Predictive modeling of initiation and delayed mental health contact for depression.

BACKGROUND: Depression is prevalent among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, yet rates of Veteran mental health care utilization remain modest. The current study examined: factors in electronic health records (EHR) associated with lack of treatment initiation and treatment delay; the accuracy of regression and machine learning models to predict initiation of treatment. METHODS: We obtained data from the VA Corporate Data Warehouse (CDW). EHR data were extracted for 127,423 Veterans who deployed to Iraq/Afghanistan after 9/11 with a positive depression screen and a first depression diagnosis between 2001 and 2021. We also obtained 12-month pre-diagnosis and post-diagnosis patient data. Retrospective cohort analysis was employed to test if predictors can reliably differentiate patients who initiated, delayed, or received no mental health treatment associated with their depression diagnosis. RESULTS: 108,457 Veterans with depression, initiated depression-related care (55,492 Veterans delayed treatment beyond one month). Those who were male, without VA disability benefits, with a mild depression diagnosis, and had a history of psychotherapy were less likely to initiate treatment. Among those who initiated care, those with single and mild depression episodes at baseline, with either PTSD or who lacked comorbidities were more likely to delay treatment for depression. A history of mental health treatment, of an anxiety disorder, and a positive depression screen were each related to faster treatment initiation. Classification of patients was modest (ROC AUC = 0.59 95%CI = 0.586-0.602; machine learning F-measure = 0.46). CONCLUSIONS: Having VA disability benefits was the strongest predictor of treatment initiation after a depression diagnosis and a history of mental health treatment was the strongest predictor of delayed initiation of treatment. The complexity of the relationship between VA benefits and history of mental health care with treatment initiation after a depression diagnosis is further discussed. Modest classification accuracy with currently known predictors suggests the need to identify additional predictors of successful depression management.

Mental health treatment utilization patterns among 108,457 Afghanistan and Iraq veterans with depression.

People with depression often underutilize mental health care. This study was conceived as a first step toward a clinical decision support tool that helps identify patients who are at higher risk of underutilizing care. The primary goals were to (a) describe treatment utilization patterns, early termination, and return to care; (b) identify factors associated with early termination of treatment; and (c) evaluate the accuracy of regression models to predict early termination. These goals were evaluated in a retrospective cohort analysis of 108,457 U.S. veterans who received care from the Veterans Health Administration between 2001 and 2021. Our final sample was 16.5% female with an average age of 34.5. Veterans were included if they had a depression diagnosis, a positive depression screen, and received general health care services at least a year before and after their depression diagnosis. Using treatment quality guidelines, the threshold for treatment underutilization was defined as receiving fewer than four psychotherapy sessions or less than 84 days of antidepressants. Over one fifth of veterans (21.6%) received less than the minimally recommended care for depression. The odds of underutilizing treatment increased with lack of Veterans Administration benefits, male gender, racial/ethnic minority status, and having received mental health treatment in the past (adjusted OR > 1.1). Posttraumatic stress disorder comorbidity correlated with increased depression treatment utilization (adjusted OR < .9). Models with demographic and clinical information from medical records performed modestly in classifying patients who underutilized depression treatment (area under the curve = 0.595, 95% CI [0.588, 0.603]). Most veterans in this cohort received at least the minimum recommended treatment for depression. To improve the prediction of underutilization, patient factors associated with treatment underutilization likely need to be supplemented by additional clinical information. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social anxiety and interpersonal risk for suicidal ideation: A longitudinal daily diary analysis.

INTRODUCTION: Social anxiety is associated with elevated suicidal ideation (SI). One potential explanation is that socially anxious persons experience frequent interpersonal stressors that elicit SI. Longitudinal designs with temporal ordering are needed to adequately test this hypothesis. Therefore, this study leveraged a longitudinal design combining trait and daily reports. METHODS: Two hundred eleven community adult participants with elevated levels of depression and/or social anxiety completed social anxiety and SI measures at baseline and again at a 1.5-month follow-up. Between these assessments, participants completed a 14-day diary study that assessed three forms of interpersonal distress: unfavorable social comparisons, perceived barriers to seeking social support, and loneliness. RESULTS: As predicted, simple mediation models revealed that baseline social anxiety had a significant indirect effect on SI severity at 1.5 months postbaseline via unfavorable social comparisons (indirect effect: ß = 0.07, p < 0.05) and barriers to seeking support (indirect effect: ß = 0.08, p < 0.05); however, social anxiety did not have a significant indirect effect on SI severity through loneliness. CONCLUSION: Study results are consistent with the proposition that increases in interpersonal distress may explain socially anxious persons' vulnerability to SI. Implications of these findings for the research, assessment, and treatment of suicidality in social anxiety are discussed.

Young Adult Mental Health Beyond the COVID-19 Era: Can Enlightened Policy Promote Long-Term Change?

The status of mental health for adolescents and young adults has aptly been termed a "crisis" across research, clinical, and policy quarters. Arguably, the status quo provision of mental health services for adolescents and young adults is neither acceptable nor salvageable in its current form. Instead, only a wholesale policy transformation of mental health sciences can address crises of this scope. Pandemic-related impacts on mental health, particularly among young adults, have clearly exposed the need for the mental healthcare field to develop a set of transformative priorities to achieve long overdue, systemic changes: (1) frequent mental health tracking, (2) increased access to mental health care, (3) working with and within communities, (4) collaboration across disciplines and stakeholders, (5) prevention-focused emphasis, (6) use of dimensional descriptions over categorical pronouncements, and (7) addressing systemic inequities. The pandemic required changes in mental healthcare that can and should be the beginning of long-needed reform, calling upon all mental health care disciplines to embrace innovation and relinquish outdated traditions.

Psychological well-being in US veterans with non-fatal suicide attempts: A multi-cohort population-based study.

BACKGROUND: Most people who survive suicide attempts neither re-attempt suicide nor die by suicide. Research on suicide attempt survivors has primarily focused on negative endpoints (e.g., increased suicide risk) rather than positive outcomes. One important outcome is psychological well-being (PWB), defined as positive functioning across emotional, intrapersonal, and interpersonal domains. We compared PWB among US military veterans with (i.e., attempt survivors) and without (i.e., non-attempters) a history of suicide attempt(s) using data from three nationally representative cohorts. METHODS: Each US veteran cohort (Cohort1: N = 3148; Cohort2: N = 1474; Cohort3: N = 4042) completed measures of suicidality (e.g., attempt history), character strengths (e.g., curiosity, optimism), psychological symptoms (e.g., depression), and indicators of PWB (e.g., happiness). t-Tests were conducted to examine group differences in PWB; hierarchical regressions were conducted to examine suicide attempt status as a predictor of PWB controlling for symptoms and demographics. Multivariable regressions were conducted to identify predictors of PWB among attempt survivors. RESULTS: In each cohort, reported PWB was markedly lower among suicide attempt survivors than non-attempters (ds = 0.9-1.2), even after adjusting for mental health symptoms. Individual differences in PWB were observed, with a subset of suicide attempt survivors reporting higher PWB levels than non-attempters (1.4-7.4 %). Curiosity and optimism were positively associated with PWB among suicide attempt survivors (rs = 0.60-0.78). LIMITATIONS: Data were cross-sectional, limiting inferences about causation and directionality of associations. CONCLUSIONS: Findings highlight diminished PWB as an important and understudied concern among veteran attempt survivors. Collectively, our findings underscore the importance of considering PWB in the research, assessment, and treatment of suicidality.

Only Human: Mental-Health Difficulties Among Clinical, Counseling, and School Psychology Faculty and Trainees.

How common are mental-health difficulties among applied psychologists? This question is paradoxically neglected, perhaps because disclosure and discussion of these experiences remain taboo within the field. This study documented high rates of mental-health difficulties (both diagnosed and undiagnosed) among faculty, graduate students, and others affiliated with accredited doctoral and internship programs in clinical, counseling, and school psychology. More than 80% of respondents (n = 1,395 of 1,692) reported a lifetime history mental-health difficulties, and nearly half (48%) reported a diagnosed mental disorder. Among those with diagnosed and undiagnosed mental-health difficulties, the most common reported concerns were depression, generalized anxiety disorder, and suicidal thoughts or behaviors. Participants who reported diagnosed mental disorders endorsed, on average, more specific mental-health difficulties and were more likely to report current difficulties than were undiagnosed participants. Graduate students were more likely to endorse both diagnosed and undiagnosed mental-health difficulties than were faculty, and they were more likely to report ongoing difficulties. Overall, rates of mental disorders within clinical, counseling, and school-psychology faculty and trainees were similar to or greater than those observed in the general population. We discuss the implications of these results and suggest specific directions for future research on this heretofore neglected topic.

Future Well-Being Among U.S. Youth Who Attempted Suicide and Survived.

To what extent does a suicide attempt impair a person's future well-being? We estimated the prevalence of future well-being (FWB) among suicide attempt survivors using a nationally representative sample of 15,170 youths. Suicide attempt survivors were classified as having high FWB if they reported (a) a suicide attempt at Wave I, (b) no suicidal ideation or attempts over the past year at Wave III (7 years after), and (c) a well-being profile at or above the top quartile of nonsuicidal peers. Seventy-five of 574 suicide attempt survivors (∼13%) met criteria for FWB at Wave III, compared to 26% of nonsuicidal peers. Wave I well-being levels, not depressive symptoms, predicted the likelihood of FWB at Wave III (OR = 1.23, 95% CI [1.05, 1.44], p < .05). In conclusion, a nonfatal suicide attempt reduced but did not preclude FWB in a large national sample. The observation that a segment of the population of suicide attempt survivors achieves FWB carries implications for the prognosis of suicidal behavior and the value of incorporating well-being into investigations of suicide-related phenomena.

Future Well-Being Among People Who Attempt Suicide and Survive: Research Recommendations.

Over 48,000 people died by suicide in 2018 in the United States, and more than 25 times that number attempted suicide. Research on suicide has focused much more on risk factors and adverse outcomes than on protective factors and more healthy functioning. Consequently, little is known regarding relatively positive long-term psychological adaptation among people who attempt suicide and survive. We recommend inquiry into the phenomenon of long-term well-being after nonfatal suicide attempts, and we explain how this inquiry complements traditional risk research by (a) providing a more comprehensive understanding of the sequelae of suicide attempts, (b) identifying protective factors for potential use in interventions and prevention, and (c) contributing to knowledge and public education that reduce the stigma associated with suicide-related behaviors.

Optimal well-being in the aftermath of anxiety disorders: A 10-year longitudinal investigation.

BACKGROUND: Although preliminary research has explored the possibility of optimal well-being after depression, it is unclear how rates compare to anxiety. Using Generalized Anxiety Disorder (GAD) and Panic Disorder (PD) as exemplars of anxiety, we tested the rates of optimal well-being one decade after being diagnosed with an anxiety disorder. Based on reward deficits in depression, we pre-registered our primary hypothesis that optimal well-being would be more prevalent after anxiety than depression as well as tested two exploratory hypotheses. METHOD: We used data from the Midlife in the United States (MIDUS) study, which contains a nationally representative sample across two waves, 10 years apart. To reach optimal well-being, participants needed to have no symptoms of GAD, PD, or major depressive disorder (MDD) at the 10 year follow-up and exceed cut-offs across nine dimensions of well-being. RESULTS: The results failed to support our primary hypothesis. Follow-up optimal well-being rates were highest for adults previously diagnosed with MDD (8.7%), then PD (6.1%), and finally GAD (0%). Exploratory analyses revealed optimal well-being was approximately twice as prevalent in people without anxiety or depression at baseline and provided partial support for baseline well-being predicting optimal well-being after anxiety. Results were largely replicated across different classifications of optimal well-being. LIMITATIONS: Findings are limited by the somewhat unique measurement of anxiety in the MIDUS sample as well as the relatively high rate of missing data. CONCLUSIONS: We discuss possible explanations for less prevalent optimal well-being after anxiety vs. depression and the long-term positivity deficits from GAD.

Eyeing ambiguity: Pupillary reactivity during early automatic interpretations in major depressive disorder.

Automatic interpretation biases (AIB) are theorized to be a risk factor for depression. However, documenting AIB in depressed persons has been challenging and the source (affective vs cognitive) of AIB remains unclear. We conducted a psychophysiological investigation of AIB in a sample of 25 clinical interview assessed individuals experiencing a current major depressive episode and 28 never-depressed control individuals. Participants completed the Word Sentence Association Paradigm for Depression while their pupil size was recorded. Repeated measures ANOVAs were used to examine behavioral response data and multilevel modeling was used to examine pupillary reactivity (change from trial baseline). Compared to controls, the depressed group was both more likely to endorse negative AIB (p = .001, d = 1.01) and less likely to endorse benign AIB (p = .011, d = 0.72). Further, the depressed group exhibited significantly increased pupil size while processing negative words when they endorsed a negative interpretation compared with controls (ps = .010-.037, ds = 0.69-0.87), but did not differ during other AIB trial types. Within group comparisons revealed greater differentiation between interpretations in the healthy control group in both reaction time and pupillary reactivity AIB measures. This depression-related pupillary reactivity pattern fits with an emotional salience-based explanation better than a cognitive effort-based hypothesis of negative AIB, while pupillary reactivity pattern within the control group is consistent with a benign bias. People with depression lack benign AIB and may be more emotionally engaged during negative AIB than healthy controls.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Listening to the blues: An ecological momentary assessment of music choice in depression.

Persons with depression consistently report a different pattern of music preference, compared to nondepressed persons. Are such preferences maladaptive or beneficial? We tested this question in a study with 3 parts that examined 77 participants' (39 with and 38 without clinical depression) music choice in daily life, affective changes after music listening, and the reasons for music listening. During a 3-day ecological momentary assessment, participants chose a song from a preset music library of happy and sad songs and rated their affect before and after hearing the chosen song. In addition, we analyzed the characteristics (e.g., tempo) of songs participants listened to more than 5 times over 7 days (from participants' Spotfiy music streaming accounts; favorite songs). Finally, we analyzed the reasons for music listening in general when feeling happy and sad. Unlike nondepressed persons, persons with depression lacked a preference for happy over sad songs in daily contexts. Notably, both groups reported increased relaxedness as well as decreased happiness after hearing sad songs. Further, favorite songs of persons with depression had a slower tempo than nondepressed persons' ones. When reporting reasons to listen to music when feeling sad, both groups were less likely to report that they listened to music to increase high arousal positive affect, compared to other reasons. One reason that may attract persons with depression to sad music is a desire to feel calm. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Depression presentations, stigma, and mental health literacy: A critical review and YouTube content analysis.

We review knowledge concerning public presentations for depression. These presentations impact illness beliefs and may influence public stigma, self-stigma, and depression literacy. We provide a critical review of messages, images, and information concerning depression's causes, continuum conceptualization, timeline, curability, coping/treatment regimen, and strengths. To provide data regarding the prevalence of particular presentations, we conducted a content analysis of 327 videos about depression representative of material on the YouTube social media platform. YouTube presentations of depression indicate that depression: 1) is caused by either biological (49.5%) or environmental (41.3%) factors; 2) is a categorical construct (71%); 3) is treatable, with 61% of relevant videos (n = 249) presenting recovery as "likely"; 4) is chronic, found in 76% of videos mentioning timeline; 5) is recurrent (32.5%); 6) is mostly treated via medication (47.4%) or therapy (42.8%), although diet/exercise (28.4%) and alternative treatments (22.6%) are commonly endorsed; and 7) is rarely associated with strength (15.3%). Nearly one-third of videos were uploaded by non-professional vloggers, while just 9% were uploaded by mental health organizations. We discuss how these presentations may influence stigmatizing attitudes and depression literacy among people with and without depression and suggest future research directions to better understand how to optimize public presentations.

Daily Affective Dynamics Predict Depression Symptom Trajectories Among Adults with Major and Minor Depression.

Affective dynamics have been increasingly recognized as important indicators of emotional health and well-being. Depression has been associated with altered affective dynamics, but little is known about how daily life affective dynamics predict depression's naturalistic course. We investigated positive and negative affective dynamics (e.g., inertia, variability, and instability) among adults with depressive disorders (N = 60) and healthy controls (N = 38) in both cross-sectional and prospective analyses predicting weekly depression symptoms over 6 months. Relative to controls, depressed individuals showed elevated daily negative affect (NA) and NA variability along with decreased positive affect (PA). However, groups did not significantly differ on other affective dynamic indices. Based on multivariate prospective analyses of depressed individuals (follow-up N = 36), higher daily NA and lower daily PA were independently associated with higher and average weekly depressive symptom severity over the subsequent 6 months. Exploratory analyses of depression symptom trajectory shape revealed that higher NA and PA variability, NA inertia, and NA instability all predicted an initial increase and eventual return to higher depression symptom levels over the 6-month follow-up period. Daily life affective dynamics may have utility for predicting the naturalistic course of depression, which may help guide interventions targeting affective dynamics in vulnerable individuals.

Why do depressed people prefer sad music?

One of the cardinal symptoms of major depressive disorder (MDD) is persistent sadness. Do people with MDD actually prefer sad stimuli, potentially perpetuating their depression? Millgram, Joormann, Huppert, and Tamir (2015) observed such preferences and interpreted them as reflecting a maladaptive emotion regulatory goal to upregulate sad feelings. We assessed emotional music choice among both those with MDD and healthy controls (HC), and assessed the reasons for music preferences in these two groups. Seventy-six female participants (38 per group) completed two tasks: (1) Millgram et al.'s (2015) music task wherein participants listened to happy, neutral, and sad music excerpts and chose the one they wanted to listen to most, and (2) a novel Emotional Music Selection Task (EMST) wherein participants chose preferred music clips, varying in emotion and energy level, in paired-choice trials. In the replication music task, MDD people were more likely to choose sad music. However, inconsistent with any motivation to upregulate sadness, people with MDD reported that they chose sad music because it was low in energy levels (e.g., relaxing). EMST results revealed that MDD people had a stronger preference for both low energy and sad music, relative to HC. The strong appeal of sad music to people with MDD may be related to its calming effects rather than any desire to increase or maintain sad feelings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Emotion Regulation Among Adolescents With Pediatric Depression As a Function of Anxiety Comorbidity.

Background: Both depression and anxiety (two of the most common internalizing psychopathologies among youths) are associated with difficulties in emotion regulation (ER). Little is known about whether anxiety as a comorbid condition has an effect on the habitual use of different ER strategies in youngsters with depression histories. We aimed 1) to compare ER in adolescents with histories of childhood onset major depressive disorder (MDD) with and without comorbid anxiety and 2) to examine whether certain ER response clusters (Cognitive, Social, and Behavioral/Physical) characterize comorbid children and adolescents. Methods: We analyzed data on 217 youth (11-18 years old) with depression history: 85 subjects with lifetime anxiety comorbidity (comorbid group) and 132 without lifetime anxiety (non-comorbid group). Psychiatric diagnosis was established by a comprehensive Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-based diagnostic procedure. ER strategies were examined via the self-rated "Feelings and Me" Child version questionnaire (FAM-C). Results: The comorbid group used maladaptive ER strategies significantly more frequently than the non-comorbid youngsters. The Behavioral/Physical and Social ER skills, especially those reflecting social withdrawal and self-harm, were responsible for the higher maladaptive scores. Limitations: Because our study is a cross-sectional analysis, we have no information about the development or the onset of maladaptive ER strategies. Therefore, we were unable to examine whether maladaptive ER was a risk factor or a consequence of the internalizing psychopathology and comorbidity. Conclusions: Comorbid anxiety worsens the impaired use of ER strategies in depression-prone youths. Further longitudinal research is needed to explore the causal role of dysfunctional ER in the development of internalizing psychopathology.

Optimal Well-Being after Major Depression.

Can people achieve optimal well-being and thrive after major depression? Contemporary epidemiology dismisses this possibility, viewing depression as a recurrent, burdensome condition with a bleak prognosis. To estimate the prevalence of thriving after depression in United States adults, we used data from the Midlife Development in the United States (MIDUS) study. To count as thriving after depression, a person had to exhibit no evidence of major depression, and had to exceed cut offs across nine facets of psychological well-being that characterize the top 25% of US nondepressed adults. Overall, nearly 10% of adults with study documented depression were thriving ten years later. The phenomenon of thriving after depression has implications for how the prognosis of depression is conceptualized and for how mental health professionals communicate with patients. Knowing what makes thriving outcomes possible offers new leverage points to help reduce the global burden of depression.

Dysregulated behavioral responses to hedonic probes among youth with depression histories and their high-risk siblings.

Affect dysregulation in response to rewarding stimuli has been proposed as a vulnerability factor for major depressive disorder (MDD). However, it remains unclear how affective behavioral dynamics may be altered among individuals who are at high risk for depression but not currently depressed. We examined the dynamics of affective facial behavior during hedonic probes among 3 groups of adolescents: remitted probands who had histories of childhood-onset MDD (n = 187), never-depressed siblings of probands (high familial risk; n = 207), and healthy controls (n = 166). Participants' happy and sad facial expressions were coded during 3 hedonic laboratory tasks: receiving a preferred prize, describing a positive autobiographical memory, and watching a humorous film. Happy and sad behavioral dynamics were indexed by mean level- and time-dependent reactivity, variability (mean of the squared successive differences), and inertia (autocorrelation). Relative to controls, probands and siblings exhibited a more rapid decrease in happy behaviors, and probands exhibited higher inertia of sad behaviors during hedonic probes. Both probands and siblings exhibited lower inertia of sad behaviors while receiving a desired prize, which highlights the importance of context variation in testing hypotheses. Overall, our study provides new evidence that hedonic behavioral dysregulation, as reflected in dynamic facial behavior, may highlight depression vulnerability. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Curious Neglect of High Functioning After Psychopathology: The Case of Depression.

We address a key issue at the intersection of emotion, psychopathology, and public health-the startling lack of attention to people who experience benign outcomes, and even flourish, after recovering from depression. A rereading of the epidemiological literature suggests that the orthodox view of depression as chronic, recurrent, and lifelong is overstated. A significant subset of people recover and thrive after depression, yet research on such individuals has been rare. To facilitate work on this topic, we present a generative research framework. This framework includes (a) a proposed definition of healthy end-state functioning that goes beyond a reduction in clinical symptoms, (b) recommendations for specific measures to assess high functioning, and (c) a road map for a research agenda aimed at discovering how and why people flourish after emotional disturbance. Given that depression remains the most burdensome health condition worldwide, focus on what makes these excellent outcomes possible has enormous significance for the public health.

Are attitudes towards emotions associated with depression? A Conceptual and meta-analytic review.

OBJECTIVES: We performed a conceptual and meta-analytic review of the relationship between negative cognitive and affective evaluations of negative emotional experiences (negative ATE) and depression. We examined the negative ATE-depression relationship in terms of three ATE constructs: fear of emotion, non-acceptance of emotion, and distress intolerance. We also explored whether the negative ATE-depression relationship differs as a function of specific emotions. METHODS: Seventy articles with a total sample of 19950 adults were included in the general analysis, and 10 studies with a total sample of 1726 were included in the emotion-specific analysis. RESULTS: In the general analysis, negative ATE was associated with depression with a medium to large effect. Notably, this effect size was stronger than previously observed associations between emotion regulation strategies and depression (Aldao et al., 2010). In the emotion-specific analysis, negative attitudes towards depressive affect had a particularly strong association with depression. LIMITATIONS: Limitations include heterogeneity in effect sizes and a small number of samples for the emotion-specific analyses. CONCLUSIONS: The present review is the first to establish a systematic relationship between negative ATE and depression. We close with suggestions for future work designed to understand why negative ATE is related to depression, which can lead to understanding of depression's etiology and ways to refine interventions to alter ATE.