Die Depression ist eine Erkrankung mit einer hohen Prävalenz, die mit einem hohen Risiko für Suizidalität assoziiert ist. Traumata während der Kindheit gelten als einer der Hauptrisikofaktoren für Depressionen und Suizide. Die Assoziation einer Hyperaktivität des adrenergen Nervensystems und sowohl Depressionen als auch Suizidalität ist gut belegt. Mit einer antidepressiven Behandlung können suizidale Handlungen verhindert werden, jedoch gibt es eine Subgruppe, in der Suizidgedanken während der Therapie neu auftreten oder sich intensivieren (TWOSI). Während bereits mehrere genetische Polymorphismen mit dem Auftreten von Suizidgedanken während der Therapie assoziiert werden konnten, gibt es noch keine geeignete Methode, diese Patienten vor Therapiebeginn zu identifizieren, um deren Krankheitsverlauf genauer zu überwachen. Im Rahmen unserer Studie untersuchten wir stationäre Patienten mit einer depressiven Episode mittels eines Langzeit-EKGs zur Messung der Herzfrequenz und verschiedener Herzratenvariabilitätsparameter. Außerdem wurde bei Studieneinschluss durch einen Selbstbeurteilungsfragebogen verschiedene Formen einer Traumatisierung in der Kindheit erhoben und sowohl bei Aufnahme als auch in den darauffolgenden Wochen eine Fremdbeurteilungsskala zur Erfassung der Suizidgedanken durchgeführt. Dabei zeigte sich, dass elf der insgesamt 89 Patienten ein Neuauftreten oder eine Verschlechterung von Suizidgedanken zeigten. Hierbei stellte sich heraus, dass TWOSI� Patienten schwerwiegendere emotionale Missbrauchserfahrungen in ihrer Kindheit erlebt hatten. Zudem zeigten diese Patienten eine höhere adrenerge Aktivität, widergespiegelt durch eine erhöhte Herzfrequenz und eine niedrigere Herzratenvariabilität. Somit könnte sich mit zunehmender Schwere der Kindheitstraumatisierung ein Überwiegen der sympathischen Aktivität ergeben, und daraus wiederum ein höheres Risiko für die Intensivierung der Suizidgedanken während der Behandlung. Messungen des autonomen Nervensystems könnten in Zukunft als Werkzeug dienen, Patienten mit einem erhöhten Risiko für TWOSI zu identifizieren. / Depression is a common disorder, which is associated with a high risk of suicidality. Among the many risk factors for both Major Depressive Disorder and suicidality are traumata during childhood. In addition, both conditions are associated with an increase of the adrenergic nervous system. Depression can be treated effectively with antidepressants and antidepressant medication is able to prevent suicide attempts. However, there is a long lasting discussion, if there is an emergence or an increase in suicidal ideation, called treatment emergent suicidal ideation (TESI) or treatment worsening suicidal ideation (TWOSI), caused by antidepressants, especially in the first few weeks of treatment or dose adjustments. Several genetic polymorphisms were identified to be associated with TWOSI, but yet, there is no suitable method to identify patients at risk before initiation of treatment . We recruited 89 depressed in-patients. Treatment Emergent or Worsening Suicidal Ideation (TWOSI) was defined as an emergence or an increase in the Columbia suicide severity rating scale in the first 4 weeks of treatment with antidepressants in a naturalistic setting. In addition, adverse events in childhood were assessed using the Childhood Trauma Questionnaire (CTQ). We evaluated the adrenergic nervous system measuring heart rate and heart rate variability with a 24-h-ECG-recording in the first week after admission. 11 patients experienced TWOSI. These subjects had a higher score in the emotional abuse section of the CTQ. Patients with an increase in suicidal thoughts had a significantly higher heart rate and significantly lower heart rate variability parameters than the comparison group. Our findings suggest that adverse events in childhood lead to a higher adrenergic arousal and thus to a higher risk to develop suicidal ideation during multimodal treatment of depression including antidepressants. After replication in large studies HRV measures may be used to identify patients at risk for TWOSI.

Podium presentation on avaian based green care therapy for people living with depression.

Bibliography: pages 83-86. / This study attempts to identify the incidence of depression in patients on haemodialysis treatment and the consequences it has for clinical social work intervention. The awareness of depression in haemodialysis arose out of the researcher's practice as a social worker in the renal unit at Groote Schuur Hospital. The study adopts a quantitative-descriptive research design. Eighteen patients currently on haemodialysis treatment were sampled and interviewed. A standardized scale, The Hospital Anxiety and Depression (HAD) Scale, was used to obtain the data. The data was analysed through use of the scoring method provided with the scale and from which inferences were made. The results conclude that depression is not prevalent in patients on haemodialysis treatment. However the incidence is significant enough to consider the implications it has for clinical social work intervention and recommendations are made in this regard.

Indiana University-Purdue University Indianapolis (IUPUI) / The restaurant industry is one of the largest in the United States, and employees within this industry deal with poor working conditions on a daily basis. Despite this, there has been a surprising dearth of research to understand the mental health needs of these workers. The aims of this study were to establish a prevalence of burnout and depression, and understand the relationships between these two outcomes with the constructs of bullying, perfectionism, and social support. To do so, restaurant workers (N=453) were recruited to complete an on-line survey. Results revealed a high prevalence of depressive symptoms and an overextended profile of burnout. Both bullying and perfectionism displayed significant positive relationships with depression and burnout, while social support demonstrated significant negative relationships with burnout and depression. When analyzed in a three-way interaction, social support failed to significantly moderate the effects of bullying and perfectionism on depression and burnout. Results indicate that depression and burnout are serious concerns among restaurant workers. Additionally, bullying and perfectionism are promising targets to consider in future research as mechanisms leading to depression and burnout among restaurant workers.

Indiana University-Purdue University Indianapolis (IUPUI) / Systemic inflammation is one potential mechanism underlying the depression to cardiovascular disease (CVD) relationship. In addition, somatic rather than cognitive/affective symptoms of depression may be more predictive of poorer CVD outcomes due to systemic inflammation. However, the small existing literature in this area has yielded mixed results. Therefore, the present study aimed to examine longitudinal associations between depressive symptom clusters and inflammatory biomarkers implicated in CVD (i.e., interleukin-6, IL-6; and C-reactive protein, CRP) using data from the eIMPACT trial. In addition, race was examined as a moderator given findings from two previous studies. The eIMPACT trial was a phase II, single-center randomized controlled trial comparing 12 months of the eIMPACT intervention to usual primary care for depression. Participants were 216 primary care patients aged ≥ 50 years with a depressive disorder and CVD risk factors but no clinical CVD from a safety net healthcare system (Mage = 58.7 years, 78% female, 50% Black, Meducation = 12.8 years). Depressive symptoms clusters (i.e., somatic and cognitive/affective clusters) were assessed using the Patient Health Questionnaire-9 (PHQ-9). IL-6 and high-sensitivity CRP were assessed by the local clinical research laboratory using R&D Systems ELISA kits. Change variables were modeled in MPlus using a latent difference score approach. The results of this study were largely null. Very few associations between depressive symptom clusters and inflammatory biomarkers implicated in CVD were observed, and the detected relationships may be due to type I error. Similarly, only one association was observed for race as a moderator, and the detected relationship may be due to type I error. The present findings do not provide strong support for the longitudinal associations between depressive symptom clusters and inflammatory biomarkers implicated in CVD nor the moderating effects of race. However, the present findings do not rule out the possibility of these relationships given important study limitations, such as study design and power. Future prospective cohort studies with multiple waves of data collection are needed to determine the longitudinal associations between depression facets and various inflammatory biomarkers implicated in CVD. In addition, a biologically-based approach to identifying facets of depression – e.g., the endophenotype model – may provide a clearer understanding of the depression-inflammation relationship.

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Two opposing effects on "behavior, a depressant effect and a disinhibitory effect, have been attributed to the "benzodiazepine tranquillizers including chlordiazepoxide. The depressant effect has "been reported to undergo tolerance with repeated doses over several days. The first experiment here was designed to determine the number of days required for tolerance at the 15 mg/kg dose. When no tolerance was found in a test of spontaneous activity, further studies were conducted to determine why no tolerance had occurred and to study conditions under which tolerance might be found.

Technological advances and industrialization that moved production from cottage activities to large factories and business enterprises, the advent of reliable birth control that afforded women greater freedom from chi Idrearing , the contemporary women's movement that supported women's efforts to extend their strengths and interests beyond childrearing and the home, and more recently, economic necessity, have all contributed to the increasing number of families where both husband and wife work full-time outside the home. These changes have not been without stress for the women and men involved in a transition from roles and responsibilities traditionally circumscribed on the basis of sex, to possibilities of more nontraditional arrangements of family and work responsibilities.

The prevalence of depression in contemporary society has prompted disturbing questions regarding the quality of life. Despite staggering statistics, however, basic issues regarding the etiology and treatment of depressive disorders remain largely unresolved. In recent years a heightened emphasis has been placed on the impact of stressful life events on the onset and maintenance of depressive symptomatology. This approach supplements more traditional concern with real or symbolic losses in depressed individuals. The finding of higher rates of depression among women has also generated increasing interest.