BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity va...BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity variables affect MDD.We hypothesize that high-level trait-and state-related stress-sensitivity factors may have different cumulative effects on the clinical symptoms and follow-up outcomes of MDD.AIM To investigate how stress-sensitivity factors added up and affected MDD clinical symptoms and follow-up results.METHODS In this prospective study,281 MDD patients were enrolled from a tertiary care setting.High-level stress-sensitivity factors were classified as trait anxiety,state anxiety,perceived stress,and neuroticism,with a total score in the top quartile of the research cohort.The cumulative effects of stress-sensitivity factors on cognitive dysfunction,disability and functional impairment,suicide risk,and depressive and anxiety symptoms were examined using an analysis of variance with linear trend analysis.Correlations were investigated further using multiple regression analysis.RESULTS Regarding high-level stress-sensitivity factors,53.40%of patients had at least one at baseline,and 29.61%had two or more.Four high-level stress-sensitivity components had significant cumulative impacts on MDD symptoms at baseline(all P<0.001).Perceived stress predicted the greatest effect sizes of state-related factors on depressive symptoms(partialη^(2)=0.153;standardizedβ=0.195;P<0.05).The follow-up outcomes were significantly impacted only by the high-level trait-related components,mainly when it came to depressive symptoms and suicide risk,which were predicted by trait anxiety and neuroticism,respectively(partialη^(2)=0.204 and 0.156;standardizedβ=0.247 and 0.392;P<0.05).CONCLUSION To enhance outcomes of MDD and lower the suicide risk,screening for stress-sensitivity factors and considering multifaceted measures,mainly focusing on trait-related ones,should be addressed clinically.展开更多
BACKGROUND Rumination is a critical psychological factor contributing to the relapse of major depressive episodes(MDEs)and a core residual symptom in remitted MDEs.Investigating its neural correlations is essential fo...BACKGROUND Rumination is a critical psychological factor contributing to the relapse of major depressive episodes(MDEs)and a core residual symptom in remitted MDEs.Investigating its neural correlations is essential for developing strategies to prevent MDE relapse.Despite its clinical importance,the brain network mechanisms underlying rumination in remitted MDE patients have yet to be fully elucidated.AIM To investigate the brain network mechanism underlying rumination in patients with remitted MDEs using functional magnetic resonance imaging(fMRI).METHODS We conducted an fMRI-based rumination-distraction task to induce rumination and distraction states in 51 patients with remitted MDEs.Functional connectivity(FC)was analyzed using the network-based statistic(NBS)approach,and eight topological metrics were calculated to compare the network topological properties between the two states.Correlation analyses were further performed to identify the relationships between individual rumination levels and the significantly altered brain network metrics.RESULTS The NBS analysis revealed that the altered FCs between the rumination and distraction states were located primarily in the frontoparietal,default mode,and cerebellar networks.No significant correlation was detected between these altered FCs and individual rumination levels.Among the eight topological metrics,the clustering coefficient,shortest path length,and local efficiency were significantly lower during rumination and positively correlated with individual rumination levels.In contrast,global efficiency was greater in the rumination state than in the distraction state and was negatively correlated with individual rumination levels.CONCLUSION Our work revealed the altered FC and topological properties during rumination in remitted MDE patients,offering valuable insights into the neural mechanisms of rumination from a brain network perspective.展开更多
基金Supported by Science and Technology Innovation 2030-Major Projects,No.2021ZD0202000National Key Research and Development Program of China,No.2019YFA0706200+2 种基金National Natural Science Foundation of China,No.82371535Science and Technology Innovation Program of Hunan Province,No.2023RC3083Fundamental Research Funds for the Central Universities of Central South University,No.2023ZZTS0838.
文摘BACKGROUND Sensitivity to stress is essential in the onset,clinical symptoms,course,and prognosis of major depressive disorder(MDD).Meanwhile,it was unclear how variously classified but connected stress-sensitivity variables affect MDD.We hypothesize that high-level trait-and state-related stress-sensitivity factors may have different cumulative effects on the clinical symptoms and follow-up outcomes of MDD.AIM To investigate how stress-sensitivity factors added up and affected MDD clinical symptoms and follow-up results.METHODS In this prospective study,281 MDD patients were enrolled from a tertiary care setting.High-level stress-sensitivity factors were classified as trait anxiety,state anxiety,perceived stress,and neuroticism,with a total score in the top quartile of the research cohort.The cumulative effects of stress-sensitivity factors on cognitive dysfunction,disability and functional impairment,suicide risk,and depressive and anxiety symptoms were examined using an analysis of variance with linear trend analysis.Correlations were investigated further using multiple regression analysis.RESULTS Regarding high-level stress-sensitivity factors,53.40%of patients had at least one at baseline,and 29.61%had two or more.Four high-level stress-sensitivity components had significant cumulative impacts on MDD symptoms at baseline(all P<0.001).Perceived stress predicted the greatest effect sizes of state-related factors on depressive symptoms(partialη^(2)=0.153;standardizedβ=0.195;P<0.05).The follow-up outcomes were significantly impacted only by the high-level trait-related components,mainly when it came to depressive symptoms and suicide risk,which were predicted by trait anxiety and neuroticism,respectively(partialη^(2)=0.204 and 0.156;standardizedβ=0.247 and 0.392;P<0.05).CONCLUSION To enhance outcomes of MDD and lower the suicide risk,screening for stress-sensitivity factors and considering multifaceted measures,mainly focusing on trait-related ones,should be addressed clinically.
基金the National Key Research and Development Program of China,No.2021ZD0202000the National Natural Science Foundation of China,No.82101612 and No.82471570+1 种基金the Natural Science Foundation of Hunan Province,China,No.2022JJ40692the Science and Technology Innovation Program of Hunan Province,No.2021RC2040 and No.2024RC3056.
文摘BACKGROUND Rumination is a critical psychological factor contributing to the relapse of major depressive episodes(MDEs)and a core residual symptom in remitted MDEs.Investigating its neural correlations is essential for developing strategies to prevent MDE relapse.Despite its clinical importance,the brain network mechanisms underlying rumination in remitted MDE patients have yet to be fully elucidated.AIM To investigate the brain network mechanism underlying rumination in patients with remitted MDEs using functional magnetic resonance imaging(fMRI).METHODS We conducted an fMRI-based rumination-distraction task to induce rumination and distraction states in 51 patients with remitted MDEs.Functional connectivity(FC)was analyzed using the network-based statistic(NBS)approach,and eight topological metrics were calculated to compare the network topological properties between the two states.Correlation analyses were further performed to identify the relationships between individual rumination levels and the significantly altered brain network metrics.RESULTS The NBS analysis revealed that the altered FCs between the rumination and distraction states were located primarily in the frontoparietal,default mode,and cerebellar networks.No significant correlation was detected between these altered FCs and individual rumination levels.Among the eight topological metrics,the clustering coefficient,shortest path length,and local efficiency were significantly lower during rumination and positively correlated with individual rumination levels.In contrast,global efficiency was greater in the rumination state than in the distraction state and was negatively correlated with individual rumination levels.CONCLUSION Our work revealed the altered FC and topological properties during rumination in remitted MDE patients,offering valuable insights into the neural mechanisms of rumination from a brain network perspective.
