Insomnia more common in teens whose mums had postnatal depression

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More than a third (36%) of teenagers whose mothers suffered from postnatal depression experienced sleep problems at the age of 18, compared to only one in five (22%) teenagers whose mothers didn’t suffer from postnatal depression.

Insomnia affects between one in two and one in 10 people worldwide and can be debilitating. It can lead to memory problems and fatigue, and raises the risk of developing high blood pressure and heart disease.

Such health problems have a high economic cost, both direct (healthcare, drugs, tests and research) and indirect (absenteeism, lack of productivity).

Now, for the first time, researchers have looked to see if postnatal depression in women could contribute to their children having sleep problems in adolescence. It is already well established that postnatal depression can affect a child’s mental health and how well they do at school but the impact of it on sleep has not been examined before.

By looking at Children of the 90s (University of Bristol), a unique 25-year-long study of 14,500 mothers and their children (born in 1991 or 1992), researchers were able to ask teenagers when they were 16 and 18 about their sleep problems and compare their answers to the information more than 10,000 mothers had provided years before about postnatal depression. The study is based at the University of Bristol.

By assessing the problem so many years after the children were born, the researchers were able to rule out sleepless nights during infancy as the cause of the postnatal depression and ask the teenagers themselves about their sleep problems rather than rely on what their mothers said (which may have been affected by their depression).

What they found is that more than a third (36%) of teenagers whose mothers suffered from postnatal depression experienced sleep problems at the age of 18, compared to only one in five (22%) teenagers whose mothers didn’t suffer from postnatal depression.

This was the case even after a number of important factors were taken into account:

  • Whether the teenager suffered from depression when they were aged 16
  • Whether the teenager had experienced sleep problems as a young child (measured at the ages of 6, 18 and 26 months)
  • The mother’s education, her age when the child was born, and the number of other children in the family
  • Whether the mother smoked or experienced depression when pregnant

Although a mother’s depression increases the likelihood that her child will have sleep problems, the reasons for this are not clear.

Dr Rebecca Pearson from the University of Bristol, who supervised the research, suggests three possible reasons:

  • Shared genes between the mother and child can affect sleeping patterns
  • Antenatal depression which precedes postnatal depression can have a biological effect on the child while it is still in the womb
  • Postnatal depression can make it more difficult for mothers to help regulate their baby’s emotions and their ability to establish regular and calm sleeping patterns. Continued depressive symptoms in the mother during her child’s early years (up to age 12) were also found to play a role.

Speaking about the findings, she said:

“Postnatal depression can make it more difficult for mothers to interact with their babies and this could make it particularly hard to establish a regular sleeping routine and help babies to learn to regulate their emotions and settle themselves to sleep. A noisy, disruptive house can also make it difficult for children to sleep and such environments can be linked to maternal depression.

Depressed mothers are increasingly offered support to improve their mood and to promote positive interactions with their babies and we would advocate that such support also considers the child’s sleeping pattern. As we’ve shown here, maternal depression can potentially have serious long-term implications for the health and wellbeing of both the mother and her child.

There is substantial evidence that postnatal depression is linked with a broad range of child difficulties. Individual risks are often small but because depression in mothers can influence so many aspects of their child’s development, in total it is very costly.”

Anna Taylor, a medical undergraduate student at the University of Bristol who led the research, explained that:

“Poor sleep affects school performance as well as physical and mental health, all of which can have significant impact on the child’s life and what they are able to achieve, so preventing sleep problems is really important. The cost of supporting depressed mothers is far smaller than the longer-term costs of dealing with multiple problems later in life.”

Dr Pearson added:

“As far as we’re aware, no one has ever looked at the long-term effects of postnatal depression on a child’s sleeping habits as reported by the children themselves as teenagers. Luckily, Children of the 90s, with its 25-year dataset, allows us to go back in time and examine these issues in great detail.”

via University of Bristol – ALSPAC – Insomnia more common in teens whose mums had postnatal depression

The full paper, The association between maternal postnatal depressive symptoms and offspring sleep problems in adolescence has been published Open Access in Psychological Medicine, and can be viewed here.

Get your sleep and treat depression to guard against Alzheimer’s disease

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The September International Psychogeriatrics Article of the Month is entitled “Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: dementia” by Shanna L. Burke, Peter Maramaldi, Tamara Cadet and Walter Kukull. This blog piece was released by Florida International University and can be viewed here.

New research suggests that lack of sleep and untreated depression may increase the risk of Alzheimer’s disease, even for those who do not have a genetic predisposition for the disease.

Depression and sleeplessness have long been considered symptoms of Alzheimer’s disease. This study indicates that whether in combination with genetic risk factors or on their own, untreated depression and lack of sleep may lead to the onset of Alzheimer’s disease dementia later in life.

“Previous research has attempted to explore the relationship between depression, sleep disturbance and Alzheimer’s disease. Our research is significant in that it is the first to find an increased risk of Alzheimer’s disease due to insomnia and depression independently, as well as in combination with genetic risk factors,” said Shanna L. Burke, assistant professor of social work at the FIU Robert Stempel College of Public Health & Social Work.

Alzheimer’s disease currently affects more than 39.9 million people worldwide. In the United States, it is the most common form of dementia in the elderly, affecting 1 in 10 people over the age of 65.

Although treating the genetic risk factors for Alzheimer’s disease isn’t possible yet, these findings suggest that alleviating depression and sleep disturbance may decrease the chances of a person developing the disease.

Burke served as the primary investigator for the study. She and the other members of the research team—Peter Maramaldi, Tamara Cadet and Walter Kukull—present their findings in Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: dementia, which was recently highlighted as “Paper of the Month” in the journal International Psychogeriatrics. Commentary and associated findings on the study were provided by Dr. David Steffens, chair of the department of psychiatry at the University of Connecticut.

“Future studies are needed to better understand the role of sleep in development of Alzheimer’s Disease, either as an independent risk factor or as a key depressive symptom that might further unlock the link between depression and Alzheimer’s,” said Steffens.

The full paper “Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: dementia” is available free of charge for a limited time here.

The commentary paper “J’accuse! depression as a likely culprit in cases of AD” by David C. Steffens is also available free of charge for a limited time here.

Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds « Swansea University

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Antidepressant prescribing amongst children and young people has shown a significant increase of 28% in the past decade, even though recorded diagnoses of depression have gone down, according to new research published today.

One in ten children and young people suffer from some kind of mental health problem, including depression and anxiety. Concerns about under-diagnosis and under-treatment contrast with worries about over-prescribing and the medicalisation of unhappiness in young people.

The research, published in Psychological Medicine, and carried out by a team which included several Swansea University experts, was led by Ann John, associate professor at Swansea University Medical School, who is also a qualified GP. The team looked at data from 358,000 registered patients between 6 and 18 years old, living in Wales, UK, between 2003 and 2013. The data was drawn from GPs and other NHS primary care services.

The research found that:
• Antidepressant prescribing rose significantly, by 28%, mainly in older adolescents
• Depression diagnoses showed a steady decline by just over a quarter, while symptoms of depression more than doubled
• Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose
• Just over half of new antidepressant prescriptions were associated with depression. The rest were associated with diagnoses such as anxiety and pain

The findings led the researchers to call for new strategies to implement current guidance for managing depression in children and young people.

Dr Ann John, associate professor at Swansea University Medical School, said: “These findings add to the growing debate over increasing prescribing of anti-depressants to children and young people.

The main issue is whether they being prescribed with enough cause. The rise in prescribing may reflect a genuine increase in depression and its symptoms, or increased awareness and better treatment by GPs, or poor access to psychological therapies and specialist care, or even increased help-seeking.

Whatever the explanation it’s important that each individual young person is listened to and gets the right kind of help for their problem. We need to support those who support young people and their families, helping them to act in keeping with current guidance.”

Dr John underlined the importance of responding appropriately to the needs of young people:

“The teenage years are a phase of gaining independence, engaging with the world and testing boundaries. This can result in a normal developmental range of emotional responses- stress, loneliness, sadness and frustration. For others the mental health issues are more serious, and historically they were often not recognised, talked about or treated.

Teenagers may be moving into adulthood without many of the skills necessary to deal with these issues if we don’t manage them well at an early age.

It can be hard to distinguish between what is emotional turmoil and what warrants a mental health diagnosis in a young person.

We need to ensure GPs are trained to really understand the lives and moods of young people, as well as knowing what warning signs they should look out for. For some young people reassurance that this is within the range of normal human experience may be appropriate. For others, talking therapies may be the best option, as they have a proven track record of improving symptoms for those with mild and moderate depression.
In more serious cases, anti-depressants should be used together with talking therapies. Improving access to talking therapies is very important. Otherwise, if waiting times are too long, it’s more likely that a prescription will be given. If an antidepressant is required, fluoxetine should be the first option.”

via Swansea University – Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds

The full paper, published in Psychological Medicine, “Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study” by A. John, A. L. Marchant, D. L. Fone, J. I. McGregor, M. S. Dennis, J. O. A. Tan and K. Lloyd has been published Open Access and can be viewed here free of charge.

Researchers find lifestyle link in depression

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Researchers following the progress of 1200 people for five years have found strong links between unhealthy lifestyles and depression.

Researchers at the University of Tasmania’s Menzies Institute for Medical Research studied the impact of lifestyle on depression and the impact of depression on lifestyle. This is the first time the association has been looked at from both sides.

The lead author of the study, Dr Seana Gall, said that people with healthier lifestyles at the beginning of the study were significantly less likely (22%) to develop a first episode of depression over the five years, while there was a tendency for those with a history of depression to lose points in a lifestyle assessment over the five years (46% more likely than those without a history of depression at the beginning of the study). Lifestyles were assessed through a score comprising body mass index, smoking, alcohol consumption, leisure time, physical activity and diet.

These associations occurred regardless of other predictive factors such as socio-economic position, parental and marital status, social support, major life events, cardiovascular disease history and self-rated physical health.

Participants were aged 26-36 years at the beginning of the study (2004-2006) and 31-41 years at follow-up (2009-2011).

Dr Gall said the study’s grouping of health behaviours (i.e. the overall lifestyle) rather than looking at individual risk factors was significant. “This is the first study to consider the association between this number of health behaviours and risk of developing depression over time,” Dr Gall said. “Studying individual risk factors and their relationship with depression ignores the fact that risk factors often cluster as unhealthy lifestyles.

“Our findings have implications for reducing the higher risk of cardiovascular disease that is seen in those with depression and also potentially reducing the risk of developing depression in young people” Dr Gall said. “The study highlights the need for holistic management of young adults in terms of their mental and physical health, including health behaviours.

Dr Gall said the results suggested that a healthier lifestyle may protect against the first onset of depression and therefore the findings were relevant for those managing the physical and mental health of younger adults.

 

via University of Tasmania – Researchers find lifestyle link in depression

 

The full paper, published in Psychological Medicine, “Bi-directional associations between healthy lifestyles and mood disorders in young adults: The Childhood Determinants of Adult Health Study” by S. L. Gall, K. Sanderson, K. J. Smith, G. Patton, T. Dwyer and A. Venn can be viewed here free of charge until 30th August 2016.

 

Early screening spots emergency workers at greater risk of mental illness

Ambulance

Study offers new direction for preventative interventions to increase mental resilience to stress and trauma

Emergency services workers who are more likely to suffer episodes of mental ill health later in their careers can be spotted in the first week of training. That’s the conclusion of a Wellcome Trust funded study carried out with trainee paramedics.

Researchers from the University of Oxford and King’s College London wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services. Their results are published in the journal Psychological Medicine.

Dr Jennifer Wild from the University of Oxford explained: ‘Emergency workers are regularly exposed to stressful and traumatic situations and some of them will experience periods of mental illness. Some of the factors that make that more likely can be changed through resilience training, reducing the risk of PTSD and depression. We wanted to test whether we could identify such risk factors, making it possible to spot people at higher risk early in their training and to develop interventions that target these risk factors to strengthen their resilience.’

The researchers followed a group of around 400 new ambulance staff through the first two years of their three-year training period. During the initial six-week classroom phase of the training, the students were given a number of assessments to establish their thinking styles, coping behaviour, psychiatric history and personality traits.

Follow up sessions were carried out every four months for the next two years to see if any of the participants had had PTSD or depression. After two years, a final assessment looked at quality of life, as well as smoking, alcohol and drug use, days off work, weight change, burnout and insomnia.

Professor Anke Ehlers said: ‘While just under one in five experienced PTSD or depression in the two years, most got better by the next four-month follow-up.

‘However, there were still lasting effects. Those who had reported mental ill health were more likely to have sleep problems at 2 years. They were also more likely to have days off work. Paramedics who developed an episode of PTSD were also more likely to report gaining weight and smoking.’

The team found that even accounting for past psychiatric history, people were more likely to experience PTSD and depression if they had lower perceived resilience to trauma, or if they dwelled on stressful events from the past before they started their training.   Significantly, the number of traumatic incidents they experienced could not be used to predict PTSD but was relevant to predicting MD, suggesting a cumulative risk of different exposures to trauma for depression.

Dr Wild said: ‘This is not about screening out particular people in training. Early assessment means that those who are more at risk can be offered training to improve their resilience to stressful and traumatic experiences. That has the potential to reduce episodes of PTSD and major depression and improve the long term health of a valued and essential workforce.’

The full paper has been published Open Access in Psychological Medicine, ‘A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression’ by  J. Wild et al. can be viewed here free of charge.

Source: Early screening spots emergency workers at greater risk of mental illness- University of Oxford/News

Emotion-processing networks disrupted in sufferers of depression – via UIC News Center

depressed teenage girl

Regions of the brain that normally work together to process emotion become decoupled in people who experience multiple episodes of depression, neuroscientists report. The findings may help identify which patients will benefit from longterm antidepressant treatment to prevent the recurrence of depressive episodes.

The study, led by researchers at the University of Illinois at Chicago, is published in the journal Psychological Medicine.

“Half of people who have a first depressive episode will go on to have another within two years,” says Scott Langenecker, associate professor of psychiatry and psychology at UIC and corresponding author on the study.

Disruptions in the network of areas of the brain that are simultaneously active during problem-solving and emotional processing have been implicated in several mental illnesses, including depression. But in addition, “hyperconnectivity,” or too much connection, within the “resting network,” or areas active during rest and self-reflection, has also been linked to depression.

“If we can identify different network connectivity patterns that are associated with depression, then we may be able to determine which are risk factors for poorer outcomes down the line, such as having multiple episodes, and we can keep those patients on preventive or maintenance medication,” Langenecker explained. “We can also start to see what medications work best for people with different connectivity patterns, to develop more personalized treatment plans.”

In previous research, Langenecker found that the emotional and cognitive brain networks were hyperconnected in young adults who had depression. Areas of the brain related to rumination – thinking about the same thing over and over again – a known risk factor for depression, were also overly connected in adolescents who had experienced depression.

In the new study, Langenecker said he and his coworkers wanted to see if different patterns of network-disruption would show up in young adults who had experienced only one episode of depression versus several episodes.

The researchers used functional magnetic resonance imaging, or fMRI, to scan the brains of 77 young adults (average age: 21.) Seventeen of the participants were experiencing major depression at the time of the scan, while 34 were currently well. Of these 51 patients, 36 had experienced at least one episode of depression in the past, and these individuals were compared  to 26 participants who had never experienced a major depressive episode. None were taking psychiatric medication at the time they were scanned.

All fMRI scans were done in a resting state — to show which areas of the brain are most synchronously active as one relaxes and lets their mind wander.

The researchers found that the amygdala, a region involved in detecting emotion, is decoupled from the emotional network in people who have had multiple episodes of depression. This may cause emotional-information processing to be less accurate, Langenecker said, and could explain “negative processing-bias”  in which depression sufferers perceive even neutral information as negative.

The researchers also saw that participants who had had at least one prior depressive episode — whether or not they were depressed at the time of the scan — exhibited increased connectivity between the resting and cognitive networks.

“This may be an adaptation the brain makes to help regulate emotional biases or rumination,” Langenecker said.

“Since this study provides just a snapshot of the brain at one point in time, longer-term studies are needed, to determine whether the patterns we saw may be predictive of a future of multiple episodes for some patients and might help us identify who should have maintenance treatments and targets for new preventive treatments,” he said.

Rachel Jacobs, Alyssa Barba, Jennifer Gowins, Heide Klumpp, Lisanne Jenkins, Dr. Olusola Ajilore and Dr. K. Luan Phan of the UIC College of Medicine, and Dr. Brian Mickey, Dr. Marta Pecina, Margaret Sikora, Kelly Ryan, David Hsu, Robert Welsh and Jon-Kar Zubieta of the University of Michigan are co-authors on the paper.

This study was funded in part by the UIC Center for Clinical and Translational Science and grants RO1 Q2 601, MH091811 and RO1 MH101487 from the National Institutes of Health. – See more at: http://news.uic.edu/emotion-processing-networks-disrupted-in-sufferers-of-depression#sthash.2snQXaQd.dpuf

Source: Emotion-processing networks disrupted in sufferers of depression | UIC News Center

The full paper, published in Psychological Medicine, “Decoupling of the amygdala to other salience network regions in adolescent-onset recurrent major depressive disorder” by  S. A. Langenecker et al. can be viewed here free of charge until 31st March 2016.

Common mental disorders prevalent in UK military « King’s College London

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Symptoms of anxiety and depression appear to be twice as frequent in the UK military as in the general working population, according to research carried out at the King’s Centre for Military Health Research (KCMHR), King’s College London and published in Psychological Medicine.

The study compared data from over 7,000 personnel serving in the UK Armed Forces with 7,000 people from the general population identified as being in employment from the Health Survey for England. Both surveys used the General Health Questionnaire (GHQ) and it was found that symptoms of common mental disorders (CMD) (i.e. anxiety and depression), appeared to be twice as frequent in the military as in the general working population. In fact, 18% of men and 25% of women serving in the Armed Forces reported symptoms of CMD compared to 8% of men and 12% of women in the general working population.  This difference was apparent at both time points of the study, 2003 and 2008.

Lead author, Dr Laura Goodwin from KCMHR said ‘This is the first formal comparison of common mental disorders between the serving military and the general working population. Whilst symptoms of common mental disorders appear to be twice as common in the military after accounting for age, gender and social class, there is more to be done to understand these differences.’

The researchers had previously found that there is a tendency for over reporting of symptoms of anxiety and depression in occupational studies aimed at specific groups such as police, teachers and social workers. The Health Survey for England was a population study in which an individual’s occupation was not the main focus, which is likely to have had some effect on the results.

One way it was a considerable improvement on earlier research was that previous studies have all been forced to compare different measures of CMD, which is a major limitation, whereas in this study all participants completed the same questionnaire, the GHQ. Also, some previous surveys have included individuals who are unemployed and those with long-term health problems and disabilities and these groups are more likely to report symptoms of depression and anxiety, so this comparison of military employees with only those in employment from the general population is a fairer like-for-like comparison.

The survey included questions such as whether the subject felt they were ‘playing a useful part in things’, and military respondents were almost three times more likely to disagree with this statement than the general population at both time points. On the other hand, the smallest difference between the military and general population was found for the statement ‘felt constantly under strain’.

The researchers suggest that differences in the prevalence of symptoms of depression and anxiety in this extensive study could be explained by the frequency and intensity of stressful events experienced by military personnel and that military life requires extended periods spent away from family and friends, for training and exercises as well as for deployment.

Professor Nicola Fear, KCMHR concludes: ‘This highlights that symptoms of depression and anxiety are common in the Armed Forces, in fact, they are more common than alcohol misuse or post-traumatic stress disorder (PTSD).  The findings draw attention to the need for Defence Medical Services to continue to focus on identifying and treating depression and anxiety in addition to PTSD.’

Paper reference: Goodwin, L. et al. ‘Are common mental disorders more prevalent in the UK serving military compared to the general working population?’ published in Psychological Medicine DOI: http://dx.doi.org/10.1017/S0033291714002980

via King’s College London – Common mental disorders prevalent in UK military.

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