Mediating Effects of Neural Targets on Depression, Weight, and Anxiety Outcomes of an Integrated Collaborative Care Intervention: The ENGAGE-2 Mechanistic Pilot Randomized Clinical Trial.
Anxiety
Cognitive control
Depression
Functional neuroimaging
Negative affect
Obesity
Journal
Biological psychiatry global open science
ISSN: 2667-1743
Titre abrégé: Biol Psychiatry Glob Open Sci
Pays: United States
ID NLM: 9918227369306676
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
07
01
2022
revised:
25
02
2022
accepted:
24
03
2022
medline:
5
4
2022
pubmed:
5
4
2022
entrez:
31
7
2023
Statut:
epublish
Résumé
Integrated treatments for comorbid depression (often with anxiety) and obesity are lacking; mechanisms are poorly investigated. In a mechanistic pilot trial, adults with body mass index ≥30 and Patient Health Questionnaire-9 scores ≥10 were randomized to usual care ( Participants were 47.0 years (SD = 11.9 years), 76% women, 55% Black, and 20% Latino. Depression Symptom Checklist-20 (between-group difference, -0.3 [95% CI: -0.6 to -0.1]) and Generalized Anxiety Disorder Scale-7 (-2.9 [-4.7 to -1.1]) scores, but not body mass index, decreased significantly at 6 months in the intervention versus usual care groups. Only Generalized Anxiety Disorder Scale-7 score changes at 6 months significantly correlated with neural target changes at 2 months in the negative affect (anterior insula, subgenual/pregenual anterior cingulate cortex, amygdala) and cognitive control circuits (dorsal lateral prefrontal cortex, dorsal anterior cingulate cortex). Effects were medium to large (0.41-1.18 SDs). Neural target changes at 2 months in the cognitive control circuit only differed by treatment group. Effects were medium (0.58-0.79 SDs). Compared with usual care, the study intervention led to significantly improved depression but not weight loss, and the results on neural targets were null for both outcomes. The significant intervention effect on anxiety might be mediated through changes in the cognitive control circuit, but this warrants replication.
Sections du résumé
Background
UNASSIGNED
Integrated treatments for comorbid depression (often with anxiety) and obesity are lacking; mechanisms are poorly investigated.
Methods
UNASSIGNED
In a mechanistic pilot trial, adults with body mass index ≥30 and Patient Health Questionnaire-9 scores ≥10 were randomized to usual care (
Results
UNASSIGNED
Participants were 47.0 years (SD = 11.9 years), 76% women, 55% Black, and 20% Latino. Depression Symptom Checklist-20 (between-group difference, -0.3 [95% CI: -0.6 to -0.1]) and Generalized Anxiety Disorder Scale-7 (-2.9 [-4.7 to -1.1]) scores, but not body mass index, decreased significantly at 6 months in the intervention versus usual care groups. Only Generalized Anxiety Disorder Scale-7 score changes at 6 months significantly correlated with neural target changes at 2 months in the negative affect (anterior insula, subgenual/pregenual anterior cingulate cortex, amygdala) and cognitive control circuits (dorsal lateral prefrontal cortex, dorsal anterior cingulate cortex). Effects were medium to large (0.41-1.18 SDs). Neural target changes at 2 months in the cognitive control circuit only differed by treatment group. Effects were medium (0.58-0.79 SDs).
Conclusions
UNASSIGNED
Compared with usual care, the study intervention led to significantly improved depression but not weight loss, and the results on neural targets were null for both outcomes. The significant intervention effect on anxiety might be mediated through changes in the cognitive control circuit, but this warrants replication.
Identifiants
pubmed: 37519462
doi: 10.1016/j.bpsgos.2022.03.012
pii: S2667-1743(22)00051-9
pmc: PMC10382700
doi:
Types de publication
Journal Article
Langues
eng
Pagination
430-442Informations de copyright
© 2022 The Authors.
Références
EBioMedicine. 2021 May;67:103387
pubmed: 34004422
Obes Res Clin Pract. 2020 May - Jun;14(3):210-216
pubmed: 32460966
J Psychiatry Neurosci. 2020 Nov 18;46(1):E97-E110
pubmed: 33206039
Biol Psychiatry. 2022 Mar 15;91(6):561-571
pubmed: 34482948
JAMA. 2016 Sep 13;316(10):1104-5
pubmed: 27623464
Arch Gen Psychiatry. 1978 Oct;35(10):1189-95
pubmed: 697537
N Engl J Med. 2010 Dec 30;363(27):2611-20
pubmed: 21190455
JAMA. 2004 Apr 7;291(13):1569-77
pubmed: 15069044
Am J Clin Nutr. 2021 Dec 1;114(6):2060-2073
pubmed: 34476464
Control Clin Trials. 2002 Dec;23(6):662-74
pubmed: 12505244
Obes Sci Pract. 2020 Aug 12;6(6):735-740
pubmed: 33354349
Arch Intern Med. 2006 May 22;166(10):1092-7
pubmed: 16717171
JAMA Netw Open. 2020 Sep 1;3(9):e2019686
pubmed: 32876685
J Affect Disord. 2020 Dec 1;277:55-64
pubmed: 32799105
BMC Psychiatry. 2019 Jan 8;19(1):13
pubmed: 30621636
Am Psychol. 1989 Sep;44(9):1175-84
pubmed: 2782727
Nutrients. 2020 Jul 07;12(7):
pubmed: 32645970
Contemp Clin Trials. 2020 Aug;95:106072
pubmed: 32621905
J Med Internet Res. 2013 Jul 19;15(7):e139
pubmed: 23872035
Psychol Med. 2020 Apr;50(5):727-736
pubmed: 32204741
Behav Res Ther. 2018 Feb;101:58-70
pubmed: 29074231
Arch Gen Psychiatry. 2002 Oct;59(10):877-83
pubmed: 12365874
Contemp Clin Trials. 2010 Jul;31(4):312-22
pubmed: 20350619
Curr Diab Rep. 2022 Apr;22(4):157-168
pubmed: 35304703
JAMA. 2019 Mar 5;321(9):869-879
pubmed: 30835308
Lancet Psychiatry. 2016 May;3(5):472-80
pubmed: 27150382
Obesity (Silver Spring). 2021 Feb;29(2):438-445
pubmed: 33043562
Am J Prev Med. 2009 Dec;37(6):505-11
pubmed: 19944916
Br J Psychiatry. 1976 Jul;129:61-7
pubmed: 938806
Depress Anxiety. 2017 Jan;34(1):9-24
pubmed: 27653321
Brain Behav. 2019 Jun;9(6):e01284
pubmed: 31066227
JAMA Psychiatry. 2020 Jul 1;77(7):663-664
pubmed: 32211837
MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1049-1057
pubmed: 32790653
JAMA Netw Open. 2021 Mar 1;4(3):e212536
pubmed: 33749764
Brain Sci. 2019 Apr 14;9(4):
pubmed: 31013983
JAMA Psychiatry. 2019 Dec 1;76(12):1219-1220
pubmed: 31389991
Neuropsychopharmacology. 2021 Mar;46(4):774-782
pubmed: 33349674
Curr Behav Neurosci Rep. 2014 Sep 1;1(3):144-153
pubmed: 25147755
Neuropsychopharmacology. 2019 Aug;44(9):1639-1648
pubmed: 31060042
N Engl J Med. 2019 Jul 18;381(3):285-286
pubmed: 31314974
Neuropsychopharmacology. 2019 Aug;44(9):1613-1622
pubmed: 31039579
Depress Anxiety. 2016 Oct;33(10):967-977
pubmed: 27454009
Behav Res Ther. 2018 Feb;101:3-11
pubmed: 29110885
Epilepsy Behav. 2010 Nov;19(3):225-31
pubmed: 20609631