An Anxious And Non-anxious Depression Survey Among Middle School Students In Changsha And Specific G×G,G×E Interactions On Adolescent Major Depressive Disorder

Chapter 2:An Anxious and Non-anxious Survey among Middle School Students in ChangshaObjective:To describe the prevalence characteristics of depression in middle school students, including rate, difference of rate between sexes and among different age groups. To explore the clinical characteristics and related factors of anxious and non-anxious adolescent Major Depressive Disorder (MDD).Methods:A sample of 10 middle schools,3965 students (ages 11-18 years) in Changsha were screened using cluster sampling. Child or the parent Mood and Feelings Questionnaire (MFQ-C,MFQ-P), Child Anxiety Related Emotional Disorders (SCARED), Adolescent Self-rating Life Event Checklist (ASLEC), Social Support Rating Scale for Children and Adolescents (SSRS-CA), Parental Bonding Instrument (PBI), Behavioral Inhibition Scale (BIS), Family Assessment Device (FAD), Resilience Scale (RS), Children Cognitive Distortions Questionnaire (CCDQ), strength and difficulty questionnaire (SDQ), Self-Rating Depression Scale (SDS), fundamental information of students, their parents and the parenting style were filled out by students and their parents. Individuals whose MFQ-C score=18 (cut-off) were viewed as potential depressive students. Individuals whose MFQ-C=18 and SCARED>25 were viewed as anxious depressive students; Individuals whose MFQ-C=18 and SCARED<25 were viewed as non-anxious depressive students.Results:(1) Prevalence rate of subjects over MFQ-C cut-off point is 30.70%,26.8%in males and 34.6%in females, prevalence in females is higher than that in males. The prevalence rate is 18%in early adolescence (11-12 years),30.9%in middle adolescence (13-15 years),36.5%in late adolescence (16-18 years). Prevalence in middle adolescence is higher than early adolescence (LRx2=40.70, P=0.000), and prevalence in late adolescence is even higher (LR x2=11.41, P=0.001)。(2) 55.3%of potential depressive students are anxious-depression, and 44.7%are non-anxious depression. The prevalence of anxious depression is higher than non-anxious depression (Fisher's exact P =0.000), with females higher than males.(3) Anxious depressive students scored higher than non-anxious depressive students on SDQ emotional symptoms (t=14.33, P =0.000),conduct problems (t=3.17, P=0.002), peer relationship problems (t=2.39, P=0.017), attention deficit and hyperactivity problems (t=3.17, P=0.002), total difficulty score (t=10.51, P =0.000); Anxious depressive students scored higher than non-anxious depressive students on MFQ-C, cognitive distortion, subjective social support and stressful life events (P< 0.05).Conclusion:(1) Prevalence rate of depression in 11-to-18 year-old adolescents is 30.70%,26.8%in males and 34.6%in females, prevalence in females is higher than that in males. The prevalence rate is 18%in early adolescence,30.9%in middle adolescence,36.5%in late adolescence. There is an increase trend from early adolescence to late adolescence. The prevalence rate of anxious depression is higher than non-anxious depression, with females higher than males.(2) Anxious depressive students have higher depressive scores, more behavioral problems, more attention deficit and hyperactivity problems, more peer relationship problems, more cognitive distortion and experienced more stressful life events.Chapter 3:A Case-control Study on the Related Socio-psychological Factors of Adolescent Major Depressive DisorderObjective:To explore the related socio-psychological factors of adolescent MDD and try to identify the strongest predictors of adolescent MDD.Methods:394 subjects (173 MDD patients,221 normal controls) were recruited to the study. MFQ-C,SCARED,self-report BI,SDS,CCDQ,PBI,ASLEC,SSRS-CA,RS were filled out by patients and FAD, parents-report BIS, MFQ-P, and fundamental information about patients, their parents, home environment and parenting were filled out or evaluated by their parents. Means of all these socio-psychological factors were compared between adolescent MDD group and normal control group. Variables which were identified to be related to adolescent MDD were used as independent variables in binary logistic regression to screen the strongest predictors of adolescent MDD.Results:Parental education level, family structure, family relationship, paternal parenting, consistency in parenting, current physical health conditions, past history of severe physical illness, RS, CCDQ, ASLEC, FAD, PBI parental care and protection scores, self-report BI, SSRS-CA are statistically different between cases and controls (all P<0.05). PBI maternal care, ASLEC, RS are the variables in the binary logistic regression model.Conclusion:Parental educational level, family structure, family relationship, paternal parenting, consistency in parenting, current physical health conditions, past history of severe physical illness, resilience, cognitive distortion, stressful life events, family function, PBI parental care and protection scores, self-report behavioral inhibition, social support are related factors of adolescent MDD. Among these factors, PBI maternal care, stressful life events, resilience are the strongest predictors of adolescent MDD.Chapter 4Specific G x G and G x E interactions on Adolescent MDDObjective:To explore the association of biallelic 5-HTTLPR polymorphism, triallelic5-HTTLPR polymorphism (5-HTTLPR+ rs25531), MAOA gene-linked polymorphic region (MAOA-u VNTR/MAOA-LPR) and adolescent MDD. To test whether or not there are gene-gene interactions(biallelic5-HTTLPR×MAOA-uVNTR,triallelic 5-HTTLPR×MAOA-u VNTR) and gene-environment interactions (biallelic 5-HTTLPR×SLEs, triallelic 5-HTTLPR×SLEs, MAOA-u VNTR×SLEs) which related to adolescent MDD.Methods:404 Chinese Han subjects, including 187 adolescent patients with MDD and 217 normal control students were recruited to the research.5-HTTLPR, rs25531 and MAOA-u VNTR were genotyped using SNaPshot SNP genotyping method. ASLEC were filled out to evaluate the stressful life events the subjects experienced in the past 1 year.Results:Biallelic 5-HTTLPR polymorphism, triallelic 5-HTTLPR polymorphism, MAOA-u VNTR polymorphisms have no direct effect on adolescent MDD in terms of the occurrence, severity of MDD and with/without anxiety and suicidal behavior/ideation/attempt. There are no genexgene interactions related to adolescent MDD were found between biallelic 5-HTTLPR/triallelic 5-HTTLPR and MAOA-u VNTR. There were also no G×E interactions related to adolescent MDD were found between biallelic 5-HTTLPR/triallelic 5-HTTLPR/MAOA-u VNTR and SLEs. There is no evidence of triallelic 5-HTTLPR×MAOA-u VNTR interaction related to adolescent MDD; Biallelic 5-HTTLPR L/S×MAOA-u VNTR S/L interactions may be related to adolescent MDD.Conclusion:Biallelic 5-HTTLPR polymorphism, triallelic 5-HTTLPR polymorphism, MAOA-u VNTR polymorphisms have no direct effect on adolescent MDD. There are no G×E interactions related to adolescent MDD were found between biallelic 5-HTTLPR/triallelic 5-HTTLPR/MAOA-u VNTR and SLEs. There is no evidence of triallelic 5-HTTLPR×MAOA-u VNTR interaction related to adolescent MDD; Biallelic 5-HTTLPR L/S×MAOA-u VNTR S/L interactions may be related to adolescent MDD.