Severe premenstrual syndrome and bipolar disorder: a tragic confusion

Bipolar disorder and severe premenstrual syndrome (PMS) have many symptoms in common, but it is important to establish the correct diagnosis between a severe psychiatric disorder and an endocrine disorder appropriately treatable with hormones. The measurement of hormone levels is not helpful in making this distinction, as they are all premenopausal women with normal follicle-stimulating hormone and estradiol levels. The diagnosis of PMS should come from the history relating the occurrence of cyclical mood and behaviour changes with menstruation, the improvement during pregnancy, postnatal depression and the presence of runs of many good days a month and the somatic symptoms of mastalgia, bloating and headaches. Young women with severe PMS do not respond to the antidepressants and mood-stabilizing drugs typically used for bipolar disorder.     

The History and Timing of Depression Onset as Predictors of Young Adult Self‐Esteem

Depression often emerges early in the lifecourse and is consistently shown to be associated with poor self‐esteem. The 3 main objectives of the current study are to (1) evaluate the association between a history major depression and self‐esteem in young adulthood, (2) assess the relationship between timing of depression onset and young adult self‐esteem, and (3) help rule out the alternative interpretation that the relationship between major depression and self‐esteem is due to state dependence bias stemming from recent depressive symptoms and stressful life events. To address these objectives we use data from a 2‐wave panel study based on a community sample of young adults in Miami‐Dade County, Florida (n=1,197). Results indicated that a history of major depression during sensitive periods of social development is associated with negative changes in self‐esteem over a 2‐year period during the transition to young adulthood. Among those with a history of depression, earlier onset was more problematic than later onset for young adult self‐esteem, although the difference disappeared once the level of self‐esteem 2 years prior was controlled. The linkages between the history and timing of depression onset with self‐esteem were observed net of recent depressive symptoms and stressful life events and are thus robust to an alternative interpretation of state dependence. The findings support the argument that major depression, especially if it develops earlier during child‐adolescent development, has negative consequences for one's self‐esteem.     

Mental health around and after the menopause

The menopause is a time in a woman's life when it is recognized that biological and social changes can impact upon mental wellbeing. Several studies have investigated the relationship between menopause and psychological symptoms, especially depression, with mixed results. In part, this is due to a considerable overlap between depressive symptoms and those due to declining estrogen levels, causing challenges in assessment. However it appears that vulnerable women are at a higher risk of succumbing to depression during menopausal transition. Antidepressants remain the mainstay of treating depressive symptoms, with little conclusive evidence for hormone replacement therapy. Memory problems during menopause are a common complaint, but there is no demonstrated link to subsequent dementia. This paper also reviews considerations of diagnosis and treatment of postmenopausal depression.     

Depressive Symptoms and Their Association With Adverse Environmental Factors and Substance Use in Runaway and Homeless Youths

We used diathesis‐stress and stress‐sensitization models to determine whether family maltreatment, street‐related traumatic events, stressful life events, and substance use were associated with depressive symptoms in runaway and homeless youths (RHY) in Los Angeles. Greater severity of depressive symptoms was significantly related to family maltreatment, being exposed to more traumatic stressors during homelessness, and current substance use compared to no substance use. Family maltreatment was also found to moderate the relationship between traumatic stressors and depressive symptoms. Importantly, cumulative exposure to the investigated risk factors at varying levels was associated with more severe depressive symptoms. Using a trauma‐informed approach to screen for RHY at risk of depression may pave the way for secondary prevention of major depression in RHY.     

Life Stress and Depression in University Students: Clinical Illustrations of Recent Research

Abstract

Through the use of case vignettes, this paper demonstrates the clinical relevance of findings from previously reported research conducted at the University of Toronto. These published studies link life stress to depression in university students. Three psychosocial factors—a family history of psychiatric illness, stressful life events, and lack of social support—are found to be significantly related to depressive symptoms. A fourth psychosocial factor, childhood or adolescent loss of a nurturing person, was not significantly related to the occurrence of depression. However, that factor remains an important therapeutic focus for a number of depressed students. In addition, the absence of at least a single confidant and certain life events (recent loss of a significant person, changes in living arrangements or academic situation, and financial problems) were identified as specific risk factors for depression. Although depression experienced by students is often serious enough to warrant professional intervention, only a minority seek professional help. The majority of those who do seek help are women; male students are less likely to associate somatic symptoms with emotional problems and are less willing to seek psychiatric help. The four case studies presented illustrate the clinical relevance of these research findings.     

Examining the role of parental factors on depression among Urban African American youth living in public housing

This study examined the potential risk and protective parental factors associated with depression among African American youth living in public housing. Utilizing a community-based participatory research approach, 239 African-American youth surveys were collected during 2013–2014 in two urban public housing developments with low socioeconomic profiles. Over half (52.3%) of the sample was in high school and female (58%). 65.3% reported living with their mother while 38% reported being employed. Bivariate analysis revealed significant correlations between depression and maternal substance abuse, paternal monitoring, parent-child relationship, and family time. Results from the regression analyses indicated that higher depression scores were significantly associated with youth who reported poor parent-child relationships, low levels of paternal supervision and high levels of maternal drug abuse. These findings provide support for claims about the importance of parent-child relationship and paternal monitoring as a protective factor for depressive symptoms, particularly during adolescence. Moreover, findings suggest that interventions which are targeted towards urban African American youth should address parental factors as a pathway to decrease depression among this population.     

Parental Divorce and Offspring Depressive Symptoms: Dutch Developmental Trends During Early Adolescence

In this study, we investigated if the association between parental divorce and depressive symptoms changes during early adolescence and if developmental patterns are similar for boys and girls. Data were collected in a prospective population cohort of Dutch adolescents (N = 2,149), aged 10 – 15 years. Outcome variables were self‐reported and parent‐reported depressive symptoms. The effects of divorce were adjusted for parental depression. In both self‐reported and parent‐reported data, we found a three‐way interaction of gender, age, and parental divorce, indicating that with increasing age, parental divorce became more strongly associated with depressive symptoms among girls, but not boys. These results suggest that girls with divorced parents are at particularly high risk to develop depressive symptoms during adolescence.     

Disorganized attachment,mentalization and dissociation in context of childhood trauma: Implications for depressive symptoms

Extensive evidence indicates that adults with experience of childhood trauma and disorganised attachment are at a higher risk of suffering from depressive symptoms, while at the same time dissociation and mentalisation are very important risk and protective factors in this relation. Although mentalisation and dissociation are mentioned as potential mediators of this relationship, very few studies have analysed the mutual relations between these variables. Bearing in mind the importance of creating more specific and effective ways for dealing with depression, especially within vulnerable groups such as the traumatised, the aim of this research is to examine a serial mediation model in which disorganisation is modelled as effecting a decrease in mentalisation, in turn lead to dissociation, thereby resulting in depressive symptoms. Adult respondents (N = 153) with a history of interpersonal childhood trauma were selected from a larger geographical cluster sample from the general population of Serbia. The respondents filled in a battery of instruments, including The Childhood Traumatic Events Scale, Relationship Questionnaire – CV, Patient Health Questionnaire, Short Scale for the Assessment of Stress-Related Dissociation Symptomatology and the Mentalisation Scale. Our findings suggest that disorganisation has an effect on depression by leading to a decrease in the ability to mentalise, which further triggers dissociation, resulting in depressive symptoms as a final consequence (estimated indirect effect = 0.014, 95 percent CI = 0.005 to 0.026). Additionally, the specific indirect effect involving dissociation as the sole mediator was also significant (estimated indirect effect = 0.058, 95 percent CI = 0.030 to 0.091). Targeting dissociative symptoms in the treatment in patients struggling with depression aftermath of traumatic experience could gain a great benefit for recognition and selection of more adequate treatment strategies.     

ADHD,depression, and substance abuse risk among beginning college students

Abstract

Objective: This study examined differences in substance use, depression, and academic functioning among ADHD and non-ADHD college students. Participants: Included 1,748 students (ages 18–25; women 68.4%; Caucasian 71.3%) with and without history of ADHD. Methods: We assessed the relationship of ADHD to substance use variables, controlling for depressive symptoms and examined relationships with GPA. Results: ADHD students were more likely to have engaged in frequent alcohol use, binge drinking, regular marijuana use and to have used other drugs in the last year. They reported higher depression symptoms than non-ADHD students, although substance abuse risk remained high even when controlling for depressive symptoms. ADHD students had lower overall GPA than those without ADHD. However, this difference was no longer significant when controlling for depression and marijuana use. Conclusions: College campuses should consider programing aimed at identifying ADHD students at risk for developing substance abuse problems and emotional difficulties.     

Patterns of positivity: Positive affect trajectories among infants of mothers with a history of depression

This study examined positive affect (PA) trajectories over the first year of life among infants of mothers with a history of depression (N = 191) as well as predictors (i.e., maternal prenatal and postpartum depression symptoms, maternal parenting behaviors) of those trajectories. Infant PA was observed in play and feeding tasks during laboratory visits at 3, 6, and 12 months of age; parenting behaviors were observed at 3 months. Mothers completed questionnaires regarding their symptoms of depression throughout the prenatal period and during the first 3 months postpartum. Growth curve analyses indicated that infant PA increased across time, and this finding replicated across both the play and feeding tasks, though increases slowed over time. Neither maternal prenatal nor postpartum depression symptoms predicted infants' PA trajectories, but mothers' PA, positive parenting, and disengaged parenting were associated with infant PA during the play task. Our finding that infant PA increased over the first year postpartum suggests PA trajectories among infants of mothers with a history of depression may be indices of resilience, despite risks associated with their mothers' history of depression. Furthermore, this study highlights parenting behaviors that may be important targets of prevention and early intervention efforts to bolster infant PA.     

Predicting Adolescents' Organized Activity Involvement: The Role of Maternal Depression History,Family Relationship Quality,and Adolescent Cognitions

Although the potential benefits of organized activity involvement during high school have been documented, little is known about what familial and individual characteristics are associated with higher levels of participation. Using structural equation modeling, this longitudinal study examined the extent to which maternal depression history (i.e., risk), family relationship quality, and adolescents' cognitions (i.e., self‐worth and attributional style), predicted organized activity involvement during high school among 145 adolescents, controlling for socioeconomic status and adolescent depressive symptoms. Results showed that risk predicted less adolescent high school activity involvement, and this relation was mediated by family relationship quality. Family relationship quality indirectly affected activity involvement through adolescent cognitions. The overall predictive model generally supported the importance of the interplay between family and individual factors in predicting activity involvement during high school.     

Testing an explanatory model of the development of depressive symptoms in young women during a life transition

Factors to explain the rising incidence of depressive symptoms among young women making the transition from home to university life were investigated. A path analysis of data from 213 18- and 19-year-old women entering a large university indicated that negative life events, interpersonally derived social support, self-esteem, and depressive symptoms were significantly related. Negative life events that affected the women's self-esteem (drawn from the women's performance in interpersonal relationships) were most strongly associated with depressive symptoms, and self-esteem derived through efficacy (i.e., taking control and acting assertively) was not associated with negative events. The women in the sample appeared to derive efficacy self-esteem from relationships. An analysis of the data supported developing interventions to improve interpersonal relationships rather than focusing on competence in gaining access to resources.     

Health behavior correlates of depression among university students

The frequency of symptoms of depression and selected health-related practices and events was measured in a sample of 572 students at a large midwestern university. Students reported many symptoms of depression, with women experiencing depression more often and to a greater degree than men. Depression was significantly correlated with 17 of the 22 practices and states of affect examined, but uncorrelated with certain health-related activities commonly identified with poor emotional well-being. Both the determinants and manifestations of depression among university students require further in-depth investigation. Implications for health professionals and other university personnel are discussed.     

Resolution of depression among victims of intimate partner violence: is cessation of violence enough?

The objective of this article is to assess the effect of abuse cessation on depressive symptoms among women abused by a male intimate partner. This prospective cohort study of Seattle women with a history of intimate partner violence (IPV) who were classified by history of abuse and abuse status at 3 month, 9 month, and 2 year follow-up interviews. Relative risks (RR) were calculated using generalized estimating equations. Among subjects with a history of psychological abuse only, cessation of abuse was associated with a nonsignificant reduction in the likelihood of depression compared to subjects whose abuse continued (aRR = 0.88; 95%CI: 0.75,1.03). Among subjects with a history of physical/sexual abuse and psychological abuse, cessation of physical/sexual abuse only was associated with a 27% decline, and cessation of both types of abuse was associated with a 35% decline in the likelihood of depression (aRR = 0.73, 95%CI: 0.63,0.86; and aRR = 0.65; 95%CI: 0.55,0.76; respectively). Cessation of abuse among victims of IPV is associated with a decreased prevalence of depression.     

Shift Work,Role Overload,and the Transition to Parenthood

This article examines how the work hours, work schedules, and role overload of working‐class couples are related to depressive symptoms and relationship conflict across the transition to parenthood. Data are from 132 dual‐earner couples interviewed 5 times across the transition. Multilevel modeling analyses revealed that working evening or night shifts, as opposed to day shifts, was related to higher levels of depressive symptoms. For mothers only, working rotating shifts predicted relationship conflict. Increases in role overload were positively related to both depression and conflict; working a nonday shift explained variance in depression and conflict above and beyond role overload. Results suggest that for new parents, working nonday shifts may be a risk factor for depressive symptoms and relationship conflict.     

Alcohol misuse among college athletes: self-medication for psychiatric symptoms?

A collegiate athlete population was surveyed for alcohol abuse as well as self-reported depression, anxiety, and other psychiatric symptoms. This study revealed that in a group of 262 athletes there were 21 percent who reported high alcohol use and problems associated with its use. Significant correlations were found between reported alcohol abuse and self-reported symptoms of depression and general psychiatric symptoms. Subjects with positive depression and psychiatric symptom ratings in the "severe" range had a significantly higher rate of alcohol abuse than subjects who had low depression and low or mild symptom ratings. Conversely, subjects reporting higher rates of alcohol misuse had more psychiatric symptoms. These findings suggest a possible causal link between psychopathology and serious alcohol abuse among college athletes. They also point to the need for routine depression and anxiety screening in college students who are typically beginning a significant exposure to alcohol.     

No strings attached: the nature of casual sex in college students

The purpose of this paper was to identify the circumstances associated with casual sex encounters, as well as to identify the link between casual sex, depressive symptoms, and infidelity among college students. We found that casual sex was a fairly common occurrence that was related to early sexual transition, engaging in first sex with a casual sex partner, drug use and alcohol consumption. Casual sex occurred more often between "friends" rather than with strangers. Depressive symptoms were associated with engaging in casual sex differently for males and females. Males who engaging in casual sex reported the fewest symptoms of depression and females who had a history of casual sex reported the most depressive symptoms. Frequencies of affectionate and genital behaviors were associated with expectations of the relationship, the relationship to the partner, infidelity, and the individual's relationship style. Results are discussed in light of evolutionary and socio-cultural theories of sexuality.     

Use of endocrine hormones for treating depression

Disturbances in some endocrine hormones have been implicated in the pathophysiology of depression. Some of these hormones (and drugs that affect hormone function) have been used as therapeutic agents for the treatment of depression, especially adrenal, thyroid, and gonadal axis hormones. Open-label and controlled studies of various drugs that directly suppress or inhibit adrenal axis function have shown some benefit for the treatment of major depression, including treatment-resistant depression. Thyroid hormone augmentation is effective for nonresponders to antidepressant agents, although it has not been studied extensively. Estrogen may improve mild mood symptoms in perimenopausal women but may not be effective alone for major depression. Evidence of the antidepressant effects of testosterone in men is inconsistent, with mixed results from controlled studies. The adrenal steroid hormone dehydroepiandrosterone has an important role in mood regulation and may have significant antidepressant effects.     

Incidence and risk factors for symptoms from the eyes among professional computer users

Personal computers are used by a majority of the working population in their professions. Little is known about risk-factors for incident symptoms from the eyes among professional computer users. The aim was to study the incidence and risk-factors for symptoms from the eyes among professional computer users.This study is a part of a comprehensive prospective follow-up study of factors associated with the incidence of symptoms among professional computer users. 1531 computer users of different professions at 46 companies were invited, whereof 1283 answered a baseline questionnaire (498 men; 785 women) and 1246 at least one of 10 monthly follow-up questionnaires. The computer work-station and equipment were generally of a good standard. The majority used CRT displays.During the follow-up period 329 subjects reported eye symptoms. The overall incidence rate in the whole study group was 0.38 per person-year, 0.23 in the subgroup of subjects who were symptom free at baseline and 1.06 among subjects who reported eye symptoms at baseline. In the bivariate analyses significant associations were found with all explanatory variables, except BMI. The reduced multivariate model showed significant associations with extended computer work, visual discomfort (dose-response), eye symptoms at baseline (higher risk), sex (women=higher risk) and nicotine use.The incidence of eye problems among professional computer users is high and related to both individual and work-related factors.     

Family formation: A positive outcome for vulnerable young women?

While marriage and childbirth are generally considered positive adult outcomes, it is not clear that this holds true among low income young women. Beyond adolescent parenting, little empirical data exists on various types of family formation in this population. The aims of this study were twofold: (1) to understand predictors of type of family formation (e.g., none, childrearing, marriage, or both) among 4385 young women with childhood histories of poverty and/or maltreatment; and (2) to explore whether family formation patterns were associated with negative adult behavioral and health outcomes. Results of the AIM 1 multinomial regression analysis of family formation indicated that the likelihood of childrearing with or without marriage increased with an increase in the number of adolescent risk behaviors after controlling for the maltreatment and/or poverty histories. Among women with maltreatment histories, early onset maltreatment was associated with childrearing or marriage compared to no family. Among previously maltreated women, predictors of family formation varied according to prior poverty history. AIM 2 Cox regression results indicated that having children with or without marriage was associated with a higher risk of negative outcomes after controlling for maltreatment and adolescent risk factors. Bivariate analyses suggested that most of the increased risk was associated with having at least two children. Findings underscore the importance of preventing adolescent risk behaviors among low income and maltreated girls as well as early and unplanned births among vulnerable young adult women.