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BACKGROUND Few high-quality observational studies have been conducted to examine clinically relevant features of emotional distress and Major Depressive Disorder (MDD) in adults with primary cerebral glioma. Our knowledge of these important complications of glioma is currently poor. AIMS This thesis aims to answer a series of relevant clinical questions. I have studied: [1] the frequency, independent clinical associations and course of general emotional distress measured using the NCCN Distress Thermometer (DT); [2] the utility of three depression screening tools for identifying MDD; [3] the frequency, independent clinical associations and course of MDD in glioma; [4] current patterns of practice, and the apparent tolerability of antidepressant treatment of depression in glioma; and [5] barriers to the effective management of MDD in glioma. METHODS I conducted a prospective, twin-centre, observational cohort study. Adults with a new histological diagnosis of primary supratentorial glioma were enrolled and interviewed three times: shortly after starting radiotherapy (T1), three months later (T2) and six months later (T3). At each time point participants completed the DT, the Hospital Anxiety and Depression Scale (Depression subscale, HAD-D), the Patient Health Questionnaire-9 (PHQ-9) and the Structured Clinical Interview for DSMIV MDD (SCID). Barriers to depression management were studied using questionnaires completed by the patient and their named GP. RESULTS During a two-year recruitment period, 223 patients were eligible and 155 provided useable data (57.4% male, mean age = 54.2 years, 85.8% high-grade glioma, 78.1% radical radiotherapy, 55.5% chemotherapy). [1] High distress (DT score ≥ 4/10) was consistently a frequent complication, occurring in between 36.4% ± 7.6% of patients at T1 to 33.7% ± 10.2% at T3. In a logistic regression analysis, high distress at T1 was independently associated with MDD, functional impairment and younger age (χ2 for model = 39.882, p < 0.001, R Square = 0.312). Patients who reported high distress at T1 (median DT score = 8; IQR 7 - 9) remained highly distressed on follow-up (T2 median score = 8, IQR 6 - 8; T3 median score = 7, IQR 5 - 8). [2] As screening tools, the HAD-D and PHQ-9 showed good internal consistency (α = 0.769 - 0.862 at any time point). The HAD-D displayed the best operating characteristics on ROC curve analysis. At a threshold of 7+, sensitivity = 0.933, specificity = 0.907 and Positive Predictive Value (PPV) = 0.56. A threshold of 8+ displayed similar PPV, however. [3] The cross-sectional prevalence of MDD was 13.5% ± 5.4% at T1, 14.8% ± 6.7% at T2 and 6.8% ± 5.8% at T3. Inter-rater diagnostic agreement was good (κ = 0.81, 95% CI 0.60 – 1.00). MDD was independently associated with a past history of depression (OR = 3.8, 95%CI 1.5 - 9.8), and with current functional impairment (OR = 3.6, 95%CI 1.4 - 9.4). MDD persisted for at least three months in 9/17 patients who could be followed up. [4] The frequency of antidepressant prescription was 8.4% ± 4.4% at T1, 7.4% ± 4.9% at T2 and 12.6% ± 6.9% at T3. Citalopram was the most frequent antidepressant choice. Antidepressant tolerability appeared to be good among patients who could be followed up. [5] Barriers to the management of depression included 78.4% of GPs regarding major depression as a normal reaction to having glioma, and 39.2% expressing a belief that major depression did not always require treatment. In addition, most patients expressed a degree of resistance to any kind of future depression treatment. DISCUSSION This is the largest cohort study of depression in consecutively presenting adults with glioma, and the first to utilise criterion standard structured interview diagnoses in a longitudinal design. There is a degree of theoretical uncertainty about the nosological validity of MDD in glioma, although the clinical relevance of this uncertainty can be debated. Methodological limitations to the presented study include an absence of alternative potential psychiatric diagnoses to MDD, the likelihood of selection bias in recruitment, and considerable attrition. Due to these and other limitations, findings from this study are tentative and should ideally be replicated. Clinicians should have a high index of suspicion for identifying low mood in glioma patients, particularly those with functional impairment or previous depressive episodes. The HAD-D (suggested threshold 8+) can reasonably be used to screen for depression, if desired. Caution is required when prescribing antidepressants. Clinicians should be educated about the frequency and consequences of MDD in glioma. Researchers interested in psychological neuro-oncology could convene a meeting to guide future projects, particularly since multi-centre studies may be necessary to recruit sufficient sample sizes in future.

Background: Research suggests that prenatal depression is associated with disrupted maternal responses to infant stimuli, with depressed women not showing the bias towards distressed infants observed in non depressed women (Pearson, 2010). The current study examined depression related differences in women’s self reported responses to infant stimuli, early in pregnancy, investigating if maternal responses in pregnancy are more associated with a reduced comforting response, or a heightened avoidant response. Method: Women in this study were referred by community midwives as part of a cohort study. Pregnant women with clinical depression (n=38), and comparison non-depressed women (n=67), were exposed to images of distressed, neutral and happy infant faces. The women were asked to rate how they responded to the images, along three scales: wanting to comfort, wanting to turn away, and feelings of anxiety. Results: Women with depression showed significantly different response patterns to women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away from distressed infant faces (odds ratio 4.15, p<.01, 95% confidence intervals (CI) = 1.63-10.5). They were also substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face (odds ratio .22, p<.01, 95% confidence intervals (CI) = .09-.54). Conclusions: The findings from this study are consistent with both a heightened avoidant and a reduced comforting response towards distressed infants in depressed pregnant women. This study provides further evidence that depression disrupts maternal preparations at a conscious level. Keyword: Depression; Maternal Responsiveness; Self Report; Pregnancy; Prenatal; Perinatal.

Research shows that low levels of social acceptance, body satisfaction, and athletic competence increase risks for depressive symptoms among both girls and boys (Harter, Marold, & Whitesell, 1992). Little is known, however, about factors that can mediate these risks. To better understand how sports involvement may mediate risks for depressive symptoms, this study uses a multivariate structural model to examine how the qualitative nature of team sports involvement operates to influence risks for depressive symptoms. Participants were 455 students from a high school in a moderately-sized city. Girls reported lower mean levels of body satisfaction and athletic engagement and tended have higher levels of depressive symptoms. No sex differences were observed in experiences of positive team sports involvement. Structural equation modeling showed that the mediating model fit the data well. Implications for community- and school-based sports programs are discussed.

Bakgrund: Depression definieras som en ihållande förekomst av nedstämdhet som påverkar individens tankar, känslor och beteende. Risken för att kvinnor någon gång drabbas av depression är 30 %. Fysisk aktivitet minskar risken för depression genom att dämpa och hindra uppkomsten av depressiva symptom. Fysisk aktivitet på recept, FaR, är en metod som används av sjukvården för att främja fysisk aktivitet. Syfte: Syftet var att beskriva kvinnors erfarenheter av fysisk aktivitet vid depression. Metod: En litteraturstudie där resultatet baseras på tio vetenskapliga originalartiklar med kvalitativ ansats. Resultat: Resultatet utgörs av huvudteman och underteman som beskriver att fysisk aktivitet påverkar kvinnors välbefinnande samt ger upphov till känslor av mening och sammanhang. Kvinnor erfar att det kan uppstå hinder för att utföra fysisk aktivitet där brist på tid och avsaknad av motivation återfinns. Slutsats: Fysisk aktivitet påverkar kvinnorna positivt fysiskt och psykiskt eftersom träningen ett sätt till möjlig självbehandling. Motivation är en av de avgörande faktorerna som finns för att kvinnorna ska kunna utföra fysisk aktivitet. Sjuksköterskan innehar en viktig roll för att kunna stödja och motivera patienten till fortsatt träning. Därav är det viktigt att sjuksköterskan har ett följsamt förhållningssätt. Sjuksköterskan upplever svårigheter att förskriva FaR då de saknar tillräckligt med kunskap.

This thesis explores the histories of mild to moderate depression and the use of over the counter (OTC) St. John’s wort (St. John’s wort) during the 1990s. In doing so it not only investigates the diagnosis and definition of mental illnesses, it also raises questions about the interface between conventional and alternative medicine. Using a variety of printed sources, including popular media articles, scientific and medical journal publications, and St. John’s wort self-help books, a number of historical themes are explored. This thesis takes issue with existing medical historical studies of depression. Firstly it is argued that they have presented progressive depression histories. Secondly, it is suggested that they have retrospectively diagnosed depression on the basis of similar symptoms. It is therefore argued that illness is specific to the time in which it exists and should be understood within its own historical timeframe. During the 1990s standardised St. John’s wort was promoted as a natural and safe remedy. Adverts and media reports also highlighted the fact that it had a long medical history. Although this thesis establishes that the plant has been traditionally used to treat physical illnesses, it seems that a growing distrust of conventional antidepressants, combined with an established interest in alternative medicine, encouraged some lay people to use the remedy to treat mild mood disorders. It is further argued that lay people have a history of self-treating minor mental illnesses using preparatory and OTC remedies such as preparatory nerve tonics. Not only did lay people desire autonomous treatments, it also seems that standardised St. John’s wort provided a functional role as an OTC remedy. By the 1990s the concepts of responsible self-care and self-treatment were being actively encouraged by medical authorities. Therefore this thesis reclassifies the passive mild to moderately depressed patient as an active consumer. Following an analysis of the popular media it is suggested that the 1990s coverage of depression and its treatments was confusing. Indeed, depression and its treatment with conventional medicines and St. John’s wort were sometimes presented as part of a wider life style choice. Finally, it is argued that by the 1990s standardised St. John’s wort received the same scientific and medical scrutiny as conventional medicines. It is therefore suggested that the remedy represents a situation in which the boundaries between conventional and alternative medicines have become increasingly indistinguishable.

As disc-shaped detectors are one of the primary means of measuring the neutron density, a better solution is desirable if the error due to the depression factor is to be made negligible. In this paper, an attempt is made to solve this problem in the oblate spheroidal co-ordinate system which most nearly describes the disc-shaped detector, so that solutions may be obtained that describe depression factors for detectors of varying thicknesses and radii.

The current work assesses the relationship between reinforcement sensitivity theory (RST) and Personality Traits for the DSM-5 (PID-5), to explore the degree to which they are associated with mood disorder symptoms. Participants (N = 138) from a large public university in the South were administered a semi-structured interview to assess for current mood disorder and anxiety symptoms. They were also administered self-report inventories, including the Behavioral Inhibition System (BIS) and Behavioral Approach System (BAS) scales and the Personality Inventory for DSM-5 (PID-5). Results indicate that both the BIS/BAS scales and the PID-5 scales were strongly associated with current mood symptoms. However, the maladaptive personality traits demonstrated significantly greater associations with symptoms compared to the BIS/BAS scales. Results also indicated support for using a 2-factor model of BIS as opposed to a single factor model. Personality models (such as the five factor model) are strongly associated with mood symptoms. Results from this study add to the literature by demonstrating credibility of an alternative five-factor model of personality focused on maladaptive traits. Knowledge of individual maladaptive personality profiles can be easily obtained and used to influence case conceptualizations and create treatment plans in clinical settings.