Anhedonic Depression Is Not Associated With Risk of Recurrent Major Adverse Cardiac Events and All-Cause Mortality in Acute Coronary Syndrome Patients

Background Depression after acute coronary syndrome (ACS) is common and increases risks of adverse outcomes, but it remains unclear which depression features are most associated with major adverse cardiac events (MACE) and all-cause mortality (ACM). Purpose To examine whether a subtype of depression characterized by anhedonia and major depressive disorder (MDD) predicts 1-year MACE/ACM occurrence in ACS patients compared to no MDD history. We also consider other depression features in the literature as predictors. Methods Patients (N = 1,087) presenting to a hospital with ACS completed a self-report measure of current depressive symptoms in-hospital and a diagnostic interview assessing MDD within 1 week post-hospitalization. MACE/ACM events were assessed at 1-, 6-, and 12-month follow-ups. Cox regression models were used to examine the association of the anhedonic depression subtype and MDD without anhedonia with time to MACE/ACM, adjusting for sociodemographic and clinical covariates. Results There were 142 MACE/ACM events over the 12-month follow-up. The 1-year MACE/ACM in patients with anhedonic depression, compared to those with no MDD, was somewhat higher in an age-adjusted model (hazard ratio [HR] = 1.63, p = .08), but was not significant after further covariate adjustment (HR = 1.24, p = .47). Of the additional depression features, moderate-to-severe self-reported depressive symptoms significantly predicted the risk of MACE/ACM, even in covariate-adjusted models (HR = 1.72, p = .04), but the continuous measure of self-reported depressive symptoms did not. Conclusion The anhedonic depression subtype did not uniquely predict MACE/ACM as hypothesized. Moderate-to-severe levels of total self-reported depressive symptoms, however, may be associated with increased MACE/ACM risk, even after accounting for potential sociodemographic and clinical confounders.

Psychological Predictors of Precautionary Behaviors in Response to COVID-19: A Structural Model

The first lines of defense during an epidemic are behavioral interventions, including stay-at-home measures or precautionary health training, aimed at reducing contact and disease transmission. Examining the psychosocial variables that may lead to greater adoption of such precautionary behaviors is critical. The present study examines predictors of precautionary practices against coronavirus disease 2019 (COVID-19) in 709 Mexican participants from 24 states. The study was conducted via online questionnaire between the end of March and the beginning of April 2020, when the pandemic response was in its initial stages in Mexico. The instrument included demographic items, as well as scales assessing COVID-19-resembling symptoms, empathy, impulsivity, anhedonic depression, general health practices, alcohol consumption, and COVID-19-associated precautionary behaviors. Most participants reported adopting limited social distancing or other precautionary behaviors against COVID-19. The results of a structural equation model demonstrated that the presence of COVID-19 symptoms was related to impulsivity and general health behaviors. However, no direct association between precautionary behaviors and the presence of COVID-19 symptoms was found. In turn, precautionary behaviors were more prevalent among participants who reported higher empathy and general health behaviors and were inhibited indirectly by impulsivity via alcohol consumption. Furthermore, the model suggests that anhedonic depression symptoms have a negative indirect effect on precautionary behaviors via general health behaviors. Finally, impulsivity showed a negative direct effect on general health behavior. These results highlight the role that general physical health and mental health play on precautionary behavior and the critical importance of addressing issues such as depression, general health behaviors, and impulsivity in promoting safe actions and the protection of self and others.

Efficacy of attention bias modification training for depressed adults: a randomized clinical trial

Background This study examined the efficacy of attention bias modification training (ABMT) for the treatment of depression. Methods In this randomized clinical trial, 145 adults (77% female, 62% white) with at least moderate depression severity [i.e. self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) ⩾13] and a negative attention bias were randomized to active ABMT, sham ABMT, or assessments only. The training consisted of two in-clinic and three (brief) at-home ABMT sessions per week for 4 weeks (2224 training trials total). The pre-registered primary outcome was change in QIDS-SR. Secondary outcomes were the 17-item Hamilton Depression Rating Scale (HRSD) and anhedonic depression and anxious arousal from the Mood and Anxiety Symptom Questionnaire (MASQ). Primary and secondary outcomes were administered at baseline and four weekly assessments during ABMT. Results Intent-to-treat analyses indicated that, relative to assessment-only, active ABMT significantly reduced QIDS-SR and HRSD scores by an additional 0.62 ± 0.23 (p = 0.008, d = −0.57) and 0.74 ± 0.31 (p = 0.021, d = −0.49) points per week. Similar results were observed for active v. sham ABMT: a greater symptom reduction of 0.44 ± 0.24 QIDS-SR (p = 0.067, d = −0.41) and 0.69 ± 0.32 HRSD (p = 0.033, d = −0.42) points per week. Sham ABMT did not significantly differ from the assessment-only condition. No significant differences were observed for the MASQ scales. Conclusion Depressed individuals with at least modest negative attentional bias benefitted from active ABMT.

Efficacy of Attention Bias Modification Training for Depressed Adults: A Randomized Clinical Trial

Background: This study examined the efficacy Attention Bias Modification Training (ABMT) for the treatment of depression. Methods: In this randomized clinical trial, 145 adults (77% female, 62% white) with at least moderate depression severity (i.e., self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) ≥ 13) and a negative attention bias were randomized to active ABMT, sham ABMT, or assessments only. Training consisted of two in-clinic and three (brief) at-home ABMT sessions per week for four weeks (2,224 training trials total). The pre-registered primary outcome was change in QIDS-SR. Secondary outcomes were the 17-item Hamilton Depression Rating Scale (HRSD) and anhedonic depression and anxious arousal from the Mood and Anxiety Symptom Questionnaire (MASQ). Primary and secondary outcomes were administered at baseline and four weekly assessments during ABMT. Results: Intent-to-treat analyses indicated that, relative to assessment only, active ABMT significantly reduced QIDS-SR and HRSD scores by an additional 0.62 ± 0.23 (p = .008, d = -0.57) and 0.74 ± 0.31 (p = .021, d = -0.49) points per week. Similar results were observed for active vs sham ABMT: a greater symptom reduction of 0.44 ± 0.24 QIDS-SR (p = .067, d = -0.41) and 0.69 ± 0.32 HRSD (p = .033, d = -0.42) points per week. Sham ABMT did not significantly differ from the assessment-only condition. No significant differences were observed for the MASQ scales.Conclusion: Depressed individuals with at least modest negative attentional bias benefitted from active ABMT.

1099 Sleep Restriction Leads To Greater Next-day Anxiety: The Moderating Role Of Anxiety And Depression

Introduction Evidence from both experimental and daily-diary studies suggests that a single night of sleep restriction leads to higher levels of anxiety the following day. Depressive symptoms also increase the next day in healthy populations, although sleep restriction has demonstrated short-term antidepressant properties in depressed populations. Relatively little research has examined symptoms of anxiety and depression separately on days following naturally-occurring sleep restriction and whether any change from the previous day might be moderated by baseline levels of anxiety or depression. Methods Undergraduates completed electronic daily diaries twice per day for 14 days (N = 96). Upon waking, participants answered questions assessing their sleep, and every evening, before going to bed, completed the Mood and Anxiety Symptom Questionnaire - Short Form to assess daily levels of general distress, anxious arousal, and anhedonic depression. The State-Trait Anxiety Inventory - State and the Center for Epidemiologic Studies Depression Scale provided baseline measures of anxiety and depression, respectively. A night of sleep restriction was operationally defined as one for which participants reported obtaining 4 hours of sleep or less. Results Multilevel modeling revealed that anxious arousal was higher following sleep restriction (β =.92, z=2.40, p=.017). This was moderated by baseline anxiety (β =.09, z=2.89, p=.004) and baseline depression (β =.09, z=3.39, p=.001) so that anxious arousal was even higher the next day for individuals reporting a high number of anxious and depressive symptoms. These effects remained significant after controlling for lagged anxious arousal, gender, baseline anxiety and depression, substance use, and napping. Conversely, no significant results were found when next-day general distress or anhedonic depression were examined. Conclusion Our results suggest that naturally-occurring sleep restriction is accompanied by increases in anxiety, but not depressive symptoms, the following day. This effect is heightened in individuals with higher baseline levels of anxiety and depression. Support N/A

Structure of Affect in Types of Anxiety and Depression

Although anxiety and depression are treated as separate conditions, the literature concerning their affective functioning is inconclusive. To address this issue, we analyzed types of anxiety (arousal and apprehension) and depression (valence and anhedonic). We hypothesized that the similarities and differences in the structure of affect would be related to the specific structural components and functions (reactive or regulative) of the types. We assessed the valence (negative and positive affect) and content (specific emotions) of affect by the Positive and Negative Affect Schedule – Expanded Form (PANAS-X) in 1,632 participants from a general population. Regression analyses showed that the anxiety and depression types (measured by Anxiety and Depression Questionnaire) can be differentiated by the content of affect, but not its valence: Fear was characteristic for anxiety, especially the arousal anxiety. Valence depression was primarily related to hostility, while anhedonic depression was predicted by sadness, guilt, and lowered joviality. Moreover, as expected, regulative emotions (e.g., joviality) were stronger predictors of the regulative apprehension anxiety and anhedonic depression, while the more reactive fear was more strongly related to the reactive arousal anxiety than to regulative apprehension anxiety. These results confirm that the structure of affect is related to the structure and functions of anxiety and depression types.