Although unintentional weight loss (UWL) and depressive symptoms are critical outcomes following diagnosis and treatment for head and neck cancer (HNC), there is a limited understanding of how they influence one another over time. As part of a large, prospective study on HNC outcomes, growth curve modeling was used to evaluate 564 patients’ trajectories of depressive symptoms and percentage UWL and analyze longitudinal associations between these variables across the first year following HNC diagnosis. The hypothesized temporal precedence model was not supported—pretreatment depressive symptoms predicted neither total percentage weight loss at 6 months (t(561) = -1.50, p = .13), nor rates of curvilinear change in percentage weight loss over time (t(561) = 1.38, p = .17). The opposite temporal precedence model also lacked support—early weight loss predicted neither level of depressive symptoms at 6 months (t (432) = 0.24, p = .81), nor rates of linear change in depressive symptoms over time (t (432) = 1.31, p = .19). Instead, a pattern of concurrent covariation emerged—changes in depressive symptoms over time were associated with concurrent changes in UWL (t (1148) = 2.05, p = .041) and changes in UWL over time were associated with concurrent changes in depressive symptoms (t (556) = 2.43, p = .015). That is, to the extent that depressive symptoms increased on a monthly basis, patients lost incrementally more weight than was lost due to the passage of time, and to the extent that weight loss increased on a monthly basis, depressive symptoms also increased. Together, these bidirectional results depicted an ongoing transactional interplay between depressive symptoms and UWL across time, such that changes in either variable resulted in deviations from the average trajectory of the other variable. Patient-reported pain and eating abilities emerged as potential mechanisms through which these variables influence one another. The results have important clinical implications, indicating that ongoing screening and treatment for depression and weight loss throughout the first year after HNC could benefit patients’ psychological and nutritional outcomes alike.

Background Being diagnosed with HIV/AIDS and commencement of lifelong antiretroviral therapy (ART) with the requirement of high adherence can exacerbate or trigger depressive disorders. Prevalence of major depression is substantially higher in people living with HIV/AIDS (PLWHA) than those in the general population. More than 50% of PLWHA are likely to meet one or more criteria for depression in their lifetime. However, access to interventions for depressive disorders remains limited in Low- and Middle-Income Countries (LMICs) where more than 90% of people with depressive disorders are not receiving formal treatment. The role of evidence-based psychological treatments has been fundamental in reducing the huge treatment gap in LMICs. Although brief, flexible and effective psychological treatments are emerging, issues in relation to their acceptability, feasibility and effectiveness in HIV populations remain unexplored. Therefore, this thesis aimed to adapt and pilot group interpersonal therapy (IPT) for treatment of depressive symptoms including its acceptability and feasibility for PLWHA. This thesis has been the first that attempted to adapt and pilot group IPT for treatment of depression in the HIV population in Ethiopia. The findings of this thesis can serve as a baseline for researchers interested in adapting or developing psychological treatments in the HIV population in Ethiopia. The findings contribute information on the process used in examining acceptability and feasibility of psychological interventions which provides indications for conducting future trials to test the effectiveness of group IPT. Methods First, a systematic review and meta-analysis of randomised controlled trials was conducted to identify the most effective psychological treatments for depressive symptoms for PLWHA in LMICs. Second, a survey of major depressive disorder (MDD) was conducted among PLWHA who were attending ART follow-up appointments at the Felege-Hiwot Referral Hospital (FHRH) in Northwest Ethiopia. The survey served as a baseline to identify cases for piloting of group IPT and helped to identify areas for intervention. Third, the intervention areas were further explored among stakeholders from the ART clinic including PLWHA and this was followed by a stepwise adaptation of the group IPT manual. Furthermore, a formative qualitative study was conducted to examine explanatory models of depression and to explore acceptable contexts for implementation of group IPT. A total of three focus groups were conducted with purposively selected case managers, adherence supporters and service users 2 at the ART clinic. The qualitative data were analysed based on a framework approach using predefined thematic concepts. Fourth, a pilot study of the group IPT intervention was conducted among PLWHA to evaluate the acceptability and feasibility of peer-administered group IPT for treatment of depressive symptoms for PLWHA in Ethiopia. A single-arm, prepost, peer-administered, group IPT interventional study was conducted with 31 consecutively recruited participants. The participants were assigned to four IPT groups for the intervention. A post-intervention evaluation of depressive symptoms, perceived social support (PSS), functional disability and quality of life (QoL) was conducted using the same instruments used at the baseline. No control group was included in this pilot study. Results The findings of the systematic review and meta-analysis revealed that trials that used IPT have shown good effectiveness in treating depressive symptoms of PLWHA in LMICs. The baseline study found 32.5% prevalence of MDD among randomly selected PLWHA (N=393). MDD was positively associated with reduced adherence to ART, functional disability and negatively associated with overall QoL. Overall findings of the baseline and the qualitative study indicated that psychosocial problems are the most important factors that need intervention for depression for PLWHA. The main findings in relation to the adaptation of the WHO group IPT were: i) an IPT group that contains five to ten people was perceived to be acceptable and mixed gender groups were recommended; ii) sessions were recommended to be conducted in private rooms for 1.5 to 2 hours, and on a weekly basis. Findings of the pilot study indicated that depression scores reduced significantly between baseline and postintervention (mean difference (MD)=9.92; t=-7.82; p<0.001). The mean PSS scores (MD=0.79; t=2.84; p=0.009) and the mean QoL scores (MD=0.39, t=4.58, p<0.001) improved significantly between baseline and post-intervention. All the IPT intervention areas (life change, disagreement, grief and loneliness) were found to be applicable to and important areas associated with depression in PLWHA in Ethiopia. Most importantly, disagreement within a family and life change due to HIV/AIDS, such as sickness and separation were faced by almost all PLWHA included in the study, followed by loneliness or social isolation as result of HIV stigma, and grief due to loss of loved ones including a spouse, a child, a mother or a father. Overall evaluation of the pilot indicated that the procedures and outcomes of group based IPT were perceived as acceptable. Participants of the intervention gained benefits in resolving psychosocial problems and reported high satisfaction with counsellors and intervention setting. The eight weekly sessions that lasted around two hours were acceptable; however, 3 additional sessions were recommended by some counsellors until everyone recovers from depression. Conclusion The overall findings of this thesis suggested that group IPT was found to be acceptable and feasible for PLWHA in Ethiopia. Future studies should focus on examining its effectiveness for treating depressive disorders among PLWHA in Ethiopia.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Introduction: Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. Methods: Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. Results: Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother–child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3–30.2) and 6.9% (95% CI: 6.1–7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85–1.30). The sample did not have moderate or severe malnutrition. Conclusions: There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done. / Revisión por pares

Background: Adolescent female depressive symptomatology is an unrecognized mood disorder that impairs health in adolescence or adulthood. However, the long-term effects of pre-pregnancy depressive symptoms on birth outcomes in adulthood have not been given adequate empirical assessments. Method: In this study, we assessed the relationship between the life time duration of depressive symptoms over a 14-year period and birth outcomes (LBW and PTB) among a sample of 6023 female respondents who took part in the National Longitudinal Study of Adolescent to Adult Health (Add Health). We used the generalized estimating equation (GEE) models to assess these relationships. Results: Exposure to elevated depressive symptoms in late adolescence, but not in adulthood, was associated with increased odds of LBW by more than 2-fold in early and young adulthoods (adjusted odds ratio [aOR] = 2.19; 95% confidence interval, CI: 1.56, 3.08). Depressive symptoms in early adulthood were independently associated with increased odds of PTB and were higher for black mothers. Maternal race modified the relationship between consistent reporting of depressive symptoms in adolescence and LBW or PTB in adulthood. Conclusion: This study provides compelling evidence that effects of elevated depressive symptomatology on LBW or PTB appear to be linked to a specific development period in adolescence. National policies to address social inequalities and stratification particularly in health at all stages of human development, will provide an important step in reducing depressive symptoms prior to early adulthood and in pregnancy and childbirth.

Objective: Proper assessment and early identification of depressive symptoms are essential to initiate treatment and minimize the risk for poor outcomes in youth with epilepsy (YWE). The current study examined the predictive utility of the Neurological Disorders Depression Inventory-Epilepsy for Youth (NDDI-E-Y) and the Neuro-QOL Depression Short Form (Neuro-QOL SF) in explaining variance in overall depressive symptoms and specific symptom clusters on the gold standard Children's Depression Inventory-2 (CDI-2). Methods: Cross-sectional study examining 99 YWE (female 68, mean age 14.7 years) during a routine epilepsy visit, who completed self-report measures of depressive symptoms, including the NDDI-E-Y, CDI-2, and the Neuro-QOL SF. Caregivers completed a measure of seizure severity. All sociodemographic and medical information was evaluated through electronic medical record review. Results: After accounting for seizure and demographic variables, the NDDI-E-Y accounted for 45% of the variance in the CDI-2 Total score and the CDI-2 Ineffectiveness subscale. Furthermore, the NDDI-E-Y predicted CDI-2 Total scores and subscales similarly, with the exception of explaining significantly more variance in the CDI-2 Ineffectiveness subscale compared to the Negative Mood subscale. The NDDI-E-Y explained greater variance compared to Neuro-QOL SF across the Total (48% vs. 37%) and all CDI-2 subscale scores; however, the NDDI-E-Y emerged as a stronger predictor of only CDI-2 Ineffectiveness. Both the NDDI-E-Y and Neuro-QOL SF accounted for the lowest amount of variance in CDI-2 Negative Mood. Sensitivity was poor for the Neuro-QOL SF in predicting high versus low CDI-2 scores. Significance: The NDDI-E-Y has strong psychometrics and can be easily integrated into routine epilepsy care for quick, brief screening of depressive symptoms in YWE.

No description available.

In recent decades, research on family life and religion has been conducted. Much of the research done on religion and well-being has shown beneficial effects of religion or religious practices on well-being (Bonner, Koven, & Patrick, 2003; Loser, Klein, Hill, & Dollahite, 2008). Using data from the Flourishing Families Project (N = 359 adolescents), the relationship between religious variables (family religious practices, family religious importance and religiosity), family climate measures (family connectedness and parent conflict) and adolescent depressive symptoms was examined. Results indicate no significant relationship between religious variables and adolescent depressive symptoms, but a positive relationship between parent conflict and adolescent depressive symptoms and a negative relationship between family connectedness and adolescent depressive symptoms. These findings suggest that while family climate is important to adolescent depressive symptoms, religious activity as measured by family practices is not protective.

No description available.

Objective: People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms. Design: 181 PLWH from across the United States completed an online survey. Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index. Results: Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms. Conclusions: PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.

According to differential susceptibility theory (DST), some children may be more sensitive to both positive and negative features of the environment. However, research has generated a list of widely disparate temperamental traits that may reflect differential susceptibility to the environment. In addition, findings have implicated these temperament × environment interactions in predicting a wide variety of child outcomes. This study uses a novel evolutionary model of temperament to examine whether differential susceptibility operates in a domain-general or domain-specific manner. Using a racially and socioeconomically diverse sample of 243 preschoolers and their parents (56% female; 48% African American), we examined the interactions between maternal and paternal parenting quality and two evolutionary informed temperament profiles (i.e., Hawks and Doves) in predicting changes in teacher-reported conduct problems and depressive symptoms from preschool to first grade. Results suggest that differential susceptibility operates in a domain-specific fashion. Specifically, the "Hawk" temperament was differentially susceptible to maternal parenting in predicting externalizing problems. In contrast, the "Dove" temperament was susceptible to both paternal and maternal parenting quality in predicting changes in depressive symptoms. Findings provide support for an integrative framework that synthesizes DST with an evolutionary, function-based approach to temperament.