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Online support groups have shown a strong potential to foster resourceful environments for people living with depression without restrictions of time, space, and stigma. Research has found that users of those groups exchange various types of support. However, due to the scarcity of research, many other aspects of depression online support groups remain inconclusive. In particular, how the support exchange contributes to the everyday lives of users living with depression remains unclear. To contribute to filing some of the knowledge gaps, the present study explored what kinds of support were requested and provided in a depression online support group. By doing so, this study aimed to examine the roles of the depression online support group in the management of depression. Mixed methods were employed with a concurrent triangulation strategy. A sample of 980 posts were selected systematically from the support group. Demographic and clinical information of the users who made those posts were recorded. Quantitative and qualitative content analyses were conducted to examine the types of support being exchanged through those posts. Inter-coder reliability was calculated to ensure the consistency of the coding process. The results indicate that users sought informational support, various types of emotional support and coaching support, and social companionship. Users not only sought listening ears, but also practical advice to cope with the situations they were going through. The group appeared to serve its users as a place to meet others with similar experience; to manage loneliness; to discuss what they could not discuss elsewhere; to "just vent"; to gain advice from multiple perspectives on an issue that had been magnifying the impact of depression; to share the experience with formal care provision systems; to express immediate support needs; to share useful discoveries, accomplishments, and creative ways to manage depression; and to experience the value of helping others. This study supports the idea that depression online support groups have the strong potential to contribute to the everyday lives of people living with depression in a way that is not available elsewhere and in a way that complement to the overall framework of existing care provision systems.

Certain electrophysiological markers hold promise in distinguishing individuals with major depressive disorder (MDD) and in predicting antidepressant response, thereby assisting with assessment and optimizing treatment, respectively. This thesis examined resting brain activity via electroencephalographic (EEG) recordings, as well as EEG-derived event-related potentials (ERPs) to auditory stimuli and facial expression presentations in individuals with MDD and controls. Additionally, the utility of resting EEG as well as auditory ERPs (AEPs), and the associated loudness-dependence of AEPs (LDAEP) slope, were assessed in predicating outcome to chronic treatment with one of three antidepressant regimens [escitalopram (ESC); bupropion (BUP); ESC+BUP]. Relative to controls, depressed adults had lower pretreatment cortical activity in regions implicated in approach motives/positive processing. Increased anterior cingulate cortex (ACC)-localized theta was observed, possibly reflecting emotion/cognitive regulation disturbances in the disorder. AEPs and LDAEPs, putative indices of serotonin activity (implicated in MDD etiology), were largely unaltered in MDD. Assessment of ERPs to facial expression processing indicated slightly blunted late preconscious perceptual processing of expressions, and prolonged processing of intensely sad faces in MDD. Faces were rated as sadder overall in MDD, indicating a negative processing bias. Treatment responders (vs. non-responders) exhibited baseline cortical hypoactivity; after a week of treatment, cortical arousal emerged in responders. Increased baseline left fronto-cortical activity and early shifts towards this profile were noted in responders (vs. non-responders). Responders exhibited a steep, and non-responders shallow, baseline N1 LDAEP derived from primary auditory cortex activity. P2 LDAEP slopes (primary auditory cortex-derived) increased after a week of treatment in responders and decreased in non-responders. Consistent with overall findings, ESC responders displayed baseline cortical hypoactivity and steep LDAEP-sLORETA slopes (vs. non-responders). BUP responders also exhibited steep baseline slopes and high ACC theta. These results indicate that specific resting brain activity profiles appear to distinguish depressed from non-depressed individuals. Subtle ERP modulations to simple auditory and emotive processing also existed in MDD. Resting alpha power, ACC theta activity and LDAEP slopes predicted antidepressant response in general, but were limited in predicting outcome to a particular treatment, which may be associated with limited sample sizes.

Online support groups have shown a strong potential to foster resourceful environments for people living with depression without restrictions of time, space, and stigma. Research has found that users of those groups exchange various types of support. However, due to the scarcity of research, many other aspects of depression online support groups remain inconclusive. In particular, how the support exchange contributes to the everyday lives of users living with depression remains unclear. To contribute to filing some of the knowledge gaps, the present study explored what kinds of support were requested and provided in a depression online support group. By doing so, this study aimed to examine the roles of the depression online support group in the management of depression. Mixed methods were employed with a concurrent triangulation strategy. A sample of 980 posts were selected systematically from the support group. Demographic and clinical information of the users who made those posts were recorded. Quantitative and qualitative content analyses were conducted to examine the types of support being exchanged through those posts. Inter-coder reliability was calculated to ensure the consistency of the coding process. The results indicate that users sought informational support, various types of emotional support and coaching support, and social companionship. Users not only sought listening ears, but also practical advice to cope with the situations they were going through. The group appeared to serve its users as a place to meet others with similar experience; to manage loneliness; to discuss what they could not discuss elsewhere; to "just vent"; to gain advice from multiple perspectives on an issue that had been magnifying the impact of depression; to share the experience with formal care provision systems; to express immediate support needs; to share useful discoveries, accomplishments, and creative ways to manage depression; and to experience the value of helping others. This study supports the idea that depression online support groups have the strong potential to contribute to the everyday lives of people living with depression in a way that is not available elsewhere and in a way that complement to the overall framework of existing care provision systems.

Self-harming behaviours and suicidality are a serious problem in psychiatric patients with major depressive disorder (MDD) and borderline personality disorder (BPD). Suicidal behaviours are sometimes seen as manipulative and attention-seeking in BPD patients, and are therefore not considered as dangerous as the same behaviours in MDD patients. The Suicidal Feelings and Self-Harm Questionnaire, which examines suicidal intent, was administered to all new outpatients at the Psychiatric Treatment Clinic in the Department of Psychiatry at the University of Alberta Hospital in Edmonton, Canada. Thirty-seven percent of the MDD patients, 78% of the BPD patients, and 77% of patients with comorbid MDD and BPD reported a history of self-harm. Suicidal intent was measured by asking the patients whether they expected to die as a result of their self-harm. There was no statistically significant difference between the diagnostic groups in this regard. This suggests that BPD patients are no less serious about their intent to die than those with MDD.

abstract: Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD) are highly prevalent illnesses that can result in profound impairment. While many patients with these disorders present in primary care, research suggests that physicians under-detect and suboptimally manage MDD and PTSD in their patients. The development of more effective training interventions to aid primary care providers in diagnosing mental health disorders is of the utmost importance. This research focuses on evaluating computer-based training tools (Avatars) for training family physicians to better diagnose MDD and PTSD. Three interventions are compared: a "choice" avatar simulation training program, a "fixed" avatar simulation training program, and a text-based training program for training physicians to improve their diagnostic interviewing skills in detecting and diagnosing MDD and PTSD. Two one-way ANCOVAs were used to analyze the differences between the groups on diagnostic accuracy while controlling for mental health experience. In order to assess specifically how prior mental health experience affected diagnostic accuracy the covariate of prior mental health experience was then used as an independent variable and simple main effects and pairwise comparisons were evaluated. Results indicated that for the MDD case both avatar treatment groups significantly outperformed the text-based treatment in diagnostic accuracy regardless of prior mental health experience. For the PTSD case those receiving the fixed avatar simulation training more accurately diagnosed PTSD than the text-based training group and the choice-avatar training group regardless of prior mental health experience. Confidence ratings indicated that the majority of participants were very confident with their diagnoses for both cases. Discussion focused on the utility of avatar technology in medical education. The findings in this study indicate that avatar technology aided the participants in diagnosing MDD and PTSD better than traditional text-based methods employed to train PCPs to diagnose. Regardless of experience level the fixed avatar group outperformed the other groups for both cases. Avatar technology used in diagnostic training can be user-friendly and cost-effective. It can also have a world-wide reach. Additional educational benefit could be provided by using automated text analysis to provide physicians with feedback based on the extent to which their case diagnostic summaries cover relevant content. In conclusion, avatar technology can offer robust training that could be potentially transferred to real environment performance. / Dissertation/Thesis / Ph.D. Counseling Psychology 2012

This essay investigates the relationship between a malfunctioning Default Mode Network (DMN) and the diagnosis of Major Depressive Disorder (MDD). A deeper understanding of how the DMN affects those brain processes which are implicated in MDD may offer new approaches to reduce the suffering of the very large number of MDD-afflicted patients. The MDD-DMN relationship has been investigated by studying scientific articles within the field of cognitive neuroscience and searching the articles for clues on how a malfunctioning DMN might correlate with the diagnosis of MDD. The essay concludes that there is much experimental evidence in support of there being a strong coupling between a malfunctioning DMN and the diagnosis of MDD.

Há poucos estudos voltados para a heterogeneidade do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos, apesar de ser um transtorno psiquiátrico comum. As freqüentes associações do TDAH com outros problemas psiquiátricos aumentam a sua morbidade. Dentre essas comorbidades, destacase o transtorno depressivo maior (TDM), que além de ser freqüente influencia o impacto e a abordagem terapêutica do TDAH. Foram avaliados 320 adultos em atendimento ambulatorial para TDAH. O diagnóstico seguiu os critérios do DSM-IV. As entrevistas foram realizadas com a versão em português do K-SADS-E para TDAH e transtorno opositor desafiante (TOD), e com o SCID-IV de transtornos do eixo I para as comorbidades psiquiátricas. Os diagnósticos foram confirmados por avaliação clínica. Modelos de regressão foram aplicados para testar a associação entre a ocorrência de TDM e os desfechos clínicos e demográficos avaliados. Os indivíduos com TDAH e TDM apresentaram maior freqüência de diagnóstico de transtornos de ansiedade e experiência de tratamento prévio (tanto psicoterápico quanto farmacológico) quando comparados a indivíduos com TDAH, sem TDM. Por outro lado, apresentaram menos freqüentemente diagnóstico de dependência de drogas e histórico escolar de repetência ou suspensões de classe. Não houve diferença significativa entre os grupos com ou sem TDM quanto à idade do diagnóstico de TDAH. Os achados sugerem uma utilidade do diagnóstico de TDM como um indicador relevante de determinadas características clínicas em adultos com TDAH. A maior procura por tratamento relacionada ao TDM não foi acompanhada de um diagnóstico mais precoce do TDAH, como seria esperado. Se confirmados, esses dados apontam para a necessidade de pesquisas e educação médica voltadas para um reconhecimento mais eficiente e precoce do TDAH em pacientes que buscam atendimento em saúde mental por outras causas. / There are few studies on the heterogeneity of adult ADHD, despite it is a common psychiatric disorder. The frequent comorbidity between ADHD and other psychiatric problems, increases the morbidity of the disorder. Major depressive disorder (MDD) stands out between other ADHD comorbidities, since it is frequent and influences ADHD outcomes and therapeutic approach. Three hundred and twenty adult outpatients were evaluated for ADHD. Diagnosis followed DSM-IV criteria. Interviews to evaluate ADHD and oppositional defiant disorder (ODD) were performed based on the Portuguese-language version of K-SADS-E and Psychiatric comorbidities were evaluated using SCID-IV for axis I disorders. Diagnoses were confirmed by clinical interview. Regression models were applied to test MDD association with clinical and demographic outcomes. Subjects presenting ADHD and MDD had a higher frequency of anxiety diagnosis and prior experience of psychotherapy and/or pharmacological treatment when compared to ADHD subjects free of MDD. On the other hand, they reported less often drug dependence diagnosis, grade repetition and school suspensions. There was no significant difference between groups with or without MDD on the age at ADHD diagnosis. These findings suggest that the MDD diagnosis may be useful as an important indicator of certain clinical characteristics in adults with ADHD. The more frequent search for treatment attributable to MDD diagnosis was not accompanied by an earlier ADHD diagnosis, as expected. If confirmed, the present data point to the need for research and medical education towards an earlier and more efficient ADHD diagnosis in patients who search for mental health care for other reasons.

DEAF1 is a transcription factor linked to suicide and depression and is recurrently mutated in non-syndromic intellectual disorder (ID). In humans with major depressive disorder (MDD), DEAF1 is reported to have altered expression in the prefrontal cortex and the dorsal raphe nucleus of females but not males, and therefore may function in sex-specific depression. Standard (whole body) knockout of Deaf1 has been reported to alter 5-hydroxytryptamine (serotonin) receptor 1A (Htr1a) levels in the frontal cortex and dorsal raphe nucleus. We hypothesized that mice with targeted deletion of Deaf1 in brain would produce behavior phenotypes analogous to human MDD and ID, and that changes in Deaf1-target gene expression would be associated with behavior changes. To test this hypothesis, we produced a mouse line to allow conditional gene targeting of exons 2-5 (Deaf1-flox). Deaf1-flox mice were bred to congenic status onto a C57BL/6 background, and were then bred to mice transgenic for the Nestin-Cre gene to produce embryonic knockout of Deaf1 in neuronal precursor cells. Adult mice were tested for anxiety behavior using the Elevated Plus Maze and Open Field Exploration tests, and were tested for depression-like behavior using the Porsolt forced swim and sucrose preference tests. Relative to control mice, both male and female mice with homozygous deletion of Deaf1 in brain displayed increased anxiety measured by the anxiety tests, and no differences were measured in tests for depression-like behavior. Rotarod testing showed no deficits in motor skills of male mice. Learning and memory in mice were tested using Morris Water Maze (MWM) and fear conditioning. No change in long-term memory in male mice was observed in MWM, but both male and female mice lacking Deaf1 displayed severe deficits in fear conditioning tests. Eif4g3 and Tmem80 are target genes of Deaf1 and decreased mRNA levels were observed for Eif4g3 and Tmem80 throughout the brain of Deaf1 knockout mice, with no change in Htr1a mRNA levels. Our results demonstrate that conditional knockout of Deaf1 in neuronal precursors produces anxiety behavior and deficits in learning and memory in adult mice, potentially without changes in Htr1a mRNA levels, and that this mouse model may be useful in understanding the molecular mechanisms underlying MDD and ID in humans.

Há poucos estudos voltados para a heterogeneidade do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos, apesar de ser um transtorno psiquiátrico comum. As freqüentes associações do TDAH com outros problemas psiquiátricos aumentam a sua morbidade. Dentre essas comorbidades, destacase o transtorno depressivo maior (TDM), que além de ser freqüente influencia o impacto e a abordagem terapêutica do TDAH. Foram avaliados 320 adultos em atendimento ambulatorial para TDAH. O diagnóstico seguiu os critérios do DSM-IV. As entrevistas foram realizadas com a versão em português do K-SADS-E para TDAH e transtorno opositor desafiante (TOD), e com o SCID-IV de transtornos do eixo I para as comorbidades psiquiátricas. Os diagnósticos foram confirmados por avaliação clínica. Modelos de regressão foram aplicados para testar a associação entre a ocorrência de TDM e os desfechos clínicos e demográficos avaliados. Os indivíduos com TDAH e TDM apresentaram maior freqüência de diagnóstico de transtornos de ansiedade e experiência de tratamento prévio (tanto psicoterápico quanto farmacológico) quando comparados a indivíduos com TDAH, sem TDM. Por outro lado, apresentaram menos freqüentemente diagnóstico de dependência de drogas e histórico escolar de repetência ou suspensões de classe. Não houve diferença significativa entre os grupos com ou sem TDM quanto à idade do diagnóstico de TDAH. Os achados sugerem uma utilidade do diagnóstico de TDM como um indicador relevante de determinadas características clínicas em adultos com TDAH. A maior procura por tratamento relacionada ao TDM não foi acompanhada de um diagnóstico mais precoce do TDAH, como seria esperado. Se confirmados, esses dados apontam para a necessidade de pesquisas e educação médica voltadas para um reconhecimento mais eficiente e precoce do TDAH em pacientes que buscam atendimento em saúde mental por outras causas. / There are few studies on the heterogeneity of adult ADHD, despite it is a common psychiatric disorder. The frequent comorbidity between ADHD and other psychiatric problems, increases the morbidity of the disorder. Major depressive disorder (MDD) stands out between other ADHD comorbidities, since it is frequent and influences ADHD outcomes and therapeutic approach. Three hundred and twenty adult outpatients were evaluated for ADHD. Diagnosis followed DSM-IV criteria. Interviews to evaluate ADHD and oppositional defiant disorder (ODD) were performed based on the Portuguese-language version of K-SADS-E and Psychiatric comorbidities were evaluated using SCID-IV for axis I disorders. Diagnoses were confirmed by clinical interview. Regression models were applied to test MDD association with clinical and demographic outcomes. Subjects presenting ADHD and MDD had a higher frequency of anxiety diagnosis and prior experience of psychotherapy and/or pharmacological treatment when compared to ADHD subjects free of MDD. On the other hand, they reported less often drug dependence diagnosis, grade repetition and school suspensions. There was no significant difference between groups with or without MDD on the age at ADHD diagnosis. These findings suggest that the MDD diagnosis may be useful as an important indicator of certain clinical characteristics in adults with ADHD. The more frequent search for treatment attributable to MDD diagnosis was not accompanied by an earlier ADHD diagnosis, as expected. If confirmed, the present data point to the need for research and medical education towards an earlier and more efficient ADHD diagnosis in patients who search for mental health care for other reasons.