Dynamic cognitive characteristics of emotional conflict in subthreshold depressed patients: An Event-Related Potential Study

Subthreshold depression (SubD) has a considerable impact on an individual’s subjective well-being and psychosocial functioning, and is a risk factor for Major depression disorder (MDD). The inability to effectively control and resolve emotional conflict is a typical symptom of certain mood disorders, and the aim of this study was to confirm impairments in cognitive processing mechanisms for emotional conflict processing in SubD patients with event-related potential (ERP) recording. The study of the mechanisms of emotional conflict in subthreshold depression may provide an ideal model for understanding the neurophysiological mechanisms and developing preventive strategies in patients with MDD. Methods:The Healthy control (HC) and SubD groups were recruited, with 32 subjects in each group completing the word-face Stroop paradigm, during which ERP amplitudes and latencies were recorded. Results:Compared to HC group, the SubD group had lower accuracy and longer response times in both the "consistent stimulus" and "inconsistent stimulus" conditions. Regardless of the stimulus condition, the SubD group had a greater N2 amplitude in the prefrontal mid-lobe region. In the SubD group, the N450 amplitude was also found to be greater in the prefrontal middle region for the "incongruent stimulus minus congruent stimulus" and the conflict SP amplitude was smaller in the parieto-occipital region for the "incongruent stimulus minus congruent stimulus". Conclusions:The findings suggest that, supported by behavioural and brain evidence, people with SubD have dynamic cognitive deficits in emotional conflict processing, specifically greater sensitivity to early processing of emotional stimuli and sharper detection of emotional conflict, but more delayed adaptation and response options following emotional conflict resolution.

Perceiving Positive Facial Expression Can Relieve Depressive Moods: The Effect of Emotional Contagion on Mood in People With Subthreshold Depression

Emotional contagion is a phenomenon by which an individual’s emotions directly trigger similar emotions in others. We explored the possibility that perceiving others’ emotional facial expressions affect mood in people with subthreshold depression (sD). Around 49 participants were divided into the following four groups: participants with no depression (ND) presented with happy faces; ND participants presented with sad faces; sD participants presented with happy faces; and sD participants presented with sad faces. Participants were asked to answer an inventory about their emotional states before and after viewing the emotional faces to investigate the influence of emotional contagion on their mood. Regardless of depressive tendency, the groups presented with happy faces exhibited a slight increase in the happy mood score and a decrease in the sad mood score. The groups presented with sad faces exhibited an increased sad mood score and a decreased happy mood score. These results demonstrate that emotional contagion affects the mood in people with sD, as well as in individuals with ND. These results indicate that emotional contagion could relieve depressive moods in people with sD. It demonstrates the importance of the emotional facial expressions of those around people with sD such as family and friends from the viewpoint of emotional contagion.

Cost-effectiveness of a stepped care program to prevent depression among primary care patients with diabetes mellitus type 2 and/or coronary heart disease and subthreshold depression in comparison with usual care

Background Patients with diabetes mellitus type 2 (DM2) and/or coronary heart disease (CHD) are at high risk to develop major depression. Preventing incident major depression may be an important tool in reducing the personal and societal burden of depression. The aim of the current study was to assess the cost-effectiveness of a stepped care program to prevent major depression (Step-Dep) in diabetes mellitus type 2 and/or coronary heart disease patients with subthreshold depression in comparison with usual care. Methods An economic evaluation with 12 months follow-up was conducted alongside a pragmatic cluster-randomized controlled trial from a societal perspective. Participants received care as usual (n = 140) or Step-Dep (n = 96) which consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to a general practitioner. Primary outcomes were quality-adjusted life years (QALYs) and cumulative incidence of major depression. Costs were measured every 3 months. Missing data was imputed using multiple imputation. Uncertainty around cost-effectiveness outcomes was estimated using bootstrapping and presented in cost-effectiveness planes and acceptability curves. Results There were no significant differences in QALYs or depression incidence between treatment groups. Secondary care costs (mean difference €1644, 95% CI €344; €3370) and informal care costs (mean difference €1930, 95% CI €528; €4089) were significantly higher in the Step-Dep group than in the usual care group. The difference in total societal costs (€1001, 95% CI €-3975; €6409) was not statistically significant. The probability of the Step-Dep intervention being cost-effective was low, with a maximum of 0.41 at a ceiling ratio of €30,000 per QALY gained and 0.32 at a ceiling ratio of €0 per prevented case of major depression. Conclusions The Step-Dep intervention is not cost-effective compared to usual care in a population of patients with DM2/CHD and subthreshold depression. Therefore, widespread implementation cannot be recommended. Trial registration The trial was registered in the Netherlands Trial Register (NTR3715).

Intradermal Thumbtack Needle Alleviates Depressive Symptoms and Resets Executive Control System Function in Young Patients With Subthreshold Depression: A Study Protocol of a Randomized, Controlled, and Single-Blind Trial {1}

Background: Subthreshold depression is the prodromal stage of a depressive episode, which is characterized by depressive symptoms but fails to meet the diagnostic criteria for depression. At present, there is no recognized therapy for subthreshold depression worldwide. Studies have also shown that acupoint stimulation can significantly decrease depressive symptoms by modulating different executive control systems, such as reward circuits and motivational circuits. In this proposed study, our objective is to evaluate the efficacy of intradermal thumbtack needle therapy, a continuous and effective acupoint stimulation therapy, on subthreshold depression and generate hypotheses on the mechanism by which this therapy resets executive control system function in young patients with subthreshold depression.Method: In this randomized controlled trial, all eligible participants are diagnosed with subthreshold depression. Participants are randomly assigned to two groups at a ratio of 1:1 and receive either intradermal thumbtack needle or sham intradermal thumbtack needle therapy. The primary outcome is self-reported depression severity on the 9-item Patient Health Questionnaire (PHQ-9) from baseline to 6 weeks. The secondary outcomes include the Short Form Survey (SF-12) and the Generalized Anxiety Disorder Assessment (GAD-7) complementarity. Two psychological paradigms, the Attention Network Test (ANT) and the Psychomotor Vigilance Task (PVT), and functional magnetic resonance imaging (fMRI) will be used to evaluate the mechanism. These two psychological paradigms will explain the mechanism from the perspective of executive control in psychology, and fMRI will reflect the change in functional reset of the executive control system from an imaging point of view. The results are obtained at the start of treatment andthe end of treatment. The entire duration of the study will be approximately 12 months. Discussion: This study is designed to evaluate the efficacy of intradermal thumbtack needle on StD patients. Additionally, mechanisms by which this therapy resets executive control system function will be studied Trial registration: NCT04319562. [ClinicalTrials.gov] [registered before start of inclusion; 24 March 2020] {2a and 2b}