[The German S3 guideline for depressive disorders in childhood and adolescence: new developments]. / S3-Leitlinie Depressive Störungen im Kindes- und Jugendalter: Wo geht es hin?

The German guideline for the treatment of depressive disorders in children and adolescents was first published in July 2013. Currently, this guideline is undergoing revision, in which the recommendations of the original version of the guideline are revisited and updated. This report aims to give an overview of the current status and the next steps for this revision.As part of the revision process, the key questions posited in the original version were expanded upon. In this, new questions were added regarding complementary therapies, that is, therapies meant to be administered in addition to the usual treatment, as well as regarding the transitionary period from adolescence into adulthood. For all key questions, new systematic literature searches were conducted in order to update the relevant evidence. For this, randomized controlled studies, systematic reviews, and non-controlled intervention studies were included and rated according to their relevance as well as possible risks of bias. Thus, all studies could be assigned a level of evidence that takes into account both the quality and the importance of the study to the guideline.This report will give a brief overview of the most important insights resulting from the new evidence base identified for the revision. While insights regarding psychotherapy are largely unchanged, there are changes in the evidence for certain antidepressants. In the field of complementary therapies, new evidence has been found for physical activity. In general, it is likely that most recommendations of the original guideline regarding first- and second-line treatments will be updated. The completion of the revision and the publishing of the revised guideline are expected to take until the end of 2023.

Serum Proteomic Analysis of Cannabis Use Disorder in Male Patients.

Cannabis use has been growing recently and it is legally consumed in many countries. Cannabis has a variety of phytochemicals including cannabinoids, which might impair the peripheral systems responses affecting inflammatory and immunological pathways. However, the exact signaling pathways that induce these effects need further understanding. The objective of this study is to investigate the serum proteomic profiling in patients diagnosed with cannabis use disorder (CUD) as compared with healthy control subjects. The novelty of our study is to highlight the differentially changes proteins in the serum of CUD patients. Certain proteins can be targeted in the future to attenuate the toxicological effects of cannabis. Blood samples were collected from 20 male individuals: 10 healthy controls and 10 CUD patients. An untargeted proteomic technique employing two-dimensional difference in gel electrophoresis coupled with mass spectrometry was employed in this study to assess the differentially expressed proteins. The proteomic analysis identified a total of 121 proteins that showed significant changes in protein expression between CUD patients (experimental group) and healthy individuals (control group). For instance, the serum expression of inactive tyrosine protein kinase PEAK1 and tumor necrosis factor alpha-induced protein 3 were increased in CUD group. In contrast, the serum expression of transthyretin and serotransferrin were reduced in CUD group. Among these proteins, 55 proteins were significantly upregulated and 66 proteins significantly downregulated in CUD patients as compared with healthy control group. Ingenuity pathway analysis (IPA) found that these differentially expressed proteins are linked to p38MAPK, interleukin 12 complex, nuclear factor-κB, and other signaling pathways. Our work indicates that the differentially expressed serum proteins between CUD and control groups are correlated to liver X receptor/retinoid X receptor (RXR), farnesoid X receptor/RXR activation, and acute phase response signaling.

[Sleep disorders reduce the therapeutic success of inpatient psychosomatic treatments for depressive disorders]. / Schlafstörungen verringern den Therapieerfolg stationärer psychosomatischer Behandlungen bei depressiven Störungen.

Sleep disorders reduce the therapeutic success of inpatient psychosomatic treatments for depressive disorders Objective: What influence do difficulties in falling and staying asleep in patients with depressive disorders have on the success of psychosomatic treatment? Method: The Data were collected in a naturalistic, multicenter observational study (STOP-D) at the beginning (T1), the end (T2) and six months later after discharge (T3). The sample consisted of female patients with depressive disorders (N = 487) who were treated for M = 61.7 days (SD = 26.8). An insomnia scale with a total of seven items was created subsequently to T1 from Items of the Beck Depression Inventory (BDI-I), from the Hamilton Depression Scale (HAMD) and from the Global Severe Index (GSI) from the Symptom Checklist 90 (SCL-90-R). Then groups were formed on changes in insomnia symptoms from T1 to T2. These two groups "sleep improver" and "sleep deteriorators" were tested by analysis of variance. Results: The subsequently constructed insomnia scale showed good psychometric characteristics in the performed analyses. Patients who reported an improvement in their sleep disturbances during inpatient psychosomatic treatment had significantly lower depression scores in the self-evaluation inventories (BDI-I und SCL-90-R) than patients without improvements in their sleep patterns. This effect was even more pronounced for the catamnestic period. Discussion: Insomnia symptoms in depressed female patients can be an important indicator of the effect of inpatient psychosomatic treatment and can have negative impact on the sustainability of the therapy success.

Comparison of efficacy and safety of complementary and alternative therapies for essential hypertension with anxiety or depression disorder.

BACKGROUND: Essential hypertension (EH) with anxiety or depression belongs to the category of psycho-cardiology. Hypertension is closely related to anxiety and depression. The adverse reactions of Western medicine are apparent and the compliance is poor. Supplementary and replacement therapies have accumulated rich experience in clinical practices, which can reduce side effects and improve clinical efficacy. This study intends to use the Bayesian network meta-analysis (NMA) analysis method for the first time to gather randomized controlled trials (RCTs) related to complementary and alternative therapies in the treatment of hypertension with anxiety or depression disorder and rank efficacy and safety, to provide a reference basis for the treatment of hypertension with anxiety or depression disorder. METHODS: All randomized controlled trials (RCTs) and registered and ongoing trials of Chinese and English databases, related to supplementation and replacement therapies of EH with anxiety or depression disorder, published from initial state to February 2021, will be collected in the form of computer retrieval. Two researchers will independently screen the literature, extracting data, assessing bias risk and assessing heterogeneity. We will use software WinBUGS 1.4.3 and Stata 16.0 for pairwise meta-analysis and NMA to comprehensively evaluate various interventions. The quality of evidence will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: This NMA will comprehensively compare and rank the efficacy and safety of a series of complementary and alternative therapies in treating EH with anxiety or depression disorder. CONCLUSION: Supplementary and replacement therapies have accumulated rich experience of clinical practices in improving EH with anxiety or depression disorder. We expect that this NMA will guide practice and research by providing reliable evidence of evidence-based medicine for the treatment of EH with anxiety or depression disorder. PROTOCOL REGISTRATION NUMBER: INPLASY202120068.

Omega-3 fatty-acids modulate symptoms of depressive disorder, serum levels of omega-3 fatty acids and omega-6/omega-3 ratio in children. A randomized, double-blind and controlled trial.

Omega-3 fatty acids (FA) are a promising adjuvant therapy for depressive disorder (DD) in adults. The objective of this single-centre, randomized, double-blind and controlled study was to compare the efficacy of an omega-3 FA fish oil emulsion with a control oil emulsion alongside the standard treatment for depression in children and adolescents suffering from DD or mixed anxiety depressive disorder (MADD) and to analyse serum fatty acid levels and omega-6/omega-3 FA ratio before and after the intervention. 60 children were randomised 1:1 to the intervention (Om3) or active comparator (Om6) groups. Children's Depression Inventory (CDI) ratings were performed at the baseline, every 2 weeks for a 12-week intervention period. Significant reductions in CDI scores were observed after 6 and 12 weeks of intervention in the Om3 group and in the DD subgroup compared to the Om6 and MADD subgroup. Ratio of omega-6/omega-3 decreased in Om3 but not in Om6 from 24.2/1 to 7.6/1 after 6 weeks, EPA, omega-6/omega-3 ratio, but not DHA, correlated with severity symptoms at the baseline. An omega-3 fatty acid rich fish oil emulsion may be an effective adjuvant supplement during the treatment of depressive disorders in children. Trial registration: ISRCTN 81655012.

Metta-based group meditation and individual cognitive behavioral therapy (MeCBT) for chronic depression: study protocol for a randomized controlled trial.

BACKGROUND: Depression is a widespread disorder with severe impacts for individuals and society, especially in its chronic form. Current treatment approaches for persistent depression have focused primarily on reducing negative affect and have paid little attention to promoting positive affect. Previous studies have shown that metta meditation increases positive affect in chronically depressed patients. Results from previous trials provide evidence for the efficacy of a stand-alone metta meditation group treatment in combination with mindfulness-based approaches. Further research is needed to better understand the implementation of meditation practice into everyday life. Therefore, mindfulness and metta meditation in a group setting are combined with individual cognitive behavioral therapy (CBT) into a new, low-intensity, cost-effective treatment ("MeCBT") for chronic depression. METHODS/DESIGN: In this single-center, randomized, observer-blinded, parallel-group clinical trial we will test the efficacy of MeCBT in reducing depression compared to a wait-list control condition. Forty-eight participants in a balanced design will be allocated randomly to a treatment group or a wait-list control group. Metta-based group meditation will be offered in eight weekly sessions and one additional half-day retreat. Subsequent individual CBT will be conducted in eight fortnightly sessions. Outcome measures will be assessed at four time points: before intervention (T0); after group meditation (T1); after individual CBT (T2); and, in the treated group only, at 6-month follow-up (T3). Changes in depressive symptoms (clinician rating), assessed with the Quick Inventory of Depressive Symptoms (QIDS-C) are the primary outcome. We expect a significant decline of depressive symptoms at T2 compared to the wait-list control group. Secondary outcome measures include self-rated depression, mindfulness, benevolence, rumination, emotion regulation, social connectedness, social functioning, as well as behavioral and cognitive avoidance. We will explore changes at T1 and T2 in all these secondary outcome variables. DISCUSSION: To our knowledge this is the first study to combine a group program focusing on Metta meditation with state-of-the art individual CBT specifically tailored to chronic depression. Implications for further refinement and examination of the treatment program are discussed. TRIAL REGISTRATION: ISRCTN, ISRCTN97264476. Registered 29 March 2018 (applied on 14 December 2017)-retrospectively registered.

Risk factors for depression. New evidence on selenium deficiency and depressive disorders. / Czynniki ryzyka depresji. O nowych przeslankach na temat znaczenia niedoborów selenu.

OBJECTIVES: This study aims to evaluate the effect of selenium deficiency on depressive disorders with adjustment for possible confounders. Its importance among non-dietary and dietary risk factors for depression is discussed using empirical evidence. METHODS: A structural equation model was fitted using diagonally weighted least squares estimation with adjusted chi-square test statistics (WLSMV). The average daily intake of selenium and other nutrients was calculated to verify their possible association with self-reported depressive disorders. The effect of dietary patterns was adjusted for possible confounders, including the presence of chronic diseases, life problems, pain levels, physical activity, and income. The study was performed on a sample of 9,354 men and women aged 45-65 of the Polish-Norwegian Study (PONS) cohort. RESULTS: The model shows a significant effect of low selenium intake (standardized total effect of 0.133), high lipids intake (0.102) and low iron intake (0.065) on depressive disorders. Other dietary factors fail to make a significant contribution to depressive disorders, according to the model (p > 0.05). Among the considered non-dietary risk factors, home stress (0.181), pain (0.179) and low income (0.178) show a strong correlation with depression. Pain mediates a small part of the effect of morbidity (0.140). Depressive disorders are also associated with work problems (0.123) and low physical activity (0.024). CONCLUSIONS: Selenium intake is most strongly related to depression among all the dietary factors considered. In the model, the effect of dietary risk factors on depressive disorders is moderate when compared to non-dietary variables. Chronic pain, low income and morbidity are the main correlatives of depressive disorders.

[Internal medicine between soma and psyche : Functional bodily complaints and depressive disorders in outpatient care]. / Innere Medizin zwischen Soma und Psyche : Funktionelle Körperbeschwerden und depressive Störungen in der ambulanten Versorgung.

Somatoform disorders are encountered in primary medical care with above-average frequency but are too rarely named as such in the differential diagnostics. The prevalence is approximately 30 % with a predominance of female patients. This patient group puts the physician-patient relationship to the acid test from the very beginning due to the fixation on organ-related symptoms, the expectations of repeated instrumental diagnostics and the special way of acting. The consequences are frequent changes of physicians, chronification and disappointment on both sides; however, a workable physician-patient relationship can be developed through an empathic but critically distanced fundamental attitude of the general internist based on a biopsychosocial illness concept. In the further course corrections in the understanding and expression of the illness on the part of the patient can be achieved with a pacing and leading strategy and with psychoeducative measures. The primary psychologization of functional complaints will not satisfy the affected person but outpatient psychotherapy should be initiated only after the patient has been well-prepared. Measures with medications mostly remain unspecific and serve only for relief of symptoms. For comorbidities with anxiety and/or depressive disorders the use of selective serotonin reuptake inhibitors should be considered.

Violência, estressores e sinais iridológicos em mulheres com depressão: um estudo exploratório / Violence, stressors and iridological signs in women with depression: an exploratory study

Violência é fenômeno complexo e multifatorial, que representa grave problema de saúde pública mundial. O objetivo deste estudo foi avaliar a relação entre violência, estressores, estresse, gravidade de sintomas depressivos e sinais iridológicos em mulheres com Transtorno Depressivo. Trata-se de estudo exploratório, descritivo-analítico, transversal, realizado em dois serviços de saúde mental no interior de São Paulo- BR. Foram utilizados dois protocolos compostos por questionários, instrumentos psicométricos e roteiro para avaliação de sinais iridológicos. Utilizou-se estatística descritiva e inferencial, testes paramétricos e não paramétricos (testes de associação, Qui-quadrado de Pearson, Exato de Fisher, ANOVA e Kruskal-Wallis) e regressão logística processadas no programa R, nível de significância de 5%. O estudo foi aprovado e respeitou todos os parâmetros éticos para investigações envolvendo seres humanos. Participaram do estudo 55 mulheres com Transtorno Depressivo, em atendimento ambulatorial em serviços de saúde e todas apresentaram experiências de violência ou estressores sérios na vida (variável desfecho). Para as análises inferenciais tais experiências foram classificadas em três grupos: mulheres com múltiplos tipos de violência (76,9%); violência interpessoal unicamente (11,5%), outros eventos estressores sérios unicamente (11,5%). Observou-se que 63,6% sofreram estresse precoce; 27,3% apresentaram TEPT; 63,6% sintomas de estresse atual; 32,7% apresentaram gravidade dos sintomas de depressão moderados; 63,4%sinais iridológicos de anéis de tensão compatíveis com risco moderado a altíssimo de estresse e 83,6% apresentaram lacuna na íris, com maior vulnerabilidade ao desenvolvimento de psicopatologia ao longo da vida. Não foi confirmada a relação entre a variável desfecho com: estresse, gravidade de sintomas depressivos e sinais iridológicos. Entretanto, as variáveis idade e doença psiquiátrica na família, ajustada pela presença de escolaridade e uso de antidepressivo apresentaram relação estatisticamente significativa com a variável desfecho. Este resultado permite inferir que a violência e estressores sérios podem comprometer, principalmente, a saúde de mulheres sendo estes temas relevantes para a formação de recursos humanos e desenvolvimento de intervenções de prevenção de agravos e promoção de saúde. As variáveis investigadas neste estudo se mostraram relevantes, porém, estudos sequenciais, longitudinais e do tipo caso controle, podem reforçar esta evidência e são recomendados.

Violence is a complex and multifactorial phenomenon, which represents a serious worldwide public health problem. The aim of this study was to assess the relationship between violence, stressors, stress, severity of depressive symptoms and iridological signs in women with Depressive Disorder. This is an exploratory, descriptive-analytical, cross-sectional study, carried out in two mental health services in the interior of São Paulo-BR. Two protocols composed of questionnaires; psychometric instruments and a script for the evaluation of iridological signs were used. Descriptive and inferential statistics, parametric and non-parametric tests (association tests, Pearson's Chi-square, Fisher's Exact, ANOVA and Kruskal-Wallis) and logistic regression processed in the R program were used, with a significance level of 5%. The study was approved and respected all ethical parameters for investigations involving human beings. 55 women with Depressive Disorder participated in the study, in outpatient care in health services and all had experiences of violence or serious stressors in life (outcome variable). For inferential analyzes, these experiences were classified into three groups: women with multiple types of violence (76.9%); interpersonal violence only (11.5%), other serious stressful events only (11.5%). It was observed that 63.6% suffered early stress; 27.3% had PTSD; 63.6% symptoms of current stress; 32.7% had severity of symptoms of moderate depression; 63.4% iridological signs of tension rings compatible with moderate to very high risk of stress and 83.6% presented a gap in the iris, with greater vulnerability to the development of psychopathology throughout life. The relationship between the outcome variable with: stress, severity of depressive symptoms and iridological signs has not been confirmed. However, the variables age and psychiatric illness in the family, adjusted for the presence of education and use of antidepressants, showed a statistically significant relationship with the outcome variable. This result allows us to infer that violence and serious stressors can compromise the health of women, these topics being relevant for the training of human resources and the development of health prevention and health promotion interventions. The variables investigated in this study proved to be relevant; however, sequential, longitudinal and case-control studies can reinforce this evidence and are recommended.

[Network analyses: Are we moving toward a new conceptualization and treatment of mental disorder?] / Les analyses par réseau : vers une nouvelle conceptualisation et prise en charge des troubles mentaux ?

In a break with categorical and dimensional approaches and thus the classical medical model, the network approach applied to psychopathology constitutes a holistic approach to mental disorders. In this approach, mental disorders are conceived as an interconnected system of symptoms in which symptoms are the cause of each other. It is suggested that the interaction between the different symptoms would result in a feedback loop that leads to the installation and maintenance of these symptoms/disorders. In addition, this approach proposes that co-morbidities are the result of symptom-symptom interactions that cross the diagnostic boundary and interact with symptoms from other psychiatric disorders. A growing number of studies have applied the network approach to elucidate causal interactions within the symptoms of depression, post-traumatic stress disorder, schizophrenia, or anxiety disorders. The overall objective of this review is to raise awareness among researchers and clinicians in psychiatry and clinical psychology of the network approach applied to psychopathology. To do this, we present the main concepts and principles of the network approach and its application in post-traumatic stress disorder. We also discuss recent criticisms of this approach and its clinical applications.

The impact of exposure, relaxation, and rescripting therapy for post-trauma nightmares on suicidal ideation.

OBJECTIVE: This study investigated whether a brief psychotherapy for post-trauma nightmares (exposure, relaxation, and rescripting therapy [ERRT]), reduced suicidal ideation (SI). We hypothesized that: (a) nightmare frequency and severity, post-traumatic stress disorder (PTSD), depression, and sleep quality would be related to SI at pretreatment; (b) SI would decrease from pre- to post-treatment; and (c) the decrease in SI would remain after controlling for change in PTSD and depression. METHOD: Seventy-five individuals exposed to a traumatic event and who experienced frequent nightmares (minimum one per week) participated in ERRT. Participants were not required to have a psychological diagnosis. Thirty percent endorsed SI at pretreatment. RESULTS: Depression and PTSD were related to SI at pretreatment. SI decreased following treatment; however, the third hypothesis was not supported. CONCLUSION: Results suggest brief psychotherapy targeting post-trauma nightmares may decrease SI. More research is necessary to determine what factors contribute to decreases in SI.

Collaborative Care for Depression of Adults and Adolescents: Measuring the Effectiveness of Screening and Treatment Uptake.

OBJECTIVE: This study analyzed effectiveness of screening, referrals, and treatment uptake of a collaborative care for depression intervention across 10 primary care clinics in Chicago. METHODS: Between November 2016 and December 2017, patients (N=25,369) were screened with the Patient Health Questionnaire-2 and the Patient Health Questionnaire-9 on the basis of an eligibility algorithm. Electronic health record data were analyzed for sample characteristics, screening rates, referrals, and treatment pathways. To identify disparities, a test of proportions was conducted between eligible and screened patients as well as referred and treated patients. RESULTS: Screenings, referrals, and uptake occurred proportionately across subgroups except for patients ages 12-17. Adolescent age was associated with disproportionate Patient Health Questionnaire-9 screenings and with treatment disengagement. CONCLUSIONS: The intervention shows promise in expanding access to care and reducing disparities. Greater access to psychotherapies and innovative treatment modalities, particularly for adolescents, may improve overall treatment uptake.

Comparison of the utility of the PHQ and CES-D for depression screening among youth with HIV in an integrated care setting.

BACKGROUND: Depressive symptoms are well documented among people living with HIV and some evidence suggests that youth living with HIV (YLWH) are more affected than their adult counterparts. Therefore, screening for depression is imperative among YLWH to ensure optimal health. The objective of this study is to compare the utility of the Center for Epidemiological Studies-Depression (CES-D) and the Patient Health Questionnaire (PHQ) as depression screeners in an integrated care setting serving YLWH in the southeastern United States. METHODS: As a part of standard care, the CES-D and the PHQ were administered to YLWH. A Retrospective review of patient records was conducted. Using receiver operating characteristic (ROC) curve analysis and reports from mental health providers, researchers compared the utility of the screeners. RESULTS: The sample consisted of 121 cases from 2017. Youth ranged in age from 12-25 (M = 20.68, SD = 2.75). Most were Black/African American (59.5%) males (56.2%) who acquired HIV behaviorally (51.2%). Sexual orientation was nearly evenly split between heterosexual (37.2%) and homosexual (34.7%). The CES-D demonstrated higher specificity and sensitivity for identifying clinical depression, yet, this was not significantly different from the PHQ, p = .09. LIMITATIONS: Generalizability of findings may be limited as the study sample included youth from a single integrated care setting. CONCLUSION: Both the PHQ and the CES-D demonstrate utility for depression screening among YLWH. However, the PHQ may be preferable for use within a clinical setting.

Symptom hyper-expression in advanced cancer patients with anxiety and depression admitted to an acute supportive/palliative care unit.

PURPOSE: The aim of this study was to compare symptom expression in advanced cancer patients with depression and anxiety and in patients with no such symptoms. METHODS: Secondary analysis of a previous study assessing the role of an acute palliative supportive care unit (APSCU) in a comprehensive cancer center. Patients completed the Edmonton Symptom Assessment System (ESAS) at admission (T0) and 7 days after or at discharge (T7). RESULTS: Three hundred-fourteen consecutive cancer patients admitted to the APSCU were surveyed. Eighty-six and 66 patients improved their level of depression and anxiety, respectively (passing from ≥ 4 to 0-3, from T0 to T7), after that palliative care intervention resulted in a significant improvement of the other symptoms. Changes were statistically significant for both symptoms (P < 0.0005). Patients admitted for uncontrolled pain were more likely to be anxious, while patients admitted for other symptoms or end-of-life care were more likely to be depressed. The presence of anxiety and depression (≥ 4/10 on ESAS) was significantly associated with a higher level of symptom expression at admission and at T7 (P < 0.0005). In patients presenting both psychological symptoms, symptom expression was significantly more relevant in comparison with patients not reporting moderate-severe psychological symptoms. Pain and depression were independently associated with anxiety at T0. Variables independently associated with depression at T0 were drowsiness, appetite, and anxiety. CONCLUSIONS: Psychological symptoms of ESAS concur to hyper-express some symptoms and make symptom control more difficult. A clear association between anxiety and depression exists.

Long-term improvements after mindfulness-based group therapy of depression, anxiety and stress and adjustment disorders: A randomized controlled trial.

BACKGROUND: Although mindfulness-based group therapies (MGTs) for depressive, anxiety or stress and adjustment disorders are promising, there is a substantial lack of knowledge regarding the long-term improvements after such therapies in these common psychiatric disorders. METHODS: Two hundred and fifteen patients were randomized in a randomized clinical trial (RCT) (ClinicalTrials.gov ID: NCT01476371) conducted in 2012 at 16 primary healthcare centres in southern Sweden. The patients were randomized to MGT or treatment as usual (TAU) and completed four psychometric self-rated scales after 8 weeks of treatment. Approximately 12 months after the completion of the 8-week treatment, the same scales were repeated. Ordinal and generalized linear-mixed models, adjusted for cluster effects, were used for the analysis. RESULTS: For all four psychometric scales (MADRS-S [Montgomery-Åsberg Depression Rating Scale-S], HADS-D, HADS-A [Hospital Anxiety and Depression Scale A and D] and PHQ-9 [Patient Health Questionnaire-9]) the scores at the 1-year follow-up were significantly improved (all P values <0.001) in both groups. Furthermore, there were no significant differences between the MGT and TAU in the psychometric scores at the 1-year follow-up. CONCLUSIONS: To the best of our knowledge, this is the first RCT comparing the long-term improvements after MGT with TAU. Although it cannot be excluded that our findings are a result of the natural course of common psychiatric disorders or other factors, they suggest a long-term positive improvement after both MGT and TAU.

Development and feasibility assessment of a collaborative stepped care intervention for management of depression in the mental health in primary care (MeHPriC) project, Lagos, Nigeria.

BACKGROUND: This study aimed to develop and test the feasibility of a primary care worker-led psychological intervention as the main feature of a collaborative stepped care for depression that is effective, affordable, culturally acceptable, tailored to patients' clinical condition and easily integrate-able into the primary care schedule in Nigeria. METHODS: Using the Medical Research Council framework, in the first stage (modelling/theoretical development), experts reviewed and distilled evidence from literature to form the intervention components. In the second (formative) stage, local stakeholders were consulted on the practical application and feasibility of the proposed intervention. The third (piloting) stage involved testing for the clinical efficacy and acceptability of the components of the draft intervention. RESULTS: The final intervention components included a 2-stage screening (red-flagging and further evaluation), psychoeducation, low-intensity psychological therapy (problem-solving therapy for primary care), antidepressant prescription, proactive mobile telephony adherence support and referral to the mental health specialist if needed. At 3 months, 71.6% of depressed patients on the intervention improved. The intervention was perceived to be acceptable and useful by over 70% of health workers and clients and had high ratings (>70% score) by expert panels on intervention simplicity, facilitation strategies, and quality of delivery. CONCLUSIONS: The development and feasibility testing of our integrated intervention encompassed review of current literature, expert opinions and consultation with local stakeholders and end users. Our intervention package was largely deemed acceptable, relevant, useful, and feasible. Important lessons learnt with this process will help in future intervention developments.

Opportunities to Improve Detection and Treatment of Depression Among Patients With Breast Cancer Treated in an Integrated Delivery System.

CONTEXT: Patients with cancer commonly experience depression. If not addressed, depression can lead to reduced quality of life and survival. OBJECTIVE: Given the introduction of national initiatives to improve management of psychiatric symptoms among patients with cancer, we examined patterns of depression detection and treatment over time, and with respect to patient characteristics. METHODS: This cross-sectional study linked data from the Pathways Study, a prospective cohort study of women diagnosed with breast cancer at Kaiser Permanente Northern California between 2005 and 2013, with data from Kaiser Permanente Northern California's electronic medical record. Pathways participants eligible for this analysis had no known prior depression but reported depressive symptoms at baseline. We used modified Poisson regression to assess the association of cancer diagnosis year and other patient characteristics with receipt of a documented clinician response to depressive symptoms (depression diagnosis, mental health referral, or antidepressant prescription). RESULTS: Of the 725 women in our sample, 34% received a clinician response to depression. We observed no statistically significant association of breast cancer diagnosis year with clinician response. Characteristics associated with clinician response included Asian race (adjusted risk ratio, Asian vs. white: 0.44, 95% CI: 0.29-0.68) and depression severity (adjusted risk ratio, mild-moderate vs. severe depression: 1.45, 95% CI: 1.11-1.88). CONCLUSION: Most patients in our sample did not receive a clinician response to their study-reported depression, and rates of response do not appear to have improved over time. Asian women, and those with less severe depression, appeared to be at increased risk of having unmet mental health care needs.

Depression Assessment in Clinical Trials and Pre-clinical Tests: A Critical Review.

Depression is deeply rooted in human behavior. The development of new antidepressants demands the creation of animal models to investigate new drugs, which potentially could work as antidepressants. The aim of this review is to discuss the different ways of assessing depression in clinical research, including clinical trials, and the different animal behavioral tests used to study depression and test the efficacy of antidepressants in pre-clinical studies. In clinical practice, a categorical classification, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD) can be used for diagnosis, through the use of structured and semi-structured interviews. On the other hand, depression can also be assessed using a dimensional approach, through self- or clinicianrated questionnaires. Regarding the assessment of the efficacy of antidepressants in animal models, several tests are routinely used, namely the Forced Swim Test, the Modified Forced Swim Test, the Tail Suspension Test and the Sucrose Preference Test. These tests are informative, providing that the following rules are taken into account: 1) more than one test is used, with coherent results; 2) secondary drug effects, the most frequent being putative changes in motor activity, are taken into account and properly controlled with specific tests run concomitantly; 3) each test and specific protocol is validated with data from at least a gold standard antidepressant drug. We herein briefly discuss the potential and limitations of each of those tests.

Mindful attention moderating the effect of experiential avoidance in terms of mental health among Latinos in a federally qualified health center.

The present study examined the moderating role of mindful attention in the relation between experiential avoidance and anxious arousal, social anxiety, depressive symptoms, and the number of mood and anxiety disorders among a sample of Latinos seeking health services at a primary care facility. Participants included 326 adult Latinos (Mage = 39.79 years, SD = 11.27; 88.9% female; 98.2% used Spanish as their first language). Results provided empirical evidence of an interaction between mindful attention and experiential avoidance for anxious arousal, social anxiety, depressive symptoms, and the number of mood and anxiety disorders in the studied sample. Specifically, among Latinos with lower (vs higher) levels of mindfulness, greater experiential avoidance was related to greater anxiety/depressive symptoms and number of mood and anxiety disorders. Together, these data provide novel empirical evidence of the clinically relevant interplay between mindful attention and experiential avoidance regarding a relatively wide array of negative emotional symptoms and disorders among Latino primary care patients. Limitations of the study include a largely female sample and cross-sectional data.

Integrating clients' religion and spirituality within psychotherapy: A comprehensive meta-analysis.

Some religious or spiritual (R/S) clients seek psychotherapy that integrates R/S values, while others may be reticent to disclose R/S-related aspects of struggles in a presumably secular setting. We meta-analyzed 97 outcome studies (N = 7,181) examining the efficacy of tailoring treatment to patients' R/S beliefs and values. We compared the effectiveness of R/S-tailored psychotherapy with no-treatment controls, alternate secular treatments, and additive secular treatments. R/S-adapted psychotherapy resulted in greater improvement in clients' psychological (g = 0.74, p < 0.000) and spiritual (g = 0.74, p < 0.000) functioning compared with no treatment and non R/S psychotherapies (psychological: g = 0.33, p < 0.001; spiritual: g = 0.43, p < 0.001). In more rigorous additive studies, R/S-accommodated psychotherapies were equally effective to standard approaches in reducing psychological distress (g = 0.13, p = 0.258), but resulted in greater spiritual well-being (g = 0.34, p < 0.000). We feature several clinical examples and conclude with evidence-based therapeutic practices.