Lucinda Wedgwood

Smoking cessation and depression: current knowledge and future directions

This paper reviews the literature on comorbid smoking and depression. Current models used to explain this co-occurrence are examined, as are treatment options (both psychological and pharmacological). This paper surmises that treatment planning should consider factors that potentially confound treatment efficacy, including the nature of the depressive illness and the patients smoking profile. Although there is limited research examining the benefits of a stepped-care framework, a tiered treatment format appears to work well, assisting those who require minimal treatment, as well as those who prolonged difficulties. Further research examining a stepped-care framework for smokers at risk of depression is required, as is appropriate training for health practitioners using this model. Further directions for research and practice are also discussed.

Women and depression: a 30 year learning curve

This paper reviews 30 years of longitudinal research, initially undertaken to examine gender differences in rates of major depression and psychosocial risk factors for depression. The research focus has broadened to include the impact of anxiety on depression onset, coping styles for stress and depression, genetic and environmental influences on depression onset, and more recently, a shift towards examining positive mental health. The original cohort consisted of a socially homogenous group of postgraduate teacher trainees and does not attempt to represent the normal variability in an adult population. However, the issues raised by this research provide many insights about real and artefactual factors that contribute to the rate and experience of depression. The study findings are supplemented by data from other studies undertaken by this research team that are pertinent to the topic and add weight to some of the observations from the Teachers’ Study.

Temperament, substance use and psychopathology in a prisoner population: implications for treatment.

Objective: The association between temperament and drug use or temperament and psychopathology has previously been restricted to community clinical or non-clinical samples. The aim of the present study was therefore to examine these associations in a large cohort of Australian offenders using Cloningers Temperament and Character Inventory (TCI). Methods: A total of 1322 prisoners from New South Wales (NSW) who completed all dimensions of the TCI and were screened for mental illness using the Australian National Survey of Mental Health and Wellbeing were included in the study. Results: A total of 15% of the sample fulfilled the criteria for a diagnosis for depression, 36% for anxiety disorders and 54% for a substance abuse disorder. Using logistic regression analysis, the TCI dimensions of harm-avoidance and low self-direction predicted depression. Being female, a poly-substance user and having high harm-avoidance, persistence, self-direction and self-transcendence predicted anxiety disorders. Significant stepped trends across age, gender, and type of drug use were found for all TCI dimensions. Conclusions: The TCI is useful in identifying prisoners with a history of psychopathology and substance misuse. This tool also provides clinically relevant information about at-risk individuals and has the potential to guide the development of intervention programmes for inmates.

Predicting mental health and well-being in adulthood.

Although previous research focused on identifying risk factors for mental disorders (or ill-being), recent research has demonstrated a shift towards factors predicting mental well-being. A series of variables from a longitudinal study was used to compare 2 interpretations of mental well-being, namely mental health, defined as lack of DSM caseness, and dispositional optimism. Using logistic and linear regression analyses, the significant predictors of mental health were fewer adverse life events, higher self-esteem, greater perceived social support, and less anticipated depressogenic effects when goals were not met, while optimism was predicted by fewer adverse life events, higher self-esteem, lower neuroticism, and higher femininity scores. After discussion of the implications of both definitions, it is proposed that both can potentially be used as proxies for mental health when more direct well-being measures are unavailable. This article reinforces the need for precise conception(s) of mental well-being, allowing objective measures to guide future research.

Expressive writing for high-risk drug dependent patients in a primary care clinic: A pilot study

BackgroundPrevious research has shown that expressive writing is beneficial in terms of both physical and emotional health outcomes. This study aimed to investigate the effectiveness and acceptability of a brief expressive writing intervention for high-risk drug dependent patients in a primary care clinic, and to determine the relationship between linguistic features of writing and health outcomes.MethodsParticipants completed four 15-minute expressive writing tasks over a week, in which they described their thoughts and feelings about a recent stressful event. Self-report measures of physical (SF-12) and psychological health (DASS-21) were administered at baseline and at a two-week follow-up. Fifty-three participants were recruited and 14 (26%) completed all measures.ResultsNo statistically significant benefits in physical or psychological health were found, although all outcomes changed in the direction of improvement. The intervention was well-received and was rated as beneficial by participants. The use of more positive emotion words in writing was associated with improvements in depression and stress, and flexibility in first person pronoun use was associated with improvements in anxiety. Increasing use of cognitive process words was associated with worsening depressive mood.ConclusionAlthough no significant benefits in physical and psychological health were found, improvements in psychological wellbeing were associated with certain writing styles and expressive writing was deemed acceptable by high-risk drug dependent patients. Given the difficulties in implementing psychosocial interventions in this population, further research using a larger sample is warranted.

Actions Taken to Cope with Depression in Patients Seeking Specialist Care

OBJECTIVE To assess the rates and perceived effectiveness of actions used to cope with depression and the factors influencing these in an outpatient sample seeking help for depression. METHOD One hundred and seventy-six patients (74 male, 102 female) aged 16-82 years (M = 42, SD = 14.4 years) with a major depressive episode (DSM-IV criteria) were assessed using a number of measures that covered sociodemographics, history of psychiatric illness, actions taken to alleviate depression and their perceived effectiveness. Logistic regression analyses assessed age, gender and illness characteristics associated with the use and perceived effectiveness of strategies adopted to manage depression. RESULTS Medical interventions were used and perceived to be effective in alleviating depressive symptoms by most of the sample, as were self-help and complementary therapies. Sociodemographic and illness-related characteristics had a significant influence, with younger age and having experienced an episode of anxiety disorder found to be the strongest predictors for the use of coping strategies. Being female was the strongest predictor for their effectiveness. CONCLUSION A range of actions for depression, including medical and complementary interventions, were used and found to be helpful in a sample that had sought professional help for depression. Gender, age, depression and anxiety factors were all found to predict the use and perceived effectiveness of these strategies.

The Stress Sampler Study II: psychological functioning and coping within a diabetes sample.

308 tested if alterations in dysbindin mRNA were found in the hippocampus of patients with schizophrenia by using in situ hybridization. We found signifi cantly reduced dysbindin mRNA in the dentate gyrus, CA4 and CA3, but not CA1, subregions of the hippocampus of patients with schizophrenia as compared with normal controls. Additionally, we found that dysbindin mRNA levels strongly and positively correlated with synaptophysin and spinophilin mRNA levels, which are known to be reduced in patients with schizophrenia. Our results suggest that reductions in dysbindin protein previously found in the hippocampus of patients with schizophrenia may be because of decreased dysbindin mRNA. The signifi cant reduction of dysbindin mRNA found in the hippocampus confi rms and extends our initial fi ndings that dysbindin mRNA is signifi cantly reduced in the frontal cortex and tends to be decreased in the midbrain of patients with schizophrenia (Weickert et al. 2004). Taken together, our results suggest that dysbindin mRNA reduction is not anatomically restricted, but may be anatomically specifi c, in the brains of patients with schizophrenia. Furthermore, subfi eld-specifi c reductions in dysbindin mRNA may lead to subfi eld-specifi c synaptic pathology in the hippocampus of patients with schizophrenic.

Stress Sampler I: psychosocial adjustment and psychiatric and physical comorbidity in diabetes mellitus.

305 measured on the SF-36. In general, depression was not associated with a diagnosis of either asthma or COPD. Conclusions: The prevalence of depression was higher than in previous studies. Importantly, depression was more common in people with signifi cant health risk factors but not with chronic lung diseases. Regular exercise was associated with a reduction in rates of depression. The possible reasons for this will be examined.

Phenotypic correlates of the serotonin transporter gene.

249 little is known about patterns of anxiety across this period. This study aimed to 1) assess patterns of anxiety and depression across pregnancy and the postpartum, 2) investigate associations between antenatal mood and HPA axis hormones and 3) determine the extent to which antenatal anxiety, depression and HPA axis activity predict postnatal mood disorders. Methods: Participants were recruited antenatally as part of a prospective study undertaken at the Royal Hospital for Women, Sydney. Ninety-four women completed self-report measures of anxiety and depression at 30–32 and 36-38 weeks gestation, and at 6 months postpartum. They were also administered a structured diagnostic interview (MINI-Plus) at 36–38 weeks gestation and at 6 months postpartum to determine the presence of DSM-IV anxiety and depression. Blood samples were collected at 30–32 weeks gestation for bioassays of HPA axis hormones (CRH, ACTH and cortisol). Results: The data indicate signifi cant stability in maternal mood across pregnancy and the postpartum and associations between anxiety and depression were moderate-high at each assessment. Despite the stability of depression, an anxiety disorder in pregnancy appears to be a greater risk factor for a postnatal anxiety [odds ratio (OR) = 10.20, P < 0.005] or depressive disorder (OR = 7.90, P < 0.005) than antenatal depression. Antenatal neuroendocrine parameters were unrelated to either antenatal or postnatal anxiety or depression. Conclusion: These results clearly highlight the importance of anxiety in both the preand postnatal periods.