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1.
J Womens Health (Larchmt) ; 22(8): 694-701, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23863074

ABSTRACT

BACKGROUND: Poor sleep, common during pregnancy, is associated with negative health risks. The study aimed to identify predictors of clinically significant insomnia among pregnant Latinas. METHODS: A total of 1289 pregnant Latinas recruited from obstetric clinics completed the Insomnia Severity Index (ISI) and questions about demographics and sleep. RESULTS: Clinically significant insomnia (ISI≥10) was present among 17% of participants. Significant correlates of clinically significant insomnia were higher scores on the Edinburgh Postnatal Depression Scale (EPDS) after removing the sleep item (47% of women with EPDS≥9 and 9% with EPDS<9), completing measures in English (rather than Spanish: 26% versus 13%), and income but not pregnancy week, age, highest education level, or marital status. The highest percentage of clinically significant insomnia (59%) was experienced by women with EPDS≥9 who completed measures in English. The lowest percentage of clinically significant insomnia (6.2%) was experienced by women with EPDS<9 who completed measures in Spanish. CONCLUSIONS: In this sample of low-income, mostly Spanish-speaking pregnant Latinas, rates of clinically significant insomnia appear to be higher than rates among nonpregnant Latinas. Rates of clinically significant insomnia are particularly high among Latinas with elevated depressive symptom severity, a known risk for insomnia. Acculturation, as indicated by completing measures in English, may be another risk specific to Latinas, possibly owing to loss of some ethnicity-specific protective factors (e.g., social support, strong family ties, and group identity). It will be important to directly test this explanation in future research.


Subject(s)
Depression/ethnology , Hispanic or Latino/statistics & numerical data , Pregnancy Complications/ethnology , Sleep Initiation and Maintenance Disorders/ethnology , Socioeconomic Factors , Acculturation , Adolescent , Adult , Analysis of Variance , California/epidemiology , Cross-Sectional Studies , Depression/complications , Depression/psychology , Female , Hispanic or Latino/psychology , Humans , Language , Pregnancy , Pregnancy Trimester, Third , ROC Curve , Risk Factors , Severity of Illness Index , Sleep Initiation and Maintenance Disorders/complications , Sleep Initiation and Maintenance Disorders/psychology , Social Support , Surveys and Questionnaires
2.
Am J Obstet Gynecol ; 207(6): 506.e1-6, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23099192

ABSTRACT

OBJECTIVE: The purpose of this study was to estimate the frequency of identification of major depressive disorder by providers during prenatal care. STUDY DESIGN: A cohort of pregnant women who were participating in a randomized controlled trial and who had received a diagnosis of major depressive disorder was examined. Women were included in the current study if prenatal clinic records were available and legible. RESULTS: Clinical depression was noted in 56% of prenatal charts and on 24% of problem lists. Physicians and certified nurse midwives noted depression equally (P = .935); physicians more frequently noted mental health referral (23% vs 0%; P = .01), and midwives more frequently included depression on the problem list (P = .01). Recent medication use, which was stopped before conception or study participation, predicted notation of depression in the chart (P = .001). CONCLUSION: Depression frequently is missed during pregnancy and, when identified, is underacknowledged as a problem. Women who have not recently used antidepressant medication are more likely to be missed. Better screening and acknowledgment are needed.


Subject(s)
Depressive Disorder, Major/diagnosis , Prenatal Care , Adult , Antidepressive Agents/therapeutic use , Cohort Studies , Depressive Disorder, Major/drug therapy , Female , Humans , Mass Screening/statistics & numerical data , Pregnancy , Randomized Controlled Trials as Topic
3.
Infant Behav Dev ; 33(4): 605-12, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20723998

ABSTRACT

This study assessed whether elevated severities of maternal depression and disturbed maternal sleep would be associated with maternal perceptions of higher Negative Affectivity of her infant. Sixty-nine mothers participated in this study. The study was part of a larger randomized controlled study testing the efficacy of acupuncture as a treatment for depression during pregnancy. The present study focused on data collected at 6 months postpartum in a naturalistic follow-up design, using the Hamilton Rating Scale for Depression (HRSD), maternal sleep diaries (completed daily for 1 week), and the Infant Behavior Questionnaire-Revised (IBQ-R). Regression analyses revealed that (a) maternal depression severity was a significant predictor of the IBQ-R Distress and Falling Reactivity scales and (b) poor maternal sleep was a significant predictor of the IBQ-R Sadness scale. Our findings support previous findings of significant links between maternal emotional distress and perceived Negative Affectivity of her infant's temperament and provide a novel insight linking maternal poor sleep with perceived sadness of the infant.


Subject(s)
Infant Behavior/psychology , Maternal Behavior/psychology , Mood Disorders/physiopathology , Mothers/psychology , Sleep Wake Disorders/physiopathology , Acupuncture/methods , Adolescent , Adult , Analysis of Variance , Female , Humans , Infant , Male , Mood Disorders/psychology , Postpartum Period , Pregnancy , Psychiatric Status Rating Scales , Regression Analysis , Sleep Wake Disorders/rehabilitation , Surveys and Questionnaires , Young Adult
4.
Obstet Gynecol ; 115(3): 511-520, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20177281

ABSTRACT

OBJECTIVE: To estimate the efficacy of acupuncture for depression during pregnancy in a randomized controlled trial. METHODS: A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for major depressive disorder were randomized to receive either acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). Junior acupuncturists, who were not told about treatment assignment, needled participants at points prescribed by senior acupuncturists. All treatments were standardized. The primary outcome was the Hamilton Rating Scale for Depression, administered by masked raters at baseline and after 4 and 8 weeks of treatment. Continuous data were analyzed using mixed effects models and by intent to treat. RESULTS: Fifty-two women were randomized to acupuncture specific for depression, 49 to control acupuncture, and 49 to massage. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity (P<.05) compared with the combined controls (Cohen's d=0.39, 95% confidence interval [CI] 0.01-0.77) or control acupuncture alone (P<.05; Cohen's d=0.46, 95% CI 0.01-0.92). They also had significantly greater response rate (63.0%) than the combined controls (44.3%; P<.05; number needed to treat, 5.3; 95% CI 2.8-75.0) and control acupuncture alone (37.5%; P<.05: number needed to treat, 3.9; 95% CI 2.2-19.8). Symptom reduction and response rates did not differ significantly between controls (control acupuncture, 37.5%; massage, 50.0%). CONCLUSION: The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00186654.


Subject(s)
Acupuncture Therapy , Depressive Disorder, Major/therapy , Pregnancy Complications/psychology , Pregnancy Complications/therapy , Adult , Female , Humans , Massage , Pregnancy
5.
Curr Psychiatry Rep ; 11(6): 437-42, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19909664

ABSTRACT

Historically, insomnia has been viewed as a symptom of depressive illness that is expected to resolve with adequate treatment of the depressive disorder. This article reviews the evidence that increasingly challenges this simplistic view and summarizes research demonstrating the multifaceted interplay between insomnia and depression. It discusses the prevalence, clinical significance, and time course of insomnia, distinguishing between poor sleep and an insomnia disorder. The article also discusses abnormalities in sleep architecture in major depressive disorder and theories about the pathways connecting sleep and depression. It concludes with a discussion of issues related to treatment, including the effects of antidepressants on sleep and new evidence of the utility of adding an insomnia-specific therapy for improved management of depressed patients with comorbid insomnia.


Subject(s)
Depressive Disorder/complications , Sleep Initiation and Maintenance Disorders/complications , Behavior Therapy , Humans , Severity of Illness Index , Sleep Initiation and Maintenance Disorders/therapy
6.
Neurobiol Learn Mem ; 90(4): 644-50, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18755284

ABSTRACT

Arousal-related processes associated with heightened heart rate (HR) predict memory enhancement, especially for emotionally arousing stimuli. In addition, phasic HR deceleration reflects "orienting" and sensory receptivity during perception of stimuli. We hypothesized that both tonic elevations in HR as well as phasic HR deceleration during viewing of pictures would be associated with deeper encoding and better subsequent memory for stimuli. Emotional pictures are more memorable and cause greater HR deceleration than neutral pictures. Thus, we predicted that the relations between cardiac activity and memory enhancement would be most pronounced for emotionally-laden compared to neutral pictures. We measured HR in 53 males during viewing of unpleasant, neutral, and pleasant pictures, and tested memory for the pictures two days later. Phasic HR deceleration during viewing of individual pictures was greater for subsequently remembered than forgotten pictures across all three emotion categories. Elevated mean HR across the entire encoding epoch also predicted better memory performance, but only for emotionally arousing pictures. Elevated mean HR and phasic HR deceleration were associated, such that individuals with greater tonic HR also showed greater HR decelerations during picture viewing, but only for emotionally arousing pictures. Results suggest that tonic elevations in HR are associated both with greater orienting and heightened memory for emotionally arousing stimuli.


Subject(s)
Affect/physiology , Emotions/physiology , Heart Rate/physiology , Memory/physiology , Orientation/physiology , Photography , Adolescent , Female , Humans , Hydrocortisone/blood , Male , Patient Selection , Visual Perception/physiology
7.
J Affect Disord ; 103(1-3): 173-9, 2007 Nov.
Article in English | MEDLINE | ID: mdl-17320191

ABSTRACT

BACKGROUND: Impaired cardiac vagal control (CVC), as indexed by respiratory sinus arrhythmia, has been investigated as a risk factor for major depressive disorder (MDD), but prior findings are mixed with respect to whether impaired CVC predicts greater global depression severity and/or a more severe course of disorder. One possible explanation for mixed findings is that CVC abnormalities in MDD are related more closely to specific depression symptoms than to the syndrome as a whole. METHODS: Depression severity (both global and symptom-specific indices) and electrocardiogram measures of resting CVC were obtained from 151 diagnosed MDD participants at intake, before randomization to a novel treatment for depression (acupuncture), and again after 8 and 16 weeks. RESULTS: Resting CVC did not predict global indices of depression in cross-sectional or longitudinal analyses. In symptom-specific analyses, resting CVC was positively related to sad mood and crying and inversely related to middle and late insomnia. Improvement in late insomnia was related to increases in CVC over time. LIMITATIONS: Relationships between CVC and MDD were studied only within the clinical range of severity. Symptom analyses were exploratory and hence did not correct for Type I error. CONCLUSIONS: Resting CVC did not exhibit concurrent or prospective relations with overall depression severity but a few specific symptoms did. Symptomatic heterogeneity across samples may account for mixed findings within the CVC-depression literature.


Subject(s)
Arrhythmia, Sinus/physiopathology , Depressive Disorder, Major/physiopathology , Electrocardiography , Heart/innervation , Vagus Nerve/physiopathology , Acupuncture , Adaptation, Psychological/physiology , Adult , Arrhythmia, Sinus/diagnosis , Arrhythmia, Sinus/psychology , Arrhythmia, Sinus/therapy , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Depressive Disorder, Major/therapy , Emotions/physiology , Female , Heart Rate/physiology , Humans , Individuality , Male , Middle Aged , Personality Inventory , Prognosis , Risk Factors , Treatment Outcome
8.
Biol Psychol ; 75(1): 32-6, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17204359

ABSTRACT

Previous studies suggest depression is a risk factor for all cause mortality, with depressed men at greater risk than depressed women. Diminished cardiac vagal control (CVC) in depressed patients has also been found to increase risk of cardiac mortality. Previous research found that depressed women have higher CVC than depressed men suggesting CVC might be related to the discrepancy in mortality rates between depressed men and women. This finding, however, was in the context of a study with several methodological weaknesses. The current study sought to replicate the sex difference in CVC in a sample of 137 medically healthy and clinically diagnosed depressed patients. Main effects of sex and age significantly predicted CVC such that depressed women had greater CVC and CVC decreased with age in the cross-sectional sample. The results suggest greater CVC in depressed women might confer cardioprotective functions, which may partially explain the sex difference in mortality rates in the depressed population.


Subject(s)
Cardiovascular Diseases/mortality , Depressive Disorder, Major/physiopathology , Heart/innervation , Sex Characteristics , Vagus Nerve/physiopathology , Adult , Arrhythmia, Sinus/physiopathology , Attention/physiology , Cardiovascular Diseases/physiopathology , Cause of Death , Depressive Disorder, Major/mortality , Electrocardiography , Female , Heart Rate/physiology , Humans , Male , Middle Aged , Prognosis , Reference Values , Risk Factors , Statistics as Topic , Survival Analysis
10.
Biol Psychol ; 74(2): 243-62, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17070982

ABSTRACT

This paper focuses on pragmatic issues in obtaining measures of cardiac vagal control, and overviews a set of freely available software tools for obtaining several widely used metrics that putatively reflect sympathetic and/or parasympathetic contributions to cardiac chronotropy. After an overview of those metrics, and a discussion of potential confounds and extraneous influences, an empirical examination of the relationships amongst these metrics is provided. This study examined 10 metrics in 96 unselected college students under conditions of resting baseline and serial paced arithmetic. Intercorrelations between metrics were very high. Factor analyses were conducted on the metrics reflecting variability in cardiac rate, once at baseline and again during mental arithmetic. Factor structure was highly stable across tasks, and included a factor that had high loadings of all variables except Toichi's "cardiac sympathetic index" (CSI), and a second factor that was defined predominantly by the CSI. Although generally highly correlated, the various metrics responded differently under challenge.


Subject(s)
Heart Rate/physiology , Heart/physiology , Vagus Nerve/physiology , Arrhythmia, Sinus/diagnosis , Arrhythmia, Sinus/physiopathology , Electrocardiography , Female , Humans , Male , Parasympathetic Nervous System/physiopathology , Respiratory Physiological Phenomena , Software , Sympathetic Nervous System/physiopathology
11.
BMC Pediatr ; 6: 29, 2006 Nov 08.
Article in English | MEDLINE | ID: mdl-17090333

ABSTRACT

BACKGROUND: Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. METHODS: 22 children, aged 5-18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with < or = 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. RESULTS: At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P < 0.01) months and significantly greater decrease in days with missed activities at one (85% vs. 15%, P = 0.02) and two (95% vs. 77%. P = 0.05) months. During the two months of follow-up, more children who had learned guided imagery met the threshold of < or = 4 day of pain each month and no missed activities (RR = 7.3, 95%CI [1.1,48.6]) than children who learned only the breathing exercises. CONCLUSION: The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.


Subject(s)
Abdominal Pain/therapy , Breathing Exercises , Imagery, Psychotherapy , Adolescent , Child , Child, Preschool , Female , Humans , Male , Recurrence
12.
J Clin Psychiatry ; 67(11): 1665-73, 2006 Nov.
Article in English | MEDLINE | ID: mdl-17196044

ABSTRACT

OBJECTIVE: To assess the efficacy of acupuncture as an intervention for major depressive disorder (MDD). METHOD: Acupuncture was examined in 151 patients with MDD (DSM-IV) who were randomly assigned to 1 of 3 groups in a double-blind randomized controlled trial. The specific intervention involved Traditional Chinese Medicine (TCM)-style acupuncture with manual stimulation for depression; the control conditions consisted of (1) a nonspecific intervention using a comparable number of legitimate acupuncture points not specifically targeted to depressive symptoms and (2) a waitlist condition, which involved waiting without intervention for 8 weeks. After 8 weeks, all patients received the depression-specific acupuncture. Each 8-week intervention regimen consisted of 12 acupuncture sessions delivered in an acupuncturist's office in the community. The primary outcome measure was the 17-item Hamilton Rating Scale for Depression. The study was conducted from February 1998 to April 2002. RESULTS: Twenty patients terminated treatment before the completion of the 8-week intervention (13%) but not differentially by study group. Random regression models of the intent-to-treat sample revealed that although patients receiving acupuncture improved more than those awaiting intervention, no evidence of differential efficacy of the depression-specific over nonspecific intervention was found. Response rates in acupuncture-treated patients were relatively low after 8 weeks (22% and 39% for specific and nonspecific intervention groups, respectively), with the response rate after the entire 16-week trial reaching 50%. CONCLUSION: Although TCM manual acupuncture is a well-tolerated intervention, results fail to support its efficacy as a monotherapy for MDD. It can't be ruled out that factors unique to the implementation of acupuncture in this research study may have limited the efficacy of interventions compared to those provided in naturalistic settings. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT00010517.


Subject(s)
Acupuncture/methods , Depressive Disorder, Major/therapy , Adult , Depressive Disorder, Major/classification , Double-Blind Method , Female , Humans , Male , Treatment Outcome
13.
J Psychiatr Res ; 37(4): 335-43, 2003.
Article in English | MEDLINE | ID: mdl-12765856

ABSTRACT

Perception of illness has been described as an important predictor in the medical health psychology literature, but has been given little attention in the domain of mental disorders. The patient's Perception of Depression Questionnaire (PDIQ) is a newly developed measure whose factor structure and psychometric properties were evaluated on a sample of 174 outpatients meeting criteria for major depressive disorder. The clinical utility of the questionnaire was assessed on a sub-sample of 121 participants in a study of acupuncture treatment for depression. The questionnaire has four subscales, each with high internal consistency and high test-retest reliability. These four subscales are: Self-Efficacy, which reflects perceived controllability of the illness, Externalizing, which reflects attributing the illness to external causes, Hopeless/Flawed, which reflect a belief that depression is a personal trait and therefore there is little hope for cure, and Holistic, which reflects a belief in alternative therapies. Although the PDIQ did not predict outcome, its subscales were related to adherence to treatment, treatment preference, expectations, and therapeutic alliance. The subscales have adequate convergent/discriminant validity and are clinically relevant to aspects of treatment provision.


Subject(s)
Depressive Disorder/psychology , Adult , Factor Analysis, Statistical , Female , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Psychometrics , Reproducibility of Results , Research Design , Self Efficacy , Self-Assessment , Surveys and Questionnaires
14.
Psychophysiology ; 39(6): 861-4, 2002 Nov.
Article in English | MEDLINE | ID: mdl-12462513

ABSTRACT

Increased vagal tone has been associated with treatment success using pharmacological agents and cognitive-behavioral treatment in major depression, but not using electroconvulsive therapy. The present study investigated whether increases in vagal tone would be associated with favorable treatment response with nonpharmacological treatment. At baseline and following treatment, 16 subjects were administered the Hamilton Rating Scale for Depression (HRSD) followed by electrocardiographic recording. Those with little change in vagal tone from before to after treatment showed minimal reduction in HRSD score (-4.8); those with larger vagal tone change showed a large decrease in HRSD score (-14.8). Changes in vagal tone are thus related to favorable treatment response in depression, and do not represent anticholinergic pharmacological effects. Future work manipulating vagal tone might prove informative in teasing apart the causal role of vagal tone and depression.


Subject(s)
Acupuncture Therapy , Arousal/physiology , Depressive Disorder, Major/therapy , Electrocardiography , Vagus Nerve/physiopathology , Adolescent , Adult , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Double-Blind Method , Female , Heart Rate/physiology , Humans , Middle Aged , Treatment Outcome
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