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Objective: There is a socioeconomic gradient to depression risks, with more pronounced inequality amid macroenvironmental potential traumatic events. Between mid-2019 and mid-2020, the Hong Kong population experienced drastic societal changes, including the escalating civil unrest and the COVID-19 pandemic. We examined the change of the socioeconomic gradient in depression and the potential intermediary role of daily routine disruptions., Method: We conducted repeated territory-wide telephone surveys in July 2019 and July 2020 with 1112 and 2034 population-representative Cantonese-speaking Hong Kong citizens above 15 years old, respectively. Stratified by year, we examined the association between socioeconomic indicators (education attainment, household income, employment status and marital status) and probable depression (nine-item Patient Health Questionnaire [PHQ-9] ⩾ 10) using logistic regression. Differences in the socioeconomic gradient between 2019 and 2020 were tested. Finally, we performed a path analysis to test for the mediating role of daily routine disruptions., Results: Logistic regression showed that higher education attainment in 2019 and being married in 2020 were protective against probable depression. Interaction analysis showed that the inverse association of higher education attainment with probable depression attenuated in 2020 but that of being married increased. Path analysis showed that the mediated effects through daily routine disruptions accounted for 95.9% of the socioeconomic gradient of probable depression in 2020, compared with 13.1% in 2019., Conclusion: From July 2019 to July 2020, the mediating role of daily routine disruptions in the socioeconomic gradient of depression in Hong Kong increased. It is thus implied that infection control measures should consider the relevant potential mental health impacts accordingly.

Objective: To determine whether sleep disturbance and symptoms of depression mediate the relationship between pain and cognitive dysfunction (CD) in a sample of 115 patients with systemic lupus erythematosus (SLE)., Methods: A total of 115 patients with SLE completed questionnaires regarding pain, perceived stress, depression, sleep, and CD. Relationships among pain, sleep, depression, and CD were assessed using bootstrap mediation models, controlling for race/ethnicity, fibromyalgia diagnosis, current corticosteroid use, disease activity and damage, and perceived stress., Results: Mediation analyses indicated that the effect of pain on CD was mediated by sleep disturbance (β = 0.30) and depression symptoms (β = 0.33). These effects were maintained even after controlling for the aforementioned covariates, of which only disease activity (β = 0.20) and stress (β = 0.22) remained significantly linked to CD (overall model R 2 = 0.53; all P < 0.05)., Conclusion: After controlling for disease activity and perceived stress, the relationship between pain and CD was explained by sleep disturbance and depression symptoms. Although these relationships need validation in longitudinal studies with additional measurement modalities, our findings may indicate promising, nonpharmacologic intervention avenues for SLE patients with pain and CD. Specifically, cognitive behavioral therapies for depression and sleep are known to reduce distress and enhance functioning across various psychosocial domains. Given the symptom burden of SLE, interventions that maximize potential benefits without the use of additional pharmacologic treatments may be of particular utility., (© 2018, American College of Rheumatology.)

Background: Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics., Method: Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit., Results: A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15-3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98-10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7-15) (OR = 0.96; 95% CI = 0.56-1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26-0.97)., Conclusions: The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.Declaration of interestDrs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Objective: PTSD and depression are related to perceived physical health impairment in veterans, but little is known about the effects of psychological treatment on impairment. We examined the impact of an interactive online treatment for veterans with trauma-related distress, including (a) whether treatment effects include reduced perceived physical impairment, and (b) how these treatment effects are related to symptoms of PTSD and depression., Method: A randomized controlled trial assessed the impact on perceived physical health impairment of interactive online treatment for veterans with symptoms of PTSD and depression. Veterans were randomized to either the Vets Prevail program (n = 209), or a no-treatment control (n = 94) completing measures of depression and PTSD symptomology as well as perceived physical health impairment at 6 and 12 weeks following baseline assessment We conducted a series of multiple and single mediation analyses to examine how the effects of Vets Prevail on these outcomes are related., Results: Compared with control, Vets Prevail was (a) associated with significant reductions in perceived physical health impairment, and (b) this relationship was mediated by reductions in symptoms of PTSD, but not depression. Further analysis showed that perceived physical health impairment also mediated the relationships between intervention and PTSD and depression symptoms., Conclusions: Findings indicate that Vets Prevail reduces perceptions of physical health impairment by reducing PTSD symptomology. It is also possible that treatment initiated more complex, bidirectional relationships such that improvements in psychological distress and in perceived physical health impairment reinforced each other over time. Findings demonstrate that Vets Prevail may help veterans overcome traditional barriers to care and achieve improvements in multiple areas of functioning. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: Traumatic events and posttraumatic stress disorder (PTSD) are associated with increased risk for cardiopulmonary disease (CPD) in veterans, men, and primarily White populations. Less is known about trauma, PTSD, and CPD burden among low-income, racial minority residents who are at elevated risk for trauma and PTSD. It was hypothesized that traumatic events and PTSD would be significantly associated with CPD burden among low-income, racial minority residents., Methods: We evaluated cross-sectional relationships between traumatic events, PTSD, depression, and CPD burden in 251 low-income, urban, primarily Black adults diagnosed with heart failure. Data were analyzed using bivariate analyses, logistic and linear regression., Results: Forty-three percent endorsed at least one traumatic event. Twenty-one percent endorsed two or more traumatic events. In logistic regression analyses, traumatic events were associated with increased prevalence of coronary artery disease (adjusted odds=1.33, p<.05), hypertension (adjusted odds=1.28, p<.05), chronic obstructive pulmonary disease (adjusted odds=1.52, p<.01), and cardiac arrest (adjusted odds=1.27, p<.05). PTSD was also related to increased risk for chronic obstructive pulmonary disease (adjusted odds=1.22, p<.05) and was associated with earlier onset of heart failure (β=-.13, p<.05)., Limitations: The study utilizes cross-sectional, self-report data., Conclusions: Findings support the link between traumatic events, PTSD, and CPD burden in low-income, primarily Black patients with heart failure. Depression appears to be less closely linked to CPD burden, despite receiving significant attention in the literature. The accumulation of traumatic events may exacerbate CPD burden among urban, low-income, racial minority residents with heart failure; findings highlight the importance of PTSD screening., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: This study examined the prevalence and critical predictors of anxiety and depressive symptoms and self-rated health, following the Umbrella Movement in Hong Kong., Methods: Random digit dialing recruited a population-representative sample of 1208 Chinese Hong Kong citizens (mean age=46.89 years; 63% female) in the first two weeks of February 2015. Respondents gave their informed consent and reported personal, social, and economic resource loss since the Umbrella Movement (Conservation of Resources-Evaluation), current anxiety symptoms (State-Trait Anxiety Inventory) and depressive symptoms (Patient Health Questionnaire-9), and self-rated health (1=very good, 4=very bad)., Results: A total of 47.35% (95% CI=44.55, 50.17) respondents reported moderate/severe anxiety symptoms and 14.4% (95% CI=12.54, 16.50) reported moderate/severe depressive symptoms; 9.11% (95% CI=7.61, 10.86) reported "poor" or "very poor" health. Multivariable regressions revealed that personal and social resource loss was associated with higher anxiety and depressive symptoms and greater odds of "very poor" health (adjusted odds ratios/incidence rate ratios=5-102%), independent of lower education level and income and being unmarried., Limitations: This study was cross-sectional in nature and thus could not determine causality from the associations between resource loss and outcome variables. Second, the telephone survey relied on self-reports; response bias and social desirability could influence respondents' answers and discount data validity. Third, potential confounders such as preexisting mental and physical health issues and concurrent predictors like exposure to the Umbrella Movement were not assessed., Conclusions: This is one of the first studies following any recent political movement (e.g., The Arab Spring) to quantify distress and the associated correlates of distress among affected citizens. Perceived psychosocial resource losses were critical predictors of poor outcomes., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Social support is consistently associated with reduced risk of depression. Few studies have investigated how this relationship may be modified by alcohol use, the effects of which may be particularly relevant in traumatized populations in which rates of alcohol use are known to be high., Methods: In 2008 a representative sample of 1622 Jewish and Palestinian citizens in Israel were interviewed by phone at two time points during a period of ongoing terrorism and war threat. Two multivariable mixed effects regression models were estimated to measure the longitudinal association of social support from family and friends on depression symptoms. Three-way interaction terms between social support, alcohol use and time were entered into the models to test for effect modification., Results: Findings indicated that increased family social support was associated with less depression symptomatology (p=<.01); this relationship was modified by alcohol use and time (p=<.01). Social support from friends was also associated with fewer depression symptoms (p=<.01) and this relationship was modified by alcohol use and time as well (p=<.01). Stratified analyses in both models revealed that the effect of social support was stronger for those who drank alcohol regularly than those who did not drink or drank rarely., Conclusions: These findings suggest that social support is a more important protective factor for depression among regular drinkers than among those who do not drink or drink rarely in the context of political violence. Additional research is warranted to determine whether these findings are stable in other populations and settings., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

We hypothesized that loss of interpersonal, financial and work resources would mediate the relationship between physical and sexual abuse, cancer-related Posttraumatic Stress Disorder (PTSD) symptoms, noncancer-related PTSD symptoms and depressive mood among women with cancer. Participants were 64 women with heterogeneous cancers (64.1% breast cancer) seeking outpatient treatment. Structured interviews were conducted to assess for pre-cancer interpersonal trauma, recent loss of interpersonal, financial and work resources, cancer-related PTSD symptoms, noncancer-related PTSD symptoms and depressive mood. Only interpersonal loss mediated the relationship between earlier interpersonal trauma and current PTSD symptoms and depressive mood. Implications of the findings are discussed.

Purpose: We sought to assess the predictors of depressive symptoms in a population-based cohort exposed to ongoing and widespread terrorism., Methods: Interviews of a representative sample of adults living in Israel, including both Jews and Arabs, were conducted between August and September 2004, with follow-up interviews taking place between February and April 2005. Censoring weights were estimated to account for differential loss to follow-up. Zero-inflated negative binomial models with bootstrapped confidence intervals were fit to assess predictors of severity of depressive symptoms, assessed using items from the Patient Health Questionnaire., Results: A total of 1613 Israeli residents participated in the baseline interview (80.8% Jewish, 49.4% male, mean age 43 years); 840 residents also participated in the follow-up interview. In multivariable models, Israeli Arab ethnicity, lower household income, lower social support, experiencing economic loss from terrorism, experiencing higher levels of psychosocial resource loss, and meeting criteria for post-traumatic stress disorder were significantly associated with increased severity of depressive symptoms., Conclusions: Material deprivation is the primary modifiable risk factor for depressive symptoms in the context of ongoing terrorism. Efforts to minimize ongoing material and economic stressors may mitigate the mental health consequences of ongoing terrorism.

The authors interviewed by phone 2,752 randomly selected individuals in New York City within 6 to 9 months after the attacks of September 11, 2001 on the World Trade Center, and 1,939 of these were reinterviewed at a 12- to 16-month follow-up. It was hypothesized that resource loss would significantly predict probable posttraumatic stress disorder (PTSD) and probable depression since September 11, and that resource loss's impact would be independent of previously identified predictors relating to individuals' demographic characteristics, history of stressful event exposure, prior trauma history, peritraumatic experience, and social support. Second, it was predicted that reported traumatic growth would be related to greater, not lesser, psychological distress. The authors' findings supported their hypotheses for resource loss, but traumatic growth was unrelated to psychological outcomes when other predictors were controlled.

This study represents one of the largest examinations of how child abuse, adult rape, and social support impact inner-city women (N = 777). Using retrospective self-report, the effects of interpersonal trauma were shown to be cumulative such that women who experienced either child abuse or adult rape were 6 times more likely to have probable posttraumatic stress disorder (PTSD), whereas women who experienced both child abuse and rape were 17 times more likely to have probable PTSD. High social support predicted lower PTSD severity for women who experienced both child abuse and adult rape, but not for women who reported one or none of these traumas. Results suggest that social support, when left intact, might buffer the cumulative impact of child and adult interpersonal traumas.

Past research has examined the stress resiliency of individuals high in sense of personal-mastery. However, it has been theorized that within more collectivist cultures, a sense of shared efficacy, which we call communal-mastery, may be more central to people's resiliency in the face of challenging life circumstances. We compared the impact of sense of self-mastery (ie., "I am the key to my success") to that of communal-mastery (ie., "I am successful by virtue of my social attachments") in a prospective study among a group of rural 103 Native American women residing on Indian Reservations in Montana. We found that women high in communal-mastery experienced less increase in depressive mood and anger, especially when faced with high stress circumstances, than women who were low in communal-mastery. In addition, the beneficial impact of communal-mastery was found to be more effective than self-mastery for these women.

The impact of perceived child abuse history on 160 adult, Native American women's emotional well-being (i.e., depressive mood and anger) and AIDS risk was examined. How sense of mastery and social support might lead to women's greater resiliency was also investigated. Child physical-emotional abuse was found to have greater impact on depressive mood and anger and AIDS risk than did child sexual abuse. This finding was independent of current stress in women's lives. Women who were physically-emotionally abused as children had 5.14 times greater odds of having a sexually transmitted disease in their lifetimes than did women who experienced only marginal or no physical-emotional abuse. Moreover, consistent with the communal culture of Native Americans, social support was found to contribute more to resilience than sense mastery did. Reasons for the greater predictive power of child physical-emotional abuse compared with child sexual abuse in a growing number of studies are discussed.

The relationship of antisocial and prosocial coping behaviors to individual and relationship well-being was prospectively examined in a sample of fire-emergency workers (FEWs) and their marital or romantic partners (69 couples). Results of hierarchical multiple regression equations indicated that FEWs' antisocial coping was related to higher levels of depressive symptoms. Prosocial coping was related to decreased anger expression and increased relationship adjustment. Partners' prosocial coping was a significant predictor of FEWs' reports of better relationship adjustment. For partners, prosocial coping was positively related to their relationship adjustment. FEWs' coping was unrelated to partners' outcome. Results for the FEWs support the notion that coping has direct and crossover effects. Moreover, results indicate that prosocial and antisocial coping behaviors have differential effects on well-being.

We examined the differential impact of chronic versus acute economic stress on depressive mood among a sample of 1241 low-income, single, European and African American women. Based on Hobfoll's (1988, 1989) conservation of resources (COR) theory, we predicted that acute resource loss would be more distressing than chronic economic lack. That is, although chronically impoverished conditions are stressful, the attendant resource losses created will be more distressing. We further predicted that mastery and social support would be more beneficial in offsetting the negative consequences of acute resource loss than the negative consequences of chronic economic lack, because acute loss creates identifiable demands that resources may address. Hence, we hypothesized that mastery and social support would show stress buffering effects only for material loss, not chronic lack. The findings generally supported the hypotheses, but mastery buffered only European American women's resource loss and social support buffered only African American women's resource loss. The findings are discussed in light of implications for prevention within theoretical and cultural contexts.

The relationship of weight and self-esteem to depressive symptomatology was examined among 36 African American and 96 European American pregnant inner-city women. Lower self-esteem and higher deviations from medically ideal weight predicted increased dysphoria during the 3rd trimester for European American women, but only lower self-esteem predicted increased dysphoria for African American women. These results support the hypothesis that African Americans are less likely than European Americans to experience negative psychological repercussions of greater weight. Consistent with findings among nonpregnant middle-class samples, these results extend the association between heavier weight and increased risk for psychological distress to pregnant women of European American descent.

Examined a dual-axis model of coping that included both action (active vs. passive) and social dimensions (prosocial vs. antisocial) of coping strategies among a combined sample of students and community residents. We developed an assessment device to represent the model and allow investigation. Mixed support for the model and instrument were noted. Women were more prosocial than men in their coping, but no less active. Men were more likely to use antisocial and aggressive, but less assertive coping strategies than women. More prosocial, action coping strategies were also more likely to be related to greater sense of mastery and more liberal gender-role orientation. Antisocial and passive strategies tended to be related to lower mastery and more traditional gender-role orientation. Active coping was related to lower emotional distress for men and women, but both prosocial and antisocial coping were related to greater emotional distress for men, suggesting that men may have a narrower band of beneficial coping strategies than do women.