BackgroundPatients with chronic heart failure and their family caregivers may experience adverse emotional problems, such as depression. Mutuality, which refers to the relationship between caregivers and those they care for, is an important factor affecting depression in the dyads. The purpose of this study was to investigate the relationship between mutuality and depression in patients with CHF and their caregivers in China.MethodsIn this cross-sectional study, we used the Mutuality Scale and the Self-Rating Depression Scale to (...) measure mutuality and depression of patients and caregivers. We used SPSS version 26.0 and AMOS version 21.0 to analyze the data. An APIM was established to analyze the actor-partner effects of patient-caregiver mutuality and depression.ResultsA total of 250 dyads of patients and caregivers were included in the study. There were statistically significant differences in mutuality and depression between CHF patients and caregivers. The 4 dimensions of patients’ mutuality all have the actor effect on depression. There were 3 partner effects of caregivers’ “pleasurable activities”, “shared values”, and “reciprocity” on depression. Regarding caregiver depression, we only found an actor effect of caregivers’ “shared values” on depression.ConclusionThe relationship between patients and caregivers should be evaluated in the clinical setting, and it is very important to develop intervention measures to improve the adverse emotional problems affecting both patients and their caregivers. (shrink)

ObjectivesQuality of Life depends on the discrepancy between desired and current experiences, thus in chronic illness, adjustment of expectations and interpretation of the current situation are crucial. Depression is known to influence this gap, and the present study aims to further assess the role of resilience and health locus of control.MethodsA total of 94 patients with neurological disorders were screened via telephone regarding depression, resilience and HLC. Current and desired state of several life domains were assessed, such (...) as Fitness, General Health, Pain, Daily Activities, Finances, Leisure, and Family. Elastic net regularization and analyses of variance were used to disentangle the impact of depression, resilience, HLC, and sociodemographic factors on the perception of current and desired state, and the gap between both.ResultsA gap was present for all domains but largest for pain. Interpretation of the current state was linked to desired state, HLC, and age. All gaps were related to depression; certain domains were in addition influenced by resilience, HLC and sociodemographic factors. Of note, for most domains, patients did not select the highest possible desired state.ConclusionOlder patients with neurological disorders report a gap between current and desired state for many aspects of life. Adjusting expectations is beneficial in the face of declining health, but a reasonably increased desired state may positively influence the perception of the current situation. Depression negatively influences the interpretation of the Calman gap. (shrink)

One popular description of current society is that it is a depressed society and medical evidence about depression’s prevalence may well make such an estimation plausible. However, such normative-critical assessments surrounding depression have to date usually operated with a one-sided understanding of depression. This understanding widely neglects the various ways depression manifests as well as its comorbidities. This becomes evident at the latest when considering one of depression’s most prominent and well-known comorbidities: chronic pain. (...) Against this background, we aim in this article to substantiate our leading claim that the phenomenal interconnection between depression and chronic pain must be acknowledged in the global diagnosis of a depressive society. Thus, we argue here for a complementation of the dominant interpretation of a depressed society. This would support the overcoming of oversimplified images and estimations about depression in current society and further, help to recognize chronic pain properly on the larger scale of assessments that address society as a whole. (shrink)

Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward (...) poorly life quality, social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives. (shrink)

Objective: Individually, vision and hearing impairments have been linked to higher levels of anxiety and depression. We investigated the effect of dual sensory impairment in a large representative sample of Spanish adults. Methods: Data from a total of 23,089 adults from the Spanish National Health Survey 2017 were analyzed. Self-reported difficulty of seeing and hearing, and depression and chronic anxiety were analyzed. Multivariable logistic regression was assessed for difficulty with vision alone, hearing alone and with difficulty with (...) both, adjusting for gender, age, marital status, living as a couple, education, smoking, alcohol consumption, BMI, physical activity, use of glasses/contact lenses, and hearing aid. Results: Visual difficulty, hearing difficulty, and dual difficulties were all associated with significantly higher odds for depression and for chronic anxiety. Dual sensory difficulty was associated with higher odds ratios for depression and anxiety when compared to either impairment alone. Conclusion: Dual sensory difficulty is associated with significantly higher odds of anxiety and depression when compared to either vision or hearing difficulty alone. Appropriate interventions are needed to address any reversible causes of vision and hearing as well as anxiety and depression in people in these specific groups. (shrink)

Individuals with chronic pain often experience co-existing sleep problems and depression-related states. Chronic pain, sleep problems, and depression interrelate, and have been shown to exacerbate one another, which negatively impacts quality of life. This study explored the relationships between pain severity, pain interference, sleep quality, and depression among individuals with chronic pain. Secondly, we tested whether sleep quality may moderate the relationship between pain and depression. A cross-sectional survey was completed by 1,059 adults (...) with non-malignant chronic pain conditions and collected measures related to pain severity, pain interference, sleep quality, and depression. Multiple regression analyses found that pain severity, pain interference, and sleep quality are all significantly associated with depression. Secondly, moderated regression analyses revealed that sleep quality moderates the relationship between pain interference and depression among individuals with chronic pain such that good sleep quality attenuates the effect of pain interference on depression, and poor sleep quality amplifies the effect of pain interference on depression. These findings suggest that sleep quality may be a relevant therapeutic target for individuals with chronic pain and co-existing depression. (shrink)

In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of the (...) will. I will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions. These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her ‘depressive disabilities’. Lastly, I will compare this manner of life-conduct with the constellation of includence, as described by Tellenbach, and discuss the limitations of this study. (shrink)

Chronic pain is a serious public health problem with a strong affective-motivational component that makes it difficult to treat. Most patients with chronic pain suffer from severe depression; hence, both conditions coexist and exacerbate one another. Brain inflammatory mediators are critical for maintaining depression-pain syndrome and could be substrates for it. The goal of our paper was to review clinical and preclinical findings to identify the neuroinflammatory profile associated with the cooccurrence of pain and depression. (...) In addition, we aimed to explore the regulatory effect of neuronal reorganization on the inflammatory response in pain and depression. We conducted a quantitative review supplemented by manual screening. Our results revealed inflammatory signatures in different preclinical models and clinical articles regarding depression-pain syndrome. We also identified that improvements in depressive symptoms and amelioration of pain can be modulated through direct targeting of inflammatory mediators, such as cytokines and molecular inhibitors of the inflammatory cascade. Additionally, therapeutic targets that improve and regulate the synaptic environment and its neurotransmitters may act as anti-inflammatory compounds, reducing local damage-associated molecular patterns and inhibiting the activation of immune and glial cells. Taken together, our data will help to better elucidate the neuroinflammatory profile in pain and depression and may help to identify pharmacological targets for effective management of depression-pain syndrome. (shrink)

Globally, chronic disease and conditions such as diabetes, cardiovascular disease, depression and cancer are the leading causes of morbidity and mortality. Why, then, are public health efforts and programs aimed at preventing chronic disease so difficult to implement and maintain? Also, why is primary care—the key medical specialty for helping persons with chronic disease manage their illnesses—in decline? Public health suffers from its often being socially controversial, personally intrusive, irritating to many powerful corporate interests, and structurally (...) designed to be largely invisible and, as a result, taken for granted. Primary care struggles from low reimbursements, relative to specialists, excessive paperwork and time demands that are unattractive to medical students. Our paper concludes with a discussion of why the need for more aggressive public health and redesigned primary care is great, will grow substantially in the near future, and yet will continue to struggle with funding and public popularity. (shrink)

Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronic pains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronic pain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP) in the learning andmemory literature, are forms of neuroplasticity inwhich increased neural activity leads to a longlasting increase in (...) the excitability of neuronsthrough structural modifications at pre- andpost-synaptic sites. Moreover, the synapticmodifications of wind-up and LTP share a commonmechanism: a glutamate N -methyl-D-aspartate(NMDA) receptor interaction that initiates a calciummediated biochemical cascade that ultimately enhancessignal processing at the -amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA) receptor. This paper arguesthat chronic pain, which has no adaptive value, canbe accounted for in terms of the highly adaptivephenomenon of activity-dependent neural plasticity;hence, some cases of chronic pain can beconceptualized as a memory trace in spinal neurons. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 255-259 [Access article in PDF] On the Evolution of Depression Mike W. Martin Keywords: Depression, morality, mental disorders, psychobiology, evolutionary psychiatry. In "Depression as a Mind-Body Problem," Walter Glannon outlines a psychosocial-physiological explanation of depression as a psychological response to chronic stress—today, especially social stress—in which cortisol imbalances disrupt neurotransmitters. Accordingly, treatment for depression should combine psychopharmacology (...) and psychotherapy—a valuable reminder in light of the current restrictions on funding for health care (Hobson and Leonard 2001). My comments focus, however, on Glannon's objections to evolutionary theorists who explain our capacity for depression as adaptive to the natural and social environment. His objections are implausible because he fails to distinguish depression as a mood and a disorder. What Is Depression? Explaining the psychology, sociology, physiology, and evolution of depression presupposes knowing what depression is and hence what is being explained. As a blunt but important distinction, let us contrast depression as a mood and as a mood disorder.As a mood, depression is a state of low spirits, typically involving painful and low affect (of a kind needing further specification). Not all negative low moods are depressions. It is notoriously difficult to distinguish depression from grief, sadness, gloom, and a host of additional ways to feel down—especially because today many people use "I'm depressed" as a blanket expression for virtually any low mood. For the purposes of this paper, it is not necessary to attempt a full-blown analysis of depressed moods (and emotions). I would emphasize, however, that depressed moods involve values. They involve negative evaluations of ourselves, major events in our lives, life in its entirety, or the values that have been guiding us. Typically, to be depressed is to experience such things as feelings of worthlessness, dejection about failures, despair and hopelessness, and loss of caring and commitment. Thus, we might be sad or grieving but not depressed because we retain a solid grip on what is valuable and worthwhile. In any case, there should be no general presumption that depressed moods are all bad or undesirable. Instead, we should be prepared to appreciate the importance of depressed moods in connection with questions of value, identity, and even moral insight (Martin 2000). Depressed persons are not necessarily sick.In contrast, depression as a mood disorder is, by definition, pathologic. Moreover, usually it is not a depressed mood, although it involves depressed moods. On the one hand, depression as a disorder is defined as pathologic, a notion that is itself understood in terms of values—the values of health and, indirectly, moral values that define what is culturally acceptable. Thus, even severe [End Page 255] grief can be nonpathologic, even though it involves depressed moods, when it is within the range of "culturally-sanctioned responses" (APA 2000, xxxi). On the other hand, only sometimes is depression a single pathologic mood, as in major depressive episodes that can strike with a terrifying and suicidal severity (APA 2000, 375). Usually, however, the pathology is not a single depressed mood, but instead a longer-term state involving recurring depressed moods and additional features, such as poor concentration, insomnia, poor appetite or overeating, and so on. For some purposes, such as research funding and billing insurance companies and government health providers, these pathologies can be equated with what is currently in the DSM. Yet, there are many additional states of suboptimal health, in which the DSM criteria are only partly met.What does Glannon mean by depression? He does not define it, but he makes it perfectly clear that he intends depression as a disorder. Or rather, it is a set of mental disorders, including the "depressive disorders" of major depressive disorder, dysthymic disorder, depressive disorder not otherwise specified, and a variety of bipolar disorders and some anxiety disorders. Glannon sometimes indicates his primary topic is "severe depression," which of course is not a DSM category (nor always a mark of pathology). For the most part, however, he says his topic is "chronic depression," which might suggest dysthymia, "a chronically depressed mood for most of... (shrink)

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Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8–18 (...) years were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities, socioemotional functioning, psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key. (shrink)

An intriguing question in the field of stress is what makes an individual more likely to be susceptible or resilient to stress‐induced depression. Predisposition to stress susceptibility is believed to be influenced by genetic factors and early adversity. However, beyond genetics and life experiences, recent evidence has highlighted social rank as a key determinant of susceptibility to stress, underscoring dominant individuals as the vulnerable ones. This evidence is in conflict with epidemiological, clinical, and animal work pointing at a link (...) between social subordination and depression. Here, we review and analyze rodent protocols addressing the relevance of social rank to predict vulnerability to chronic social stress. We also discuss whether a specific social status (i.e., dominance or subordination) is the appropriate predictor of vulnerability to develop stress‐induced depression or rather, the loss of social rank and resources. (shrink)

The diagnosis of a chronic illness during young adulthood represents a non-normative life transition influencing the identity definition process, as well as the individual psychological adjustment. The study examined if relationships between identity motives (self-esteem, efficacy, continuity, distinctiveness, belonging, and meaning), health-related quality of life, and depressive symptoms differ between healthy young adults and young adults diagnosed with multiple sclerosis (MS). Two hundred one people (101 MS patients and 100 healthy controls), aged 18–35 years, completed a self-report questionnaire. Young (...) adults with MS reported lower health-related quality of life and lower efficacy motive than their healthy peers. Among MS patients, high meaning was related to lower depressive symptoms, whereas high continuity and high belonging were related to higher health-related quality of life than in healthy controls. The study highlights the relevance of identity motives for the adjustment to MS and has implications for psychological interventions with young patients. (shrink)

The present study examined relationships between chronic regulatory focus and motivation to improve upon academic outcomes in a sample of individuals varying in degree of hopelessness depression (HD) symptoms. Participants recalled a recent negative academic outcome, completed a measure of regulatory focus, reported their subsequent motivation to improve upon future academic outcomes, and then indicated whether their grades on examinations, assignments, and their GPAs had improved or worsened since the described outcome. Results indicate that degree of HD symptoms (...) positively relates to prevention focus and negatively relates to promotion focus, and the negative relationships between HD symptoms and both motivation and performance outcomes are mediated by (lack of) promotion focus. (shrink)

Resilience factors have been suggested as key mechanisms in the relation between symptoms and disability among individuals with chronic pain. However, there is a need to better operationalize resilience and to empirically evaluate its role and function. The present study examined psychological flexibility as a resilience factor in relation to symptoms and functioning among 252 adults with chronic pain applying for participation in a digital ACT-based self-help treatment. Participants completed measures of symptoms (pain intensity, anxiety), functioning (pain interference, (...) depression), as well as the hypothesized resilience factor psychological flexibility (measured as avoidance, value obstruction, and value progress). As expected, symptoms, functioning and resilience factors were significantly associated. Hierarchical linear regression analyses showed that psychological flexibility significantly contributed to the prediction of pain interference and depression when adjusting for age, pain and anxiety. Also, participants with low levels of psychological flexibility were more likely to be on sick leave. Furthermore, a series of multiple mediation analyses showed that psychological flexibility (avoidance, value obstruction, value progress) had a significant indirect effect on the relationship between symptoms and functioning. Avoidance was consistently shown to contribute to the indirect effect. Results support previous findings and suggest the importance of psychological flexibility as a resilience factor among individuals with chronic pain and anxiety. (shrink)

There exists a strong need for research in clinical sport psychology which does not merely gather information on prevalence rates for psychological disorders and case studies of affected athletes. Rather, research should also uncover the underlying psychological variables which increase the risk for depression and burnout in elite athletes. Many studies gather general factors (e.g. gender, injury, sport discipline) and stay on a more descriptive level. Both constructs (burnout and depression) are based on a temporal, stress-related process model (...) assuming the development of either syndrome results from unfavorable personal (e.g. dysfunctional attitudes, perfectionism, negative coping strategies) or environmental (e.g. cohesion) factors coexisting with severe stressors (i.e. chronic stress). Integrating this knowledge, we propose a shared model for depression and burnout in athletes: a sport specific diathesis-stress model. The present longitudinal study assesses data throughout one sporting season to analyze predictors for both constructs in junior elite athletes. Hierarchical multiple linear regression analyses resulted in six predictors for best model fit. The following factors demonstrated a significant impact on predicting (a) burnout or (b) depression scores at the end of the season: dysfunctional attitudes (a and b), coping strategies (a and b), perfectionism (a), recovery (b), stress (a) and the level of depression at onset (b). Variables such as cohesion or attributional style did not significantly predict depression or burnout. The study supports the structure of a process model (diathesis-stress model) for burnout and depression with the assumption of temporal progression. With some vulnerabilities and their temporal, developmental link identified, prevention can become athlete-specific, effective and economical. (shrink)

This book examines the role of British object relations theory in order to explore our understanding and treatment of depression. It challenges current conceptualizations of depression while simultaneously discussing the complex nature of depression, its long-lasting and chronic implications and the susceptibility to relapse many may face. Illuminated throughout by case studies, areas of discussion include: Freud’s theory of depression analytic subtypes of depression a theoretical contribution to the problem of relapse the correlation between (...) dream work and the work of mourning. _Object Relations in Depression_ offers a psychoanalytic discussion of the multifaceted nature of depression and as such will be of great interest to all those in the psychoanalytic field. (shrink)

In 1997, David Foster Wallace published “The Depressed Person,” a short story about a privileged, deeply unhappy woman dedicated to exploring and recounting the texture and etiology of her chronic depression. This essay argues that “The Depressed Person” challenges the long-standing assumption that narrativizing the pain of depression is crucial to overcoming it, and the contemporary view that empathic responses from others promote recovery of the depressed. Taken together, these two critiques inform Wallace’s portrayal of chronic (...) depression as an interactive phenomenon that is articulated, sustained, and regenerated through problematic contexts of interaction. Written at a time when public knowledge of and talk about depression was surging, “The Depressed Person” holds an important, if presently under-recognized place, in the expansive corpus of depression texts that emerged in the 1990s. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 265-269 [Access article in PDF] The Psychology and Physiology of Depression Walter Glannon Trauma and stressful events can disrupt the physiologic homeostasis of our bodies and brains. The physiologic stress response consists of neural and endocrine mechanisms whose function is to reestablish homeostasis. These mechanisms include the secretion of glucocorticoids (cortisol) and catecholemines (epinephrine and norepinephrine). Once an external event has ceased (...) to be a stressor or threat to a human organism, an integrated system of negative feedback loops inhibits the continued production of these hormones and effectively shuts down the stress response. These mechanisms are adaptive in the sense that they ensure the survival of the organism by reestablishing homeostasis. But prolonged exposure to real or perceived stressors can trigger prolonged secretion of stress hormones, thereby disrupting the feedback systems and causing a cascade of pathogenic events. The stress response is a double-edged sword. An acute stress response can protect an organism from external threats and reestablish homeostasis. But a chronic stress response can cause the body's defenses to become damaging rather than protective and to result in various disorders. Acute stress responses are adaptive. Chronic stress responses are often maladaptive and pathogenic.In "Depression as a Mind-Body Problem," I characterized major clinical depression as a disorder resulting from a maladaptive chronic stress response (Glannon 2003). Specifically, I argued that depression often results when our beliefs and emotions are out of proportion to the true nature of external events. The mind prolongs rather than constrains the physiologic stress response. Depression is not a disorder of the brain alone or the mind alone, however. Endocrine and immune dysfunction can contribute to the dysfunction in the brain and central nervous system that are involved in depression. Moreover, the contents of the mental states that initiate the sequence of events leading to depression are reflections of the person's natural and social environment. Thus, a satisfactory account of depression requires an analysis of the interconnections among the central nervous, endocrine, and immune systems, as well as the mind and the environment. All of these factors support the description of depression as a psychoneuroimmunologic disorder.Mike Martin (Martin 2003) and Thomas Fuchs (Fuchs 2003) discuss important aspects of depression that I did not elaborate in my paper. Martin argues that I fail to distinguish between depression as a mood and depression as a disorder. This is pertinent to the distinction evolutionary psychiatrists draw between moods that are adaptive and moods that are maladaptive. In contrast to my negative characterization of depression, Martin also makes a case for the positive [End Page 265] contributions of depression to meaningful life. Fuchs explores the notion of the brain as an organ of translation enabling patients to have meaningful subjective experience. The emphasis on subjectivity has important implications for potential preventive and therapeutic interventions for depression. For whether a person perceives an external event as a stressor may play a crucial role in the physiologic stress response. I will address the main points of these two authors in turn.Contrary to what Martin claims, I explicitly defined chronic depression as an affective (mood) disorder. My focus was on the clinical definition of major depression as a moderately severe to severe chronic disorder. It consists of affective, cognitive, and even physical dysfunction that interferes with a person's ability to carry out the normal tasks of daily life. This characterization of major chronic depression distinguishes it from milder forms of depression, such as dysthymia. Because these milder forms do not involve the same type or degree of dysfunction as more severe forms, they are not appropriately characterized as pathologies. For this reason, I focused on Nesse's (2000) discussion of depression rather than on his discussion of low mood. In fairness to Nesse and Stevens and Price (2000), not all forms of depression are pathologic according to the evolutionary view they defend. Some passive aspects of mild depression may be useful in alerting us to dangerous or wasteful behavior. It does seem plausible to describe depressed moods as falling along a continuum from those that... (shrink)

Addiction poses a complex challenge in spite of all the progress made toward understanding and treating it. A multidisciplinary approach is needed and this paper attempts to integrate relevant neurobiological, behavioral, and subjective data under a common denominator described as a latent type of depression. It is called latent because it remains a silent syndrome due to two main reasons. The first one relates to the natural use of defenses against a predominant effect of chronic subjective pain, which (...) arises from an ambivalent type of separation distress that compromises opioid regulation (PANIC system). Furthermore, it provokes a neurochemical cascade that impacts several neuromodulatory systems. The second reason is that such chronic subjective pain usually exhausts the natural defensive system, frequently leading the person to look for other resources such as the neurochemical manipulation of psychic pain. Thus, both the use of defenses and of psychotoxic drugs make the underlying depression hard to assess, even for the very person suffering from it. The causes, course and treatment of this type of affective configuration are discussed in this paper as an attempt to explain some of the difficulties so far encountered and to contribute to potential alternative lines of treatment. (shrink)

This paper points to a more expansive conception of grief by arguing that the losses of illness can be genuine objects of grief. I argue for this by illuminating underappreciated structural features of typical grief — that is, grief over a bereavement — which are shared but under-recognized. I offer a common chronic illness, chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), as a striking case study. I then use this analysis to highlight some clinical challenges that arise should this claim (...) receive uptake in clinical practice. Extant literature on CFS/ME tells us that rates of comorbid depression are atypically high. If one accepts that people with CFS/ ME can grieve over losses associated with the condition, and that grief can be easily mistaken for depression in this context, this might suggest that rates of comorbid depression are inflated. I show, however, that the challenge of distinguishing between healthy and pathological grief arises in its place, and is just as tricky to solve. (shrink)

Major depressive disorder is a highly prevalent psychiatric disorder, and recurrent depression is associated with severe and chronic impairment. Identifying markers of risk is imperative to i...

Physiologically accurate mouse models of cancer are critical in the pre‐clinical development of novel cancer therapies. However, current standardized animal‐housing temperatures elicit chronic cold‐associated stress in mice, which is further increased in the presence of tumor. This cold‐stress significantly impacts experimental outcomes. Data from our lab and others suggest standard housing fundamentally alters murine physiology, and this can produce altered immune baselines in tumor and other disease models. Researchers may thus underestimate the efficacy of therapies that are benefitted by (...) immune responses. A potential mediator, norepinephrine, also underlies stress pathways common in mice and humans. Therefore, research into mechanisms connecting cold‐stress and norepinephrine signaling with immune depression in mice could highlight new combination therapies for humans to simultaneously target stress while stimulating anti‐tumor immunity. (shrink)

Pain is the single most common reason patients seek care in the emergency department. Given the prevalence of pain as a presenting complaint, one might expect emergency physicians to assign its treatment a high priority; however, pain is often seemingly invisible to the emergency physician. Multiple research studies have documented that the undertreatment of pain, or oligoanalgesia, is a frequent occurrence. Pain that is not acknowledged and managed appropriately causes dissatisfaction with medical care, hostility toward the physician, unscheduled returns to (...) the emergency department, delayed return to full function, and potentially, an increased risk of litigation. Failure to recognize and treat pain may result in anxiety, depression, sleep disturbances, increased oxygen demands with the potential for end organ ischemia, and decreased movement with an increased risk of venous thrombosis. (shrink)

We propose the “microbiota‐inflammasome” hypothesis of major depressive disorder (MDD, a mental illness affecting the way a person feels and thinks, characterized by long‐lasting feelings of sadness). We hypothesize that pathological shifts in gut microbiota composition (dysbiosis) caused by stress and gut conditions result in the upregulation of pro‐inflammatory pathways mediated by the Nod‐like receptors family pyrin domain containing 3 (NLRP3) inflammasome (an intracellular platform involved in the activation of inflammatory processes). This upregulation exacerbates depressive symptomatology and further compounds gut (...) dysbiosis. In this review we describe MDD/chronic stress‐induced changes in: 1) NLRP3 inflammasome; 2) gut microbiota; and 3) metabolic pathways; and how inflammasome signaling may affect depressive‐like behavior and gut microbiota composition. The implication is that novel therapeutic strategies could emerge for MDD and co‐morbid conditions. A number of testable predictions surface from this microbiota‐gut‐inflammasome‐brain hypothesis of MDD, using approaches that modulate gut microbiota composition via inflammasome modulation, fecal microbiota transplantation, psychobiotics supplementation, or dietary change. (shrink)

Major depressive disorder (MDD) is a severe mental illness that affects 5 to 20% of the general population. Current antidepressant drugs exerts only a partial clinical efficacy because approximately 30% of depressed patients failed to respond to these drugs and antidepressants produce remission only in 30% of patients. This can be explained by the fact that the complex pathophysiology of depression has not been completely elucidated, and treatments have been mainly developed following the “monoaminergic hypothesis” of depression without (...) considering the key role of other factors involved in the pathogenesis of MDD, such as the role of chronic stress and neuroinflammation. Chronic stress acts as a risk factor for the development of MDD through the impairment of neurotrophins signaling such as brain-derived neurotrophic factor (BDNF) and transforming-growth-factor-β1 (TGF-β1). Stress-induced depressive pathology contributes to altered BDNF level and function in MDD patients and, thereby, an impairment of neuroplasticity at the regional and circuit level. Recent studies demonstrate that aerobic exercise strongly increases BDNF production and it may contribute as a non-pharmacological strategy to improve the treatment of cognitive and affective symptoms in MDD. Here we will provide a general overview on the possible synergism between physical activity and antidepressants in MDD. Physical activity can synergize with antidepressant treatment by rescuing neurotrophin signaling in MDD patients, promoting neuronal health and recovery of function in MDD-related circuits, finally enhancing pharmacotherapeutic response. This synergism might be particularly relevant in elderly patients with late-life depression, a clinical subgroup with an increased risk to develop dementia. (shrink)

Research documents that many chronic non-malignant pain patients experience existential, spiritual and religious needs; however, research knowledge is missing on if and how physicians approach these needs. We conducted a systematic review to explore the extent to which physicians address these needs in their communication with chronic non-malignant pain patients and to explore the facilitators and challenges of this communication. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching Embase, Medline, Scopus and PsycINFO. The (...) quality of the included articles was assessed based on design-specific screening tools. We included four of 2337 screened articles and found the quality to be good. Physicians’ communication about existential, spiritual and religious needs was given low priority and depended on the patients’ own initiative, except when clinicians were interested in holistic care. Patient dissatisfaction with the physician’s attention to these needs was related to higher pain and depression. Physicians’ challenges for addressing these needs were their tendency to prioritize physiological aspects and close further elaboration of existential needs when addressed by the patients. The main facilitator was the individual physician’s willingness to listen with openness and empathy to the patients’ existential concerns. A tentative conclusion is that physicians rarely meet the existential, spiritual and religious needs of their chronic non-malignant pain patients. This might be due to higher priority of physical aspects, lack of time and a lack of knowledge about the importance of and training in the ability to address these needs. Further research is needed on physicians’ communication about existential, spiritual and religious needs and on their training in here. (shrink)

The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline score on the Montgomery–Asberg Depression Rating Scale. A subsample of 41 patients from an RCT was included. For each case, two sessions of brief inpatient psychodynamic psychotherapy were transcribed and then (...) coded using the Defense Mechanism Rating Scales and the Psychotic Defense Mechanism Rating Scales, an additional scale developed to study psychotic defenses. Results showed that defensive functioning and mature and immature defense changed during psychotherapy and predicted treatment response. Patient’s defenses observed throughout therapy also predicted treatment response at 12-month follow-up. The addition of psychotic defenses allows a better prediction of the treatment response. Overall, these results are in line with previous research and provide further validation of defensive functioning as a predictor of outcomes and a mechanism of change in psychotherapy. (shrink)

Background: Chinese Taoist cognitive therapy (CTCT), a culture-oriented psychological therapy for Chinese mental well-being, has been proposed for decades. However, the evidence for its effects is unclear. This study aimed to systematically assess the effect of this therapy on symptoms of depression and anxiety in Chinese adults. Methods: Relevant studies were searched from major electronic databases through November 2018 without language limits. Several search terms used include “anxiety” OR “depression” AND “Taoism” OR “Daoism” OR “Chinese Taoist Cognitive Therapy”. (...) A total of 11 clinical trials focusing on CTCT were included in this meta-analysis. Random-effects meta-analytical models were conducted. Heterogeneity and publication bias were also explored. Results: Eight clinical trials for 580 subjects were included. The majority of these studies explored samples with depressive symptoms. Overall, CTCT significantly reduced depressive symptoms with a small positive effect (SMD = 0.16, 95% CI: -0.36-0.68). Medium-to-large effect sizes were observed across individuals with clinical or nonclinical depression and chronic physical diseases (SMD = 0.70, 95%CI: 0.27-1.13 and SMD = 0.72, 95%CI: 0.09-1.35, respectively). However, the effectiveness for anxiety symptoms remains debatable. Conclusions: Our findings hold promise that CTCT can help reduce depressive symptoms in Chinese adults, including patients with chronic physical diseases and clinical or nonclinical depression. Our findings may be generalized to Chinese communities in other countries. (shrink)

As someone diagnosed with severe chronic mental illness early in my adolescence, I have spent over half of my life feeling out of step with the rest of the world due to hospitalizations, treatment programs, and the disruptions caused by anxiety, anorexia, depression, and obsessive–compulsive disorder. The effect of my mental health conditions compounded by these treatment environments means I often feel that I experience time passing differently, which results in sensations of removal and isolation from those around (...) me. The global shutdown caused by the COVID-19 pandemic seemed a way for normative bodies to experience the passing of time the way I always have. In this paper, I extend Dr. Sara Wasson’s analysis of the ways in which chronic pain resists narrative coherence to my own temporal experience of chronic mental illness, specifically my embodied experience of the pandemic. I use that embodied experience as a case study for examining how the reciprocal nature of time and narrativity, as outlined by Dr. Paul Ricoeur, can create isolation for those struggling with their temporality due to chronic mental illness. To acknowledge and grapple with the ramifications of discursive and material privilege involved in such situations, I include an analysis of Robert Desjarlais’s 1994 article “Struggling Along: The Possibilities for Experience among the Homeless Mentally Ill,” in which he investigates a similar phenomenon of being outside of structured sequential narrative time in the residents of a Boston shelter for the mentally ill. (shrink)

The transcription factor CREB has been implicated in signalling pathways relevant for pathogenesis and therapy of depression. CREB is upregulated and activated in the hippocampus by chronic antidepressant treatment, similarly as neurogenesis. Surprisingly, a recent study using CREB‐deficient mice also demonstrates an upregulation of neurogenesis correlating with an antidepressant behavioral phenotype.1 Interestingly, CREB‐deficient mice show a rapid behavioral response to antidepressants, while wild‐type mice do not. This minireview tries to reconcile these new findings with established concepts on CREB, (...) neurogenesis and depression. It also outlines some crucial experiments and lines of future research that could clarify some of the pending questions. BioEssays 29:957–961, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

The moment when a person’s actual relationships fall short of desired relationships is commonly identified as the etiological moment of chronic loneliness, which can lead to physical and psychological effects like depression, worse recovery from illness and increased mortality. But, this etiology fails to explain the nature and severe impact of loneliness. Here, we use philosophical analysis and neuroscience to show that human beings develop and maintain our world-picture (our sense of what is true, important, and good) through (...) joint attention and action, motivated by friendship, in the Aristotelian sense of “other selves” who share a sense of the true and the good, and desire the good for each other as much as for themselves. The true etiological event of loneliness is the moment one’s world-picture becomes unshared. The pathogenesis is a resultant decay of our world-picture, with brain and behavior changes following as sequelae. (shrink)

Chronic pain is of significant global concern. There is growing evidence that body–mind therapies and psychological approaches can contribute toward changing chronic pain perceptions. This is the first model described in the literature that combines a mindfulness-based approach with dance movement therapy and explores the potential psychological and pain-related changes for this client population. In this paper, the results from the pilot study are presented involving patients with chronic headache recruited in an outpatient rehabilitation setting.Methods: In this (...) pilot study, 29 patients with chronic headache were randomized to either the Mindful-Based Dance Movement Therapy group or the waiting list control group. The MBDMT group was offered 10 sessions in a clinical outpatient rehabilitation setting for 5 weeks. Data were collected pre- and post-intervention and 16 weeks after the intervention was finished. The Hospital Anxiety and Depression Scale, Patient Health Questionnaire−9, Five Facet Mindfulness Questionnaire, and Numeric Rating Scale were used as outcome measures.Results: The working model of MBDMT identifies nine therapeutic mechanisms. Per-protocol analysis reveals statistically significant reduction of pain intensity and depression scores in favor of the MBDMT group, and these improvements were maintained in the follow-up assessment.Conclusions: The results suggest that MBDMT is a feasible and promising therapy approach for chronic pain patients. The pilot study offered sufficient information and preliminary results in the desirable direction to enable the researchers to move to a randomized controlled trial stage in order to establish the efficacy of the intervention.Clinical Trial Registration: The study was registered in the www.researchregistry.com, registry. (shrink)

Chronic pain is associated with high levels of mental health issues and alterations in cognitive processing. Cognitive-behavioral models illustrate the role of memory alterations in the development and maintenance of chronic pain as well as in mental health disorders which frequently co-occur with chronic pain. This study aims to expand our understanding of specific cognitive mechanisms underlying chronic pain which may in turn shed light on cognitive processes underlying pain-related psychological distress. Individuals who reported a history (...) of chronic pain and individuals who reported no history of chronic pain were recruited from MTurk to complete an online survey including standardized measures of anxiety and depression and two sentence completion tasks that assessed autobiographical memory and future thinking specificity and content. Chi square analyses revealed that participants who endorsed experiencing chronic pain were significantly more likely to recall at least one painful and negative event and to imagine at least one anticipated painful event in their future. Two ANCOVAs were performed to examine the degree to which chronic pain endorsement influenced specificity in memory and future imagining. Individuals with a history of chronic pain and higher levels of depression symptom severity generated autobiographical memories with significantly less specificity; whereas, individuals with a history of chronic pain also generated future autobiographical events with significantly less specificity. In addition, individuals with a history of chronic pain were more likely to generate episodes related to pain when asked to recall the past or imagine the future. Further research is needed to improve our understanding of the etiology of autobiographical memory and future thinking specificity and content in the pathogenesis of mental health conditions in the context of chronic pain. (shrink)

The present study investigated relationships between counterfactual thinking, control motivation, and depression. Mildly depressed and nondepressed participants described negative life events that might happen again (repeatable event condition) or probably will not happen again (nonrepeatable event condition) and then made upward counterfactuals about these events. Compared to nondepressed participants, depressed participants made more counterfactuals about controllable than uncontrollable aspects of the events they described, and this effect was mediated by general control loss perceptions in the repeatable event condition. Making (...) more counterfactuals about controllable than uncontrollable aspects also enhanced retrospective control perceptions, but only in the repeatable event condition. Functional and dysfunctional implications of making counterfactuals about controllable features of events are discussed. (shrink)

Over 100 million Americans suffer from chronic pain, which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year. Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (...) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions. However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women with chronic musculoskeletal pain. Functional magnetic resonance imaging data were collected pre- and post-ACT, and changes in functional connectivity were measured using Network-Based Statistics. Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire, the Chronic Pain Acceptance Questionnaire, the Center for Epidemiologic Studies Depression Scale, and the NIH Toolbox Neuro-QoLTM scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection, emotion, and cognitive control. These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies. (shrink)

Since the Nuremberg trials (1947–1949), informed consent has become central for ethical practice in patient care and biomedical research. Codes of ethics emanating from the Nuremberg Code (1947) recognize the importance of protecting patients and research subjects from abuses, manipulation and deception. Informed consent empowers individuals to autonomously and voluntarily accept or reject participation in either clinical treatment or research. In some cases, however, the underlying mental or physical condition of the individual may alter his or her cognitive abilities and (...) compromise the informed consent process. This is particularly true in chronic psychiatric conditions such as Treatment-Resistant Depression (TRD), where individuals may fail to respond to traditional antidepressant treatments (e.g., psychotherapy, pharmacotherapy). Moreover, it may raise further concerns for an individual’s motivation to consent and the level of understanding of the treatment or research procedure. This paper focuses on the informed consent process for Vagus Nerve Stimulation (VNS) in the treatment of individuals diagnosed with TRD. Specifically, the paper addresses how depression may affect the decision-making capacity of an individual and the potential ethical and legal impact of failure to appreciate the seven elements of the consenting process (competence, voluntariness, disclosure, recommendation, understanding, decision, and authorization). To ensure the protection of vulnerable individuals with psychiatric disorders such as TRD and promote ethical behavior in biomedical research and patient care while avoiding potential legal pitfalls, we propose a paradigm that requires a stringent evaluation process of decision-making capacity for informed consent. (shrink)

BackgroundChronic airway diseases are prevalent and costly conditions. Interdisciplinary rehabilitation programs that include Acceptance and Commitment-based components could be important to tackle the vicious circle linking progression of the disease, inactivity, and psychopathological symptoms.MethodsA retrospective evaluation of routinely collected data of an interdisciplinary rehabilitation program was performed. The program included group sessions including patient education, breathing exercise, occupational therapy and an ACT-based psychological treatment, and individual sessions of physical therapy. Demographic data, clinical characteristics of the patients and the values of (...) outcome variables before treatment, at discharge, at 3 months, and at 6 months were extracted from medical records. Multiple imputation was employed to address missing data. Linear mixed models were employed to assess changes over time. Multivariable logistic regression was performed to assess predictors of a minimum clinically important change of health status from baseline to the 6-months follow-up.ResultsData from 31 patients with chronic obstructive pulmonary disease and 12 patients with bronchiectasis were extracted. Health status improved from baseline to discharge to the 3 months follow-up, but not to the 6 months follow-up. Anxiety and depression improved across all the time points. Quality of life did not improve over time. Having a worse health status at baseline and fewer depressive symptoms were significantly associated with achieving a minimum clinically important change of health status at 6 months. The effects of the interdisciplinary program were not different for patients with COPD or with bronchiectasis.DiscussionInterdisciplinary programs including ACT-based components are promising treatments for the rehabilitation of patients with chronic airway diseases. (shrink)

BackgroundThe Coronavirus 2019 outbreak has led to a considerable proportion of adverse psychological symptoms in different subpopulations. This study aimed to investigate the status of anxiety and depression and their associated factors in the adult, working-age population in Mainland China at the early remission stage of the COVID-19 pandemic.MethodsAn online study was conducted among 1,863 participants in 29 provinces in Mainland China from March 23 to 31, 2020. Their mental health was evaluated by the generalized anxiety disorder scale and (...) the patient health questionnaire. Descriptive analysis, Chi-square, and multiple logistic regressions were applied.ResultsAbout 44.5% of the participants had anxiety, 49.2% had depression, and 37.9% showed a combination of depression and anxiety. Around 83.7% of the participants claimed that the pandemic had a negative impact on their medical needs, which was the primary predictor of mental health, the degree of impact being positively related to the prevalence of anxiety and depression. More chronic diseases, moderate to bad self-rated health, severe perceived infection risk, and younger age group were the common risk factors for anxiety and depression. Having no children, unemployment, and a college-level educational background were associated with higher anxiety prevalence, whereas unmarried participants were correlated with higher depression prevalence.ConclusionThe working-age population showed a relatively high risk of anxiety and depression in Mainland China at the early remission stage of the pandemic. To improve medical services capacity for routine and delayed medical service needs should be a part of policy-makers’ priority agenda during this period of crisis. (shrink)

The World Health Organization, in its last review of its International Classification of Diseases, established a new classification for chronic pain. Among the principal categories, of particular interest is chronic primary pain as a new type of diagnosis in those cases in which the etiology of the disease is not clear, being termed as chronic primary visceral pain when it is situated in the thorax, abdomen, or pelvis. Due to the novelty of the term, the objective of (...) the systematic review was to examine the psychopathological and neuropsychological disorders associated with chronic primary visceral pain. We carried out a search of the scientific literature following the PRISMA directives using the Pubmed, Medline, PsycInfo and Scopus databases. A total of 33 articles were selected after applying the inclusion and exclusion criteria. The analysis of the studies showed that most persons with chronic primary visceral pain suffer from at least one psychological disorder; the most prevalent being anxiety, depressive or somatoform disorders. The most frequent psychopathological symptoms are anxiety, depression and somatization. Similarly, the findings are insufficient to determine the existence of deficits in the domains of executive functioning, memory and intelligence. However, the existence of attention biases does seem to be clear. This review supposes a starting point for conceptualizing chronic primary visceral pain. It is necessary to continue further research so as to obtain a better understanding of this pathology and the disorders associated. (shrink)