Special Issue: Mental Health
Schizophrenia is a chronic, recurrent and disabling psychotic disorder. Enhancing patient adherence and preventing recurrence are the key factors of treating schizophrenia, and the core determinants of prognosis and social functional recovery of these patients. Recommended by guidelines/consensuses as one treatment for schizophrenia, long-acting injectable (LAI) antipsychotics have been an important intervention for treating schizophrenia and for preventing its recurrence. At the same time, as community settings are important sites for the rehabilitation of schizophrenia, considerable efforts have been made to explore models of community-based management of schizophrenia. Currently, the use of LAI antipsychotics in community-based management of schizophrenia has been highlighted in multiple policies and documents of China, but its application is negatively influenced partially by community physicians' insufficient understanding and application skills regarding LAI antipsychotics, which has become a bottleneck that hinders the comprehensive rehabilitation of schizophrenics. In view of this, a consensus was developed based on clinical evidence, previous guidelines and consensuses, expert individual practice and features of community settings in China, by a group of 13 experts, including psychiatrists from the Chinese Schizophrenia Coordination Group, Chinese Society of Psychiatry, and general medicine experts from the Chinese Society of General Practice. This consensus will significantly contribute to the solving of problems in the use of LAI antipsychotics for community-based management of schizophrenia, and the improvement of patient adherence and prognosis.
Mental health problems among college students have become increasingly prominent. Social anxiety is one of the prevalent psychological problems among college students.
To explore the research hot spots, frontiers and trends on social anxiety among college students, and provide reference for researchers participating in the research of college students' social anxiety in the future.
643 English articles in database of Web of Science (WOS) and 166 Chinese articles in database of China National Knowledge Infrastructure (CNKI) from 2000 to 2021 were analyzed using CiteSpace on August 27, 2021.
The number of English articles on social anxiety among college students showed an increasing trend from 2000 to 2021. The research hot spots and frontiers of social anxiety among college students were mainly focused on substance abuse, mobile phone and internet addiction, negative evaluation fear, racial differences, psychological intervention and COVID-19 epidemic. The future research trends were mainly focused on the mechanism of substance abuse and mobile phone addiction.
Chinese scholars can refer to the research hot spots, trends and the differences between domestic and foreign research shown by this visual analysis, and focus on the related problems of substance abuse and mobile internet addiction among college students with social anxiety.
Exercise has been confirmed by most studies to be effective in preventing and treating depression, and has become a recommended treatment by many researchers. However, previous research results on exercise interventions for depression have not been effectively integrated, and there is still a lack of uniform clinical exercise therapy guidelines across countries. In this paper, we systematically and comprehensively discussed the effects of exercise on depression, including the effects of exercise types, intensities, frequencies, and amounts of exercise on the efficacy of depression interventions in different populations, and summarized the neurobiological mechanisms involved in the development of depression as well as the antidepressant effects of exercise by sorting out relevant literature. This paper shows that in exercise interventions for depression, aerobic exercise is the most frequently chosen type of exercise, the intensity of which is usually moderate to high intensity, and the frequency and amount of exercise are recommended at high frequency and dosage. The neurobiological mechanisms of exercise resistance to depression are mainly that exercise can improve the morphological structure of central nervous system tissue, increase the levels of a series of neurotrophic factors, thereby enhancing neuronal plasticity, and improve the function of the neurosecretory system, reducing damage to brain tissue caused by neuroinflammatory responses and oxidative stress. This paper can provide a certain reference for the development and implementation of clinical exercise prescription for depression in China, and draw on the in-depth development of exercise antidepressant research.
Chinese men who have sex with men (MSM) have a higher prevalence of depression than the general population. Long-term depression symptoms could increase the risk of having physical harm, self-harm and suicide. Therefore, depression issues among MSM need to be solved urgently.
To explore the latent classes of depression, and the influence of HIV-related knowledge and anticipated stigma on depression among MSM.
Usingthe General Information Questionnaire, HIV Knowledge Questionnaire, Anticipated HIV Stigma Scale and 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) , an online questionnaire survey was conducted from December 2020 to March 2021 via the same-sex social network of Blued7.5. A total of 1396 MSM with HIVinfection or unclear status of HIVinfection were sampled by use of convenience sampling to attend the survey. The latent classes of depressive symptoms were analyzed by latent class analysis. Multinomial Logistic regression analysis was used to explore the correlation of the latent class of depression with HIV-related knowledge or anticipated HIV stigma.
Finally, 1 394 cases (99.9%.) who returned responsive questionnaires were included. The 10 items of CES-D-10 were taken as observed indicators, and exploratory latent class analysis was employed to identify the latent classes of depression based on model from 1 to 5 classes. The 4-class model was finally selected, and the probabilities of each class were 40.1% (no obvious depression) , 21.6% (possible risk of depression) , 28.0% (possible mild depression) , and 10.3% (possible moderate to severe depression) . The accuracy of the classification was assessed by test for homogeneity according to the cut-off value of CES-D-10 (0=no depression, 1=depression) and the results of latent class analysis (0= no obvious depression and possible risk of depression, 1= possible mild depression and possible moderate to severe depression) , and the result showed that Kappa=0.735 (P<0.001) . Multinomial Logistic regression analysis indicated that a high level of HIV-related knowledge (OR=0.926, P=0.001) , undergraduate attainment or above (OR=0.642, P=0.003) were related to possible risk of depression. The anticipated HIV stigma (OR=1.594, P<0.001) and being married (OR=0.593, P=0.026) were related to possible mild depression. A high level of HIV-related knowledge (OR=0.935, P=0.026) , anticipated HIV stigma (OR=2.239, P<0.001) and no long-term employment (OR=1.518, P=0.045) were related to possible moderate to severe depression.
The depression in MSM population presented obvious category characteristics, which may be a new idea for tailoring interventions to depression in MSM. Relevant authorities may cooperate with social media to deliver interventions incorporated with HIV-related knowledge and anticipated HIV stigma to prevent and control the development of depression in MSM.
Postpartum depression (PPD) is a common maternal mental health issue induced by a combination of biopsychosocial factors, which seriously affects the physical and mental health of mothers and infants. Screening for individual maternal risk factors during pregnancy for predicting PPD will contribute to early identification and treatment of PPD. Many prediction models have been developed and extensively used in the research on the etiology of PPD, and classifying and comparing different types of the models could provide an important reference for selecting a rational method for developing the model, and help to increase the forms of PPD screening and diagnosis.
Efficacy and Safety of Wuling Capsule Combined with Fupentixol and Melitracen Tablets in Active Ulcerative Colitis Patients Accompanied with Anxiety and Depression
Psychotherapy is an important component of the treatment program for inflammatory bowel disease (IBD) , a common chronic incurable digestive system disease accompanied with psychosomatic disorder, which involves ulcerative colitis (UC) . Wuling capsule has proven to be effective in multiple gastrointestinal diseases with psychosomatic disorders, but there are rare studies about its effect on improving the condition, anxiety and depression of UC patients.
To investigate the efficacy and safety of Wuling capsule with Fupentixol and melitracen tablets in active UC patients with anxiety and depression.
A total of 120 active UC patients with anxiety and depression were selected from Gastroenterology Clinic or Inpatient Department of the Second Affiliated Hospital of Zhejiang Chinese Medical University and Zhejiang Provincial Tongde Hospital from January 2019 to December 2020, and equally, double-blindly randomized into control group, Deanxit group, Wuling capsule group and combination group, receiving Mesalazine sustained-release tablets (hereinafter referred to Mesalazine) , Mesalazine with Fupentixol and melitracen tablets, Mesalazine with Wuling capsules, Mesalazine with Fupentixol and melitracen tablets and Wuling capsules, respectively. All of the four groups were treated for 8 consecutive weeks as a course. Pre- and post-treatment main clinical symptom score, modified Mayo score, inflammatory response indicators, Zung Self-rating Anxiety Scale (SAS) score, Zung Self-rating Depression Scale (SDS) score, and Inflammatory Bowel Disease Questionnaire (IBDQ) score were compared across the four groups. Meanwhile, safety evaluation for the four treatments was conducted.
Finally, 113 cases (except Wuling capsule group containing 29 cases, other three groups containing 28 cases) who completed this study were included for analysis. Compared with other three groups, combination group showed lower post-treatment diarrhea score, mucus with blood and pus in stools score, abdominal pain score and total score of clinical symptoms, modified Mayo score, erythrocyte sedimentation rate, serum levels of C-reactive protein, tumor necrosis factor-α and interleukin-6, as well as SAS and SDS scores, and higher scores of bowel, systemic, emotional and social domains and total IBDQ score (P<0.05) . One control group case had abdominal distension and one Deanxit group case had hyposomnia during treatment, but were spontaneously relieved.
In active UC patients accompanied with anxiety and depression, Wuling capsule with Fupentixol and melitracen tablets could relieve the clinical symptoms, severity of condition, inflammatory response, anxiety and depression disorders, improve the quality of life, with relatively high safety. Therefore, Wuling capsule may be a choice for optimizing the comprehensive treatment plan of UC.
Social Support and Its Associated Factors among Family Caregivers of Persons with Severe Mental Illness
Understanding the characteristics of social support of family caregivers of persons with severe mental illness, and identifying the associated factors are the preconditions of developing evidence-based intervention strategies to improve social support for this vulnerable group. Among the limited studies concerned family caregivers of patients with severe mental illness, the majority focused on their own individual factors, leaving patient- and family-level associated factors largely under-investigated.
To explore the social support and associated factors among family caregivers of persons with severe mental illness, providing a theoretical basis for the development of evidence-based strategies to enhance the level of social support in this group.
A cross-sectional design was used. Multistage sampling was used to select three tertiary grade A mental health organizations from three cities located in eastern, central, and western China, respectively (one was extracted from each city) , then from which, family caregivers of persons with severe mental illness who received outpatient services between August 2018 and December 2019 were selected, and their family caregivers (n=1 001) were recruited as participants. A self-administered survey was conducted in the family caregivers using a questionnaire〔consisting of two parts: demographics and the Social Support Rating Scale (SSRS) 〕compiled by our research team to collect their individual and family information and social support status, as well as patients' (the care receivers') information. Multiple linear regression was employed to identify associated factors for the total score and domain scores of SSRS.
The mean total score of SSRS for the family caregivers was (34.4±9.1) . And the mean score for its three domains, subjective social support, objective social support, and social support utilization was (20.3±6.2) , (7.5±2.8) , (6.6±2.3) , respectively. The type of occupation of the caregivers, and the type of mental diseases and stability of symptoms of patients cared by them, as well as mean household monthly income per person were associated with the total score of SSRS for the family caregivers (P<0.05) . Furthermore, marital status and religious belief of caregivers, as well as their relationship with the patients cared by them also affected the total score of SSRS of the family caregivers (P<0.05) . As for the scores of domains of SSRS, they were found to be influenced by the type of occupation of the caregivers, the type of mental diseases and stability of symptoms of patients cared by them, and mean household monthly income per person (P<0.05) . Besides that, gender, marital status, living area (rural or urban) , and religious belief of caregivers, their relationship with patients cared by them, and the amount of family subsidies also affected the score of subjective social support of family caregivers (P<0.05) ; the amount of family subsidies also affected the objective social support score of family caregivers (P<0.05) ; gender and living area (rural or urban) of caregivers, and the amount of family subsidies also affected the score of social support utilization of family caregivers (P<0.05) .
Family caregivers of patients with severe mental illness possessed a low level of social support, had limited access to social support, perceived insufficient support, and used social support rather insufficiently. There were differences in factors associated with their overall social support and domain-specific social support. More attention should be paid to family caregivers who are single, unemployed, have low household monthly income per person, care for patients with schizophrenia or unstable mental symptoms, and provide them with support in accordance with their needs, by which their care burden can be alleviated, and their physical and mental health will be improved eventually.
Drug therapy is one of the main treatment approaches for depression, and a consideration of patient preferences can effectively improve patient compliance with medication. Several studies have been conducted to explore the medication choice preferences of patients with depression, but there is a lack of studies to systematically collect and summarize the medication choice preferences of patients with depression.
To systematically review the studies related to the application of discrete choice experiment (DCE) and best-worst scaling (BWS) to the medication choice preferences of patients with depression, in order to provide reference for clinical rational drug use of patients with depression and future studies of preferences.
CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed, Web of Science and EmBase were systematically searched for the studies related to the application of DCE and BWS to the medication choice preferences of patients with depression from inception to 2021-12-31, using "DCE" "BWS" "depression" "discrete choice experiment" "best-worst scaling" as keywords on January 2022. Data were extracted from the included literature, and the PREFS checklist was used for the quality assessment of all studies. The attributes included in the study were classified into three categories of outcome, process and cost, and their relative importance on the impact of medication preferences of patients was assessed.
A total of 7 papers were included, all of which were studies related to DCE, involving 47 attributes, among which 41 were classified as outcome attributes, 5 were classified as process attributes, and 1 was classified as a cost attribute. A total of 9 most important attribute results were obtained from the 7 studies, the outcome attribute was considered most important 8 times and the cost attribute was considered most important 1 time. Among the outcome attributes, adverse effects were considered most important 5 times and effectiveness was considered most important 3 times. Based on the PREFS checklist, one study received a score of four and six studies received a score of three. Most studies need further improvement in terms of respondents and findings.
Outcome attributes are most important in the medicine taking process of patients with depression, which needs attention of clinicians and policy makers. There is room for improvement in the dimensions of variance reporting and experimental design, it is recommended for further improvement of research design in terms of respondents interpretation of findings and experimental design in future research, in order to provide more high-quality evidence for research of medication preferences of patients with depression.
Prevalence and Associated Factors of Depression among Middle-aged and Elderly Women YE Haichun1, YAN Yajie2,3, WANG Quan2, 3* 1.School of Nursing, Shandong Xiehe University, Jinan 250109, China 2.School of Health Sciences, Wuhan University, Wuhan 430071, China 3.Global Health Institute, Wuhan University, Wuhan 430072, China *Corresponding author: WANG Quan, Associate professor, Master supervisor. E-mail: wangquan73@whu.edu.cn 【Abstract】Background Depression is a common mental illness threatening physical and psychological health of middle-aged and elderly people. However, there are few large-scale studies focusing on depression and its influencing factors in middle-aged and elderly Chinese women. Objective To investigate the depression prevalence and associated factors in middle-agedand elderly Chinese women, providing evidence for exploring mental health and effective interventions in this population.Methods This study was conducted from January to March 2021. Data were obtained from the China Health and RetirementLongitudinal Study (CHARLS), involving 7963 women at age 45 or over, including demographic characteristics, physicalhealth status, socio-economic features, life satisfaction, regional distribution(eastern, central or western China), and depressive prevalence assessed by the 10-item Centre for Epidemiologic Studies Depression Scale (CES-D-10). The score of CES-D-10 ≥ 10 was considered as depressive symptoms. Robust OLS regression, robust Tobit regression and robust Logit regression were used to identify associated factors of depressive symptoms. Results The median CES-D-10 score of the participants was 8(4, 14)points. Except for 4490 cases(56.39%), the remaining 3473 cases (43.61%) were found with depressive symptoms, including1715(41.52%) aged 45-59 years, and 1758(45.88%) aged 60 or over. Analyses using three regression models indicated that age and age squared(OR=1.099, 0.999), education level (OR=0.897), living in rural or urban areas (OR=0.731), self-rated health (OR=1.245), physical disability (OR=1.332), chronic disease (OR=1.172), troubled with body pains(OR=1.579), BADL (activities of daily living) disability(OR=1.734), IADL(instrumental activities of daily living) disability(OR=1.967), living with spouse(partner)or not(OR=0.763), number of children(OR=1.074), using the internet or not(OR=0.773), having care support or not when needed (OR=1.509), having debt(OR=1.017), life satisfaction (OR=2.150), and regional distribution (OR=1.275) were associated with depression(P<0.05). Conclusion According to the data analysis of this study, the prevalence of depressive symptoms among middle-aged and elderly Chinese women was high, accounting for more than 40%. To control and prevent depressive symptoms to improve mental health status in this population, it is suggested to improve their education level, physical health status, family relations and life satisfaction, reduce their debt-financed consumption, and to offer them more ways to access information, and more social support, as well as to promote urbanization. 【Key words】 Depression; Middle aged; Aged; Femininity; China Health and Retirement Longitudinal Survey; Root cause analysis Studies have shown that depression, as a common psychological disorder among middle-aged and elderly people, can contribute to a high risk of self-harm and suicide [1-2], as well as the risk of cognitive dysfunction and senile dementia [3], which not only reduces the quality of life of middle-aged and elderly people, but a big contributor to the family economic burden and national medical and health resources burden [4]. A great deal of research indicating that there is a gender gap in depression, which is more common in middle-aged and elderly women [5-7].The transition of family identity of middle-aged womenis highly consistent with the China's reform and opening up, the transition period of family and social ethics, and they are more adversely affected in life and psychology.Therefore, it is of great practical importance to understand the mental health status of middle-aged and elderly women in China, especially to explore as many influencing factors as possible.Given this, the study used the 2018 survey data of the China Health and Retirement Longitudinal Survey (CHARLS) to analyze prevalence and associated factors of depression in middle-aged and elderly Chinese women, providing evidence for exploring mental health and effective interventions in this population. 1.Objectivesand Methods 1.1. Objectives This study was conducted from January to March 2021. Data were obtained from the fourth wave survey data of the China Health and Retirement Longitudinal Study (CHARLS, wave 4), which was released in September 2020 and involved 19816 respondents from 150 counties/districts and 450 villages/communities, with good sample representation [8]. Inclusion criteria :(1) age ≥ 45 years; (2) female; (3) respondents who clearly responded to the 10-item version of the Centre for Epidemiological Studies Depression Scale. Exclusion criteria: inability to complete the survey or refusal to participate in the survey. After removing samples with missing selected variables, a total of 7963 middle-aged and elderly women were included in the study. The CHARLS was approved by the Ethical Review Committee of Peking University. (IRB00001052-11015) andthe informed consent was signedat the time of participation with all participants. 1.2. Methods 1.2.1.The investigation content of CHARLS related to the study The contents included demographic characteristics (age, education levels, residency), physical health status (self-reported health, physical disability, chronic disease, troubled with body pains,BADL disability, IADL disability), sociological characteristics (living with spouse/partner or not, number of family members, number of children, number of children who visit their parents at least once a month, caring for grandchildren, number of still alive parents, social activities, using the internet or not, and having care support or not when needed), economic characteristics (having jobs other than self-employed agricultural, individual income, having debt, retirement), life satisfaction, and regional distribution.For BADL, respondents were asked to answer whether they had difficulty in six activities of daily living included dressing, bathing/showering, feeding oneself, getting in or out of bed, using the toilet, and controlling urination and defecation, while theIADL contained doing household chores, cooking, shopping, managing finances, taking medications, and using telephone calls. For both BADL and IADL, answers were categorized as: “do not have any difficulty”, “have difficulties but still can do it”, “have difficulties and help is needed”, “cannot complete it”. Those respondents who reported any difficulty in any item of BADL/IADL were defined as having BADL disability or IADL disability [9]. 1.2.2.Measures of depression The 10-item version of the Centre for Epidemiological Studies Depression Scale (CES-D-10)was used to assess depression in middle-aged and elderly women.The CES-D-10 was revised by ANDRESEN et al. [10] based on the results of item analysis to overcome the problems of long answer time, sensitive item content and high rejection rate in the original CES-D-20.The CES-D-10 scale included the following: (1) I was bothered by things that do not usually bother me. (2) I had trouble keeping my mind on what I was doing. (3) I felt depressed. (4) I felt that everything I did was an effort. (5) I felt hopeful about the future. (6) I felt fearful. (7) My sleep was restless. (8) I was happy. (9) I felt lonely. (10) I could not get “going”.By asked respondents “How often this past week did you ...” answered the above ten items, each item was scored from 0 to 3:“rarely or none of the time (less than 1 day) was scored as 0,” “some or a little of the time(1–2 days) was scored as 1,”, “occasionally or a moderate amount of the time(3–4 days) was scored as 2,” “most or all of the time (5–7 days) was scored as 3.”The responses the two positive feelings of the item 5 and the item 8 were scored as 3, 2, 1 and 0. The total CES-D 10 score ranged from 0 to 30, respondents were classified as scores 10-30 being having depression symptoms and those with scores 0-9 as being without depression symptoms. With a higher score indicating a greater severity of depressive symptoms [10]. The Cronbach’s alpha of CES-D-10 was 0.788[11]. 1.3. Statistical analysis Statistical analyses were performed using Stata version 14.1 software. The measurement data that did not conform to normal distribution were described by M (P25, P75), and counting data were described in relative numbers. Robust OLS regression, Tobit regression and Logit regression were used to analyze the influencing factors of depression in middle-aged and elderly women. Two sided P<0.05 was considered as statistically significant. 2. Results 2.1. The characteristics of the sample Among 7963 middle-aged and elderly women, 4131 (51.88%) were aged from 45 to 59, and 3832 (48.12%) were aged 60 and above. Other demographic characteristics, physical health status, sociological characteristics, economic characteristics, life satisfaction and regional distribution are shown in Table 1. Table 1. Characteristics of 7963 middle-aged and elderly women.
Note: BADL, basic activities of daily living; IADL, instrumental activities of daily living; The number of family members, number of children, number of children who visit their parents at least once a month, the number of still alive parents (including foster parents, father, mother, father-in-law, mother-in-law), individual income, and having debt were recorded as continuous variables and not listed in the table 1. 2.2. Prevalence of depression in middle-aged and elderly women Among 7963 middle-aged and elderly women, the median CES-D-10 score of the participants was 8(4, 14)points. Except for 4490 cases (56.39%), the remaining 3473 cases (43.61%) were found with depressive symptoms, including 1715(41.52%) aged 45-59 years, and 1758(45.88%) aged 60 or over. 2.3. Regression analysis of the influencing factors of depression in middle-aged and elderly women Based on the analysis of relevant literature[12-13], we selected demographic characteristics, physical health status, sociological and economic characteristics, life satisfaction and regional distribution of middle-aged and elderly women as independent variables. For age, the quadratic term of age was introduced in regression according to existing literature[14]. The CES-D-10 scoreof middle-aged and elderly women wasseen as dependent variables, and the above independent variables were included for OLS regression analysis (the assignments of variables used in the study are all shown in Table 2).The multi-collinearity test was performed first, and it was found that the maximum VIF of each variable except age and its quadratic term was 1.88, indicating that there was no multi-collinearity problem.Then,heteroscedasticity test was carried out and it was found that there was heteroscedasticity, so robust OLS regression was used. The result of the robust OLS regression analysis showed that age and age squared, education level, residency, self-reported health, physical disability, chronic disease, troubled with body pains, BADL disability, IADL disability, living with spouse (partner) or not, number of family members, number of children, using the internet or not, having care support or not when needed, having jobs other than self-employed agricultural or not, individual income, having debt, life satisfaction, and regional distribution were correlated with depression in middle-aged and elderly women (P<0.05). Table 2. Assignment of variables possibly associated with depression among middle-aged and elderly women. Note: CES-D, Center for Epidemiologic Studies Depression Scale; BADL, basic activities of daily living; IADL, instrumental activities of daily living. The total CES-D-10 score of 10 items ranged from 0 to 30, and does not conform to normal distribution, OLS regression may produce estimation errors, so the dependent variables and independent variables are included for further analysis in robust Tobit regression, and the results show that age and age squared, education level, residency, self-reported health, physical disability, chronic disease, troubled with body pains, BADL disability, IADL disability, living with spouse (partner) or not, number of family members, number of children, using the internet or not, having care support or not when needed, having jobs other than self-employed agricultural or not, having debt, life satisfaction, and regional distribution were associated with depression in middle-aged and elderly women (P<0.05). With or without depressive symptoms as dependent variables, the above independent variables were included for robust Logit regression. The results indicated that age and age squared, education level, residency, self-reported health, physical disability, chronic disease, troubled with body pains, BADL disability, IADL disability, living with spouse (partner) or not, number of children, using the internet or not, having care support or not when needed, having debt, life satisfaction, and regional distribution have significant impact on depression in middle-aged and elderly women (P<0.05) (Table 3). The results of the three regression models showed that age and age squared, education level, living in rural or urban areas, self-rated health, physical disability, chronic disease, troubled with body pains, BADL disability, IADL disability, living with spouse (partner) or not, number of children, using the internet or not, having care support or not when needed, having debt, life satisfaction, and regional distribution were associated with depression. Table 3. Robust OLS regression, robust Tobit regression and robust Logit regression analyses of influencing factors possibly associated with depression among middle-aged and elderly women. Note: BADL, basic activities of daily living; IADL, instrumental activities of daily living; a, Chi-square statistic. 3. Discussion Previous studies have found that the rate ofdepression for women was higher than that for men,and the prevalence of depressive symptoms in middle-aged and elderly women in China was 43.2% [15].The results of this study showed that middle-aged and elderly women with depressive symptoms accounted for 43.61% (3473/7963), which was close to the above results.Demographic variables, including age, education levels and residency, can affect the depressive symptoms of middle-aged and elderly women. Among them, the influence of age on depressive symptoms was relatively complex, asthe coefficient of age’s level valuewas significantly positive and coefficient of age squaredwas significantly negative, which was in the shape of inverted U-shaped parabola, and the peak age of onset was 52 years old.This was similar to the results of relevant domestic studies, depression symptoms firstworsened and then alleviated with age, and the peak age of onset was between 50 and 60 years old[14].One study reported that higher education level reduced the correlation between social isolation and depressive symptoms in men, but not in women [16]. However, the results of this study showed that the higher level of education, the lower the risk of depression symptoms in middle-aged and elderly women, which was consistent with the results of Li J S et al. [14].The results of our study showed that compared with living in rural areas, middle-aged and elderly women living in urban areas had a lower risk of developing depressive symptoms, which was similar to the results of HE et al. [17],Kong XK et al. [18]. The improvement of the level of urbanization significantly reduced the rate of depression. Results indicated that physical health status was related to depressive symptoms in middle-aged and elderly women, including poor self-rated health, physical disability, chronic disease,troubled with body pains, BADL disability, IADL disability, which werethe influencing factorsfor depression symptoms in those population, supported by relevant research findings [19-21].The results suggestedthat medical workers should attach great importance to the physical health of those population and minimize the negative impact of physical illness on mental health. The results of the study showed that the number of children was associated withdepressive symptoms in middle-aged and elderly women, similar to previous literature [22]. The more the number of children, the higher the risk of depression symptoms they were.Thereasons why middle-aged and elderly females were more affected by depression symptomscould be attributed to two aspects: on the one hand, the large number of childrenincreases the cost of living, education and healthcare for middle-aged and elderly women, leading to a heavier economic burden.On the other hand, employment, marriage and other problems of multiple children may also increase the psychological burden of middle-aged and elderly women, and then lead to developing depression.In contrast, if living togetherwith a spouse or a partner, the symptoms of depression can be reduced. A spouse or a partner can take careeach other andsolve some tough problems together,especially when it comes to the children.Our study found that surfing the internet or not was also associated with depressive symptoms in middle-aged and elderly women, and the reason was that surfing the internet increased access to information and interpersonal communication. Our results also indicated thathaving care support or not when needed was related to depressive symptoms in middle-aged and older women. When they without care support from family members, relatives and friendswhen needed, depressive symptoms were evident, which may be related to the lack of relevant social support.This result pushed urgent requirements for us to concern overthe mental health status of the special groups and the government to improve the elder social security system. The results of this study also showed that having debt was associated withdepressive symptoms in middle-aged and elderly women.Over-consumption and debt management have gradually become a common economic phenomenon, but the modern financial consciousness has not followed up, resulting in middle-aged and elderly women have more psychological pressure for debt. Life satisfaction was correlated with depression symptoms in middle-aged and elderly women, which was confirmed in previous studies[23], indicating thatpeople who were less satisfied with their lives had more negative psychological feelings and were more prone to be depressed. Moreover,as confirmedin several studies [24-25],there was an imbalance in the regional distribution of depression symptoms in China, which may be closely related to the level of economic development among regions. Much can be doneby relevant institutions and departments to narrow the regional differences between middle-aged and elderly women, improve the level of social equity, and promote the healthy development of mental healthof this populationin different regions. To sum up, according to the data analysis of this study, the prevalence of depressive symptoms among middle-aged and elderly Chinese women was high, accounting for more than 40%. To control and prevent depressive symptoms to improve mental health status in this population, it is suggested to improve their education level, physical health status, family relations and life satisfaction, reduce their debt-financed consumption, and to offer them more ways to access information, and more social support, as well as to promote urbanization. Acknowledgments The authors would like to thank the Institute of Social Science Survey of Peking University for their organizing of CHARLS, and all the participants, investigators and assistants of CHARLS. Author Contributions All authors have approved the final manuscript. Declaration of Competing Interest None. References [1] Yi S W. Depressive symptoms on the geriatric depression scale and suicide deaths in older middle-aged men: a prospective cohort study[J]. J Prev Med Public Health, 2016,49(3):176-82. DOI:10.3961/jpmph.16.012. [2] FERRARI A J, SOMERVILLE A J, BAXTER A J, et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature[J]. Psychol Med, 2013,43(3):471-81. DOI: 10.1017/S0033291712001511. [3] HESER K, TEBARTH F, WIESE B, et al. 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Development and Application Effect of Knowledge-to-action Framework-based Health Management in Adolescents with Depressive Disorder in Remote Counties
The prevalence of depressive disorder in adolescents is increasing. Adolescents with depressive disorder in remote counties and their families have a low awareness of the disease, and often are difficult to complete the whole treatment.
To explore the application effect of knowledge-to-action (KTA) framework-based health management in adolescents with depressive disorder in remote counties.
Ninety-four adolescents with depressive disorder coming from remote countries were recruited from the Second Affiliated Hospital of Nanchang University from June to December 2020. They were randomly divided into a routine group (receiving a 12-week routine health management) and a KTA group (receiving a 12-week KTA framework-based health management) . At the time of enrollment and 12 weeks after intervention, the status of non-suicidal self-injury was assessed by the Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ) , mobile phone use was evaluated by the Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) , the anxiety was evaluated with the score of the Screen for Child Anxiety Related Emotional Disorders (SCARED) , and the depression was assessed by the Depression Self-Rating Scale for Childhood (DSRS) .
Two groups had no significant differences in mean total scores of ANSAQ, SQAPMPU, SCARED, and DSRS before receiving intervention (P>0.05) .Two groups had no significant differences in each dimension score of SQAPMPU before receiving intervention (P>0.05) .After the 12-week intervention, the mean total scores of ANSAQ, SQAPMPU, SCARED, and DSRS decreased significantly in both groups (P<0.05) , and they were lowered more significantly in the KTA group (P<0.05) , the each dimension score of SQAPMPU decreased significantly in both groups (P<0.05) , and they were lowered more significantly in the KTA group (P<0.05) .
KTA framework-based health management could effectively reduce the incidence of non-suicidal self-injury and the problematic use rate of mobile phones, relieve the anxiety and depression in adolescents with depressive disorder in remote counties, indicating that this type of health management may have good applicability as an outpatient management in this group.
The prevention and treatment of depression is a priority among mental health issues in China, and pregnant women are a key target group. Prenatal depression is easily ignored although it is highly prevalent and harmful. To reduce its prevalence, it is crucial to identifying the interaction mechanism between psychosocial factors (such as marital satisfaction and partner support) associated with prenatal depression, and controlling the modifiable risk factors.
To explore the relationship between marital satisfaction, partner phubing and depression in late-pregnancy women, and to assess the level of mediating effect of marital satisfaction on the relationship between the latter two, providing maternal and child healthcare professionals with evidence on interventions for prenatal depression.
Convenience sampling method was used to select women in late pregnancy who underwent routine prenatal check-ups in the Obstetrics Clinic, the First Affiliated Hospital of Anhui Medical University from October 2020 to May 2021. A self-designed general information questionnaire was used to collect sociodemographic and obstetric data. The Partner Phubbing Scale (PPS) was used to assess partner phubbing prevalence. The Quality of Marriage Index (QMI) was used to measure the level of marital satisfaction. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the prenatal depression prevalence. Mplus 8.3 was used to establish a structural equation model for mediation analysis.
Altogether, 300 cases were recruited. All of them were included for analysis except nine cases who returned unresponsive questionnaires, obtaining a survey response rate of 97.00%. The prenatal depression prevalence in the respondents was 40.89% (119/291) . The mean scores of PPS, QMI, and EPDS for them were (25.6±6.3) , (37.9±6.0) , and (8.0±3.5) , respectively. Correlation analysis showed that partner phubbing was negatively associated with marital satisfaction (r=-0.292, P<0.01) , and positively associated with prenatal depression (r=0.350, P<0.01) . Marital satisfaction level was negatively correlated with prenatal depression (r=-0.338, P<0.01) . Mediation analysis revealed that the size of direct effect of partner phubbing on prenatal depression was 0.214, accounting for 82.63% of the total effect. Marital satisfaction partially mediated the relationship between partner phubbing and prenatal depression, with a size of mediation effect of 0.045, accounting for 17.37% of the total effect.
Partner phubbing could positively predict depression in late pregnancy, and their relationship may be partially mediated by marital satisfaction. To reduce the prevalence of depression in late pregnancy, maternal and child healthcare professionals could improve the marriage of pregnant woman via providing them with interventions to decrease the prevalence of partner phubbing.
The prevalence of sub-health problems is increasing in young and middle-aged office building occupants, in which the percentage of mental health problems is on the rise. Shanghai took the lead in delivering family doctor services via the health station set in an office building in June 2018, but mental health in young and middle-aged people has not yet been insufficiently covered by the services.
To assess the prevalence of anxiety and influencing factors in young and middle-aged office building occupants in Shanghai.
A questionnaire survey for estimating anxiety prevalence was carried out in typically sampled office buildings from Hongkou District, Pudong New District and Jing'an District of Shanghai during December 2019 to December 2020. Cluster random sampling was used to sample young and middle-aged occupants (18-59 years old) in the buildings, and 2 198 cases of them who completed the survey were included as the participants for analysis. Anxiety was diagnosed by the score of the Zung's Self-Rating Anxiety Scale. Multiple linear regression was used to estimate the association of anxiety prevalence with socio-demographic and economic characteristics, and health status as well as lifestyle.
Among the participants, the prevalence of no anxiety, mild, moderate and severe anxiety was 60.42% (1 328/2 198), 18.61% (409/2 198), 12.46% (274/2 198), and 8.51% (187/2 198), respectively. Multiple linear regression analysis found that registered place of household (Shanghai or not), education level, self-rated social class, self-rated health, frequency of physical examination, level of fatigue, chronic disease prevalence and regular medication were associated with anxiety prevalence (P<0.05) .
The prevalence of anxiety was high in this group of population, which may be associated with the population characteristics. In view of this, mental health should be valued during the delivery of family doctor services for these people, and targeted interventions can be provided according to personal anxiety status when necessary.
In China, 80% of the grandparents are taking part in caring for grandchildren. However, it has been found by available studies that involvement in taking care of grandchildren may increase the risk of depression among grandparents, which would seriously harm their quality of life, and the risk of depression is associated with parent-grandparent coparenting conflict, grandparents' sense of valued elder and sense of mastery, but the underlying mechanism still requires further investigation.
To investigate the influence of parent-grandparent coparenting conflict on grandparents' depression, and to explore the mediating and moderating mechanisms that grandparents' sense of mastery and sense of valued elder may play in it.
This study used two surveys. Grandparents (totally 626 cases) who participated in caring for grandchildren were selected by snowball sampling to attend an online survey or by convenience sampling to attend an offline survey from August to November 2021 using four questionnaires, namely the Coparenting Relationship Scale (CRS), the Pearlin Mastery scale (PMS), Grandparent Meaning Scale (GMS), and the 9-item Chinese version of the Center for Epidemiological Studies Depression Scale (CES-D-C). Pearson correlation was used to analyze the relationship of mother-grandparent coparenting conflict score, father-grandparent coparenting conflict score, PMS score, score of the valued elder dimension of the GMS and CES-D-C. PROCESS was used to examine the mediating effect of grandparents' sense of mastery and the moderating effect of their sense of valued elder between parent-grandparent coparenting conflict and grandparents' depression, and to draw a simple slope diagram.
A total of 626 cases returned responsive questionnaires, with a response rate of 99.2%. The prevalence of depression tendency was 12.0% (75/626) in this study. The score of CES-D-C〔 (5.36±4.14) 〕 was found to be significantly positively correlated with mother-grandparent coparenting conflict score〔 (9.87±3.08), r=0.28, P<0.05〕, and father-grandparent coparenting conflict score〔 (7.34±3.25), r=0.35, P<0.05〕, but was negatively correlated with the PMS score 〔 (12.61±5.48), r=-0.25, P<0.05〕and the score of valued elder dimension〔 (84.13±8.58), r=-0.21, P<0.05〕. Grandparents' sense of mastery partially mediated the relationship of grandparents' depression with mother-grandparent coparenting conflict (with a size of indirect effect of 0.05, accounting for 17.2% of the total effects) and father-grandparent coparenting conflict (with a size of indirect effect of 0.04, accounting for 11.4% of the total effects). Grandparents' sense of valued elder moderated the relationship of grandparents' depression with mother-grandparent coparenting conflict (b=-0.06, P<0.05), and father-grandparent coparenting conflict (b=-0.07, P<0.05). The results of simple slope tests showed that among those with lower sense of valued elder, father-grandparent or mother-grandparent co-parenting conflict had a stronger influence on their depression than their counterparts with higher sense of valued elder.
Parent-grandparent (either mother-grandparent or father-grandparent) coparenting conflict is an important associated factor for grandparent's depression In this association, grandparent's sense of mastery plays a mediating role, while grandparent's sense of valued elder exerts a moderating effect. To reduce the risk of depression and promote the metal health among elders who take part in coparenting, efforts can be made to reduce coparenting conflicts and enhance the elders' sense of mastery and sense of valued elder.
Prevalence and Influencing Factors of Receiving Regular Interviews for Patients with Severe Mental Disorders in Communities
Patients with severe mental disorders pose a serious threat to social stability due to lack of insight and high recurrence and disability rates. Therefore, it is essential to conduct regular interviews with these patients to better evaluate their conditions comprehensively, so as to timely deliver appropriate interventions, thereby improving the level of severe mental disorder management.
To explore the prevalence of receiving regular interviews and associated factors in patients with severe mental disorders in the community, providing information for improving the quality of severe mental disorder management via interviews.
Basic and follow-up management data of Wuxi severe mental disorder patients with files created as of 2019 were collected from Jiangsu Severe Mental Disorder Patients Management System during October to December 2020. The prevalence of these patients receiving regular interviews was analyzed, and associated factors were examined by Logistic regression analysis.
A total of 27 778 samples were included, with a prevalence of receiving regular interviews of 81.08% (22 523/27 778) . Logistic regression analysis showed that non-local hukou〔OR (95%CI) =0.704 (0.640, 0.775) 〕, ≤44 years old〔OR (95%CI) =0.522 (0.472, 0.578) 〕, education level〔high school/secondary vocational school: OR (95%CI) =0.493 (0.446, 0.545) and junior college: OR (95%CI) =0.470 (0.415, 0.532) 〕, full-time employment〔OR (95%CI) =0.715 (0.668, 0.766) 〕, unmarried〔OR (95%CI) =0.746 (0.665, 0.838) 〕, non-poor〔OR (95%CI) =0.587 (0.517, 0.666) 〕, no antipsychotic treatment〔OR (95%CI) =0.491 (0.440, 0.548) 〕, 0-10-year medication treatment〔OR (95%CI) =0.881 (0.778, 0.998) 〕, receiving no management subsidy〔OR (95%CI) =0.807 (0.704, 0.926) 〕, not participating in community rehabilitation services〔OR (95%CI) =0.844 (0.716, 0.996) 〕were barriers to receive regular interviews (P<0.05) .
The prevalence of receiving regular interviews in Wuxi severe mental disorder patients needs to be improved. And recommended interventions include developing favorable policies for conducting regular interviews, carrying out relevant heath publicity and education, reducing the stigma of mental disorders, improving the awareness of mental disorders, and increasing social supports, with special focus on patients who are non-locals, aged≤44 years old, employed full-time, unmarried, non-poor, have high school or above education, have 0-10-year medication treatment but no antipsychotic treatment, have no subsidy for management, and do not participate in community rehabilitation services.
Study on the Moderating Effect of Body Mass Index in Correlation of Anxiety and Depression Disorders
As two different kinds of mental disorders, anxiety disorder and depressive disorder could probably coexist in one with the proceeding of the illness. However, there are few studies on how to prevent and treat the coexistence of anxiety and depressive disorders.
To discuss the relationship between anxiety and depressive disorders, and the moderating effect of body mass index (BMI) in their relationship.
By use of simple random sampling, 86 outpatients and inpatients with anxiety disorders were selected from the First Affiliated Hospital of Nanchang University during June 1st to August, 31st, 2021. A self-made demographic questionnaire was used to obtain the demographic information. The Hamilton Anxiety Rating Scale was used to assess the anxiety level. The Hamilton Rating Scale for Depression was used to assess the depression level. Pearson correlation analyses were performed to assess the relationship between anxiety and depression disorders, and that between BMI and anxiety or depression disorder. Hierarchical regression analysis was adopted to explore the moderating effect of BMI on the relationship between anxiety and depressive disorders.
Eighty eligible cases were also diagnosed with depression. The anxiety prevalence was significantly increased with depression prevalence (r=0.70, P<0.01) . BMI had no significant linear correlation with anxiety prevalence (r=0.03, P>0.05) . BMI also had no significant linear correlation with depression prevalence (r=0.14, P>0.05) . BMI moderated the relationship between anxiety and depression disorders significantly (β=-0.16, P<0.01) .
BMI can weaken the effect of anxiety disorder on depression, helping prevent them from developing into comorbid mental disorders, providing new ideas for developing new dietary standard or exercise patterns for mental health prevention and treatment in the future and expands the research field of nutritional psychiatry to a certain extent.
There are many subtypes of major depressive disorder (MDD) . Evidence about the differentiation of them is mostly based on symptomatological characteristics, but rarely by objective biological indicators.
To explore the differences in event-related potential (ERP) N400 between patients with different subtypes of depression, providing an objective electrophysiological basis for subtyping depression.
Two hundred and nine outpatients and inpatients who met the diagnostic criteria of MDD in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition were selected from First Hospital of Shanxi Medical University from February 2019 to December 2021, including 78 with anxious depression (ASD+MD-) , 46 with melancholic depression (ASD-MD+) , 61 with anxious and melancholic depression (ASD+MD+) , and 24 with non-anxious and melancholic depression (ASD-MD-) subtyped using the 30-item Inventory of Depressive Symptomatology (IDS-30) and 17-item Hamilton Depression Rating Scale (HAMD-17) . Thirty-five community-living health volunteers were recruited as controls at the same time.The factor and total scores of the HAMD-17 and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) of all subjects were collected. And the latency and amplitude of N400 component of all subjects were collected by inducing N400 components through understanding ambiguous words at the end of sentences.
(1) The total score and factor scores of HAMD-17 differed significantly across MDD subgroups and control group (P< 0.05) . The total score of HAMD-17 in each of the four MDD subgroups was much higher than that in control group (P<0.05) . ASD+MD+ subgroup had significantly higher total score of HAMD-17 than both ASD-MD- and ASD-MD+ subgroups (P<0.05) .ASD+MD- subgroup had significantly higher total score of HAMD-17 than ASD-MD+ subgroup (P<0.05) . The score of anxiety factor in each of the four MDD subgroups was obviously higher than that in control group (P<0.05) . ASD+MD- subgroup had obviously higher score of anxiety factor than both ASD-MD+ and ASD-MD- subgroups (P<0.05) .ASD+MD+ subgroup had prominently higher score of anxiety factor than both ASD-MD+ and ASD-MD- subgroups (P < 0.05) . The score of body weight factor in ASD+MD+ or ASD+MD- subgroup was much higher than that in control group (P<0.05) .ASD+MD+ subgroup had much higher score of body weight factor than both ASD-MD- and ASD-MD+ subgroups (P<0.05) . The score of cognitive impairment factor in each of the four MDD subgroups was much higher than that in control group (P<0.05) .ASD+MD+ subgroup had much higher score of cognitive impairment factor than ASD-MD+ subgroup (P<0.05) . The scores of block factor and sleep disturbance factor in each of the four MDD subgroups were significantly higher than those in the control group (P<0.05) . (2) The total score and factor scores of RBANS varied significantly across four MDD subgroups and control group (P<0.05) .The total score of RBANS and scores of its factors of immediate memory, visual span, speech function, attention, and delayed memory in each of the four MDD subgroups were much lower than those in the control group (P<0.05) . The score of immediate memory factor in ASD+MD+ group was notably lower than that in ASD-MD+ group (P<0.05) . (3) There were no significant differences in latency and amplitude of N400 component across four MDD subgroups and controls (P>0.05) .There were no significant differences in latency and amplitude of N400 component across different electrode sites (P>0.05) , and there were no interaction between no-depression or each of the four subtypes of MDD and electrode sites (P>0.05) . (4) The N400 amplitude value at Fz electrode was negatively correlated with the cognitive impairment factor score (r=-0.170, P=0.016) .The N400 amplitude value at Cz electrode was positively correlated with the block factor score (r=0.151, P=0.033) .The N400 amplitude valueat Pz electrode was positively correlated with the block factor score (r=0.174, P=0.014) .The N400 amplitude value of the Fz electrode was positively correlated with the immediate memory score (r=0.138, P=0.050) .The N400 latency value at Cz electrode was negatively correlated with the delayed memory score (r=-0.155, P=0.028) .
Extensive cognitive impairment was found in MDD patients, including impaired immediate memory, speech function, attention and delayed memory. ASD+MD+ and ASD+ MD-patients had more severe symptoms, and ASD+MD+ patients had the most severe cognitive impairment. N400 amplitude value was negatively correlated with cognitive impairment and positively correlated with block factor in MDD patients. But these patients demonstrated no impaired function of speech integration induced by ambiguous words at the end of sentences.
Association between Depression Prevalence and Adverse Childhood Experiences in Middle-aged and Older People
Depression prevalence and adverse childhood experiences (ACEs) in middle-aged and older people has become an increasingly concerned issue, yet it in Chinese population has been less reported, and needs to be further explored.
To investigate the epidemiology of ACEs among middle-aged and elderly Chinese people, and to analyze its association with depression prevalence, providing an accurate delineation of ACEs and depression prevalence in this group of Chinese people.
Information of 7 035 middle-aged and elderly people≥ 45 years old who met the research requirements were selected during July to August, 2021 from the database of China Health and Retirement Longitudinal Study held by Institute of Social Science Survey, Peking University, in which the questions in the Center for Epidemiologic Studies Depression Scale used in the CHARLS, ACEs (including abuse, neglect, dysfunctional family) and individual characteristics were screened and generated into new dummy variables with the weight reassigned. Covariates of those with ACEs (treatment group) and those without (control group) were included in a propensity score matching model, and propensity scores of them were estimated using robust standard errors in multivariate Logistic regression, then the covariates of two groups were matched using the 1∶1 nearest neighbor matching, and were checked using balance diagnostics and common support assumption. The influence of ACEs on the depression in those with ACEs was quantified by the average treatment effect on the treated.
Of the 7 035 respondents, 6 529 (92.81%) had experienced ACEs, 1 802 (25.61%) had experienced at least four ACEs, and 1 003 (14.26%) had a depressive state. Multivariate Logistic regression model demonstrated that age, gender, and self-rated health status were significantly associated with ACEs (P<0.05) . Individual characteristics of both groups after propensity score matching were comparable (P>0.05) , and went through the check of balance diagnostics and common support assumption. Propensity score matching-based analysis revealed that the risk of depression prevalence in those with ACEs was increased by a factor of 6.9% compared with those without (P<0.001) .
The prevalence of ACEs among middle-aged and elderly Chinese people was higher, which may significantly increase the risk of depression prevalence. Therefore, it is urgently needed to establish a system of ACEs screening and intervening to improve the level of healthcare services and well-being for these people.
Modified Electroconvulsive Therapy in Patients with Schizophrenia：Curative Effect and Responses of Neurotransmitters in Brain and Different Brain Regions
Neurotransmitters in multiple brain regions in schizophrenia patients have been extensively studied using encephal of luctuograph in terms of functional features, and also been explored using modified electroconvulsive therapy (MECT) regarding their responses to MECT, but responses of neurotransmitters in a specific region to MECT have been rarely examined.
To examine pre- and post-treatment changes of neurotransmitters in brain and different brain regions in patients with schizophrenia with MECT, and to investigate the possible neurobiological mechanism of MECT.
Fifty-one schizophrenia patients were recruited from Changzhou Dean Hospital from January 2019 to December 2020. All of them had signed the written informed consent form of receiving MECT prior to the participation in the study, and received MECT with unchanged antipsychotic medications during the study period. Scores of new 5-factor model of the PANSS (20 items) , neurotransmitters in brain and different brain regions 24 hours before the first MECT and 24 hours after the end of MECT were compared among all patients.
Compared with those 24 hours before the first MECT, scores of positive factor, negative factor, hostile excitement, anxiety and depression, cognitive and total PANSS score, as well as gamma-aminobutyric acid (GABA) in brain and left posterior brain region, and glutamate (Glu) in left posterior brain region significantly decreased, but dopamine (DA) in brain and right frontal brain region significantly increased 24 hours after the end of MECT (P<0.05) .
MECT has certain anti psychotic effect in patients with schizophrenia, its neurobiological mechanism may be related with the influence on GABA and DA in brain, GABA and Glu in left posterior brain region, as well as DA in right frontal brain region.
Attention bias modification (ABM) , a newly emerging focus in emotion modification research, is a treatment to reduce individuals' attention bias toward negative stimuli to improve their abnormal cognition via repeated computer-based attention trainings toward neutral or positive stimuli. Recent studies about depression treated using ABM are increasing, but based on insufficient evidence with various efficacy assessment indicators.
To systematically assess the effect of ABM in patients with depression.
Databases including PubMed, The Cochrane Library, EMBase, CBM, CNKI, WanFang Data and VIP were searched from inception to December 31st, 2021 for randomized controlled trials (RCTs) regarding depressive patients treated by ABM (experimental group with computer-based ABM trainings) compared with placebo trainings under the same conditions (control group with no interventions or sham ABM trainings) . Primary outcome measures included Hamilton Rating Scale for Depression (HAMD/HRSD) , Beck Depression Inventory (BDI) and Center for Epidemiologic Studies Depression Scale (CES-D) . Secondary outcome measures included the State-Trait Anxiety Inventory (STAI-T) and Ruminative Responses Scale (RRS) . Two researchers independently performed literature enrollment, and extracted data, and evaluated the risk of bias using Risk of Bias 2 (RoB 2.0) tool. RevMan 5.4 and Stata 12.0 were used for Meta-analysis.
Thirteen RCTs involving 968 patients were included, among which one had two trials. Risk of bias was low in seven RCTs, unclear in four, and high in two. Meta-analysis showed that the overall improvement of depression, anxiety and rumination in the experimental group was better than that in the control group (P<0.05) . Further analysis indicated that two groups had no significant differences in mean scores of BDI and HAMD within a follow-up period of less than two months (P>0.05) . When the follow-up time was prolonged to at least two months, the mean BDI score was still similar in both groups (P>0.05) .
ABM treatment could improve depressive, anxiety symptom and rumination in patients with depression, but its long-term effect needs to be studied further.
Cardiovascular disease and psychological disease are the two major public health problems threatening the health of Chinese residents. At present, there are about 11 million patients with coronary heart disease (CHD) in China. The comorbidity rate of coronary heart disease hospitalized patients with depression can reach 51%, and the combined major depression is 3.1% to 11.2%. At present, there are few studies on the association between thyroid function and depression status in CHD patients.
To explore the association between thyroid function and depression status in patients with CHD.
From October 2017 to February 2018, 561 patients diagnosed CHD from the Department of Cardiology of Guangdong Provincial People's Hospital were selected, and divided into coronary heart disease without depression group and CHD combined depression group according to whether depression was combined, which was evaluated by the patient health Questionnaire-9 (PHQ-9) . The gender, age, body mass index (BMI) , comorbid diseases (hypertension, diabetes, dyslipidemia, acute myocardial infarction) , the levels of high-sensitivity C-reactive protein (hs-CRP) , high-sensitivity troponin T (hs-cTnT) , N-terminal-B-type natriuretic peptide precursor (NT-proBNP) , serum free triiodothyronine, free thyroxine, thyroid-stimulating hormone, free triiodothyronine (FT3) , free thyroxine (FT4) and thyroid stimulating hormone (TSH) of patients wre recorded. Univariate and multivariate Logistic regression was used to analyze the effect of FT3 on the risk of depression in patients with CHD.
CHD without depression group included 350 cases (62.4%) , CHD complicated with depression group included 211 cases (37.6%) , with 148 mild depression cases (26.4%) , 46 moderate depression cases (8.2%) , 17 severe depression cases (3.0%) . The level of FT3 in the CHD complicated with depression group was lower than that in the CHD without depression group (P<0.05) , but there was no significant difference in FT4 and TSH levels between the CHD complicated with depression group and the CHD without depression group (P>0.05) . PHQ-9 score was negatively correlated with FT3 level (rs=-0.114, P<0.05) and positively correlated with age (rs=0.093) and hs-CRP (rs=0.090) (P<0.05) in the CHD combined with depression group. The results of the univariate and multivariate Logistic regression to analyze the effect of FT3 on the risk of depression in patients with CHD showed that for each standard deviation of FT3, the risk of depression in patients with CHD decreased by 20%〔OR=0.8, 95%CI (0.67, 0.96) 〕. Similar results were observed in the FT3 quintile stratified analysis, in which the lowest risk of incident depression was observed in CHD patients in the FT3 quartile (4.98-5.34 pmol / L) , andunivariate analysis (unadjusted) showed a significant trend in OR values among the quintiles of FT3 (P<0.05) .
The level of serum FT3 in patients with CHD complicated with depression was lower than that in patients without depression, and the level of FT3 in severe depression group was more significant. FT3 may be a potential biochemical marker of depression in patients with CHD, and it is recommended that patients with CHD and depression should be evaluated for thyroid function.
Generalized anxiety disorder is a common chronic psychiatric disorder, which leads to cognitive impairment and seriously affects the quality of life and social function of patients.
To compare the differences in cognitive function between GAD inpatients and healthy controls.
From August 2018 to January 2020, GAD patients hospitalized in Nanfang Hospital, Southern Medical University were selected as the GAD group (n=30) . At the same time, age- and gender-matched healthy volunteers were recruited from the escorts of inpatients in Nanfang Hospital, Southern Medical University as the healthy control group (n=30) . The Hamilton Anxiety Scale (HAMA) , Hamilton Depression Scale (HAMD) and Beck scale for suicide ideation-Chinese Version (BSI-CV) were used for psychological evaluation. Psychomotor vigilance task (PVT) , Go/No-go association task and N-back task were used to evaluate the cognitive function of attention, inhibition and working memory separately. The differences in general conditions, psychological characteristics, and cognitive function between two groups were compared. Multivariate Logistic regression analysis was further used to compare the differences in cognitive function between GAD inpatients and healthy controls.
The total scores of HAMA and HAMD, the total scores of BSI-CV at the most severe condition and the proportion of the patients with suicidal ideation at the most severe condition in GAD group were higher than those in control group (P<0.05) . N-back task: the percentage of hitting targets at 1-back (NBACK1a) and 2-back (NBACK2a) in GAD group were both significantly lower than that in control group (P<0.05) ; the average reaction time of hitting targets at 1-back (NBACK1b) in GAD group was significantly longer than that in control group (P<0.05) . Multivariate Logistic regression analysis showed that NBACK1a〔OR=0.946, 95%CI (0.898, 0.997) , P=0.038〕and NBACK1b〔OR=1.007, 95%CI (1.000, 1.014) , P=0.042〕 were the influencing factors of GAD.
GAD inpatients perform worse than healthy controls mainly in working memory, which deserves more clinical attention.
Motivation impairment is highly valued in the treatment and functional rehabilitation of schizophrenia as it is a core symptom of the illness. Although new developments have been made in motivation impairment, but its associated factors are not entirely clear. We reviewed recent studies in motivational impairment in schizophrenia, and made a detailed summary of the features, assessment, and associated factors of motivational impairment, providing ideas for the development of strategies for clinical intervention of schizophrenia.
Brain White Matter Fiber Bundle Alterations and Severity of Depression in Patients with Post-stroke Depression
Post-stroke depression (PSD) , a common complication in stroke patients, may increase the disability and mortality, however, its pathogenesis is unknown yet.
To observe the white matter fiber bundle alterations by diffusion tensor tractography (DTT) , and to explore its correlation with depression in patients with PSD.
Participants were selected from the First Affiliated Hospital of Jinzhou Medical University from September 2019 to September 2020, involving 40 inpatients with first-episode ischemic stroke (20 were found with PSD, and 20 without) , and 20 physical examinees as healthy controls. DTT was performed in all participants, fractional anisotropy (FA) and number of fiber bundles in regions of interest (ROIs) were compared across PSD and non-PSD inpatients and healthy controls. Pearson correlation analysis was performed to analyze the correlations of FA and number of fiber bundles on the side of stroke in the ROIs with 24-item Hamilton Rating Scale for Depression (HAMD-24) in PDS inpatients.
In PSD inpatients, the FA of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle and uncinate fasciculus on the side of the stroke was significantly lower than those on the contralateral side (P<0.05) . And the number of fiber bundle of inferior fronto-occipital fascicles, corticospinal tract and frontopontine tract on the side of the stroke was significantly less than those on the contralateral side (P<0.05) . Compared to non-PSD inpatients or healthy controls, PSD inpatients demonstrated significantly lower FA of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle and uncinate fasciculus, and notable less number of fiber bundles of inferior fronto-occipital fascicles, corticospinal tract and frontopontine tract on the side of the stroke (P<0.05) . Pearson correlation analysis revealed that, the FA of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle or uncinate fasciculus on the side of the stroke was negatively correlated with HAMD-24 score in PSD inpatients (r=-0.469, -0.769, -0.728, -0.801, -0.839, P<0.05) ; the number of fiber bundle of inferior fronto-occipital fascicles, corticospinal tract or frontopontine tract on the side of the stroke was negatively correlated with HAMD-24 score in PSD inpatients (r=-0.858, -0.806, -0.694, P<0.01) .
There were impairment changes of structure of inferior fronto-occipital fascicles, corticospinal tract, frontopontine tract, cingulum bundle and uncinate fasciculus in patients with PSD, and these changes may be significantly correlated with the severity of depression, indicating that some white matter fiber bundle alterations may be involved in the onset of PSD.
Schizophrenia is a severe mental disorder that endangers patients and their families' lives as well as the society. Over 80% of patients cannot be cured completely, one contributor to which is patients' lack of self-determined motivation for treatment. There are few studies on self-determined motivation for treatment among patients with schizophrenia in China. Self-determined motivation facilitates the development of positive emotions, behaviors and cognition, which also plays a vital role in the promotion health-related behaviors. We reviewed the latest advances in self-determined motivation towards rehabilitation treatment in schizophrenia patients, and gave a summary of the features and measurement methods regarding self-determined motivation, as well as its roles in predicting the effect of cognitive remediation, physical therapy and other types of rehabilitation treatment, and in maintaining treatment adherence. After that, we made suggestions on the problems to be solved. To improve treatment adherence and cure rate in schizophrenia patients, future studies may focus on developing appropriate interventions in accordance with the self-determined motivation of the patients.
Considerable evidence suggests that people with depressive disorder are at higher risk for somatic symptoms than normal people, but the mechanisms of susceptibility are unclear. Some studies suggest that the levels of precursor of brain-derived neurotrophic factor (ProBDNF) and inflammatory cytokines in depressive disorder patients are higher, but it is still unclear whether this is related to the accompanying somatic symptoms.
To explore the characteristics of somatic symptoms, and their correlations with BDNF and inflammatory cytokines in patients with major depressive disorder (MDD) .
A total of 59 MDD outpatients and inpatients from Mental Health Department, First Hospital of Shanxi Medical University and 32 healthy volunteers from the community were recruited from February 2019 to December 2020. Somatic symptoms were diagnosed using the Somatic Self-rating Scale (SSS, SSS score >36 and SSS score ≤36 were defined as with somatic symptoms or without, respectively) . Depression was assessed using the Hamilton Depression Rating Scale (HAMD-17) . Clinical data were collected, including gender, age, years of education, HAMD-17 score, SSS score, absorbance of ProBDNF and BDNF, and inflammatory cytokines (CRP, IL-4, IL-10, IL-18, IL-23a, HMGB1, IL-6, TNF-α, IFN-α) . Spearman's rank correlation analysis was used to investigate the correlation of somatic symptoms (including dizziness and headache, frequent and urgency of urination, cardiovascular symptoms, muscle soreness, gastrointestinal symptoms, tingling and twitching of hands and feet, choking and sighing, blurred vision, and discomfort of the throat) , SSS-S factor score and HAMD-17 score with ProBDNF and BDNF, and inflammatory cytokines.
MDD patients with somatic symptoms had higher total HAMD-17 score than those without (P<0.001) . Both MDD patients with and without somatic symptoms had higher total HAMD-17 score than healthy volunteers (P<0.001) . MDD patients with somatic symptoms had higher total SSS score and SSS-S factor score than those without (P<0.001) . And they also had higher total SSS score and SSS-S factor score than healthy volunteers (P<0.001) . MDD patients with somatic symptoms had higher BDNF than those without (P<0.05) . The IFN-α in healthy volunteers was lower than of MDD patients with or without somatic symptoms (P<0.001) . ProBDNF was negatively correlated with muscle soreness (rs=-0.262, P<0.05) . CRP was negatively correlated with tingling and twitching of hands and feet (rs=-0.386, P<0.01) . IL-4 had a negative correlation with gastrointestinal symptoms (rs=-0.336, P<0.01) . IL-10 had a positivecorrelation with blurred vision (rs=0.286, P<0.05) . BDNF was positively correlated with dizziness and headache (r=0.339, P<0.01) , cardiovascular symptoms (rs=0.309, P<0.05) , gastrointestinal symptoms (rs=0.278, P<0.05) , muscle soreness (rs=0.419, P<0.01) , tingling and twitching of hands and feet (rs=0.286, P<0.05) , choking and sighing (rs=0.372, P<0.01) , discomfort of the throat (rs=0.392, P<0.01) and SSS-S factor score (rs=0.418, P<0.01) . IL-6 was positively correlated with cardiovascular symptoms (rs=0.283, P<0.05) and choking and sighing (rs=0.374, P<0.01) . TNF-α was negatively correlated with muscle soreness (rs=-0.299, P<0.05) . IFN-α showed a negative correlation with blurred vision (rs=-0.267, P<0.05) .
The peripheral blood IFN-α of MDD patients was lower than that of normal people. The severity of depression and BDNF level were higher in MDD patients with somatic symptoms than those without. The elevation of multiple inflammatory cytokines was correlated with the increase in the risk of somatic symptoms, suggesting that patients with MDD may be prone to somatic symptoms and adverse outcomes, requiring early intervention.
Special Issue: Mental Health
