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Tag: depression

  • Early puberty in first-born daughters linked to prenatal stress in their mothers

    Early puberty in first-born daughters linked to prenatal stress in their mothers

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    A UCLA-led team of researchers has found a correlation between early signs of adrenal puberty in first-born daughters and their mothers’ having experienced high levels of prenatal stress. They did not find the same result in boys or daughters who were not first-born.

    The 15-year longitudinal study’s findings were published in the February issue of Psychoneuroendocrinology.

    The study was the first to identify earlier patterns of adrenal puberty as a result of prenatal stress. Adrenal puberty is marked by changes like the growth of body hair, pimples and aspects of cognitive maturation, but does not include breast development or the onset of menstruation for girls or testicular enlargement for boys.

    The finding adds to research in the field of fetal programming, studies that explore the impact that stress and other factors affecting pregnant mothers can have on fetuses and children long after birth.

    “This is a first-of-its-kind finding and is fascinating to look at through an evolutionary lens,” said UCLA anthropologist Molly Fox, who led the study with colleagues from UC Irvine, UC Merced, Chapman University and the University of Denver.

    Fox explains that a first-born daughter’s maturation, but not early onset of menstruation, may enable her to help her mother rear her other children successfully. The daughter becomes mature enough to help take care of children while not yet able to produce her own children, who would require her attention.

    The finding also provides insights into the so-called “eldest daughter syndrome,” the socio-cultural phenomenon discussed online that refers to the childcare and other domestic labor that first-born females often take on, consciously or unconsciously, to help with the traditional parental or adult responsibilities required to run a household. The online discussions focus on oldest daughters feeling an overwhelming sense of responsibility for their family’s well-being.

    Researchers recruited participants for the study from two obstetric clinics in Southern California during routine first trimester prenatal care visits. The women were 30 years old on average, all 18 or older, and experiencing singleton pregnancies. For about half of them, this was their first pregnancy. All were English-speaking, 45% were white/non-Latina and 30% were Latina. All were nonsmoking and not using steroid medications, tobacco, alcohol or other recreational drugs during pregnancy. Of the children born to these mothers, 48% were female and 52% were male.

    Women’s stress, depression and anxiety levels were measured at 15-, 19-, 25-, 31- and 37-weeks’ gestation to create a prenatal psychological distress composite score. They were also assessed at two to three months postpartum to assign a postnatal distress composite score. The depression assessment asked respondents to rate the truth of statements such as “I felt lonely.” An example of an anxiety question was how often they felt particular symptoms, such as “jittery.”

    At ages 8–10, 11–12 and 13–16, children’s biomarkers of adrenal and gonadal puberty were separately measured, including body hair, skin changes, growth in height or growth spurts, breast development and the onset of menstruation (in females), voice changes and facial hair growth (in males). Hormone levels that are indicators of adrenal and gonadal puberty were measured through saliva samples at all assessment stages.

    The study also measured childhood adversity to account for other factors known to correlate to early maturation or signs of puberty in children and adolescents. These included the death of a parent or parental separation before age 5, the absence of the father and low income-to-needs ratios experienced at ages 7–9.

    This research adds to the body of knowledge in our field showing the significant and lifelong impacts to women and their offspring when it comes to prenatal emotional, environmental and other factors. This is important as we continue to come up with practical and policy solutions that contribute to greater access to healthcare and the general wellbeing of pregnant mothers.”

    Molly Fox, UCLA anthropologist 

    Source:

    University of California – Los Angeles

    Journal reference:

    Fox, M. M., et al. (2024). Mothers’ prenatal distress accelerates adrenal pubertal development in daughters. Psychoneuroendocrinology. doi.org/10.1016/j.psyneuen.2023.106671.

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  • Sleep-circadian disturbances can trigger or worsen a range of psychiatric disorders

    Sleep-circadian disturbances can trigger or worsen a range of psychiatric disorders

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    Problems with our sleep and internal body clock can trigger or worsen a range of psychiatric disorders, according to a new review of recent research evidence.

    The review, published today [19 February] in Proceedings of the National Academy of Sciences (PNAS), suggests gaining a better understanding of the relationship between sleep, circadian rhythms and mental health could unlock new holistic treatments to alleviate mental health problems.

    Sleep-circadian disturbances are the rule, rather than the exception, across every category of psychiatric disorders. Sleep disturbances, such as insomnia, are well understood in the development and maintenance of psychiatric disorders, but our understanding of circadian disturbances lags behind.


    It is important to understand how these factors interact so we can develop and apply sleep-circadian interventions that benefit the sleep and mental health symptoms of patients.”


    Dr Sarah L. Chellappa from the University of Southampton, senior author of the review

    An international team of researchers from the University of Southampton, Kings College London, Stanford University and other institutions explored recent evidence on sleep and circadian factors, focusing on adolescents and young adults with psychiatric disorders. This is a time when people are most at risk of developing mental health disorders and when disruption to sleep and circadian rhythms are likely to occur.

    Insomnia is more common in people with mental health disorders than in the general population – during remission, acute episodes and especially in early psychosis, where difficulty falling and staying asleep affects over half of individuals. Around a quarter to a third of people with mood disorders have both insomnia and hypersomnia, where patients find it hard to sleep at night, but are sleepier in the daytime. Similar proportions of people with psychosis experience this combination of sleep disorders.

    Meanwhile, the few studies looking at circadian rhythm sleep-wake disorders (CRSWD) suggest that 32 per cent of patients with bipolar disorder go to sleep and wake later than usual (a condition called Delayed Sleep-Wake Phase Disorder). Body clock processes (such as endogenous cortisol rhythms) have been reported to run seven hours ahead during manic episodes and four to five hours behind during the depressive phase. Timing is normalized upon successful treatment.

    What are the mechanisms?

    The researchers examined the possible mechanisms behind sleep-circadian disturbances in psychiatric disorders. During adolescence, physiological changes in how we sleep combine with behavioural changes, such as staying up later, getting less sleep on school nights and sleeping in on weekends.

    Dr Nicholas Meyer, from King’s College London, who co-led the review said: “This variability in the duration and timing of sleep can lead to a misalignment between our body clock and our sleep-wake rhythms can increase the risk of sleep disturbances and adverse mental health outcomes.”

    Researchers also looked at the role of genes, exposure to light, neuroplasticity and other possible factors. Those with a genetic predisposition towards a reduced change in activity levels between rest and wake phases are more likely to experience depression, mood instability, and neuroticism. Population-level surveys show self-reported time outdoors was associated with a lower probability of mood disorder. Sleep is thought to play a key role in how the brain forms new neural connections and processes emotional memories.

    New treatments

    Dr Renske Lok, from Stanford University, who co-led the review said: “Targeting sleep and circadian risk factors presents the opportunity to develop new preventative measures and therapies. Some of these are population-level considerations, such as the timing of school and work days, or changes in the built environment to optimize light exposure. Others are personalized interventions tailored to individual circadian parameters.”

    Cognitive Behavioural Therapy for Insomnia (CBT-I) has been shown to reduce anxiety and depressive symptoms, as well as trauma symptoms in people experiencing PTSD.

    In unipolar and bipolar depression, light therapy (delivered on rising in the morning) was effective compared with a placebo. Using it in combination with medication was also more effective than using medication alone. Other findings suggest light is effective in treating perinatal depression.

    The timing of medication, meals and exercise could also impact circadian phases. Taking melatonin in the evening can help people with Delayed Sleep-Wake Phase Disorder to shift their body clock forward towards a more conventional sleep pattern and may have beneficial effects in comorbid psychiatric disorders. Nightshift work can adversely affect mental health but eating in the daytime rather than during the night could help, with research showing daytime eating prevents mood impairment.

    The review also points to innovative multicomponent interventions, such as Transdiagnostic Intervention for Sleep and Circadian dysfunction (Trans-C). This combines modules that address different aspects of sleep and circadian rhythms into a sleep health framework that applies to a range of mental health disorders.

    Dr Chellappa said: “Collectively, research into mental health is poised to take advantage of extraordinary advances in sleep and circadian science and translate these into improved understanding and treatment of psychiatric disorders.”

    The research was funded by the Alexander Von Humboldt Foundation.

    Source:

    University of Southampton

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  • Survey of US adults reveals common cognitive symptoms in post-COVID-19 patients, linked to impaired daily functioning and depression

    Survey of US adults reveals common cognitive symptoms in post-COVID-19 patients, linked to impaired daily functioning and depression

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    In a recent study published in the journal JAMA Network Open, a team of scientists examined how prevalent self-reported cognitive symptoms were in individuals with post-coronavirus disease 2019 (COVID-19) condition as compared to individuals who had prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections but had not developed post-COVID-19 condition. They also evaluated the impact of these cognitive symptoms on mood, function, and employment status.

    Study: Cognitive Symptoms of Post–COVID-19 Condition and Daily Functioning. Image Credit: PeopleImages.com - Yuri A/Shutterstock.com
    Study: Cognitive Symptoms of Post–COVID-19 Condition and Daily Functioning. Image Credit: PeopleImages.com – Yuri A/Shutterstock.com

    Background

    One of the long-term impacts of the COVID-19 pandemic has been post-COVID-19 condition, commonly referred to as long coronavirus disease (long COVID), where the symptoms of acute SARS-CoV-2 infections persist or remerge months after recovering from the initial infection. The condition consists of wide-ranging symptoms affecting numerous organ systems, with fatigue, shortness of breath, and post-exertional malaise being the most common symptoms.

    Changes in mood and cognitive impairments have also been reported, with studies confirming the long-lasting impact of SARS-CoV-2 infections on neurological health. These persistent physical and neurological symptoms continue to have a significant impact on the functioning and quality of life of the patients long after they have recovered from the initial infection. Understanding how this condition impacts the individual’s productivity or employment status is essential to forming effective treatment mechanisms and public health strategies.

    About the study

    In the present study, the researchers used data from a survey conducted across the United States (U.S.) during two COVID-19 waves among individuals who had reported post-COVID-19 condition symptoms and those who reported complete recovery after a SARS-CoV-2 infection. The data was collected between December 2022 and January 2023 and then again from April to May 2023 across 50 U.S. states.

    The participants were above 18 years of age, and the study population was balanced for demographic factors such as gender, age, race, and ethnicity. A validated measure for patient-reported outcomes was used to design the questions on cognitive symptoms, which largely included questions on how often patients experienced specific symptoms over the previous week with replies on a five-point scale.

    The questions addressed the prevalence of symptoms such as trouble remembering, trouble starting tasks, slowed thinking, finding multitasking difficult, decision-making problems, and needing to pay extra attention to avoid errors. The number of symptoms and presence of these symptoms based on an occurrence rate of at least once a day were recorded for each patient.

    A nine-item questionnaire was also used to assess depressive symptoms in patients. Additionally, the patients were asked to describe how these cognitive post-COVID-19 symptoms interfered with their daily activities. The employment status of the participants was also recorded and categorized as full-time, contract, part-time, self-employed, homemaker, student, retired, or unemployed.

    Sociodemographic information collected from the participants included self-reported race and ethnicity data. The initial SARS-CoV-2 infection and post-COVID-19 condition were defined based on self-reported symptoms from the participants, such as reports of positive test results for COVID-19.

    Results

    The results showed that cognitive symptoms were prevalent in individuals experiencing post-COVID-19 conditions, and these symptoms were associated with functional impairments and a lower likelihood of holding full-time employment. The severity of depressive symptoms was also greater for individuals with cognitive post-COVID-19 symptoms.

    The number of individuals with post-COVID-19 condition who reported experiencing cognitive impairments was significantly higher than those who reported cognitive symptoms but did not have post-COVID-19 condition. Furthermore, women, younger individuals, and people with lower income levels showed a higher prevalence of cognitive symptoms than those in other sociodemographic groups.

    The researchers believe that the higher prevalence of cognitive impairments reported among younger individuals could be due to the notable change from the baseline measurements before the COVID-19 pandemic. Among older individuals, who might already be experiencing cognitive decline associated with age, the cognitive impairments due to post-COVID-19 condition might not be as apparent as in younger individuals.

    The study also suggested that the association between increased prevalence of cognitive impairments among individuals from lower-income households could reflect the influence of economic stress on the vulnerability to cognitive symptoms of post-COVID-19 conditions.

    Conclusions

    Overall, the study found that cognitive decline was highly prevalent among individuals with long COVID or post-COVID-19 conditions, especially among younger individuals, women, and those from low-income households.

    Furthermore, the probability of full-time employment was found to be lower among individuals experiencing cognitive impairments due to long COVID, highlighting the need for public health strategies and treatment measures to improve the quality of life and functional abilities of individuals suffering from post-COVID-19 condition.

    Journal reference:

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  • Can grandparental support improve the mental health of single mothers?

    Can grandparental support improve the mental health of single mothers?

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    In a recent study in Population Studies, researchers explored the role of grandparental support in protecting mothers from depression.

    Their results indicate that grandparental support may matter more for single mothers, while the role of grandmothers is more significant than that of grandfathers.

    Study: Grandparental support and maternal depression: Do grandparents’ characteristics matter more for separating mothers? Image Credit: Monkey Business Images/Shutterstock.comStudy: Grandparental support and maternal depression: Do grandparents’ characteristics matter more for separating mothers? Image Credit: Monkey Business Images/Shutterstock.com

    Background

    Mothers often bear a larger share of childcare responsibilities compared to fathers, especially among single parents due to various circumstances such as widowhood or separation. In many cases of parental separation, children tend to primarily reside with their mothers, even when custody is shared.

    Separated mothers may need the support of family members as they navigate the challenges associated with single parenthood.

    Grandparents can be a significant source of support for families with young children, particularly if they are younger, retired, healthy, and live close to their children and grandchildren.

    Having a strong support system is known to be protective against depression, but few studies have explored the association between grandparental support and maternal depression.

    Single mothers may be more likely to develop symptoms of depression and emotional stress than those who are partnered. Therefore, such investigations affect parental well-being, childcare, and related social policies.

    About the study

    In this study, researchers explored whether maternal depression differed based on the characteristics of grandparents, if these differences were greater for separating mothers compared to partnered ones, and whether grandparent characteristics lead to different trajectories in maternal depression when they are separating.

    Focusing on mothers of children aged less than 12 years, the authors measured depression by using antidepressant purchases as a proxy, though this could underestimate mild depressive symptom prevalence.

    The mothers were all born in Finland from 1945 to 1995. Mothers who were followed for at least three hours between 2000 and 2014 and whose children could be linked to at least one grandparent were included in the study.

    The dataset included information on three generations – children, biological parents, and maternal and paternal grandparents.

    Mothers were classified as non-separating if their union had not been dissolved during the child’s 13th birthday. In contrast, separated mothers lived with their children for a year after a parental separation. Maternal age, income, education, employment status, and area of residence were included as controls.

    The grandparents’ characteristics were age, union stability, geographical proximity, and health. Lower age, stable unions, greater geographical proximity, and good health were beneficial and hypothesized to be associated with lower maternal depression.

    These effects were also predicted to be greater for separating mothers compared to non-separating ones and grandmothers compared to grandfathers.

    Findings

    Grandparents were less than 70 years old on average, and separating mothers were more likely than non-separating ones to have parents who were still working.

    Non-separating mothers were less likely to live close to their parents but more likely to live close to their parents-in-law. Separating mothers were likelier to have parents or in-laws who did not live together.

    Mothers were more likely to use antidepressants if their children’s grandparents were older, in poor health, or were not employed.

    They were also more likely to have bought the medication if they did not live close to their children’s grandparents or if their parents did not live together. All mothers were significantly more likely to use antidepressants if their parents were in poor health.

    As predicted, these differences were more pronounced for mothers who were separating from their partners, who were also significantly more likely to use antidepressants.

    Maternal grandparents, particularly the grandmother, had a particularly important role to play in reducing maternal depression.

    The use of psychotropic medications by mothers showed similar trends to antidepressant use, suggesting that the results were robust to multiple mental health treatments.

    Conclusions

    The findings demonstrate how multigenerational support exchanges can have important implications for mental health.

    Grandparents provide support and resources for their daughters as they bring up their children, reducing mental stress and depression during this critical time.

    These contributions are even more significant during periods of upheaval, such as maternal separation from their partner.

    A limitation of the study is that it uses antidepressant and psychotropic medication use as a proxy for depression; however, this may underestimate actual depression prevalence since it may not capture less severe symptoms.

    For children whose parents were separated, the dataset did not include information on the father’s involvement after separation. Exchanges of support between generations were also not directly measured.

    Focusing only on Finland, the results of this study cannot be easily generalized to other populations. Future research can shed further light on these gaps.

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  • Unlocking the brain’s decision-making secrets for future insights

    Unlocking the brain’s decision-making secrets for future insights

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    Researchers at Washington University School of Medicine in St. Louis have found important clues to how people make choices involving obtaining information about the future. The scientists identified a set of mental rules that governs decision-making about rewards, including cognitive rewards such as satisfying curiosity, and they identified the part of the brain that regulates this type of decision-making.

    Researchers at Washington University School of Medicine in St. Louis have new insight on what goes on inside people’s heads as they make decisions to obtain information about the future. The scientists identified a set of mental rules that governs decision-making about physical rewards — for example, food or money — and cognitive rewards – like the joy felt when accessing sought information. And they identified the part of the brain that regulates this type of decision-making. The process occurs in the lateral habenula, an ancient brain structure shared by species as distantly related as people and fish.

    The findings not only offer insight on the body’s most mysterious organ but have potential to help people struggling with tough choices, whether due to the inherent complexity of certain decisions — such as whether to take a genetic test that might return unwelcome information — or due to mental illnesses that affect the ability to make decisions, such as obsessive-compulsive disorder (OCD), anxiety and depression.

    The study is available in Nature Neuroscience.

    Identifying the circuits involved with assigning value to cognitive rewards, like information about the future, is really important, because that kind of valuation is often what breaks down in mental disorders. If we can understand exactly what part of the decision-making process is malfunctioning in an individual, we may be able to target that aspect of the process precisely and treat some mental illnesses more effectively.”


    Ilya Monosov, PhD, senior author, professor of neuroscience at Washington University

    Making a choice between two options often requires weighing the values of and making trade-offs between multiple factors. Some of these factors are concrete and practical. But there are also intangible factors that can provide powerful motivation to choose one option over another, such as the desire to satisfy curiosity and gain information. Some information has practical value, of course, such as advance warning of an incoming hurricane. But experiments have shown that people and animals value obtaining information even when they cannot parlay it into something useful.

    “Take, for example, a student who turns in a final exam and then wants to know the results immediately,” said co-first author Yang-Yang Feng, an MD/PhD student who designed and led the the study’s experiments with human participants. “Finding out your score today versus finding out in a week won’t change the results or gain you any kind of advantage. But some people want to know so badly that they will pay to find out early. That’s called noninstrumental information seeking, trying to obtain information for its own sake.”

    Historically, the drive to obtain practical rewards, such as money or food, and the drive to obtain information have been studied as separate phenomena. This division is artificial and oversimplifies the choices people make in the real world, the researchers said.

    Feng and co-first author Ethan Bromberg-Martin, PhD, a senior scientist in Monosov’s lab, designed experiments that required participants to make trade-offs between rewards and noninstrumental information, to come to a final decision. Study participants were given a choice between two options, each of which gave them a chance at obtaining a few cents. The amount of money they could win and the likelihood of winning it varied. Some of the options came with the promise to learn the outcome early, before actual money arrived. In separate experiments, monkeys were offered analogous choices, with juice as the reward instead of money.

    “By analyzing the trade-offs individuals made, we were able to work out some of the rules that individuals use to decide how much they’re willing to pay for information,” Bromberg-Martin said. “These rules generalized between humans and animals, suggesting that this abstract value may be conserved through evolution.”

    One of the key principles they uncovered is that individuals seek information largely to resolve uncertainty. The more uncertainty, the more they are willing to pay for information about it. Intuitively, this makes sense. You would probably be willing to pay more to find out the outcome of a $100 bet than a $1 bet, especially if you could get the information sooner rather than later. These and other principles form a logical framework that the brain relies on to make choices.

    But sometimes the system malfunctions.

    “Some people with OCD exhibit what’s known as checking behaviors, where they go back and check the same thing over and over,” Monosov said. “This is aberrant information-seeking behavior, and it is basically due to a misprocessing of uncertainty.”

    As part of this study, the team discovered that decision-making algorithms are implemented through a neurological circuit that culminates in the lateral habenula, a tiny structure located deep in the brain. The lateral habenula is a major regulator of dopamine and has been linked to mental illnesses including depression, anxiety and OCD.

    The team is working on using tasks requiring participants to make choices, similar to those in this study, to classify people with OCD into subtypes that correspond to how their brains process uncertainty. Doing so would be a step toward more targeted therapies.

    “A person may be fine in some regards, but their uncertainty processing is off in one specific way,” Monosov said. “Rather than saying that someone has a broad mental disorder such as OCD, we could say that their uncertainty processing is broken in this specific way, and here’s how we can modulate it. It’s a step toward more personalized medicine for mental illnesses.”

    Source:

    Washington University School of Medicine

    Journal reference:

    Bromberg-Martin, E. S., et al. (2024). A neural mechanism for conserved value computations integrating information and rewards. Nature Neuroscience. doi.org/10.1038/s41593-023-01511-4.

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  • Exercise is an effective treatment for depression, with walking, jogging, yoga, and strength training more effective than other exercises

    Exercise is an effective treatment for depression, with walking, jogging, yoga, and strength training more effective than other exercises

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    In a recent systematic review and network meta-analysis published in the British Medical Journal, researchers determined the potentially most effective exercise regimen and dosage in managing major depressive disorder (MDD) in comparison to antidepressants, psychotherapy, and control interventions.

    Study: Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. Image Credit: Dmytrenko Vlad/Shutterstock.com
    Study: Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. Image Credit: Dmytrenko Vlad/Shutterstock.com

    They found that exercise, in the form of yoga, walking, jogging, or strength training, is an effective and well-tolerated treatment for depression, suggesting its potential as a core intervention alongside antidepressants and psychotherapy, regardless of comorbidities or baseline depression levels.

    Background

    MDD is a leading global cause of disability, impacting life satisfaction significantly and exacerbating comorbidities. Despite the availability of treatments, the potential resistance and limited access to them emphasize the urgent need for evidence-based interventions. Although exercise is suggested as a potential adjunct or alternative to traditional treatments for depression, backed by international guidelines, the recommendations on dose and modality vary across regions. Guidelines suggest diverse approaches, including group exercise programs, aerobic or resistance training, or a combination of both.

    Existing pairwise meta-analyses assessing specific exercise modalities versus comparators face challenges due to heterogeneous treatments and comparisons, leading to ambiguous effect estimates. Overviews of reviews have attempted to address this by combining pairwise meta-analyses, but differences in analytical methods can still lead to confusion.

    In this regard, network meta-analyses may offer a more precise approach by simultaneously modeling direct and indirect comparisons between interventions. Previous network meta-analyses have examined the effects of exercise on various outcomes, including depression, but may have been underpowered to explore moderators such as dose and modality.

    To address this gap, researchers in the present study conducted a comprehensive search of randomized trials to identify the optimal dose and modality of exercise for depression, considering factors like participants’ sex, age, and baseline depression level. To enhance the intervention effects for depression, they investigated autonomy support and behavior change techniques, examining their associations with intervention outcomes. Additionally, they explored intervention mechanisms, including self-confidence and affect, through formal mediation analyses in the included studies.

    About the studyTop of Form

    In the present study, randomized controlled trials investigating exercise as a treatment for depression were included, with participants meeting the criteria for MDD, either clinically diagnosed or self-reported to exceed established clinical thresholds. Data were sourced from Medline, Embase, Cochrane Library, SPORTDiscus, and PsycINFO databases. Studies were eligible whether all participants or only a subgroup had depression.

    Studies with various comparison conditions, participant profiles, and languages were considered, aiming to evaluate exercise’s efficacy in depression treatment comprehensively. Exclusion criteria were interventions shorter than a week, insufficient depression outcome data, and inability to calculate effect sizes. A total of 218 studies were included, with 495 arms and 14,170 participants.

    For each study, intervention details, including exercise frequency, intensity, type, and duration, were assessed alongside behavior change techniques, level of autonomy, comparison conditions, and participant characteristics. The energy expenditure dose of exercise was determined for each arm in the form of metabolic equivalents of task (METs) min/week.

    The risk of bias in the included studies was assessed using Cochrane’s tool. Bayesian arm-based multilevel network meta-analysis models were employed for main and moderation analyses, using standardized mean change from baseline as the summary measure. Active control conditions were grouped together (such as usual care and placebo tablet), while waitlist control was considered separately due to its typically poorer effects. Netmeta and CINeMA were used for assessing credibility and modeling acceptability. Prespecified moderation and sensitivity analyses were performed to assess the robustness of the findings.

    Results and discussion

    Compared to active controls, dance showed large reductions in depression (Hedges’ g -0.96), followed by moderate reductions for walking or jogging (g -0.63), yoga (g -0.55), strength training (g -0.49), mixed aerobic exercises (g -0.43), and tai chi or qigong (g -0.42). Moderate effects were also seen on combining exercise with SSRIs (short for selective serotonin reuptake inhibitor, g -0.55) or combining aerobic exercise with psychotherapy (g -0.54).

    These treatments outperformed the clinically important difference threshold (g -0.20). Strength training and yoga had lower dropout rates compared to active controls and were perceived as the most acceptable options. Effects were moderate for cognitive behavior therapy alone (g -0.55) and small for SSRIs (g -0.26). However, while the publication bias was found to be low, only one study met the criteria for low risk of bias.

    Although the review provides insights into the potential of dance for the treatment of depression, the small number of studies, bias in study designs, and lack of blinding in interventions limit the strength of the overall recommendations.

    Conclusion

    In conclusion, as per the study, exercises including walking, strength training, and yoga show promise as a treatment for depression, although the confidence in the findings may vary. In the future, tailoring exercise-based interventions to suit individual characteristics and combining them as core treatment along with antidepressants and psychotherapy may improve the outcomes for patients with MDD, offering accessible options, particularly for those with barriers to participation.

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  • Proximity and health of grandparents influence mothers’ antidepressant use

    Proximity and health of grandparents influence mothers’ antidepressant use

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    Mothers are less likely to take antidepressants if their own parents and parents-in-law are healthy and live close by– a new study finds.

    On the flip side of the coin, antidepressant use was highest in mothers whose parents and parents-in-law were elderly, in poor health, and lived far away – possibly due to the stress caused by needing to care for and support older grandparents instead of receiving help from them.

    The findings of this new longitudinal study which tracked 488,000 mothers of young children between 2000-2014 are published today in the peer-reviewed journal Population Studies.

    Previous studies have consistently shown that younger grandparents in good health are more likely to provide support and childcare.”


    Niina Metsä-Simola, co-author of the study and demographics researcher at the University of Helsinki

    “Whereas having an old and frail grandparent may even place an additional burden on mothers, as they cannot expect to receive support from such grandparents but instead need to continue providing support upwards.”

    In the group assessed, of mothers in Finland, the effect was seen to be strongest for women who separated from their partners during the study period. “This makes sense,” Metsä-Simola suggests, “as separated mothers often take on primary physical custody of their child, and may often need to rely on relatives to cope with the challenges of single motherhood.

    “Mothers in such a situation may need to take on additional work, affecting their need for childcare, and may even need to move home. Having practical and emotional support at such a time would be invaluable.

    “Parents of young children, especially those entering single parenthood, may be especially vulnerable to the adverse mental health effects of separation.

    “This could explain why, in our study, grandparental support was particularly relevant for the mental health of separating mothers.

    According to Metsä-Simola, the fact that these findings were documented in Finland – a country with a long history of pro-egalitarian policies – is highly relevant.

    In Finland and other Nordic countries, mothers have universal access to health and social services, as well as affordable early-childhood care and education. Low-cost housing with care is provided for older people. Yet despite such generous policies, there was still a link between grandparents’ proximity, age, and health, and mothers’ antidepressant use. It remains to be seen if the link is stronger in less egalitarian countries like the UK.

    “Our study suggests that support exchanges across generations matter for mothers’ mental health, even in the context of a Nordic welfare state where all parents-;including single parents-;benefit from generous institutional support,” says Metsä-Simola.

    “Even in the pro-egalitarian context of Finland, potential availability of grandparental support matters for maternal mental health, especially among the vulnerable population subgroup of separating mothers.”

    Although the research team was able to measure several characteristics of both the maternal and paternal grandparents, a limitation of the study was that their data set contained no direct measure of the support exchanges between mothers and grandparents.

    This meant that they could not observe how often grandparents provided childcare and how involved they were in the lives of their children and grandchildren.

    The paper recommends that future research could adopt a “broader perspective”, studying whether the depression trajectories of separating childless women are moderated by the characteristics of their own parents and (ex-)parents-in-law, as these women do not receive childcare help but may still benefit from other types of support.

    In addition, the team suggests future research examines how women’s other characteristics, such as partnership and fertility behaviors, shape the association between their parents’ characteristics and their own mental health.

    Source:

    Journal reference:

    Metsä-Simola, N., et al. (2024) Grandparental support and maternal depression: do grandparental characteristics matter more for separating mothers?. Population Studies. doi.org/10.1080/00324728.2023.2287493.

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  • Interpersonal distrust from childhood bullying linked to mental health problems in teens

    Interpersonal distrust from childhood bullying linked to mental health problems in teens

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    A new study, co-led by UCLA Health and the University of Glasgow, found that young teenagers who develop a strong distrust of other people as a result of childhood bullying are substantially more likely to have significant mental health problems as they enter adulthood compared to those who do not develop interpersonal trust issues.

    The study, published in the journal Nature Mental Health on Feb. 13, is believed to be the first to examine the link between peer bullying, interpersonal distrust, and the subsequent development of mental health problems, such as anxiety, depression, hyperactivity and anger.

    Researchers used data from 10,000 children in the United Kingdom who were studied for nearly two decades as part of the Millennium Cohort Study. From these data, the researchers found that adolescents who were bullied at age 11 and in turn developed greater interpersonal distrust by age 14 were around 3.5 times more likely to experience clinically significant mental health problems at age 17 compared to those who developed less distrust.

    The findings could help schools and other institutions to develop new evidence-based interventions to counter the negative mental health impacts of bullying, according to the study’s senior author Dr. George Slavich, who directs UCLA Health’s Laboratory for Stress Assessment and Research.

    There are few public health topics more important than youth mental health right now. In order to help teens reach their fullest potential, we need to invest in research that identifies risk factors for poor health and that translates this knowledge into prevention programs that can improve lifelong health and resilience.”


    Dr. George Slavich,  study’s senior author

    The findings come amid growing public health concerns about the mental health of youth. Recent studies by the U.S. Centers for Disease Control and Prevention found that 44.2% of sampled high school students in the U.S. reported being depressed for at least two weeks in 2021, with one in 10 students who were surveyed having reported attempted suicide that year.

    In this new study, the researchers viewed these alarming trends from the perspective of Social Safety Theory, which hypothesizes that social threats, such as bullying, impact mental health partly by instilling the belief that other people cannot be trusted, or that the world is an unfriendly, dangerous or unpredictable place.

    Prior research has identified associations between bullying and mental and behavioral health issues among youth, including its impact on substance abuse, depression, anxiety, self-harm and suicidal thoughts. However, following youth over time, this study is the first to confirm the suspected pathway of how bullying leads to distrust and, in turn, mental health problems in late adolescence.

    Slavich said when people develop clinically significant mental health problems during the teenage years, it can increase their risk of experiencing both mental and physical health issues across the entire lifespan if left unaddressed.

    In addition to interpersonal distrust, the authors examined if diet, sleep or physical activity also linked peer bullying with subsequent mental health problems. However, only interpersonal distrust was found to relate bullying to greater risk of experiencing mental health problems at age 17.

    “What these data suggest is that we really need school-based programs that help foster a sense of interpersonal trust at the level of the classroom and school,” Slavich said. “One way to do that would be to develop evidence-based programs that are especially focused on the transition to high school and college, and that frame school as an opportunity to develop close, long-lasting relationships.”

    The study was co-authored by Dr. George Slavich, Professor of Psychiatry and Biobehavioral Sciences at UCLA, and Dr. Dimitris Tsomokos, a researcher at the University of Glasgow.

    Source:

    University of California – Los Angeles Health Sciences

    Journal reference:

    Tsomokos, D. I., & Slavich, G. M. (2024). Bullying fosters interpersonal distrust and degrades adolescent mental health as predicted by Social Safety Theory. Nature Mental Health. doi.org/10.1038/s44220-024-00203-7.

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  • Trial investigates efficacy of online supervised group mental and physical rehabilitation program for long COVID patients

    Trial investigates efficacy of online supervised group mental and physical rehabilitation program for long COVID patients

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    In a recent study published in the BMJ, researchers evaluated the efficacy of an online supervised group mental and physical rehabilitation program in adults with long COVID.

    Study: Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial. Image Credit: Dmitry Demidovich/Shutterstock.com
    Study: Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial. Image Credit: Dmitry Demidovich/Shutterstock.com

    Background

    Over 17 million people in the European region of the World Health Organization (WHO) may have experienced coronavirus disease 2019 (COVID-19) symptoms longer than four weeks. Common symptoms of this multisystem condition, known as long COVID or post-COVID-19 condition, include muscle aches, fatigue, dyspnea, and cognitive dysfunction that can profoundly impact quality of life, societal participation, and economic productivity. The pathophysiology of long COVID has not been fully characterized.

    As such, current medical management and treatments have limited efficacy. The biopsychosocial care model may improve outcomes for long COVID patients. Multicomponent mental and physical rehabilitation could improve fatigue, quality of life, and breathlessness. So far, few quasi-experimental studies evaluated exercise-based interventions for individuals with long COVID, with no definitive, high-quality evidence.

    About the study

    In the present study, researchers evaluated the clinical effectiveness of a group rehabilitation program for people with long COVID. The rehabilitation exercise and psychological support after COVID-19 infection (REGAIN) was a multi-center, parallel-group, pragmatic, randomized controlled trial. Participants were recruited in England and Wales. Adults (26-86 years) discharged at least three months after hospitalization with COVID-19 who had ongoing mental and physical sequelae were recruited.

    Subjects were excluded if they had severe mental health problems, contraindications to exercise training, or were enrolled in other rehabilitation programs. A baseline questionnaire was administered before randomization to REGAIN or usual care. Usual care participants received the best practice usual care; this involved an online consultation with a trained practitioner, wherein generic advice was provided on recovery and physical activity.

    The REGAIN intervention was an eight-week, supervised, home-based, group rehabilitation program, providing online consultation with a REGAIN practitioner. REGAIN participants joined weekly live online group exercise and psychological support sessions. Equipment-free, supervised, personalized exercise sessions were delivered in online groups to improve fatigue, cardiovascular fitness, balance, and strength and restore confidence in daily living activities.

    Psychological support sessions were aimed at augmenting psychological capability and increasing COVID-19-related knowledge and its impact on everyday life. The primary outcome of the study was health-related quality of life, determined using the patient-reported outcomes measurement information system (PROMIS). Secondary outcomes included dyspnea, cognitive function, physical activity, anxiety, depression, and general health, among others. Outcomes were assessed at three, six, and 12 months.

    Findings

    Of over 39,000 people invited to participate between January 2021 and July 2022, 1,043 expressed interest. Following exclusions, 298 and 287 subjects were randomized to REGAIN and usual care, respectively. Most participants were female (52%), White (88%), and obese/overweight (88%). One-third of participants required intensive care during COVID-19 hospitalization.

    The average time from discharge to randomization was 323 days. The baseline health-related quality of life was low; around 40% had low physical activity. More than a third of participants could not work due to long COVID. Primary outcome data were available for 80% of REGAIN and 86% of usual care participants. The health-related quality of life improved more for REGAIN participants than usual care recipients at three months.

    There was a significant group difference in health-related quality of life, primarily driven by three PROMIS sub-scores – fatigue, depression, and pain interference. While the effect of the intervention was not evident at six months, it was sustained at 12 months. REGAIN participants had increased odds of being more physically active than usual care recipients. At three months, 7% more REGAIN subjects met the physical activity guideline (> 150 minutes of moderate-intensity activity per week).

    Furthermore, more REGAIN participants reported feeling much better compared to three months than usual care subjects. Adverse events were reported in both groups. Most serious adverse events were related to hospitalization or extended stay at the hospital. Two adverse events were related to the REGAIN intervention. One serious adverse event was possibly related to the intervention. Post-exertional exacerbation of symptoms was not observed.

    Conclusions

    In sum, the REGAIN intervention was clinically effective in improving health-related quality of life for adults with post-COVID-19 condition compared to usual care at three months post-randomization. This effect was mainly due to improvements in pain interference, fatigue, and depression. Moreover, the effect was sustained at 12 months. In both groups, there were improvements in the overall quality of life and other well-being indices.

    Journal reference:

    • Gordon McGregor, Harbinder Sandhu, Julie Bruce, et al. Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial. BMJ, 2024. doi: 10.1136/bmj-2023-076506
      https://www.bmj.com/content/384/bmj-2023-076506
       

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  • Women experience larger increase in antidepressant use after break-up than men, study suggests

    Women experience larger increase in antidepressant use after break-up than men, study suggests

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    While both divorce and remarriage in later life are becoming more frequent, there is inadequate research on their effects on mental health. A new study in the Journal of Epidemiology and Community Health explored patterns of antidepressant use among Finnish adults aged 50–70 years experiencing divorce, separation from cohabitation, or bereavement, alongside usage trends before and after subsequent repartnering.

    Study: Trajectories of antidepressant use before and after union dissolution and re-partnering in later life: a prospective total population register-based cohort study. Image Credit: Antonio Guillem/Shutterstock.com
    Study: Trajectories of antidepressant use before and after union dissolution and re-partnering in later life: a prospective total population register-based cohort study. Image Credit: Antonio Guillem/Shutterstock.com

    Background

    Unlike earlier generations, older people are today more likely to divorce and remarry or pick up new partners. However, such relationships typically do not last as long as marital unions and repeated re-partnering is common in this subgroup.

    About 10-15% of people above the age of 55 years have symptoms of clinical depression. Correlates of poor mental health have been identified, including divorce, non-marital separation, and partner death, but not much research deals with these factors in this population.

    Existing studies indicate that older adults show increased signs of depression, clinical or otherwise, after a divorce. However, a US study showed that depressive symptoms began before the divorce, peaking with the divorce and slowly subsiding to pre-divorce levels over the next four years.

    Other research indicates similar trends, though recovery in a UK study appeared to be considerably faster than in several US studies. However, all these did not separately examine depression and antidepressant use among couples who broke up while cohabiting. The effect of new relationships is also unclear, though some research in the US indicates that depressive symptoms are reduced with the formation of new partnerships, mostly among men.

    The study is based on Finnish population registry data from 1996 to 2018. It included nearly 230,000 people between 50 and 70 years old in the years 2000-2014. The focus was on the use of antidepressants over a period extending four years before to four years after the end of any relationship, including by death and the subsequent formation of a new relationship.

    What did the study show?

    Of the large group, approximately a third each was bereaved, divorced, or separated from cohabiting partners between the ages of 50 and 70 years. Separations were likely to occur at earlier ages compared to bereavements, leading to differences in socioeconomic characteristics between these categories.

    That is, separated people were more often employed, had more income, and lived with children compared to bereaved individuals. The latter were more likely to own their homes.

    Following bereavement, less than 8% formed new relationships, vs. one in five after divorce. In contrast, almost half of those who left their cohabiting partners found new partners. Men were more likely to find new partners after bereavement or losing their live-in partners, a difference not so marked among divorcees. A larger income was correlated with a higher rate of finding new partners.

    Both men and women had similar mean ages at the point of marital dissolution or forming new relationships.

    After adjusting for potential confounders, the scientists found that both males and females used antidepressants significantly more during the four years preceding and succeeding relationship breakups.

    When calculated as percentage points, the increase in divorce was five for men vs seven for women. With non-marital relationships, it was smaller, by three and four, respectively. Men who lost their partners increased antidepressant use by five, and women by six percentage points.

    People were most likely to up their antidepressant use just before the end of the relationship, with a slow fall after that. The final extent of use was, however, on a sustained higher level compared to that before the event.

    Even after forming new relationships, antidepressant use failed to return to the original level, with the fall by 0.1-1.5 percentage points being temporary. Women showed a larger increase in their antidepressant use than men and showed an extremely transient partial recovery after finding new partners.

    While men showed a modest rise in use during the four years preceding separation from live-in partners, this declined to the level recorded one year before the event and stabilized. Women showed larger increases, but hardly any recovery following such separation, and use rates began to climb at a slower rate from year one onwards.

    After a live-in partner breakup, antidepressant use declined slightly during the four years before re-partnering for both sexes. It began to rise again one year after re-partnering, for men, but in 6 months, for women.

    Among bereaved couples, antidepressant use began to climb within the four years preceding the event, but especially fast among women. Men and women showed a steep rise in antidepressant use three months after losing their partners to death compared to 3 months before. A small decline in use occurred later, but it never returned to baseline.

    After finding new partners post-bereavement, both sexes showed a drop in antidepressant use over the six months before to 6 months after this event. For women, this continued to rise thereafter.

    With divorce, men and women began using more antidepressants over the four years before, peaking in the preceding six months. This was followed by a fall associated with divorce, though use rates remained higher than before divorce. With re-partnering, the trend continued to rise over the eight years before and after, with a break in the one year just before re-partnering for women. For men, this break lasted one year before and after re-partnering (the “honeymoon effect”).

    What are the implications?

    Both men and women suffered equal rates of depression, as reflected by antidepressant use following bereavement in later life. However, when separating from live-in partners, women showed twice as high increases in antidepressant use as men.

    The authors suggest that losing one’s life partner may trigger a cascade of detrimental effects, including loss of income and social support that build up over time, and this appears particularly relevant to women who experience separation from their live-in partners relative to men in the same situation.

    “The greater increases in [antidepressant] use associated with union dissolution among women in our study may indeed relate to the fact that the costs of union dissolution on mental health fall more heavily on women than men.”

    More research is required to understand why forming new partnerships is helpful in reducing antidepressant use only among bereaved and separated live-in couples but not divorcees.

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