Delirium, depression, and long-term cognition

ABSTRACT Objectives: We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment. Design and measurements: A health proxy reported history of depression. Separate models examined the effect of preadmission history of depression on: (a) intensive care unit (ICU) course, measured as DCF days; (b) depression symptom severity at 3 and 12 months, measured by the Beck Depression Inventory-II (BDI-II); and (c) cognitive performance at 3 and 12 months, measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) global score. Setting and participants: Patients admitted to the medical/surgical ICU services were eligible. Results: Of 821 subjects eligible at enrollment, 261 (33%) had preadmission history of depression. After adjusting for covariates, preadmission history of depression was not associated with less DCF days (OR 0.78, 95% CI, 0.59–1.03 p = 0.077). A prior history of depression was associated with higher BDI-II scores at 3 and 12 months (3 months OR 2.15, 95% CI, 1.42–3.24 p = <0.001; 12 months OR 1.89, 95% CI, 1.24–2.87 p = 0.003). We did not observe an association between preadmission history of depression and cognitive performance at either 3 or 12 months (3 months beta coefficient −0.04, 95% CI, −2.70–2.62 p = 0.97; 12 months 1.5, 95% CI, −1.26–4.26 p = 0.28). Conclusion: Patients with a depression history prior to ICU stay exhibit a greater severity of depressive symptoms in the year after hospitalization.

Lifetime Prevalence and Risk Factors for Perinatal Depression in a Large Cohort of Women with Depression

ObjectivesAmongst women with a history of depression, this study sought to identify risk factors associated with reporting perinatal depression (PND)). Lifetime prevalence, length and severity of PND were evaluated, as well as the effect of PND onset either after previous depression episodes, or as the first episode of depression.SettingThe Australian Genetics of Depression Study (AGDS), an online case cohort study of the etiology of depression.ParticipantsIn a large sample of parous women who met DSM criteria for major depressive disorder (MDD) (n=7,182), we identified two subgroups of PND cases (Edinburgh Postnatal Depression Scale score >= 13) with and without prior depression history (n=2,261; n=878 respectively). For a range of risk factors, both subgroups were compared to women with MDD who did not report depressive symptoms in the perinatal period (non-perinatal depression (NPD) cases). PND cases with prior depression history were compared to NPD cases with depression onset before their first pregnancy (n=672). PND cases without prior depression history were compared to all NPD cases (n=2,124).Primary and secondary outcome measuresDescriptive measures reported lifetime prevalence, length, and severity of PND. Logistic regression compared a range of characteristics of PND cases to those of the comparison group of NPD cases.ResultsOf women who experienced depression prior to first pregnancy, PND cases were significantly more likely to report more episodes of depression (OR=1.1 per additional depression episode, CI=[1.1-1.1], P=1.9e-13), non-European ancestry (OR=1.5, CI=[1.0-2.1], P=3.4e-02), severe nausea during pregnancy (OR=1.3, CI=[1.1-1.6], P=6.6e-03) and emotional abuse (OR=1.4, CI=[1.1-1.7], P=5.3e-03). Women without any depression before their first perinatal episode were significantly more likely to report emotional abuse (OR=1.3, CI=[1.1-1.6], P=1.0e-02) than women with NPD.ConclusionsThe majority of parous women in this study experienced PND, associated with more complex, severe depression. Results highlight the importance of perinatal assessments of depressive symptoms, particularly for women with a history of depression or childhood adverse experiences.

Personality Traits in Burning Mouth Syndrome Patients With and Without a History of Depression

Objectives: So far, the strong link between neuroticism, chronic pain, and depression has been well-documented in literatures. Some suggested that they might share etiological factors, thus resulting in overlapping constructs. However, such effect has never been tested in burning mouth syndrome (BMS) patients, a complex phenomenon influenced by both neuropathic and psychopathological factors. We aim to clarify how personality affects individual's pain and pain-related experiences.Methods: Two hundred forty-eight patients with BMS provided demographic information and psychiatric history; completed Ten-Item Personality Inventory, a Visual Analog Scale of pain, and McGill Pain Questionnaire; and provided adequate parameters of depressive state, catastrophizing thinking, and central sensitization.Results: BMS patients with depression history suffered more severe clinical symptoms and scored higher in neuroticism and less in openness and extraversion than did those without psychiatric diagnoses. After age, sex, and duration of pain were controlled, neuroticism in BMS patients with depression correlates with affective dimension of pain. Instead, if psychiatric history is absent, neuroticism correlates with sensory dimension and pain intensity. In both groups, higher neuroticism, unlike other personality facets, contributed to a more severe clinical condition.Conclusion: Of the five traits, neuroticism appears to be the most crucial dimension associated with the pain symptoms and patient's conditions. This study implies that management of pain must extend beyond solely providing pain-relieving medication and must require a holistic and multidisciplinary approach.

Lifetime Prevalence and Risk Factors for Perinatal Depression in a Large Cohort of Women with Depression

BackgroundHistory of psychiatric disorders, particularly depression, is the strongest risk factor for perinatal depression (PND). Yet many women without such history experience their first depression episode perinatally, whilst other women with depression history do not experience any episodes during the perinatal period. PND may itself be heterogenous, according to differences in psychiatric history. However, a comprehensive investigation of characteristics of women with PND, with and without a prior psychiatric history, has not been attempted.MethodsIn a large sample of parous women with depression, we sought to identify risk factors associated with PND after previous depression episodes, or as first-onset depression. Using data from the Australian Genetics of Depression Study, we identified two subgroups of PND cases (Edinburgh Postnatal Depression Scale score >= 13) with and without prior depression history. For both subgroups, we investigated lifetime prevalence, length and severity of PND. Logistic regression compared a range of characteristics of cases to those of a comparison group with major depression without any perinatal episodes. ResultsCriteria for PND was met by 5,058 (70%) of 7,182 parous women who met criteria for major depression. Of women reporting depression onset before first pregnancy, 2,261 (77%) PND cases were compared to 672 (23%) without PND. Among women reporting their first depression episode during or after their first pregnancy, 878 women for whom this first episode was PND were compared to 2,124 parous women who had experienced depression but never perinatally. Of women who experienced depression prior to first pregnancy, PND cases were significantly more likely to report more episodes of depression (OR=1.1 per additional depression episode, CI=[1.1-1.1], P=1.3E-13), non-European ancestry (OR=1.8, CI=[1.3-2.5], P=1.2E-03), severe nausea during pregnancy (OR=1.3, CI=[1.1-1.6], P=6.6E-03) and emotional abuse (OR=1.4, CI=[1.1-1.7], P=2.0E-03). Women without any depression before their first perinatal episode were significantly more likely to report emotional abuse (OR=1.3, CI=[1.1-1.6], P=1.1E-02) than women with depression without PND.ConclusionsThe majority of parous women in this study experienced PND, associated with more complex, severe depression. Results highlight the importance of perinatal assessments of depressive symptoms, particularly for women with a history of depression or childhood adverse experiences.

Associations between conformity to masculine norms and depression: age effects from a population study of Australian men

Background Strict adherence to masculine norms has been associated with deleterious consequences for the physical and mental health of men. However, population-based research is lacking, and it remains unclear whether ageing influences adherence to masculine norms and the extent to which mental health problems like depression are implicated. Methods This study reports on data from 14,516 males aged 15–55 years who participated in Wave 1 of the Australian Longitudinal Study of Male Health (Ten to Men). Group differences in self-reported conformity to masculine norms (CMNI-22), current depressive symptoms (PHQ-9), and self-reported 12-month depression history were examined for males aged 15–17 years, 18–25 years, 26–35 years, 36–50 years, and 51–55 years. Generalised linear models were used to examine the relationships between these variables across age groups. Results Conformity to masculine norms decreased significantly with age. However, models predicting depression generally showed that higher conformity to masculine norms was associated with an increased risk of current depressive symptoms, especially in the oldest age group. Conversely, higher conformity was associated with a decreased likelihood of a self-reported 12-month depression history, although nuances were present between age groups, such that this trend was not evident in the oldest age group. Conclusions Findings provide important insights into the complex relationship between conformity to masculine norms and depressive symptoms across the lifespan and further highlight the importance of mental health campaigns that address the complexities of gendered help-seeking behaviour for men.

Emotional regulation neural circuitry abnormalities in adult bipolar disorder: dissociating effects of long-term depression history from relationships with present symptoms

Bipolar disorder (BD) is common and debilitating and confounding effects of depression history on neural activity in BD are unknown. We aimed to dissociate neural activity reflecting past depression-load vs. present symptom severity using the Course and Outcome of Bipolar Youth (COBY), a prospective longitudinal cohort study of pediatric-onset BD. In n = 54 COBY (18–32 years), we modeled depression scores over time (up to 17.5 years) using a standardized autoregressive moving average (ARMA) model, followed by k-means cluster analysis. N = 36 healthy participants (HC, 20–36 years) were included. Using two factorial analyses, we parsed the impact of ARMA-defined past depression-load on neural activity from the impact of current symptoms on neural activity (p < 0.001, k > 30) and examined relationships with past and present symptoms (ps FDR-corrected). ARMA identified three COBY groups based on past depression-load. ARMA-defined COBY participants with the greatest past depression-load vs. other groups showed greater activity in right temporoparietal junction, thalamus, insula, premotor cortex, left fusiform gyrus, bilateral precuneus and cerebellum. In contrast, BD-COBY participants vs. HC showed greater activity in left hippocampus, dorsolateral prefrontal cortex, and right somatosensory cortex, plus the above thalamus, premotor cortex and cerebellum; activity positively correlated with present symptom severity in most regions. Past depression-load was related to social cognition and salience perception network activity, potentially reflecting heightened attention to socially relevant distracters, while present symptoms were associated with emotion processing and reappraisal network activity, potentially reflecting abnormal emotional experience and regulation. Differentiating aberrant neural activity related to long-term depression vs. present affective symptoms can help target interventions to networks associated with pathophysiological processes, rather than long-term illness effects.

Orbitofrontal Cortex Grey Matter Volume is Related to Children's Depressive Symptoms

Adults with a history of depression show distinct patterns of grey matter volume (GMV) in frontal cortical (e.g., prefrontal cortex, orbitofrontal cortex) and limbic (e.g., anterior cingulate, amygdala, hippocampus, dorsal striatum) structures, regions relevant to the processing and regulation of reward, which is impaired in the context of depression. However, it is unclear whether these GMV associations with depression precede depressive disorder onset or whether GMV is related to early emerging symptoms or familial depression. To address these questions, we used voxel-based morphometry (VBM) to examine GMV in 85 community-dwelling children (M = 11.12 years, SD = .63 years) screened for current and lifetime depression. Associations between children’s depressive symptoms (self- and mother-report of children’s symptoms), children’s maternal depression history, and GMV were examined. Although maternal depression history was unrelated to children’s GMV, child GMV in the orbitofrontal cortex (OFC) was negatively related to children’s self-reported depressive symptoms, using both a priori ROI and whole-brain analyses. Moderated regression analyses indicated that girls’ GMV was negatively related to girls’ depressive symptoms (as indexed by both self- and mother-report of girls’ symptoms), whereas boys’ symptoms were positively related to GMV. Our findings suggest that brain morphology in the OFC, a region with functional roles in processes relevant to depressive symptoms (i.e., reward-based learning and reward processing), is associated with early depressive symptoms prior to the development of clinically significant depression.