Bidirectional Relationship between Depression and Cognitive Function: Evidence from a Psychosocial Intervention

At present, there is a paucity of naturalistic studies directly comparing the effectiveness of psychotherapy alone versus collaborative psychotherapy and psychiatric care in the management of depression and anxiety in patients with cancer. This study tested the hypothesis that collaborative psychiatric and psychological care would lead to greater reductions in depression and anxiety symptoms in patients with cancer compared with psychotherapy alone. We analyzed treatment outcomes of 433 adult patients with cancer, of which 252 patients received psychotherapy alone and 181 patients received collaborative psychotherapy and psychiatric care. Longitudinal changes in depressive (i.e., PHQ-9) and anxiety symptoms (GAD-7)were examined between groups using latent growth curve modeling. After controlling for treatment length and psychotherapy provider effects, results indicated collaborative care was more effective than psychotherapy alone for depressive symptoms (γ12 = -0.13, p = 0.037). The simple slope for collaborative care was -0.25 (p = 0.022) and the simple slope for psychotherapy alone was -0.13 (p = 0.006), suggesting collaborative care resulted in greater reductions in depressive symptoms compared with psychotherapy alone. In contrast, there were no significant differences between psychotherapy alone and collaborative psychotherapy and psychiatric care in reducing anxiety symptoms (γ12 = -0.08, p = 0.158). Collaborative psychotherapy and psychiatric care may individually address unique aspects of mental health conditions in patients with cancer, namely depressive symptoms. Mental healthcare efforts may benefit from implementing collaborative care models where patients receive psychiatric services and psychotherapy to effectively address depressive symptoms in the treatment of this patient population.

Reduction of depressive symptoms predicts improved glycaemic control: Secondary results from the DIAMOS study

BackgroundYoga is a low risk intervention that is accessible, adaptable for older adults, easily incorporated into daily life, and potentially sustainable. It combines mental and physical practice and includes instruction on breathing, stress reduction, and mindfulness meditation. Previous research documents that yoga can target modifiable risk factors for Mild Cognitive Impairment (MCI) progression, including stress, depression, cardiovascular health, insulin resistance, and inflammation. We describe a pilot randomized trial of yoga for individuals with MCI.MethodsParticipants were 37 individuals with amnestic MCI who were randomly assigned to receive 12 weeks of twice‐weekly yoga intervention (YI; n = 18) or healthy living education classes (HLE; n = 19). The yoga classes were 60‐min, designed for safety (using props and chairs), and followed a fixed sequence of breathing practices, meditation, warmups, standing and seated postures, simple inversions, and relaxation. HLE classes involved interactive discussion and presentations addressing topics relevant to aging and cognitive impairment. Participants completed neuropsychological and mood measures at baseline and immediately post‐intervention.ResultsThere were no group differences for age, education, race, sex, class attendance rates, or percent taking dementia medications. Results of ANCOVA, controlling for baseline scores, did not show any statistically significant differences in neuropsychological domains between the groups. However, medium effect sizes in favor of the YI were seen for visuospatial skills (Cohen’s d = 0.47) and executive functioning/working memory (Cohen’s d = 0.58). Minimal to small effects were found for attention/speed, language, and learning and memory. The yoga group showed significant declines in perceived stress compared to HLE (p<0.05; Cohen’s d = 0.74). Surprisingly, HLE resulted in significantly greater reductions in depressive symptoms after the intervention compared to the YI (p<0.05; Cohen’s d = 0.78).ConclusionsAlthough small sample sizes likely impacted our ability to detect statistically significant results, these findings indicate that the YI was feasible and may improve aspects of neuropsychological functioning in individuals with MCI. Results support stress reduction as a possible mechanism for the YI. The interactive nature of HLE class may explain its effect on mood. Future studies should address a yoga intervention in a larger sample.

(Reprinted with permission from American Psychiatric Association, http://psychiatryonline.org/guidelines).

IntroductionBehavioral activation (BA) therapy is effective in treating depression in both adults and adolescents, and internet-based BA (iBA) therapy showed promise during the COVID-19 pandemic. Adolescents with depression often exhibit motivational impairment, which is associated with reduced motivation and engagement in rewarding activities as well as a heightened risk of problematic internet use. This study examined the differential benefits of iBA in alleviating depressive symptoms in adolescents with relatively high and low Reward Probability Index (RPI) levels.MethodsUsing a randomized controlled trial design, this secondary analysis included 38 adolescents diagnosed with major depressive disorder, who were randomly assigned to either the iBA or internet-based psychoeducation and supportive therapy (iST) groups. Depressive symptoms, BA levels, and RPI were assessed at pre-treatment, post-treatment, and the 3-month follow-up.ResultsThe findings revealed that adolescents with low baseline RPI who received iBA showed a significantly greater reduction in depressive symptoms than those with high baseline RPI. Additionally, adolescents with low baseline RPI in the iBA group showed a significantly greater reduction in depressive symptoms than those in the iST group.DiscussionThese results suggest that iBA is particularly beneficial for adolescents with low RPI, especially those experiencing anhedonia, and provides a promising approach to enhance treatment outcomes in this population. High accessibility of iBA may promote engagement in rewarding real-life activities.

The rising prevalence of cognitive impairment has made it a critical public health priority. Nurses are central to chronic disease management, yet the efficacy of the interventions in older adults with cognitive disorders remains uncertain. To evaluate the efficacy of nurse-led interventions in older adults with cognitive disorders. A comprehensive search was conducted across seven electronic databases from their inception to August 2025. This meta-analysis focused on nurse-led interventions. The primary outcome was cognitive function, and secondary outcomes included depressive symptoms and quality of life. Due to the heterogeneity of the studies, we employed a random effects model for the meta-analysis. The results indicated that nurse-led interventions significantly improved cognition (SMD = 0.64; 95% CI, 0.39-0.88; p < 0.05), substantially alleviated depressive symptoms (SMD = -0.32; 95% CI, -0.53-0.11; p < 0.05) and enhanced quality of life (QoL) (SMD = 0.40; 95% CI, 0.17-0.64; p < 0.05). The results of this study indicate that nurse-led interventions are highly beneficial for elderly individuals with mild cognitive impairment (MCI) or dementia. In future research, it is necessary to comprehensively consider the roles that nurses undertake. They should play an active role in the recovery from chronic diseases. These findings provide an important basis for policymakers and clinicians. PROSPERO Registration number: CRD42024619016.

Older adults with mild cognitive impairment (MCI) are at increased risk of progression to dementia. Whether it is feasible to engage this population in expressive arts therapy and yield effects on cognition and depression for older adults with MCI remained unclear. The aim of this study examined the effects of expressive arts therapy on the cognitive function and depression levels of older adults with MCI in day care centers in Taiwan. A quasi-experimental design was conducted in a sample of day care centers older adults with MCI. A total of 88 participants with MCI were assigned to the intervention or comparison group. The intervention groups participated in an expressive arts therapy for 12 weeks in addition to their daily activities. Data were collected at the baseline point and immediately after post-intervention. Generalized estimating equations were used to examine the effect of the intervention on the outcomes. At week 12, findings indicated that the intervention group had significant improvement in cognitive function and depression over time than the comparison group. These findings provide evidence for the feasibility and efficacy of expressive arts therapy intervention in older adults with MCI.

Purpose: Depressive and anxiety symptoms are common amongst individuals with chronic kidney disease and are known to affect quality of life adversely. Psychosocial interventions have been shown to decrease depressive and anxiety symptoms in various chronic diseases, but few studies have examined their efficacy in people with chronic kidney disease and no meta-analysis has been published. Thus, the aim of the present systematic review and meta-analysis was to evaluate the effects of psychosocial interventions on depressive and anxiety symptoms as well as quality of life in individuals diagnosed with chronic kidney disease and/or their carers.Methods: In this systematic review and meta-analysis, we included published randomized controlled trials comparing psychosocial interventions versus usual care for impacting depressive and anxiety symptoms and quality of life.Results: Eight studies were included in the systematic review and six of these were subjected to meta-analysis. Psychosocial interventions were associated with a medium effect size for reduction in depressive symptoms and a small effect size for improved quality of life in the in individuals with chronic-kidney-disease and their carers. Some evidence suggested a reduction in anxiety.Conclusion: Psychosocial interventions appear to reduce depressive symptoms and improve quality of life in patients with chronic-kidney-disease and their carers and to have some beneficial impact on anxiety. However, the small number of identified studies indicates a need for further research in this field.

Depression and depressive symptoms commonly co-occur with mild cognitive impairment (MCI) and dementia in older adults (Ismail et al., 2017; Panza et al., 2010), and may occur for various reasons, including as an emotional response to cognitive decline (Bennett &amp; Thomas, 2014; Richard et al., 2013). Emotional responses may be explained by a decline in sense of control, or the belief in one’s ability to influence their environment to achieve desired outcomes, which declines with age as cognitive and physical abilities change and limit independence (e.g., Lachman &amp; Weaver, 1998). Using data taken from years 2006 to 2018 of the Health and Retirement Study (HRS), a mixed model regression indicated that cognitive functioning on the Modified Telephone Interview for Cognitive Status (TICS-27) was significantly associated with depressive symptoms on the Center for Epidemiologic Studies Depression (CES-D-8), β = -.02, t (45,163) = -5.65, p &amp;lt; .001, R2 = .49. Further, TICS-27 in 2016 predicted CES-D-8 in 2018, and this relation was mediated by sense of control in 2018, measured using the subscale of the Midlife Development Inventory, while controlling for demographic variables, β = -.02, SE = .004, 95% CI [-.03, -.01], Δ R2 = .11. The findings of this study confirm that cognitive function predicts depressive symptoms and highlight the importance of sense of control in explaining this emotional reaction. These findings have critical implications for preventing and treating depressive symptoms in older adults, particularly those with signs of cognitive dysfunction.

Studies have shown that leisure activities, such as tabletop games, not only increase social interactions and reduce depression among older adults, but also help improve their cognitive function. However, the effects of tabletop games on cognition in older adults are yet to be comprehensively analyzed. The purpose of this study was to review and examine the effects of tabletop games on cognition in older adults. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were searched in seven electronic databases from their inception to December 2020. A total of 3946 studies were retrieved, among which 11 studies were systematically reviewed and 10 were meta-analyzed. In older adults with intact cognition, tabletop games had positive effects on their global cognition (standardized mean differences [SMD] = 1.36, 95% confidence intervals [CI]: 0.37-2.34, P < 0.001) and executive function (SMD = 0.47, 95% CI: 0.12-0.83, P < 0.001). In older adults with cognitive impairment, significant differences were found in global cognition (SMD = 0.53, 95% CI: 0.09-0.98, P = 0.02). Tabletop games had the characteristics of cognitive training and interpersonal interactions. After receiving tabletop game interventions, the cognitive functioning in older adults with intact cognition and those with mild cognitive impairment or dementia was improved. For older adults, in addition to improving cognitive functioning, tabletop games also increased their social participation and interactions. Systematic Review Registration: This review has been registered in the PROSPERO (CRD42021254085).

Background: There is ongoing research into the potential use of psychedelics and 3,4-methylenedioxy-methamphetamine (MDMA) as alternatives to commonly used medications for treating major depressive and anxiety disorders. Aims: We aimed to assess the efficacy of psychedelics and MDMA in managing depressive and anxiety symptoms and evaluate their safety profiles. Methods: We searched five databases for randomized controlled trials of psychedelics and MDMA targeting depressive and anxiety symptoms and conducted a meta-analysis using a random effects model when possible. The review protocol is registered in PROSPERO under CRD42022341325. Results: Psilocybin induced a rapid and sustained reduction in depressive and anxiety symptoms in patients with major depressive disorder and in patients with life-threatening cancer. MDMA induced a decrease in depressive symptoms in patients with life-threatening cancer, autism spectrum disorder, and post-traumatic stress disorder. MDMA’s effect size was either negligible or negative in reducing generalized anxiety symptoms, but MDMA reduced social anxiety symptoms. Ayahuasca induced a reduction in depressive symptoms in individuals with treatment-resistant major depressive and personality disorders. Lysergic acid diethylamide (LSD) induced a decrease in anxiety symptoms in individuals with life-threatening cancer. Psilocybin’s adverse effects were noticeable for elevated blood pressure, headaches, and panic attacks. For MDMA, elevated blood pressure, headaches, panic attacks, and feeling cold were noticeable. Conclusions: Psychedelics (psilocybin, ayahuasca, and LSD) and MDMA have the potential to induce a reduction in depressive and anxiety symptoms. Adverse effects are noticed. Rigorous randomized controlled studies with larger sample sizes utilizing instruments with better reliability and validity are warranted.

Physical exercise is an effective treatment for depression, yet little is known about the temporal dynamics of symptom improvement during exercise interventions. In this randomized controlled trial, 64 adults with moderate to severe depressive symptoms were allocated to a 10-week supervised Nordic walking (NW) program (n=48) or a non-active control condition (n=16). The NW group completed two weekly training sessions at moderate intensity (65-75% HRmax). Depressive symptoms were assessed at baseline, mid-intervention (Week 5), and post-intervention (Week 10) using the Beck Depression Inventory-II. Primary analyses examined Group × Time effects on symptom severity. Secondary analyses explored (via a Group × Depression intensity × Time ANOVA) whether baseline depression intensity moderated treatment response. A significant Group × Time interaction indicated greater reductions in depressive symptoms in the NW group compared with controls. Symptom improvement was most pronounced during the first half of intervention (Hedges's g=-0.98), with smaller changes thereafter (Hedges's g=-0.40 from mid- to post-intervention). In addition, a significant Group × Depression intensity × Time interaction suggests that participants with severe baseline depression experienced larger and more rapid improvement than those with moderate symptoms in the first five weeks. Supervised Nordic walking was found to be associated with substantial reductions in depressive symptoms within five weeks, particularly among individuals with severe depression. Implications of our findings and study's limitations are discussed.

BackgroundStudies on adults suggest that the presence of comorbid depression and Borderline Personality Disorder (BPD) is associated with an elevated risk of self-harming behaviours and that self-harming behaviours, when present, will have higher severity. This comorbidity, furthermore, complicates clinical assessments, which may be an obstacle to early identification and proper intervention. Adolescents who self-harm frequently report high levels of depressive symptoms, but this is often not reflected in the clinicians’ assessment. BPD is still a controversial diagnosis in young people, and less is known about the clinical significance of comorbid BPD in adolescent populations.The purpose of the present study was to examine the impact of BPD on the assessment and course of self-reported and clinician-rated depression in self-harming adolescents before and after a treatment period of 19 weeks. We hypothesized that, compared to adolescents without BPD, adolescents with BPD would self-report higher levels of depression at baseline, and that they would have less reduction in depressive symptoms.MethodsA total of 39 adolescents with depressive disorders and BPD-traits participating in a randomised controlled trial on treatment of self-harm with Dialectical Behaviour Therapy adapted for Adolescents or enhanced usual care were included. Adolescents with full-syndrome BPD (n = 10) were compared with adolescents with sub-threshold BPD (n = 29) with respect to their self-reported and clinician-rated depressive symptoms, suicidal ideation and global level of functioning at baseline, and after 19 weeks of treatment (end of trial period).ResultsAt baseline, adolescents with full-syndrome BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation compared to adolescents with sub-threshold BPD, whereas the two groups were rated as equally depressed by the clinicians. At trial completion, all participants had a significant reduction in suicidal ideation, however, adolescents with BPD had a poorer treatment outcome in terms of significantly higher levels of clinician-rated and self-reported depressive symptoms and significantly lower levels of global functioning. At baseline as well as at trial completion, self-reported and clinician-rated levels of depressive symptoms were not significantly correlated in adolescents with BPD. In a multiple linear regression analysis, a diagnosis of BPD and a high baseline level of clinician-rated depressive symptoms predicted higher levels of depressive symptoms at trial completion, whereas receiving Dialectical Behaviour Therapy predicted lower levels of depressive symptoms.ConclusionOur findings suggest that a diagnosis of BPD may have a strong impact on the assessment and course of depressive symptoms in self-harming adolescents. Although rated as equally depressed, adolescents with BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation at baseline, and showed a poorer outcome in terms of higher levels of depressive symptoms and lower levels of global functioning at trial completion compared to adolescents with sub-threshold BPD. Our findings suggest that receiving Dialectical Behaviour Therapy could lead to a greater reduction in depressive symptoms, although firm conclusions cannot be drawn given the limited sample size.Clinicians should be aware of the possibility of underestimating the severity of depression in the context of emotional and behavioral dysregulation. Providing BPD specific treatments seems to be important to achieve sufficient treatment response with regard to depressive symptoms in adolescents with BPD-traits.Trial registrationTreatment for Adolescents With Deliberate Self Harm; NCT00675129, registered May 2008.

Reward positivity (RewP), a neurophysiologic index of reward responsivity, is consistently reduced in participants with depression and, to a lesser extent, anxiety. It remains unknown, however, whether RewP can be altered as psychiatric symptoms change with treatment. The current study addressed this question by examining differences in RewP within patients before and after 12 weeks of treatment with a selective serotonin reuptake inhibitor (SSRI) or cognitive-behavioral therapy (CBT). We also examined the utility of RewP as a predictor of symptom change during CBT and SSRI treatment. Participants were recruited between 2014 and 2017 and included adults with a primary DSM-5 anxiety or depressive disorder (n = 63) and healthy controls (n = 25). At baseline and 12 weeks, participants completed a monetary award task while electroencephalogram (EEG) was recorded. Between EEG sessions, patients completed CBT or SSRI treatment. At baseline, higher levels of depressive symptoms were associated with a more attenuated RewP. We found no significant differences between patients and healthy controls in the degree of RewP change across the 12 weeks; however, among patients, the extent of increase in RewP robustly correlated with the extent of decline in depressive (t = -2.21, P = .03) and anxiety (t = -2.57, P = .02) symptoms following CBT and SSRI treatment. Additionally, a more attenuated RewP at baseline predicted a greater reduction in depressive symptoms following treatment with SSRIs (t = -2.04, P < .05), but not after CBT. These findings highlight neural responsiveness to reward as both a mechanism and a predictor of depressive symptom change that may be used serve as an objective index of symptom improvement. ClinicalTrials.gov identifier: NCT01903447.

This study evaluated whether 333 seronegative African American female drug users (aged 18–59 years) participating in an HIV intervention and with higher levels of emotional distress, specifically symptoms of depression and anxiety, reduced HIV risk behaviors to a lesser extent than those with lower levels of emotional distress. Participants were recruited between June 1998 and January 2001 from inner-city Atlanta (Georgia, U.S.) neighborhoods and were randomly assigned to one of two enhanced gender-specific and culturally specific HIV intervention conditions or to the NIDA standard condition. Participants were interviewed at baseline, post-intervention and at 6-month follow-up with a structured questionnaire including information on sociodemographics, sexual and drug-using behavior, and psychosocial characteristics. Despite a significant decline in symptoms of emotional distress during the study period, the women in this sample reported high levels of depressive and anxiety symptoms at baseline and 6-month follow-up. Higher levels of emotional distress were positively associated with post-intervention sexual and drug-taking risk. Women in both enhanced intervention conditions reduced their sexual and drug-taking risks more than women in the standard intervention. Those in the motivation intervention arm experienced a greater reduction in depressive symptoms, accompanied by a greater reduction in sexual risk behavior. Findings suggest the need for effective interventions and mental health resources among subgroups of high-risk women who may be most resistant to behavioral change.