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Translational Psychiatry Sep 2023Rumination is a maladaptive style of regulating thoughts and emotions. It is a common symptom of Major Depressive Disorder (MDD), and more severe rumination is...
Rumination is a maladaptive style of regulating thoughts and emotions. It is a common symptom of Major Depressive Disorder (MDD), and more severe rumination is associated with poorer medication and psychotherapy treatment outcomes, particularly among women. It is unclear to what extent rumination may influence the outcomes of, or be responsive to, repetitive Transcranial Magnetic Stimulation (rTMS) treatment of MDD. We retrospectively examined data collected during rTMS treatment of 155 patients (age 42.52 ± 14.22, 79 female) with moderately severe treatment-resistant MDD. The severity of rumination and depression was assessed before and during a course of 30 sessions of measurement-based rTMS treatment using the Ruminative Responses Scale (RSS) and the Patient Health Questionnaire (PHQ-9), respectively. Relationships among baseline levels of rumination, depression, and treatment outcome were assessed using a series of repeated measures linear mixed effects models. Both depression and rumination symptoms significantly improved after treatment, but improvement in depression was not a significant mediator of rumination improvement. Higher baseline rumination (but not depression severity) was associated with poorer depression outcomes independently of depression severity. Female gender was a significant predictor of worse outcomes for all RRS subscales. Both depressive and ruminative symptoms in MDD improved following rTMS treatment. These improvements were correlated, but improvement in rumination was not fully explained by reduction in depressive symptoms. These findings suggest that while improvement in rumination and depression severity during rTMS treatment are correlated, they are partly independent processes. Future studies should examine whether rumination symptoms should be specifically targeted with different rTMS treatment parameters.
Topics: Female; Humans; Transcranial Magnetic Stimulation; Depressive Disorder, Major; Retrospective Studies; Depressive Disorder, Treatment-Resistant; Psychotherapy
PubMed: 37684229
DOI: 10.1038/s41398-023-02566-4 -
Journal of Medical Internet Research Sep 2023The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with...
Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study.
BACKGROUND
The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one's transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH).
OBJECTIVE
The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH.
METHODS
We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing.
RESULTS
Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA.
CONCLUSIONS
This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737.
Topics: Pregnancy; Humans; Female; Hypertension, Pregnancy-Induced; Anxiety; Anxiety Disorders; Emotions; Electronic Mail
PubMed: 37672324
DOI: 10.2196/42686 -
PloS One 2023Discontinuing antidepressant medication (ADM) can be challenging for patients and clinicians. In the current study we investigated if Mindfulness-Based Cognitive Therapy... (Randomized Controlled Trial)
Randomized Controlled Trial
Discontinuing antidepressant medication (ADM) can be challenging for patients and clinicians. In the current study we investigated if Mindfulness-Based Cognitive Therapy (MBCT) added to supported protocolized discontinuation (SPD) is more effective than SPD alone to help patients discontinue ADM. This study describes a prospective, cluster-randomized controlled trial (completed). From 151 invited primary care practices in the Netherlands, 36 (24%) were willing to participate and randomly allocated to SPD+MBCT (k = 20) or SPD (k = 16). Adults using ADM > 9 months were invited by GPs to discuss tapering, followed by either MBCT+SPD, or SPD alone. Exclusion criteria included current psychiatric treatment; substance use disorder; non-psychiatric indication for ADM; attended MBCT within past 5 years; cognitive barriers. From the approximately 3000 invited patients, 276 responded, 119 participated in the interventions and 92 completed all assessments. All patients were offered a decision aid and a personalized tapering schedule (with GP). MBCT consisted of eight group sessions of 2.5 hours and one full day of practice. SPD was optional and consisted of consultations with a mental health assistant. Patients were assessed at baseline and 6, 9 and 12 months follow-up, non-blinded. In line with our protocol, primary outcome was full discontinuation of ADM within 6 months. Secondary outcomes were depression, anxiety, withdrawal symptoms, rumination, well-being, mindfulness skills, and self-compassion. Patients allocated to SPD + MBCT (n = 73) were not significantly more successful in discontinuing (44%) than those allocated to SPD (n = 46; 33%), OR 1.60, 95% CI 0.73 to 3.49, p = .24, number needed to treat = 9. Only 20/73 allocated to MBCT (27%) completed MBCT. No serious adverse events were reported. In conclusion, we were unable to demonstrate a significant benefit of adding MBCT to SPD to support discontinuation in general practice. Actual participation in patient-tailored interventions was low, both for practices and for patients. (Trial registration: ClinicalTrials.gov PRS ID: NCT03361514 registered December 2017).
Topics: Adult; Humans; Mindfulness; Prospective Studies; Family Practice; General Practice; Antidepressive Agents
PubMed: 37669281
DOI: 10.1371/journal.pone.0290965 -
Frontiers in Psychology 2023Cognitive deficits are common and disabling residual symptoms following major depressive disorder (MDD) and are related to increased risk of relapse. Residual cognitive...
Long-term outcomes of an internet-delivered cognitive enhancement intervention targeting residual cognitive deficits after major depressive disorder: a 2-year follow-up of an open trial.
BACKGROUND
Cognitive deficits are common and disabling residual symptoms following major depressive disorder (MDD) and are related to increased risk of relapse. Residual cognitive deficits should thus be considered an important target for treatment. However, few have reported long-term outcomes of interventions targeting residual cognitive deficits.
OBJECTIVE
This study aimed to (1) investigate change between pre-treatment and 2-year follow-up assessments in cognitive deficits, rumination, and symptoms of MDD after an internet-delivered intervention targeting residual cognitive deficits; (2) to investigate stability in outcomes between 6-month and 2-year follow-up assessments; (3) to report the number of participants' experiencing a new episode of MDD in the follow-up period; and (4) to investigate differences in outcomes between those who experienced a new episode of MDD and those who did not.
METHODS
A total of 43 partly remitted adults were included to test a guided internet-delivered intervention, which consisted of 10 modules involving psychoeducation, cognitive strategies, and attention training. Participants were assessed at pre-treatment, post-treatment, after 6-months, and after 2-years, with measures assessing self-reported residual cognitive deficits, rumination, symptoms of MDD and relapse. Overall, 32 participants completed the 2-year follow-up assessment.
RESULTS
Between the pre-treatment and 2-year follow-up assessments, there was a reduction in cognitive deficits and rumination, while there was an increase in symptoms of MDD. Cognitive deficits were stable between the 6-month and the 2-year follow-up, while there was an increase in rumination and symptoms of MDD. Thirteen of 32 participants reported a new episode of MDD during the follow-up period. The relapse group reported longer duration of MDD at pre-treatment and showed a difference in all outcomes after 2 years compared to the no-relapse group. The no-relapse group showed improvement in MDD symptoms at post-treatment, while the relapse group did not.
CONCLUSION
Delivering cognitive enhancement interventions over the internet is potentially related to stable improvements in residual cognitive deficits. The effects on rumination and symptoms of MDD are less certain. Lack of improvement in MDD symptoms after the intervention period should be investigated as an indicator of relapse. Results should be interpreted with caution due to the lack of control group and sample size.
PubMed: 37655198
DOI: 10.3389/fpsyg.2023.1194689 -
Sleep Advances : a Journal of the Sleep... 2023Combining mindfulness with behavioral sleep strategies has been found to alleviate symptoms of insomnia and depression during pregnancy, but mechanisms for this...
OBJECTIVES
Combining mindfulness with behavioral sleep strategies has been found to alleviate symptoms of insomnia and depression during pregnancy, but mechanisms for this treatment approach remain unclear. The present study examined nocturnal cognitive arousal and sleep effort as potential treatment mechanisms for alleviating insomnia and depression via a mindfulness sleep program for pregnant women.
METHODS
Secondary analysis from a proof-of-concept trial of 12 pregnant women with DSM-5 insomnia disorder who were treated with Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness framework. Data were collected across eight weekly assessments: pretreatment, six sessions, and posttreatment. Measures included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale's cognitive factor (PSASC), and the Glasgow sleep effort scale (GSES). We used linear mixed modeling to test cognitive arousal and sleep effort as concurrent and prospective predictors of insomnia and depression.
RESULTS
Most patients reported high cognitive arousal before PUMAS (75.0%), which decreased to 8.3% after treatment. All insomnia remitters reported low cognitive arousal after treatment, whereas half of nonremitters continued reporting high cognitive arousal. Both nocturnal cognitive arousal and sleep effort were associated with same-week changes in insomnia throughout treatment, and sleep effort yielded a prospective effect on insomnia. Lower levels of nocturnal cognitive arousal and sleep effort prospectively predicted reductions in depression.
CONCLUSIONS
The present study offers preliminary evidence that reducing sleep effort and nocturnal cognitive arousal may serve as key mechanisms for alleviating insomnia and depression via mindfulness-based insomnia therapy. ClinicalTrials.gov ID: NCT04443959.
PubMed: 37645455
DOI: 10.1093/sleepadvances/zpad031 -
Journal of Dairy Science Dec 2023Understanding changes in parameters recorded by automated health monitoring systems based on ear-attached sensors on the days immediately before and after diagnosis of... (Observational Study)
Observational Study
Metritis and clinical mastitis events in lactating dairy cows were associated with altered patterns of rumination, physical activity, and lying behavior monitored by an ear-attached sensor.
Understanding changes in parameters recorded by automated health monitoring systems based on ear-attached sensors on the days immediately before and after diagnosis of metritis and clinical mastitis can help develop dairy cow health monitoring strategies. The objective of this observational cohort study was to characterize rumination time, physical activity, and lying time monitored by an ear-attached sensor before, during, and after clinical diagnosis (CD) of metritis and clinical mastitis. Lactating Holsteins monitored daily for 21 d in milk for detection of health disorders were retrospectively included in the no clinical health disorder group (NCHD; n = 616) if no disorders were diagnosed. Cows were included in the metritis (MET; n = 69) or clinical mastitis (MAST; n = 36) group if diagnosed only with nonsevere metritis (watery, reddish, and fetid uterine discharge with or without pyrexia) or nonsevere clinical mastitis (visibly abnormal milk secretion with or without signs of udder inflammation, with no pyrexia and no systemic signs of disease), respectively. Cows diagnosed with severe metritis (signs of metritis plus systemic signs of disease) or severe clinical mastitis (signs of mastitis plus pyrexia and systemic signs of disease), and cows diagnosed with nonsevere metritis or clinical mastitis plus another disorder within -7 to +7 d of CD of metritis or clinical mastitis diagnosis, were included in the metritis plus (MET+; n = 25) or the clinical mastitis plus (MAST+; n = 15) group, respectively. Cows were fitted with an ear-attached accelerometer to measure rumination time, physical activity, and lying time. Mean daily values, mean value absolute change, and relative change for the mean daily value from 3 or 5 d before CD to the nadir for cows with metritis and clinical mastitis, respectively, were analyzed with linear mixed models with or without repeated measures. Rumination time and physical activity were lesser, and lying time was greater for the MET and MET+ groups than for the NCHD group for most days from -4 to +7 d of CD of metritis. Generally, daily rumination time, physical activity, and lying time differences were greater and more prolonged between the MET+ and NCHD than between the MET and NCHD groups. Similarly, cows in the MAST and MAST+ groups had lesser rumination time and physical activity than cows in the NCHD group for several days before diagnosis. Lying time was greater for the MAST+ than the NCHD group on d -1 and 0 relative to CD. Absolute values and relative changes from 3 d before CD to the day of the nadir for rumination time and physical activity, or peak for lying time, were different for cows in the MET and MET+ groups than for the NCHD group. Similar results were observed for the MAST and MAST+ groups compared with the NCHD group. For cows with metritis, either an increase in rumination time and physical activity or a decrease in lying time was observed from the day of CD to resolution of clinical signs, but no changes were observed for the NCHD. Cows with clinical mastitis and the NCHD group had different rumination times, physical activity, and lying times on the day of CD and resolution of clinical signs, but cows with clinical mastitis had no significant changes from the day of CD to resolution of clinical signs. We conclude that cows affected by metritis and clinical mastitis presented substantial alterations of the patterns of rumination time, physical activity, and lying time captured by an ear-attached sensor. Thus, automated health monitoring systems based on ear-attached sensors might be used as an aid for identifying cows with metritis and clinical mastitis. Moreover, behavioral parameter changes after CD might be good indicators of resolution of clinical signs of metritis but not mastitis.
Topics: Humans; Female; Cattle; Animals; Lactation; Retrospective Studies; Cattle Diseases; Pelvic Inflammatory Disease; Milk; Mastitis; Exercise; Fever
PubMed: 37641281
DOI: 10.3168/jds.2022-23157 -
Journal of Dairy Science Dec 2023The objective of this observational cohort study was to characterize the pattern of rumination time (RT), physical activity (PA), and lying time (LT) monitored by an... (Observational Study)
Observational Study
Metabolic-digestive clinical disorders of lactating dairy cows were associated with alterations of rumination, physical activity, and lying behavior monitored by an ear-attached sensor.
The objective of this observational cohort study was to characterize the pattern of rumination time (RT), physical activity (PA), and lying time (LT) monitored by an automated health monitoring system, based on an ear-attached sensor, immediately before, during, and after clinical diagnosis (CD) of metabolic-digestive disorders. Sensor data were collected from 820 lactating Holstein cows monitored daily from calving up to 21 DIM for detection of health disorders (HD). Cows were grouped retrospectively in the no-clinical health disorder group (NCHD; n = 616) if no HD were diagnosed, or the metabolic-digestive group (METB-DIG; n = 58) if diagnosed with clinical ketosis or indigestion only. Cows with another clinical health disorder within -7 to +7 d of CD of displaced abomasum, clinical ketosis, or indigestion were included in the metabolic-digestive plus one group (METB-DIG+1; n = 25). Daily RT, PA, and LT, and absolute and relative changes within -7 to +7 d of CD were analyzed with linear mixed models with or without repeated measures. Rumination time and PA were smaller, and LT was greater for the METB-DIG and METB-DIG+1 group than for cows in the NCHD group for most days from -7 to +7 d of CD of HD. In general, daily RT, PA, and LT differences were larger between the METB-DIG+1 and NCHD groups than between the METB-DIG and NCHD groups. In most cases, RT and PA decreased to a nadir and LT increased to a peak immediately before or after CD of HD, with a return to levels similar to the NCHD group within 7 d of CD. Absolute values and relative changes from 5 d before CD to the day of the nadir for RT and PA or peak for LT were different for cows in the METB-DIG and METB-DIG+1 group than for the NCHD group. For PA, the METB-DIG+1 group had greater changes than the METB-DIG group. For cows affected by metabolic-digestive disorders, RT, PA, and LT on the day of CD and resolution of clinical signs were different than for cows in the NCHD group, but an increase in RT and PA or a decrease in LT was observed from the day of CD to the day of resolution of clinical signs. We conclude that dairy cows diagnosed with metabolic-digestive disorders including displaced abomasum, clinical ketosis, and indigestion presented substantial alterations in the pattern of RT, PA, and LT captured by an ear-attached sensor. Thus, automated health monitoring systems based on ear-attached sensors might be used as an aid for identifying cows with metabolic-digestive disorders. Moreover, RT, PA, and LT changes after CD might be positive indicators of recovery from metabolic-digestive disorders.
Topics: Female; Cattle; Animals; Humans; Lactation; Milk; Dyspepsia; Retrospective Studies; Ketosis; Cattle Diseases; Postpartum Period
PubMed: 37641247
DOI: 10.3168/jds.2022-23156 -
Behaviour Research and Therapy Sep 2023In Major Depressive Disorder, first evidence shows heightened mood-reactivity toward daily events. Related longitudinal studies in remitted patients with recurrent major...
In Major Depressive Disorder, first evidence shows heightened mood-reactivity toward daily events. Related longitudinal studies in remitted patients with recurrent major depression are lacking. Long-term changes in such short-term within-person associations can be analysed via measurement burst designs. Two bursts, separated by approximately 4.4 years, consisted of a baseline session and an Ambulatory Assessment (burst-1: 3 days, burst-2: 5 days). Via smartphone, 54 initially remitted patients with recurrent major depression indicated their negative and positive affect, rumination, self-acceptance, and the occurrence of negative and positive daily events ten times and collected saliva cortisol samples five times per day. In bursts with higher depression levels, patients showed blunted negative affect- and cortisol-reactivity and stronger decreases in positive affect and self-acceptance toward negative daily events, as well as stronger increases in self-acceptance following positive daily events. However, patients with higher depression levels demonstrated stronger ruminative stress-reactivity within bursts. Furthermore, patients with higher depression levels showed an increase of affective stress-reactivity over bursts, such that negative affect more strongly increased and positive affect more strongly decreased following negative daily events over bursts. Following positive daily events, patients with higher depression levels showed stronger decreases in negative affect within bursts and a decrease of self-acceptance-reactivity over bursts. To conclude, measurement burst designs enable to examine intraindividual variability and change of micro-level processes, and possible moderators thereof, potentially providing prognostic information for the course of recurrent major depression.
Topics: Humans; Depression; Depressive Disorder, Major; Hydrocortisone; Affect; Saliva; Chronic Disease; Stress, Psychological
PubMed: 37586185
DOI: 10.1016/j.brat.2023.104383 -
Comprehensive Psychiatry Oct 2023Although existing studies have proved that autistic traits (AT) may have relations to non-suicidal self-injury (NSSI) behaviors, its associations with anxiety,...
Although existing studies have proved that autistic traits (AT) may have relations to non-suicidal self-injury (NSSI) behaviors, its associations with anxiety, rumination and experiential avoidance (EA) are still unclear. The current study, based on a sample of 1317 Chinese college students, explored the associations between AT, anxiety and NSSI, and the possible modulating roles of rumination and EA in these associations. The results shows that 1) a total of 334 (25.36%) students reported a history of NSSI and 30 (2.28%) students were categorized as high AT; 2) Students with high AT reported higher rates of NSSI than those with low AT (36.67% vs. 25.10%); 3) AT, anxiety, rumination and EA have positive relations with NSSI; 4) AT predicted NSSI indirectly through anxiety; 5) Rumination and EA significantly moderated the effects of AT on NSSI via anxiety. In conclusion, this study confirms the indirect effect of AT on NSSI through anxiety in Chinese college students, and further clarifies the reinforcing effects of rumination and EA on the associations between AT, anxiety and NSSI. These findings suggest that developing adaptive emotion-regulating strategies and positive coping styles might promote the prevention and treatment of NSSI behaviors among autistic individuals.
Topics: Humans; Autistic Disorder; Anxiety; Emotions; Self-Injurious Behavior; Students
PubMed: 37566951
DOI: 10.1016/j.comppsych.2023.152407 -
Frontiers in Psychiatry 2023Mindfulness training among patients with major depressive disorder (MDD) reduces symptoms, prevents relapse, improves prognosis, and is more efficient for those with a...
Mindfulness training among patients with major depressive disorder (MDD) reduces symptoms, prevents relapse, improves prognosis, and is more efficient for those with a high level of trait mindfulness. Upon hospital admission, 126 MDD patients completed the Beck Depression Inventory (BDI), World Health Organization Quality of Life Brief, Five-Factor Mindfulness Questionnaire (FFMQ), and the Rumination Response Scale (RRS). The 65 patients that scored less than the median of all subjects on the FFMQ were placed into the low mindfulness level (LML) group. The other 61 patients were placed in the high mindfulness level (HML) group. All facet scores were statistically different between the mental health assessment scores of the HML and LML groups except for RRS brooding and FFMQ nonjudgement. Trait mindfulness level exhibited a negative and bidirectional association with MDD severity primarily through the facets of description and aware actions. Trait mindfulness was also related positively with age primarily through the facets of nonreactivity and nonjudgement. Being married is positively associated with trait mindfulness levels primarily through the facet of observation and by an associated increase in perceived quality of life. Mindfulness training prior to MDD diagnosis also associates positively with trait mindfulness level. Hospitalized MDD patients should have their trait mindfulness levels characterized to predict treatment efficiency, help establish a prognosis, and identify mindfulness-related therapeutic targets.
PubMed: 37496685
DOI: 10.3389/fpsyt.2023.1144989