Reduced autobiographical memory specificity is considered to be a vulnerability factor for depression and is a significant predictor of the course of depression. Previous studies have shown that different natures of rumination (abstract versus concrete) have different effects on autobiographical memory specificity. Knowing more about the relationship among depression, rumination, and autobiographical memory specificity is important for understanding the cognitive biases in depression. This study explored whether rumination of different valences had different effects on autobiographical memory specificity in participants with major depressive disorder. A 2 (group: MDD, control) x 2 (rumination: positive, negative) x 2 (time: pre, post) mixed design was used. Fifty-two currently depressed people and 52 nonpsychiatric controls completed this experiment. They did the Autobiographical Memory Test and the mood ratings before and after either the positive or the negative rumination task. In the rumination task, they were requested to focus their attention on some specific thoughts about themselves. Results showed a significant group (depressed, control) x time (pre, post) interaction effect for the number of specific memories. This was a result of a significant decrease in specific memories retrieved after negative rumination in the depressed group, but not after positive rumination. No significant result was found among the nonpsychiatric controls. These findings seem to be related to the inhibitory deficit of depressed people in keeping task-irrelevant negative materials from the working memory. Therefore, the working memory capacity is lowered and fewer specific memories are retrieved. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

Among all types of psychiatric disorder, depression is the most prevalent one which affect nearly one third of the contemporary adult population. Depression also ranks top with regard to women’s health and is now contributing heavily to the global disease burden. WHO makes clear that the overall rates of women's depression confirmed across all centers are almost 2 times higher than that of men. This review was performed with aim to examine the risk factors of female depression in developing countries. It also focuses on the strategies and policy recommendations for policy makers. In summary, results included poverty, educational level, unemployment, being unmarried, marital crisis, victims of violence, undesired pregnancies, lack of social support, poor relationships with parents and in-laws, history of depression, were associated with perinatal depression. Besides, financial difficulties, not living with parents, lack social support, expose to violence, bad school behavior and maternal depression were associated with female adolescent depression. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Depression is the leading cause of premature death and disability worldwide. The globally aging population with increasing burdens of chronic diseases is certain to face increasing problems. Elderly people in whom physical and mental co-morbidities are common represent a group that is highly susceptible to the harm of depression. Worse still, the reduced accessibility of elderly to healthcare implies that the public health burden of depression seen in the healthcare sector is only tip of the clinical iceberg. Objectives: This review aims to synthesize the current evidence of public health burden of geriatric depression, and the public health challenges in tackling this growing threat in the context of under-detection, social disparities and population ageing, and to summarize its current situation in Hong Kong and compare with other Methods: A literature search was conducted in databases PubMed, Medline and Cochrane (January 2002-June 2012) using the keywords “depression, depressive episode, epidemiology, prevalence, incidence, elderly”. A total of 1285full-text articles were obtained, out of which 52 articles were potentially relevant. Critical appraisal was performed on articles after a priori specified inclusion and exclusion criteria were applied. After removing the duplicates and examining the contents, 15 articles were adopted for review. Results: Depression brings along heavy disease burden which highly associated with mortality and morbidity. Late-life depression accounts for 17-37% in primary care settings, while around 3% in the community. The ongoing problems of under-detection, under-treatment and the progressive population ageing increase the challenges and complexity of matter. Gender difference is identified, while social support, social relationships and socioeconomic status were shown to be highly correlated with elderly depression in both the East and the West. Conclusions: Elderly depression is a global threat causing increasing public health burden to healthcare systems and societies worldwide. Over the decades, public health sector is facing numerous challenges intackling it, including the practice-related challenges complicated by characteristics of elderly, policy-related challenges explained by the clinical iceberg concept, and societal related challenges. By understanding the older population and challenges in the community control of depression, it is the time to action and turn public health over a new leaf. / published_or_final_version / Public Health / Master / Master of Public Health

Cognitive deficits have been shown to be responsible for the onset and maintenance of depression, while psychological resources are known to enhance psychological wellbeing. The present study aimed to understand the mechanism of depression by integrating both perspectives. Partial support was found for the hypothesis that participants with higher levels of negative attentional bias tended to engage in more brooding rumination, which in turn predicted more depressive symptoms. On the other hand, partial support was found for the hypothesis that participants with higher levels of cautiousness or vitality tended to engage in less negative attentional bias and brooding rumination, which in turn predicted less depressive symptoms. Implications for clinical practice and research were discussed in detail. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Introduction Depression can lead to long term health burden; while alcohol is now also one of the global burdens of diseases. This review is trying to investigate how healthy population can be at risk when the trends of alcohol consumption are increasing. Methods and Results This review studied 11 journals out of 1096 literature in PubMed / Medline / PsyInfo for alcohol and depression association via prospective cohort or longitudinal study. Results varied in outcomes measured and no conclusion on developed causality with alcohol and depression. Discussions Some significant associations may be observed at heavy use of alcohol or binge drinking groups. Young adolescents association was not as significant as adult studies results. Some stratification on gender difference is also non-conclusive. Population on heavy drinking and dependency are at risk of developing depression. Conclusions Future perspectives in research like the need of developing high quality research and more on population approach studies focusing on alcohol and depression should be carried. Prevention of alcohol-related problems especially in young people or population as a whole should include policies reducing overall alcohol consumption, or reducing the rates of high-risk drinking. / published_or_final_version / Public Health / Master / Master of Public Health

Introduction Geriatric depression is one of the major public health issues around the world. Geriatric depression is often being misinterpreted as a normal aspect of aging process, but it is indeed a complex psychological problem that would result in significant increases in DALYs. With effective treatments, depressive symptoms and signs can be reduced. Nevertheless, pharmacological intervention is often used as the first-line treatment for geriatric depression. In recent years, different types of non-pharmacological intervention have been getting more attention in terms of theirs effectiveness in treating geriatric depression. Objectives Primary objective is to determine whether two categories of non-pharmacological intervention (physical activity and reminiscence therapy) are effective in relieving depression in elderly that are 60 years old or older. The other objectives are to examine enduring effects of physical activity and reminiscence therapy, and compare the effectiveness of reminiscence therapy and physical activity in alleviating depressive symptoms in elderly compared with no intervention and/or other intervention. Methods Relevant studies published between the year of 2000 and 2013 were searched and identified through several electronic databases, including the Cochrane Library, PubMed, Medline, PsycINFO and Google Scholar, with a combination of keywords. All randomized controlled trials that examine physical activity and reminiscence therapy on elderly that are 60 years old or older, being diagnosed or indicated as suffering from depression were included. The methodological quality of each study was assessed. The outcome measure of this review is the depression symptom level. Main Result A total of 12 randomized controlled trials met the inclusion criteria, in which seven were about physical activity and five of them were about reminiscence therapy. Significant immediate reduction in depressive symptoms was found in five out of seven physical activity studies and in four out of five reminiscence studies. Three and two studies respectively on physical activity and reminiscence therapy had assessed the effect at follow-up and looked at the lasting effect. In two physical activity studies that have assessed the short-term effect beyond the completion of intervention, incongruent findings were found. Only one physical activity study has examined the long-term effect and it reported significant positive result. On the other hand, there were two reminiscence therapy studies assessing the short-term effect on depressive symptoms. These two studies reported significant improvement in depressive symptoms. Since there were few studies reporting the medium and long-term effect of physical activity and reminiscence therapy, no conclusion can be made on their enduring effect of reducing depressive symptoms. Conclusions Physical activity and reminiscence therapy appear to be effective non-pharmacological interventions for relieving depressive symptoms in elderly. They may complement pharmacological intervention and/or may offer alternative treatment option for elderly with depression. However, the mode, intensity, duration, type, format of physical activity and reminiscence therapy on depressive symptoms in elderly remain unclear. Further testing is need before these interventions can be routinely used to alleviate depressive symptoms in elderly with depression. / published_or_final_version / Public Health / Master / Master of Public Health

Breastfeeding is well known to be beneficial to both the mother and the baby. To the baby, it is associated with decreased short-term health problems such as diarrhea and respiratory infections, as well as decreased long-term health consequences such as type 2 diabetes, obesity, and raised blood cholesterol levels. To the mother, it is suggested to reduce type 2 diabetes, breast cancer, as well as ovarian cancer. Increasing exclusive breastfeeding rate, in which higher proportion of infants are given breast milk only, could also benefit the society as a whole. It is shown to reduce health care cost and premature deaths. Despite the gradual elevation of ever breastfeeding rate in Hong Kong up to 83% in 2013, the exclusive breastfeeding rate at 2 months postpartum remained relatively low at 21.7%. On the other hand, postpartum depression is a debilitating condition to both the mother and the baby. The prevalence was about 10-15%. And it could lead to deteriorated quality of life to the mother and increased maternal suicidal rate. It could also affect the long-term development of the baby. Previous studies showed controversial results on the association between breastfeeding and postpartum depression. Some suggested breastfeeding being protective against postpartum depression, while other studies did not show significant results. However, there was still no formal study in the local Chinese population about the issue. In view of that, the current study aimed at assessing the association between breastfeeding and postpartum depressive symptoms in the local Chinese population. This was a cross-sectional study which included 600 mothers with data retrieved from MCHCs’ database. Demographic data and breastfeeding status were included in binary logistic regression analysis with Edinburgh Postnatal Depression Scale (EPDS) result of either screened positive or negative as the outcome. The odds ratio of being screened positive in EPDS with more depressive symptoms for mothers with exclusive breastfeeding, compared with mothers not on breastfeeding (OR=0.42, 95% CI=0.19, 0.93) and mothers with non-exclusive breastfeeding (OR=0.40, 95% CI=0.19, 0.85) were both statistically significant after adjusted for the demographic data. Subgroup analysis on those intended for exclusive breastfeeding shortly after delivery also showed significant results. Those who succeeded in maintaining exclusive breastfeeding at 6-8 weeks postpartum were significantly less likely to be screened positive in EPDS (OR=0.07, 95% CI=0.01, 0.41) compared to those who could not maintain exclusive breastfeeding. This study proposed to assess whether there is an association between breastfeeding and decreased maternal postpartum depressive symptoms in local Chinese population. The results reiterated the advantages of breastfeeding and warranted more intense efforts in promoting and protecting breastfeeding. The large effect shown in the subgroup analysis highlighted the importance of maintaining exclusive breastfeeding. Since this study could only establish association, the results could not show causation and future studies should focus on establishing the temporality of causation between breastfeeding and decreased maternal postpartum depressive symptoms. Stricter adjustment for potential confounders should also be achieved with a prospective study better designed to control for temporality and time-varying confounders in the future. / published_or_final_version / Public Health / Master / Master of Public Health

Background Due to the aging of the population and the increasing prevalence of overweight and obesity, the global prevalence of diabetes had been steadily rising. The onset of depression among this diabetes population is a public health issue because of the negative impact on diabetes self-care, treatment adherence and increases in healthcare costs. Three previous meta-analyses have showed that diabetes patients are at an increased risk of developing depression when compared to their non-diabetes counterparts. However, none of these meta-analyses have included primary studies that consisted of primarily Chinese subjects or have considered studies published in Chinese. Thus, there is a knowledge gap for a meta-analysis to study the onset of depression among both Chinese and non-Chinese diabetes subjects. Methods Studies will be selected based on the pre-specified inclusion and exclusion criteria. Studies that are ambiguous to this study criterion will not be selected. Studies are retrieved from three electronic databases, PUBMED, Cochrane library and Wanfang databases. Keywords of “diabet*” and “depress*” where “*” indicated a truncated term were used to identify articles related to diabetes and depression. Only longitudinal studies are selected. Chinese and English articles that are published on or before 31 July 2013 are considered. Besides data collection, quality assessment are also performed based on a tool developed with reference to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. Results 12 longitudinal studies are identified after the quality assessment procedures, with one study being a Chinese study from Taiwan. In this meta-analysis, the pooled unadjusted odds ratio was 1.26 [95% confidence interval: 1.09, 1.45]. The pooled adjusted hazards ratio is 1.26 [95% confidence interval: 1.12, 1.41]. Since both pooled unadjusted odds ratio and pooled adjusted hazards ratio estimates did not include 1, it may imply that the increases in risk of depression onset among diabetes subjects are significant, whether controlled for confounding factors or not. Conclusion This meta-analysis showed a significant increase in the risk of depression onset among Chinese and non-Chinese diabetes subjects, when compared to their non-diabetes counterparts. There are possible public health implications for depression screening needs for the diabetes population in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

abstract / Anatomy / Doctoral / Doctor of Philosophy

Major depressive disorder (MDD) is a prevalent and disabling disorder worldwide and in Hong Kong. It can occur alone or as a psychiatric sequelae of stroke known as post stroke depression (PSD). Our recent randomized controlled trial (RCT) found that additional dense cranial electroacupuncture stimulation (DCEAS) produced significantly greater improvement on depressive symptoms in patients with MDD compared to conventional antidepressants alone. However, the effectiveness of DCEAS on PSD and the underlying neural mechanism of its antidepressant effects remain unclear and need further investigation. This thesis consisted of three studies aimed to evaluate the efficacy of DCEAS as an additional therapy in PSD and to explore the neuroimaging correlates of DCEAS in MDD using PET and fMRI modalities. The purpose of Study 1 was to examine whether additional DCEAS was effective in treating PSD. A single blind RCT was conducted in 43 PSD patients treated with antidepressants and same body acupuncture combined with sham or active DCEAS with 3 acupuncture sessions per week for 4 weeks. Clinical outcomes included the Hamilton Depression Rating Scale 17-Item (HAMD-17), Clinical Global Impression - Severity Scale (CGI-S), and Barthel Index (BI).The results showed that DCEAS significantly reduced HAMD-17 at week 1, CGI-S at week 1 and endpoint whereas BI was more significantly decreased in control group. A combination of DCEAS and body acupuncture can be considered as an augmenting treatment for PSD. Study 2 aimed to explore the potential effects of DCEAS in regulating abnormal glucose metabolism in patients with MDD using 18F-FDG PET/CT. A single blind RCT was conducted in 25 MDD patients treated with antidepressants combined with sham or active DCEAS with 3 acupuncture sessions per week for 6 weeks. Clinical outcomes were measured using the HAMD-17, Zung Self-Rating Depression Scale (SDS), CGI-S and Insomnia Severity Index (ISI). There was a significant difference on the slope in SDS in linear mixed model analysis, indicating a faster improvement in subjective depressive symptoms by DCEAS. While the increased 18F-FDG signals in the cerebellum were normalized in both groups, the reversion of the reduced 18F-FDG signals in the left prefrontal cortex was only observed in DCEAS-treated patients, suggesting that additional DCEAS could more vigorously improve abnormal brain glucose metabolism in MDD. The purpose of Study 3 was to further investigate the neuropsychological and functional neuroimaging correlates of the antidepressant effects of DCEAS in the same pool of MDD subjects in Study 2 using fMRI with sad-face paradigm. The sad-face stimulation increased BOLD signals in an extensive neural network of the brain, including the frontal, temporal, parietal, limbic system and cerebellum. Additional DCEAS extensively suppressed the abnormal BOLD signals in these brain regions, more apparently in left caudate and cingulate, whereas sham treatment had slightly suppressive effects in fewer brain regions, suggesting that additional DCEAS could more robustly alter the biases towards sadness in MDD. In conclusion, DCEAS additional treatment is more effective in reducing depressive symptoms in patients with PSD, improving brain glucose metabolism and normalizing the abnormal neural activation due to biases towards sadness in patients with MDD. / published_or_final_version / Chinese Medicine / Doctoral / Doctor of Philosophy