Background Conventional categorical criteria have limitations in assessing the prevalence and severity of depressive mixed state (DMX). Thus, we have developed a new scale for screening and quantification of DMX and examined the symptomatological structure and severity of DMX in individuals with major depressive episode (MDE). Methods Subjects were 154 patients with MDE (57 males and 97 females; age 13–83 years). Our original Japanese version of the self-administered 12-item questionnaire to assess DMX (DMX-12), together with the Quick Inventory of Depressive Symptomatology Self-Report Japanese version (QIDS-SR-J) and global assessment of functioning, were administered to each participant. The symptomatological structure of the DMX-12 was examined by exploratory factor analysis. Multiple regression analyses were used to analyze factors contributing to the DMX-12 scale. The relationships of this scale with categorical diagnoses (mixed depression by Benazzi and mixed features by DSM-5) were also investigated. Results A three-factor model of the DMX-12 was extracted from exploratory factor analysis, namely, “spontaneous instability”, “vulnerable responsiveness”, and “disruptive emotion/behavior”. Multiple regression analyses revealed that age was negatively correlated with total DMX-12 score, while bipolarity and the QIDS-SR-J score were positively correlated. A higher score on the disruptive emotion/behavior subscale was observed in patients with mixed depression and mixed features. Conclusion The DMX-12 seems to be useful for screening DMX in conjunction with conventional categorical diagnoses. Severely depressed younger subjects with potential bipolarity are more likely to develop DMX. The disruptive emotion/behavior subscale of the DMX-12 may be the most helpful in distinguishing patients with DMX from non-mixed patients.

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The Ruminative Responses Scale (RRS) is a measure of depressive rumination which has two subscales: Brooding and Reflection. This article examines the longitudinal predictions for depression and the test-retest reliability of the Brooding and Reflection of the Japanese RRS. Japanese university students (N = 378) completed the RRS, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Inventory to Diagnose Depression, Lifetime Version (IDDL) which was modified to assess symptoms experienced in the 8-wk. follow-up period. The standardized betas of the initial Brooding and Reflection subscales for the IDDL scores were significant and positive after controlling for baseline CES-D scores, but those for the CES-D scores at Time 2 were not significant. Longitudinal predictions of Brooding were partially consistent with those of other language versions (significant in almost all studies); however, longitudinal predictions of Reflection were not consistent with those of other language versions (negative in previous studies). The test-retest correlations of both subscales were similar to those obtained in Western countries.

Although the definition of depressive mixed state, more commonly known as mixed depression, is still controversial, about one-third of major depressive episodes are held to contain mixed components. The most frequent manifestations of mixed depression are irritability, distractibility and psychomotor agitation, although these symptoms are not included in the mixed features during a major depressive episode according to the DSM-5 criteria, which is therefore unlikely to cover the full scope of mixed depression in real-world settings. Mixed depression often accompanies risky behavior including impulsive suicide attempts. The early detection and treatment of these unstable conditions is therefore necessary. Also, sufficiently sensitive and specific screening methods for depressive mixed state are needed to avoid both under-and over-diagnosis. Antidepressants should be avoided since these drugs often worsen irritability, agitation and impulsivity, and increase risky behavior. Instead, combination therapy with mood stabilizer(s) to prevent the relapse of the depressive mixed state and atypical antipsychotics for rapid stabilization in the acute phase should be considered. Because there is very little evidence for effective pharmacotherapy in mixed depression, the efficacy of various mood-stabilizing agents, either as monotherapy or in combination therapies, should be extensively examined in the future using quantitative assessments of the psychopathology of mixed depression in patients with confirmed diagnoses of mixed depression.

Multi-dimensional structure of the Attitudes Towards Ambiguity Scale (ATAS: original Japanese version) and its relationship with the Acceptance and Action Questionnaire (AAQ) were investigated. We administered the ATAS and the Japanese version of the AAQ to 1019 Japanese healthy volunteers (513 females and 506 males; age range 18–78 years). Trial of exploratory factor analysis extracted four distinct clusters (Enjoyment; α = .83, Anxiety; α = .75, Exclusion; α = .75, and Noninterference; α = .65) from the ATAS item pool, suggestive of diversity in cognitive/ emotional/ behavioral responses to ambiguity. Confirmative factor analysis showed similar goodness in fit indices between the new four-factor model in the present study and the original five-factor model in our previous study (Nishimura 2007). Considering interpretability by using large number of representative samples with general population in the present study, we adopted the four-factor model. The ATAS Anxiety subscale was negatively correlated with the AAQ willingness subscale (r = −.39, p < .001), while the ATAS Enjoyment subscale was positively correlated with the AAQ Action subscale (r = .40, p < .001). It is thus suggested that one who enjoys ambiguous situations can adopt two distinct attitudes: Excluding ambiguity from active resolution, or not interfering with ambiguity due to good tolerance of this experience, which can lead to positive and flexible commitments in life. In contrast, one who tends to be anxious about ambiguity may be characterized by exclusion-based attitudes due to intolerance of ambiguity, leading to lowered acceptance of their feelings and of the reality of circumstances. Cognitive/emotional attitudes towards ambiguity may affect acceptance of inner experience and active commitment to reality.

BackgroundThis study was conducted to investigate the relationship between symptoms of gambling problems, gambling behaviours, and cognitive distortions among a university student population in Japan ages 20 to 29 years. We aimed to address the gap in knowledge of gambling disorders and treatment for this population.MethodsData were obtained from 1471 Japanese undergraduate students from 19 universities in Japan. Descriptive statistics and hierarchical multivariate regression analysis were used to investigate whether the factors of gambling cognitive distortions would have predictive effects on gambling disorder symptoms.ResultsResults indicated that 5.1% of the participants are classifiable as probable disordered gamblers. The bias of the gambling type to pachinko and pachislot was unique to gamblers in Japan. Of the students sampled, 342 self-reported gambling symptoms via the South Oaks Gambling Screen. Hierarchical multivariate regression analysis indicated that one domain of gambling cognitive distortions was associated significantly with gambling symptoms among the 342 symptomatic participants: gambling expectancy (β = 0.19, p < .05). The multivariate model explained 47% of the variance in the gambling symptoms.ConclusionThis study successfully contributed to the sparse research on university student gambling in Japan. Specifically, our results indicated a statistically significant relationship between gambling cognitive distortions and gambling disorder symptoms. These results can inform the development of preventive education and treatment for university students with gambling disorder in Japan. The report also describes needs for future research of university students with gambling disorder.

Summary .-The Ruminative Responses Scale, a measure of depressive rumination, contains two subscales: Brooding and Refl ection. Treynor, Gonzalez, and NolenHoeksema (2003) proposed that Brooding is maladaptive and Refl ection is adaptive. This article examined the relationships among Brooding, Refl ection, and previous depression in two samples of Japanese undergraduates, who were non-depressed at the time of their participation. Based on answers to a self-report measure, participants were divided into a formerly depressed group, who had experienced an episode that met the criteria for major depression, and a never-depressed group. Logistic regression analyses were conducted with Brooding, Refl ection, and current depression as the independent variables and past depression as the dependent variable. Brooding had consistent positive associations with past depression. The relationship between Refl ection and past depression was not signifi cant for one sample, but was statistically signifi cant and positive in the second sample. In the second sample, Brooding and Refl ection both were related with past depression after controlling for worry.

BackgroundThere is an urgent need to establish effective strategies for suicide prevention. Stigma against depression may be a potential anti-protective factor for suicide. Thus, we investigated baseline levels of awareness and attitudes toward depression and its treatment among the general population by our original 18-item questionnaire, which we aimed to validate in the present study. Next, we conducted two types of educational interventions and examined the results to clarify the difference in the quality of these lectures.MethodsSubjects were 834 citizens (245 males and 589 females) who received an anti-stigma-targeted (n = 467) or non-targeted lecture (n = 367). An 18-item questionnaire assessing levels of awareness and attitudes toward depression and its treatments was administered to each participant before and after the lecture. A chi-square test was used to investigate categorical variables for background data on the participants. Factor analysis of baseline scores was conducted on the 18 questionnaire items. Student’s t-test was used for analysis of the gender effect. A two-way analysis of variance (ANOVA) was used for comparison among the 5 age groups and comparison of the effect of the two lectures. Multiple regression analysis was applied to examine the determinants of improved attitudes after intervention.ResultsPublic attitudes toward depression consisted of 4 distinct elements, which were disease-model attitudes, help-seeking behavior, negative affect toward depression, and non-medication solutions. Older participants had poorer disease-model attitudes and more negative affect toward depression, whereas younger participants showed poorer help-seeking behavior (p < 0.05). The anti-stigma-targeted lecture was superior to the non-targeted lecture in improving disease-model attitudes and non-medication solutions (p < 0.05). Multiple regression analyses revealed that each subscale score at post-lecture was strongly dependent on its own baseline subscale score (p < 0.01), and that baseline disease-model attitudes also affected post-lecture scores on negative affect toward depression and non-medication solutions (p < 0.01).ConclusionsThe educational intervention appears useful for acquiring accurate attitudes toward depression in a medical model. However, other strategies should be considered to enhance help-seeking behavior, especially in younger people.