Network analyses reveal which symptoms improve (or not) following an Internet intervention (Deprexis) for depression

Background: Depression is a heterogeneous collection of symptoms. Prior meta-analyses using symptom sum scores have shown the Internet intervention, Deprexis, to be an efficacious treatment for depression. However, no prior research has investigated how Deprexis (or any other Internet intervention for depression) impacts specific symptoms of depression. The current study utilizes symptom-level analyses to examine which symptoms are directly, indirectly, or minimally influenced by treatment. Methods: Network analysis and mean-level approaches examined which symptoms, assessed by the Quick Inventory of Depression Symptoms (QIDS-SR), were affected by an 8-week course of Deprexis compared to a waitlist in a nationally recruited sample from the United States (N = 295). Results: Deprexis directly improved the symptoms of sadness and indecision. Change in these symptoms, in turn, were associated with change in early insomnia, middle insomnia, self-dislike, fatigue, anhedonia, suicidality, slowness, and agitation. All of these symptoms (except for agitation and early insomnia) show decreases with Deprexis compared to a waitlist after correcting for multiple comparisons. Six additional symptoms, particularly the somatic symptoms, were not impacted by Deprexis compared to waitlist. Conclusions: In this sample, the efficacy of Deprexis was due to its direct impact on sadness and indecision. Examining treatment-related change in specific symptoms may facilitate a more nuanced understanding of how a treatment works compared to examining symptom sum scores. Symptom-level approaches may also identify symptoms that do not improve and provide important direction for future treatment development.

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Symptom centrality and infrequency of endorsement identify adolescent depression symptoms more strongly associated with life satisfaction

10.31234/osf.io/79hcj ◽

2018 ◽

Author(s):

Michael C Mullarkey ◽

Igor Marchetti ◽

Karen Bluth ◽

Caryn L Carlson ◽

Jason Shumake ◽

...

Keyword(s):

Life Satisfaction ◽

Adolescent Depression ◽

Community Sample ◽

Depression Symptoms ◽

Depression Symptom ◽

Cross Sectional ◽

Fine Grained ◽

Symptoms Of Depression ◽

Large N ◽

Symptom Level

Although depression symptoms are often treated as interchangeable, some symptoms may relate to adolescent life satisfaction more strongly than others. To assess this premise, we first conducted a network analysis on the Mood and Feelings Questionnaire (MFQ) in a large (N = 1,059), cross-sectional sample of community adolescents (age M = 14.72 ± 1.79). The most central symptoms of adolescent depression, as indexed by strength, were self-hatred, loneliness, sadness, and worthlessness while the least frequently endorsed symptoms were self-hatred, anhedonia, feeling like a bad person, and feeling unloved. Moreover, the more central a depression symptom was in the network (i.e., higher strength), the more variance it shared with life satisfaction (r = 0.59, 95% CI: 0.27, 0.76). How frequently a symptom was endorsed was negatively associated with the variance symptoms shared with life satisfaction (r = -0.48, 95% CI: -0.63, -0.21). Cross-validated, prediction focused models found central symptoms were expected to predict more out of fold variance in life satisfaction than peripheral symptoms and frequently endorsed symptoms, but not the least frequently endorsed symptoms. These findings show certain depression symptoms may be more strongly associated with life satisfaction in adolescence and these symptoms can be identified by multiple symptom-level metrics. Limitations include use of cross-sectional data and utilizing a community sample. Better understanding which symptoms of depression share more variance with important outcomes like life satisfaction could help us develop a more fine-grained understanding of adolescent depression.

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Association between negative cognitive bias and depression: A symptom-level approach

10.31234/osf.io/d3xfh ◽

2018 ◽

Author(s):

Christopher G Beevers ◽

Michael C Mullarkey ◽

Justin Dainer-Best ◽

Rochelle A Stewart ◽

Jocelyn Labrada ◽

...

Keyword(s):

Cognitive Bias ◽

Cognitive Biases ◽

Eye Gaze ◽

Depression Symptoms ◽

Depression Symptom ◽

Symptoms Of Depression ◽

Symptom Level ◽

General Scientific ◽

Symptom Predictors ◽

Variance Explained

Cognitive models of depression posit that negatively biased self-referent processing and attention have important roles in the disorder. However, depression is a heterogeneous collection of symptoms and it is unlikely that all symptoms are associated with these negative cognitive biases. The current study involved 218 community adults whose depression ranged from no symptoms to clinical levels of depression. Random forest machine learning was used to identifythe most important depression symptom predictors of each negative cognitive bias. Depression symptoms were measured with the Beck Depression Inventory – II. Performance of models was evaluated using predictive R-squared (𝑅2 𝑝𝑟𝑒𝑑), the expected variance explained in data not used to train the algorithm, estimated by 10 repetitions of 10-fold cross-validation. Using the Self- Referent Encoding Task (SRET), depression symptoms explained 34% to 45% of the variance in negative self-referent processing. The symptoms of sadness, self-dislike, pessimism, feelings of punishment, and indecision were most important. Notably, many depression symptoms made virtually no contribution to this prediction. In contrast, for attention bias for sad stimuli, measured with the dot-probe task using behavioral reaction time and eye gaze metrics, no reliable symptom predictors were identified. Findings indicate that a symptom-level approach may provide new insights into which symptoms, if any, are associated with negative cognitive biases in depression. General Scientific Summary: This study finds that many symptoms of depression are not strongly associated with thinking negatively about oneself or attending to negative information. This implies that negative cognitive biases may not be strongly associated with depression per se, but may instead contribute to the maintenance of specific depression symptoms, such as sadness, self-dislike, pessimism, feelings of punishment, and indecision.

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Direction of Dependence Between Specific Symptoms of Depression: A Non-Gaussian Approach

Clinical Psychological Science ◽

10.1177/2167702619875410 ◽

2019 ◽

Vol 8 (2) ◽

pp. 240-251 ◽

Cited By ~ 2

Author(s):

Regina García-Velázquez ◽

Markus Jokela ◽

Tom Henrik Rosenström

Keyword(s):

Simulation Study ◽

Type I Error ◽

The United States ◽

Type I ◽

Symptoms Of Depression ◽

Large Samples ◽

Affective Symptoms ◽

Non Gaussian ◽

Specific Symptoms ◽

Practical Implications

Psychopathology could arise from direct interactions between symptoms. Evidence suggests that the mechanisms underlying somatic and cognitive-affective symptoms of depression are different. The aim of this study was to explore dynamic associations among cognitive-affective depression criteria. We used distribution-based direction of dependence models, which estimate whether the presence of symptom A is more likely to depend on the presence of symptom B than vice versa. We analyzed six large samples of adults from the United States ( N = 34,963) and conducted a simulation study to test the performance of the algorithm with ordinal variables and a second simulation study focusing on Type I error. Our results were consistent with the literature: Depressed mood and anhedonia were reactive to changes in other symptoms, whereas suicidality may reinforce other symptoms or reflect factors doing so. We discuss the results in the context of other empirical findings and theories of depression, reflect on the potential of these methods in psychopathology, and consider some practical implications.

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Self-Dislike and Sadness are Central Symptoms of Depression in College Students: A Network Analysis

10.31234/osf.io/fujmb ◽

2018 ◽

Author(s):

Michael C Mullarkey ◽

Rochelle A Stewart ◽

Tony T Wells ◽

Jason Shumake ◽

Christopher G Beevers

Keyword(s):

College Students ◽

Public Health Issue ◽

Depression Symptoms ◽

Symptom Change ◽

Cross Sectional ◽

Network Analyses ◽

Symptoms Of Depression ◽

Highly Correlated ◽

Single Time Point ◽

Time Point

Depression in college students is an important public health issue. There is growing recognition that some depression symptoms may have a more central role in the disorder than others. We use network analyses to identify the most central symptoms of depression in college students. In a cross-sectional network the BDI-SF was collected at a single time point (N = 10,005) and in a symptom change network the BDI-SF was collected at two time points separated on average by approximately two months (N = 700). In both samples, the most central depression symptoms were self-dislike and sadness. Centrality scores for the cross-sectional network were highly correlated (r = .86) with the centrality scores for the symptom change network. Self-dislike and sadness may have important roles in college student depression. Additional work experimentally targeting and changing these central symptoms is needed to determine whether they have a causal role in the disorder.

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Suicidal Behavior in German Adolescents

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000331 ◽

2015 ◽

Vol 43 (1) ◽

pp. 39-45 ◽

Cited By ~ 4

Author(s):

Joana Straub ◽

Ferdinand Keller ◽

Nina Sproeber ◽

Michael G. Koelch ◽

Paul L. Plener

Keyword(s):

Suicidal Behavior ◽

Suicide Attempts ◽

Depression Scale ◽

Epidemiological Studies ◽

Present Sample ◽

Manic Symptoms ◽

Symptoms Of Depression ◽

Adolescent Sample ◽

History Of ◽

Sum Scores

Objective: Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date. Methods: 1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior. Results: In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores. Conclusions: Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.

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Proportion of Individuals With Past-Year Suicidal Ideation Who Attempted Suicide Over the Past 10 Years in the United States, and the Influence of Age and Sex

Crisis ◽

10.1027/0227-5910/a000690 ◽

2020 ◽

pp. 1-5

Author(s):

Shannon Lange ◽

Courtney Bagge ◽

Charlotte Probst ◽

Jürgen Rehm

Keyword(s):

United States ◽

Suicidal Ideation ◽

Random Effects ◽

Attempted Suicide ◽

Suicide Attempts ◽

The United States ◽

Individual Level ◽

The Past ◽

Meta Analyses ◽

Age Category

Abstract. Background: In recent years, the rate of death by suicide has been increasing disproportionately among females and young adults in the United States. Presumably this trend has been mirrored by the proportion of individuals with suicidal ideation who attempted suicide. Aim: We aimed to investigate whether the proportion of individuals in the United States with suicidal ideation who attempted suicide differed by age and/or sex, and whether this proportion has increased over time. Method: Individual-level data from the National Survey on Drug Use and Health (NSDUH), 2008–2017, were used to estimate the year-, age category-, and sex-specific proportion of individuals with past-year suicidal ideation who attempted suicide. We then determined whether this proportion differed by age category, sex, and across years using random-effects meta-regression. Overall, age category- and sex-specific proportions across survey years were estimated using random-effects meta-analyses. Results: Although the proportion was found to be significantly higher among females and those aged 18–25 years, it had not significantly increased over the past 10 years. Limitations: Data were self-reported and restricted to past-year suicidal ideation and suicide attempts. Conclusion: The increase in the death by suicide rate in the United States over the past 10 years was not mirrored by the proportion of individuals with past-year suicidal ideation who attempted suicide during this period.

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Bereavement or Breakup: A Network Approach to Modeling Differential Pathways into Depression

10.31234/osf.io/38r4j ◽

2019 ◽

Author(s):

Julian Burger ◽

Margaret S. Stroebe ◽

Pasqualina Perrig-Chiello ◽

Henk A.W. Schut ◽

Stefanie Spahni ◽

...

Keyword(s):

Depressive Symptoms ◽

Graphical Models ◽

Contextual Factors ◽

Marital Disruption ◽

Depression Symptoms ◽

Depression Symptom ◽

Multiple Time ◽

Cross Sectional ◽

Network Analyses ◽

Within Subjects

Background: Prior network analyses demonstrated that the death of a loved one potentially precedes specific depression symptoms, primarily loneliness, which in turn links to other depressive symptoms. In this study, we extend prior research by comparing depression symptom network structures following two types of marital disruption: bereavement versus separation. Methods: We fitted two Gaussian Graphical Models to cross-sectional data from a Swiss survey of older persons (145 bereaved, 217 separated, and 362 married controls), and compared symptom levels across bereaved and separated individuals. Results: Separated compared to widowed individuals were more likely to perceive an unfriendly environment and oneself as a failure. Both types of marital disruption were linked primarily to loneliness, from where different relations emerged to other depressive symptoms. Amongst others, loneliness had a stronger connection to perceiving oneself as a failure in separated compared to widowed individuals. Conversely, loneliness had a stronger connection to getting going in widowed individuals. Limitations: Analyses are based on cross-sectional between-subjects data, and conclusions regarding dynamic processes on the within-subjects level remain putative. Further, some of the estimated parameters in the network exhibited overlapping confidence intervals and their order needs to be interpreted with care. Replications should thus aim for studies with multiple time points and larger samples. Conclusions: The findings of this study add to a growing body of literature indicating that depressive symptom patterns depend on contextual factors. If replicated on the within-subjects level, such findings have implications for setting up patient-tailored treatment approaches in dependence of contextual factors.

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Specificity and detail in autobiographical memory retrieval: A multi-site (re)investigation.

10.31234/osf.io/mb5g8 ◽

2020 ◽

Author(s):

David John Hallford ◽

Tom Joseph Barry ◽

Eline Belmans ◽

Filip Raes ◽

Sam Dax ◽

...

Keyword(s):

Hong Kong ◽

Autobiographical Memory ◽

Memory Retrieval ◽

Severe Depression ◽

Depression Symptoms ◽

Autobiographical Memories ◽

Memory Specificity ◽

Specific Event ◽

Meta Analyses ◽

Cue Words

This investigation examined conflicting suggestions regarding the association between problems retrieving specific autobiographical memories and the tendency to retrieve the details of these memories. We also examined whether these tendencies are differentially related to depression symptoms. U.S., Belgian, Hong Kong and Japanese participants retrieved memories related to cue words. Responses were coded for if they referred to a specific event (i.e., an event lasting less than 24 hours) and their details (What? Where? Who?). Across sites, and in meta-analyses, the retrieval of more specific memories was associated with retrieval of more details. Memories that were specific included more detail than non-specific memories. Across sites, retrieval of more specific memories and more detail was associated with less severe depression symptoms. Episodic specificity and detailedness are related but separable constructs. Future investigations of autobiographical memory specificity, and methods for alleviating problematic specificity, should consider measures of episodic detailedness.

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Examining the Temporal Dynamics of Anxiety and Depressive Symptoms During a Therapist-Supported, Smartphone-Based Intervention for Major Depression (Preprint)

10.2196/preprints.25280 ◽

2020 ◽

Author(s):

Santiago Allende ◽

Valerie Forman-Hoffman ◽

Philippe Goldin

Keyword(s):

Depressive Symptoms ◽

Temporal Relationship ◽

Temporal Dynamics ◽

Digital Health ◽

Quadratic Function ◽

Depression Symptoms ◽

Symptoms Of Depression ◽

Effect Model ◽

End Of Treatment ◽

Highly Correlated

UNSTRUCTURED Background: Anxiety and depression symptoms are highly correlated in adults with depression; however, little is known about their interaction and temporal dynamics of change during treatment. Thus, the primary aim of this study was to examine the temporal dynamics of anxiety and depressive symptoms during a 12-week therapist-supported, smartphone-delivered digital health intervention for symptoms of depression and anxiety, the Meru Health Program (MHP). Method: A total of 290 participants from the MHP were included in the present analyses (age Mean = 39.64, SD = 10.25 years; 79% female; 54% self-reported psychotropic medication use). A variance components model was used to examine whether (1) reporting greater anxiety during the current week relative to anxiety reported in other weeks would be associated with greater reporting of depressive symptoms during the current week, while a time-varying effect model was used to examine whether, (2) consistent with findings reported by Wright et al. (2014), the temporal relationship between anxiety and depressive symptoms during the intervention would be expressed as a quadratic function marked by a weak association at baseline, followed by an increase to a peak before demonstrating a negligible decrease until the end of treatment. Results: In support of hypothesis 1, we found that reporting greater anxiety symptoms during the current week relative to other weeks was associated with greater depressive symptoms during the current week. Contrary to hypothesis 2, the temporal relationship between anxiety and depressive symptoms evidenced a recurring pattern, with the association increasing during the initial weeks, decreasing during mid-treatment and sharply increasing toward the end of treatment. Conclusions: The present findings demonstrate that anxiety and depressive symptoms overlap and fluctuate in concert during a smartphone-based intervention for anxiety and depressive symptoms. The present findings may warrant more refined intervention strategies specifically tailored to co-occurring patterns of change in symptoms.

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A Systematic Review on Barriers to Palliative Care in Oncology

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120983283 ◽

2021 ◽

pp. 104990912098328

Author(s):

Jyotsana Parajuli ◽

Judith E. Hupcey

Keyword(s):

United States ◽

Systematic Review ◽

Palliative Care ◽

Full Text ◽

Literature Search ◽

Intervention Development ◽

The United States ◽

Care Utilization ◽

Review Of Literature ◽

Meta Analyses

The number of people with cancer and the need for palliative care among this population is increasing in the United States. Despite this growing need, several barriers exist to the utilization of palliative care in oncology. The purpose of this study was to synthesize the evidence on the barriers to palliative care utilization in an oncology population. A systematic review of literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, and Psych Info databases were used for the literature search. Articles were included if they: 1) focused on cancer, (2) examined and discussed barriers to palliative care, and c) were peer reviewed, published in English, and had an accessible full text. A total of 29 studies (8 quantitative, 18 qualitative, and 3 mixed-methods) were identified and synthesized for this review. The sample size of the included studies ranged from 10 participants to 313 participants. The barriers to palliative care were categorized into barriers related to the patient and family, b) barriers related to providers, and c) barriers related to the healthcare system or policy. The factors identified in this review provide guidance for intervention development to mitigate the existing barriers and facilitate the use palliative care in individuals with cancer.

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