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Neural response to evaluating depression predicts perceivers' mental health treatment recommendations.

ABSTRACT: Nonstigmatized perceivers' initial evaluations of stigmatized individuals have profound consequences for the well-being of those stigmatized individuals. However, the mechanism by which this occurs remains underexplored. Specifically, what beliefs about the stigmatized condition (stigma-related beliefs) shape how nonstigmatized perceivers evaluate and behave toward stigmatized individuals? We examined these questions with respect to depression-related stigmatization because depression is highly stigmatized and nondepressed individuals' behavior (e.g., willingness to recommend treatment) directly relates to removing stigma and increasing well-being. In Study 1, we identified common stigma-related beliefs associated with depression (e.g., not a serious illness, controllable, threatening), and found that only perceptions that depression is a serious condition predicted nondepressed perceivers' willingness to recommend mental health treatment. Moreover, perceivers' beliefs that depression is a distressing condition mediated the relationship between perceived seriousness and treatment recommendations (Study 1). In Study 2, we used fMRI to disentangle the potential processes connecting distress to nondepressed perceivers' self-reported treatment intentions. Heightened activity in the dorsomedial prefrontal cortex (dmPFC)-a region widely implicated in evaluating others-and the ventrolateral prefrontal cortex (vlPFC)-a region widely implicated in regulating negative emotions-emerged when nondepressed perceivers evaluated individuals who were ostensibly depressed. Beliefs that depression is a distressing condition mediated the relationship between dmPFC (but not vlPFC) activity and nondepressed individuals' self-reported treatment recommendations.

SUBMITTER: Krendl AC

PROVIDER: S-EPMC5806511 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Neural response to evaluating depression predicts perceivers' mental health treatment recommendations.

Krendl Anne C AC Cassidy Brittany S BS

Cognitive, affective & behavioral neuroscience 20171201 6

Nonstigmatized perceivers' initial evaluations of stigmatized individuals have profound consequences for the well-being of those stigmatized individuals. However, the mechanism by which this occurs remains underexplored. Specifically, what beliefs about the stigmatized condition (stigma-related beliefs) shape how nonstigmatized perceivers evaluate and behave toward stigmatized individuals? We examined these questions with respect to depression-related stigmatization because depression is highly ...[more]

PMID: 28895092

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Project description:Existing cognitive and clinical predictors of treatment response to date are not of sufficient strength to meaningfully impact treatment decision making and are not readily employed in clinical settings. This study investigated whether clinical and cognitive markers used in a tertiary care clinic could predict response to usual treatment over a period of 4 to 6 months in a sample of 75 depressed adults. Patients (N = 384) were sequentially tested in 2 half-day clinics as part of a quality improvement project at an outpatient tertiary care center between August 2003 and September 2007; additional subjects evaluated in the clinic between 2007 and 2009 were also included. Diagnosis was according to DSM-IV-TR criteria and completed by residents and attending faculty. Test scores obtained at intake visits on a computerized neuropsychological screening battery were the Parametric Go/No-Go task and Facial Emotion Perception Task. Treatment outcome was assessed using 9-item Patient Health Questionnaire (PHQ-9) self-ratings at follow-up (n = 75). Usual treatment included psychotropic medication and psychotherapy. Decline in PHQ-9 scores was predicted on the basis of baseline PHQ-9 score and education, with neuropsychological variables entered in the second step. PHQ-9 scores declined by 46% at follow-up (56% responders). Using 2-step multiple regression, baseline PHQ-9 score (P ≤ .05) and education (P ≤ .01) were significant step 1 predictors of percent change in PHQ-9 follow-up scores. In step 2 of the model, faster processing speed with interference resolution (go reaction time) independently explained a significant amount of variance over and above variables in step 1 (12% of variance, P < .01), while other cognitive and affective skills did not. This 2-step model accounted for 28% of the variance in treatment change in PHQ-9 scores. Processing speed with interference resolution also accounted for 12% variance in treatment and follow-up attrition. Use of executive functioning assessments in clinics may help identify individuals with cognitive weaknesses at risk for not responding to standard treatments.

Project description:AimsResidential instability, including transience (i.e. unusually frequent mobility), is associated with higher risk for emotional and behavioural problems in children and young adults. However, most studies have not compared the effect of recent v. more distal moves on mental health or on mental health treatment. This study examined associations between recent (past year) and distal (past 2-4 years) residential transience and past year major depressive episode (MDE) and mental health treatment in a nationally representative sample of US adolescents aged 12-17.MethodsData are from the 2010-2014 National Surveys on Drug Use and Health (n = ~107 300 adolescents). T-tests were used to examine the prevalence of MDE by number of moves in the past 5 years among a nationally representative sample of adolescents. Additionally, multivariable logistic regression models were used to evaluate the adjusted association between recent (⩾2 moves in the past year) and distal (⩾4 moves in the past 5 years, but no recent transience) and (1) past year MDE and (2) past year mental health treatment among adolescents with MDE.ResultsMDE prevalence increased linearly with number of moves in the past 5 years (p < 0.001). The adjusted odds of MDE were greater among youths with distal transience (adjusted odds ratio (AOR) = 1.25, 95% confidence interval (CI) = 1.09-1.44) and among those with proximal transience (AOR = 1.31, 95% CI = 1.17-1.46), compared with those without transience in the past 5 years. The MDE prevalence did not differ between those with distal and proximal transience (p = 0.163). In youths with past year MDE, the prevalence of past year mental health treatment was greater among those with proximal transience compared with those without transience (AOR = 1.40, 95% CI = 1.15-1.70), but there was no significant difference in treatment among those with distal v. no transience.ConclusionsDistal and recent transience are associated with past year MDE among adolescents. Adolescents with MDE who had recent transience were more likely to receive past year mental health treatment compared with those without transience. However, those with only distal transience were not more likely to receive treatment. Parents, school officials and health care providers should be aware that residential mobility in the past 5 years may indicate increased odds of depression among adolescents even among adolescents whose housing stability has improved in the past year.

Dataset Information

Neural response to evaluating depression predicts perceivers' mental health treatment recommendations.

Publications

Neural response to evaluating depression predicts perceivers' mental health treatment recommendations.

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