Diana Koszycki

Prenatal Social Support, Postnatal Social Support, and Postpartum Depression

PURPOSEnTo assess the association of antenatal and postnatal social support with postpartum depression (PPD).nnnMETHODSnWe carried out a prospective cohort study of 534 pregnant women between February and September 2007 in Hunan, China. The association between prenatal and postnatal social support with PPD was examined.nnnRESULTSnA total of 103 (19.29%) women had PPD. Women with low prenatal and postnatal social support had higher rates of PPD. For prenatal support, PPD was 28.20% in the lowest quartile versus 9.90% in the highest quartile (adjusted odds ratio [OR]: 3.38, 95% confidence interval [CI]=1.64,6.98). For postnatal support, PPD was 44.10% in the lowest quartile versus 5.40% in the highest quartile (adjusted OR: 9.64, 95% CI=4.09, 22.69).nnnCONCLUSIONSnLower or lack of social support is a risk factor of PPD. The association between postnatal social support and PPD is much stronger than that of prenatal social support.

Behavioral, cardiovascular, and neuroendocrine profiles following CCK-4 challenge in healthy volunteers: a comparison of panickers and nonpanickers.

Healthy subjects who panic following systemic cholecystokinin‐tetrapeptide (CCK‐4) challenge typically exhibit a symptom profile reminiscent of that evident among panic patients. However, the biological concomitants of CCK‐4‐induced panic in healthy subjects remain obscure. Accordingly, we evaluated the behavioral, cardiovascular, and neuroendocrine effects of CCK‐4 in panickers and nonpanickers. Predictably, subjects who panicked with CCK‐4 experienced more intense symptoms of panic and greater increases in ratings of fearful and anxious mood than did subjects who did not panic. CCK‐4‐induced increases in diastolic blood pressure, adrenocorticotropic hormone, prolactin, and growth hormone secretion were also significantly enhanced in subjects who panicked. The results of this study demonstrate that the behavioral experience of CCK‐4‐induced panic in healthy individuals is accompanied by marked biological changes and provide confirmation that CCK‐4 is a useful model of panic for research among nonclinical subjects. Depression and Anxiety 8:1–7, 1998.

A multifaith spiritually based intervention for generalized anxiety disorder: a pilot randomized trial†

This pilot trial evaluated the efficacy of a multifaith spiritually based intervention (SBI) for generalized anxiety disorder (GAD). Patients meeting DSM-IV criteria for GAD of at least moderate severity were randomized to either 12 sessions of the SBI (n=11) delivered by a spiritual care counselor or 12 sessions of psychologist-administered cognitive-behavioral therapy (CBT; n=11). Outcome measures were completed at baseline, post-treatment, and 3-month and 6-month follow-ups. Primary efficacy measures included the Hamilton Anxiety Rating Scale, Beck Anxiety Inventory, and Penn State Worry Questionnaire. Data analysis was performed on the intent-to-treat sample using the Last Observation Carried Forward method. Eighteen patients (82%) completed the study. The SBI produced robust and clinically significant reductions from baseline in psychic and somatic symptoms of GAD and was comparable in efficacy to CBT. A reduction in depressive symptoms and improvement in social adjustment was also observed. Treatment response occurred in 63.6% of SBI-treated and 72.3% of CBT-treated patients. Gains were maintained at 3-month and 6-month follow-ups. These preliminary findings are encouraging and suggest that a multifaith SBI may be an effective treatment option for GAD. Further randomized controlled trials are needed to establish the efficacy of this intervention.

Neurohormonal responses to cholecystokinin tetrapeptide: a comparison of younger and older healthy subjects

We recently found that, compared with younger healthy subjects, older healthy subjects had less symptomatic and cardiovascular response to the panicogenic agent cholecystokinin tetrapeptide (CCK-4). As an exploratory part of that study, we also evaluated the effect of aging on neurohormonal responses to CCK-4. These hormonal data are the focus of this article. Forty healthy volunteers aged 20-35 years and 40 healthy volunteers aged 65-81 years, divided equally between men and women, were compared on their hormonal responses (maximum change from baseline in growth hormone [GH], prolactin, adrenocorticotropic hormone [ACTH], and cortisol) to the intravenous administration of 50 microg of CCK-4 or placebo. Blood samples for serum hormone determination were collected at 2 minutes prior to the intravenous challenge (baseline) and at 2, 5, and 10 minutes after the challenge. In both age groups, maximum increase in prolactin, ACTH and cortisol was significantly greater with CCK-4 than with placebo. Following administration of CCK-4, younger and older groups did not significantly differ in maximum increase in prolactin, ACTH, or cortisol. Older subjects had a statistically significant smaller increase in GH compared with younger subjects but the magnitude of the difference was small and of doubtful clinical relevance. Older subjects who had a panic attack had significantly greater elevations of all hormones compared with those who did not panic and younger panickers had a significantly greater elevation of GH compared with young nonpanickers. For the most part, maximum changes in hormonal levels were not correlated with symptom severity, suggesting that other factors may have contributed to the differential effect of panic on the HPA axis.

Negative affect mediates the relationship between interpersonal problems and binge-eating disorder symptoms and psychopathology in a clinical sample: a test of the interpersonal model.

This study evaluated the validity of the interpersonal model of binge-eating disorder (BED) psychopathology in a clinical sample of women with BED. Data from a cross-sectional sample of 255 women with BED were examined for the direct effects of interpersonal problems on BED symptoms and psychopathology, and indirect effects mediated by negative affect. Structural equation modelling analyses demonstrated that higher levels of interpersonal problems were associated with greater negative affect, and greater negative affect was associated with higher frequency of BED symptoms and psychopathology. There was a significant indirect effect of interpersonal problems on BED symptoms and psychopathology mediated through negative affect. Interpersonal problems may lead to greater BED symptoms and psychopathology, and this relationship may be partially explained by elevated negative affect. The results of the study are the first to provide support for the interpersonal model of BED symptoms and psychopathology in a clinical sample of women.

Design and rationale for a randomized, controlled trial of interpersonal psychotherapy and citalopram for depression in coronary artery disease (CREATE).

Objective: Recognition that depression is associated with increased morbidity and mortality in coronary artery disease (CAD) patients has augmented the need for evidence-based treatment guidelines. This article presents the design of a multisite, Canadian trial of the efficacy, safety, and tolerability of interpersonal psychotherapy (IPT), an empirically supported, depression-focused therapy, and the selective serotonin reuptake inhibitor citalopram, alone or in combination, in the treatment of major depression in CAD patients. Methods: Two hundred eighty stable CAD patients with a current major depressive episode of at least 4 weeks’ duration, based on the Structured Clinical Interview for Depression (SCID), and who have a baseline score >19 on a centralized, telephone-administered, 24-item Hamilton Depression Rating Scale (HAM-D) will be randomly assigned to receive 12 weekly IPT sessions or 12 weekly sessions of standardized clinical management (CM). Patients are also randomly assigned to receive 20 to 40 mg per day of citalopram or pill-placebo. This results in a 2-by-2 factorial design with four groups: IPT plus pill-placebo, IPT plus citalopram, CM plus pill-placebo, and CM plus citalopram. This permits the evaluation of both IPT and citalopram. Blinded, centralized, 24-item, HAM-D telephone ratings constitute the primary outcome variable. The self-report Beck Depression Inventory-II is the secondary outcome. Analyses will involve the intent-to-treat principle with last observation carried forward for incomplete assessments. Results: Not applicable. Conclusions: The results of this trial will contribute to the development of evidence-based clinical guidelines for managing depression in the context of CAD. CREATE = Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy; IPT = interpersonal psychotherapy; CAD = coronary artery disease; SCID = Structured Clinical Interview for Depression; HAM-D = Hamilton Depression Rating Scale; CM = clinical management; SADHART = Sertraline Antidepressant Heart Attack Randomized Trial; ENRICHD = Enhancing Recovery in Coronary Heart Disease; SSRI = selective serotonin reuptake inhibitor; ECG = electrocardiogram; NIMH = National Institute of Mental Health; TDCRP = Treatment of Depression Collaborative Research Program; MMSE = Mini-mental Status Exam; STAR*D = Sequenced Treatment Alternatives to Relieve Depression; IDS = Inventory for Depressive Symptomatology; BDI-II = Beck Depression Inventory-II; IPRI = Interpersonal Relationship Inventory; FPI = Functional Performance Inventory; SAE = serious adverse event; LOCF = last observation carried forward; DSMB = data safety monitoring board.

Knowing when not to use the Internet: Shyness and adolescents' on-line and off-line interactions with friends

The goal of the study was to explore the content of on-line and off-line peer interactions among shy and non-shy adolescents. Participants were 148 ten-to-eighteen year old adolescents in Rome, Italy (n=98) and Ottawa, Canada (n=50). Participants completed self reports of shyness and loneliness and web logs of their interactions with friends both in person and on-line. Among the results, there was little general difference in the general content and emotion expressed during the two modalities of interaction with friends, both of which were used in a wide variety of ways. Importantly, shy participants used the on-line modality more extensively than their non-shy counterparts to express negative emotions and to convey content regarding negative exchanges with peers. Such use of electronic communication may be an important contributor to their loneliness.

Fetal sex, social support, and postpartum depression.

Objective: To examine the impact of prenatal and postnatal social support on the association between fetal sex and postpartum depression (PPD). Method: We conducted a prospective cohort study in Changsha, China, between February and September 2007. We first compared the sociodemographic and obstetric characteristics, and the prenatal and postnatal social support between women who gave birth to a female infant and those who gave birth to a male infant. We then examined the association between fetal sex and PPD by following logistic regression models: fetal sex as the independent variable; with adjustment for sociodemographic and obstetric factors; with adjustment for sociodemographic, obstetric factors, and prenatal social support; and with adjustment for sociodemographic, obstetric factors, and postnatal social support. Results: Postnatal social support scores were much lower in women who gave birth to a female infant than in those who gave birth to a male infant. The odds ratio of PPD for women who gave birth to a female infant, as compared with those who gave birth to a male infant, was 3.67 (95% CI 2.31 to 5.84). The increased risk of PPD for women who gave birth to a female infant remained after adjustment for sociodemographic and obstetric factors and prenatal social support, but disappeared after adjustment for postnatal social support score. Conclusion: We conclude that increased risk of PPD in Chinese women who give birth to a female infant is caused by lack of social support after childbirth.

A Multifaith Spiritually Based Intervention Versus Supportive Therapy for Generalized Anxiety Disorder: A Pilot Randomized Controlled Trial

Objectives We have previously reported that a multifaith spiritually based intervention (SBI) may have efficacy in the treatment of generalized anxiety disorder (GAD). This randomized pilot trial tested whether the SBI had greater efficacy than a nonspecific control condition in GAD. Method Twenty-three participants with GAD of at least moderate severity were randomized to 12 individual sessions of the SBI (n = 11) or supportive psychotherapy (SP)—our control condition (n = 12). Results Intent-to-treat analysis revealed the SBI fared better than SP in decreasing blind clinician ratings of anxiety and illness severity and self-report worry and intolerance of uncertainty, with large between-group effect sizes. The SBI also produced greater changes in spiritual well-being. Results remained the same when supplementary analyses were performed on the completer sample. Treatment gains were maintained at 3-months follow-up. Conclusions This small pilot trial demonstrates that a nondenominational SBI has greater efficacy than a rigorous control in improving symptoms of GAD and enhancing spiritual well-being. These results are encouraging and further research on the efficacy of the SBI and its underlying mechanisms is warranted.

Anxiety sensitivity does not predict fearful responding to 35% carbon dioxide in patients with panic disorder.

The aim of the present study was to examine the relationship between anxiety sensitivity, as measured by the Anxiety Sensitivity Index (ASI), and four dimensions of behavioural reactivity to a single inhalation of 35% carbon dioxide (CO(2)) in 31 patients with panic disorder. ASI scores correlated positively with baseline State-Trait Anxiety Inventory scores but did not correlate with post-CO(2) scores. Correlational analyses revealed a significant, albeit modest, correlation between anxiety sensitivity and cognitive symptoms induced with CO(2). However, no significant association was found between anxiety sensitivity and other dimensions of CO(2)-induced anxiety, including severity of somatic symptoms, subjective levels of anxiety, fear or apprehension, and fear of the somatic symptoms induced by CO(2). Overall, these data do not support the view that anxiety sensitivity plays a key role in mediating behavioural sensitivity to CO(2) inhalation in panic disorder.