Lloyd Balbuena

Religious Attendance, Spirituality, and Major Depression in Canada: A 14-Year Follow-up Study

Objective: Although there have been numerous studies on the relation of religion or spirituality and major depression, few used a longitudinal, nationally representative sample. Our study sought to examine the effect of religious attendance, self-declared importance of spiritual values, and self-identification as a spiritual person on major depression. Method: Data coming from 8 waves (1994 to 2008) of the longitudinal Canadian National Population Health Survey were used. People (n = 12 583) who were not depressed at baseline (1994) were followed during 14 years. Depression at each cycle was assessed using the Composite International Interview—Short Form for Major Depression. Weibull proportional hazards regression was used to model longitudinal risk of depression, with religious attendance or spirituality as a predictor. Results: At baseline, monthly religious attenders tended to be older, female, and married, compared with occasional and nonattenders. The Weibull regression model revealed a 22% lower risk of depression for monthly attenders (hazard ratio 0.78, 95% CI 0.63 to 0.95), compared with nonattenders, after controlling for age, household income, family and personal history of depression, marital status, education, and perceived social support. Neither self-reported importance of spiritual values nor identification as a spiritual person was related to major depressive episodes. Conclusion: Attending religious services at least monthly has a protective effect against major depression.

Does Assertive Community Outreach Improve Social Support? Results From the Lambeth Study of Early-Episode Psychosis

OBJECTIVES Specialized early intervention by a team providing assertive community treatment (ACT) is beneficial to the recovery, housing, and employment of individuals with schizophrenia, but few studies have examined its effect on social support. This study assessed whether the ACT model of care was related to clinical and social outcomes among patients who had experienced a first episode of psychosis. METHODS The sample was drawn from the Lambeth Early Onset Trial, a study of 144 patients in the United Kingdom who sought treatment for a first episode of psychosis between January 2000 and October 2001 and who were randomly assigned to a specialized early intervention modeled on ACT or standard care. The Positive and Negative Syndrome Scale, the Global Assessment of Functioning, and the Significant Others Scale were administered at six-month and 18-month follow-ups. RESULTS Data on social support were available at both follow-ups for 57 patients assigned to specialized care and 50 patients assigned to standard care. The two groups were similar in personal characteristics, relationship status, and living arrangements at baseline and at six-month follow-up, but by 18 months, patients in specialized care reported having a higher mean±SD number of significant others in their social networks than did standard care patients (2.40±1.20 and 1.71±1.06, respectively; p=.01). They also achieved superior clinical outcomes at 18 months, and these outcomes were associated with network size. CONCLUSION Early intervention by using an ACT model of care may improve clinical results by reestablishing or maintaining bonds between patients and family, friends, and acquaintances.

Physical activity, obesity and risk for esophageal adenocarcinoma

Over the past three decades, an increasing incidence of esophageal adenocarcinoma (EADC) has been reported throughout North America and Europe at a rate exceeding that of any other human solid tumor. Recent studies have clearly implicated chronic gastroesophageal reflux disease and several lifestyle risk factors, including tobacco consumption, diet and obesity, to be associated with increased risk of EADC. Although physical inactivity is now recognized as a risk factor for several chronic diseases including cancer, only a very limited number of studies have specifically evaluated the association between physical activity and esophageal malignancy. Furthermore, the precise biological mechanisms underlying the association between physical activity, obesity and cancer risk remain unclear. Since successful promotion of healthy body weight and exercise may substantially reduce the future incidence of cancer in the population, the purpose of this review is to explore current evidence linking physical activity, obesity and risk of malignancy - specifically EADC.

Maintaining sleep and physical activity alleviate mood instability

OBJECTIVE Building on previous work indicating that mood instability is the hallmark of neuroticism, our aim was to examine whether changes in exercise, sleep duration and leisure predicted decreases in mood instability with time. METHODS We used data from 3374 participants of the British Health and Lifestyle Study who answered the Eysenck Personality Inventory-Neuroticism subscale (EPI-N) and the General Health Questionnaire on two occasions 7 years apart. We predicted mood instability scores derived from the EPI-N at follow-up using self-reported changes in exercise, sleep duration and leisure hours between the two time points as independent variables. RESULTS We confirmed the observation that mood instability decreases with age. Maintaining ones exercise at baseline level decreased mood instability (beta=-0.21) while sleeping less increased mood instability (beta=0.14). Change in leisure time was not independently related to mood instability after accounting for the two other lifestyle factors. CONCLUSION Personality, at least with regard to mood instability, can be modified by lifestyle factors. Exercise and sleep support mood stability and could be important components of preventative mental health (as well as physical health) benefits.

When social anxiety and depression go together: A population study of comorbidity and associated consequences

BACKGROUND Despite several studies suggesting higher depression severity and dysfunction occurring in individuals with major depressive disorder (MDD) comorbid with social anxiety disorder (SAD), a clear understanding of the specific risks associated with this comorbidity is lacking. In this study we compared the disease characteristics and level of disability of individuals with MDD-SAD with other comorbidities between depression and anxiety. METHODS Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N=20,013) were used. Individuals were divided in four groups comparing MDD-SAD with MDD alone, as well as other comorbidities between MDD and one anxiety (MDD-1ANX) or more than two anxiety disorders (MDD≥2ANX), with respect to several clinical, demographic, and functional characteristics. RESULTS MDD-SAD comorbidity in the general population occurred in younger people, particularly men, and seemed to have an earlier onset of MDD. Occupational and social dysfunction was similar between individuals with MDD-SAD and those with MDD-1ANX. However, individuals with MDD≥2ANX had significantly higher severity as measured by suicidality as well as substance abuse and social and occupational dysfunction. SAD was the most prevalent comorbid anxiety in this group. LIMITATIONS The findings of this study were derived from the cross-sectional data. CONCLUSION Our results suggest that the particular risks associated with MDD-SAD are the early onset and likelihood of additional anxiety, leading to higher severity and disability levels. Clinicians should increase the screening and treatment of SAD and other anxiety disorders in individuals with MDD given the higher associated health risk and functional impairment.

The relationship between mood instability and depression: Implications for studying and treating depression

BACKGROUND Most individuals with depressed mood report mood fluctuations (Mood Instability) within hours or days. This is not recognized in diagnostic criteria or standard rating scales for depression. HYPOTHESIS That mood instability is a distinct component of the development of depression that has been omitted from criteria for depression because of reliance on retrospective recall and structured interviews. The inclusion of Mood Instability would enhance research into causes and treatment of depression. STUDIES We examined three datasets that used retrospective and prospective measures of depressed symptom ratings and mood instability to determine the relationship between the two. Study 1 used data from the 1991 UK Health and Lifestyle Surveys (HALS). Studies 2 and 3 used clinical samples. The scales used to assess mood instability were the mood instability factor from the Eysenck Personality Inventory Neuroticism Scale, the Affective Lability Scale (ALS), and the Visual Analogue Depression Scale (VAS). The depression scales (depressive symptoms) were the General Health Questionnaire (GHQ) depression factor, the Beck Depression Inventory IA (BDI) and the mean from the Visual Analogue Depression Scale (VAS). We used partial correlation analysis to assess the association between mood instability and depression and exploratory factor analysis to determine the factor structure of items pooled from the mood instability and depression scales from studies 1 and 2. RESULTS Mood Instability was found to be moderately associated with depressive symptoms. The Pearsons r-values ranged from 0.49 to 0.57. The correlation was lower when recalling mood in the past. The factor analytic solution supported the hypothesis that MI and depressive symptoms are related but distinct constructs. CONCLUSIONS Reliance exclusively on the retrospective assessment of depressive symptoms has occluded the widespread occurrence of mood instability. Including Mood Instability in diagnostic and assessment criteria would enhance causal and treatment research in depression.

Mood instability as a precursor to depressive illness: A prospective and mediational analysis

Objective: Mood instability levels are high in depression, but temporal precedence and potential mechanisms are unknown. Hypotheses tested were as follows: (1) mood instability is associated with depression cross-sectionally, (2) mood instability predicts new onset and maintenance of depression prospectively and (3) the mood instability and depression link are mediated by sleep problems, alcohol abuse and life events. Method: Data from the National Psychiatric Morbidity Survey 2000 at baseline (N = 8580) and 18-month follow-up (N = 2413) were used. Regression modeling controlling for socio-demographic factors, anxiety and hypomanic mood was conducted. Multiple mediational analyses were used to test our conceptual path model. Results: Mood instability was associated with depression cross-sectionally (odds ratio: 5.28; 95% confidence interval: [3.67, 7.59]; p < 0.001) and predicted depression inception (odds ratio: 2.43; 95% confidence interval: [1.03–5.76]; p = 0.042) after controlling for important confounders. Mood instability did not predict maintenance of depression. Sleep difficulties and severe problems with close friends and family significantly mediated the link between mood instability and new onset depression (23.05% and 6.19% of the link, respectively). Alcohol abuse and divorce were not important mediators in the model. Conclusion: Mood instability is a precursor of a depressive episode, predicting its onset. Difficulties in sleep are a significant part of the pathway. Interventions targeting mood instability and sleep problems have the potential to reduce the risk of depression.

The Relationship between Mood Instability and Suicidal Thoughts

The objective of this study was to determine whether affective instability predicts suicidal thoughts. Data from a Dutch panel study (N = 1686) was used. Affective instability was assessed with 7 items representing suddenly shifting moods. Suicidal thoughts were assessed by the occurrence of suicidal thoughts in the past week. Negative affect was indexed by anxious, depressed and angry moods extracted by factor analysis. Odds ratios using logistic regression modeling were calculated, adjusting for clinical and demographic variables. The study found that both males (OR: 1.14; 95% CI: 1.02–1.28) and females (OR: 1.11; 95% CI: 1.00–1.23) were more likely to experience suicidal thinking with higher affective instability. Affective instability and negative affect independently predict suicidal thoughts. Affective instability requires more attention in the assessment of suicide risk.

Lamotrigine reduces affective instability in depressed patients with mixed mood and anxiety disorders.

AUTHOR DISCLOSURE INFORMATION The authors declare no conflicts of interest. *Berlin Research Network of Depression: Christoph Richter, MD; Bruno Steinacher, MD, PhD; TomBschor, MD, PhD; Sebastian Erbe, MD; Albert Dieffenbacher, MD, PhD; Samuel Elstner, MD; Marcus Gastpar, MD, PhD; Brigitte SchulzRatei, MD, PhD; Hubertus Himmerich, MD, PhD; Joachim Zeiler, MD, PhD; Alexandra Lingesleben, MD; Andreas Heinz, MD, PhD; Jürgen Gallinat, MD, PhD; Meryam Schouler-Ocak, MD, PhD; Gernot Deter, MD; Hartmut Dormhagen, MD; Rainer Hellweg, MD, PhD; Phillip Sterzer, MD, PhD; Andreas Ströhle, MD, PhD; Thomas Stamm, MD; Mazda Adli, MD, PhD; Roland Ricken, MD; Friedel M. Reischies, MD, PhD; Peter Bräunig, MD, PhD; Ramona Pietsch, MD; Iris Hauth, MD; Frank Godemann, MD, PhD; Peter Neu, MD, PhD. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercialNoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Mood instability underlies the relationship between impulsivity and internalizing psychopathology

Impulsivity, the tendency to act without adequate forethought, has been associated with various internalizing disorders. Mood instability, the tendency to experience rapid and intense mood swings, relates to both internalizing disorders and impulsivity. We hypothesized that the association between mood instability and impulsivity accounts for the relationship between impulsivity and internalizing psychopathology. We conducted two studies to test our hypothesis. In Study 1 we used data from the 2007 Adult Psychiatric Morbidity Survey to examine mood instability in the relationship between depression and impulsivity. Mood instability and impulsivity were assessed with the Structured Clinical Interview for DSM-IV Axis-II Personality Disorders and depression was assessed with the revised Clinical Interview Schedule. In Study 2 we used data from the 1984 and 1991 British Health and Lifestyle Surveys to examine mood instability in the longitudinal relationship between impulsivity and internalizing symptoms. Mood instability and impulsivity were measured with the Eysenck Personality Inventory and internalizing symptoms were assessed with the General Health Questionnaire. In both studies we used a sequential regression analysis to test our hypothesis. Results from Study 1 showed that participants with depression were more likely to report impulsivity, but this effect became nonsignificant when mood instability was included in the same regression model. In Study 2 impulsivity predicted internalizing symptoms seven years in the future, but this effect became nonsignificant after mood instability was included in the same regression model. We conclude that impulsivity relates to internalizing psychopathology largely by being associated with mood instability. Research and therapy for internalizing conditions might be more productively directed at mood instability rather than impulsivity.