Annual Research Review: Defining and treating pediatric treatment‐resistant depression

Journal of Child Psychology and Psychiatry, Год журнала: 2020, Номер 61(3), С. 312 - 332

Опубликована: Фев. 4, 2020

Background Adolescent major depressive disorder (MDD) is a significant health problem, associated with substantial morbidity, cost, and mortality. Depression risk factor for suicide, which now the second leading cause of death in young people. Up to twenty per cent adolescents will experience MDD before adulthood, while proportion improve standard‐of‐care treatments (psychotherapy medication), roughly one third not. Methods Here, we have reviewed literature order discuss concept treatment‐resistant depression (TRD) adolescence, examine factors, diagnostic difficulties, challenges evaluating symptom improvement, providing guidance on how define adequate medication psychotherapy treatment trials. Results We propose staging model adolescent TRD review literature. The evidence base first‐ second‐line primarily derives from four large pediatric clinical trials (TADS, TORDIA, ADAPT, IMPACT). After two medications trial evidence‐based failed alleviate symptoms, becomes quite thin subsequent treatments. effectiveness switches, augmentation, interventional (i.e., transcranial magnetic stimulation, electroconvulsive therapy, ketamine) TRD. Comparisons are drawn adult literature, areas future research highlighted. Conclusions As limited this population, careful consideration known risks side effects escalated (e.g., mood stabilizers atypical antipsychotics) warranted weighed against potential, but often untested, benefits.

Язык: Английский

---

Prevalence and Trends in Suicidal Behavior Among US Military Veterans During the COVID-19 Pandemic

JAMA Psychiatry, Год журнала: 2021, Номер 78(11), С. 1218 - 1218

Опубликована: Авг. 25, 2021

The COVID-19 pandemic has raised considerable concerns about increased risk for suicidal behavior among US military veterans, who already had elevated rates of suicide before the pandemic.To examine longitudinal changes in from to nearly 10 months into and identify factors COVID-related variables associated with new-onset ideation (SI).This population-based prospective cohort study used data first second wave National Health Resilience Veterans Study, conducted November 18, 2019, December 19, 2020. Median dates collection prepandemic peripandemic assessments were 21, 14, 2020, after start public health emergency US. A total 3078 veterans aged 22 99 years included study.Past-year SI attempts.In this (mean [SD] age, 63.2 [14.7] years; 91.6% men; 79.3% non-Hispanic White 10.3% Black 6.0% Hispanic veterans), 233 (7.8%) reported past-year SI, 8 (0.3%) attempts at assessment. Past-year decreased 10.6% (95% CI, 9.6%-11.8%) 7.8% 6.9%-8.8%). 82 (2.6%) developed over follow-up period. After adjusting sociodemographic characteristics, strongest COVID-19-related low social support (odds ratio [OR], 2.77; 95% 1.46-5.28), attempt history (OR, 6.31; 2.71-14.67), lifetime posttraumatic stress disorder and/or depression 2.25; 1.16-4.35), alcohol use severity 1.06; 1.01-1.12), infection 2.41; 1.41-5.01), worsening relationships during 1.47; 1.16-1.88).The results suggest that despite grim forecasts would exacerbate suicidality rate population level pandemic. infected more than twice as likely report which suggests need future research potential link between behavior.

Язык: Английский

---

Moral injury and suicidal behavior among US combat veterans: Results from the 2019–2020 National Health and Resilience in Veterans Study

Depression and Anxiety, Год журнала: 2021, Номер 38(6), С. 606 - 614

Опубликована: Март 5, 2021

Background Recent research suggests that exposure to potentially morally injurious experiences (PMIEs) may be associated with increased risk for suicidal behavior among US combat veterans, but population-based data on these associations are scarce. This study examined the association between PMIEs current ideation (SI), lifetime suicide plans (SP), and attempts (SA) in a contemporary, nationally representative sample of veterans. Methods Data were analyzed from 2019–2020 National Health Resilience Veterans Study, which surveyed veterans (n = 1321). assessed using Moral Injury Events Scale (MIES). Multivariable logistic regression analyses conducted examine MIES total scores specific types behavior. Results Thirty-six point three percent reported at least one PMIE. Perceived transgressions by self, others, betrayal SI, SP, SA (odds ratios [ORs] 1.21–1.27, all p s < .05), after adjusting sociodemographic, trauma, psychiatric characteristics. significantly, albeit weakly, SP (OR 1.03, .01), not SI/SA. Depression, posttraumatic stress disorder (PTSD), age emerged as strongest correlates SI/SP/SA (14.9%–38.1% explained variance), while accounted comparatively modest amount variance (3.3%–8.9%). Conclusions Reports prevalent behavior, above beyond severity exposure, PTSD, depression. Implications clinical practice future discussed, including need methodological advancements measurement moral injury.

Язык: Английский

---

Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury: analysis of baseline data from the ADVANCE cohort study

The Lancet Psychiatry, Год журнала: 2022, Номер 9(7), С. 547 - 554

Опубликована: Июнь 16, 2022

BackgroundThe long-term psychosocial outcomes of UK armed forces personnel who sustained serious combat injuries during deployment to Afghanistan are largely unknown. We aimed assess rates probable post-traumatic stress disorder (PTSD), depression, anxiety, and mental health-associated multimorbidity in a representative sample serving ex-serving military with injuries, compared matched uninjured personnel.MethodsThis analysis used baseline data from the ADVANCE cohort study, which injured individuals were recruited deployed had physical according records provided by Ministry Defence. Participants group frequency-matched age, rank, regiment, deployment, role on deployment. through postal, email, telephone invitations. completed comprehensive health assessment, including assessment self-reported measures (PTSD Checklist, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7). The PTSD, groups. study is ongoing registered ISRCTN registry, ISRCTN57285353.Findings579 combat-injured participants (161 amputation 418 non-amputation injuries) 565 included analysis. median age 33 years (IQR 30–37 years) at time assessment. 90·3% identified as White 9·7% all other ethnic PTSD (16·9% [n=89] vs 10·5% [n=53]; adjusted odds ratio [AOR] 1·67 [95% CI 1·16–2·41], depression (23·6% [n=129] 16·8% [n=87]; AOR 1·46 [1·08–2·03]), anxiety (20·8% [n=111] 13·5% [n=71]; 1·56 [1·13–2·24]) (15·3% [n=81] 9·8% [n=49]; 1·62 [1·12–2·49]) greater than group. Minimal differences reporting any poor outcome noted between injury subgroup (AOR range 0·77–0·97), whereas up double for 1·74–2·02).InterpretationSerious associated outcomes. However, type influenced this relationship. Regardless injury, represents present general population, well increased psychological burden multimorbidity.FundingThe Charity.

Язык: Английский

---

Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults

American Journal of Psychiatry, Год журнала: 2023, Номер 180(7), С. 483 - 494

Опубликована: Апрель 11, 2023

Objective: The authors sought to determine the impact of selected social determinants health (SDoH) on psychological and well-being (defined as depression, cognition, self-rated health) among Black Hispanic/Latinx adults relative White 51–89 years age. Methods: Disparities in depressive symptomatology, were measured 2,306 non–Hispanic/Latinx Black, 1,593 Hispanic/Latinx, 7,244 who participated Health Retirement Study (N=11,143). Blinder-Oaxaca decomposition was used examine whether differences SDoH explained a larger share disparities than age, sex, measures health, behaviors, care utilization. Selected included education, parental number worked, marital status, veteran geographic residence, nativity income, insurance coverage. Results: reported worse adults. associated with proportion Black–White symptomatology (51%), cognition (39%), (37%) Hispanic/Latinx–White disparity (76%) (75%), but age physical correlated (28%). Education, parity these disparities. Conclusions: Differences underlie racial/ethnic older are key SDoH.

Язык: Английский

---

The Social Psychology of Trauma

Опубликована: Апрель 4, 2024

Many of us have been affected by trauma and struggle to manage our health well-being. The social psychological approach highlights how cultural forces, as much individual ones, are central we experience cope with adversity. This book integrates psychology, politics, medicine offer a new understanding that speaks the causes consequences traumatic experiences. Connecting personal political, Muldoon details evidence experiences can, under certain conditions, impact people's political positions appetite for change. perspective reveals socially situated phenomenon linked power privilege or disempowerment disadvantage. discussion will interest those supporting them, well students, researchers, practitioners, policy makers in clinical science. title is available open access on Cambridge Core.

Язык: Английский

---

The National Health and Resilience in Veterans Study: A Narrative Review and Future Directions

Frontiers in Psychiatry, Год журнала: 2020, Номер 11

Опубликована: Дек. 9, 2020

United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population lacking. Such critical to informing design large-scale outreach initiatives, and ensure effectiveness service care delivery both within outside Veterans Affairs healthcare system. The National Health Resilience in Study (NHRVS) is a contemporary, prospective study two independent cohorts ( n = 3,157 1,484) U.S. veterans, which examining longitudinal changes, key risk protective factors for several outcomes. In narrative review, we summarize main findings all NHRVS studies 82) published as June 2020, discuss clinical implications, limitations, future directions study. Review these articles was organized into six major topic areas: post-traumatic stress disorder, suicidality, aging, resilience growth, special topics relevant genetics epigenetics. Collectively, results suggest that while significant minority screen positive mental disorders, majority psychologically resilient. They further prevention treatment efforts designed promote psychosocial characteristics (i.e., resilience, gratitude, purpose life), social connectedness secure attachment, community integration, engagement) help mitigate psychological growth population.

Язык: Английский

---

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

European journal of psychotraumatology, Год журнала: 2020, Номер 11(1)

Опубликована: Март 20, 2020

Background: Moral Injury (MI) is one of the adverse consequences combat. Following exposure to potentially morally injurious events (PMIEs)––events perceived as violations deep moral beliefs by oneself or trusted individuals––a significant minority veterans could develop posttraumatic stress disorder (PTSD) and depression.Objective: The current study represents first attempt apply a network analysis model examine an exploratory empirical conceptualization PMIEs during military service, post-traumatic symptom clusters, depression, combat among Israel Defence Forces veterans.Method: A volunteer sample 191 Israeli were recruited 2017, completed validated self-report questionnaires tapping PMIEs, PTSD, depression in cross-sectional design study. regularized Gaussian graphical was estimated.Results: Network revealed strong bridge associations between PTSD nodes most nodes. PMIE-betrayal negative alterations cognitions mood (NACM) cluster found have bridging function other PTSD. Depression be connected nodes.Conclusions: study's findings offer overview complex relationships clusters veterans. PMIEs––notably, betrayal-based experiences––are related directly through depressive symptoms. Some possible mechanisms for links clinical implications specific interventions are discussed.

Язык: Английский

---

Trauma-Sensitive Yoga for Post-Traumatic Stress Disorder in Women Veterans who Experienced Military Sexual Trauma: Interim Results from a Randomized Controlled Trial

The Journal of Alternative and Complementary Medicine, Год журнала: 2021, Номер 27(S1), С. S - 59

Опубликована: Март 1, 2021

Objective: To conduct an interim analysis of data collected from ongoing multisite randomized controlled trial (RCT) assessing the effectiveness Trauma Center Trauma-Sensitive Yoga (TCTSY) for post-traumatic stress disorder (PTSD) among women veterans with PTSD related to military sexual trauma (MST). The purpose was assess outcomes primary site, which is geographically, demographically, culturally, and procedurally distinct second site. Design: RCT conducted within a Veterans Administration Health Care System. Data collection included preintervention through 3 months postintervention. Participants: Enrollment main site 152 women. sample size intent-to-treat 104. majority were African American (91.3%) mean age 48.46 years. Intervention: TCTSY intervention (n = 58) by TCTSY-certified yoga facilitators consisted 10 weekly 60-min group sessions. control intervention, cognitive processing therapy (CPT; n 46), 12 90-min sessions per protocol clinicians in Clinic. Outcome measures: Clinician Administered Scale DSM-5 (CAPS-5) used current diagnosis symptom severity, including overall four clusters. checklist (PCL-5) obtain self-report total score Results: findings reported here are results one clinical For both CAPS-5 PCL-5, scores all criterion decreased significantly (p < 0.01) over time five multilevel linear models CPT groups, without significant differences between groups. There clinically meaningful improvements seen 51.1%–64.3% subjects 43.5%–73.7% decreasing their points or more. Effect sizes severity large (Cohen's d 1.10–1.18) 0.90–1.40). Intervention completion higher (60.3%) than (34.8%). Symptom improvement occurred earlier (midintervention) (2 weeks postintervention). Safety: no unanticipated adverse events this study. Conclusion: study demonstrate that may be effective treatment yields more quickly, has retention CPT, sustained effect. alternative trauma-focused MST. registered ClinicalTrials.gov (CTR no.: NCT02640690).

Язык: Английский

---

PTSD and obesity in U.S. military veterans: Prevalence, health burden, and suicidality.

Psychiatry Research, Год журнала: 2020, Номер 291, С. 113242 - 113242

Опубликована: Июнь 17, 2020

Язык: Английский

---