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Journal of Affective Disorders Sep 2013Inflammatory markers are raised in cross-sectional studies of depressed patients and may represent an important mediating factor for behaviour, neural plasticity and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Inflammatory markers are raised in cross-sectional studies of depressed patients and may represent an important mediating factor for behaviour, neural plasticity and brain structure.
METHODS
We undertook a systematic review of longitudinal studies, investigating whether raised inflammatory markers indicate an increased risk of subsequent depressive symptoms. We searched three databases (1970-2012) for longitudinal studies with repeat data on CRP or IL-6 levels and subsequent depressive symptoms. We calculated effect sizes using a mixed-effects model, with separate meta-analyses for inflammatory markers and age groups.
RESULTS
We identified eight papers for CRP (14,832 participants) and three for IL-6 (3695 participants). There was a significant association between increased CRP and depressive symptoms (weighted-mean effect size 'unadjusted r'=0.069, p<0.0005; 'adjusted r'=0.046, p<0.0005), with moderate heterogeneity between studies (Q=11.21, p=0.08, I(2)=46.5). For IL-6 the weighted-mean effect size was smaller ('unadjusted r'=0.045, p-value=0.007; 'adjusted r'=0.097, p-value=0.06).
LIMITATIONS
The meta-analysis was based on a relatively small number of studies (particularly for IL-6) and only two inflammatory markers. There was moderate heterogeneity between studies and some evidence of publication bias.
CONCLUSIONS
Raised inflammatory markers have a small but significant association with the subsequent development of depressive symptoms. This is a robust effect which remains significant after adjustment for age and a wide range of factors associated with risk for depression. Our results support the hypothesis that there is a causal pathway from inflammation to depression.
Topics: Biomarkers; C-Reactive Protein; Cross-Sectional Studies; Depressive Disorder; Female; Humans; Interleukin-6; Male
PubMed: 23870425
DOI: 10.1016/j.jad.2013.06.004 -
Psychiatry and Clinical Neurosciences May 2023
Meta-Analysis
Topics: Male; Humans; Phosphodiesterase 5 Inhibitors; Depressive Disorder, Major
PubMed: 36806363
DOI: 10.1111/pcn.13537 -
Journal of Affective Disorders Feb 2016Comparisons of illness characteristics between patients with schizoaffective disorder (SAD) patients and unipolar depression (UD) are rare, even though UD is one of the... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Comparisons of illness characteristics between patients with schizoaffective disorder (SAD) patients and unipolar depression (UD) are rare, even though UD is one of the most important differential diagnoses of SAD. Also, the variability of illness characteristics (heterogeneity) has not been compared. We compared illness characteristics and their heterogeneity among SAD, UD, and - as another important differential diagnosis - schizophrenia (S).
METHODS
In order to reduce sampling bias we systematically searched for studies simultaneously comparing samples of patients with SAD, UD, and S. Using random effects and Mantel-Haenszel models we estimated and compared demographic, illness course and psychopathology parameters, using pooled standard deviations as a measurement of heterogeneity.
RESULTS
Out of 155 articles found by an earlier meta-analysis, 765 screened in Medline, 2738 screened in EMBASE, and 855 screened in PsycINFO we selected 24 studies, covering 3714 patients diagnosed according to RDC, DSM-III, DSM-IIIR, DSM-IV, or ICD-10. In almost all key characteristics, samples with schizoaffective disorders fell between unipolar depression and schizophrenia, with a tendency towards schizophrenia. On average, UD patients were significantly older at illness onset (33.0 years, SAD: 25.2, S: 23.4), more often women (59% vs. 57% vs. 39%) and more often married (53% vs. 39% vs. 27%). Their psychopathology was also less severe, as measured by BPRS, GAS, and HAMD. In demographic and clinical variables heterogeneity was roughly 5% larger in UD than in SAD, and samples of patients with schizophrenia had the lowest pooled heterogeneity. A similar picture emerged in a sensitivity analysis with coefficient of variation as the measurement of heterogeneity.
LIMITATIONS
Relative to bipolar disorder there are fewer studies including unipolar patients. No studies based on DSM-5 could be included.
CONCLUSIONS
Regarding unipolar affective disorder this study confirms what we have shown for bipolar disorders in earlier studies: schizoaffective disorder falls between schizophrenia and affective disorders, and there are relevant quantitative differences in key illness characteristics, which supports the validity of the schizoaffective disorder concept. Contrary to our expectations heterogeneity is not larger in SAD than in UD and not substantially higher than in S. Lower reliability of the diagnosis of SAD therefore cannot be ascribed to higher variability of illness characteristics in SAD.
Topics: Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Psychotic Disorders; Reproducibility of Results; Schizophrenia
PubMed: 26599364
DOI: 10.1016/j.jad.2015.10.045 -
Breast (Edinburgh, Scotland) Apr 2019Depressive symptoms are common comorbidities among breast cancer (BC) patients. Non-pharmacological therapies (NPTs) such as exercise and psychotherapy may reduce... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Depressive symptoms are common comorbidities among breast cancer (BC) patients. Non-pharmacological therapies (NPTs) such as exercise and psychotherapy may reduce depressive symptoms; however, the evidence is inconclusive. The objective of this study is to evaluate if NPTs reduce depressive symptoms among BC patients.
METHODS
A systematic review and meta-analysis of randomized clinical trials (RCTs) of NPTs for BC patients were performed. A literature search was conducted from eight databases in English, Portuguese and Spanish from 2006 to 2017. Inclusion criteria were: RCTs that evaluated depressive symptoms as a primary or secondary outcome that did not include pharmacological interventions and did include a non-intervened control group, with at least 30 participants in non-terminal BC stage with no current psychiatric illness. A meta-analysis for each NPT was performed with DerSimonian and Laird's method for the random effects model. Sensitivity analyses were conducted. Heterogeneity and publication bias were assessed.
RESULTS
A total of 41 eligible RCTs were identified. Overall, NPTs significantly reduced depressive symptoms (Summary standardized mean difference (SMD) = -0.516; 95%CI: -0.814, -0.218; I = 96.2). Of the types of NPTs, psychotherapy significantly reduced depressive symptoms (Summary SMD = -0.819; 95% CI: -1.608, -0.030; I = 91.53). A significant difference emerged for Mindfulness (Summary SMD = -0.241; 95% CI: -0.412, -0.070; I = 28.6%) and yoga (Summary SMD = -0.305; 95% CI: -0.602, -0.007; I = 41.0%) when the heterogeneity was reduced. No evidence of publication bias was observed.
CONCLUSIONS
Psychotherapy and mind-body therapies may reduce depressive symptoms in women with BC. Laughter and couples therapy warrant attention in future studies.
Topics: Biofeedback, Psychology; Breast Neoplasms; Depressive Disorder; Female; Humans; Mind-Body Therapies; Psychotherapy; Randomized Controlled Trials as Topic; Relaxation Therapy
PubMed: 30776733
DOI: 10.1016/j.breast.2019.01.006 -
International Journal of Geriatric... Sep 2016Supportive behaviors (both instrumental and emotional) from spouses and close family members can impact the trajectory of older adults' depressive symptoms.... (Review)
Review
OBJECTIVE
Supportive behaviors (both instrumental and emotional) from spouses and close family members can impact the trajectory of older adults' depressive symptoms. Interventions that target both the patient and support person may be more effective than interventions that target the patient only, in terms of alleviating mood symptoms in the identified patient. The purpose of this paper was to review the characteristics and findings of dyadic and family-oriented interventions for late-life mood disorders to determine if they are effective and beneficial.
METHODS
Following PRISMA guidelines, we conducted a systematic review of reports in the literature on dyadic or family-oriented interventions for late-life mood disorders. We searched PubMed, OVID PsycINFO, and EMBASE for peer-reviewed journal articles in English through October 2014.
RESULTS
We identified 13 articles, representing a total of 10 independent investigations. Identified studies focused on spouses and close family members as support persons. Effect sizes for dyadic interventions that treated major depressive disorder were, on average, moderately strong, while effect sizes for dyadic interventions that reduced depressive symptoms were generally small. We did not identify any dyadic studies that treated bipolar disorder.
CONCLUSIONS
This review showed that dyadic interventions are feasible and that these interventions can decrease symptomatology in individuals who have major depressive disorder. Research is needed to understand the relative efficacy of a dyadic approach over a single-target approach in treating depression. Copyright © 2016 John Wiley & Sons, Ltd.
Topics: Bipolar Disorder; Depressive Disorder; Depressive Disorder, Major; Family; Family Therapy; Humans; Mood Disorders; Spouses
PubMed: 26799782
DOI: 10.1002/gps.4434 -
The British Journal of Psychiatry : the... Feb 2017Many patients with depressive disorders demonstrate resistance to psychological therapy. A frequent finding is hypothalamic-pituitary-adrenal (HPA) axis alterations. As... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many patients with depressive disorders demonstrate resistance to psychological therapy. A frequent finding is hypothalamic-pituitary-adrenal (HPA) axis alterations. As cortisol is known to modulate cognitive processes, those patients may be less likely to profit from psychological therapy.
AIMS
To conduct a systematic review and meta-analysis on cortisol as a predictor of psychological therapy response.
METHOD
The Cochrane Library, EMBASE, MEDLINE and PsycINFO databases were searched. Records were included if they looked at patients with any depressive disorder engaging in psychological therapy, with a pre-treatment cortisol and a post-treatment symptom measure.
RESULTS
Eight articles satisfied our selection criteria. The higher the cortisol levels before starting psychological therapy, the more symptoms patients with depression experienced at the end of treatment and/or the smaller their symptom change.
CONCLUSIONS
Our findings suggest that patients with depression with elevated HPA functioning are less responsive to psychological therapy.
Topics: Depressive Disorder; Humans; Hydrocortisone; Outcome Assessment, Health Care; Psychotherapy
PubMed: 27908897
DOI: 10.1192/bjp.bp.115.180653 -
Revista Brasileira de Psiquiatria (Sao... Oct 2012Since the first publication of Cloninger's psychobiological model of personality, the relationship between temperament and character dimensions and psychiatric disorders... (Review)
Review
INTRODUCTION
Since the first publication of Cloninger's psychobiological model of personality, the relationship between temperament and character dimensions and psychiatric disorders has been widely studied. The exact nature of this interaction, however, is still unclear. Different models have been proposed (state-dependency, vulnerability, continuous spectrum etc).
OBJECTIVE
To analyze the relationship between temperament and character dimensions with depression and panic disorder.
METHOD
Systematic review on interventional studies published up until December 2011 on MEDLINE and ISI databases. Also, a brief review on genetic studies is hereby undertaken, aiming to discuss the gene-environment interaction in relation to this topic.
RESULTS
Thirteen studies were included: 10 related to depression and 3 to panic disorder (or unspecific anxiety symptoms). All of them showed association between high harm avoidance (HA) and low self-directedness (SD) with depression and anxiety symptoms. Longitudinal studies demonstrated that these traits may not be just state-dependent.
CONCLUSIONS
HA and SD dimensions are associated with both the occurrence of depressive and anxiety symptoms. There is also some evidence to suggest that high HA and low SD indicates susceptibility to depression. Longitudinal studies are not sufficient to affirm the same about panic disorder up to the present moment.
Topics: Character; Depression; Depressive Disorder; Humans; Mental Disorders; Panic Disorder; Personality Assessment; Temperament
PubMed: 23429781
DOI: 10.1016/j.rbp.2012.03.002 -
Journal of Affective Disorders Jul 2024This systematic review and meta-analysis aimed to address the limited generalizability of studies on defense mechanisms in depression by comparing depressive individuals... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review and meta-analysis aimed to address the limited generalizability of studies on defense mechanisms in depression by comparing depressive individuals with non-clinical controls (aim a) and examining changes throughout psychological interventions (aim b) (PROSPERO CRD42023442620).
METHODS
We followed PRISMA 2020 guidelines, searching PubMed/Web of Science/(EBSCO)PsycINFO until 13/04/2023 for studies evaluating defense mechanisms with measures based on the hierarchical model in depressive patients versus non-clinical controls or throughout psychological intervention. We conducted random-effect meta-analyses for mature defenses/non-mature (neurotic/immature) defenses/overall defensive functioning (ODF), with standardized mean difference (SMD) as outcome measure metric. Meta-regression/sub-group/sensitivity analyses were conducted. Study quality was appraised using the Newcastle-Ottawa Scale (NOS), and certainty of evidence for aim b outcomes was evaluated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).
RESULTS
18 studies were included (mean NOS score = 5.56). Depressive patients used significantly more non-mature defenses than non-clinical controls (SMD = 0.74; k = 13). Non-clinical controls did not significantly differ in use of mature defenses compared to depressive patients (SMD = 0.33; k = 14). Significant moderators were publication year/NOS score/geographical distribution/mean age for non-mature defenses and NOS score/geographical distribution for mature defenses. Throughout psychological interventions, only ODF significantly increased (SMD = 0.55; k = 2) (GRADE = very low).
LIMITATIONS
Quality of many studies was medium/sub-optimal, and longitudinal studies were scarce.
CONCLUSION
Individuals with depressive disorders show a high use of non-mature defenses that could be assessed and targeted in psychological interventions, especially in younger patients.
Topics: Humans; Depressive Disorder; Defense Mechanisms
PubMed: 38663554
DOI: 10.1016/j.jad.2024.04.091 -
Depression and Anxiety Sep 2016Internet-delivered cognitive behavioral therapy (iCBT) is a relatively novel treatment method that may improve the accessibility of mental health care for individuals... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Internet-delivered cognitive behavioral therapy (iCBT) is a relatively novel treatment method that may improve the accessibility of mental health care for individuals with posttraumatic stress disorder (PTSD). The aim of this meta-analysis was to evaluate the effectiveness of iCBT compared to inactive (waitlist control and treatment-as-usual (TAU)) and active other interventions in reducing PTSD symptoms.
METHODS
A meta-analysis of 12 randomized controlled trials (14 comparisons) and 1,306 participants was conducted.
RESULTS
The pooled effect size of the 11 comparisons (10 studies, 1,139 participants) that compared iCBT to waitlist and TAU control was moderate (g = 0.71, 95% CI [0.49-0.93], P < .001), and showed moderate heterogeneity. The pooled effect size of the three studies (three comparisons) comparing iCBT to other interventions was small (g = 0.28, 95% CI [-0.00 to 0.56], P = .05), with low heterogeneity.
CONCLUSION
The findings of this systematic review and meta-analysis show that iCBT is an effective treatment for individuals with PTSD and comorbid depressive symptoms. However, further research is needed for effective dissemination of iCBT in clinical practice.
Topics: Adult; Cognitive Behavioral Therapy; Comorbidity; Depressive Disorder; Female; Humans; Internet; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic; Therapy, Computer-Assisted; Treatment Outcome
PubMed: 27322710
DOI: 10.1002/da.22533 -
Psychiatry Research Nov 2018Cognitive deficits are frequently observed in major depressive disorder (MDD), as well as impaired long-term psychosocial functioning. However, the relationship between...
Cognitive deficits are frequently observed in major depressive disorder (MDD), as well as impaired long-term psychosocial functioning. However, the relationship between cognitive deficits and psychosocial functioning in MDD is under-investigated. We aim to systematically review the literature on the relationship between specific cognitive impairments and psychosocial functioning in MDD. We systematically reviewed English-language literature in PubMed, PsychINFO, Scopus and Web of Science using search terms related to psychosocial functioning. Additional studies were identified by searching reference lists. Following our inclusion/exclusion criteria, 28 studies were reviewed. Inclusion criteria included age (> 18), MDD diagnosed by standard tools (e.g., DSM-IV), use of cognitive and psychosocial assessments. Cross-sectional studies indicated that cognitive deficits in domains of executive functioning, attention, memory, and global cognition are associated with psychosocial dysfunction in domains of as quality of life, and social, occupational, and global functioning. The cognition-functioning relationship was also observed in longitudinal studies, showing that only specific cognitive domains affected psychosocial outcomes over the long-term course of illness. Older age and greater MDD symptom severity appear to enhance cognition-psychosocial dysfunction relationship, however little is known regarding the role of a number of other clinical factors (e.g., psychosis, illness duration).
Topics: Cognitive Dysfunction; Cross-Sectional Studies; Depressive Disorder, Major; Humans; Quality of Life; Social Behavior
PubMed: 30149273
DOI: 10.1016/j.psychres.2018.08.033