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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Sleep disturbance is a symptom of and a well-known risk factor for depression. Further, atypical functioning of the HPA axis has been linked to the pathogenesis of depression. The purpose of this study was to examine the role of adolescent HPA axis functioning in the link between adolescent sleep problems and later depressive symptoms. Methods: A sample of 157 17–18 year old adolescents (61.8% female) completed the Pittsburgh Sleep Quality Inventory (PSQI) and provided salivary cortisol samples throughout the day for three consecutive days. Two years later, adolescents reported their depressive symptoms via the Center for Epidemiological Studies Depression Scale (CES-D). Results: Individuals (age 17–18) with greater sleep disturbance reported greater depressive symptoms two years later (age 19–20). This association occurred through the indirect effect of sleep disturbance on the cortisol awakening response (CAR) (indirect effect = 0.14, 95%CI [.02 -.39]). Conclusions: One pathway through which sleep problems may lead to depressive symptoms is by up-regulating components of the body’s physiological stress response system that can be measured through the cortisol awakening response. Behavioral interventions that target sleep disturbance in adolescents may mitigate this neurobiological pathway to depression during this high-risk developmental phase.
In ‘Anselm and Actuality’, David Lewis argued that the assessment of Anselm’s ontological arguments is best achieved when the familiar modal expressions in which the arguments are typically formulated are translated into counterpart theory. I present Lewis’s fascinating translations of the ontological argument found in Anselm’s Proslogion II. Lewis’s formulations are interesting and ingenious, but not especially charitable. There are several better, and more credible, translations of Anselm’s argument into counterpart theory. The argument in revised translation is valid and its premises are all plausible – far more plausible than those offered in Lewis’s original translation. Some concluding remarks are offered in the final section.
To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines.
Design
Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol.
Setting
Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries.
Subjects
A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project.
Results
The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8–37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded).
Conclusions
Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group.
Family meals have been negatively associated with overweight in children, while television (TV) viewing during meals has been associated with a poorer diet. The aim of the present study was to assess the association of eating family breakfast and dinner, and having a TV on during dinner, with overweight in nine European countries and whether these associations differed between Northern and Southern & Eastern Europe.
Design
Cross-sectional data. Schoolchildren reported family meals and TV viewing. BMI was based on parental reports on height and weight of their children. Cut-off points for overweight by the International Obesity Task Force were used. Logistic regressions were performed adjusted by age, gender and parental education.
Setting
Schools in Northern European (Sweden, the Netherlands, Iceland, Germany and Finland) and Southern & Eastern European (Portugal, Greece, Bulgaria and Slovenia) countries, participating in the PRO GREENS project.
Subjects
Children aged 10–12 years in (n 6316).
Results
In the sample, 21 % of the children were overweight, from 35 % in Greece to 10 % in the Netherlands. Only a few associations were found between family meals and TV viewing during dinner with overweight in the nine countries. Northern European children, compared with other regions, were significantly more likely to be overweight if they had fewer family breakfasts and more often viewed TV during dinner.
Conclusions
The associations between family meals and TV viewing during dinner with overweight were few and showed significance only in Northern Europe. Differences in foods consumed during family meals and in health-related lifestyles between Northern and Southern & Eastern Europe may explain these discrepancies.
Much of recent moral philosophy has been concerned with the relation between individual rationality and individual obligation. Familiar gametheoretic analyses, in particular the Prisoner's Dilemma, at least suggest that unconstrained pursuit of rational self-interest leads to collective ill. The difficulty is nicely illustrated by comparing the preference-orderings of distinct individuals over the possible outcomes of their actions to their collective preference-ordering. Consider the following typical version of the Prisoner's Dilemma, where R2 and C2 represent respectively “R has confessed to the crime” and “C has confessed to the crime,” and Rl and Cl correspond to “It is not the case that R has confessed” and “It is not the case that C has confessed.”
Recent work in moral theory includes an intriguing new argument that the vagueness of moral properties, together with two well-known and well-received metaethical principles, entails the incredible conclusion that it is impossible to be moral. I show that the argument equivocates between “it is true that A and B are morally indistinguishable” and “it is not false that A and B are morally indistinguishable.” As expected the argument is interesting but unsound. It is therefore not impossible to be moral.
There is evidence that the prevalence of common mental disorders varies across Europe.
Aims
To compare prevalence of common mental disorders in general practice attendees in six European countries.
Method
Unselected attendees to general practices in the UK, Spain, Portugal, Slovenia, Estonia and The Netherlands were assessed for major depression, panic syndrome and other anxiety syndrome. Prevalence of DSM–IV major depression, other anxiety syndrome and panic syndrome was compared between the UK and other countries after taking account of differences in demographic factors and practice consultation rates.
Results
Prevalence was estimated in 2344 men and 4865 women. The highest prevalence for all disorders occurred in the UK and Spain, and lowest in Slovenia and The Netherlands. Men aged 30–50 and women aged 18–30 had the highest prevalence of major depression; men aged 40–60 had the highest prevalence of anxiety, and men and women aged 40–50 had the highest prevalence of panic syndrome. Demographic factors accounted for the variance between the UK and Spain but otherwise had little impact on the significance of observed country differences.
Conclusions
These results add to the evidence for real differences between European countries in prevalence of psychological disorders and show that the burden of care on general practitioners varies markedly between countries.
Property-identical divine-command theory (PDCT) is the view that being obligatory is identical to being commanded by God in just the way that being water is identical to being H2O. If these identity statements are true, then they express necessary a posteriori truths. PDCT has been defended in Robert M. Adams (1987) and William Alston (1990). More recently Mark C. Murphy (2002) has argued that property-identical divine-command theory is inconsistent with two well-known and well-received theses: the free-command thesis and the supervenience thesis. I show that Murphy's argument is vitiated by mistaken assumptions about the substitutivity of metaphysical identicals in contexts of supervenience. The free-command thesis and the supervenience thesis therefore pose no serious threat to PDCT.
The celebrated free-will defence was designed to show that the ideal-world thesis presents no challenge to theism. The ideal-world thesis states that, in any world in which God exists, He can actualize a world containing moral good and no moral evil. I consider an intriguing two-stage argument that Michael Bergmann advances for the free-will defence, and show that the argument provides atheologians with no reason to abandon the ideal-world thesis. I show next that the existence of worlds in which every essence is transworld untrustworthy provides atheologians with no better reason to abandon the ideal-world thesis. I conclude that neither the free-will defence nor Bergmann's revised free-will defence is a convincing response to the atheological challenge.
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