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Treatments for depression have improved, and their availability has markedly increased since the 1980s. Mysteriously the general population prevalence of depression has not decreased. This "treatment-prevalence paradox" (TPP) raises fundamental questions about the diagnosis and treatment of depression. We propose and evaluate seven explanations for the TPP. First, two explanations assume that improved and more widely available treatments have reduced prevalence, but that the reduction has been offset by an increase in: 1) misdiagnosing distress as depression, yielding more "false positive" diagnoses; or 2) an actual increase in depression incidence. Second, the remaining five explanations assume prevalence has not decreased, but suggest that: 3) treatments are less efficacious and 4) less enduring than the literature suggests; 5) trial efficacy doesn't generalize to real-world settings; 6) population-level treatment impact differs for chronic-recurrent versus non-recurrent cases; and 7) treatments have some iatrogenic consequences. Any of these seven explanations could undermine treatment impact on prevalence, thereby helping to explain the TPP. Our analysis reveals that there is little evidence that incidence or prevalence have increased as a result of error or fact (Explanations 1 and 2), and strong evidence that (a) the published literature overestimates short- and long-term treatment efficacy, (b) treatments are considerably less effective as deployed in "real world" settings, and (c) treatment impact differs substantially for chronic-recurrent cases relative to non-recurrent cases. Collectively, these a-c explanations likely account for most of the TPP. Lastly, little research exists on iatrogenic effects of current treatments (Explanation 7), but further exploration is critical., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Despite major expansions of evidence-based treatments of common mental disorders in recent decades, especially antidepressant medication, the point prevalence of depression has not decreased; instead it probably increased in young adults. We question whether antidepressants (AD)-monotherapy and low-fidelity-to-guideline psychological treatment (PT) might have no effect or even adverse effects in some patients and contexts that dilute the benefits of treatment at the population level, making it harder for population-based studies to detect treatment-driven prevalence reductions. Randomized Clinical Trial (RCT)s have not identified these effects because AD-monotherapy and low-fidelity PT are uncommon in RCTs where treatment protocols are specified and carefully monitored, unlike treatment in real-world settings. Second, RCTs may have missed the bigger picture of ultimate outcomes due to too short follow-ups. We elaborate two mechanisms through which AD-monotherapy and low-fidelity PT could produce adverse effects on long-term illness course. Both mechanisms are speculative and we outline how to test.

Background: Research in depression has progressed rapidly over the past four decades. Yet depression rates are not subsiding and treatment success is not improving. We examine the extent to which the gap between science and practice is associated with the level of integration in how depression is considered in research and stakeholder-relevant documents., Methods: We used a network-science perspective to analyze similar uses of depression relevant terms in the Google News corpus (approximately 1 billion words) and the Web of Science database (120 000 documents)., Results: These analyses yielded consistent pictures of insular modules associated with: (1) patient/providers, (2) academics, and (3) industry. Within academia insular modules associated with psychology, general medical, and psychiatry/neuroscience/biology were also detected., Conclusions: These analyses suggest that the domain of depression is fragmented, and that advancements of relevance to one stakeholder group (academics, industry, or patients) may not translate to the others. We consider potential causes and associated responses to this fragmentation that could help to unify and advance translation from research on depression to the clinic, largely involving harmonizing employed language, bridging conceptual domains, and increasing communication across stakeholder groups.

Background: This study examined whether changes in mindfulness skills following Mindfulness-based Cognitive Therapy (MBCT) are predictive of long-term changes in personality traits., Methods: Using data from the MOMENT study, we included 278 participants with recurrent depression in remission allocated to Mindfulness-Based Cognitive Therapy (MBCT). Mindfulness skills were measured with the FFMQ at baseline, after treatment and at 15-month follow-up and personality traits with the NEO-PI-R at baseline and follow-up., Results: For 138 participants, complete repeated assessments of mindfulness and personality traits were available. Following MBCT participants manifested significant improvement of mindfulness skills. Moreover, at 15-month follow-up participants showed significantly lower levels of neuroticism and higher levels of conscientiousness. Large improvements in mindfulness skills after treatment predicted the long-term changes in neuroticism but not in conscientiousness, while controlling for use of maintenance antidepressant medication, baseline depression severity and change in depression severity during follow-up (IDS-C). In particular improvements in the facets of acting with awareness predicted lower levels of neuroticism. Sensitivity analyses with multiple data imputation yielded similar results., Limitations: Uncontrolled clinical study with substantial attrition based on data of two randomized controlled trials., Conclusions: The design of the present study precludes to establish whether there is any causal association between changes in mindfulness and subsequent changes in neuroticism. MBCT could be a viable intervention to directly target one of the most important risk factors for onset and maintenance of recurrent depression and other mental disorders, i.e. neuroticism., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Alterations in physiological reactivity to stress are argued to be central mechanisms linking adverse childhood environmental experiences to internalizing and externalizing psychopathology. Childhood trauma exposure may influence physiological reactivity to stress in distinct ways from other forms of childhood adversity. This study applied a novel theoretical model to investigate the impact of childhood trauma on cardiovascular stress reactivity - the biopsychosocial model of challenge and threat. This model suggests that inefficient cardiovascular responses to stress - a threat as opposed to challenge profile - are characterized by blunted cardiac output (CO) reactivity and increased vascular resistance. We examined whether childhood trauma exposure predicted an indicator of the threat profile of cardiovascular reactivity and whether such a pattern was associated with adolescent psychopathology in a population-representative sample of 488 adolescents (M=16.17years old, 49.2% boys) in the TRacking Adolescents' Individual Lives Survey (TRAILS). Exposure to trauma was associated with both internalizing and externalizing symptoms and a pattern of cardiovascular reactivity consistent with the threat profile, including blunted CO reactivity during a social stress task. Blunted CO reactivity, in turn, was positively associated with externalizing, but not internalizing symptoms and mediated the link between trauma and externalizing psychopathology. None of these associations varied by gender. The biopsychosocial model of challenge and threat provides a novel theoretical framework for understanding disruptions in physiological reactivity to stress following childhood trauma exposure, revealing a potential pathway linking such exposure with externalizing problems in adolescents., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Although loss of pleasure (i.e., anhedonia) is one of the two core symptoms of depression, very little research has examined the relation between depressive symptoms and the experience of pleasure in daily life. This exploratory study in two population-based adolescent samples aimed to examine how depressive symptoms and anhedonia specifically were related to (1) the proportion and intensity of positive events, (2) mean and variability of positive affect (PA), (3) reactivity to positive events, and (4) reactivity to PA (i.e., whether PA elicits positive events). We used Experience Sampling to measure positive events and PA several times a day during 6 to 14 days in early (N = 284) and late (N = 74) adolescents. Results showed that depressive symptoms were related to a lower proportion and intensity of positive events, lower mean PA, and higher variability in PA regardless of sex and stage of adolescence. No clear evidence was found for differential reactivity to positive events or to PA. Anhedonia was not associated with most daily life experiences of pleasure. Our findings, though preliminary, suggest that although adolescents with many depressive symptoms experience less positive events and lower PA, they are able to enjoy pleasurable events to the same extent as individuals with fewer depressive symptoms.

Adolescence is marked by increases in the incidence of major depression (MDD), a disorder recognized as one of the leading causes of disability. Anhedonia and depressed mood predict both onset and chronicity of major depression (MDD), but have never been studied together longitudinally in the general adolescent population. The present study examined (1) the course and the stability of anhedonia and depressed mood and (2) their cross-sectional and longitudinal relations during adolescence. The study cohort consisted of 2,230 adolescents. Anhedonia and depressed mood were assessed with items of the YSR and ASR self-report forms at four measurement waves between ages 11 and 19. The proportion of adolescents reporting anhedonia decreased between ages 11 and 19, while the proportion of female adolescents reporting depressed mood increased. The stability of anhedonia and the cross-sectional association between anhedonia and depressed mood was larger at age 19 than at age 11. We found a mutual association between anhedonia and depressed mood without a clear temporal sequence. The presence of anhedonia at the end of adolescence might put adolescents at increased risk for MDD given the increasingly stronger stability and association with depressed mood. This suggests that it becomes more difficult to prevent MDD during late adolescence compared with early and middle adolescence.

Objective: to investigate the association of life events during pregnancy with change in antenatal anxiety and depression symptoms. We distinguished pregnancy related and non-pregnancy related events and assessed specificity of these associations for depressive or anxious symptoms. In addition, we investigated whether the associations were affected by personality or childhood adversities., Design: observational prospective cohort study, Setting: primary and secondary obstetric care centres in the Netherlands, Participants: 1603 women during their first trimester of pregnancy between May 2010 and May 2012 MEASUREMENTS AND FINDINGS: we performed linear regression analyses to test the associations of pregnancy related, non-pregnancy related life events, childhood adversities and the personality traits neuroticism and extraversion with the change in symptoms of anxiety (State Trait Anxiety Inventory) and depression (Edinburgh Postnatal Depression Scale) from week 12 to week 36. Life events during pregnancy were associated with increasing antenatal symptoms of anxiety and depression. Effect sizes associated with the highest numbers of events observed ranged from 0.59 to 1.31. Pregnancy related events were specifically associated with increasing symptoms of anxiety (p=0.009), whereas non-pregnancy related events were merely associated with an increase in symptoms of depression (p<0.001). Neither personality traits nor childhood trauma influenced the associations under study., Key Conclusions: the most important finding is that pregnancy related life events during pregnancy increase levels of antenatal anxiety, whereas depression levels increase when women experience life events that are unrelated to pregnancy. Furthermore, non-pregnancy related events show stronger associations with increases in symptoms of anxiety or depression compared to pregnancy related events., Implications for Practice: our findings may help midwives to tailor psychosocial care to the specific risks of the pregnant woman which may eventually have a positive impact on the health of mother and child., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

In the study reported here, the main question we investigated was whether attention style could be a conditional adaptation. We organized participants of the TRacking Adolescents' Individual Lives Survey (TRAILS; N = 2,230) into shifters, sustainers, and two comparison groups, depending on their performance on a shifting- and a sustained-attention task at age 11 years. Compared with sustainers, shifters reported more pre- and perinatal risk factors and more childhood stress, and they adopted a faster life-history strategy. These differences were not found between the comparison groups, who performed well or poorly on both tasks, which suggests that specialization for either sustained or shifting attention is the key to conditional adaptation. In a subsample (n = 860), we found that stress did not increase depression risk in shifters, whereas a mismatch between early and recent stress predicted depression in sustainers. Cumulative stress predicted depression in the comparison group. These results suggest that shifters retain high levels of plasticity throughout life, whereas sustainers' adapted their phenotype early in life to the expected mature environment.

Depressive problems and academic performance, social well-being, and social problems in adolescents are strongly associated. However, longitudinal and bidirectional relations between the two remain unclear, as well as the role of gender. Consequently, this study focuses on the relation between depressive problems and three types of functioning in adolescents while testing gender differences. Depressive problems and functioning of 2,230 children were measured with structured questionnaires. The measurements took place biennially over 3 waves, from late childhood into adolescence (age range = 10-18 years). To examine the longitudinal relation between depression and functioning, path analyses with cross-lagged effects were conducted with structural equation modeling. Multigroup analyses were used to test for gender differences, which were only observed for academic performance. Other findings indicated substantial stability in depressive problems and functioning over time and within-wave correlations between depression and the 3 types of functioning. Poor social well-being was predicted by depressive problems but not the other way around. The relation between depressive and social problems was bidirectional, that is, they predicted each other. Finally, depressive problems and academic performance were bidirectionally related as well but only in girls., (PsycINFO Database Record (c) 2014 APA, all rights reserved.)

Anxiety and depressive problems have often been related to higher hypothalamic-pituitary-adrenal (HPA)-axis activity (basal morning cortisol levels and cortisol awakening response [CAR]) and externalizing problems to lower HPA-axis activity. However, associations appear weaker and more inconsistent than initially assumed. Previous studies from the Tracking Adolescents Individual Lives Study (TRAILS) suggested sex-differences in these relationships and differential associations with specific dimensions of depressive problems in a general population sample of children (10-12 years). Using the TRAILS population sample (n=1604), we tested hypotheses on the association between single day cortisol (basal morning levels and CAR) and specifically constructed dimensions of anxiety (cognitive versus somatic), depressive (cognitive-affective versus somatic), and externalizing problems (reactive versus proactive aggression), and explored the modifying role of sex. Moreover, we repeated analyses in an independent same-aged clinic-referred sample (n=357). Structural Equation Modeling was used to investigate the association between cortisol and higher- and lower-order (thus, broad and specific) problem dimensions based on self-reports in an integrated model. Overall, findings were consistent across the population and clinic-referred samples, as well as with the existing literature. Most support was found for higher cortisol (mainly CAR) in relation to depressive problems. However, in general, associations were weak in both samples. Therefore, the present results shed doubt on the relevance of single day cortisol measurements for problem behaviors in the milder range. Associations may be stronger in more severe or persistent psychopathology., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Clinical and epidemiological studies, further supported by meta-analytic studies, indicate a possible association between chronicity (i.e., persistence or recurrence) of depression and hypothalamic-pituitary-adrenal (HPA) axis responsiveness to psychosocial stress. In the present study, we examined whether and how chronicity of depressive problems predicts cortisol responses to a standardized social stress test in adolescents. Data were collected in a high-risk focus sample (n=351) of the Tracking Adolescents' Individual Lives Survey (TRAILS) cohort, a large prospective population study with bi- to triennial measurements. Depressive problems were assessed around age 11, 13.5, and 16. Cortisol levels were measured in saliva, sampled before, during, and after the Groningen Social Stress Test (GSST), to determine the cortisol response to psychosocial stress. The area under the curve with respect to the increase (AUCi) (i.e., change from baseline) of the cortisol response was used as a measure of HPA axis response. By means of linear regression analysis and repeated-measures analysis of variance, it was examined whether chronicity of depressive problems predicted the cortisol response to the GSST around the age of 16. Chronicity of depressive problems was significantly associated with cortisol stress responses. The relationship was curvilinear, with recent-onset depressive problems predicting an increased cortisol response, and more chronic depressive problems a blunted response. The results of this study suggest that depressive problems initially increase cortisol responses to stress, but that this pattern reverses when depressive problems persist over prolonged periods of time., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

We assessed if the Revised Child Anxiety and Depression Scale (RCADS) measures anxiety symptoms similarly across age groups within adolescence. This is crucial for valid comparison of anxiety levels between different age groups. Anxiety symptoms were assessed biennially in a representative population sample (n = 2226) at three time points (age range 10-17 years) using the RCADS anxiety subscales (generalized anxiety disorder [GAD], obsessive-compulsive disorder [OCD], panic disorder [PD], separation anxiety [SA], social phobia [SP]). We examined longitudinal measurement invariance of the RCADS, using longitudinal confirmatory factor analysis, by examining the factor structure (configural invariance), factor loadings (metric invariance) and thresholds (strong invariance). We found that all anxiety subtypes were configural invariant. Metric invariance held for items on the GAD, OCD, PD and SA subscales; yet, for the SP subscale three items showed modest longitudinal variation at age 10-12. Model fit decreased modestly when enforcing additional constraints across time; however, model fit for these models was still adequate to excellent. We conclude that the RCADS measures anxiety symptoms similarly across time in a general population sample of adolescents; hence, measured changes in anxiety symptoms very likely reflect true changes in anxiety levels. We consider the instrument suitable to assess anxiety levels across adolescence., (Copyright © 2013 John Wiley & Sons, Ltd.)

Purpose: Low levels of physical activity (PA) have been shown to be associated with depression in adults. The few studies that focused on adolescents yielded mixed and inconsistent results. Efforts to examine the direction of this relationship have been inconclusive up to now. The aims of this study were therefore to investigate (1) the direction of the inverse association between PA and depressive symptoms over time, and (2) whether these associations are specific to particular clusters of depressive symptoms in adolescents., Methods: Depressive symptoms and PA were assessed in a population sample of adolescents (N = 2,230) who were measured at three waves between age 10 and age 17. Depressive symptoms were measured by the Affective Problems scale of the Youth Self-Report and Child Behavior Checklist, whereas PA was operationalized as the amount of time spent on physical exercise. Structural equation modeling was used to examine bidirectional effects of PA and depressive symptoms over time., Results: We found significant cross-lagged paths from prior PA to later depression as well as from prior depression to later PA (beta values = -.039 to -.047). After subdividing depression into affective and somatic symptoms, the affective symptoms were reciprocally related to PA, whereas the paths between somatic symptoms and PA did not reach statistical significance., Conclusions: An inverse bidirectional association between PA and general depressive symptoms was observed. This association was restricted to affective symptoms., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Neuroticism and extraversion are affected by depressive disorder state. Less is known about depressive state effects on conscientiousness, agreeableness and openness. Furthermore, state effects of anxiety disorders on personality have been far less studied than those of depressive disorder. Here, we aim to determine the extent of change in all five personality traits associated with the occurrence of or recovery from depressive and anxiety disorders., Methods: Using the Composite International Diagnostic Interview (CIDI) at baseline and two-year follow-up, respondents from the Netherlands Study of Depression and Anxiety (NESDA) were divided into four groups: unaffected at baseline and follow-up, occurrence, recovery, and affected at baseline and follow-up. Personality change (NEO-five factor inventory) was examined in the occurrence and recovery groups relative to the unaffected and affected groups, respectively. Analyses were repeated, differentiating between (specific) depressive and anxiety disorders., Results: We found small state effects of affective disorders on neuroticism, extraversion and conscientiousness. Corrected for each other, both depressive and anxiety disorders showed small state effects on neuroticism, but effects on extraversion and conscientiousness were mainly associated with depressive disorders., Conclusions: State effects were small. When assessing neuroticism, the presence of both depressive and anxiety disorders should be taken into account, as both may independently increase neuroticism scores. However, when assessing extraversion and conscientiousness, depressive disorders but not anxiety disorders are likely to be of influence. Agreeableness and openness are influenced by neither., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The present study examines the relationship between neurocognitive functioning and affective problems through adolescence, in a cross-sectional and longitudinal perspective. Baseline response speed, response speed variability, response inhibition, attentional flexibility and working memory were assessed in a cohort of 2,179 adolescents (age 10-12 years) from the TRacking Adolescents' Individual Lives Survey (TRAILS). Affective problems were measured with the DSM-oriented Affective Problems scale of the Youth Self Report at wave 1 (baseline assessment), wave 2 (after 2.5 years) and wave 3 (after 5 years). Cross-sectionally, baseline response speed, response time variability, response inhibition and working memory were associated with baseline affective problems in girls, but not in boys. Longitudinally, enhanced response time variability predicted affective problems after 2.5 and 5 years in girls, but not in boys. Decreased response inhibition predicted affective problems after 5 years follow-up in girls, and again not in boys. The results are discussed in light of recent insights in gender differences in adolescence and state-trait issues in depression.

Depression runs in families and is considered a stress-related disorder. Familial risk for depression may be transmitted via deregulated psychophysiological stress responses from parent to child. In this study, we examined the association between self-assessed lifetime parental depressive problems (PDP) and adolescent offspring' cortisol responses to a social stress test. Data were collected as part of the third assessment wave of TRAILS (TRacking Adolescents' Individual Lives Survey), a large prospective population study of Dutch adolescents. Data of 330 adolescents (mean age 16.04; 40.9% girls) who participated in a laboratory session, including a standardized performance-related social stress task (public speaking and mental arithmetic) were examined. Four saliva cortisol samples were collected before, during and after the social stress task which were analyzed with repeated measures Analysis of Variance. Lifetime parental depressive problems were assessed by self-reports from both biological parents. PDP was associated with daughter' cortisol responses (F(3,133)=3.90, p=.02), but no association was found in sons (F(3,193)=0.27, p=.78). Girls whose parents ever experienced depressive symptoms displayed a blunted cortisol response to the standardized social stress test, while girls whose parents never had such problems displayed the characteristic curvilinear response pattern. This effect was not mediated by offspring stress history (age 0-16). Analyses were corrected for smoking behaviour and adolescent depressed mood. The fact that PDP were measured by self-report questionnaires and did not reflect clinical DSM-IV diagnosis could be considered a limitation of the study., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Despite extensive research on the relationship between depression and coronary artery disease (CAD) after an acute coronary syndrome (ACS), causal interpretations are still difficult. This uncertainty has led to much confusion regarding screening and treatment for depression in CAD patients., Method: A critical and conceptual analysis of the pertinent literature, which elaborates the implications of the heterogeneity in symptom pattern, etiology, and course of depression in CAD patients., Results: We propose an integrative dynamic model of the depression-CAD relationship. The model rests on three core hypotheses: (1) Depression in CAD patients consists of mixtures of two types of depression, denoted as 'cognitive/affective' and 'somatic' depression, each having a somewhat characteristic symptom expression and etiology. (2) Effects of depression on CAD depend on the type and duration of depression. The dynamic aspect of the model indicates that post-ACS depression shifts, when it persists, from a marker of the severity (somatic type) and meaning (cognitive/affective type) of the ACS to a largely indirect causal factor in the progression of CAD. (3) The most plausible pathways mediating the effects of persistent/recurrent depression, irrespective of type, on cardiac prognosis are behavioral and act by making depressed CAD patients more susceptible to other CAD risks. The model offers testable predictions and explanations for a variety of apparently unrelated or inconsistent findings., Conclusion: The proposed model may have potential for integrating findings regarding the depression-CAD relationship, contributing to the clarification of discords on screening and treatment of depression, and guiding future research., (Copyright © 2011 S. Karger AG, Basel.)

Early-onset cannabis use is widespread in many countries and might cause later onset of depression. Sound epidemiologic data across countries are missing. The authors estimated the suspected causal association that links early-onset (age <17 years) cannabis use with later-onset (age > or =17 years) risk of a depression spell, using data on 85,088 subjects from 17 countries participating in the population-based World Health Organization World Mental Health Survey Initiative (2001-2005). In all surveys, multistage household probability samples were evaluated with a fully structured diagnostic interview for assessment of psychiatric conditions. The association between early-onset cannabis use and later risk of a depression spell was studied using conditional logistic regression with local area matching of cases and controls, controlling for sex, age, tobacco use, and other mental health problems. The overall association was modest (controlled for sex and age, risk ratio = 1.5, 95% confidence interval: 1.4, 1.7), was statistically robust in 5 countries, and showed no sex difference. The association did not change appreciably with statistical adjustment for mental health problems, except for childhood conduct problems, which reduced the association to nonsignificance. This study did not allow differentiation of levels of cannabis use; this issue deserves consideration in future research.

Background: Depression measures that include somatic symptoms may inflate severity estimates among medically ill patients, including those with cardiovascular disease., Aims: To evaluate whether people receiving in-patient treatment following acute myocardial infarction (AMI) had higher somatic symptom scores on the Beck Depression Inventory-II (BDI-II) than a non-medically ill control group matched on cognitive/affective scores., Method: Somatic scores on the BDI-II were compared between 209 patients admitted to hospital following an AMI and 209 psychiatry out-patients matched on gender, age and cognitive/affective scores, and between 366 post-AMI patients and 366 undergraduate students matched on gender and cognitive/affective scores., Results: Somatic symptoms accounted for 44.1% of total BDI-II score for the 209 post-AMI and psychiatry out-patient groups, 52.7% for the 366 post-AMI patients and 46.4% for the students. Post-AMI patients had somatic scores on average 1.1 points higher than the students (P<0.001). Across groups, somatic scores accounted for approximately 70% of low total scores (BDI-II <4) v. approximately 35% in patients with total BDI-II scores of 12 or more., Conclusions: Our findings contradict assertions that self-report depressive symptom measures inflate severity scores in post-AMI patients. However, the preponderance of somatic symptoms at low score levels across groups suggests that BDI-II scores may include a small amount of somatic symptom variance not necessarily related to depression in post-AMI and non-medically ill respondents.

Background: It is well known that functional somatic symptoms (FSS) are associated with anxiety and depression. However, evidence is lacking about how they are related to FSS. The aim of this study was to clarify these relationships and examine whether anxiety and depression are distinctly related to FSS. We hypothesized that anxiety contributes to the development of FSS and that depression is a consequence of FSS., Methods: FSS, anxiety, and depression were measured in adolescents (N = 2230, 51% women) by subscales of the Youth Self-Report during three assessment waves (adolescents successively aged: 10-12, 12-14, and 14-17) and by corresponding subscales of the Child Behavior Checklist. Using structural equation models, we combined trait and state models of FSS with those of anxiety and depression, respectively. We identified which relationships (contemporaneous and two-year lagged) significantly connected the states of FSS with the states of anxiety and depression., Results: Trait variables were all highly interrelated (r = .54-.63). Contrary to our hypothesis, both state anxiety (beta = .35) and state depression (beta = .45) had a strong contemporaneous effect on state FSS. In turn, state FSS had a weak two-year lagged effect on state anxiety (beta = .11) and an even weaker effect on state depression (beta = .06)., Conclusions: While the effect of anxiety and depression on FSS is strong and immediate, FSS exert a weaker and delayed influence on anxiety and depression. Further research should be done to detect the exact ways in which anxiety and depression lead to FSS, and FSS lead to anxiety and depression.

Objective: To examine in a nonclinical sample of preadolescents the possibility that somatic and cognitive-affective depressive symptoms are differentially related with the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. Depression is a well-known risk factor for cardiovascular disease and mortality. Dysregulation of the ANS and the HPA axis have been proposed as underlying mechanisms. Several studies suggest that only a subset of the depression symptoms account for associations with cardiovascular prognosis., Methods: Self-reported somatic and cognitive-affective depressive symptoms were examined in relationship to heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and the cortisol awakening response (CAR) in 2049 preadolescents (mean age = 11.1 years; 50.7% = girls) from the Tracking Adolescents' Individual Lives Survey (TRAILS)., Results: Physiological measurements were not associated with the overall measure of depressive symptoms. Somatic depressive symptoms were negatively related to HRV and BRS, and positively to the CAR; cognitive-affective depressive symptoms were positively related to HRV and BRS, and negatively to the CAR. Associations with the CAR pertained to boys only., Conclusions: Somatic and cognitive-affective depressive symptoms differ in their association with both cardiac autonomic and HPA axis function in preadolescents. Particularly, somatic depression symptoms may mark cardiac risk.

Background: Respiratory sinus arrhythmia (RSA) has been proposed as a physiological marker of emotion-regulation capacity, and shown to be cross-sectionally associated with depression. Little is known about the role of RSA as a predictor of (subclinical) depressive symptoms over time and as a modifier of the depressogenic effect of stressful life events (SLEs)., Methods: In a longitudinal population-based study with data collected in 1653 adolescents twice (at age 11 and 13.5 years, respectively), RSA was assessed in supine position at the first assessment wave. Depressive symptoms were assessed at both waves and SLEs experienced between the two waves at the last wave., Results: Low levels of RSA were not associated with concurrent or future depressive symptoms, and did not enhance the depressogenic effects of SLEs., Conclusions: In a normal population of young adolescents, a low level of RSA does not identify adolescents at risk for depressive symptoms when confronted with SLEs. In post hoc analyses, among those reporting high exposure to stressful life events, higher RSA tended to predict less self-reported anxiety and more self-reported somatic symptoms as compared to those with lower RSA.

Rejection sensitivity and the associated fear of negative social evaluation (FNSE) trait are characteristics of hypocortisolemic syndromes such as atypical depression. However, a meta-analysis showed that acute FNSE evokes strong cortisol responses in humans. This is consistent with suggestions that hypocortisolism reflects a protective adaptation to a history of high cortisol responses. This leads us to hypothesize that measures of trait FNSE relate to hypocortisolism. Moreover, because FNSE relates positively to depressed mood state, but negatively to cortisol, we expect that the positive relationship between depressed mood state and cortisol will show up most clearly when controlling for the confounding effect of FNSE on this relationship. In the present study we measured salivary cortisol awakening response and psychological variables in 194 community women aged 18-30 years. The results confirmed our hypotheses. We propose that dispositional FNSE is associated with a history of frequent high cortisol responses, leading to long-term protective inhibition of further cortisol and energy mobilization. The present results have special relevance for mental health problems that have high prevalence among young women.

The Netherlands Study of Depression and Anxiety (NESDA) is a multi-site naturalistic cohort study to: (1) describe the long-term course and consequences of depressive and anxiety disorders, and (2) to integrate biological and psychosocial research paradigms within an epidemiological approach in order to examine (interaction between) predictors of the long-term course and consequences. Its design is an eight-year longitudinal cohort study among 2981 participants aged 18 through 65 years. The sample consists of 1701 persons with a current (six-month recency) diagnosis of depression and/or anxiety disorder, 907 persons with life-time diagnoses or at risk because of a family history or subthreshold depressive or anxiety symptoms, and 373 healthy controls. Recruitment took place in the general population, in general practices (through a three-stage screening procedure), and in mental health organizations in order to recruit persons reflecting various settings and developmental stages of psychopathology. During a four-hour baseline assessment including written questionnaires, interviews, a medical examination, a cognitive computer task and collection of blood and saliva samples, extensive information was gathered about key (mental) health outcomes and demographic, psychosocial, clinical, biological and genetic determinants. Detailed assessments will be repeated after one, two, four and eight years of follow-up. The findings of NESDA are expected to provide more detailed insight into (predictors of) the long-term course of depressive and anxiety disorders in adults. Besides its scientific relevance, this may contribute to more effective prevention and treatment of depressive and anxiety disorders.

Objective: Depression and type-D personality have both been associated with worse cardiac prognosis in myocardial infarction (MI) patients. There is some debate, however, that the association between depression and cardiac prognosis is confounded by somatic health. We therefore compared to what extent depression and type-D personality are associated with somatic health., Method: We studied the association of depressive disorder and type-D with baseline somatic health in a subsample of 1205 post-MI patients from the Myocardial Infarction and Depression Intervention Trial study. Depressive disorder was assessed according to ICD-10 criteria with the Composite International Diagnostic Interview during the post-MI year and type-D with the DS14 at 1-year follow-up. Somatic health was operationalized by baseline LVEF, Charlson Comorbidity Index, previous MI, and CABG or PTCA during hospital admission., Results: Prevalence rates were 17.1% for post-MI depression and 18.7% for type-D. After controlling for potential confounders, post-MI depression was associated with poorer baseline LVEF [odds ratio (OR)=3.17, 95% confidence interval (CI)=2.28-4.41] and greater comorbidity (OR=1.46, 95% CI=1.02-2.09), whereas type-D personality was not (LVEF: OR=1.31, 95% CI=0.93-1.87; comorbidity: OR=0.92, 95% CI=0.63-1.35)., Conclusion: Post-MI depression during the post-MI year is more related to somatic health than type-D personality at 12 months post-MI and, specifically, somatic symptoms of depression. Confounding of cardiovascular effects of psychological distress by poor somatic health status is thus more likely to occur in post-MI depression than in type-D personality.

Previous studies could not evaluate adequately the extent to which deviant levels of personality measures and psychosocial functioning found before and after a major depressive episode (MDE) should be attributed to subthreshold depressive symptoms. Our aim is to investigate whether pre- and post-MDE personality alterations and psychosocial disability truly reflect vulnerability, or whether they can be accounted for by the presence of subthreshold depressive symptoms. Data were derived from the Netherlands Mental Health and Incidence Study, a prospective general population study with three waves. Psychopathology was measured with the Composite International Diagnostic Interview (CIDI). Course of depressive symptoms was assessed with the Life Chart Instrument in a cohort of 195 respondents with a new or recurrent MDE between waves 2 and 3. Personality and psychosocial functioning were assessed with, respectively, four and two different measures. Alterations in measurements of personality and psychosocial functioning were present before onset and after remission of an MDE. Most pre- and postonset alterations occurred in the presence of subthreshold depressive symptoms. But even without these subthreshold symptoms, some alterations in measurements of personality and psychosocial functioning were found before and after an MDE. Depressive complaints between waves 2 and 3 were retrospectively assessed, and only a limited set of brief questionnaires was used to assess personality styles and psychosocial functioning. It is unlikely that the pre- and post-MDE alterations in personality and psychosocial functioning observed in earlier studies are entirely due to subthreshold depressive symptoms. This suggests that a depressive episode is interwoven in a long-standing and enduring pattern of mild personality deviance and limitations in psychosocial functioning.

Objectives: The purpose of this research was to explore the prospective relationship between the use of beta-blockers and depression in myocardial infarction (MI) patients., Background: Beta-blocker use has been reported to be associated with the development of depression, but the methodological quality of studies in this field is weak., Methods: In a multicenter study, MI patients (n = 127 non-beta-blocker users and n = 254 beta-blocker users) were assessed for depressive symptoms (using the Beck Depression Inventory [BDI] at baseline and t = 3, 6, and 12 months post-MI) and International Classification of Diseases-10 depressive disorder (Composite International Diagnostic Interview). Patients were matched using the frequency matching procedure according to age, gender, hospital of admission, presence of baseline depressive symptoms, and left ventricular function., Results: No significant differences were found between non-beta-blocker users and beta-blocker users on the presence of depressive symptoms (p > 0.10 at any of the time points) or depressive disorder (p = 0.86). Controlling for confounders did not alter these findings. A trend toward increasing BDI scores was seen in patients with long-term use of beta-blockers and patients with higher beta-blocker dose., Conclusions: In post-MI patients, prescription of beta-blockers is not associated with an increase in depressive symptoms or depressive disorders in the first year after MI. However, long-term and high-dosage effects cannot be ruled out.

Background: Depressive symptoms can be triggered by negative social experiences and individuals' processing of these experiences. This study focuses on the interaction between temperament, perceived parenting, and gender in relation to depressive problems in a Dutch population sample of preadolescents., Methods: The sample consisted of 2230 ten-to-twelve-year-olds from the North of The Netherlands. Perceived parenting (overprotection, rejection, emotional warmth) was assessed by the EMBU (a Swedish acronym for My Memories of Upbringing) for Children, temperament (fearfulness and frustration) by the parent version of the Early Adolescent Temperament Questionnaire-Revised, and depressive problems by the Child Behavior Checklist (parent report) and the Youth Self-Report (child report)., Results: All parenting and temperament factors were significantly associated with depressive problems. Frustration increased the depressogenic effect of parental overprotection and lack of emotional warmth. Fearfulness increased the effect of rejection in girls, but not in boys. Furthermore, the association between frustration and depression was stronger in boys., Conclusions: These findings support the hypothesis that the effect of specific parenting behaviors depends on the temperament and gender of the child.

Unsatisfying interpersonal relationships are involved in the onset and course of depression. However, little is known about the underlying mechanisms. In this study we investigated the nonverbal communication between 101 patients with remitted depression and interviewers. We related the interaction between the patients' and interviewers' behavior to patients' satisfaction with the interview and to the risk of recurrence of depression. We registered the patients' and interviewers' nonverbal displays of involvement during a clinical interview and assessed the patients' satisfaction with the interview. Possible recurrence of depression was assessed within a 2-year follow-up. Based on findings in healthy people, we hypothesized that the more similar the levels of the patients' and interviewers' behavior became during the interview, the more satisfied the patients would turn out to be. Furthermore, we hypothesized that lack of similarity in the levels of the patients' and interviewers' involvement behavior would predict recurrence of depression. Our hypotheses were confirmed: The more the patients' and interviewers' behavior converged, the more satisfied the patients were with the interview and the lower the risk of recurrence of depression. Satisfaction did not mediate the association between convergence and risk of recurrence. Also, no gender effects were found. We conclude that nonverbal communication processes are involved in the risk of recurrence of depression. Remitted people's difficulties in reaching nonverbal convergence with others may hamper them in their interpersonal functioning and, as a consequence, may put them at risk for new episodes of depression., ((c) 2006 Wiley-Liss, Inc.)

Background: Depression following myocardial infarction (MI) can be a first-ever episode for some, whereas for others, it may represent a recurrent episode or one that was present at the onset of the infarction. We investigated if there are differences in pre- and post-MI characteristics between these subtypes., Methods: Four hundred sixty-eight patients admitted for an MI were assessed for the presence of an ICD-10 depressive disorder following MI. A comparison was made between first-ever and ongoing or recurrent depression on demographic and cardiac data, personality, and depression characteristics., Results: Depressive disorder during the first post-MI year was present in 25.4% of the MI patients (n = 119), and almost half were ongoing or recurrent (n = 53, 44.5%). Recurrent and ongoing depression was related to high neuroticism (Z = 2.77, P < .01), whereas first-ever depression was associated with MI severity (poor left ventricular ejection fraction: Z = 1.64, P = .05; PTCA or CABG during hospitalization: Z = 1.88, P = .03; arrhythmic events: Z = 1.49, P = .06)., Conclusions: Our results suggest that in the first-ever post-MI depression cases, depression may be triggered by the severity of the MI, whereas ongoing and recurrent depression is more related to personality. Future research should address the question whether these subtypes of depression differ in cardiovascular prognosis and response to psychiatric treatment.

Gender differences in the buffer-effect of social support in the relation between stressful circumstances and the development of depression and anxiety disorders are widely assumed, but few studies address this three-way interaction between gender, stress, and support. Data in the present study came from the baseline assessment of the Adolescents at Risk for Anxiety and Depression (ARIADNE) study in 502 adolescent and young-adult children of 356 parents in the Netherlands with a depression, panic disorder and/or obsessive-compulsive disorder. Results indicate that the daughters benefit more from social support than the sons when problems in parent-offspring communication are high, but that this effect holds only for depression symptoms and particularly in relation to problems in father-offspring communication. Social support does not seem to play a role in the development of anxiety.

Objective: The aim of this study was to identify cardiologic, psychologic, and demographic risk factors in two groups of patients with post-myocardial infarction (MI) depressive symptoms (in-hospital and during the postdischarge year)., Methods: Patients admitted for MI were assessed for depressive symptoms with the Beck Depression Inventory (BDI) during hospitalization and 3, 6, and 12 months post-MI. We contrasted both groups with nondepressed patients., Results: Pre-MI vital exhaustion, living alone, history of depressive disorder, history of MI, poor performance on exercise tolerance testing, and female gender were significantly and independently associated with in-hospital depressive symptoms. Pre-MI vital exhaustion, history of depressive disorder, female gender, poor ejection fraction, and longer hospital stay were independent predictors of the development of postdischarge depressive symptoms., Conclusions: Post-MI depressive symptoms seem largely driven by the psychological and social consequences of the MI in patients vulnerable to depression, as indexed by a history of depression and vital exhaustion.

Background: Although good physician communication is associated with positive patient outcomes, it does not figure in current depression treatment guidelines. We examined the effect of depression treatment, communicative skills and their interaction on patient outcomes for depression in primary care., Methods: In a cohort of 348 patients with ICD-10 depression in primary care, patient outcomes were studied over 3- and 12-month follow-ups. The association of these outcomes with both depression-specific process of care variables and a nonspecific variable-communicative skillfulness of GP-was examined. Patient outcomes consisted of change from baseline in symptomatology, disability, activity limitation days, and duration of the depressive episode., Results: In accordance with treatment guidelines, some main effects of depression treatment were found, in particular on symptomatology, but these remained small (effect size<0.50). A moderate effect was found for treatment with a sedative, which proved to be related to worse patient outcomes at 12 months. An accurate GP diagnosis of depression and adequate antidepressant treatment were associated with better patient outcomes, but only when provided by GPs with good communicative skills. In contrast to the main effects, these interactions were seen on disability and activity limitation days, not on symptomatology., Limitations: The study is observational and does not permit firm conclusions about causal relationships. Communicative skillfulness of the GP was assessed by patient report only., Conclusion: Neither depression-specific interventions nor good GP communication skills seem to be sufficient for optimal patient improvement. Only the combination of treatments according to guidelines and good communication skills results in an effective antidepressive treatment.

Objective: The authors tested the hypothesis that elderly subjects with premorbid depressive symptoms are at increased risk of poor adjustment after a somatic event., Methods: The GLAS study contains a baseline assessment and a follow-up of subjects who experienced post-baseline acute myocardial infarction, cancer, congestive heart failure, or fall-related injury of the extremities within 5 years after baseline assessment. Follow-up was conducted at 8 weeks, 6 months, and 1 year after the somatic event. Of a baseline sample of 5,279 elderly subjects (57 and older), 1,124 subjects who experienced one of the specified events were contacted, and sufficient follow-up data were obtained from 558 subjects. Authors analyzed the course of self-reported physical, role, and social functioning, and general health and well-being in subjects without baseline limitations. Patients with poor adjustment after the event were compared with patients with good adjustment on baseline depressive symptoms. They used logistic-regression analysis, controlling for several confounders., Results: In multivariate analyses, pre-event depressive symptoms were associated with an increased risk of poor adjustment in terms of social and role functioning, well-being, and general health, but not physical functioning., Conclusions: Elderly persons living in the community reporting depressive symptoms are at increased risk of poor psychosocial adjustment after a somatic event. Each reported baseline depressive symptom was associated with an increased risk of chronic decline; this finding stresses the importance of detecting and treating depression in community-living elderly persons.

The vulnerability-accumulation (or scarring) hypothesis postulates that the experience of depression induces a lasting increase in vulnerability, and through this raises the risk of recurrence. We examined the validity of the vulnerability-accumulation model for depressive episodes in later life. The sample comprised 26 elderly persons who had remitted from a depressive episode and 96 control respondents who were all selected from the participants of a large community survey among persons aged 57 years or more. Several psychosocial vulnerability indicators were assessed premorbidly, during the depressive episode and after remission. High levels of psychological distress, low life satisfaction, chronic somatic diseases, high neuroticism, and low scores on extraversion, mastery, and self-efficacy appeared to be predictors of depression in this sample. During the depressive episode, psychological distress was higher and life satisfaction, physical, role, and social functioning, as well as feelings of self-efficacy lower than before the episode. Physical and role functioning, cognitive function, and self-efficacy were lower after remission compared to premorbid levels, but (other) personality indices had not changed after remission compared to premorbid levels. Furthermore, we failed to find differences between first and recurrent episodes. Support for the vulnerability-accumulation model was limited at the most. Although psychosocial scarring may occur in the elderly, our findings tentatively suggest that this accumulation does not manifest itself in major vulnerability indicators such as neuroticism., (Copyright 2003 Wiley-Liss, Inc.)

A strong association between functional disability and depressive symptoms in older people has frequently been reported. Some studies attribute this association to the disabling effects of depression, others to the depressogenic effects of physical health-related disability. The authors examined the reciprocal effects between depressive symptoms and functional disability and their temporal character in a community-based cohort of 753 older people with physical limitations who were assessed at yearly intervals. They compared structural equation models that differed in terms of direction and speed of effects between patient-reported disability in instrumental and basic activities of daily living (IADL/ADLs) and depressive symptoms. The association between disability and depression could be separated into three components: (a) a strong contemporaneous effect of change in disability on depressive symptoms, (b) a weaker 1-year lagged effect of change in depressive symptoms on disability (probably indirect through physical health), and (c) a weak correlation between the trait (or stable) components of depression and disability. IADL/ADL disability and depressive symptoms are thus mutually reinforcing over time. Compensatory forces like effective treatment and age-related adaptation may protect elders against this potential downward trend. To improve quality of life in elderly adults, treatment should target disability when it is new and depression when it is persistent.

Several predictors of the course of depression and generalized anxiety have been identified. Whether these predictors provide a solid basis for primary care physicians (PCPs) to give an accurate prognosis remains unclear. A parallel study showed modest agreement between PCP prognosis and observed course (kappa< or = 0.21). It is the aim of the present study to establish the extent to which the one-year course of depression and generalized anxiety in primary care is in fact predictable. Predictability is operationalized as the combined predictive power of major prognostic factors identified in the literature. We identified 269 cases of ICD-10 depression and 134 of generalized anxiety among consecutive PCP attenders. For these patients a statistical model was built that provided optimal predictions of the one-year course of the disorder, based on the prognostic factors discerned. The predictions were compared with the actual course observed. Reasonable agreement (kappa = 0.37 for depression, kappa = 0.35 for anxiety) and good association (gamma = 0.66 for depression, gamma=0.67 for anxiety) were found between predicted and observed course. Nevertheless, the combined predictive power of the prognostic factors remains limited. A realistic evaluation of the accuracy of the PCP prognosis should take this limited predictability into account.

Abstract Background Depression is a common psychiatric disorder characterized by a high rate of relapse and recurrence. The most commonly used strategy to prevent relapse/recurrence is maintenance treatment with antidepressant medication (mADM). Recently, it has been shown that Mindfulness-Based Cognitive Therapy (MBCT) is at least as effective as mADM in reducing the relapse/recurrence risk. However, it is not yet known whether combination treatment of MBCT and mADM is more effective than either of these treatments alone. Given the fact that most patients have a preference for either mADM or for MBCT, the aim of the present study is to answer the following questions. First, what is the effectiveness of MBCT in addition to mADM? Second, how large is the risk of relapse/recurrence in patients withdrawing from mADM after participating in MBCT, compared to those who continue to use mADM after MBCT? Methods/design Two parallel-group, multi-center randomized controlled trials are conducted. Adult patients with a history of depression (3 or more episodes), currently either in full or partial remission and currently treated with mADM (6 months or longer) are recruited. In the first trial, we compare mADM on its own with mADM plus MBCT. In the second trial, we compare MBCT on its own, including tapering of mADM, with mADM plus MBCT. Follow-up assessments are administered at 3-month intervals for 15 months. Primary outcome is relapse/recurrence. Secondary outcomes are time to, duration and severity of relapse/recurrence, quality of life, personality, several process variables, and incremental cost-effectiveness ratio. Discussion Taking into account patient preferences, this study will provide information about a) the clinical and cost-effectiveness of mADM only compared with mADM plus MBCT, in patients with a preference for mADM, and b) the clinical and cost-effectiveness of withdrawing from mADM after MBCT, compared with mADM plus MBCT, in patients with a preference for MBCT. Trial registration ClinicalTrials.gov: NCT00928980

Background: Perinatal depression and anxiety are associated with unfavourable child outcomes.Aims: To assess among women with antenatal depression or anxiety the effectiveness of prenatally initiated cognitive-behavioural therapy (CBT) on mother and child compared with care as usual (CAU). Trial registration: Netherlands Trial Register number NTR2242.Method: Pregnant women (n = 282) who screened positive for symptoms of depression and/or anxiety were randomised to either CBT (n = 140) or CAU (n = 142). The primary outcome was child behavioural and emotional problems at age 18 months, assessed using the Child Behavior Checklist (CBCL). Secondary outcomes were maternal symptoms during and up to 18 months after pregnancy, neonatal outcomes, mother-infant bonding and child cognitive and motor development at age 18 months.Results: In total, 94 (67%) women in the CBT group and 98 (69%) in the CAU group completed the study. The mean CBCL Total Problems score was non-significantly higher in the CBT group than in the CAU group (mean difference: 1.38 (95% CI -1.82 to 4.57); t = 0.85, P = 0.399). No effects on secondary outcomes were observed except for depression and anxiety, which were higher in the CBT group than in the CAU group at mid-pregnancy. A post hoc analysis of the 98 women with anxiety disorders showed lower infant gestational age at delivery in the CBT than in the CAU group.Conclusions: Prenatally initiated CBT did not improve maternal symptoms or child outcomes among non-help-seeking women with antenatal depression or anxiety. Our findings are not in line with present recommendations for universal screening and treatment for antenatal depression or anxiety, and future work may include the relevance of baseline help-seeking. [ABSTRACT FROM AUTHOR]

Foremost cross-sectional studies of personality in common mental disorders show similar Big Five trait profiles [i.e. high neuroticism (N), low conscientiousness (C) and low extraversion (E)]. It remains undecided whether this lack of distinct personality profiles is partly due to comorbidity among disorders or contamination by current state. Using data from the Netherlands Study of Depression and Anxiety, we investigated 1046 participants with panic disorder (PD), social anxiety disorder (SAD) and/or major depressive disorder (MDD) and 474 healthy controls. Personality traits at baseline and two-year follow-up were assessed with the NEO-Five Factor Inventory. The Composite International Diagnostic Interview was used to determine the presence of emotional disorders at baseline and at two-year follow-up; the Life Chart Interview determined symptom severity in the month prior to baseline and during follow-up. By analysing pure cases and investigating the effects in remitted cases, PD participants were found to be higher in N, but not lower in E and C than controls. Pure PD participants were also lower in N and higher in E than SAD and MDD participants. Both SAD and MDD participants were characterized by high levels of N and low levels of E, irrespective of comorbidity or current disorder state. Future studies should be more attentive to confounding of personality profiles by comorbidity and state effects. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article reports on the state of the TRacking Adolescents' Individual Lives Survey (TRAILS) study, which follows youth through young adulthood in order to understand the development of mental disorders and evaluate existing interventions for individuals with a mental illness. It discusses the development of behavioral problems, the effects of gender difference on mental health, and the correlation between rule-breaking and mood disorders.

Background Depression outcomes in research and clinical practice are commonly defined by the concepts of remission, recovery, relapse, and recurrence. Despite their widespread use, there has been little empirical examination of these concepts. Therefore, we investigated profiles of individual symptoms during each of these phases of depression. Methods In a 3-year prospective study of 267 depressed primary care patients, we established the presence or absence of the individual DSM- IV depressive symptoms week-by-week during DSM- IV-defined remissions, recoveries, relapses, and recurrences. We measured symptoms in 12 quarterly assessments using the Composite International Diagnostic Interview. Results Remissions were characterized by double the proportion of time that the core symptoms were present compared to the initial phase of recoveries after a major depressive episode ( MDE; 59 versus 32%; Z = -3.03; P = .002). Before a relapse, remissions again showed elevated levels of core symptoms in comparison to the final phase of recoveries before a recurrence (58 versus 26%; Z = -2.99; P = .003). Conclusions Compared with the initial and final phases of recoveries, remissions showed a consistently higher level of core symptoms. Clinically, this means that unresolved core symptoms in the direct aftermath of a MDE seem to constitute a risk for relapse and should be the target of preventive or augmented interventions. [ABSTRACT FROM AUTHOR]

The present study examines the relationship between neurocognitive functioning and affective problems through adolescence, in a cross-sectional and longitudinal perspective. Baseline response speed, response speed variability, response inhibition, attentional flexibility and working memory were assessed in a cohort of 2,179 adolescents (age 10-12 years) from the TRacking Adolescents' Individual Lives Survey (TRAILS). Affective problems were measured with the DSM-oriented Affective Problems scale of the Youth Self Report at wave 1 (baseline assessment), wave 2 (after 2.5 years) and wave 3 (after 5 years). Cross-sectionally, baseline response speed, response time variability, response inhibition and working memory were associated with baseline affective problems in girls, but not in boys. Longitudinally, enhanced response time variability predicted affective problems after 2.5 and 5 years in girls, but not in boys. Decreased response inhibition predicted affective problems after 5 years follow-up in girls, and again not in boys. The results are discussed in light of recent insights in gender differences in adolescence and state-trait issues in depression. [ABSTRACT FROM AUTHOR]