Review Article
The efficacy of non-invasive, non-convulsive electrical neuromodulation on depression, anxiety and sleep disturbance: a systematic review and meta-analysis
- Ying-Chih Cheng, Po-Hsiu Kuo, Min-I Su, Wei-Lieh Huang
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- Published online by Cambridge University Press:
- 02 February 2022, pp. 801-812
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The effects of non-invasive, non-convulsive electrical neuromodulation (NINCEN) on depression, anxiety and sleep disturbance are inconsistent in different studies. Previous meta-analyses on transcranial direct current stimulation (tDCS) and cerebral electrotherapy stimulation (CES) suggested that these methods are effective on depression. However, not all types of NINECN were included; results on anxiety and sleep disturbance were lacking and the influence of different populations and treatment parameters was not completely analyzed. We searched PubMed, Embase, PsycInfo, PsycArticles and CINAHL before March 2021 and included published randomized clinical trials of all types of NINCEN for symptoms of depression, anxiety and sleep in clinical and non-clinical populations. Data were pooled using a random-effects model. The main outcome was change in the severity of depressive symptoms after NINCEN treatment. A total of 58 studies on NINCEN were included in the meta-analysis. Active tDCS showed a significant effect on depressive symptoms (Hedges' g = 0.544), anxiety (Hedges' g = 0.667) and response rate (odds ratio = 1.9594) compared to sham control. CES also had a significant effect on depression (Hedges' g = 0.654) and anxiety (Hedges' g = 0.711). For all types of NINCEN, active stimulation was significantly effective on depression, anxiety, sleep efficiency, sleep latency, total sleep time, etc. Our results showed that tDCS has significant effects on both depression and anxiety and that these effects are robust for different populations and treatment parameters. The rational expectation of the tDCS effect is ‘response’ rather than ‘remission’. CES also is effective for depression and anxiety, especially in patients with disorders of low severity.
Original Article
The trait and state negative affect can be separately predicted by stable and variable resting-state functional connectivity
- Yu Li, Kaixiang Zhuang, Zili Yi, Dongtao Wei, Jiangzhou Sun, Jiang Qiu
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- Published online by Cambridge University Press:
- 13 July 2020, pp. 813-823
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Background
Many emotional experiences such as anxiety and depression are influenced by negative affect (NA). NA has both trait and state features, which play different roles in physiological and mental health. Attending to NA common to various emotional experiences and their trait-state features might help deepen the understanding of the shared foundation of related emotional disorders.
MethodsThe principal component of five measures was calculated to indicate individuals' NA level. Applying the connectivity-based correlation analysis, we first identified resting-state functional connectives (FCs) relating to NA in sample 1 (n = 367), which were validated through an independent sample (n = 232; sample 2). Next, based on the variability of FCs across large timescale, we further divided the NA-related FCs into high- and low-variability groups. Finally, FCs in different variability groups were separately applied to predict individuals' neuroticism level (which is assumed to be the core trait-related factor underlying NA), and the change of NA level (which represents the state-related fluctuation of NA).
ResultsThe low-variability FCs were primarily within the default mode network (DMN) and between the DMN and dorsal attention network/sensory system and significantly predicted trait rather than state NA. The high-variability FCs were primarily between the DMN and ventral attention network, the fronto-parietal network and DMN/sensory system, and significantly predicted the change of NA level.
ConclusionsThe trait and state NA can be separately predicted by stable and variable spontaneous FCs with different attentional processes and emotion regulatory mechanisms, which could deepen our understanding of NA.
Emotional distress in young adults during the COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study
- Lilly Shanahan, Annekatrin Steinhoff, Laura Bechtiger, Aja L. Murray, Amy Nivette, Urs Hepp, Denis Ribeaud, Manuel Eisner
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- Published online by Cambridge University Press:
- 23 June 2020, pp. 824-833
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Background
The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown could be considered a ‘perfect storm’ for increases in emotional distress. Such increases can only be identified by studies that use data collected before and during the pandemic. Longitudinal data are also needed to examine (1) the roles of previous distress and stressors in emotional distress during the pandemic and (2) how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress is accounted for.
MethodsData came from a cohort study (N = 768). Emotional distress (perceived stress, internalizing symptoms, and anger), COVID-19-related stressors, and coping strategies were measured during the pandemic/lockdown when participants were aged 22. Previous distress and stressors were measured before COVID-19 (at age 20).
ResultsOn average, participants showed increased levels of perceived stress and anger (but not internalizing symptoms) during the pandemic compared to before. Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-pandemic economic and psychosocial stressors (e.g. lifestyle and economic disruptions) and hopelessness, and pre-pandemic social stressors (e.g. bullying victimization and stressful life events). Most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress in final models. Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing.
ConclusionsIn our community sample, pre-pandemic distress, secondary consequences of the pandemic (e.g. lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults' emotional distress than COVID-19-related health risk exposures.
Altered brain structural and functional connectivity in schizotypy
- Yong-ming Wang, Xin-lu Cai, Rui-ting Zhang, Yi-jing Zhang, Han-yu Zhou, Yi Wang, Ya Wang, Jia Huang, Yan-yu Wang, Eric F. C. Cheung, Raymond C. K. Chan
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- Published online by Cambridge University Press:
- 17 July 2020, pp. 834-843
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Background
Schizotypy refers to schizophrenia-like traits below the clinical threshold in the general population. The pathological development of schizophrenia has been postulated to evolve from the initial coexistence of ‘brain disconnection’ and ‘brain connectivity compensation’ to ‘brain connectivity decompensation’.
MethodsIn this study, we examined the brain connectivity changes associated with schizotypy by combining brain white matter structural connectivity, static and dynamic functional connectivity analysis of diffusion tensor imaging data and resting-state functional magnetic resonance imaging data. A total of 87 participants with a high level of schizotypal traits and 122 control participants completed the experiment. Group differences in whole-brain white matter structural connectivity probability, static mean functional connectivity strength, dynamic functional connectivity variability and stability among 264 brain sub-regions of interests were investigated.
ResultsWe found that individuals with high schizotypy exhibited increased structural connectivity probability within the task control network and within the default mode network; increased variability and decreased stability of functional connectivity within the default mode network and between the auditory network and the subcortical network; and decreased static mean functional connectivity strength mainly associated with the sensorimotor network, the default mode network and the task control network.
ConclusionsThese findings highlight the specific changes in brain connectivity associated with schizotypy and indicate that both decompensatory and compensatory changes in structural connectivity within the default mode network and the task control network in the context of whole-brain functional disconnection may be an important neurobiological correlate in individuals with high schizotypy.
Dorsolateral prefrontal cortex and amygdala function during cognitive reappraisal predicts weight restoration and emotion regulation impairment in anorexia nervosa
- Trevor Steward, Ignacio Martínez-Zalacaín, Gemma Mestre-Bach, Isabel Sánchez, Nadine Riesco, Susana Jiménez-Murcia, Jose A Fernández-Formoso, Misericordia Veciana de las Heras, Nuria Custal, Jose M Menchón, Carles Soriano-Mas, Fernando Fernandez-Aranda
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- 23 July 2020, pp. 844-852
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Background
Although deficits in affective processing are a core component of anorexia nervosa (AN), we lack a detailed characterization of the neurobiological underpinnings of emotion regulation impairment in AN. Moreover, it remains unclear whether these neural correlates scale with clinical outcomes.
MethodsWe investigated the neural correlates of negative emotion regulation in a sample of young women receiving day-hospital treatment for AN (n = 21) and healthy controls (n = 21). We aimed to determine whether aberrant brain activation patterns during emotion regulation predicted weight gain following treatment in AN patients and were linked to AN severity. To achieve this, participants completed a cognitive reappraisal paradigm during functional magnetic resonance imaging. Skin conductance response, as well as subjective distress ratings, were recorded to corroborate task engagement.
ResultsCompared to controls, patients with AN showed reduced activation in the dorsolateral prefrontal cortex (dlPFC) during cognitive reappraisal [pFWE<0.05, threshold-free cluster enhancement (TFCE) corrected]. Importantly, psycho–physiological interaction analysis revealed reduced functional connectivity between the dlPFC and the amygdala in AN patients during emotion regulation (pFWE<0.05, TFCE corrected), and dlPFC-amygdala uncoupling was associated with emotion regulation deficits (r = −0.511, p = 0.018) and eating disorder severity (r = −0.565, p = .008) in the AN group. Finally, dlPFC activity positively correlated with increases in body mass index (r = 0.471, p = 0.042) and in body fat mass percentage (r = 0.605, p = 0.008) following 12 weeks of treatment.
ConclusionsTaken together, our findings indicate that individuals with AN present altered fronto-amygdalar response during cognitive reappraisal and that this response may serve as a predictor of response to treatment and be linked to clinical severity.
Inhibitory control of positive and negative information and adolescent depressive symptoms: a population-based cohort study
- Gemma Lewis, Katherine S. Button, Rebecca M. Pearson, Marcus R. Munafò, Glyn Lewis
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- 17 July 2020, pp. 853-863
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Background
Large population-based cohort studies of neuropsychological factors that characterise or precede depressive symptoms are rare. Most studies use small case-control or cross-sectional designs, which may cause selection bias and cannot test temporality. In a large UK population-based cohort, we investigated cross-sectional and longitudinal associations between inhibitory control of positive and negative information and adolescent depressive symptoms.
MethodsCohort study of 2328 UK adolescents who completed an affective go/no-go task at age 18. Depressive symptoms were assessed with the Clinical Interview Schedule Revised (CIS-R) and short Mood and Feeling Questionnaire (sMFQ) at age 18, and with the sMFQ 1 year later (age 19). Analyses were multilevel and traditional linear regressions, before and after adjusting for confounders.
ResultsCross-sectionally, we found little evidence that adolescents with more depressive symptoms made more inhibitory control errors [after adjustments, errors increased by 0.04% per 1 s.d. increase in sMFQ score (95% confidence interval 0.02–0.06)], but this association was not observed for the CIS-R. There was no evidence for an influence of valence. Longitudinally, there was no evidence that reduced inhibitory control was associated with future depressive symptoms.
ConclusionsInhibitory control of positive and negative information does not appear to be a marker of current or future depressive symptoms in adolescents and would not be a useful target in interventions to prevent adolescent depression. Our lack of convincing evidence for associations with depressive symptoms suggests that the affective go/no-go task is not a promising candidate for future neuroimaging studies of adolescent depression.
Self-compassion and dorsolateral prefrontal cortex activity during sad self-face recognition in depressed adolescents
- Guanmin Liu, Na Zhang, Jia Yuan Teoh, Christine Egan, Thomas A. Zeffiro, Richard J. Davidson, Karina Quevedo
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- 23 July 2020, pp. 864-873
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Background
Given the prevalence of adolescent depression and the modest effects of current treatments, research ought to inform development of effective intervention strategies. Self-compassion is inversely associated with depression, and self-compassion interventions have demonstrated promising effects on reducing depression. However, little is known about the neural mechanisms underlying that relationship. Maladaptive self-processing is a characteristic of depression that contributes to the onset and chronicity of depression. Because our own face is an automatic and direct cue for self-processing, this study investigated whether self-compassion was associated with neural responses during sad v. neutral self-face recognition and explore their relationship with depression severity in depressed adolescents and healthy controls (HCs).
MethodsDuring functional magnetic resonance imaging, 81 depressed youth and 37 HCs were instructed to identify whether morphed self or other faces with sad, happy, or neutral expressions resembled their own.
ResultsSelf-compassion correlated negatively with activity during sad v. neutral self-face recognition in the dorsal anterior cingulate cortex in the total sample, and in the right posterior cingulate cortex/precuneus in HCs, respectively. In depressed adolescents, higher self-compassion correlated with lower activity during sad v. neutral self-face recognition in the right dorsolateral prefrontal cortex (DLPFC), implying that less cognitive effort might be needed to avoid dwelling on sad self-faces and/or regulate negative affect induced by them. Moreover, higher self-compassion mediated the relationship between lower DLPFC activity and reduced depression severity.
ConclusionsOur findings imply that DLPFC activity might be a biological marker of a successful self-compassion intervention as potential treatment for adolescent depression.
Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial
- Rayane Chami, Valentina Cardi, Natalia Lawrence, Pamela MacDonald, Katie Rowlands, John Hodsoll, Janet Treasure
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- Published online by Cambridge University Press:
- 27 July 2020, pp. 874-883
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Background
This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology.
MethodsSeventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for 4 weeks.
ResultsRecruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable.
ConclusionsThe study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.
The psychological impact of COVID-19 pandemic on medical staff in Guangdong, China: a cross-sectional study
- Huajun Wang, Daozheng Huang, Huigen Huang, Jihui Zhang, Lan Guo, Yuting Liu, Huan Ma, Qingshan Geng
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- Published online by Cambridge University Press:
- 06 July 2020, pp. 884-892
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Background
During previous pandemic outbreaks, medical staff have reported high levels of psychological distress. The aim of the current study was to report a snapshot of the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic and its correlated factors on medical staff in Guangdong, China.
MethodsOn the 2nd and 3rd February 2020, soon after the start of the COVID-19 pandemic, we surveyed medical staff at four hospitals in Guangdong, China, to collect demographic characteristics, Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-14), and Insomnia Severity Index (ISI) scores.
ResultsComplete responses were received from 1045 medical staff. Respondents were divided into high- and low-risk groups according to their working environment of contacting with potential or confirmed COVID-19 cases. The proportion of staff with anxiety (55.4% v. 43.0%, p < 0.001) or depression (43.6% v. 36.8%, p = 0.028) was significantly higher in the high-risk group than the low-risk group. The percentage of staff with severe anxiety was similar in the two groups. Doctors were more susceptible to moderate-to-severe depressive symptoms. The high-risk group had higher levels of clinical insomnia (13.5% v. 8.5%, p = 0.011) and were more likely to be in the upper quartile for stress symptoms (24.7% v. 19.3%, p = 0.037) than the low-risk group. Additionally, work experience negatively correlated with insomnia symptoms.
ConclusionsIt is important for hospitals and authorities to protect both the physical and psychological health of medical staff during times of pandemic, even those with a low exposure risk.
A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets
- C. J. Brush, Greg Hajcak, Anthony J. Bocchine, Andrew A. Ude, Kristina M. Muniz, Dan Foti, Brandon L. Alderman
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- 24 August 2020, pp. 893-903
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Background
Aerobic exercise has demonstrated antidepressant efficacy among adults with major depression. There is a poor understanding of the neural mechanisms associated with these effects. Deficits in reward processing and cognitive control may be two candidate targets and predictors of treatment outcome to exercise in depression.
MethodsSixty-six young adults aged 20.23 years (s.d. = 2.39) with major depression were randomized to 8 weeks of moderate-intensity aerobic exercise (n = 35) or light stretching (n = 31). Depressive symptoms were assessed across the intervention to track symptom reduction. Reward processing [reward positivity (RewP)] and cognitive control [error-related negativity (ERN)] were assessed before and after the intervention using event-related brain potentials.
ResultsCompared to stretching, aerobic exercise resulted in greater symptom reduction (gs = 0.66). Aerobic exercise had no impact on the RewP (gav = 0.08) or ERN (gav = 0.21). In the aerobic exercise group, individuals with a larger pre-treatment RewP [odds ratio (OR) = 1.45] and increased baseline depressive symptom severity (OR = 1.18) were more likely to respond to an aerobic exercise program. Pre-treatment ERN did not predict response (OR = 0.74).
ConclusionsAerobic exercise is effective in alleviating depressive symptoms in adults with major depression, particularly for those with increased depressive symptom severity and a larger RewP at baseline. Although aerobic exercise did not modify the RewP or ERN, there is preliminary support for the utility of the RewP in predicting who is most likely to respond to exercise as a treatment for depression.
Computational modelling of attentional selectivity in depression reveals perceptual deficits
- James A. Grange, Michelle Rydon-Grange
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- Published online by Cambridge University Press:
- 27 July 2020, pp. 904-913
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Background
Depression is associated with broad deficits in cognitive control, including in visual selective attention tasks such as the flanker task. Previous computational modelling of depression and flanker task performance showed reduced pre-potent response bias and reduced executive control efficiency in depression. In the current study, we applied two computational models that account for the full dynamics of attentional selectivity.
MethodAcross three large-scale online experiments (one exploratory experiment followed by two confirmatory – and pre-registered – experiments; total N = 923), we measured attentional selectivity via the flanker task and obtained measures of depression symptomology as well as anhedonia. We then fit two computational models that account for the dynamics of attentional selectivity: The dual-stage two-phase model, and the shrinking spotlight (SSP) model.
ResultsNo behavioural measures were related to depression symptomology or anhedonia. However, a parameter of the SSP model that indexes the strength of perceptual input was consistently negatively associated with the magnitude of depression symptomatology.
ConclusionsThe findings provide evidence for deficits in perceptual representations in depression. We discuss the implications of this in relation to the hypothesis that perceptual deficits potentially exacerbate control deficits in depression.
The incidence of non-affective psychotic disorders in Chile between 2005 and 2018: results from a national register of over 30 000 cases
- Alfonso González-Valderrama, Hannah E. Jongsma, Cristián Mena, Carmen Paz Castañeda, Rubén Nachar, Juan Undurraga, Nicolás Crossley, David Aceituno, Barbara Iruretagoyena, Carlos Gallardo, Pilar Mondaca, Matías Monje, Matías Irarrazaval, Cynthia Zavala, Lucia Valmaggia, James B. Kirkbride
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- Published online by Cambridge University Press:
- 06 August 2020, pp. 914-923
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Background
Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time.
MethodsWe used national register data from Chile including all people, 10–65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20–F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest.
ResultsWe identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18–39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7–19.1]. Multilevel Poisson regression identified a strong age–sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0–59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4–30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed.
ConclusionOur findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent.
Integrative omics analysis identifies differential biological pathways that are associated with regional grey matter volume changes in major depressive disorder
- Zhiqiang Sha, Layla Banihashemi
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- Published online by Cambridge University Press:
- 29 July 2020, pp. 924-935
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Background
Major depressive disorder (MDD) is accompanied by alterations in grey matter volume. However, the biological processes associated with regional structural perturbations remain elusive.
MethodsWe applied integrative omics analysis to investigate specialized transcriptome signatures and translational determinants associated with regional grey matter variations in 2737 MDD patients relative to 3098 controls by summarizing the results from gene co-expression network analysis of Allen human brain transcriptome profiles in six donors, enrichment analysis of gene-sets and cellular structure from rodents and mediation analysis of BrainSpan proteome profile in six donors.
ResultsWe found convergent alterations of grey matter volume in MDD were associated with transcriptome profiles enriched for synaptic transmission, metabolism, immune processes and transmembrane transport. Genes with abnormal expression in post-mortem tissue in MDD were also associated with transcriptome signatures. Further gene co-expression network and enrichment analysis of MDD-related genes in these signatures revealed the modules with higher neuronal expression were enriched in the medial temporal cortex and temporo-parietal junction with genes differentially associated with neuronal development and metabolism. Also, the modules with higher non-neuronal (e.g. astrocyte and oligodendrocyte) expression were concentrated in the rostral and dorsal anterior cingulate cortex and were separately associated with immune response and transmembrane transport. Moreover, proteins as the gene expression products mediated the association between transcriptome signatures and brain volume changes in the visual and dorsolateral prefrontal cortex.
ConclusionsOur multidimensional analyses offer a novel approach to detect specific biological pathways that capture regional structural variations in MDD, which suggests structural endophenotypes associated with MDD.
Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: rates, trends and an inverse relationship between the two indicators
- Mathias Siebenförcher, Francesco D. Fritz, Matías Irarrázaval, Andrés Benavides Salcedo, Corinne Dedik, Ana Fresán Orellana, Alejandro Herrera Ramos, J. Nicolás Ivan Martínez-López, Carla Molina, Fany Alejandra Rivas Gomez, Guillermo Rivera, Ignacio Sandia Saldivia, Julio Torales, Natalia Trujillo Orrego, Andreas Heinz, Adrian P. Mundt
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- 10 August 2020, pp. 936-945
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Background
In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America.
MethodsWe searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela.
ResultsThe number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006).
ConclusionsImportant numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.
Secular trends in the incidence of eating disorders in China from 1990 to 2017: a joinpoint and age–period–cohort analysis
- Jiayuan Wu, Zhixiong Lin, Zhou Liu, Hairong He, Ling Bai, Jun Lyu
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- Published online by Cambridge University Press:
- 03 August 2020, pp. 946-956
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Background
Eating disorders (ED) have increasingly become a global topic of concern for public health. A better understanding of ED incidence is a basic requirement for improving its management. However, the temporal trend of ED incidence in China is still unknown.
MethodsThe incidence rates of ED from 1990 to 2017 were collected from the Global Burden of Disease Study 2017 database according to the following: subtype, i.e. anorexia nervosa (AN) and bulimia nervosa (BN); sex; and age group. The average annual percent changes and relative risks were calculated using joinpoint regression and the age–period–cohort model, respectively.
ResultsFrom 1990 to 2017, age-standardized incidence rates of ED continued to increase in males and females, and this variation trend was observed in AN and BN. Joinpoint regression analysis showed that the incidence rates increased in all age groups. Adolescents had the highest risk of developing ED, followed by young adults. Age effects were the most influential risk factor for ED incidence. Period effects showed that the risk of developing ED continuously increased with increasing time periods in BN, but not in ED and AN. Concerning the cohort effects, people born after the 1990s presented a higher risk of ED, though they presented a lower risk of BN as compared to the whole cohort.
ConclusionsED incidence rates continue to increase in China, particularly among adolescents and young adults. Further etiological studies are needed to explain these increases and to facilitate the early identification of high-risk individuals.
Deep learning-based classification of posttraumatic stress disorder and depression following trauma utilizing visual and auditory markers of arousal and mood
- Katharina Schultebraucks, Vijay Yadav, Arieh Y. Shalev, George A. Bonanno, Isaac R. Galatzer-Levy
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- Published online by Cambridge University Press:
- 03 August 2020, pp. 957-967
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Background
Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).
MethodsN = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.
ResultsBoth video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).
ConclusionsDirect clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.
Genetic correlation, pleiotropy, and causal associations between substance use and psychiatric disorder
- Seon-Kyeong Jang, Gretchen Saunders, MengZhen Liu, 23andMe Research Team, Yu Jiang, Dajiang J. Liu, Scott Vrieze
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- Published online by Cambridge University Press:
- 07 August 2020, pp. 968-978
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Background
Substance use occurs at a high rate in persons with a psychiatric disorder. Genetically informative studies have the potential to elucidate the etiology of these phenomena. Recent developments in genome-wide association studies (GWAS) allow new avenues of investigation.
MethodUsing results of GWAS meta-analyses, we performed a factor analysis of the genetic correlation structure, a genome-wide search of shared loci, and causally informative tests for six substance use phenotypes (four smoking, one alcohol, and one cannabis use) and five psychiatric disorders (ADHD, anorexia, depression, bipolar disorder, and schizophrenia).
ResultsTwo correlated externalizing and internalizing/psychosis factor were found, although model fit was beneath conventional standards. Of 458 loci reported in previous univariate GWAS of substance use and psychiatric disorders, about 50% (230 loci) were pleiotropic with additional 111 pleiotropic loci not reported from past GWAS. Of the 341 pleiotropic loci, 152 were associated with both substance use and psychiatric disorders, implicating neurodevelopment, cell morphogenesis, biological adhesion pathways, and enrichment in 13 different brain tissues. Seventy-five and 114 pleiotropic loci were specific to either psychiatric disorders or substance use phenotypes, implicating neuronal signaling pathway and clathrin-binding functions/structures, respectively. No consistent evidence for phenotypic causation was found across different Mendelian randomization methods.
ConclusionsGenetic etiology of substance use and psychiatric disorders is highly pleiotropic and involves shared neurodevelopmental path, neurotransmission, and intracellular trafficking. In aggregate, the patterns are not consistent with vertical pleiotropy, more likely reflecting horizontal pleiotropy or more complex forms of phenotypic causation.
Childhood maltreatment and disordered gambling in adulthood: disentangling causal and familial influences
- Genevieve F. Dash, Nicholas G. Martin, Wendy S. Slutske
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- Published online by Cambridge University Press:
- 03 August 2020, pp. 979-988
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Background
Despite abundant research on the potential causal influence of childhood maltreatment (CM) on psychological maladaptation in adulthood, almost none has implemented the discordant twin design as a means of examining the role of such experiences in later disordered gambling (DG) while accounting for genetic and family environmental confounds. The present study implemented such an approach to disentangle the potential causal and familial factors that may account for the association between CM and DG.
MethodsParticipants were 3750 twins from the Australian Twin Registry [Mage = 37.60 (s.d. = 2.31); 58% female]. CM and DG were assessed separately via two semi-structured telephone interviews. Random-intercept generalized linear mixed models were fit to the data; zygosity, sex, educational attainment, childhood psychiatric disorder, adult antisocial behavior, and alcohol use disorder (AUD) were included as covariates.
ResultsNeither quasi-causal nor familial effects of CM predicted DG after adjusting for covariates. Educational attainment appeared to reduce the risk of DG while AUD appeared to increase risk; evidence also emerged for familial effects of antisocial behavior on DG. Post-hoc analyses revealed a familial effect of CM on antisocial behavior, indicating that the association between CM and DG identified in unadjusted models and in prior studies may be accounted for by genetic and shared family environmental effects of antisociality.
ConclusionsThese findings add to the meager literature showing that CM does not exert a causal effect on DG, and present novel evidence that familial effects of antisocial behavior may account for the association between CM and DG identified in extant non-twin research.
Heritable anisotropy associated with cognitive impairments among patients with schizophrenia and their non-psychotic relatives in multiplex families
- K. M. Prasad, J. Gertler, S. Tollefson, J. A. Wood, D. Roalf, R. C. Gur, R. E. Gur, L. Almasy, M. F. Pogue-Geile, V. L. Nimgaonkar
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- Published online by Cambridge University Press:
- 03 September 2020, pp. 989-1000
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Background
To test the functional implications of impaired white matter (WM) connectivity among patients with schizophrenia and their relatives, we examined the heritability of fractional anisotropy (FA) measured on diffusion tensor imaging data acquired in Pittsburgh and Philadelphia, and its association with cognitive performance in a unique sample of 175 multigenerational non-psychotic relatives of 23 multiplex schizophrenia families and 240 unrelated controls (total = 438).
MethodsWe examined polygenic inheritance (h2r) of FA in 24 WM tracts bilaterally, and also pleiotropy to test whether heritability of FA in multiple WM tracts is secondary to genetic correlation among tracts using the Sequential Oligogenic Linkage Analysis Routines. Partial correlation tests examined the correlation of FA with performance on eight cognitive domains on the Penn Computerized Neurocognitive Battery, controlling for age, sex, site and mother's education, followed by multiple comparison corrections.
ResultsSignificant total additive genetic heritability of FA was observed in all three-categories of WM tracts (association, commissural and projection fibers), in total 33/48 tracts. There were significant genetic correlations in 40% of tracts. Diagnostic group main effects were observed only in tracts with significantly heritable FA. Correlation of FA with neurocognitive impairments was observed mainly in heritable tracts.
Conclusions:Our data show significant heritability of all three-types of tracts among relatives of schizophrenia. Significant heritability of FA of multiple tracts was not entirely due to genetic correlations among the tracts. Diagnostic group main effect and correlation with neurocognitive performance were mainly restricted to tracts with heritable FA suggesting shared genetic effects on these traits.
Front Cover (OFC, IFC) and matter
PSM volume 52 issue 5 Cover and Front matter
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- Published online by Cambridge University Press:
- 07 April 2022, pp. f1-f2
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