Journal of affective disorders最新文献

{"title":"Prevalence of poststroke anxiety and its associations with global cognitive impairment: An individual participant data analysis.","authors":"Florine Ruthmann, Jessica W Lo, Anne-Marie Mendyk-Bordet, Etienne Allart, Sebastian Köhler, Aleksandra Klimkowicz-Mrowiec, Julie Staals, Perminder S Sachdev, Régis Bordet, Thibaut Dondaine","doi":"10.1016/j.jad.2024.10.099","DOIUrl":"10.1016/j.jad.2024.10.099","url":null,"abstract":"<p><strong>Background and purpose: </strong>Anxiety is frequent after stroke; however, little is known about its determinants. This study aims to assess the prevalence and correlates of post stroke anxiety (PSA) within 3-6 months following ischemic stroke.</p><p><strong>Methods: </strong>Three cohort studies from the STROKOG consortium were involved. Demographic and clinical data were standardized. PSA and PSD were assessed using inventories. The criteria for post-stroke cognitive impairment (PSCI) were at least one cognitive domain impaired if applicable, or a Montreal Cognitive Assessment (MoCA) score. Descriptive analyses were conducted to ascertain the prevalence of anxiety. Comparisons between anxious and non-anxious patients in the total sample were made using χ² and t-tests. A two-step individual participant data (IPD) meta-analysis was employed to identify factors associated with PSA.</p><p><strong>Results: </strong>584 patients were included. The total prevalence of PSA was 35 % (95%CI = [31.23;38.97]) and ranged from 27 % to 45 % across cohorts. In the total sample, there was a higher proportion of females in the anxiety group than the non-anxiety group (χ² = 19.62; p < 0.001). Anxious patients had lower education, (χ² = 6.59; p = 0.03), higher stroke severity (t = 2.77; p = 0.002), and higher rates of PSD (χ² = 118.09; p < 0.001), and PSCI (χ² = 23.81, p < 0.001). The analysis demonstrates that the odds of presenting with PSA is larger in patients with PSCI (OR = 1.84, 95%CI = [1.14; 2.91]).</p><p><strong>Conclusions: </strong>Anxiety is frequent after stroke, especially in females, and is associated with depression and cognitive impairment.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seasonal variation in mood among individuals with and without bipolar disorder.","authors":"Jennifer R Goldschmied, Emma Palermo, Sarah Sperry, Helen J Burgess, Michael McCarthy, Anastasia Yocum, Melvin McInnis, Philip Gehrman","doi":"10.1016/j.jad.2024.10.101","DOIUrl":"10.1016/j.jad.2024.10.101","url":null,"abstract":"<p><strong>Introduction: </strong>Bipolar disorder is a disorder characterized by cyclic changes in mood, yet limited research has explored longitudinal patterns of seasonality on mood symptoms in this population. This study aimed to examine longitudinal mood symptoms in individuals with bipolar type I and II, and healthy controls to determine if seasonal patterns were present and to validate the Global Seasonality Score as a measure of seasonality.</p><p><strong>Methods: </strong>Participants from the Prechter Longitudinal Study of Bipolar Disorder were included. Seasonal variations in mood were determined from the Patient Health Questionnaire, Altman Self-Rating Mania scale, and the Seasonal Pattern Assessment Questionnaire. Mixed effects models were utilized to examine the effects of season and diagnostic group on patterns of mood over time.</p><p><strong>Results: </strong>All groups exhibited significant seasonal effects on mood symptoms, with evidence of decreased depressive symptoms and increased mania symptoms in longer daylight months. The Global Seasonality Score showed significant differences between diagnostic groups, with bipolar I and II groups demonstrating higher seasonality than healthy controls. High seasonality was associated with greater variance in mood symptoms.</p><p><strong>Conclusion: </strong>The present study found evidence of seasonal patterns in mood symptoms in individuals with bipolar type I and II. These results highlight the need for consideration of seasonality in assessment and treatment in bipolar disorder and suggest that interventions such as light therapy during seasons of heightened risk could be beneficial. The validation of the Global Seasonality Score as a reliable measure further underscores the benefit of utilizing self-report measures to identify periods of vulnerability.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental dynamics of brain network modularity and temporal co-occurrence diversity in childhood.","authors":"Zeyu Song, Qiushi Wang, Yifei Wang, Yuchen Ran, Xiaoying Tang, Hanjun Li, Zhenqi Jiang","doi":"10.1016/j.jad.2024.10.072","DOIUrl":"https://doi.org/10.1016/j.jad.2024.10.072","url":null,"abstract":"<p><strong>Objective: </strong>Brain development during childhood involves significant structural, functional, and connectivity changes, reflecting the interplay between modularity, information interaction, and functional segregation. This study aims to understand the dynamic properties of brain connectivity and their impact on cognitive development, focusing on temporal co-occurrence diversity patterns.</p><p><strong>Methods: </strong>We recruited 481 children aged 6 to 12 years from the Healthy Brain Network database. Functional MRI data were used to construct dynamic functional connectivity matrices with a sliding window approach. Modular structures were identified using multilayer network community detection, and the Dagum Gini coefficient decomposition technique, which uniquely allows for multi-faceted exploration of modular temporal co-occurrence diversities, quantified these diversities. Mediation analysis assessed the impact on small-world properties.</p><p><strong>Results: </strong>Temporal co-occurrence diversity in brain networks increased with age, especially in the default mode, frontoparietal, and salience networks. These changes were driven by disparities within and between communities. The small-world coefficient increased with age, indicating improved information processing efficiency. To validate the impact of changes in spatiotemporal interaction disparities during childhood on information transmission within brain networks, we used mediation analysis to verify its effect on alterations in small-world properties.</p><p><strong>Conclusion: </strong>This study highlights the critical developmental changes in brain modularity and spatiotemporal interaction patterns during childhood, emphasizing their role in cognitive maturation. These insights into neural mechanisms can inform the diagnosis and intervention of developmental disorders.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modelling the associations between parental depressive symptoms, hypomanic traits, and infant socio-emotional development: The mediating role of parental reflective functioning.","authors":"Aigli Raouna, Lisa-Christine Girard, Angus MacBeth","doi":"10.1016/j.jad.2024.10.096","DOIUrl":"10.1016/j.jad.2024.10.096","url":null,"abstract":"<p><strong>Background: </strong>Although understanding of maternal hypomania in the postpartum period is gradually improving, the intergenerational pathways of risk associated with hypomania in the context of postpartum depression remain unknown. It is also unclear whether distinct or shared pathways of risk exist for infants exposed to different parental mood characteristics and whether these pathways are mediated by parental reflective functioning.</p><p><strong>Methods: </strong>An online survey was administered to 1788 parents (89 % mothers, 50 % White) who were primary caregivers of a child under 2. Structural equation modelling techniques were employed to model direct and indirect associations between parental depressive symptoms, hypomanic traits and infant socio-emotional development, investigating the mediating role of parental reflective functioning.</p><p><strong>Results: </strong>Elevated levels of parental depressive symptoms, in the presence of hypomanic personality traits, were directly associated with infant socio-emotional challenges, without affecting parental reflective functioning. However, higher levels of parental hypomanic traits in the postnatal period displayed a fully mediated pathway of risk transmission to infants' socio-emotional development via their negative association with parental reflective functioning.</p><p><strong>Limitations: </strong>Results should be interpreted with caution as the reliance on self-and-parent-reported scales may have introduced biases influenced by individual perceptions and situational factors. Additionally, the cross-sectional design of this study inhibits establishing cause-and-effect relationships.</p><p><strong>Conclusions: </strong>Overall, these results highlight the critical role of both parental depressive symptoms and hypomanic traits on infant socio-emotional development, suggesting that supporting parental mood regulation and mentalizing abilities in the postnatal period could reduce the risk of early maladaptive socio-emotional trajectories in children.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining differences in the effects and contexts of naturalistic psilocybin use for White participants vs. Participants of Color: A longitudinal online survey study","authors":"","doi":"10.1016/j.jad.2024.10.058","DOIUrl":"10.1016/j.jad.2024.10.058","url":null,"abstract":"<div><h3>Background</h3><div>Psilocybin (a psychoactive compound found in “magic mushrooms” or “shrooms”) has been gaining increased attention in research and popular culture as a number of clinical and observational studies have demonstrated that it may have potential for improving mental wellbeing. Relatedly, there has been a substantial uptick in naturalistic (e.g., real-world, non-clinical) psilocybin use in the United States. While a number of longitudinal studies have demonstrated that naturalistic psilocybin use is linked to positive mental health outcomes on average, few studies have examined how the effects of psilocybin and contexts for psilocybin use may differ for White populations compared to Populations of Color.</div></div><div><h3>Objective</h3><div>To examine differences in health outcomes, subjective effects, and contexts of naturalistic psilocybin use in White participants compared to Participants of Color.</div></div><div><h3>Methods</h3><div>This study used data from a large, online longitudinal study of individuals who planned to engage in naturalistic psilocybin use (<em>N</em> = 2833). We used mixed-effects models to assess whether race/ethnicity (White vs. Participant of Color) moderated associations between time (Time 2 [initial assessment point for longitudinal measures], Time 5 [2–4 weeks post-psilocybin experience, and Time 6 [2–3 months post-experience]) and outcomes related to mental health (depression, anxiety, spiritual wellbeing, cognitive flexibility, emotion regulation [expressive suppression + cognitive reappraisal]). We also used exploratory chi-squared tests to examine differences in contexts for psilocybin use as well as differences in subjective effects related to the psilocybin experience.</div></div><div><h3>Results</h3><div>Race/ethnicity moderated the associations between time for predicting spiritual wellbeing (beta = −1.8; 95 % CI [−3.4, −0.17]; <em>p</em> &lt; 0.05), cognitive flexibility (beta = −1.5 [−2.7, −0.26]; <em>p</em> &lt; 0.05), and emotion regulation – expressive suppression (beta = 0.25 [0.06, 0.44]; p &lt; 0.05) at Time 6 (but not Time 5). Additionally, Participants of Color reported minor differences in subjective effects and context for use compared to White participants (e.g., more likely to have set an intention prior to use, report time speeding up during the experience, etc.). We found reductions in anxiety and depression for both Participants of Color and White participants, and our moderation tests for these outcomes were not significant.</div></div><div><h3>Conclusion</h3><div>Race/ethnicity impacts the associations between psilocybin use and various markers of mental wellbeing. Future longitudinal studies and experimental studies with larger samples of color can further elucidate the preliminary findings from this study.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abnormal functional lateralization and cooperation in bipolar disorder are associated with neurotransmitter and cellular profiles.","authors":"Tongqing Huang, Qiang Hua, Xiya Zhao, Weichao Tian, Hai Cao, Wenqiang Xu, Jinmei Sun, Li Zhang, Kai Wang, Gong-Jun Ji","doi":"10.1016/j.jad.2024.10.108","DOIUrl":"https://doi.org/10.1016/j.jad.2024.10.108","url":null,"abstract":"<p><strong>Background: </strong>Hemispheric lateralization and cooperation are essential for efficient brain function, and aberrations in both have been found in psychiatric disorders such as schizophrenia. This study investigated alterations in hemispheric lateralization and cooperation among patients with bipolar disorder (BD) and associations with neurotransmitter and cell-type density distributions to identify potential molecular and cellular pathomechanisms.</p><p><strong>Methods: </strong>Sixty-seven BD patients and 127 healthy controls (HCs) were examined by resting-state functional MRI (rs-fMRI). Whole-brain maps of the autonomy index (AI) and connectivity between functionally homotopic voxels (CFH) were constructed to reveal BD-specific changes in brain functional lateralization and interhemispheric cooperation, respectively. Spatial associations of regional AI and CFH abnormalities with neurotransmitter and cell-type density distributions were examined by correlation analyses.</p><p><strong>Results: </strong>Bipolar disorder patients exhibited higher AI values in left superior parietal gyrus, cerebellar right Crus I, and cerebellar right Crus II, and these regional abnormalities were associated with the relative densities (proportions) of oligodendrocyte precursor cells and microglia. Patients also exhibited lower CFH values in right inferior parietal gyrus, bilateral middle occipital gyrus, left postcentral gyrus, and bilateral cerebellar crus II, and these regional abnormalities were associated with the densities of serotonin 1A and dopamine D2 receptors, oligodendrocyte precursor cells, astrocytes, and neurons.</p><p><strong>Conclusions: </strong>These findings indicate that abnormal functional lateralization and cooperation in BD with potential molecular and cellular basis.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between bubble tea consumption and mental health among adults in mainland China: A national cross-sectional analysis of cohort study.","authors":"Jiaxin Yang, Meng Ning, Yusheng Tian, Zengyu Chen, Yiting Liu, Qiang Yu, Xuting Li, Chongmei Huang, Yamin Li, Xinjuan Wu","doi":"10.1016/j.jad.2024.10.060","DOIUrl":"10.1016/j.jad.2024.10.060","url":null,"abstract":"<p><strong>Background: </strong>Bubble tea has emerged as an essential beverage in the daily lives of many individuals, which is particularly pronounced among nurses. However, few studies have investigated the potential effects of bubble tea consumption on mental health among nurses. In this study, we aimed to investigate the association between bubble tea consumption and mental health among nurses.</p><p><strong>Methods: </strong>A cross-sectional analysis using baseline data from the Nurses' Mental Health Study (NMHS), a national cohort study. Odds ratios (ORs) were employed to evaluate the relationship between bubble tea consumption and mental health.</p><p><strong>Results: </strong>A total of 132,910 participants were enumerated nationwide in our survey. 8666 (6.52 %) were male and 124,244 (93.48 %) were female. The median age of participants was 34 years. After adjusting for potential confounders, the odds ratios (ORs) for depressive symptoms, anxiety symptoms, psychiatric diagnosis, fatigue, burnout, loneliness, and well-being trend changed across categories of bubble tea consumption. Low frequency of bubble tea consumption was associated with a lower risk of suicidal ideation, while high frequency of consumption was related to an increased suicidal risk. The relation between bubble tea and mental health varies with gender and age.</p><p><strong>Conclusions: </strong>This large-sample cross-sectional study found that consumption of bubble tea was significantly associated with increased anxiety, depression, psychiatric diagnosis, fatigue, job burnout and loneliness, and decreased well-being among nurses. Moreover, research indicates that limited consumption of bubble tea may be correlated with a reduction in suicidal ideation, whereas excessive consumption may be linked to an increase in such ideation.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognition Assessment in Virtual Reality (CAVIR): Associations with neuropsychological performance and activities of daily living in patients with mood or psychosis spectrum disorders.","authors":"Andreas E Jespersen, Anders Lumbye, Johanna Schandorff, Viktoria Damgaard, Louise B Glenthøj, Merete Nordentoft, Christina Mikkelsen, Maria Didriksen, Sisse R Ostrowski, Maj Vinberg, Eva E Wæhrens, Kamilla W Miskowiak","doi":"10.1016/j.jad.2024.10.095","DOIUrl":"10.1016/j.jad.2024.10.095","url":null,"abstract":"<p><strong>Background: </strong>More ecologically valid tools are needed to better capture daily-life cognitive impairments in patients with mood or psychosis spectrum disorders in clinical settings and cognitive treatment trials. We developed the Cognition Assessment in Virtual Reality (CAVIR) test, which assesses daily-life cognitive skills in an immersive virtual reality kitchen scenario. This study investigated the validity and sensitivity of CAVIR, including its association with activities of daily living (ADL) ability.</p><p><strong>Methods: </strong>Seventy symptomatically stable patients with mood or psychosis spectrum disorders and 70 healthy controls completed CAVIR and standard neuropsychological tests and were rated for clinical symptoms, functional capacity, and subjective cognition. In addition, patients' ADL ability was evaluated with the Assessment of Motor and Process Skills.</p><p><strong>Results: </strong>Higher global CAVIR performance correlated moderately with better global neuropsychological test scores (r_s(138) = 0.60, p < 0.001) and showed a weak to moderate association with better ADL process ability in patients (r(45) = 0.40, p < 0.01), also after adjusting for sex and age (p_s ≤ 0.03). In comparison, neuropsychological performance, interviewer- and performance-based functional capacity, and subjective cognition were not significantly associated with ADL process ability (p_s ≥ 0.09). Further, CAVIR was sensitive to cognitive impairments in patients and was able to differentiate between patients with and without the ability to undertake regular employment.</p><p><strong>Limitations: </strong>The modest sample size and concomitant medication.</p><p><strong>Conclusion: </strong>Our results indicate that CAVIR is a sensitive measure of daily-life cognitive skills in patients with mood or psychosis spectrum disorders.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topography of depressive experiences. A dialectic approach.","authors":"Guilherme Messas, Francesca Brencio","doi":"10.1016/j.jad.2024.10.064","DOIUrl":"10.1016/j.jad.2024.10.064","url":null,"abstract":"<p><p>This article aims to offer clinical descriptions and philosophical interpretations of the ontological nature of depressive experiences trying to address issues related to the contemporary diagnostic paradigm and values-based practices which shape clinical decisions. At the core of this contribution there is the idea that the variety of depressive experiences might be understood acknowledging the qualitative difference in the ontology underlying each form of depression. We argue that there is a fundamental difference between melancholia as a disease and those melancholic traits which characterizes human existence as such: while the former indicates a qualitative alteration of the global human experience, constituting psychopathological experience, the latter describes a style of disproportion of existence not pathological per se at all. Moreover, we defend the hypothesis that melancholia (in a medical sense) is a distinct unity of mental alteration, and should not be conflated with the multivarious kind of experiences merged under the name of depression, the variety of which may be understood as disorders of the personal development. It is in this context that the leading element of anthropological disproportions impact the role of pre-reflective and transcendental structures, polarizing the self and the world in a three-way topography: 1. depression as an excessive symmetric proportion between self and world; 2. depression as a disproportion between the self and the world (detriment of the self); 3. depressions as impoverishment of the transcendental value of the world.</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial.","authors":"Babalwa Zani, Lara Fairall, Inge Petersen, Naomi Folb, Arvin Bhana, Jill Hanass-Hancock, One Selohilwe, Ruwayda Petrus, Daniella Georgeu-Pepper, Ntokozo Mntambo, Tasneem Kathree, Sergio Carmona, Carl Lombard, Crick Lund, Naomi Levitt, Max Bachmann, Graham Thornicroft","doi":"10.1016/j.jad.2024.10.061","DOIUrl":"https://doi.org/10.1016/j.jad.2024.10.061","url":null,"abstract":"<p><strong>Background: </strong>HIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities.</p><p><strong>Methods: </strong>We conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL).</p><p><strong>Results: </strong>The intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = -0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = -0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study.</p><p><strong>Limitations: </strong>The highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low.</p><p><strong>Conclusion: </strong>The trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}