Depression and anxiety through pregnancy and the early postpartum : an examination of prospective relationships

<b>Background: </b>The aim of this study was to explore the prospective relationship between depressive symptoms and anxiety across pregnancy and the early postpartum.<br /><b>Methods:</b> Participants (N=207) completed the State&ndash;Trait Anxiety Inventory Trait subscale, Beck Depression Inventory, and social support and sleep quality measures at two time points during pregnancy and once in the early postpartum period.<br /><b>Results</b>: After accounting for the relative stability of anxiety and depression over time, depressive symptoms earlier in pregnancy predicted higher levels of anxiety in late pregnancy and anxiety in late pregnancy predicted higher depressive symptomatology in the early postpartum. A bi-directional model of depression and anxiety in pregnancy was supported.<br /><b>Limitations:</b> Data were based on self-reports and participating women were predominantly tertiary educated with high family incomes.<br /><b>Conclusion:</b> Our findings suggest that depressive symptoms precede the development of higher levels of anxiety and that anxiety, even at non-clinical levels, can predict higher depressive symptoms. Clinicians are advised to screen for anxiety and depression concurrently during pregnancy.<br />

An evaluation of the beyondblue depression training program for aged care workers

<b>Background:</b> The prevalence of depression among older people receiving care is high, yet the rate of treatment of this disorder is low. One way to improve the pathway to care is to train care staff to recognize the symptoms of depression and raise their confidence in responding to them. In this study we evaluated the efficacy of the beyondblue Depression Training Program to achieve this aim.<br /><b>Methods:</b> Staff (N=148) from low level care facilities and community care facilities in metropolitan Melbourne completed the beyondblue Depression Training Program, while staff in other facilities (N = 96) acted as controls. Pre-program, post-program and follow-up questionnaire data were collected and referrals for depression by staff were recorded.<br /><b>Results:</b> Training improved carers&rsquo; knowledge about depression, their self-efficacy in responding to signs of depression and their attitudes towards working with depressed aged care recipients. In addition, training increased the number of referrals for depression made by carers.<br /><b>Conclusion:</b> Training aged care staff in depression can improve the pathways to care for depressed care recipients, and has the potential to improve the quality of life of older people.<br />

Physical activity, sedentary behavior and depression among disadvantaged women

This study investigated associations between components of physical activity (PA; e.g. domain and social context) and sedentary behaviors (SBs) and risk of depression in women from disadvantaged neighborhoods. A total of 3645 women, aged 18&ndash;45 years, from disadvantaged neighborhoods, self-reported their PA, SB and depressive symptoms. Crude and adjusted odds ratios and 95% confidence intervals were calculated for each component of PA, SB and risk of depression using logistic regression analyses, adjusting for clustering by women's neighborhood of residence. Being in a higher tertile of leisure-time PA and transport-related PA was associated with lower risk of depression. No associations were apparent for domestic or work-related PA. Women who undertook a small proportion of their leisure-time PA with someone were less likely to be at risk of depression than those who undertook all leisure-time PA on their own. Women reporting greater time sitting at the computer, screen time and overall sitting time had higher odds of risk of depression compared with those reporting low levels. The domain and social context of PA may be important components in reducing the risk of depression. Reducing time spent in SB may be a key strategy in the promotion of better mental health in women from disadvantaged neighborhoods. <br />

Sedentary behavior and depression among adults : a review

<b>Background</b> Physically inactive lifestyles and sedentary behaviors (SB) are key contributors to ill health. Although the association between SB (e.g., watching TV/using the computer) and physical health has been well documented, increasing research has focused on the possible link between SB and mental health (e.g., depression). <br /><b><br />Purpose</b> This review aims to investigate the effect of SB on the risk of depression in adults.<br /><br /><b>Method</b> A systematic search for original research articles investigating associations between SB and depression in adults was performed using the several electronic data bases. <br /><br /><b>Results</b> A total of seven observational and four intervention studies were included in this review. All observational studies found positive associations between SB and risk of depression, while intervention studies showed contradictory results. <br /><b><br />Conclusion</b> Evidence for the relationship between SB and risk of depression in adults is limited by methodological weaknesses. However, on balance, this review suggests that SB is associated with an increased risk of depression. Further studies are needed assessing different types of SB and depression; the interrelationship between physical activity, SB, and depression; causal links between SB and depression; and intervention strategies aimed at reducing SB and their effects on risk of depression. <br />

Do indicated preventive interventions for depression represent good value for money?

The prevention of depression is of growing interest to researchers and policy makers. However, the question of whether interventions designed to prevent depression provide value for money at a population level remains largely unanswered. The current study assesses the cost-effectiveness of two indicated interventions designed to prevent depression: a brief psychological intervention based on bibliotherapy and a more comprehensive group-based psychological intervention following opportunistic screening for sub-syndromal depression in general practice. Method: Economic modelling using a cost utility framework was used to assess the incremental cost effectiveness ratios (ICERs) of the two interventions within the Australian population context, modelled as add-ons to current practice. The perspective was the health sector and outcomes were measured using disability-adjusted life years (DALYs). Uncertainty was measured using probabilistic uncertainty testing and important model assumptions were tested using univariate sensitivity testing. Results: The brief bibliotherapy intervention had an ICER of AU$8600 per DALY and the group-based psychological intervention had an ICER of AU$20 000 per DALY. The majority of the uncertainty simulations for both interventions fell below the cost-effectiveness threshold value of $50 000 per DALY. Extensive sensitivity testing showed that the results were robust to the assumptions made in the analyses. Conclusions: Following screening in general practice, both psychological interventions, particularly brief bibliotherapy, appear to be good value for money and worthy of further evaluation under routine care circumstances. Acceptability issues associated with such interventions, particularly to primary care practitioners as providers of the interventions and health system administrators, also need to be considered before wide-scale adoption is contemplated.<br />

Lower levels of physical activity in childhood associated with adult depression

Emerging evidence indicates that early life exposures influence adult health outcomes and there is cause to hypothesise a role for physical activity (PA) in childhood as a protective factor in adult depression. This study aimed to investigate the association between self-reported levels of PA in childhood and self-reported depressive illness. Lifetime depression and levels of physical activity (low/high) in childhood (&lt;15 yr) were ascertained by self-report in 2152 adults (20&ndash;97 yr) participating in an ongoing epidemiological study in south-eastern Australia. Data were collected between 2000 and 2006. In this sample, 141 women (18.9%) and 169 men (12.0%) reported ever having a depressive episode. Low PA in childhood was associated with an increased risk of reporting depression in adulthood (OR = 1.70, 95%CI = 1.32&ndash;2.17, p &lt; 0.001). Adjustment for age, gender and adult PA attenuated the relationship somewhat (OR = 1.35, 95%CI = 1.01&ndash;1.78, p = 0.04), however further adjustment for SES or country of birth did not affect this relationship. In this community-based study, lower levels of self-reported PA in childhood were associated with a 35% increase in odds for self-reported depression in adulthood. These results are consistent with the hypothesis that lower levels of PA in childhood may be a risk factor for adult depression.<br />

The association between physical activity and depression among young women

Young women experiencing depressive symptoms were shown to have different constraints to being active compared to young women without depressive symptoms, such as lower motivation and lower confidence in their ability to be active. Physical activity promotion initiatives may benefit from individually-tailored, multi-component programs rather than a 'one-fits-all', single-arm approach<br />

Recovering from an acute cardiac event – the relationship between depression and life satisfaction

<b>Aims.</b> This study sought to measure the rates and trajectory of depression over six months following admission for an acute cardiac event and describe the relationship between depression and life satisfaction.<br /><b>Background.</b> Co-morbid depression has an impact on cardiac mortality and is associated with the significant impairment of quality of life and well-being, impairments in psychosocial function, decreased medication adherence and increased morbidity.<br /><b>Design.</b> This was a descriptive, correlational study.<br /><b>Method.</b> The study was undertaken at a large public hospital in Melbourne. Participants were asked to complete a survey containing the cardiac depression scale (CDS) and the Personal Well-being Index.<br /><b>Results.</b> This study mapped the course of depression over six months of a cohort of patients admitted for an acute cardiac event. Significant levels of depressive symptoms were found, at a level consistent with the literature. A significant correlation between depressive symptoms as measured by the CDS and the Personal Well-being Index was found.<br /><b>Conclusions.</b> Depression remains a significant problem following admission for an acute coronary event. The Personal Wellbeing Index may be a simple, effective and non-confrontational initial screening tool for those at risk of depressive symptoms in this population. Relevance to clinical practice. Despite the known impact of depression on coronary heart disease (CHD), there is limited research describing its trajectory. This study makes a compelling case for the systematic screening for depression in patients with CHD and the importance of the nursing role in identifying at risk individuals.<br />

Vitamin D deficiency may play a role in depression

Vitamin D is known to be widely deficient in Western populations. The implications of this in terms of bone health are increasingly understood, yet its impact on other health areas, particularly mental health, is unclear. Recent data suggests that hypovitaminosis D may be common, especially in the elderly. Other studies have suggested that low levels of vitamin D are associated with poor mood. There are a number of trials that have suggested a role for Vitamin D in the supplementary treatment of depression. Dose may be a critical issue, as sun exposure and dietary intake may be low and high doses may be required.

Dietary omega-3 fatty acids and depression in a community sample

To evaluate the association between omega-3 polyunsaturated essential fatty acids and depression, data regarding prevalence rates of self-reported depression and median daily dietary intakes of these fatty acids were obtained from an age-stratified, population-based sample of women (n = 755; 23-97 year) in the Barwon Statistical Division of south-eastern Australia. A self-report questionnaire based on Diagnostic and Statistical Manual-IV criteria was utilised to determine 12-month prevalence rates of depression in this sample, and data from biennial food frequency questionnaires examining seafood and fish oil consumption over a 6-year period were examined. Differences in median dietary intakes of omega-3 fatty acids between the depressed and nondepressed cohorts were analysed and results were adjusted for age, weight and smoking status. No significant differences in median intakes were identified between the two groups of women (median, interquartile range; depressed = 0.09g/day, 0.04-0.18 versus nondepressed = 0.11 g/day, 0.05-0.22, p = 0.3), although overall average intakes of omega-3 fatty acids were lower than recommended and rates of depression within this sample higher than expected, based on previous data. Further research that takes into account ratios of omega-6 to omega-3 polyunsaturated essential fatty acids, as well as other dietary sources of omega-3 fatty acids, is warranted.

Depression and bone mineral density in a community sample of perimenopausal women: Geelong Osteoporosis Study

<b>Objective:</b> Reduced bone mineral density (BMD) in women with a history of depressive disorders has been shown in some, but not all studies. This study investigated the association between self-reported depression and BMD in an age-stratified community sample of perimenopausal women residing in the South-Eastern region of Australia.<br /> <br /><b>Design:</b> Symptoms of depression in the year between July 2000 and July 2001 were ascertained by a self-report questionnaire based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. Women in the perimenopausal group who had undergone a BMD total hip and spine assessment within the 12-month period after the depression assessment were included in the analysis, resulting in a sample of 78 women aged 45 to 60 years.<br /> <br /><b>Results:</b> In this sample, 14 women were identified as depressed. There was no difference in age, hormone therapy (HT) use, or unadjusted BMD at the total hip or spine between the depressed and nondepressed women (P = 0.14, 0.89, 0.57, and 0.70, respectively), but the depressed women tended to be heavier [depressed (median weight, interquartile range = 80 kg, 66-94) vs nondepressed (72 kg, 61-80) P = 0.06]. Whereas there was no significant difference in age-, HT-, and weight-adjusted BMD at the spine [depressed (mean &plusmn; SE = 1.21 &plusmn; 0.05) vs nondepressed (1.28 &plusmn; 0.03 g/cm2) P = 0.18], adjusted BMD at the total hip for the depressed women was 7.8% lower than for the nondepressed [depressed (mean &plusmn; SE = 0.957 &plusmn; 0.038) vs nondepressed (1.038 &plusmn; 0.023 g/cm2) P = 0.04].<br /> <br /><b>Conclusions:</b> These results suggest that in perimenopausal women, self-reported depression is associated with lower BMD at the hip.