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1.
Despite advances in clinical trial design, failure rates near 80% in phase 2 and 50% in phase 3 have recently been reported. The challenges to successful drug development are particularly acute in central nervous system trials such as for pain, schizophrenia, mania, and depression because high‐placebo response rates lessen assay sensitivity, diminish estimated treatment effect sizes, and thereby decrease statistical power. This paper addresses the importance of rigorous patient selection in major depressive disorder trials through an enhanced enrichment paradigm. This approach led to a redefinition of an ongoing, blinded phase 3 trial algorithm for patient inclusion (1) to eliminate further randomization of transient placebo responders and (2) to exclude previously randomized transient responders from the primary analysis of the double blind phase of the trial. It is illustrated for a case study for the comparison between brexpiprazole + antidepressant therapy and placebo + antidepressant therapy. Analysis of the primary endpoint showed that efficacy of brexpiprazole versus placebo could not be established statistically if the original algorithm for identification of placebo responders was used, but the enhanced enrichment approach did statistically demonstrate efficacy. Additionally, the enhanced enrichment approach identified a target population with a clinically meaningful treatment effect. Through its successful identification of a target population, the innovative enhanced enrichment approach enabled the demonstration of a positive treatment effect in a very challenging area of depression research.  相似文献   
2.
The shared resource hypothesis suggests that married couples share the same environmental resources, which shape their health concordance. This study tests its cross‐national applicability. Cross‐sectional 2012–2013 Health and Retirement Study data from China, England, Mexico, and the United States were analyzed. Heterosexual couples (age ≥60) who were married or partnered were studied (N = 20,565 pairs). Dyadic data were analyzed by multilevel models to examine the effect of self and spousal social and physical health statuses on depressive symptoms. Regression models were used to test the relationship between couples' shared resources and depressive symptom concordance. Results indicated both husbands and wives' depressive symptoms were associated with their own and spouses' social and health statuses. Most couple‐level resources were insignificant predictors for Chinese and Mexican couples' concordance, but having more social and financial resources was associated with higher concordance among British and American couples. Self‐reported health was the most consistent predictor in all countries. The shared resource hypothesis was more applicable to depressive symptom concordance within couples in the United States and England, but not in China and Mexico. Couple‐centered intervention is suggested for clinical practice, and the spousal effect should be considered in policymaking.  相似文献   
3.
We examined the moderating roles of individualistic and collectivistic cultural orientations and academic achievement on the relation between Chinese adolescents’ shyness and depressive symptoms. A sample of Chinese adolescents (N = 492) from an urban school participated in the study during seventh (T1) and eighth (T2) grades. Adolescents self‐reported their shyness, cultural orientations, and depressive symptoms. The school provided records of their academic achievement. Concurrently, shyness and individualism were positively whereas collectivism and academic achievement were negatively, associated with adolescents’ depressive symptoms. Longitudinally, T1 shyness (but not individualism, collectivism, or academic achievement) predicted T2 depressive symptoms after controlling for stability in depressive symptoms. Concurrent relations between shyness and depressive symptoms were moderated by adolescents’ cultural orientations. Specifically, collectivism was protective whereas individualism was harmful, for shy adolescents’ adjustment. Furthermore, collectivism and academic achievement jointly moderated the relations between shyness and depressive symptoms concurrently and longitudinally. The results suggest that cultural orientations may influence shy adolescents’ depression symptoms through individual‐level self‐evaluation, and indicate that cultural factors and academic achievement need to be considered comprehensively for understanding and improving shy Chinese adolescents’ psychological adjustment.  相似文献   
4.
Research indicates belonging to a gay, lesbian, and bisexual (GLB) support group is indirectly associated with fewer depressive symptoms, via higher levels of sense of belonging to the general community. The current study extended this research by testing a path model to determine whether school, teacher, and peer connectedness are influenced by sense of belonging to a community GLB youth group. A sample of 82 Australian GLB adolescents aged 14 to 18 years who currently attend high school completed the Center for Epidemiologic Studies Depression Scale, the Psychological Subscale of the Sense of Belonging Instrument, and the Social Questionnaire for Secondary Students. Results indicated very good model fit. Higher levels of belonging to a community GLB youth group were associated with higher levels of school, teacher, and peer connectedness, but only peer connectedness was directly associated with depressive symptoms. Higher levels of school and teacher connectedness were associated with higher levels of peer connectedness. Interventions aimed at increasing belonging to a community GLB youth group may have indirect benefits for the mental health of GLB adolescents, via higher levels of school, teacher, and peer connectedness.  相似文献   
5.
Never before have public sector jobs been so threatened. Fear and anxiety have shifted their focus, from performance to survival. With reference to immediately contemporary works on the NHS in particular, such as Mandelstam (2011) and Leys and Player (2011), the paper establishes the factual validity of the crisis.

The authors conducted a series of workshops for public sector staff to enable them to explore their reactions to the current situation.

It is possible to identify increasing levels of denial and other forms of resistance to change similar to those first identified by Menzies' (1959). Drawing on the work of Bion (cited Obholzer & Roberts, 1994) the paper considers the dangers of a retreat to the paranoid schizoid position, and identifies a theoretical clue in Halton (2004) for turning the trauma of change into a creative opportunity.

Art has access to emotional, spiritual and creative facets of the human mind that science cannot explore. Klein's (1975) consideration of the infantile and regressive aspect of art is acknowledged. The paper then considers what is revealed by a study of specific works of art which were presented in the workshops; including paintings by Bosch, Rousseau, Breughel and Goya. The work of Zagier-Roberts (1998) and Winnicott (1971) is called upon to endorse the usefulness of such a playful collage of responses.

Art can be used to help people move through Kubler Ross' stages of bereavement (1997); not to acceptance but out of the paranoid schizoid position into the depressive position (Klein 1975). Revisiting the work of Halton (2004) and the concept of evolutionary creativity, a move on from the depressive position can begin. Collective validation can be affirmed through a rebooting of the essential public sector values while a radical turning away from organisational priorities, to face the service user, provides a more far reaching optimism than any envisaged by an essentially limited demand for modernisation.

In conclusion the paper considers the recent contributions of Dienst (2011) and Dumenil and Levy (2011) to advocate tactical resistance to the denigration of the public sphere.  相似文献   
6.
为了探讨大学新生心理健康状态的变化趋势及存在的问题,为学校心理健康工作提供指导,通过采用症状自评量表对四川某高校2006—2010年入学的大学新生24 425人心理健康状态进行了调查分析,发现2006—2010年新生心理健康状况随着时间的发展而变化,变化幅度较大;2008年入学新生在SCL-90量表的强迫、人际敏感、抑郁、焦虑、敌对、恐怖维度上的得分达到最高分;不同性别、不同专业、来自不同地区新生的心理健康状况随着时间的推移表现出不同的差异。  相似文献   
7.
The aim of this cross-sectional study was to investigate the mediational role of common dyadic coping in the links between depressive mood and relationship satisfaction. We estimated two competing Actor–Partner Mediator Models, in which the dyad is the highest unit of analysis. The first model specified dyadic coping as a mediator in the association between relationship satisfaction and depression, whereas the second model specified dyadic coping as a mediator between depression and relationship satisfaction. Analyzing data from 198 couples, our findings provided a plausible approximation of the second model, representing the interactional model of depression. They showed that common dyadic coping mediates the link between depression and relationship satisfaction for men only.  相似文献   
8.
Consider the situation where measurements are taken at two different times and let Mj(x) be some conditional robust measure of location associated with the random variable Y at time j, given that some covariate X=x. The goal is to test H0: M1(x)=M2(x) for each xx1,?…?, xK such that the probability of one or more Type I errors is less than α, where x1,?…?, xK are K specified values of the covariate. The paper reports simulation results comparing two methods aimed at accomplishing this goal without specifying some parametric form for the regression line. The first method is based on a simple modification of the method in Wilcox [Introduction to robust estimation and hypothesis testing. 3rd ed. San Diego, CA: Academic Press; 2012, Section 11.11.1]. The main result here is that the second method, which has never been studied, can have higher power, sometimes substantially so. Data from the Well Elderly 2 study, which motivated this paper, are used to illustrate that the alternative approach can make a practical difference. Here, the estimate of Mj(x) is based in part on either a 20% trimmed mean or the Harrell–Davis quantile estimator, but in principle the more successful method can be used with any robust location estimator.  相似文献   
9.
Married Vietnamese immigrant women often face multiple stressors related to sociocultural adaptation and new family lives in South Korea. The purpose of this paper is to identify the different influences of acculturative and family life stress on depressive symptoms among Vietnamese immigrant wives. Data were collected through a questionnaire survey of 301 married Vietnamese immigrant women residing in South Korea. The study utilized linear regression analysis to test the relationships between the variables. The findings show that both acculturative and family life stress are positively related to depressive symptoms. Family life stress influences depressive symptoms to a greater extent than acculturative stress. The study emphasizes the significance of family‐related stress on mental health among married Vietnamese immigrant women in Korea and provides some implications for research, clinical practice, and policy.  相似文献   
10.
“90后”大学生心理健康状况研究   总被引:4,自引:0,他引:4  
目的:了解1990年之后出生的大学生心理健康发展水平及其影响因素,为进行心理健康教育提供依据。方法:采用整群抽样的方法,抽取了湖北省3所不同类型的高校4 792名各层次、各科别的"90后"大学生作为研究对象,采用自填式问卷调查的方式,症状自评量表SCL-90作为研究工具。结果:"90后"大学生在强迫和人际关系两个因子上,出现中度及以上问题的学生阳性检出率较高。和国内大学生常模比较,在强迫、焦虑、恐怖、偏执这4个因子得分上显著高于国内大学生常模。艺术类学生比理工类、文法经管类学生心理健康水平高。在抑郁、敌对、恐怖、偏执4个因子上男女大学生存在显著性差异。在高考录取批次上,"90后"专科生心理问题突出,本科生、高职高专、自考生心理状态相对良好。结论:湖北省高校"90后"大学生群体心理健康状况不容乐观,并在强迫、焦虑等问题上比较突出,应有针对性地实施心理健康教育。  相似文献   
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