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Background: Major depressive disorder (MDD) is a highly prevalent mental disorder which causes public health burden and personal disabilities. In people with mental illness, unemployment is an index character of functional impairment. Methods: Using the Taiwan Databank of Persons with Disability (TDPD), we collected the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) scores for people with MDD-associated disability. We recorded and analyzed the scores of participants during a 3-year period to determine the impact of employment on the trajectory of functional change. Logistic regression was performed to analyze the association between employment and changes in WHODAS 2.0 scores. Results: In people with MDD-associated disability, unemployed individuals present a worse function initially compared to employed individuals. After a 3-year period, the employed group showed a significant functional improvement in the domains of cognition, mobility, and participation. In logistic regression, the odds of having functional improvement were twice as high for those who were employed compared with those who were not. Conclusions: Higher odds of having functional improvement were noted in participants who stay in employment. Programs and strategies to help people with MDD-associated disability resume work warrant more clinical attention and supportive policies from the government.

The major objective of this study was to investigate how smoking behavior mediates the relationship between life stress and depressive symptoms in adolescents. A descriptive correlational study was conducted from February to June 2017 at a vocational high school in northern Taiwan, and 226 students were recruited through convenience sampling. Results indicated that smoking behavior played a pivotal role by partially mediating the relationship between life stress and depressive symptoms in adolescents. Life stress in adolescents significantly increased the risk of experiencing depressive symptoms, and adolescents who smoked were also at a greater risk. Assessments between the objective and self-reported smoking behavior were significantly correlated. Therefore, integrated methods for assessing life stress, smoking behavior, and depressive symptoms in adolescents are needed for teachers and clinical professionals. Implementing appropriate policies for discouraging tobacco use for adolescents experiencing life stress in order to decrease depressive symptoms in school settings is paramount., (© 2020 John Wiley & Sons Australia, Ltd.)

The brain's intrinsic activity plays a fundamental role in its function. In normal conditions this activity is responsive to behavioural context, changing as an individual switches between directed tasks and task-free conditions. A key feature of such changes is the movement of the brain between corresponding critical and sub-critical states, with these dynamics supporting efficient cognitive processing. Breakdowns in processing efficiency can occur, however, in brain disorders such as depression. It was therefore hypothesised that depressive symptoms would be related to reduced intrinsic activity responsiveness to changes in behavioural state. This was tested in a mixed group of major depressive disorder patients (n = 26) and healthy participants (n = 37) by measuring intrinsic EEG activity temporal structure, quantified with detrended fluctuation analysis (DFA), in eyes-closed (EC) and eyes-open task-free states and contrasting between the conditions. The degree to which DFA values changed between the states was found to correlate negatively with depressive symptoms. DFA values did not differ between states in those with higher symptom levels, meaning that the brain remained in a less flexible sub-critical condition. This sub-critical condition in the EC state was further found to correlate with levels of maladaptive rumination. This may reflect a general cognitive inflexibility resulting from a lack in neural activity reactivity that may predispose people to overly engage in self-directed attention. These results provide an initial link between intrinsic activity reactivity and psychological features found in psychiatric disorders., (© 2020 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Objective: Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of anxiety or depression. To explore the potential biomarkers for emotional disorders in mTBI patients, we analyzed the frequency domain of heart rate variability (HRV) and serum concentrations of four neurohormones., Methods: We assessed mTBI patients on their first visit and follow-up. Symptoms were evaluated by the Beck Anxiety Inventory and the Beck Depression Inventory, respectively. Serum levels of adrenocorticotropic hormone (ACTH), melatonin, cortisol, and insulin-like growth factor (IGF)-1 and HRV follow-ups were measured and compared., Results: mTBI patients were more vulnerable to symptoms of anxiety or depression than healthy controls. Reduced HRV was noted in mTBI patients compared to healthy controls. The mTBI patients demonstrated higher serum levels of ACTH, lower IGF-1 compared to healthy controls. In correlation analysis, only IGF-1 was positively correlated with HRV in mTBI patients. Both HRV and IGF-1 were correlated with symptom of depression while only HRV was correlated with symptom of anxiety in mTBI patients., Conclusions: We infer that HRV may be more significantly correlated with emotional disorders than is IGF-1 in mTBI patients., Significance: The study is relevant for specific diagnostic markers in mTBI patients., (Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: This study aims to estimate the risk of developing stroke within 5 years of discharge among young patients ages 18 to approximately 44 who were hospitalized for depressive disorders., Methods: Our study design features a study cohort and a comparison cohort. The study cohort included patients ages 18 to approximately 44 who were hospitalized with a principal diagnosis of depressive disorder (n = 827), whereas the comparison cohort consisted of 4,135 patients selected randomly (five for every depressed patient) and matched with the study group in terms of gender, age, and date of discharge. Each patient was tracked for 5 years after their discharge in 1998. Cox proportional hazard regressions were performed to compute the 5-year stroke-free survival rates after adjusting for possible confounding factors., Results: During the 5-year follow-up period, 50 depressed patients (6.05% of the study cohort) and 48 non-depressed subjects (1.16% of the comparison cohort) developed strokes. The adjusted hazard of stroke was 5.43 (95% confidence interval = 3.47-8.51, p < .001) times greater for depressed patients than for non-depressed subjects., Conclusions: Our findings show young patients ages 18 to approximately 44 who were hospitalized for depressive disorders were at over five times greater risk of developing stroke within 5 years of discharge compared with non-depressed age- and gender-matched subjects.

Patient suffering of major depressive disorder (MDD) often complain that subjective time seems to "drag" with respect to physical time. This may point toward a generalized dysfunction of temporal processing in MDD. In the present study, we investigated temporal preparation in MDD. "Temporal preparation" refers to an increased readiness to act before an expected event; consequently, reaction time should be reduced. MDD patients and age-matched controls were required to make a saccadic eye movement between a central and an eccentric visual target after a variable duration preparatory period. We found that MDD patients produced a larger number of premature saccades, saccades initiated prior to the appearance of the expected stimulus. These saccades were not temporally controlled; instead, they seemed to reflect reduced inhibitory control causing oculomotor impulsivity. In contrast, the latency of visually guided saccades was strongly influenced by temporal preparation in controls; significantly less so, in MDD patients. This observed reduced temporal preparation in MDD was associated with a faster decay of short-term temporal memory. Moreover, in patients producing a lot of premature responses, temporal preparation to early imperative stimuli was increased. In conclusion, reduced temporal preparation and short-term temporal memory in the oculomotor domain supports the hypothesis that temporal processing was altered in MDD patients. Moreover, oculomotor impulsivity interacted with temporal preparation. These observed deficits could reflect other underlying aspects of abnormal time experience in MDD. [ABSTRACT FROM AUTHOR]

Androgen deprivation therapy (ADT) results in testosterone suppression, a hypothesized mechanism linking ADT to depressive symptoms. This study investigated the relationship between ADT and the risk of subsequently being diagnosed with depressive disorder (DD) during a 3-year follow-up period. The patient sample for this population-based, retrospective cohort study was retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We included all 1714 patients aged over 40 years with a first-time diagnosis of prostate cancer (PC) during 2001 to 2010 who did not have an orchiectomy. Among them, we defined 868 patients who received ADT during the 3-year follow-up period as the study group, and 846 patients who did not receive ADT as the comparison group. The incidence rates of DD per 1000 person-years were 13.9 (95% confidence interval (CI): 9.5~19.6) and 6.7 (95% CI: 3.7~11.0), respectively. Cox proportional hazard regressions showed that the adjusted hazard ratio for DD for ADT recipients was 1.93 (95% CI: 1.03~3.62) relative to the comparison group. This study presents epidemiological evidence of an association between ADT and a subsequent DD diagnosis. [ABSTRACT FROM AUTHOR]

Depression is one of the frequent complications following a mild traumatic brain injury (mTBI). Recent research indicated that abnormalities in the autonomic nervous system (ANS) can be evaluated by a noninvasive power spectral analysis of the heart rate variability (HRV). In this study, we investigated whether a frequency-domain analysis of HRV was correlated with late depression in mTBI patients. In total, 181 patients diagnosed with mTBI and 83 volunteers as healthy controls were recruited in 2010-2014. Beck Depression Inventory (BDI) scores were used to evaluate depression in the 1st week of assessment and at 1.5-, 3-, 6-, 12-, and 18-month follow-ups. Correlation and logistic regression analyses of the 1st week HRV parameters with BDI scores at 18 months were performed in individual female mTBI patients. Female mTBI patients were more vulnerable to depression accompanied by reduced HRV compared to healthy controls. Over time, depression was aggravated in female mTBI patients but was alleviated in male mTBI patients. A significantly lower parasympathetic proportion of the ANS was noted at 18 months with respect to the 1st week in female mTBI patients. In addition, depression in female mTBI patients at 18 months after injury was significantly correlated with a decrease in the parasympathetic proportion of the ANS in the 1st week (ρ = −0.411; p < .05). Dysautonomia resulted in higher risks of depression in female mTBI patients. We concluded that early dysautonomia following an mTBI contributes to late depression in female mTBI patients. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To explore risk factors, such as characteristics of psychiatrist, patient and hospital at index hospitalization, associated with depressed patients who committed suicide within 3 months of discharge using a case-control design. Methods: By linking the Taiwanese nationwide mortality database and the National Health Insurance dataset, all hospitalized patients with major depression who committed suicide within a 90-day period post-discharge during the years 2002–2004 were selected as a study cohort (n =85). We randomly selected 425 cases (five for every case in the study cohort) that were matched with the study cohort in terms of age, gender and date of discharge as a control cohort. Cox proportional hazard regression was carried out to compute the adjusted 90-day survival rate after adjusting for other factors. Results: The majority of suicide occurred 30 days after discharge from hospitals, with a mean of 29.9 days. The adjusted hazard for committing suicide after hospital discharge for patients who left on their own initiative was 2.85 times (95% CI=1.387–5.856, p =0.004) greater than for those who were discharged with doctors'' approval. Furthermore, the adjusted hazard for patients who were discharged from medical centers was higher than for patients discharged from regional hospitals, by a multiple of 3.38 (95% CI=1.421–8.055, p =0.006). Limitations: Some patient-specific predictors of post-discharge suicide, such as suicidal ideation prior to admission, recent life events and social relationships with close relatives were not available. Conclusion: We conclude that, in addition to patient characteristics, hospital characteristics also constitute important risk factors for suicide within 90 days of discharge for depressed patients. [Copyright &y& Elsevier]

Serum lipids have been found to play important roles in the pathophysiology of mood disorders. The aim of the present study was therefore to investigate the relationship between symptom dimensions and serum cholesterol and triglyceride levels, and to explore correlates of lipid levels during acute mood episodes of bipolar I disorder in Taiwan. Measurements were taken of the serum cholesterol and triglyceride levels in patients with bipolar I disorder hospitalized for acute mood episodes (68 manic, eight depressive, and six mixed). The relationships between serum lipids levels and various clinical variables were examined. The mean serum levels of cholesterol (4.54 mmol/L) and triglycerides (1.16 mmol/L) of sampled patients were comparable to those of the general population in the same age segment. Severe depressive symptoms and comorbid atopic diseases were associated with higher serum cholesterol levels. A negative association was noted between serum triglyceride levels and overall psychiatric symptoms. Compared with previous studies on Western populations, racial differences may exist in lipids profiles of bipolar disorder patients during acute mood episodes. Increased serum cholesterol levels may have greater relevance to immunomodulatory system and depressive symptoms, in comparison with manic symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Background: Young adults aged from 18 to 44 years comprise a large portion of the population suffering from depression. Yet few studies have compared the likelihood of dying of natural causes or by suicide among depressed patients. This study uses a case–control approach to compare the likelihood of dying of natural causes and by suicide for depressed and non-depressed patients based on a representative national sample in Taiwan. Method: A retrospective case–control study design was used to analyze two nationwide population-based datasets: the National Health Insurance Research Database (NHIRD) and the official Cause of Death data file in Taiwan. The study cohort consisted of 827 patients from 18 to 44 years old who were hospitalized with a primary diagnosis of depressive disorder from 1998–2003. A comparison cohort of patients hospitalized for appendectomies was matched with the study sample in terms of age and gender (N =2481). Results: After adjusting for the age and comorbid medical disorders, the hazard of dying during the five-year follow-up period was 1.72 times greater for depressed patients than for appendectomy patients. Depressed patients were more likely to die by suicide during the follow-up period, as no significant difference in odds of dying from natural causes was observed between these two cohorts. Conclusion: Further studies should be initiated to identify specific risk factors for suicide among younger adults, while prevention strategies might focus on stresses associated with particular life stages, taking age and gender patterns into account. [Copyright &y& Elsevier]