The prevalence of poor sleep quality in the general population in China: a meta-analysis of epidemiological studies.

BACKGROUND: The high prevalence of poor sleep quality (PSQ) in the general population leads to negative health outcomes. Since estimates of PSQ prevalence in the Chinese general population vary widely, this meta-analysis aimed to refine these estimates and to identify moderating factors. METHODS: A comprehensive literature search was undertaken in both international (PubMed, PsycINFO, Web of Science, and EMBASE) and Chinese (Wanfang, and the China National Knowledge Infrastructure databases) databases from inception to 23 November 2023. Studies were required to have used standard scales such as the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). The pooled prevalence of PSQ and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and meta-regression analyses were performed to identify sources of heterogeneity. RESULTS: In 32 studies with a combined 376,824 participants, the pooled prevalence of PSQ was 19.0% (95% CI 15.8-22.8%; range 6.6-43.6%). Across 22 studies that reported PSQI data, the pooled mean score was 4.32 (95%CI 3.82-4.81; SD = 0.502). The pooled mean sleep duration across 8 studies was 7.62 (95% CI 7.23-8.00; SD = 0.194) hours. Subgroup analyses showed that lower education (Q = 4.12, P = 0.042), living in less developed regions (Q = 60.28, P < 0.001), and lower PSQI cutoff values (Q = 9.80, P = 0.007) were significantly associated with PSQ. Meta-regression analyses showed that study quality was inversely associated with estimated PSQ prevalence (ß = - 0.442, P = 0.004). LIMITATIONS: Although measures such as subgroup and meta-regression analyses were performed, substantial heterogeneity remained. Information related to sleep quality, such as comorbid physical diseases or psychiatric disorders, substance use, occupational types, and employment status, were not reported in most studies. CONCLUSION: One in five people in the general population of China may have PSQ and people with lower education or living in western regions may be more susceptible.

Using polygenic risk scores to investigate the evolution of smoking and mental health outcomes in UK biobank participants.

OBJECTIVE: Mendelian randomization studies report a bi-directional relation between cigarette smoking and mental disorders, yet from a clinical standpoint, mental disorders are the focus of treatment. Here, we used an event history framework to understand their evolution in the life course. Our objective was to estimate the relative contribution of genetic predispositions and self-reported smoking status (never, former, and present smoker) to hospitalizations for major depression, bipolar disorder, and schizophrenia. METHODS: We calculated polygenic risk scores (PRS) for ever smoking, pack-years of smoking as a proportion of adult life, and neuroticism in 337,140 UK Biobank participants of white British ancestry. These PRS and self-reported smoking status were entered as explanatory variables in survival models for hospitalization. RESULTS: The estimated single nucleotide polymorphisms heritabilities (h2 ) were 23%, 5.7%, and 5.7% for pack-years, ever smoking, and neuroticism respectively. PRS pack-years and PRS neuroticism were associated with higher hospitalization risk for mental disorders in all smoking status groups. The hazard for mental health hospitalization was higher in both previous (HR: 1.50, CI: 1.35-1.67) and current (HR: 3.58, 2.97-4.31) compared to never smokers, after adjusting for confounders. CONCLUSION: Since genetic liabilities for smoking and neuroticism are fixed at conception and smoking initiation generally started before age 20, our results show that preventing smoking in adolescents probably prevents the development of mental disorders.

Identifying long-term and imminent suicide predictors in a general population and a clinical sample with machine learning.

BACKGROUND: Machine learning (ML) is increasingly used to predict suicide deaths but their value for suicide prevention has not been established. Our first objective was to identify risk and protective factors in a general population. Our second objective was to identify factors indicating imminent suicide risk. METHODS: We used survival and ML models to identify lifetime predictors using the Cohort of Norway (n=173,275) and hospital diagnoses in a Saskatoon clinical sample (n=12,614). The mean follow-up times were 17 years and 3 years for the Cohort of Norway and Saskatoon respectively. People in the clinical sample had a longitudinal record of hospital visits grouped in six-month intervals. We developed models in a training set and these models predicted survival probabilities in held-out test data. RESULTS: In the general population, we found that a higher proportion of low-income residents in a county, mood symptoms, and daily smoking increased the risk of dying from suicide in both genders. In the clinical sample, the only predictors identified were male gender and older age. CONCLUSION: Suicide prevention probably requires individual actions with governmental incentives. The prediction of imminent suicide remains highly challenging, but machine learning can identify early prevention targets.

Sleep Disturbances and the Risk of Incident Suicidality: A Systematic Review and Meta-Analysis of Cohort Studies.

OBJECTIVE: The association between sleep disturbances and suicidality is not well understood partly because of the variability in research results. This meta-analysis aimed to investigate the predictive value of sleep disturbances for incident suicidality. METHODS: A systematic search was conducted in PubMed, EMBASE, PsycINFO, and Web of Science databases for studies examining sleep disturbances and incident suicidality. Cohort studies were screened following a registered protocol, and the eligible ones were meta-analyzed. RESULTS: Seven studies comprising 1,570,181 individuals at baseline, with 1407 attempting suicide and 1023 completing suicide during follow-up, were included. Individuals with baseline sleep disturbances had a significantly higher incidence of suicidality than did those without (relative risk = 2.17, 95% confidence interval [CI] = 1.45-3.24, I2 = 82.50%, p < .001). The risk of an incident suicide attempt was 3.54-fold higher (95% CI = 3.07-4.09, I2 = 0%, p = .44), whereas the risk of incident completed suicide was 1.80-fold higher (95% CI = 1.32-2.44, I2 = 59.33%, p = .01) in individuals with baseline sleep disturbances. CONCLUSIONS: Incident suicide attempts and deaths are higher among people with sleep disturbances. Regular screening and preventive measures should be undertaken for people with sleep disturbances to prevent progression into suicide attempts and deaths.Clinical Trial Registration:CRD42019136397.

Melancholic Features in Bipolar Depression and Response to Lamotrigine: A Pooled Analysis of Five Randomized Placebo-Controlled Trials.

BACKGROUND: A pilot study suggested lamotrigine may be more effective for bipolar depression with melancholic features. We tested this hypothesis in a pooled analysis of 5 randomized double-blind placebo-controlled trials of lamotrigine for acute bipolar depression. METHODS: The pooled sample consisted of 1072 adult outpatients. Depressive symptoms were assessed for 7 to 10 weeks with the Hamilton Depression Rating Scale and the Montgomery-Åsberg Depression Rating Scale. The outcome measure was end-trial response (score reduction ≥ 50%). Melancholic features were assessed with both the Structured Clinical Interview for DSM-IV and baseline depression scale items, according to DSM criteria. RESULTS: The item-based melancholic specifier was associated with numerically larger treatment effects, although subgroup-treatment interactions in logistic regression models did not reach statistical significance. The small subgroup of patients with severe psychomotor retardation also appeared to benefit from lamotrigine. However, the Structured Clinical Interview for DSM-IV melancholic specifier was not associated with larger treatment effects. Baseline depression severity was inconsistently associated with response, depending on which scale was used to define severity. The 2 melancholia variables had poor agreement despite having similar prevalences. CONCLUSIONS: Our results do not clearly support the original hypothesis but do reinforce the importance of replicating secondary analyses of clinical trials with additional data.

Mood instability, depression, and anxiety in pregnancy and adverse neonatal outcomes.

BACKGROUND: Antenatal women experience an increased level of mood and anxiety symptoms, which have negative effects on mothers' mental and physical health as well as the health of their newborns. The relation of maternal depression and anxiety in pregnancy with neonate outcomes is well-studied with inconsistent findings. However, the association between antenatal mood instability (MI) and neonatal outcomes has not been investigated even though antenatal women experience an elevated level of MI. We sought to address this gap and to contribute to the literature about pregnancy neonate outcomes by examining the relationship among antenatal MI, depression, and anxiety and neonatal outcomes. METHODS: A prospective cohort of women (n = 555) participated in this study at early pregnancy (T1, 17.4 ± 4.9 weeks) and late pregnancy (T2, 30.6 ± 2.7 weeks). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess antenatal depressive symptoms, anxiety was measured by the EPDS anxiety subscale, and mood instability was measured by a visual analogue scale with five questions. These mood states together with stress, social support, as well as lifestyle were also examined in relation to neonatal outcomes using chi-square tests and logistic regression models. RESULTS: Mood instability, depression, and anxiety were unrelated to adverse neonatal outcomes. Only primiparous status was associated with small for gestational age after Bonferroni correction. CONCLUSIONS: We report no associations between antenatal mood symptoms including MI, depression, and anxiety and neonatal outcomes. More studies are required to further explore the relationship between antenatal mood instability, depression, and anxiety and neonatal outcomes.

Modeling socio-demographic and clinical factors influencing psychiatric inpatient service use: a comparison of models for zero-Inflated and overdispersed count data.

BACKGROUND: Psychiatric disorders may occur as a single episode or be persistent and relapsing, sometimes leading to suicidal behaviours. The exact causes of psychiatric disorders are hard to determine but easy access to health care services can help to reduce their severity. The aim of this study was to investigate the factors associated with repeated hospitalizations among the patients with psychiatric illness, which may help the policy makers to target the high-risk groups in a more focused manner. METHODS: A large linked administrative database consisting of 200,537 patients with psychiatric diagnosis in the years of 2008-2012 was used in this analysis. Various counts regression models including zero-inflated and hurdle models were considered for analyzing the hospitalization rate among patients with psychiatric disorders within three months follow-up since their index visit dates. The covariates for this study consisted of socio-demographic and clinical characteristics of the patients. RESULTS: The results show that the odds of hospitalization are significantly higher among registered Indians, male patients and younger patients. Hospitalization rate depends on the patients' disease types. Having previously visited a general physician served a protective role for psychiatric hospitalization during the study period. Patients who had seen an outpatient psychiatrist were more likely to have a higher number of psychiatric hospitalizations. This may indicate that psychiatrists tend to see patients with more severe illnesses, who require hospital-based care for managing their illness. CONCLUSIONS: Providing easier access to registered Indian people and youth may reduce the need for hospital-based care. Patients with mental health conditions may benefit from greater and more timely access to primary care.

Mood instability during pregnancy and postpartum: a systematic review.

Perinatal mood instability (MI) is a common clinical observation in perinatal women, and existing research indicates that MI is strongly associated with a variety of mental disorders. The purpose of this study is to review the evidence of perinatal MI systematically, with a focus on perinatal MI, its relation to perinatal depression, and its effects on children. A systematic search of the literature using PRISMA guidelines was conducted on seven academic health databases to identify any peer-reviewed articles published in English from 1985 to July 2017. Studies were screened, data were extracted, and quality of the selected studies was assessed. A total of 1927 abstracts were returned from the search, with 1063 remaining for abstract screening after duplicate removal, and 4 quantitative studies were selected for final analysis. The selected studies addressed perinatal MI (n = 2), the relation of perinatal MI to perinatal depression (n = 1), and the effects of perinatal MI on children (n = 1). The selected studies identified that perinatal women experienced a significantly higher level of MI than non-perinatal women, MI is a prominent feature in perinatal women with and without depression, mood lability during the early postpartum predicts psychopathology up to 14 months postpartum, and maternal emotion dysregulation, rather than maternal psychopathology, increases the risk of heightened facial affect synchrony in mother-infant interaction. The study reveals a significant gap in the literature of perinatal MI.

Mood Instability and Trait Anxiety as Distinct Components of Eysenckian Neuroticism With Differential Relations to Impulsivity and Risk Taking.

This article presents the results of 2 studies that investigated mood instability in the Eysenck neuroticism scales and its relationship to trait impulsivity and risk taking. In Study 1 we examined the relationship between a mood instability factor in the Eysenck Personality Inventory and impulsivity (i.e., rapid unplanned behavior) in a general population sample of 6,066 adults. The mood instability factor was positively correlated with impulsivity. The remaining factors, largely reflecting trait anxiety, were also positively correlated with impulsivity, although these correlations disappeared when mood instability was included in the same regression model. In Study 2 we factor analyzed the short form of the revised Eysenck Personality Questionnaire to isolate mood instability and trait anxiety factors and explore their associations with risk taking in a general population sample of 394,170 adults 40 to 69 years old. The mood instability factor was positively associated with risk taking, whereas the association for the trait anxiety factor was negative. Taken together, the results suggest that mood instability and trait anxiety are separable components of Eysenckian neuroticism and that mood instability is the main component that is positively associated with trait impulsivity and risk taking. Further research is needed to clarify the factor structure of Eysenckian neuroticism.

Treatment Rate for Major Depressive Disorder in China: a Meta-Analysis of Epidemiological Studies.

Major depressive disorder (MDD) is a common psychiatric disorder in China, but its reported treatment rate varies largely across different studies. The objective of this meta-analysis was to determine the pooled treatment rate for people with MDD in China and its associated factors. Both English (PubMed, Cochrane Library, PsycINFO, Web of Science) and Chinese (Chinese National Knowledge Infrastructure, WanFang and SinoMed) databases were searched from their commencement date to November 13, 2018. Epidemiological studies that reported the treatment rate of MDD were included and synthesized using a random effects model. Fifteen studies covering 609,054 participants were included. The pooled treatment rate for MDD in China was 19.5% (95% CI: 10.7%-28.4%). Among the 15 studies, 9 reported the number of patients who received treatments in psychiatric hospitals with a pooled treatment rate of 5.2% (95% CI: 2.8%-7.5%). Meta-regression found that study quality (ß = 0.131, P = 0.028) and male gender (ß = 0.006, P = 0.039) were significantly associated with a higher treatment rate for MDD. In China, the treatment rate for MDD, particularly in psychiatric hospitals, was low. Effective public education and increasing access to mental health services will probably increase the number of people seeking and receiving treatment.

The Prevalence of Suicide Attempts and Independent Demographic and Clinical Correlates among Chronic Schizophrenia Patients in Agricultural Areas of China.

This study investigated the lifetime prevalence of suicide attempts (SA) and independent demographic and clinical correlates in stabilized schizophrenia inpatients. A cross-sectional study was conducted in three psychiatric hospitals in Anhui province, an agricultural province located in east China. Psychopathology and depressive symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Rating Scale (HAMD), respectively. A total of 315 stable schizophrenia inpatients were interviewed prior to discharge. The lifetime prevalence of SA was 22.2%. Multiple logistic regression analysis revealed that female gender (P < 0.001, OR = 3.4, 95%CI: 1.9-6.0), being married (P = 0.02, OR = 2.2, 95%CI: 1.1-4.4) and having more severe depressive symptoms (P = 0.014, OR = 1.2, 95%CI: 1.01-1.3) were independently and significantly associated with higher risk of SA. Lifetime SA is common among hospitalized schizophrenia patients living in agricultural areas of China. For suicide prevention, regular assessments, appropriate interventions and clinical management should be integrated into a community-based psychiatric service model for this population.

Melancholic Symptoms in Bipolar II Depression and Responsiveness to Lamotrigine in an Exploratory Pilot Study.

BACKGROUND: In this exploratory pilot study we reanalyzed data from a previous randomized, double-blind, placebo-controlled trial of lamotrigine for bipolar II depression in which lamotrigine was not superior to placebo to determine if splitting the sample into melancholic and nonmelancholic subgroups revealed a significant treatment effect. METHODS: Adult outpatients (n = 150) in an acute bipolar II depressive episode completed 8 weeks of treatment with lamotrigine (titrated to 200 mg/d) or placebo. Depressive symptoms were assessed at baseline and weekly with the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Montgomery-Åsberg Depression Rating Scale (MADRS). The presence of melancholic depression was determined by baseline responses to the HAMD-17 and MADRS according to the Diagnostic and Statistical Manual of Mental Disorders criteria. Cox regression models stratified by melancholic status were used to predict HAMD-17 and MADRS treatment response. Analysis-of-variance models were used to compare HAMD-17 and MADRS change scores between lamotrigine and placebo groups while testing for interactions by melancholic status. RESULTS: Lamotrigine was associated with higher odds of treatment response compared with placebo in the melancholic subgroup but not in the nonmelancholic subgroup. However, the melancholic subgroup-treatment interactions from the analysis-of-variance models were nonsignificant. CONCLUSIONS: Further research is warranted to test the hypothesis that bipolar depression with melancholic symptoms is more responsive to lamotrigine over placebo than nonmelancholic bipolar depression.

Examining the role of borderline personality traits in the relationship between major depression and nonsuicidal self-injury.

BACKGROUND: Depression and borderline personality disorder (BPD) are highly comorbid conditions that are both associated with nonsuicidal self-injury (NSSI). AIMS: The purpose of this study was to determine if depression is associated with NSSI after controlling for BPD traits. A distinction was made between NSSI for emotional regulation and NSSI for interpersonal motives. METHOD: Logistic regression analyses were conducted on cross-sectional data from a general population sample of 7370 adults who completed the 2007 Adult Psychiatric Morbidity Survey. Depressive symptoms were assessed with the revised Clinical Interview Schedule. NSSI and motives for NSSI were also assessed during clinical interviews. BPD traits were assessed with the participant-completed Structured Clinical Interview for DSM-IV Axis II Personality Disorders. RESULTS: Participants in a major depressive episode were more likely to have engaged in emotional-regulation NSSI and interpersonal NSSI than participants without depression. After controlling for BPD traits depression remained associated with emotional-regulation NSSI, whereas the association with interpersonal NSSI became nonsignificant. There were statistically significant relationships between depression and both types of NSSI occurring indirectly through BPD traits. CONCLUSIONS: BPD traits account for a significant portion of the cross-sectional relationship between depression and past NSSI that varies in size depending on the motive for NSSI. People with depression are more likely to have engaged in NSSI for emotional regulation even in the absence of prominent BPD traits. In contrast, BPD traits may be more prominent in people with depression who have engaged in interpersonal NSSI.

Ketamine-based anesthesia improves electroconvulsive therapy outcomes: a randomized-controlled study.

BACKGROUND: Major depressive disorder (MDD) is a common and debilitating condition that can be challenging to treat. Electroconvulsive therapy (ECT) is currently the therapeutic gold standard for treatment-resistant MDD. We tested our hypothesis that ketamine-based anesthesia for ECT results in superior improvement in treatment-resistant MDD outcomes compared with propofol-based anesthesia. METHODS: Patients with treatment-resistant MDD were enrolled in a randomized clinical trial with assignment to ketamine- or propofol-based anesthesia arms. Using a modified intention-to-treat analysis, we compared the median number of ECT treatments required to achieve a 50% reduction (primary outcome) and a score ≤ 10 (secondary outcome) on the Montgomery-Asberg depression rating scale (MADRS) between anesthesia groups. RESULTS: The study was terminated as significant results were found after the first planned interim analysis with 12 patients in each of the ketamine (intervention) and propofol (control) groups. All ketamine patients achieved at least a 50% MADRS reduction after a median of two ECT treatments whereas ten propofol patients (83%) achieved the same outcome after a median of four ECT treatments. All ketamine patients and seven propofol patients (58%) achieved MDD remission (MADRS ≤ 10). Log rank tests showed that both time-to-50% reduction and remission differed significantly between groups. Adverse events and recovery time were similar between groups. CONCLUSIONS: In this early-terminated small-sized study, ketamine-based anesthesia compared with propofol-based anesthesia provided response and remission after fewer ECT sessions. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01935115). Registered 4 September 2013.

Artificial ventilation during transport: A randomized crossover study of manual resuscitators with comparison to mechanical ventilators in a simulation model.

BACKGROUND: Positive-pressure ventilation in critically ill patients is commonly administered via a manual resuscitation device or a mechanical ventilator during transport. Our group previously compared delivered ventilation parameters between a self-inflating resuscitator and a flow-inflating resuscitator during simulated in-hospital pediatric transport. However, unequal group access to inline pressure manometry may have biased our results. In this study, we examined the performance of the self-inflating resuscitator and the flow-inflating resuscitator, both equipped with inline manometry, and several mechanical ventilators to deliver prescribed ventilation parameters during simulated pediatric transport. METHODS: Thirty anesthesia providers were randomized to initial resuscitator device used to hand ventilate a test lung. The resuscitators studied were a Jackson-Rees circuit (flow-inflating resuscitator) or a Laerdal pediatric silicone resuscitator (self-inflating resuscitator), both employing manometers. The scenario was repeated using several mechanical transport ventilators (Hamilton-T1, LTV® 1000, and LTV® 1200). The primary outcome was the proportion of total breaths delivered within the predefined target PIP/PEEP range (30 ± 3, 10 ± 3 cm H2 O). RESULTS: The Hamilton-T1 outperformed the other ventilators for breaths in the recommended range (χ2  = 2284, df = 2, P < .001) and with no breaths in the unacceptable range (χ2  = 2333, df = 2, P < .001). Hamilton-T1 also outperformed all human providers in proportion of delivered acceptable and unacceptable breaths (χ2  = 4540, df = 3, P < .001 and χ2  = 639, df = 3, P < .001, respectively). Compared with the flow-inflating resuscitator, the self-inflating resuscitator was associated with greater odds of breaths falling outside the recommended range (Odds ratio (95% CI): 1.81 (1.51-2.17)) or unacceptable (Odds ratio (95% CI): 1.63 (1.48-1.81)). CONCLUSION: This study demonstrates that a majority of breaths delivered by manual resuscitation device fall outside of target range regardless of provider experience or device type. The mechanical ventilator (Hamilton-T1) outperforms the other positive-pressure ventilation methods with respect to delivery of important ventilation parameters. In contrast, 100% of breaths delivered by the LTV 1200 were deemed unacceptable.

Mood instability as a precursor to depressive illness: A prospective and mediational analysis.

OBJECTIVE: Mood instability levels are high in depression, but temporal precedence and potential mechanisms are unknown. Hypotheses tested were as follows: (1) mood instability is associated with depression cross-sectionally, (2) mood instability predicts new onset and maintenance of depression prospectively and (3) the mood instability and depression link are mediated by sleep problems, alcohol abuse and life events. METHOD: Data from the National Psychiatric Morbidity Survey 2000 at baseline (N = 8580) and 18-month follow-up (N = 2413) were used. Regression modeling controlling for socio-demographic factors, anxiety and hypomanic mood was conducted. Multiple mediational analyses were used to test our conceptual path model. RESULTS: Mood instability was associated with depression cross-sectionally (odds ratio: 5.28; 95% confidence interval: [3.67, 7.59]; p < 0.001) and predicted depression inception (odds ratio: 2.43; 95% confidence interval: [1.03-5.76]; p = 0.042) after controlling for important confounders. Mood instability did not predict maintenance of depression. Sleep difficulties and severe problems with close friends and family significantly mediated the link between mood instability and new onset depression (23.05% and 6.19% of the link, respectively). Alcohol abuse and divorce were not important mediators in the model. CONCLUSION: Mood instability is a precursor of a depressive episode, predicting its onset. Difficulties in sleep are a significant part of the pathway. Interventions targeting mood instability and sleep problems have the potential to reduce the risk of depression.

Parental factors predicting social deviance and psychological outcomes in offspring: Evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC).

Objective: The objective of the present study was to examine whether exposure to prenatal psychoactive substances is associated with psychological outcomes and deviant behaviour. Methods: This was a secondary analysis of 7,769 mother-child dyads in the Avon Longitudinal Study of Parents and Children (ALSPAC) who were followed until the children were aged approximately 12 years. Parental characteristics and maternal use of various substances were collected in pregnancy and entered as predictors of psychological outcomes in childhood and deviant behaviours in early adolescence. The psychological outcomes were IQ, social cognition, working memory and inhibition, while the deviant behaviours were threatening others, truancy and cruelty to animals. Weighted logistic regression models were used to predict deviant behaviours and weighted linear regression for the psychological outcomes. Results: High prenatal alcohol exposure predicted truancy and cruelty to animals. Tobacco exposure predicted lower IQ, a greater social communication deficit, lower working memory, truancy and threatening others. Illicit drugs predicted a higher social communication deficit and truancy. All prenatal substance exposures remained significant after adjustment for peer influences and covariate imbalance. Conclusion: Alcohol, tobacco and illicit drugs were associated with deviant behaviours in early adolescence and these behaviours were preceded by psychological deficits in childhood. The present study supports the guideline that no amount of alcohol is safe to consume in pregnancy and that tobacco and illicit drugs should be avoided.

Interpersonal sensitivity and response to selective serotonin reuptake inhibitors in patients with acute major depressive disorder.

BACKGROUND: Patients with major depression often suffer from excessive interpersonal sensitivity, although it is not typically measured in antidepressant clinical trials. Preliminary evidence suggests selective serotonin reuptake inhibitors have the capacity to reduce interpersonal sensitivity. METHODS: This was a pooled analysis of data from 1709 patients in three randomized, double-blind, placebo-controlled trials of fluoxetine and paroxetine for acute major depressive disorder. Depressive symptoms were assessed with the Hamilton Depression Rating Scale. A factor from the Symptom Checklist was used to assess interpersonal sensitivity. Our outcome of interest was change from baseline scores at the last assessment (up to 8 or 12 weeks, depending on the trial). RESULTS: Both medications produced significantly greater reductions in interpersonal sensitivity relative to placebo. The effect of medication remained significant after controlling for depression improvement, which explained 18.5% of the variation in interpersonal sensitivity improvement among those treated with active medication. The effect of medication on depressive symptoms, relative to placebo, was not influenced by baseline interpersonal sensitivity. LIMITATIONS: The outcome measured interpersonal sensitivity over the last week, and the results do not necessarily reflect changes in long-standing, trait-like patterns of interpersonal sensitivity. Only two medications were studied. CONCLUSIONS: Selective serotonin reuptake inhibitors are effective at treating interpersonal sensitivity in acutely depressed patients. This appears to be a unique drug effect that is not only the result of depression improvement. Future clinical trials might benefit from assessing interpersonal sensitivity more routinely.

Maintaining sleep and physical activity alleviate mood instability.

OBJECTIVE: Building on previous work indicating that mood instability is the hallmark of neuroticism, our aim was to examine whether changes in exercise, sleep duration and leisure predicted decreases in mood instability with time. METHODS: We used data from 3374 participants of the British Health and Lifestyle Study who answered the Eysenck Personality Inventory-Neuroticism subscale (EPI-N) and the General Health Questionnaire on two occasions 7 years apart. We predicted mood instability scores derived from the EPI-N at follow-up using self-reported changes in exercise, sleep duration and leisure hours between the two time points as independent variables. RESULTS: We confirmed the observation that mood instability decreases with age. Maintaining one's exercise at baseline level decreased mood instability (beta=-0.21) while sleeping less increased mood instability (beta=0.14). Change in leisure time was not independently related to mood instability after accounting for the two other lifestyle factors. CONCLUSION: Personality, at least with regard to mood instability, can be modified by lifestyle factors. Exercise and sleep support mood stability and could be important components of preventative mental health (as well as physical health) benefits.