1% were screened positive for depression and 42.1% for anxiety. Conclusion:There was a high frequency of anxiety and depression among the professionals included in the sample. Our data reinforces the need for preventive action in the area of mental health in order to reduce the impact of risk factors. In addition, it is essential to carry out large-scale studies investigating the factors associated with the mental health of health workers in Brazil.

Objetivo: Detectar depresión y ansiedad generalizada en profesionales de la Estrategia Salud de la Familia de un municipio del interior de la Amazonia. Método:Se realizó un estudio transversal con 63 profesionales que trabajan en 12 equipos de la ESF en la ciudad de Santarém, Pará, Brasil. Se utilizaron instrumentos validados y adaptados transculturalmente: el Cuestionario de Salud del Paciente -9 y el Trastorno de Ansiedad Generalizada -7. Los datos se analizaron mediante herramientas de estadística descriptiva (frecuencias absolutas y relativas) utilizando el software Microsoft Excel 2018. Resultados:Hubo un predominio de mujeres, con edades comprendidas entre 40 y 44 años y de raza/color moreno. El estado civil predominante fue casado, la categoría profesional más representada en la muestra fue la de agentes de salud comunitarios y la mayoría de los participantes habían completado estudios superiores. El 57,1% dieron positivo en depresión y el 42,1% en ansiedad. Conclusión:Hubo una elevada frecuencia de ansiedad y depresión entre los profesionales incluidos en la muestra. Nuestros datos refuerzan la necesidad de acciones preventivas en el área de la salud mental para reducir el impacto de los factores de riesgo. Además, es fundamental la realización de grandes estudios dirigidos a investigar los factores asociados a la salud mental de los trabajadores de la salud en Brasil

An electric field modeling study with meta-analysis to understand the antidepressant effects of transcranial direct current stimulation (tDCS)

Objective: Transcranial direct current stimulation (tDCS) has mixed effects for major depressive disorder (MDD) symptoms, partially owing to large inter-experimental variability in tDCS protocols and their correlated induced electric fields (E-fields). We investigated whether the E-field strength of distinct tDCS parameters was associated with antidepressant effect. Methods: A meta-analysis was performed with placebo-controlled clinical trials of tDCS enrolling MDD patients. PubMed, EMBASE, and Web of Science were searched from inception to March 10, 2023. Effect sizes of tDCS protocols were correlated with E-field simulations (SimNIBS) of brain regions of interest (bilateral dorsolateral prefrontal cortex [DLPFC] and bilateral subgenual anterior cingulate cortex [sgACC]). Moderators of tDCS responses were also investigated. Results: A total of 20 studies were included (21 datasets, 1,008 patients), using 11 distinct tDCS protocols. Results revealed a moderate effect for MDD (g = 0.41, 95%CI 0.18-0.64), while cathode position and treatment strategy were found to be moderators of response. A negative association between effect size and tDCS-induced E-field magnitude was seen, with stronger E-fields in the right frontal and medial parts of the DLPFC (targeted by the cathode) leading to smaller effects. No association was found for the left DLPFC and the bilateral sgACC. An optimized tDCS protocol is proposed. Conclusions: Our results highlight the need for a standardized tDCS protocol in MDD clinical trials. Registration number: PROSPERO CRD42022296246.

Factores asociados con intento suicida en pacientes económicamente activos con diagnóstico de depresión mayor

Introducción: En el mundo, cada 40 segundos una persona se quita la vida; el suicidio se considera un problema de salud pública, y el intento de suicidio previo es uno de los factores de riesgo relacionados con suicidio consumado. A pesar de las estrategias implementadas y los estudios realizados, en Colombia las cifras de suicidio van en ascenso, de manera más marcada en la población económicamente activa. Objetivo: Identificar los factores sociodemográficos, familiares, personales, económicos y religiosos asociados con el intento suicida en pacientes con trastorno depresivo en edad productiva (18-62 arios), en una institución de salud mental en Bogotá, Colombia. Métodos: Se realizó un estudio de prevalencia analítica en la Clínica de Nuestra Señora de la Paz, de Bogotá; para explorar la relación entre los factores descritos y el intento suicida, se realizó una revisión de 350 historias clínicas de la población seleccionada. Resultados: El 37,7% de la muestra presentó intento de suicidio. Se encontraron asociaciones entre el intento de suicidio y la formación superior a primaria (RP = 0,47 [0,23-0,97]), no recibir ingresos (RP = 1,72 [1,13-2,61]), no tener pareja (RP = 2,10 [1,33-3,32]), el consumo de alcohol (p = 0,045), el consumo de alucinógenos (RP = 2,39 [0,97-3,43]) y la presencia de trastorno de personalidad (RP = 1,93 [1,11-3,34]). Conclusiones: Los resultados del estudio son similares a los descritos previamente en el mundo. Es necesario reconocer y abordar diversos factores asociados con el intento de suicidio en pacientes depresivos para desplegar acciones de promoción y prevención, identificación temprana e intervenciones específicas que impacten en las cifras de suicidio consumado en el país.

Introduction: Every 40 seconds, one person in the world commits suicide. As such, suicide is considered a public health problem, and prior suicide attempt is one of the risk factors associated with completed suicide. Despite the strategies implemented and the studies carried out, in Colombia suicide figures are on the rise, more markedly in the economically active population. Objective: To identify the sociodemographic, family, personal, economic and religious factors associated with suicide attempt in patients of productive age (18-62 years old) in a mental health institution in Bogota, Colombia. Methods: An analytical prevalence study was conducted at the Nuestra Señora de la Paz mental health clinic in Bogota. To explore the relationship between the factors described and suicide attempt, a review of 350 medical records of the selected population was carried out. Results: In total, 37.7% of the sample presented a suicide attempt. Associations were found between the suicide attempt and higher education than primary school (PR = 0.47 [0.23-0.97]), no economic income (PR = 1.72 [1.13-2.61]), no partner (PR = 2.10 [1.33-3.32]), alcohol consumption (p = 0.045), hallucinogen use (PR = 2.39 [0.97-3.43]) and the presence of personality disorder (PR= 1.93 [1.11-3.34]). Conclusions: The results of the study are similar to those previously described in other studies around the world. There is a need to recognize and address various factors associated with suicide attempt in depressed patients in order to implement promotion and prevention actions, early identification and specific interventions that have an impact on the numbers of completed suicide in the country.

Mapping the modulating effect of transcutaneous auricular vagus nerve stimulation on voxel-based analyses in patients with first-episode major depressive disorder: a resting-state functional magnetic resonance imaging study

Introduction: Seed-based analysis has shown that transcutaneous auricular vagus nerve stimulation (taVNS) can modulate the dysfunctional brain network in patients with major depressive disorder (MDD). However, the voxel-based neuropsychological mechanism of taVNS on patients with first-episode MDD is poorly understood. The objective of this study was to assess the effects of an 8-week course of taVNS on patients with first-episode MDD. Methods: Twenty-two patients with first-episode MDD accepted an 8-week course of taVNS treatment. Resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed before and after treatment. Voxel-based analyses were performed to characterize spontaneous brain activity. Healthy controls (n=23) were recruited to minimize test-retest effects. Analysis of covariance (ANCOVA) was performed to ascertain treatment-related changes. Then, correlations between changes in brain activity and the Hamilton Depression Rating Scale (HAM-D)/Hamilton Anxiety Scale (HAM-A) remission rate were estimated. Results: Significant group-by-time interactions on voxel-based analyses were observed in the inferior ventral striatum (VSi) and precuneus. Post-hoc analyses showed that taVNS inhibited higher brain activity in the VSi, while upregulating it in the precuneus. Functional connectivity (FC) between the VSi and precuneus decreased. Positive correlations were found between the HAM-D remission rate and changes in brain activity in the VSi. Conclusion: taVNS reduced the FC between VSi and precuneus by normalizing the abnormal spontaneous brain activity of VSi in first-episode MDD patients.

Gravidade da depressão, resposta ao tratamento e PRO (incapacidade e QoL) em pacientes com DRT em um ano de acompanhamento com tratamento padrão: análise do subgrupo brasileiro do estudo observacional multinacional TRAL / Depression severity, treatment response and PRO (disability and QoL) in TRD patients over a 1-year follow-up with standard of care: Analysis of the Brazilian subset of the multicenter, observational TRAL study

Objetivo: A depressão resistente ao tratamento (DRT) é uma preocupação primária no Brasil devido à sua natureza onerosa e complexa, enquanto o diagnóstico e o tratamento geralmente são desafiadores. O presente manuscrito apresenta os resultados clínicos de um ano de acompanhamento em pacientes com DRT em tratamento padrão (SOC) no subgrupo brasileiro do estudo de Depressão Resistente ao Tratamento na América Latina (TRAL). Métodos: Essa fase longitudinal do estudo TRAL tinha como meta caracterizar alterações nos resultados clínicos e outras variáveis de interesse (p. ex., qualidade de vida, incapacidade) em um ano de acompanhamento em pacientes com DRT em 10 centros no Brasil. Os pacientes incluídos tinham diagnóstico clínico de DRT com base nos critérios DSM-5 e confirmado por MINI. A Escala de Depressão de Montgomery-Asberg (MADRS) era usada para avaliar a gravidade da doença e os resultados clínicos. Outras escalas de depressão e instrumentos classificados pelo paciente eram usadas para medir resultados correlacionados. Resultados: Cento e cinquenta e oito pacientes com DRT, na maioria mulheres (84,4%) com idade média de 48,55 anos, foram incluídos na análise. Apenas 31,4% dos pacientes apresentaram uma resposta clinicamente significativa, 10,3% tiveram recidiva e 26,7% alcançaram remissão, conforme medido pela MADRS no final do estudo (EOS). Aproximadamente 55% dos pacientes apresentavam depressão grave/moderadamente grave no EOS. Problemas de mobilidade, cuidados pessoais, problemas nas atividades usuais e dor e desconforto foram relatados pela maioria dos pacientes no EOS, assim como comprometimento marcado/extremo das atividades no trabalho/escola e da vida social/das atividades de lazer no EOS. Conclusões: Os resultados clínicos alcançados atualmente ainda são notavelmente insatisfatórios para DRT. Portanto, o envolvimento de todas as partes interessadas é essencial para implementar protocolos de tratamento mais eficazes no Brasil.

Objective: Treatment-resistant depression (TRD) is a primary concern in Brazil due to its burdensome and complex nature, while diagnosis and treatment is often challenging. The current manuscript presents the clinical outcomes in a one-year follow-up of TRD patients under Standard-of-care (SOC) in the Brazilian subset of the Treatment-Resistant Depression in America Latina (TRAL) study. Methods: This longitudinal phase of TRAL aimed to characterize changes in the clinical outcomes and other variables of interest (e.g. quality of life, disability) in a one-year follow-up of TRD patients in 10 centers in Brazil. Included patients were clinically diagnosed with TRD based on DSM-5 criteria and confirmed by MINI. Montgomery-Asberg Depression Rating Scale (MADRS) was used to assess disease severity and clinical outcomes. Other depression scales and patient rated instruments were used to measure correlated outcomes. Results: One hundred fifty-eight TRD patients, mostly female (84.4%), averaging 48.55 years, were included in the analysis. Only 31.4% of the patients showed a clinically significant response, 10.3% had a relapse and 26.7% achieved remission, as measured through MADRS at end-of-study (EOS). Almost 55% of the patients showed moderately severe/severe depression at EOS. Mobility issues, self-care, problems with usual activities and pain and discomfort were reported by the majority of the patients at EOS, as well as marked/extreme disruption of school/work and social life/leisure activities at EOS. Conclusions: Currently achieved clinical outcomes are still remarkably unsatisfactory for TRD. Therefore, the involvement of all relevant stakeholders is essential to implement more effective treatment protocols in Brazil.

Positive screening for major depressive disorder in high-risk pregnant women / Triagem positiva para transtorno depressivo maior em gestantes de alto risco

ABSTRACT Objective: To estimate the frequency of positive screening for major depressive disorder and associated factors in high-risk pregnant women at a reference hospital of the Brazilian Public Health System. Methods: Cross-sectional study with 184 high-risk pregnant women at the Maternity at the Hospital Regional de São José , SC, Brazil. Positive screening for major depressive disorder using the Edinburgh Postpartum Depression Scale was selected as the dependent variable. Socio-demographic and pregnancy-related variables were also collected. Data were analyzed using Poisson regression with a robust estimator, including all variables that presented a p-value < 0.20 in the bivariate analysis. Statistically significant differences were considered when p ≤ 0.05. Results: The frequency of positive screening for major depressive disorder was 37.5%. Non-white skin color, income of less than USD 572,56 per month and maternal age of less than 18 years or greater than or equal to 35 years were statistically and independently associated with positive screening for major depressive disorder in high-risk pregnant women. Conclusion: The frequency of positive screening for major depressive disorder in the high-risk pregnant women studied was 37.5%. The frequency was statistically associated with skin color, family income and extremes in the maternal age.

RESUMO Objetivo: Estimar a frequência de rastreio positivo de transtorno depressivo maior e fatores associados em gestantes de alto risco em uma maternidade de referência do Sistema Único de Saúde. Métodos: Estudo transversal envolvendo 184 gestantes de alto risco da Maternidade do Hospital Regional de São José, SC, Brasil. A variável dependente foi o rastreio de transtorno depressivo maior por meio da aplicação da Escala de Depressão Pós-parto de Edimburgo. Foram coletadas ainda variáveis sociodemográficas e relacionadas à gestação. Os dados foram analisados por meio da regressão de Poisson com estimador robusto, incluindo todas as variáveis que apresentaram valor de p < 0,20 na análise bivariada. Consideraram-se diferenças estatisticamente significativas quando p ≤ 0,05. Resultados: A frequência de rastreio positivo para transtorno depressivo foi de 37,5%. Cor da pele não branca, renda mensal inferior a USD 572,56 e idade materna inferior a 18 anos ou superior ou igual a 35 anos foram estatística e independentemente associadas ao rastreamento positivo para transtorno depressivo maior em gestantes de alto risco. Conclusão: A frequência de rastreio positivo de transtorno depressivo maior em gestantes de alto risco estudadas foi de 37,5%. A frequência mostrou-se estatisticamente associada com cor de pele, renda familiar e extremos de idade materna.

Posibles mecanismos de acción de la terapia electroconvulsiva en trastornos afectivos: revisión de la evidencia disponible en investigación con seres humanos

The mechanisms of action (MA) of electroconvulsive therapy (ECT) in affective disorders are poorly understood. We synthesized and discussed the evidence provided by primary studies and systematic reviews in humans. There are differences in the methylation of candidate genes involved in the response to ECT. Functioning of the hippocampal serotonin receptor 5-HT1B is associated with the response in patients with major depressive disorder (PMDD), while the striatal dopamine transporter would participate in the response of PMDD and in patients with bipolar disorders (BD). The only neurotrophic factor associated with ECT response was vascular endothelial growth factor. In BD, some oxidative stress metabolites had a clinical correlation, while tryptophan metabolism showed a clinical association in BD and PMDD. Furthermore, in PMDD, some neurodegeneration markers were implicated in the MA of ECT. There were no other biological dimensions associated with BD. In PMDD, multiple inflammatory mediators were associated with the clinical response (natural killer cells, tumor necrosis and growth factors, and interleukins 1, 4, 6, 10,1β). Likewise, some structures and circuits consistently involved at the morphological and functional level are the default mode network, cognitive control networks, frontal, temporal, cingulate, occipital and temporal cortices, frontal, temporal, precentral, fusiform and left angular gyri, hippocampus, thalamus and amygdala. Investigations are mostly focused on PMDD, are observational, and their samples limited, but they show relatively consistent results with clinical significance.

Establishment and verification of a diagnostic prediction model for non-suicidal self-injury behaviors in adolescents with depressive disorder / 四川精神卫生

ObjectiveTo establish a diagnostic prediction model for non-suicidal self-injury （NSSI） behaviors in adolescents with depressive disorder， in order to provide references for early identification of NSSI behaviors in them. MethodsRetrospective analysis was performed on the clinical data of adolescents with depressive disorder （n=366） who were admitted to the Pediatric Department of Shenzhen Kangning Hospital from January 1 to December 31， 2021. According to the Diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for NSSI， the patients were divided into comorbid NSSI group （n=289） and non-NSSI group （n=77）. The selected adolescents were randomly divided into a training set （n=258） and a verification set （n=108） in a 7∶3 ratio. Logistic regression analysis was used to screen the independent risk factors for NSSI behaviors in adolescents with depressive disorder， which served as the basis for prediction model. Finally， the receiver operating characteristic （ROC） curve was established and the area under curve （AUC） was calculated to evaluate the discrimination in the training set and validation set. Calibration curve was applied to evaluate the calibration degree of the model. The Homser-Lemeshow （HL） test was conducted to evaluate the goodness of fit of the model. And decision curve analysis （DCA） was performed to evaluate the clinical benefit of the model. ResultsGender （β=1.734， OR=5.561， 95% CI： 2.678~11.964）， education level （β=0.864， OR=2.737， 95% CI： 1.174~4.795）， history of suicide attempts （β=0.932， OR=2.539， 95% CI： 1.253~5.144）， being an only child （β=0.745， OR=2.106， 95% CI： 1.029~4.311） and depression severity （β=0.056， OR=1.058， 95% CI： 1.025~1.092） were independent risk factors related to NSSI behaviors in adolescents with depressive disorder （P<0.05 or 0.01）. The AUC was 0.808 （95% CI： 0.746~0.870） in the training set， and was 0.722 （95% CI： 0.581~0.864） in the validation set. The prediction model showed good calibration with the HL test （P=0.561）. ConclusionGender， education level， suicide attempt history， being an only child and depression severity are independent risk factors for NSSI behaviors in adolescents with depressive disorder， furthermore， the diagnostic clinical prediction model constructed using above factors for NSSI behaviors in adolescents with depressive disorder has displayed good sensitivity and specificity.

Relationship between insomnia and suicidal ideation in adolescents with depressive disorder： the mediating role of rumination / 四川精神卫生

ObjectiveTo explore the mediating effect of rumination on the relationship between insomnia and suicidal ideation in adolescents with depressive disorder， so as to provide guidance for the preventions of suicidal ideation. MethodsA total of 302 adolescents with major depressive disorder in Department of Psychosomatic Medicine of Deyang People's Hospital from January to December 2020 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） clinical significance criterion for depressive disorder were enrolled. All individuals were assessed using Insomnia Severity Index （ISI）， Ruminative Response Scale （RRS） and Positive and Negative Suicide Ideation （PANSI）. Then the mediating effect of rumination in the relation between insomnia and suicidal ideation in adolescents with major depression disorder was analyzed using Process v3.2 model 4， and testified with the bias-corrected non-parametric percentile Bootstrap method. ResultsISI scores in adolescents with major depression disorder were positively correlated with PANSI score （r=0.400， P<0.01）， and were positively correlated with RRS total score， obsessive thinking and introspection factor score （r=0.378， 0.360， 0.333， P<0.01）. RRS score was also positively correlated with PANSI score （r=0.292， P<0.01）. Rumination exerted a partial mediating effect on the relationship between insomnia and suicidal ideation （β=0.174， 95% CI： 0.098~0.261）. ConclusionThe relationship between insomnia and suicidal ideation in adolescents with depressive disorder is partially mediated by rumination， additionally， insomnia can affect suicidal ideation in adolescents with depressive disorder both directly and indirectly through rumination.

Trends and prediction of the burden of depression among adolescents aged 10 to 24 years in China from 1990 to 2019 / 中国学校卫生

Methods@#To analyze the trend of the burden of depression among adolescents aged 10-24 years from 1990 to 2019 and predict its future trend, so as to provide a theoretical basis for prevention and treatment.@*Methods@#The prevalence and disability adjusted life years (DALYs) were determined using the 2019 Global Burden of Disease Database. The joinpoint regression model was employed to analyze the changing trend of the burden of depression among adolescents aged 10-24 years in China from 1990 to 2019. The ARIMA time series model was established using R software to predict the development trend of depression among adolescents aged 10-24 years in China from 2020 to 2029.@*Results@#From 1990 to 2019, the prevalence and DALYs rate were higher among adolescents aged 10-24 years in comparison to the general population and males. Furthermore, the prevalence and DALYs rate were higher among adolescents aged 20-24 years than among those aged 15-19 and 10-14 years, with statistical significance ( P <0.05). The joinpoint regression analysis revealed that the prevalence of depression among adolescents aged 10-24 years showed an overall decreasing trend with an average annual rate of 1.61% ( t =-10.53, P <0.05), while the prevalence of depression among male and female adolescents in the same age group also showed a decreasing trend, with an average annual decreasing rate of 1.18% ( t =-5.79) and 1.79% ( t =-11.84) ( P <0.05), and the overall decline rate was greater among women than men. There was no significant change in the prevalence of depression among adolescents aged 10-14 years from 1990 to 2019 (AAPC=-0.28, P >0.05), while the prevalence of depression among adolescents aged 15-19 years and 20-24 years also showed a decreasing trend with an average annual rate of 1.43% ( t =-12.05) and 1.90% ( t =-24.92) ( P <0.05). The ARIMA model predicted that the prevalence of depression and the rate of DALYs among adolescents aged 10-24 years would continue to decline from 2020 to 2029.@*Conclusion@#The prevention and treatment of depression among adolescents aged 10-24 years in China should focus on females and those aged 20- 24 years old. We should start from the environment and micro-environment of adolescent growth and take active and effective measures to prevent the occurrence of adolescent depression.

Development of Questionnaire for Parental Acceptability of School based Depression Symptom Screening / 中国学校卫生

Objective@#The study aimed to develop Questionnaire for Parental Acceptability of School based Depression Symptom Screening by Delphi method, so as to provide a reference and suggestions for promoting screening adolescents depression.@*Methods@#The study was conducted through the literature review and two rounds of the Delphi expert consultation. The initial construction of scale dimension and item was conducted through the literature search. A survey of 12 experts from 6 different provinces, cities and regions in China was conducted, and the Delphi technique was used to collect and analyze expert opinions data about the importance and feasibility of questionnaire content. The dimensions and specific items of the questionnaire were finally determinded.@*Results@#The response rates were 100% in both rounds of Delphi consultation. Kendall coordination degree W =0.22 ( χ 2=63.72, P <0.01), which showed the agreement of expert opinions. The initial scale consisted of 4 dimensions and 17 items, including parental cognition of school based depression screening, parental cognition of school depression screening results feedback and management, parental attitude of school based depression screening, parental utilization of mental health services. After two rounds of expert consulattion, the final scale consisted of 3 first grade dimensions including parental cognition of depression symptom, parental attitude of school based depression symptom screening and parental mental health promotion behaviour, and also cinsisted of 4 second grade dimensions including parental knowledge of depression symptom, parental attitude of school based depression symptom screening, parental choice preference of school based depression symptom screening, parental utilization of mental health services, which had a total of 25 items.@*Conclusion@#The questionnaire is developed for assessing parental acceptability of school based depression screening and associated factors. The finding will facilitate mental health services providers in the screening implementation, but further empirical research is still needed.

Comparison of serum kynurenine pathway metabolites between patients with first-episode and recurrent major depressive disorder / 四川精神卫生

BackgroundThe pathogenesis of depression remains not fully understood， and previous studies have suggested that the kynurenine pathway （KP） plays an important role in the pathogenesis of major depressive disorder. ObjectiveTo study the difference in serum KP metabolites level between patients with first-episode and recurrent major depressive disorder， and to testify the correlation between KP metabolites level with the severity of depressive symptoms， so as to provide references for the prevention of recurrence. MethodsA total of 136 patients with major depressive disorder who attended the outpatient clinics of the Affiliated Brain Hospital of Guangzhou Medical University from November 2016 to December 2018 and met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria were included， including 62 patients in the first-episode group and 74 patients in the recurrent group. Meanwhile， 60 healthy subjects were included as control group. All patients were assessed by Hamilton Depression Scale-17 item （HAMD-17）， and serum concentrations of tryptophan （TRP）， kynurenine （KYN） and kynurenic acid （KYNA） were measured by liquid chromatography tandem mass spectrometry （LC-MS/MS）. Then the correlation of HAMD-17 total score and individual item scores with the levels of KP metabolites was tested using partial correlation coefficient. ResultsCompared with the control group， the first-episode group and recurrent group showed a marked decline in TRP concentration （t=-3.044， -4.477， P<0.05 or 0.01） and an increase in KYN/TRP ratio （t=2.343， 3.644， P<0.05 or 0.01）， with significant differences. The KYNA concentrations （t=2.490， 2.636， P<0.05 or 0.01） and KYNA/KYN ratio （t=2.894， 2.616， P<0.01） in first-episode group and control group were notably elevated compared to recurrent group， with statistical difference. Partial correlation analysis in patients with first-episode major depressive disorder demonstrated that KYN/TRP ratio was positively correlated with the HAMD-17 anxiety/somatization factor score （r=0.261， P<0.05）， and KYNA/KYN ratio was negatively correlated with HAMD-17 total score and block factor score （r=-0.286， -0.282， P<0.05）. In patients with recurrent major depressive disorder， KYN/TRP ratio was positively correlated with HAMD-17 anxiety/somatization factor score （r=0.280， P<0.05）. ConclusionKP metabolites in serum differ between first-episode and recurrent major depressive disorder patients， and patients with recurrent episodes experience severe KP metabolite abnormalities. Therefore， KP metabolites are considered to be potential biomarker candidates to assist clinicians in the diagnosis and recurrent prediction of major depressive disorder. ［Funded by National Key Research and Development Program Precision Medicine Research Project （number， 2016YFC0906300）］

Research progress of anti-inflammatory agents in the treatment of major depressive disorder / 四川精神卫生

Major depressive disorder is one of the common mental disorders， and its pathogenesis is not yet fully understood. Elevated levels of inflammation are recognized as one of the mechanisms contributing to the onset of major depressive disorder. Numerous studies have indicated that non-steroidal anti-inflammatory drugs， omega-3 fatty acids， statins， pioglitazone， minocycline， N-acetylcysteine， corticosteroids and other medications may exert anti-depressant effects through their anti-inflammatory actions. This article provides a comprehensive review of the application of these drugs in the treatment of major depressive disorder， exploring the therapeutic effects and potential mechanisms of action of different anti-inflammatory agents， thereby offering a reference for the future application of anti-inflammatory interventions in the treatment of depression. ［Funded by The Ministry of Science and Technology of the People's Republic of China （Number， 2022ZD0211700）］

Pathogenesis of depression: focusing on protein levels and genetic abnormalities / 中华神经科杂志

Depression is a common psychiatric disorder characterized by a wide range of clinical manifestations, including depressed mood, psychomotor retardation, diminished motivation, anhedonia, despair, and even suicidality. The heterogeneity of the features of depression indicates the diversity of its pathogenesis. Protein levels and their genetic abnormalities are essential factors in the pathogenesis of depression. This review focuses on the levels and genetic abnormalities of depression-related proteins to further elaborate the pathogenesis of depression and presents current problems and challenges to provide a theoretical foundation for the development of novel antidepressant medications.

Analysis of regional homogeneity and functional connectivity among the depression and bipolar disorder with mixed features patients / 中华放射学杂志

Objective:To investigate the regional homogeneity (ReHo) among the major depressive disorder patients without mixed features (MDD noMF), major depressive disorder with mixed features (MMF), bipolar disorder with mixed features (BMF) and bipolar disorder patients without mixed features (BD noMF) patients, and to explore the brain activity and functional connectivity patterns of the MMF and BMF patients. Methods:This was a cross-sectional study. The MDD noMF patients (MDD noMF group), MMF patients (MMF group), BMF patients (BMF group), BD noMF patients (BD noMF group), and age-and gender-matched healthy controls (HC group) were recruited from Beijing Anding Hospital, Capital Medical University between April, 2021 and June, 2022. All the participants underwent resting-state functional MRI scanning. The ReHo values was computed with the DPABI software based on the MATLAB. Firstly, the difference in ReHo among the patients with MDD noMF, MMF, BMF, BD noMF and HC group were estimated by the analysis of covariance and the post-hoc method (LSD or Games-Howell). And then, the brain regions with significant different ReHo values were selected as the seeds to calculate the functional connectivity with the whole brain. Results:A total of 29 cases in the MDD noMF group, 24 cases in the MMF group, 26 cases in the BMF group, 29 cases in the BD noMF group, and 42 in the HC group were included. The differences in ReHo values in the left fusiform and the left precuneus of the 5 groups were statistically significant ( P<0.05). Among of them, the ReHo values of the left fusiform were lower in the MMF, BMF and BD noMF groups compared with the HC group ( P<0.05), while the ReHo values of the left precuneus in MDD noMF, MMF, BMF and BD noMF groups were higher than that in the HC group ( P<0.05). The ReHo value of the left fusiform was lower in the MMF group compared with the MDD noMF group ( P=0.001); the ReHo value of the left fusiform was lower in the BMF group compared with the MDD noMF and BD noMF groups ( P<0.05). The functional connectivity between the left fusiform and vermis, left insula, right putamen, and left medial superior frontal gyrus, and functional connectivity between the left precuneus and right superior frontal gyrus (dorsolateral) showed significant difference among the MDD noMF, MMF, BMF, BD noMF and HC groups ( P<0.05). Compared with HC group, MDD noMF, MMF, BD noMF groups showed higher functional connectivity between the left fusiform and the vermis, and MDD noMF, MMF, BMF, BD noMF group showed higher functional connectivityy between the the left fusiform and the left insula, left medial superior frontal gyrus and right putamen ( P<0.05). Compared with the MDD noMF group, the MMF, BMF and BD noMF groups showed higher functional connectivity between the left fusiform and the left insula ( P<0.05). Compared with the MDD noMF group, the BMF and BD noMF groups had higher functional connectivity between the left fusiform and the left medial superior frontal gyrus ( P<0.05). The BMF group showed higher functional connectivity of the left fusiform with the right putamen than the MDD noMF and BD noMF groups. Additonally, the BMF and BD noMF groups showed higher functional connectivity between the left precuneus and the right superior frontal gyrus (dorsolateral) than HC, MDD noMF and MMF groups ( P<0.05). Conclusions:MMF and BMF patients have local abnormalities of functional activity synchronization in the left fusiform and precuneus and abnormal functional connectivity patterns with multiple brain regions. MMF and BMF patients have specific neuroimaging features compared to MDD noMF or BD noMF patients and also share similar neuroimaging pathogenesis.