BACKGROUND Non-suicidal self-injury(NSSI)is common among adolescents with depressive disorders and poses a major public health challenge.Rumination,a key cognitive feature of depression,includes different subtypes tha...BACKGROUND Non-suicidal self-injury(NSSI)is common among adolescents with depressive disorders and poses a major public health challenge.Rumination,a key cognitive feature of depression,includes different subtypes that may relate to NSSI through distinct psychological mechanisms.However,how these subtypes interact with specific NSSI behaviors remains unclear.AIM To examine associations between rumination subtypes and specific NSSI behaviors in adolescents.METHODS We conducted a cross-sectional study with 305 hospitalized adolescents diagnosed with depressive disorders.The subjects ranged from 12-18 years in age.Rumi-nation subtypes were assessed using the Ruminative Response Scale,and 12 NSSI behaviors were evaluated using a validated questionnaire.Network analysis was applied to explore symptom-level associations and identify central symptoms.RESULTS The network analysis revealed close connections between rumination subtypes and NSSI behaviors.Brooding was linked to behaviors such as hitting objects and burning.Scratching emerged as the most influential NSSI symptom.Symptomfocused rumination served as a key bridge connecting rumination and NSSI.CONCLUSION Symptom-focused rumination and scratching were identified as potential intervention targets.These findings highlight the psychological significance of specific cognitive-behavioral links in adolescent depression and suggest directions for tailored prevention and treatment.However,the cross-sectional,single-site design limits causal inference and generalizability.Future longitudinal and multi-center studies are needed to confirm causal pathways and verify the generalizability of the findings to broader adolescent populations.展开更多
INTRODUCTION.Depressive disorders are mental illnesses that seriously affect public health.There are approximately 320 million patients with depression worldwide,accounting for 4.4% of the total disease burden.1Depres...INTRODUCTION.Depressive disorders are mental illnesses that seriously affect public health.There are approximately 320 million patients with depression worldwide,accounting for 4.4% of the total disease burden.1Depression leads to social and occupational impairment,diminished quality of life and an elevated risk of death by suicide.展开更多
Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, inc...Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, incidence and years lived with disability (YLDs) associated with depressive disorders, particularly major depressive disorder and dysthymia, in Iran from 1990 to 2021. To achieve this, the research focused on analysing these metrics across various dimensions, including temporal trends, sex differences, age categories and subnational regions.Methods The data used in this study are sourced directly from the Institute for Health Metrics and Evaluation, ensuring that the information is both authoritative and reliable. All-age count estimates and age-standardised rates (per 100 000) were calculated for prevalence, incidence and YLDs. The disease burden indicators were analysed for the period spanning from 1990 to 2021, stratified by sex, age and location. The percentage change between 1990 and 2021 was also documented. The 95% uncertainty interval (UI) was reported for each of the reported estimates.Results The prevalence of depressive disorders in Iran demonstrated a notable upward trend from 1990 to 2021, with the rate of growth being particularly pronounced within the country. The age-standardised prevalence rate per 100 000 individuals for depressive disorders in Iran was 5609 (95% UI 4810 to 6488). By 2021, the number of depression cases in Iran reached 5.2 million, which is approximately 2.37 times the figure reported in 1990. The prevalence of depressive disorders was notably higher among females compared with males. The age-standardised prevalence rate per 100 000 individuals for males was 4184 (95% UI 3545 to 4929). For females, this figure was significantly greater, reaching 7077 (95% UI 6115 to 8172). Out of the total reported cases of depressive disorders in Iran, 3.2 million were observed in females, while males accounted for 2 million cases.Conclusions The findings highlighted the considerable impact of depressive disorders in Iran, both nationally and regionally, while also revealing variations across sex and age groups. Given the shifts in the demographic structure and the growing burden of these disorders, it is essential to prioritise screening initiatives, education programmes and strategies aimed at enhancing mental health awareness and ensuring improved access to mental health services in health policy planning.展开更多
This paper examines the correlation between depressive disorders and intestinal flora.Depression is a common affective disorder characterized by low mood,loss of interest,anhedonia,high incidence,high recurrence rate,...This paper examines the correlation between depressive disorders and intestinal flora.Depression is a common affective disorder characterized by low mood,loss of interest,anhedonia,high incidence,high recurrence rate,high disability rate,and high medical costs.The incidence and harmfulness of depressive disorder are gradually increasing,and its etiology is complex and diverse,among which the abnormal intestinal flora is considered to be one of the causes of depressive disorder.This article reviews the results of several studies that found intestinal flora imbalance in depressed patients,including changes in the type and quantity of flora and changes in metabolic pathways.In addition,antibiotic and probiotic treatments have also been shown to be effective in alleviating depressive symptoms,further indicating the importance of intestinal flora disturbances in the pathogenesis of depression.We also explored the relationship between intestinal flora and the pathogenesis of depressive disorders.Through neuro-immuno-endo-crine-metabolic pathways,intestinal flora can affect the function of the central nervous system,cause changes in the host’s mental behavior,and lead to or aggravate depressive symptoms.Overall,this study not only found differences in the intestinal flora of patients with depressive disorders but also revealed the potential role of intestinal flora in the pathogenesis.Importantly,this provides a new theoretical basis for further clarifying the pathogenesis of depressive disorders and formulating diagnosis and treatment strategies.展开更多
To review the current research status of positive thought stress reduction therapy(PTSRT),psychosocial functioning of patients with depressive disorders,the shortcomings and outlook of the influence of PTSRT on positi...To review the current research status of positive thought stress reduction therapy(PTSRT),psychosocial functioning of patients with depressive disorders,the shortcomings and outlook of the influence of PTSRT on positive thought awareness,and psychosocial functioning of patients with depressive disorders.This review has the objective to provide clinical healthcare personnel with essential information about the use of PTSRT to improve the level of positive thought and psychosocial functioning of patients with depressive disorders.展开更多
Background:Depressive disorders have become a major risk factor that influences people’s health worldwide,but few studies have focused on the prevalence of depressive disorders among the Chinese elderly and their cha...Background:Depressive disorders have become a major risk factor that influences people’s health worldwide,but few studies have focused on the prevalence of depressive disorders among the Chinese elderly and their characteristics of depressive disorders.The current study is a secondary data analysis designed to explore the profiles of depressive disorders in the Chinese elderly by latent profile analysis.Methods:The China Health and Retirement Longitudinal Study(CHARLS 2018)database will be used for analysis.Latent profile analysis will be employed to identify the profiles of depressive disorders using data from the subsection“CESD Depression”in the section“Cognition and Depression”.Stepwise multinomial logistic regression will be used to explore the influencing factors of different profiles of depressive disorders among the Chinese elderly.Discussion:The prevalence of depressive disorders among the Chinese elderly and their profiles of depressive disorders will be reported.Possible influencing factors may include some demographic characteristics and associated psychological elements,which will provide a reference for further research and precise intervention.展开更多
Major depressive disorder(MDD)is a highly heterogeneous mental disorder,and its complex etiology and unclear mechanism are great obstacles to the diagnosis and treatment of the disease.Studies have shown that abnormal...Major depressive disorder(MDD)is a highly heterogeneous mental disorder,and its complex etiology and unclear mechanism are great obstacles to the diagnosis and treatment of the disease.Studies have shown that abnormal functions of the visual cortex have been reported in MDD patients,and the actions of several antidepressants coincide with improvements in the structure and synaptic functions of the visual cortex.In this review,we critically evaluate current evidence showing the involvement of the malfunctioning visual cortex in the pathophysiology and therapeutic process of depression.In addition,we discuss the molecular mechanisms of visual cortex dysfunction that may underlie the pathogenesis of MDD.Although the precise roles of visual cortex abnormalities in MDD remain uncertain,this undervalued brain region may become a novel area for the treatment of depressed patients.展开更多
BACKGROUND Electroconvulsive therapy(ECT)is used to treat major depressive disorder(MDD).Relapse is often observed even after successful ECT,followed by adequate pharmaceutical treatment for MDD.AIM To investigate the...BACKGROUND Electroconvulsive therapy(ECT)is used to treat major depressive disorder(MDD).Relapse is often observed even after successful ECT,followed by adequate pharmaceutical treatment for MDD.AIM To investigate the diagnostic factors and treatment strategies associated with depression relapse.METHODS We analyzed the relationships between relapse,the diagnostic change from MDD to bipolar disorder(BP),and treatment after the initial ECT.We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital.The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP.A receiver operating characteristic(ROC)curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.RESULTS Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study.Compared with the MDD participants,more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission(65.6%vs 15.1%,P<0.001;relative risk=4.35,95%CI:2.19-8.63,P<0.001).Twenty-nine patients experienced relapses during the three-year follow-up.In 21(72.4%,21/29)patients with relapse,the diagnosis was changed from MDD to BP.The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients(9.63±10.4 mo vs 3.38±3.77 mo,P=0.022);for most patients,the interval was less than one month.The relative risk of depressive symptoms based on diagnostic changes was 4.35(95%confidence interval:2.19–8.63,P<0.001),and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756(95%CI:0.562-0.895,P=0.007).CONCLUSION It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.展开更多
In recent years,non-suicidal self-injury(NSSI)behavior has emerged in a large number of adoles-cent depression.NSSI associated with adolescent depres-sion may be an addictive behavior,which has many sim-ilar neurobiol...In recent years,non-suicidal self-injury(NSSI)behavior has emerged in a large number of adoles-cent depression.NSSI associated with adolescent depres-sion may be an addictive behavior,which has many sim-ilar neurobiological mechanisms to substance addiction.Brain-derived neurotrophic factor(BDNF)and precursor of BDNF(proBDNF)play an important role in addiction behavior,and they may be related to endogenous opioid receptors.The location and distribution of opioidμre-ceptors in the brain are related to reward,motivation and emotion regulated by behavioral addiction.The purpose of this paper is to review the general situation,mechanism and relationship between the characteristics of NSSI be-havior addiction and brain-derived nutritional factors in adolescents with depression.展开更多
Background Biomarkers for predicting suicide risk in hospitalised patients with mental disorders have been understudied.Currently,suicide risk assessment tools based on objective indicators are limited in China.Aims T...Background Biomarkers for predicting suicide risk in hospitalised patients with mental disorders have been understudied.Currently,suicide risk assessment tools based on objective indicators are limited in China.Aims To examine the value of various biomarkers in suicide risk prediction and develop a risk assessment model with clinical utility using machine learning.Methods This cohort study analysed patients with major depressive disorder(MDD) who were hospitalised for the first time between January 2016 and March 2023 from four specialised mental health institutions.A total of 139 features,including biomarker measurements,medical orders and psychological scales,were assessed for analysis.Their suicide risk was evaluated by qualified nurses using Nurse s Global Assessment of Suicide Risk within 1 week after admission.Five machine learning models were trained with 10-fold cross-validation across three hospitals and were externally validated in an independent cohort.The primary performance was assessed using the area under the receiver operating characteristic curve(AUROC).The model was interpreted using the SHapley Additive exPlanations(SHAP) analysis.Biomarker importance was evaluated by comparing model performance with and without these biomarkers.Results Of 3143 patients with MDD included in this study,the incidence of high suicide risk within 1 week after first admission was 660(21.0%).Among all models,the Extreme Gradient Boosting can more effectively predict future risks,with an AUROC higher than 0.8(p<0.001).The SHAP values identified the 10 most important features,including five biomarkers.After clustering analysis,electroconvulsive therapy,physical restraint,β2-microglobulin and triiodothyronine were found to have heterogeneous effects on suicide risk.Combining biomarkers with other data from electronic health records significantly improved the performance and clinical utility of machine learning models based on demographics,diagnosis,laboratory tests,medical orders and psychological scales.Conclusions This study demonstrates the potential for a biomarker-based suicide risk assessment for patients with MDD,emphasising the interaction between biomarkers and therapeutic interventions.展开更多
Background:The optimal antidepressant dosages remain controversial.This study aimed to analyze the efficacy of antidepressants and characterize their dose-response relationships in the treatments of major depressive d...Background:The optimal antidepressant dosages remain controversial.This study aimed to analyze the efficacy of antidepressants and characterize their dose-response relationships in the treatments of major depressive disorders(MDD).Methods:We searched multiple databases,including the Embase,Cochrane Central Register of Controlled Trials,PubMed,and Web of Science,for the studies that were conducted between January 8,2016,and April 30,2023.The studies are double-blinded,randomized controlled trials(RCTs)involving the adults(≥18 years)with MDD.The primary outcomes were efficacy of antidepressant and the dose-response relationships.A frequentist network meta-analysis was conducted,treating participants with various dosages of the same antidepressant as a single therapy.We also implemented the model-based meta-analysis(MBMA)using a Bayesian method to explore the dose-response relationships.Results:The network meta-analysis comprised 135,180 participants from 602 studies.All the antidepressants were more effective than the placebo;toludesvenlafaxine had the highest odds ratio(OR)of 4.52(95%confidence interval[CI]:2.65-7.72),and reboxetine had the lowest OR of 1.34(95%CI:1.14-1.57).Moreover,amitriptyline,clomipramine,and reboxetine showed a linear increase in effect size from low to high doses.The effect size of toludesvenlafaxine increased significantly up to 80 mg/day and subsequently maintained the maximal dose up to 160 mg/day while the predictive curves of nefazodone were fairly flat in different dosages.Conclusions:Although most antidepressants were more efficacious than placebo in treating MDD,no consistent dose-response relationship between any antidepressants was observed.For most antidepressants,the maximum efficacy was achieved at lower or middle prescribed doses,rather than at the upper limit.展开更多
Clinically differentiating bipolarⅡdisorder(BD-Ⅱ)from major depressive disorder(MDD)remains a significant challenge in modern psychiatry.These two conditions share substantial clinical symptomatology,making accurate...Clinically differentiating bipolarⅡdisorder(BD-Ⅱ)from major depressive disorder(MDD)remains a significant challenge in modern psychiatry.These two conditions share substantial clinical symptomatology,making accurate diagnosis difficult in routine clinical practice.Misdiagnosis may lead to inappropriate treatment strategies,increased psychological and physical burdens,reduced quality of life,and impaired social functioning.Genetic overlap may partially explain the clinical similarities between MDD and BD-Ⅱ,and biomarkers along with neuroimaging techniques are receiving increasing attention as tools to aid in diagnosis.For example,electroencephalography has been shown to effectively distinguish between unipolar depression and bipolar depression;serum levels of glycogen synthase kinase-3 have also been investigated as a potential tool for differentiating between the two disorders.A comprehensive assessment integrating clinical characteristics,genetic basis research,and multimodal evaluations using neuroimaging and biomarkers through a multidisciplinary approach will help enhance clinicians'ability to distinguish between MDD and BD-Ⅱ.By improving diagnostic accuracy,more personalized and effective treatment strategies can be developed,ultimately improving patients'health outcomes and quality of life.展开更多
Mental health disorders have emerged as a critical global health challenge,profoundly impacting individuals,communities,and societies worldwide.The prevalence of mental health problems has been steadily increasing,wit...Mental health disorders have emerged as a critical global health challenge,profoundly impacting individuals,communities,and societies worldwide.The prevalence of mental health problems has been steadily increasing,with~1 in 8 people,equivalent to 970 million individuals suffering from a mental disorder in 2019(https://vizhub.healthdata.org/gbd-results).Anxiety and depressive disorders are predominant,contributing significantly to the burden of mental health issues,according to the World Health Organization.The COVID-19 pandemic has further exacerbated this situation.It led to a notable upsurge in anxiety and major depressive disorders in 2020.Estimates indicate a 26%rise in anxiety and a 28%increase in depression within that year(https://www.who.int/publications/i/item/WHO-2019-nCoVSci_Brief-Mental_health-2022.1)[1].展开更多
Objective To analyze trends in the depressive disorder burden across BRICS Plus countries and their associations with age,period,and cohort effects.Methods Prevalence,incidence,and disability-adjusted life years(DALYs...Objective To analyze trends in the depressive disorder burden across BRICS Plus countries and their associations with age,period,and cohort effects.Methods Prevalence,incidence,and disability-adjusted life years(DALYs)estimates of the depressive disorder burden were obtained from the Global Burden of Disease Study,2021.This study further assessed the period and cohort effects on depressive disorders from 1992 to 2021 using an age-periodcohort model.Results In 2021,152.6 million people had depressive disorders across the BRICS Plus countries,showing an increase of 85.6%from 1990,which caused 23.7 million DALYs.The age-standardized prevalence rate(ASPR)of depressive disorders declined by 4.1%from 1990 to 2019,followed by a substantial increase(11.3%)from 2019 to 2021.Furthermore,period and cohort effects showed that the depressive disorder burden increased over time and in the recent birth cohort.Meanwhile,the depressive disorder burden increased among adolescents,young adults,and older adults in the BRICS Plus group.Ultimately,projections for 2050 suggest a 150.0%increase in the ASPR.Conclusion This study revealed a heavy depressive disorder burden across BRICS Plus countries,especially among adolescents,young adults,and older adults.This highlights the need to strengthen specific public health strategies and policies targeting populations with different priorities.展开更多
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 Major depressive disorder(MDD)with comorbid anxiety is an intricate psychiatric condition,but limited research is available on the degree centrality(DC)between anxious MDD and nonanxious MDD patients.AIM To...BACKGROUND Major depressive disorder(MDD)with comorbid anxiety is an intricate psychiatric condition,but limited research is available on the degree centrality(DC)between anxious MDD and nonanxious MDD patients.AIM To examine changes in DC values and their use as neuroimaging biomarkers in anxious and non-anxious MDD patients.METHODS We examined 23 anxious MDD patients,30 nonanxious MDD patients,and 28 healthy controls(HCs)using the DC for data analysis.RESULTS Compared with HCs,the anxious MDD group reported markedly reduced DC values in the right fusiform gyrus(FFG)and inferior occipital gyrus,whereas elevated DC values in the left middle frontal gyrus and left inferior parietal angular gyrus.The nonanxious MDD group exhibited surged DC values in the bilateral cerebellum IX,right precuneus,and opercular part of the inferior frontal gyrus.Unlike the nonanxious MDD group,the anxious MDD group exhibited declined DC values in the right FFG and bilateral calcarine(CAL).Besides,declined DC values in the right FFG and bilateral CAL negatively correlated with anxiety scores in the MDD group.CONCLUSION This study shows that abnormal DC patterns in MDD,especially in the left CAL,can distinguish MDD from its anxiety subtype,indicating a potential neuroimaging biomarker.展开更多
In the pathogenesis of major depressive disorder, chronic stress-related neuroinflammation hinders favorable prognosis and antidepressant response. Mitochondrial DNA may be an inflammatory trigger, after its release f...In the pathogenesis of major depressive disorder, chronic stress-related neuroinflammation hinders favorable prognosis and antidepressant response. Mitochondrial DNA may be an inflammatory trigger, after its release from stress-induced dysfunctional central nervous system mitochondria into peripheral circulation. This evidence supports the potential use of peripheral mitochondrial DNA as a neuroinflammatory biomarker for the diagnosis and treatment of major depressive disorder. Herein, we critically review the neuroinflammation theory in major depressive disorder, providing compelling evidence that mitochondrial DNA release acts as a critical biological substrate, and that it constitutes the neuroinflammatory disease pathway. After its release, mitochondrial DNA can be carried in the exosomes and transported to extracellular spaces in the central nervous system and peripheral circulation. Detectable exosomes render encaged mitochondrial DNA relatively stable. This mitochondrial DNA in peripheral circulation can thus be directly detected in clinical practice. These characteristics illustrate the potential for mitochondrial DNA to serve as an innovative clinical biomarker and molecular treatment target for major depressive disorder. This review also highlights the future potential value of clinical applications combining mitochondrial DNA with a panel of other biomarkers, to improve diagnostic precision in major depressive disorder.展开更多
Major depressive disorder(MDD),a psychiatric disorder characterized by functional brain deficits,poses considerable diagnostic and treatment challenges,especially in adolescents owing to varying clinical presentations...Major depressive disorder(MDD),a psychiatric disorder characterized by functional brain deficits,poses considerable diagnostic and treatment challenges,especially in adolescents owing to varying clinical presentations.Biomarkers hold substantial clinical potential in the field of mental health,enabling objective assessments of physiological and pathological states,facilitating early diagnosis,and enhancing clinical decision-making and patient outcomes.Recent breakthroughs combine neuroimaging with machine learning(ML)to distinguish brain activity patterns between MDD patients and healthy controls,paving the way for diagnostic support and personalized treatment.However,the accuracy of the results depends on the selection of neuroimaging features and algorithms.Ensuring privacy protection,ML model accuracy,and fostering trust are essential steps prior to clinical implementation.Future research should prioritize the establishment of comprehensive legal frameworks and regulatory mechanisms for using ML in MDD diagnosis while safeguarding patient privacy and rights.By doing so,we can advance accuracy and personalized care for MDD.展开更多
Background Numerous studies have consistently demonstrated that a considerable proportion of patients with major depressive disorder (MDD) frequently exhibit pronounced dyslipidaemia. However, the causal dynamics betw...Background Numerous studies have consistently demonstrated that a considerable proportion of patients with major depressive disorder (MDD) frequently exhibit pronounced dyslipidaemia. However, the causal dynamics between MDD and dyslipidaemia remain elusive.Aims To comprehensively disentangle the genetic causality between MDD and various phenotypes of blood lipids, thereby facilitating the advancement of management strategies for these conditions.Methods We conducted a two-sample univariable Mendelian randomisation (MR) analysis using different models, including the inverse variance weighted (IVW) method and causal analysis using the summary effect (CAUSE) estimates, as well as a multivariable MR analysis. This analysis used summary statistics from genome-wide association studies (GWAS) of MDD and five lipid traits: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, total cholesterol and triglycerides (TG), encompassing 5 237 893 individuals of European and East Asian ancestries. For MDD, a total of 598 701 individuals were included, with 500 199 individuals of European ancestry (Ncase=170 756, Ncontrol=329 443) and 98 502 of East Asian ancestry (Ncase=12 588, Ncontrol=85 914). Lipid data were collected from 4 639 192 individuals through the Global Lipids Genetics Consortium (European, N=4 096 085;East Asian, N=543 107). Next, we used the two-step MR to explore the mediating factors between MDD and TG, and the risk factors affecting TG through MDD. Finally, we conducted a GWAS meta-analysis and enrichment analysis.Results In univariable MR, we observed a negative causal effect of low-density lipoprotein on MDD in both European populations (IVW: odds ratio (OR): 0.972, 95% confidence interval (CI) 0.947 to 0.998, p=0.037) and East Asian populations (IVW: OR: 0.928, 95% CI 0.864 to 0.997, p=0.042). Additionally, we identified a bidirectional causal relationship between TG and MDD, with TG having a causal effect on MDD (IVW: OR: 1.052, 95% CI 1.020 to 1.085, p=0.001) and MDD having a causal effect on TG (IVW: OR: 1.075, 95% CI 1.047 to 1.104, p<0.001). Multivariable MR analysis further supported the role of TG in MDD (OR: 1.205, 95% CI 1.034 to 1.405, p=0.017). CAUSE estimates indicated that the causal model of MDD on TG provided a better fit than the sharing model (p=0.003), while the association of TG on MDD was more likely due to horizontal correlated pleiotropy than causality. Mediation analyses revealed that waist-hip ratio (WHR) mediated 69% of the total causal effect of MDD on TG, while other identified risk factors exhibited lower mediating proportions either mediated through MDD (≤17%) or originating from MDD (≤29%). The GWAS meta-analysis highlighted potential pathways related to lipid processes and nucleosome assembling, with significant cell types identified in brain regions and liver tissues.Conclusions The findings indicate that genetic proxies of MDD are associated with elevated levels of TG, with WHR serving as a clinical indicator of the association. This suggests that interventions targeting WHR may be effective in reducing TG levels in patients with MDD.展开更多
Background The patient-reported Dimensional Anhedonia Rating Scale(DARS)has been adapted into Chinese,so there is a need to evaluate its measurement properties in a Chinese population.Aims To evaluate the reliability ...Background The patient-reported Dimensional Anhedonia Rating Scale(DARS)has been adapted into Chinese,so there is a need to evaluate its measurement properties in a Chinese population.Aims To evaluate the reliability and validity of the DARS among Chinese individuals with major depressive disorder(MDD)and its treatment sensitivity in a prospective clinical study.Methods Data were from a multicentre,prospective clinical study(NCT03294525),which recruited both patients with MDD,who were followed for 8 weeks,and healthy controls(HCs),assessed at baseline only.The analysis included confirmatory factor analysis,validity and sensitivity to change.Results Patients’mean(standard deviation(SD))age was 34.8(11.0)years,with 68.7%being female.75.2%of patients with MDD had melancholic features,followed by 63.8%with anxious distress.Patients had experienced MDD for a mean(SD)of 9.2(18)months.DARS scores covered the full range of severity with no major floor or ceiling effects.Confirmatory factor analysis showed adequate fit statistics(comparative fit index 0.976,goodness-of-fit index 0.935 and root mean square error of approximation 0.055).Convergent validity with anhedonia-related measures was confirmed.While the correlation between the DARS and the Hamilton Depression Rating Scale was not strong(r=0.31,baseline),the DARS was found to differentiate between levels of depression.Greater improvements in DARS scores were seen with the Hamilton Rating Scale for Depression responder group(effect size 1.16)compared with the non-responder group(effect size 0.46).Conclusions This study comprehensively evaluated the measurement properties of the DARS using a Chinese population with MDD.Overall,the Chinese version of DARS demonstrates good psychometric properties and has been found to be responsive to change during antidepressant treatment.The DARS is a suitable scale for assessing patient-reported anhedonia in future clinical trials.展开更多
基金Supported by Key Research and Development Program of Shaanxi Province,China,No.2024SF-YBXM-078.
文摘BACKGROUND Non-suicidal self-injury(NSSI)is common among adolescents with depressive disorders and poses a major public health challenge.Rumination,a key cognitive feature of depression,includes different subtypes that may relate to NSSI through distinct psychological mechanisms.However,how these subtypes interact with specific NSSI behaviors remains unclear.AIM To examine associations between rumination subtypes and specific NSSI behaviors in adolescents.METHODS We conducted a cross-sectional study with 305 hospitalized adolescents diagnosed with depressive disorders.The subjects ranged from 12-18 years in age.Rumi-nation subtypes were assessed using the Ruminative Response Scale,and 12 NSSI behaviors were evaluated using a validated questionnaire.Network analysis was applied to explore symptom-level associations and identify central symptoms.RESULTS The network analysis revealed close connections between rumination subtypes and NSSI behaviors.Brooding was linked to behaviors such as hitting objects and burning.Scratching emerged as the most influential NSSI symptom.Symptomfocused rumination served as a key bridge connecting rumination and NSSI.CONCLUSION Symptom-focused rumination and scratching were identified as potential intervention targets.These findings highlight the psychological significance of specific cognitive-behavioral links in adolescent depression and suggest directions for tailored prevention and treatment.However,the cross-sectional,single-site design limits causal inference and generalizability.Future longitudinal and multi-center studies are needed to confirm causal pathways and verify the generalizability of the findings to broader adolescent populations.
基金funded by the Construction Project of the"Flagship"Department of Chinese and Western Medicine Coordination(LiuL/2024-221)the 2024 Medical Service and Security Capacity Improvement Project(National Clinical Key Specialty Construction)(LiuL/Huwei Medical/2024-65)+5 种基金the Shanghai Traditional Chinese Medicine Standardization Project(LiuL/No.2023JSP03)the Shanghai Key Discipline Construction Project of Traditional Chinese Medicine(Clinical)(LiuL/2024-No.3)the Shanghai Technical Standardization Management and Promotion Project(LiuL/No.SHDC22023212)the Shanghai Municipal Health Commission Traditional Chinese Medicine Research Project(2022)(LiuL/No.2022Cx004)Clinical research project of Shanghai Health Commission-Youth Project(LW/No.20214Y0056)Shanghai Institute of Traditional Chinese Medicine for Mental Health(LW/No.SZB2023201).
文摘INTRODUCTION.Depressive disorders are mental illnesses that seriously affect public health.There are approximately 320 million patients with depression worldwide,accounting for 4.4% of the total disease burden.1Depression leads to social and occupational impairment,diminished quality of life and an elevated risk of death by suicide.
文摘Background Mental disorders rank among the leading contributors to the global disease burden, with depressive disorders being among the most prevalent.Aims The objective of this study is to examine the prevalence, incidence and years lived with disability (YLDs) associated with depressive disorders, particularly major depressive disorder and dysthymia, in Iran from 1990 to 2021. To achieve this, the research focused on analysing these metrics across various dimensions, including temporal trends, sex differences, age categories and subnational regions.Methods The data used in this study are sourced directly from the Institute for Health Metrics and Evaluation, ensuring that the information is both authoritative and reliable. All-age count estimates and age-standardised rates (per 100 000) were calculated for prevalence, incidence and YLDs. The disease burden indicators were analysed for the period spanning from 1990 to 2021, stratified by sex, age and location. The percentage change between 1990 and 2021 was also documented. The 95% uncertainty interval (UI) was reported for each of the reported estimates.Results The prevalence of depressive disorders in Iran demonstrated a notable upward trend from 1990 to 2021, with the rate of growth being particularly pronounced within the country. The age-standardised prevalence rate per 100 000 individuals for depressive disorders in Iran was 5609 (95% UI 4810 to 6488). By 2021, the number of depression cases in Iran reached 5.2 million, which is approximately 2.37 times the figure reported in 1990. The prevalence of depressive disorders was notably higher among females compared with males. The age-standardised prevalence rate per 100 000 individuals for males was 4184 (95% UI 3545 to 4929). For females, this figure was significantly greater, reaching 7077 (95% UI 6115 to 8172). Out of the total reported cases of depressive disorders in Iran, 3.2 million were observed in females, while males accounted for 2 million cases.Conclusions The findings highlighted the considerable impact of depressive disorders in Iran, both nationally and regionally, while also revealing variations across sex and age groups. Given the shifts in the demographic structure and the growing burden of these disorders, it is essential to prioritise screening initiatives, education programmes and strategies aimed at enhancing mental health awareness and ensuring improved access to mental health services in health policy planning.
文摘This paper examines the correlation between depressive disorders and intestinal flora.Depression is a common affective disorder characterized by low mood,loss of interest,anhedonia,high incidence,high recurrence rate,high disability rate,and high medical costs.The incidence and harmfulness of depressive disorder are gradually increasing,and its etiology is complex and diverse,among which the abnormal intestinal flora is considered to be one of the causes of depressive disorder.This article reviews the results of several studies that found intestinal flora imbalance in depressed patients,including changes in the type and quantity of flora and changes in metabolic pathways.In addition,antibiotic and probiotic treatments have also been shown to be effective in alleviating depressive symptoms,further indicating the importance of intestinal flora disturbances in the pathogenesis of depression.We also explored the relationship between intestinal flora and the pathogenesis of depressive disorders.Through neuro-immuno-endo-crine-metabolic pathways,intestinal flora can affect the function of the central nervous system,cause changes in the host’s mental behavior,and lead to or aggravate depressive symptoms.Overall,this study not only found differences in the intestinal flora of patients with depressive disorders but also revealed the potential role of intestinal flora in the pathogenesis.Importantly,this provides a new theoretical basis for further clarifying the pathogenesis of depressive disorders and formulating diagnosis and treatment strategies.
基金Research Project of Yunnan Provincial Psychiatric Hospital(No:Provincial Jing Research 2022-13)。
文摘To review the current research status of positive thought stress reduction therapy(PTSRT),psychosocial functioning of patients with depressive disorders,the shortcomings and outlook of the influence of PTSRT on positive thought awareness,and psychosocial functioning of patients with depressive disorders.This review has the objective to provide clinical healthcare personnel with essential information about the use of PTSRT to improve the level of positive thought and psychosocial functioning of patients with depressive disorders.
文摘Background:Depressive disorders have become a major risk factor that influences people’s health worldwide,but few studies have focused on the prevalence of depressive disorders among the Chinese elderly and their characteristics of depressive disorders.The current study is a secondary data analysis designed to explore the profiles of depressive disorders in the Chinese elderly by latent profile analysis.Methods:The China Health and Retirement Longitudinal Study(CHARLS 2018)database will be used for analysis.Latent profile analysis will be employed to identify the profiles of depressive disorders using data from the subsection“CESD Depression”in the section“Cognition and Depression”.Stepwise multinomial logistic regression will be used to explore the influencing factors of different profiles of depressive disorders among the Chinese elderly.Discussion:The prevalence of depressive disorders among the Chinese elderly and their profiles of depressive disorders will be reported.Possible influencing factors may include some demographic characteristics and associated psychological elements,which will provide a reference for further research and precise intervention.
基金This review was supported by grants from the National Natural Science Key Foundation of China(81830040 and 82130042)the China Science and Technology Innovation 2030-Major Project(2022ZD0211701 and 2021ZD0200700)+1 种基金the Science and Technology Program of Guangdong(2018B030334001)the Science and Technology Program of Shenzhen(GJHZ20210705141400002,KCXFZ20211020164543006,JCYJ20220818101615033,and 202206063000055).
文摘Major depressive disorder(MDD)is a highly heterogeneous mental disorder,and its complex etiology and unclear mechanism are great obstacles to the diagnosis and treatment of the disease.Studies have shown that abnormal functions of the visual cortex have been reported in MDD patients,and the actions of several antidepressants coincide with improvements in the structure and synaptic functions of the visual cortex.In this review,we critically evaluate current evidence showing the involvement of the malfunctioning visual cortex in the pathophysiology and therapeutic process of depression.In addition,we discuss the molecular mechanisms of visual cortex dysfunction that may underlie the pathogenesis of MDD.Although the precise roles of visual cortex abnormalities in MDD remain uncertain,this undervalued brain region may become a novel area for the treatment of depressed patients.
基金Supported by MHLW Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes program,No.21FA0201and MEXT/JSPS,No.17H00872.
文摘BACKGROUND Electroconvulsive therapy(ECT)is used to treat major depressive disorder(MDD).Relapse is often observed even after successful ECT,followed by adequate pharmaceutical treatment for MDD.AIM To investigate the diagnostic factors and treatment strategies associated with depression relapse.METHODS We analyzed the relationships between relapse,the diagnostic change from MDD to bipolar disorder(BP),and treatment after the initial ECT.We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital.The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP.A receiver operating characteristic(ROC)curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.RESULTS Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study.Compared with the MDD participants,more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission(65.6%vs 15.1%,P<0.001;relative risk=4.35,95%CI:2.19-8.63,P<0.001).Twenty-nine patients experienced relapses during the three-year follow-up.In 21(72.4%,21/29)patients with relapse,the diagnosis was changed from MDD to BP.The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients(9.63±10.4 mo vs 3.38±3.77 mo,P=0.022);for most patients,the interval was less than one month.The relative risk of depressive symptoms based on diagnostic changes was 4.35(95%confidence interval:2.19–8.63,P<0.001),and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756(95%CI:0.562-0.895,P=0.007).CONCLUSION It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.
基金Yunnan Province Psychiatric Hospital Project(Shengjing Scientific Research 2022-08).
文摘In recent years,non-suicidal self-injury(NSSI)behavior has emerged in a large number of adoles-cent depression.NSSI associated with adolescent depres-sion may be an addictive behavior,which has many sim-ilar neurobiological mechanisms to substance addiction.Brain-derived neurotrophic factor(BDNF)and precursor of BDNF(proBDNF)play an important role in addiction behavior,and they may be related to endogenous opioid receptors.The location and distribution of opioidμre-ceptors in the brain are related to reward,motivation and emotion regulated by behavioral addiction.The purpose of this paper is to review the general situation,mechanism and relationship between the characteristics of NSSI be-havior addiction and brain-derived nutritional factors in adolescents with depression.
基金supported by projects from Shanghai Putuo District Municipal Health Committee(ptkwws202413)Shanghai Municipal Health Commission(202340018)+2 种基金Shanghai Hospital Development Center(Data Sharing and Emulation of Clinical Trials,CCS-DASET:SHDC2024CRI008)Shanghai Changning District Municipal Commission of Health(CNWJXY026)School of Innovation and Entrepreneurship,Tongji University(S202310247388,X2024085 and X2024048).
文摘Background Biomarkers for predicting suicide risk in hospitalised patients with mental disorders have been understudied.Currently,suicide risk assessment tools based on objective indicators are limited in China.Aims To examine the value of various biomarkers in suicide risk prediction and develop a risk assessment model with clinical utility using machine learning.Methods This cohort study analysed patients with major depressive disorder(MDD) who were hospitalised for the first time between January 2016 and March 2023 from four specialised mental health institutions.A total of 139 features,including biomarker measurements,medical orders and psychological scales,were assessed for analysis.Their suicide risk was evaluated by qualified nurses using Nurse s Global Assessment of Suicide Risk within 1 week after admission.Five machine learning models were trained with 10-fold cross-validation across three hospitals and were externally validated in an independent cohort.The primary performance was assessed using the area under the receiver operating characteristic curve(AUROC).The model was interpreted using the SHapley Additive exPlanations(SHAP) analysis.Biomarker importance was evaluated by comparing model performance with and without these biomarkers.Results Of 3143 patients with MDD included in this study,the incidence of high suicide risk within 1 week after first admission was 660(21.0%).Among all models,the Extreme Gradient Boosting can more effectively predict future risks,with an AUROC higher than 0.8(p<0.001).The SHAP values identified the 10 most important features,including five biomarkers.After clustering analysis,electroconvulsive therapy,physical restraint,β2-microglobulin and triiodothyronine were found to have heterogeneous effects on suicide risk.Combining biomarkers with other data from electronic health records significantly improved the performance and clinical utility of machine learning models based on demographics,diagnosis,laboratory tests,medical orders and psychological scales.Conclusions This study demonstrates the potential for a biomarker-based suicide risk assessment for patients with MDD,emphasising the interaction between biomarkers and therapeutic interventions.
基金This work was supported by grants from the National Natural Science Foundation of China(No.72074011)Special Project for Director,China Center for Evidence-Based Traditional Chinese Medicine(No.2020YJSZX-2)+1 种基金the second batch of Key Projects of Scientific Act for Drug Regulation of China(No.[2021]37-10)Sci-Tech Innovation 2030-Major Project of Brain Science and Brain-Inspired Intelligence Technology(No.2021ZD0200600).
文摘Background:The optimal antidepressant dosages remain controversial.This study aimed to analyze the efficacy of antidepressants and characterize their dose-response relationships in the treatments of major depressive disorders(MDD).Methods:We searched multiple databases,including the Embase,Cochrane Central Register of Controlled Trials,PubMed,and Web of Science,for the studies that were conducted between January 8,2016,and April 30,2023.The studies are double-blinded,randomized controlled trials(RCTs)involving the adults(≥18 years)with MDD.The primary outcomes were efficacy of antidepressant and the dose-response relationships.A frequentist network meta-analysis was conducted,treating participants with various dosages of the same antidepressant as a single therapy.We also implemented the model-based meta-analysis(MBMA)using a Bayesian method to explore the dose-response relationships.Results:The network meta-analysis comprised 135,180 participants from 602 studies.All the antidepressants were more effective than the placebo;toludesvenlafaxine had the highest odds ratio(OR)of 4.52(95%confidence interval[CI]:2.65-7.72),and reboxetine had the lowest OR of 1.34(95%CI:1.14-1.57).Moreover,amitriptyline,clomipramine,and reboxetine showed a linear increase in effect size from low to high doses.The effect size of toludesvenlafaxine increased significantly up to 80 mg/day and subsequently maintained the maximal dose up to 160 mg/day while the predictive curves of nefazodone were fairly flat in different dosages.Conclusions:Although most antidepressants were more efficacious than placebo in treating MDD,no consistent dose-response relationship between any antidepressants was observed.For most antidepressants,the maximum efficacy was achieved at lower or middle prescribed doses,rather than at the upper limit.
文摘Clinically differentiating bipolarⅡdisorder(BD-Ⅱ)from major depressive disorder(MDD)remains a significant challenge in modern psychiatry.These two conditions share substantial clinical symptomatology,making accurate diagnosis difficult in routine clinical practice.Misdiagnosis may lead to inappropriate treatment strategies,increased psychological and physical burdens,reduced quality of life,and impaired social functioning.Genetic overlap may partially explain the clinical similarities between MDD and BD-Ⅱ,and biomarkers along with neuroimaging techniques are receiving increasing attention as tools to aid in diagnosis.For example,electroencephalography has been shown to effectively distinguish between unipolar depression and bipolar depression;serum levels of glycogen synthase kinase-3 have also been investigated as a potential tool for differentiating between the two disorders.A comprehensive assessment integrating clinical characteristics,genetic basis research,and multimodal evaluations using neuroimaging and biomarkers through a multidisciplinary approach will help enhance clinicians'ability to distinguish between MDD and BD-Ⅱ.By improving diagnostic accuracy,more personalized and effective treatment strategies can be developed,ultimately improving patients'health outcomes and quality of life.
基金supported by the National Natural Science Foundation of China(T2241028)STI2030-Major Projects[2021ZD0203000(2021ZD0203003)].
文摘Mental health disorders have emerged as a critical global health challenge,profoundly impacting individuals,communities,and societies worldwide.The prevalence of mental health problems has been steadily increasing,with~1 in 8 people,equivalent to 970 million individuals suffering from a mental disorder in 2019(https://vizhub.healthdata.org/gbd-results).Anxiety and depressive disorders are predominant,contributing significantly to the burden of mental health issues,according to the World Health Organization.The COVID-19 pandemic has further exacerbated this situation.It led to a notable upsurge in anxiety and major depressive disorders in 2020.Estimates indicate a 26%rise in anxiety and a 28%increase in depression within that year(https://www.who.int/publications/i/item/WHO-2019-nCoVSci_Brief-Mental_health-2022.1)[1].
基金supported by the National Natural Science Foundation of China(grant numbers 42307133 and 82073573)the Young Elite Scientists Sponsorship Program by CAST(grant number 2023QNRC001)the Beijing Education Science Planning Project(grant number ACEA24118).
文摘Objective To analyze trends in the depressive disorder burden across BRICS Plus countries and their associations with age,period,and cohort effects.Methods Prevalence,incidence,and disability-adjusted life years(DALYs)estimates of the depressive disorder burden were obtained from the Global Burden of Disease Study,2021.This study further assessed the period and cohort effects on depressive disorders from 1992 to 2021 using an age-periodcohort model.Results In 2021,152.6 million people had depressive disorders across the BRICS Plus countries,showing an increase of 85.6%from 1990,which caused 23.7 million DALYs.The age-standardized prevalence rate(ASPR)of depressive disorders declined by 4.1%from 1990 to 2019,followed by a substantial increase(11.3%)from 2019 to 2021.Furthermore,period and cohort effects showed that the depressive disorder burden increased over time and in the recent birth cohort.Meanwhile,the depressive disorder burden increased among adolescents,young adults,and older adults in the BRICS Plus group.Ultimately,projections for 2050 suggest a 150.0%increase in the ASPR.Conclusion This study revealed a heavy depressive disorder burden across BRICS Plus countries,especially among adolescents,young adults,and older adults.This highlights the need to strengthen specific public health strategies and policies targeting populations with different priorities.
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Supported by Hubei Provincial Department of Science and Technology Natural Fund,No.2024AFC056the Open Fund of the Mental Health Research Institute at Three Gorges University,No.YCXL-23-11.
文摘BACKGROUND Major depressive disorder(MDD)with comorbid anxiety is an intricate psychiatric condition,but limited research is available on the degree centrality(DC)between anxious MDD and nonanxious MDD patients.AIM To examine changes in DC values and their use as neuroimaging biomarkers in anxious and non-anxious MDD patients.METHODS We examined 23 anxious MDD patients,30 nonanxious MDD patients,and 28 healthy controls(HCs)using the DC for data analysis.RESULTS Compared with HCs,the anxious MDD group reported markedly reduced DC values in the right fusiform gyrus(FFG)and inferior occipital gyrus,whereas elevated DC values in the left middle frontal gyrus and left inferior parietal angular gyrus.The nonanxious MDD group exhibited surged DC values in the bilateral cerebellum IX,right precuneus,and opercular part of the inferior frontal gyrus.Unlike the nonanxious MDD group,the anxious MDD group exhibited declined DC values in the right FFG and bilateral calcarine(CAL).Besides,declined DC values in the right FFG and bilateral CAL negatively correlated with anxiety scores in the MDD group.CONCLUSION This study shows that abnormal DC patterns in MDD,especially in the left CAL,can distinguish MDD from its anxiety subtype,indicating a potential neuroimaging biomarker.
基金supported by the National Natural Science Foundation of China,No.81971269 (to DP)the Science and Technology Commission of Shanghai,No.YDZX20213100001003 (to DP)。
文摘In the pathogenesis of major depressive disorder, chronic stress-related neuroinflammation hinders favorable prognosis and antidepressant response. Mitochondrial DNA may be an inflammatory trigger, after its release from stress-induced dysfunctional central nervous system mitochondria into peripheral circulation. This evidence supports the potential use of peripheral mitochondrial DNA as a neuroinflammatory biomarker for the diagnosis and treatment of major depressive disorder. Herein, we critically review the neuroinflammation theory in major depressive disorder, providing compelling evidence that mitochondrial DNA release acts as a critical biological substrate, and that it constitutes the neuroinflammatory disease pathway. After its release, mitochondrial DNA can be carried in the exosomes and transported to extracellular spaces in the central nervous system and peripheral circulation. Detectable exosomes render encaged mitochondrial DNA relatively stable. This mitochondrial DNA in peripheral circulation can thus be directly detected in clinical practice. These characteristics illustrate the potential for mitochondrial DNA to serve as an innovative clinical biomarker and molecular treatment target for major depressive disorder. This review also highlights the future potential value of clinical applications combining mitochondrial DNA with a panel of other biomarkers, to improve diagnostic precision in major depressive disorder.
文摘Major depressive disorder(MDD),a psychiatric disorder characterized by functional brain deficits,poses considerable diagnostic and treatment challenges,especially in adolescents owing to varying clinical presentations.Biomarkers hold substantial clinical potential in the field of mental health,enabling objective assessments of physiological and pathological states,facilitating early diagnosis,and enhancing clinical decision-making and patient outcomes.Recent breakthroughs combine neuroimaging with machine learning(ML)to distinguish brain activity patterns between MDD patients and healthy controls,paving the way for diagnostic support and personalized treatment.However,the accuracy of the results depends on the selection of neuroimaging features and algorithms.Ensuring privacy protection,ML model accuracy,and fostering trust are essential steps prior to clinical implementation.Future research should prioritize the establishment of comprehensive legal frameworks and regulatory mechanisms for using ML in MDD diagnosis while safeguarding patient privacy and rights.By doing so,we can advance accuracy and personalized care for MDD.
基金supported by the National Natural Science Foundation of China(82071500,82271540,32370724,82401759,81871055,32070679)Shanghai Clinical Research Center for Mental Health(19MC1911100)+11 种基金Shanghai Key Laboratory of Psychotic Disorders(13dz2260500)Shanghai Municipal Administrator of Traditional Chinese Medicine(ZY-(2021-2023)-0207-01)Shanghai Municipal Health Commission Collaborative Innovation Group(2024CXJQ03)Shanghai Science and Technology Innovation Action Program(24JS2840400,24ZR1439900,21Y11921100)Shanghai Municipal Science and Technology Major Project,the National Key R&D Program of China(2023YFA0913804,2024YFA0916603,2022FYC2503300)the Program of Shanghai Academic/Technology Research Leader(21XD1423300)Shanghai Pujiang Program(21PJD063)Shanghai Municipal Science and Technology Major Project(2017SHZDZX01)Shanghai Municipal Commission of Education(2024AIZD016)the National Key R&D Program of China(2019YFA0905400,2017YFC0908105,2021YFC2702100)National Program for Support of Top-Notch Young Professionals,Taishan Scholar Program of Shandong Province(tstp20240526)the Natural Science Foundation of Shandong Province(ZR2019YQ14,YDZX2021009,2021ZDSYS06).
文摘Background Numerous studies have consistently demonstrated that a considerable proportion of patients with major depressive disorder (MDD) frequently exhibit pronounced dyslipidaemia. However, the causal dynamics between MDD and dyslipidaemia remain elusive.Aims To comprehensively disentangle the genetic causality between MDD and various phenotypes of blood lipids, thereby facilitating the advancement of management strategies for these conditions.Methods We conducted a two-sample univariable Mendelian randomisation (MR) analysis using different models, including the inverse variance weighted (IVW) method and causal analysis using the summary effect (CAUSE) estimates, as well as a multivariable MR analysis. This analysis used summary statistics from genome-wide association studies (GWAS) of MDD and five lipid traits: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, total cholesterol and triglycerides (TG), encompassing 5 237 893 individuals of European and East Asian ancestries. For MDD, a total of 598 701 individuals were included, with 500 199 individuals of European ancestry (Ncase=170 756, Ncontrol=329 443) and 98 502 of East Asian ancestry (Ncase=12 588, Ncontrol=85 914). Lipid data were collected from 4 639 192 individuals through the Global Lipids Genetics Consortium (European, N=4 096 085;East Asian, N=543 107). Next, we used the two-step MR to explore the mediating factors between MDD and TG, and the risk factors affecting TG through MDD. Finally, we conducted a GWAS meta-analysis and enrichment analysis.Results In univariable MR, we observed a negative causal effect of low-density lipoprotein on MDD in both European populations (IVW: odds ratio (OR): 0.972, 95% confidence interval (CI) 0.947 to 0.998, p=0.037) and East Asian populations (IVW: OR: 0.928, 95% CI 0.864 to 0.997, p=0.042). Additionally, we identified a bidirectional causal relationship between TG and MDD, with TG having a causal effect on MDD (IVW: OR: 1.052, 95% CI 1.020 to 1.085, p=0.001) and MDD having a causal effect on TG (IVW: OR: 1.075, 95% CI 1.047 to 1.104, p<0.001). Multivariable MR analysis further supported the role of TG in MDD (OR: 1.205, 95% CI 1.034 to 1.405, p=0.017). CAUSE estimates indicated that the causal model of MDD on TG provided a better fit than the sharing model (p=0.003), while the association of TG on MDD was more likely due to horizontal correlated pleiotropy than causality. Mediation analyses revealed that waist-hip ratio (WHR) mediated 69% of the total causal effect of MDD on TG, while other identified risk factors exhibited lower mediating proportions either mediated through MDD (≤17%) or originating from MDD (≤29%). The GWAS meta-analysis highlighted potential pathways related to lipid processes and nucleosome assembling, with significant cell types identified in brain regions and liver tissues.Conclusions The findings indicate that genetic proxies of MDD are associated with elevated levels of TG, with WHR serving as a clinical indicator of the association. This suggests that interventions targeting WHR may be effective in reducing TG levels in patients with MDD.
基金supported by the National Natural Science Foundation of China(No.82371530,82171529)the Capital Health Development Special Research Project(2022-1-4111)the National Key Technology R and D Program(No.2015BAI13B01).
文摘Background The patient-reported Dimensional Anhedonia Rating Scale(DARS)has been adapted into Chinese,so there is a need to evaluate its measurement properties in a Chinese population.Aims To evaluate the reliability and validity of the DARS among Chinese individuals with major depressive disorder(MDD)and its treatment sensitivity in a prospective clinical study.Methods Data were from a multicentre,prospective clinical study(NCT03294525),which recruited both patients with MDD,who were followed for 8 weeks,and healthy controls(HCs),assessed at baseline only.The analysis included confirmatory factor analysis,validity and sensitivity to change.Results Patients’mean(standard deviation(SD))age was 34.8(11.0)years,with 68.7%being female.75.2%of patients with MDD had melancholic features,followed by 63.8%with anxious distress.Patients had experienced MDD for a mean(SD)of 9.2(18)months.DARS scores covered the full range of severity with no major floor or ceiling effects.Confirmatory factor analysis showed adequate fit statistics(comparative fit index 0.976,goodness-of-fit index 0.935 and root mean square error of approximation 0.055).Convergent validity with anhedonia-related measures was confirmed.While the correlation between the DARS and the Hamilton Depression Rating Scale was not strong(r=0.31,baseline),the DARS was found to differentiate between levels of depression.Greater improvements in DARS scores were seen with the Hamilton Rating Scale for Depression responder group(effect size 1.16)compared with the non-responder group(effect size 0.46).Conclusions This study comprehensively evaluated the measurement properties of the DARS using a Chinese population with MDD.Overall,the Chinese version of DARS demonstrates good psychometric properties and has been found to be responsive to change during antidepressant treatment.The DARS is a suitable scale for assessing patient-reported anhedonia in future clinical trials.
