DEPRESSION AND SUICIDALITY

“Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period A Longitudinal, Population-Based Study of Late Life” by Rebecca A. Bernert, Carolyn L. Turvey, Yeates Conwell, Thomas E. Joiner, Jr., JAMA Psychiatry (2015)

Abstract:

Importance: Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.

Objective: To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.

Design, Setting, and Participants: A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents.

Main Outcomes and Measures: Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies–Depression Scale, and vital statistics.

Results: Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05)

Conclusions and Relevance: Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life. Read the full article.

“Abnormal Amygdala Resting-State Functional Connectivity in Adolescent Depression” by Kathryn R. Cullen, Melinda K. Westlund, Bonnie Klimes-Dougan, Bryon A. Mueller, Alaa Houri, Lynn E. Eberly, and Kelvin O. Lim, JAMA Psychiatry (2014)

Abstract:
Importance: Major depressive disorder (MDD) frequently emerges during adolescence and can lead to persistent illness, disability, and suicide. The maturational changes that take place in the brain during adolescence underscore the importance of examining neurobiological mechanisms during this time of early illness. However, neural mechanisms of depression in adolescents have been understudied. Research has implicated the amygdala in emotion processing in mood disorders, and adult depression studies have suggested amygdala-frontal connectivity deficits. Resting-state functional magnetic resonance imaging is an advanced tool that can be used to probe neural networks and identify brain-behavior relationships.

Objective: To examine amygdala resting-state functional connectivity (RSFC) in adolescents with and without MDD using resting-state functional magnetic resonance imaging as well as how amygdala RSFC relates to a broad range of symptom dimensions.

Design, Setting, and Participants: A cross-sectional resting-state functional magnetic resonance imaging study was conducted within a depression research program at an academic medical center. Participants included 41 adolescents and young adults aged 12 to 19 years with MDD and 29 healthy adolescents (frequency matched on age and sex) with no psychiatric diagnoses.

Main Outcomes and Measures: Using a whole-brain functional connectivity approach, we examined the correlation of spontaneous fluctuation of the blood oxygen level–dependent signal of each voxel in the whole brain with that of the amygdala.

Results: Adolescents with MDD showed lower positive RSFC between the amygdala and hippocampus, parahippocampus, and brainstem (z >2.3, corrected P < .05); this connectivity was inversely correlated with general depression (R = −.523, P = .01), dysphoria (R = −.455, P = .05), and lassitude (R = −.449, P = .05) and was positively correlated with well-being (R = .470, P = .03). Patients also demonstrated greater (positive) amygdala-precuneus RSFC (z >2.3, corrected P < .05) in contrast to negative amygdala-precuneus RSFC in the adolescents serving as controls.

Conclusions and Relevance: Impaired amygdala-hippocampal/brainstem and amygdala-precuneus RSFC have not previously been highlighted in depression and may be unique to adolescent MDD. These circuits are important for different aspects of memory and self-processing and for modulation of physiologic responses to emotion. The findings suggest potential mechanisms underlying both mood and vegetative symptoms, potentially via impaired processing of memories and visceral signals that spontaneously arise during rest, contributing to the persistent symptoms experienced by adolescents with depression. Read the full article.

“The Burden of Depression” Nature (2014)

This editorialdiscusses how mental health has gained acceptance as a medical problem, but that progress in finding treatments has been hampered by stigma. Read the full article.

“If Depression Were a Cancer” by Heidi Ledford, Nature (2014)

In this article, the author considers how research into depression has struggled, while studies of cancer have thrived. Read the full article.

“Depression: A Change of Mind” by Emily Anthes, Nature (2014)

Cognitive behavioral therapy (CBT) is the best-studied form of psychotherapy. This article explains how researchers are still struggling to understand by CBT is successful. Read the full article.

“Depression Needs Large Human-Genetics Studies” by Steve Hyman, Nature (2014)

The author of this article argues that researchers should collect genetic data from over 100,000 people in order to better understand the molecular mechanisms of depression. Read the full article.

“Depression: The Best Way Forward” Nature (2014)

This forum includes two articles about the best research strategies to adopt to improve treatments for depression. Read the full forum.