The 5-HTTLPR genotype is a significant predictor of onset of major depression following multiple adverse events. This is one of the more robust findings concerning specific biological risk factors for depression.

BackgroundDepression is twice as common in diabetes mellitus (DM) as the general population and is associated with adverse health outcomes, but access to evidence-based therapies such as cognitive behavioral therapy (CBT) is limited in routine diabetes care. Past research has shown that generic Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for depression in the general population, but it has never been evaluated in people with comorbid depression and DM.ObjectiveThe aim of our study was to examine the efficacy of a generic 6-lesson iCBT delivered over 10 weeks in people with major depressive disorder (MDD) and DM.MethodsParticipants with comorbid MDD and DM (type 1 or 2) were recruited online and randomized to an iCBT program with therapist support provided by phone and email (n=42) or a treatment as usual (TAU, n=49) control group. Outcomes were assessed through Web-based self-report questionnaires and the trial was Web-based with no face-to-face components. Primary outcomes were self-reported depression (patient health questionnaire-9, PHQ-9), diabetes-related distress (problem areas in diabetes, PAID), and self-reported glycemic control (hemoglobin A1c, HbA1c). Secondary outcomes were general distress (Kessler 10-item psychological distress scale, K-10) and disability (short form 12-item, SF-12), generalized anxiety (generalized anxiety disorder 7-item, GAD-7), and somatization (PHQ-15). The iCBT group was assessed at 3 months.ResultsA total of 27 participants (66%; 27/41) completed the iCBT program. Analyses indicated between-group superiority of iCBT over TAU at posttreatment on PHQ-9 (g=0.78), PAID (g=0.80), K-10 (g=1.06), GAD-7 (g=0.72), and SF-12 mental well-being scores (g=0.66), but no significant differences in self-reported HbA1c levels (g=0.14), SF-12 physical well-being, or PHQ-15 scores (g=0.03-0.21). Gains were maintained at 3-month follow-up in the iCBT group, and the 87% (27/31) of iCBT participants who were interviewed no longer met criteria for MDD. Clinically significant change following iCBT on PHQ-9 scores was 51% (21/41) versus 18% (9/49) in TAU.ConclusionsiCBT for depression is an efficacious, accessible treatment option for people with diabetes. Future studies should explore whether tailoring of iCBT programs improves acceptability and adherence, and evaluate the long-term outcomes following iCBT.Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ACTRN): 12613001198718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365208&isReview=true (Archived by WebCite at http://www.webcitation.org/6qCR8Fi9V)

Genetic testing for high-penetrance mutations that follow Mendelian inheritance is increasing, generally in the context of pre-and post-test genetic counselling (e.g. using the Huntington's disease genetic testing protocols). By contrast, genotyping for lowrisk susceptibility alleles is still in its infancy. Over the past decade, predictors of uptake and social impact of genetic testing for adultonset disorders that follow Mendelian inheritance have been examined. Studies on uptake of genetic testing for hereditary cancers and Huntington's disease show that educational level, disease status and psychological factors (perceived risk, diseaserelated anxiety or distress) are consistently associated with interest in testing, more so than gender, age and marital status.1,2 Studies of individuals receiving such genetic information suggest that those who do not carry 'at risk' genotypes derive psychological benefits, while those identified as 'at risk' show no adverse effects. 1,3 In 2003, Caspi et al 4 demonstrated that multiple stressful life events were more likely to lead to depression in individuals with the s/s genotype of the promoter region of the serotonin transporter gene (5-HTTLPR) than those with the s/l and l/l genotypes, that is, there was a demonstrable gene-environment interaction in depression onset. This finding was replicated by seven other research groups including our own, 5-11 with two negative reports.12,13 Recently, the s/s genotype has also been associated with depression onset after hip fracture 14 and cardiac events. 15There are no reports on predictors of uptake or impact of such genotype testing; data on its acceptance and impact are needed. We therefore decided to 'test the water' in our longitudinal cohort of individuals who had undergone genetic testing. We focused on this group as they had expressed interest, were articulate and were in a position to provide information about perceived benefits and concerns about testing for the 5-HTT genotype, which could then be examined in other groups. As they had also reviewed their personal history of depression, anxiety and adverse life events with the research team, and were past the peak age of depression onset, provision of the research results was thought less likely to lead to concerns about future onset of depression. Method ParticipantsParticipants were from an initial group of 170 adults (114 women and 56 men) recruited in 1978 during a 1-year postgraduate teacher training programme. In 1983, 165 of the initial sample formed a cohort for a longitudinal study investigating risk factors of depression and were followed up at 5-year intervals.16 Cohort members were of a similar age (mean 23 years in 1978) with similar career and life opportunities and ethnic backgrounds; 160 were White from European backgrounds, 2 and 3 were of Chinese and Indian descent respectively. These shared demographic characteristics reduced the likelihood of psychosocial confounders.By 2003, 149 of the original 165 individuals remained in the study (8 had died, 2 wer...

The research questions pertaining to mental health are varied and will determine what mental health issues are of interest and the models of work applicable. There need to be more longitudinal studies and consideration of factors which the worker brings to the workplace (psychosocial issues, personality traits), as well as interpersonal issues and consideration of systemic, organizational, political and economic factors, including leadership styles.