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In order to investigate the relationship between perceived stress, anxiety, depression and hypertension in patients with essential hypertension, a case-control study was conducted among community residents. A total of 312 residents participated in the study by completing a self-reported questionnaire, 156 of whom were hypertensive patients and 156 were healthy. The questionnaire included demographic information, Perceived Stress Scale, Beck Anxiety Inventory and Beck Depression Inventory-II. The data were analyzed using t-test, correlation analysis, Logistic regression analysis, and structural equation modeling procedure to validate the mediation model. The results of Logistic regression analysis showed that anxiety (OR = 1.082, 95% CI 1.011-1.133, P < 0.01), depression (OR = 1.041, 95% CI 1.006-1.078, P < 0.05) and age (OR = 1.033, 95% CI 1.008-1.058, P < 0.01) were risk factors for hypotension, however, perceived stress (OR = 0.955, 95% CI 0.921-0.990, P < 0.05) was a protective factor against hypertension. Furthermore, structural equation model results reported that anxiety and depression play a mediating role between perceived stress and essential hypertension. These results suggest that anxiety and depression can raise the risk of developing essential hypertension. While the relationship between perceived stress and hypertension is still debated, it is well established that perceived stress can positively predict hypertension through the mediating role of anxiety and depression. Therefore, healthcare workers should take care of the mental health of patients and provide more psychological support to help them move away from negative emotions and better control their blood pressure., Author(s): Yan Lv [sup.1] , Shuwei Hao [sup.1] Author Affiliations: (1) https://ror.org/02v51f717, grid.11135.37, 0000 0001 2256 9319, Department of Medical Psychology, School of Medical Humanities, Peking University, , 38, Xueyuan [...]

The link between psychological strain and suicidal ideation is well embedded in literature, however, the underlying mechanism is rarely explored. Therefore, this study aimed to examine the relationship between psychological strain, suicidal ideation, rumination, and depression among Pakistani young adults during the Covid-19 outbreak. In addition, it will also try to determine the mediating role of ruminative subtypes and depression in the relationship between psychological strain and suicidal ideation. The sample consists of 400 university students (83 males and 289 females) with the age range from 18 to 30 years (M = 22.25, SD = 2.40). Psychological strain scale, Suicidal Ideation Scale, Beck Depression Inventory, and Ruminative Response Scale were administered to the participants. Results indicated a significant and positive association between the study variables. Psychological strain positively influenced suicidal ideation both directly, and indirectly via brooding and depression. Both variables were found to be serially mediated by the brooding subtype of rumination and depression and not with the reflective subtype. Strain theory of suicide and response style theory also postulated important insights regarding the association of these variables in young adults, among which, strain is serially related to first brooding and then depression, which is eventually related to suicidal ideation. The present study makes a significant contribution to the literature by providing a unique conceptual and theoretical framework to identify suicide at the ideation level before it proceeds to behavior during this unprecedented time of the pandemic outbreak., Author(s): Noor Ul Ain Muneeb [sup.1] , Sumara Masood Ul Hassan [sup.1] Author Affiliations: (1) grid.412117.0, 0000 0001 2234 2376, Department of Behavioral Sciences, S3H, National University of Science and [...]

Whilst there is a large evidence base demonstrating the impact of maternal depression on the development of adolescent internalising problems, less is known about the association between paternal depression and adolescent internalising problems, and the mechanisms through which risk is conferred. This study examined the association between paternal depression and adolescent internalising problems, investigating parenting style as a pathway through which this association may be mediated. Participants included 4048 families taking part in the Growing Up in Ireland child cohort study. Self-report measures of paternal depression were completed when the study child was aged 9. Adolescents assessed paternal demandingness, responsiveness and autonomy granting at the age of 13. Adolescent internalising symptoms were measured at the age of 17/18 by the primary caregiver. A parallel multiple mediator model was used to test the total and specific indirect effects of the three parenting styles, whilst controlling for covariates and other mediators in the model. A direct effect of paternal depression on adolescent internalising problems was found (B = .051, 95% CI: 0.020, 0.083). However, no support for mediation via any of the paternal parenting styles (i.e., responsiveness, demandingness, or autonomy-granting) were found. These findings build on an emerging evidence-base demonstrating a specific direct association between paternal depression and adolescent internalising problems, and suggest that interventions ought to also target fathers suffering from depression to help reduce the risk of adolescent internalising problems., Author(s): Lorna Maciver [sup.1] , Lisa-Christine Girard [sup.1] Author Affiliations: (1) grid.4305.2, 0000 0004 1936 7988, School of Health in Social Science, Clinical Psychology, Old Medical School, University of Edinburgh, [...]

The somatic depressive symptom cluster (including appetite and sleep disturbances) is more strongly associated with insulin resistance (a diabetes risk marker) than other depressive symptom clusters. Utilizing baseline data from 129 primary care patients with depression but no diabetes in the eIMPACT trial (M.sub.age = 59 years, 78% female, 50% Black), we examined associations of somatic depressive symptoms with insulin resistance (HOMA-IR), body mass index (BMI), and high-sensitivity C-reactive protein (hsCRP). We tested BMI and hsCRP as mediators and race as a moderator of these relationships. Hyperphagia was positively associated HOMA-IR ([beta] = 0.19, p = .048) and BMI ([beta] = 0.30, p < .001); poor appetite was negatively associated with HOMA-IR ([beta] = -0.24, p = .02); hypersomnia was positively associated with HOMA-IR ([beta] = 0.28, p = .003), BMI ([beta] = 0.26, p = .003), and hsCRP ([beta] = 0.23, p = .01); and disturbed sleep was positively associated with hsCRP ([beta] = 0.21, p = .04). BMI partially mediated hyperphagia and hypersomnia's associations with HOMA-IR; hsCRP partially mediated the hypersomnia-HOMA-IR association; and race moderated the hyperphagia-HOMA-IR association (positive for White participants but null for Black participants). People with depression experiencing hyperphagia and/or hypersomnia may be a subgroup with greater insulin resistance; BMI and hsCRP are likely pathways in these relationships. This study highlights the importance of considering the direction of somatic depressive symptoms in the context of cardiometabolic disease risk., Author(s): Aubrey L. Shell [sup.1] , Michelle K. Williams [sup.1] , Jay S. Patel [sup.2] , Elizabeth A. Vrany [sup.3] , Robert V. Considine [sup.4] , Anthony J. Acton [sup.4] [...]

Background: We have previously reported activation in reward, salience and executive control regions during functional MRI (fMRI) using an approach-avoidance conflict (AAC) decision-making task with healthy adults. Further investigations into how anxiety and depressive disorders relate to differences in neural responses during AAC can inform their understanding and treatment. We tested the hypothesis that people with anxiety or depression have altered neural activation during AAC. Methods: We compared 118 treatment-seeking adults with anxiety or depression and 58 healthy adults using linear mixed-effects models to examine group-level differences in neural activation (fMRI) during AAC decision-making. Correlational analyses examined relationships between behavioural and neural measures. Results: Adults with anxiety or depression had greater striatal engagement when reacting to affective stimuli (p = 0.008, d = 0.31) regardless of valence, and weaker striatal engagement during reward feedback (p = 0.046, d = -0.27) regardless of the presence of monetary reward. They also had blunted amygdala activity during decision-making (p = 0.023, d = -0.32) regardless of the presence of conflict. Across groups, approach behaviour during conflict decision-making was inversely correlated with striatal activation during affective stimuli (p < 0.001, r = -0.28) and positively related to striatal activation during reward feedback (p < 0.001, r = 0.27). Limitations: Our transdiagnostic approach did not allow for comparisons between specific anxiety disorders, and our cross-sectional approach did not allow for causal inference. Conclusion: Anxiety and depression were associated with altered neural responses to AAC. Findings were consistent with the role of the striatum in action selection and reward responsivity, and they point toward striatal reactivity as a future treatment target. Blunting of amygdala activity in anxiety or depression may indicate a compensatory response to inhibit affective salience and maintain approach., Introduction Approach-avoidance conflict (AAC) occurs when a person makes a behavioural choice that might have rewarding or threatening outcomes. (1-3) Neural and behavioural mechanisms during AAC decision-making are relevant across [...]

PURPOSE To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support. METHODS This is a randomized controlled trial of hospitalized patients with patient health questionnaire-9 score of 10 or more. We delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention including cognitive behavioral therapy, self-management support, and patient navigation. Primary outcomes were hospital readmission and reutilization rates at 30 and 90 days post discharge. RESULTS We randomized 709 participants (353 RED-D, 356 RED-only). At 90 days, 265 (75%) intervention participants had received at least 1 RED-D session (median 4). At 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission (9% vs 10%, incidence rate ratio [IRR] 0.92 [95% CI, 0.56-1.52]) or reutilization (27% vs 24%, IRR 1.14 [95% CI, 0.85-1.54]). The intention-to-treat analysis also showed no differences at 90 days in readmission (28% vs 21%, IRR 1.30 [95% CI, 0.95-1.78]) or reutilization (70% vs 57%, IRR 1.22 [95% CI, 1.01-1.49]). In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions (3% vs 10%, IRR 0.30 [95% CI, 0.07-0.84]) compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions (11% vs 21%, IRR 0.52 [95% CI, 0.27-0.92]). Intention-to-treat analysis showed no differences between study groups on secondary outcomes. CONCLUSIONS Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention. Key words: depression; hospitalization; patient discharge; telemedicine Ann Fam Med 2022;20:246-254. https://doi.org/10.1370/afm.2801, INTRODUCTION Depression is an important risk factor for poor outcomes among patients with acute and chronic conditions. (1-5) Among patients hospitalized for acute conditions, comorbid depressive symptoms jeopardize a safe [...]

This study examined the relationships between varying levels of depressive symptoms and key dietary indicators of chronic disease risk, sugar-sweetened beverage (SSB) and fruit and vegetable (F + V) consumption, among a racially/ethnically diverse urban population in Los Angeles County (LAC). Analyses were carried out using data from a 2012 cross-sectional health survey of 1401 low-income public health center clients. Participants with a high level of depressive symptoms consumed 30% more SSBs (IRR = 1.30, 95% CI = 1.08, 1.55) than participants with a lower level of these symptoms. Other predictors of higher SSB consumption included being African American/Black (IRR = 1.65, 95% CI = 1.32, 2.05), male (IRR = 1.20, 95% CI = 1.06, 1.35), U.S. born (IRR = 1.32, 95% CI = 1.11, 1.57), and using tobacco (IRR = 1.26, 95% CI = 1.11, 1.43). Similar associations with F + V consumption were not found. Findings suggest that depressive symptoms may influence certain health behaviors in certain groups under certain situations. Policy and practice implications are discussed within this context., Author(s): Brenda Robles [sup.1] [sup.2] , Mirna Ponce Jewell [sup.1] , Courtney S. Thomas Tobin [sup.2] , Lisa V. Smith [sup.3] [sup.4] , Tony Kuo [sup.1] [sup.4] [sup.5] [sup.6] Author [...]

Context: Depression is a well-known independent risk factor for cardiovascular morbidity, mortality, and poor prognosis for a cardiac event, however, how gender effects this association is not understood. Objective: To identify the effect of gender in the association between depression and cardiovascular disease (CVD) status in the US adult population. Study Design and Analysis: Survey based, unadjusted and adjusted prevalence ratios (PR) were estimated using generalized linear model with Poisson family, and log link function using a cross-sectional survey dataset. Setting or Dataset: Secondary dataset from the National Health and Nutrition Examination Survey (NHANES) conducted during 2013-2018. Population Studied: Community-dwelling, non-institutionalized adults aged 20 years and older (N= 14,767). Instruments: The Patient Health Questionnaire (PHQ-9), a nine- item depression screening instrument. This instrument incorporates DSM-IV depression diagnostic criteria, subjects answered each of the nine items scoring points ranging from 0 to 3 on each item. Outcome Measures: CVD event (congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, or stroke). Results: CVD events were positively associated with higher PHQ-9 scores in unadjusted (PR:1.61, p, Presenters Bhaskar Thakur, PhD, Masters of Population Studies, Elizabeth Arnold, PhD, LCSW, Chance Strenth, PhD, David Schneider, MD, [...]

Objective Although previous studies have examined the impact of maternal depression on child overweight and obesity, little is known about the relationship in Latino families, who suffer from high risks of depression and obesity. We prospectively investigated the association between depressive symptoms in women with young children and child overweight and obesity (overweight/obesity) at age 7 years among Latino families. Methods Participants included 332 singletons with anthropometric measures obtained at 7 years from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, a birth cohort study. Maternal depression was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale when the children were 1, 3.5, and 7 years. Overweight and obesity was measured by body mass index (kg/m.sup.2) at age 7 years. Results 63 % of women had CES-D scores consistent with depression in at least one of the 3 given assessments. Compared to children whose mothers were never depressed, children whose mothers were depressed at all three assessments had 2.4 times the adjusted odds of overweight/obesity at age 7 years (95 % CI 1.1-5.6). However, a single positive maternal depression screen was not associated with child overweight/obesity and there was no difference in the odds of overweight/obesity by the age of the child when maternal depression occurred. Conclusion Chronic maternal depression during a child's early life was associated with child overweight/obesity at 7 years. Addressing maternal depression is a critical component of comprehensive obesity prevention and treatment strategies for Latino children., Author(s): Jocelyn Audelo[sup.1] [sup.2] , Katherine Kogut[sup.3] , Kim G. Harley[sup.2] [sup.3] , Lisa G. Rosas[sup.4] [sup.5] , Lauren Stein[sup.3] , Brenda Eskenazi[sup.1] [sup.3] Author Affiliations: (1) Maternal and Child [...]

There is accumulating evidence suggesting that depression is a risk factor for cardiovascular diseases. This study aimed to examine the hypothesis that the proinflammatory cytokine TNF-α would partially explain the link between depression and atherosclerotic endothelial changes. Rats were distributed among 6 groups: (i) control group; (ii) group subjected to chronic mild stress (CMS); (iii) group fed a cholesterol-cholic acid-thiouracil (CCT diet); and (iv) CMS group fed the CCT diet and treated with the vehicle for 8 weeks. The last 2 groups were subjected to CMS-CCT and received thalidomide (THAL) or imipramine (IMIP). Rats were assessed behaviorally (sucrose preference, open field, and forced-swimming tests). TNF-α protein was assessed from the serum, aorta, and liver. Aortic TNF-α gene expression (assessed using RT-PCR), serum lipid profile, and insulin levels were measured. Endothelial function was assessed in isolated aortic rings. The THAL and IMIP groups showed ameliorated CMS-CCT-related behavioral changes. CMS-CCT-induced metabolic and endothelial dysfunctions were improved in the THAL group but were worsened in the IMIP group. RT-PCR showed a significant reduction of aortic TNF-α mRNA expression in the THAL and IMIP treatment groups. These data paralleled the findings for aortic immunohistochemistry. The THAL group, but not the IMIP group, showed improved CMS-CCT-induced changes in the vascular reactivity of the aortic rings. Thus, TNF-α provides a target link between depression, metabolic syndrome, and endothelial dysfunction. This could open a new therapeutic approach to address the comorbidities of depression. Key words: thalidomide, depression, vascular dysfunction, TNF-α, insulin resistance. De plus en plus de donnees suggerent que la depression constitue un facteur de risque de developper des maladies cardiovasculaires. Cette etude visait a examiner l'hypothese qui propose que le TNF-α, une cytokine proinflammatoire, expliquerait partiellement le lien entre la depression et les dommages endotheliaux de l'atherosclerose. Des rats ont ete repartis en 6 groupes : (i) controle ; (ii) exposes a un stress chronique leger (SCL); (iii) nourris avec une diete comprenant du cholesterol, de l'acide cholique et de la thiouracile (CCT); (iv) et une combinaison de SCL et d'une diete CCT pendant 8 semaines (SCL- CCT) aussi que traitement vehicule. Les 2 derniers groupes ont ete exposes au SCL-CCT et ont recu de la thalidomide (THAL) ou de l'imipramine (IMIP). Les rats ont ete evalues sur le plan comportemental (tests de preference au sucrose, en champ ouvert et de nage forcee). Le niveau de TNF-α a ete mesure dans le serum, l'aorte et le foie. L'expression genique du TNF-α dans l'aorte (RT-PCR), le profil lipidique et le niveau d'insuline du serum ont ete mesures. La fonction endotheliale a ete evaluee sur des anneaux aortiques isoles. La THAL et l'IMIP amelioraient les comportements modifies par le traitement SCL-CCT. Les dysfonctions metaboliques et endotheliales induites par le traitement SCL-CCT etaient ameliorees par la THAL mais deteriorees par l'IMIP. La RT-PCR revelait une reduction significative de l'expression de l'ARNm du TNF-α par la THAL et l'IMIP. Ces donnees etaient concordantes avec les donnees immunohistochimiques. La THAL, contrairement a l'IMIP, ameliorait l'activite reactive des anneaux aortiques modifiee par le traitement SCL-CCT. Le TNF-α constitue un lien cible entre la depression, le syndrome metabolique et la dysfonction endotheliale. Cela pourrait ouvrir une nouvelle avenue therapeutique qui prend en consideration la comorbidite de la depression. [Traduit par la Redaction] Mots-cles: thalidomide, depression, dysfonction vasculaire, TNF-α, resistance a l'insuline., Introduction A growing body of clinical and epidemiological evidence suggests a link between major depressive disorders and cardiovascular diseases. Depressive symptoms are becoming increasingly common among patients with coronary artery [...]

Although NMDA receptor (NMDAR)-dependent long-term potentiation (LTP) and long-term depression (LTD) of glutamatergic transmission are candidate mechanisms for long-term spatial memory, the precise contributions of LTP and LTD remain poorly understood. Here, we report that LTP and LTD in the hippocampal CA1 region of freely moving adult rats were prevented by NMDAR 2A (GluN2A) and 2B subunit (GluN2B) preferential antagonists, respectively. These results strongly suggest that NMDAR subtype preferential antagonists are appropriate tools to probe the roles of LTP and LTD in spatial memory. Using a Morris water maze task, the LTP-blocking GluN2A antagonist had no significant effect on any aspect of performance, whereas the LTD-blocking GluN2B antagonist impaired spatial memory consolidation. Moreover, similar spatial memory deficits were induced by inhibiting the expression of LTD with intrahippocampal infusion of a short peptide that specifically interferes with AMPA receptor endocytosis. Taken together, our findings support a functional requirement of hippocampal CA1 LTD in the consolidation of long-term spatial memory. hippocampus | learning and memory | long-term potentiation | AMPA receptor endocytosis | Morris water maze doi/ 10.1073/pnas.1008200107

Two patient-level mechanisms of change, defenses, and cognition were tested over 3 time points in 65 depressed adults, approximately half receiving treatment. Early changes in automatic thoughts and immature defenses were associated with symptom change from time-one to time-three. The directionality of early automatic thought change predicting symptom change was partially supported, but immature defense change occurs simultaneously with, or after, symptom change. Given the convergent evidence of cognitive change as a mediator of depression reduction, all depression therapies should consider how they address depressive cognition. To build a more complete understanding of how to ameliorate depression, future studies should continue to include constructs from multiple theories and have measures of therapy process in addition to patient level mechanisms. [c] 2009 Wiley Periodicals, Inc. J Clin Psychol 66:215-228, 2010. Keywords: cognitive therapy; psychodynamic therapy; mechanisms of change; depression DOI: 10.1002/jclp.20645

Purpose: The purposes of these studies were to develop and initially evaluate the psychometric properties of the Reasons for Living Scale--Older Adult version (RFL-OA), an older adults version of a measure designed to assess reasons for living among individuals at risk for suicide. Design and Methods: Two studies are reported. Study 1 involved instrument development with 106 community-dwelling older adults, and initial psychometric evaluation with a second sample of 119 community-dwelling older adults. Study 2 evaluated the psychometric properties of the RFL-OA in a clinical sample. One hundred eighty-one mental health patients 50 years or older completed the RFL-OA and measures of depression, suicide ideation at the current time and at the worst point in one's life, and current mental status and physical functioning. Results: Strong psychometric properties were demonstrated for the RFL-OA, with high internal consistency (Cronbach's alpha coefficient). Convergent validity was evidenced by negative associations among RFL-OA scores and measures of depression and suicide ideation. RFL-OA scores predicted current and worst-episode suicide ideation above and beyond current depression. Discriminant validity was evidenced with measures of current mental status and physical functioning. Criterion-related validity was also demonstrated with respect to lifetime history of suicidal behavior. Implications: These findings provide preliminary support for the validity and reliability of the RFL-OA. The findings also support the potential value of attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide. Key Words: Suicide, Reasons for living, Suicide risk, Resilience doi: 10.1093/geront/gnp052

Existing literature fails to comprehensively identify factors contributing to the comorbid relationship between eating disorder (ED) behaviors and unipolar depression. Maladaptive social comparison, body dissatisfaction, and low self-esteem are disruptive psychological patterns common to both constructs. It is unclear whether a unique relationship exists between depression and eating disorder behaviors beyond the effects exerted by this negative cognitive triad. The purpose of the present study is to examine whether a unique relationship exists between depression and ED behaviors after controlling for maladaptive social comparison, body dissatisfaction, and low self-esteem. We predict minimal unique variance in ED behaviors will be explained by depression after controlling for this negative cognitive triad. Keywords: eating disorders; depression; social comparison; self-esteem; body dissatisfaction

The classic example of experience-dependent cortical plasticity is the ocular dominance (OD) shift in visual cortex after monocular deprivation (MD). The experimental model of homosynaptic longterm depression (LTD) was originally introduced to study the mechanisms that could account for deprivation-induced loss of visual responsiveness. One established LTD mechanism is a loss of sensitivity to the neurotransmitter glutamate caused by internalization of postsynaptic [alpha]-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors (AMPARs). Although it has been shown that MD similarly causes a loss of AMPARs from visual cortical synapses, the contribution of this change to the OD shift has not been established. Using an herpes simplex virus (HSV) vector, we expressed in visual cortical neurons a peptide (G2CT) designed to block AMPAR internalization by hindering the association of the C-terminal tail of the AMPAR GluR2 subunit with the AP2 clathrin adaptor complex. We found that G2CT expression interferes with NMDA receptor (NMDAR)-dependent AMPAR endocytosis and LTD, without affecting baseline synaptic transmission. When expressed in vivo, G2CT completely blocked the OD shift and depression of deprived-eye responses after MD without affecting baseline visual responsiveness or experience-dependent response potentiation in layer 4 of visual cortex. These data suggest that AMPAR internalization is essential for the loss of synaptic strength caused by sensory deprivation in visual cortex. amblyopia | glutamate receptor trafficking | monocular deprivation | visual cortex

Previous research has suggested that both exposure to potentially traumatic events (PTEs) and emotional reactions to such events act as risk factors for subsequent exposure. Although some studies have implicated posttraumatic stress disorder (PTSD) symptoms as risk factors, extant research suffers from a number of methodological limitations, including the use of cross-sectional designs and student populations. The present study sought to address these limitations using a 2-year, 3-wave national probability household sample of 2,863 adult women. After controlling for demographic characteristics, prior exposure to PTEs, and Wave 1 depression and substance abuse, PTSD reexperiencing symptoms at Wave 1 predicted subsequent exposure to interpersonal violence victimization (IPVV) perpetrated by a nonintimate perpetrator; however, PTSD symptoms did not predict intimate partner IPVV. In addition, PTSD hyperarousal symptoms were unique predictors of subsequent exposure to other traumatic stressors. Findings suggest that efforts to prevent PTEs should focus attention on both prior exposure and PTSD symptoms in response to such exposure. Keywords: posttraumatic stress disorder, risk factors for trauma exposure, revictimization, reexperiencing, hyperarousal

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.02.047 Byline: Rachel Liebert, Nicola Gavey Abstract: Over the past two decades, evidence and regulatory responses have surfaced regarding associations between selective serotonin reuptake inhibitors (SSRIs) and serious adverse effects, especially akathisia, aggression and suicidality. Given increasing concern about depression prevalence and harm, the dominance of biomedical approaches, and the normalisation of antidepressant use, reports about the potential for serious adverse effects from SSRIs present a dilemma for people working in depression intervention: the drugs are linked to 'two conflicting claims' that they may either decrease or increase harm. We present data from in-depth semi-structured interviews with nine professionals in New Zealand working in fields relating to depression and supportive of SSRIs, to investigate the negotiation of this dilemma. We analysed participants' talk about akathisia, aggression and suicidality associated with SSRIs, and found the use of rhetorical strategies that minimised the significance of risks, countered risks with notions of benefit and/or questioned the validity of risks. These discursive resources provided ways of mitigating the dilemma otherwise posed by evidence of adverse drug effects. However in doing so they referenced notions of SSRI benefit that relied upon assumptions about the efficacy of the drugs, risks of untreated depression, and the impact of adverse effects. Overall, our analysis highlights ways in which evidence of serious adverse effects from SSRIs can be rhetorically contained and undermined. Author Affiliation: Department of Psychology, The University of Auckland, Auckland, New Zealand

Purpose: Very few studies have examined cognitive decline in caregivers versus noncaregivers, and only 1 study has examined mediators of such decline. We evaluated the relationship between caregiver status and decline on the digit symbol test (DST; a measure of processing speed, attention, cognitive--motor translation, and visual scanning) and whether this relationship was mediated by depressed mood. Design and Methods: Caregivers for spouses with Alzheimer's disease (n = 122) were compared with demographically similar noncaregiver spouses (n = 117) at study entry (Time 1 = T1), T2 (1 year later), and T3 (2 years after T1). Results: Caregivers had lower DST scores and higher Hamilton depression scores at T1, T2, and T3 than noncaregivers (all p < .05). Hierarchical linear modeling revealed that although caregivers started well below noncaregivers, they experienced a more rapid rate of decline than noncaregivers (p = .047). Caregivers declined 4.5 times faster than noncaregivers. Greater depressed mood at T1 (p < .01) and T2 (p < .01) predicted DST decline and mediated DST decline in caregivers vs. noncaregivers. Implications: Depressed mood in caregivers relative to noncaregivers may influence their greater risk for DST decline. This is important because the DST predicts problem solving and everyday functions necessary for independent living and the potential well-being of their care recipients. Key Words: Stress, Caregiving, Depression, Cognition, Processing speed, Attention