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Open Access 01-12-2021 | Mood Disorders | Study protocol

The effectiveness of Tai Chi on the depressive symptom of young adults with subthreshold depression: a study protocol for a randomized controlled trial

Authors: Xiaoting Xie, Jian Song, Jingfang Zhu, Mengyu Han, Youze He, Jia Huang, Jing Tao, Jingsong Wu

Published in: Trials | Issue 1/2021

Abstract

Background

Depression is seriously affecting the physical and mental health of young people worldwide. Subthreshold depression, as an early stage of depression, is essential for early prevention and treatment of depression. Tai Chi, as a traditional Chinese mind-body therapy, may become an alternative intervention. However, the neurophysiological mechanism of Tai Chi for young people with subthreshold depression remains unclear, restricting its further promotion and application. Therefore, rigorous randomized clinical trials are needed to further observe the intervention effect of Tai Chi on young adults with subthreshold depression and explore the neurophysiological mechanism.

Method/design

This report describes a two-arm, randomized, parallel controlled trial with allocation concealment and assessor blinding. A total of 64 eligible participants are randomly allocated to the Tai Chi group and the waiting list group in a 1:1 ratio. Participants in the Tai Chi group receive 12 weeks of Tai Chi training, with a total of 36 times and each for 60 min. Specifically, the participants in the waiting list group are requested to maintain their routine lifestyle. In this study, the primary outcome measure is the mean change in scores on the PHQ-9 and HAMD-17 between baseline and 12 weeks; the secondary outcomes are the mean change in the scores on CES-D, CPSS, GAD-7, and PSQI. Besides, the saliva cortisol levels and fMRI are monitored to explore the mechanism of action of Tai Chi on subthreshold depression.

Discussion

The protocol uses a randomized controlled trial to examine the effectiveness of Tai Chi for young adults with subthreshold depression and explore neurophysiological mechanisms. If the test results are positive, it can be verified that Tai Chi can promote the physical and mental health of young adults with subthreshold depression.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900028289. Registered on 17 December 2019

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96.PubMedPubMedCentralCrossRef

Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annu Rev Public Health. 2008;29:115–29.PubMedCrossRef

Beardslee WR, Gladstone TR, O'Connor EE. Developmental risk of depression: experience matters. Child Adolesc Psychiatr Clin N Am. 2012;21(2):261–78.PubMedCrossRef

Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams P, Greenwald S, et al. Depressed adolescents grown up. JAMA. 1999;281(18):1707–13.PubMedCrossRef

Balazs J, Miklosi M, Kereszteny A, Hoven CW, Carli V, Wasserman C, et al. Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry. 2013;54(6):670–7.PubMedCrossRef

Gilbody S, Lewis H, Adamson J, Atherton K, Bailey D, Birtwistle J, et al. Effect of collaborative care vs usual care on depressive symptoms in older adults with subthreshold depression. JAMA. 2017;317(7):728.PubMedCrossRef

Wesselhoeft R, Sorensen MJ, Heiervang ER, Bilenberg N. Subthreshold depression in children and adolescents - a systematic review. J Affect Disord. 2013;151(1):7–22.PubMedCrossRef

Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–223.PubMedCrossRef

Yang J, Yao S, Zhu X, Zhang C, Ling Y, Abela JR, et al. The impact of stress on depressive symptoms is moderated by social support in Chinese adolescents with subthreshold depression: a multi-wave longitudinal study. J Affect Disord. 2010;127(1–3):113–21.PubMedCrossRef

10.

Tramonti F, Maestri M, Gronchi A, Fabbrini M, Di Coscio E, Carnicelli L, et al. Psychological well-being of patients with insomnia and its relationship with anxiety and depression. Psychol Health Med. 2016;21(3):309–16.PubMedCrossRef

11.

Hill RM, Pettit JW, Lewinsohn PM, Seeley JR, Klein DN. Escalation to major depressive disorder among adolescents with subthreshold depressive symptoms: evidence of distinct subgroups at risk. J Affect Disord. 2014;158:133–8.PubMedPubMedCentralCrossRef

12.

Karsten J, Penninx BW, Verboom CE, Nolen WA, Hartman CA. Course and risk factors of functional impairment in subthreshold depression and anxiety. Depress Anxiety. 2013;30(4):386–94.PubMedCrossRef

13.

Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015;76(2):155–62.PubMedCrossRef

14.

Wang F, Lee EK, Wu T, Benson H, Fricchione G, Wang W, et al. The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. Int J Behav Med. 2014;21(4):605–17.PubMedCrossRef

15.

Zou L, Sasaki JE, Wei GX, Huang T, Yeung AS, Neto OB, et al. Effects of mind-body exercises (Tai Chi/Yoga) on heart rate variability parameters and perceived stress: a systematic review with meta-analysis of randomized controlled trials. J Clin Med. 2018;7(11):404.PubMedCentralCrossRef

16.

Ma Y, Yeung A, Yang AC, Peng CK, Clain A, Alpert J, et al. The effects of tai chi on sleep quality in Chinese American patients with major depressive disorder: a pilot study. Behav Sleep Med. 2018;16(4):398–411.PubMedCrossRef

17.

Solloway MR, Taylor SL, Shekelle PG, Miake-Lye IM, Beroes JM, Shanman RM, et al. An evidence map of the effect of Tai Chi on health outcomes. Syst Rev. 2016;5(1):126.PubMedPubMedCentralCrossRef

18.

Lavretsky H, Alstein LL, Olmstead RE, Ercoli LM, Riparetti-Brown M, Cyr NS, et al. Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial. Am J Geriatr Psychiatry. 2011;19(10):839–50.PubMedPubMedCentralCrossRef

19.

Yeung A, Lepoutre V, Wayne P, Yeh G, Slipp LE, Fava M, et al. Tai chi treatment for depression in Chinese Americans: a pilot study. Am J Phys Med Rehabil. 2012;91(10):863–70.PubMedCrossRef

20.

Cho KL. Effect of Tai Chi on depressive symptoms amongst Chinese older patients with major depression: the role of social support. Med Sport Sci. 2008;52:146–54.PubMedCrossRef

21.

Yeung AS, Feng R, Kim D, Wayne PM, Yeh GY, Baer L, et al. A pilot, randomized controlled study of Tai Chi with passive and active controls in the treatment of depressed Chinese Americans. J Clin Psychiatry. 2017;78(5):e522–8.PubMedCrossRef

22.

Zhang J, Qin S, Zhou Y, Meng L, Su H, Zhao S. A randomized controlled trial of mindfulness-based Tai Chi Chuan for subthreshold depression adolescents. Neuropsychiatr Dis Treat. 2018;14:2313–21.PubMedPubMedCentralCrossRef

23.

Juruena MF, Bocharova M, Agustini B, Young AH. Atypical depression and non-atypical depression: is HPA axis function a biomarker? A systematic review. J Affect Disord. 2018;233:45–67.PubMedCrossRef

24.

Verduijn J, Milaneschi Y, Schoevers RA, van Hemert AM, Beekman AT, Penninx BW. Pathophysiology of major depressive disorder: mechanisms involved in etiology are not associated with clinical progression. Transl Psychiatry. 2015;5:e649.PubMedPubMedCentralCrossRef

25.

Anisman H, Merali Z, Hayley S. Neurotransmitter, peptide and cytokine processes in relation to depressive disorder: comorbidity between depression and neurodegenerative disorders. Prog Neurobiol. 2008;85(1):1–74.PubMedCrossRef

26.

Radley JJ, Anderson RM, Hamilton BA, Alcock JA, Romig-Martin SA. Chronic stress-induced alterations of dendritic spine subtypes predict functional decrements in an hypothalamo-pituitary-adrenal-inhibitory prefrontal circuit. J Neurosci. 2013;33(36):14379–91.PubMedPubMedCentralCrossRef

27.

Eyler LT, Prom-Wormley E, Fennema-Notestine C, Panizzon MS, Neale MC, Jernigan TL, et al. Genetic patterns of correlation among subcortical volumes in humans: results from a magnetic resonance imaging twin study. Hum Brain Mapp. 2011;32(4):641–53.PubMedCrossRef

28.

Farrell C, O'Keane V. Epigenetics and the glucocorticoid receptor: a review of the implications in depression. Psychiatry Res. 2016;242:349–56.PubMedCrossRef

29.

Li H, Wei D, Sun J, Chen Q, Zhang Q, Qiu J. Brain structural alterations associated with young women with subthreshold depression. Sci Rep. 2015;5:9707.PubMedPubMedCentralCrossRef

30.

Zhou H, Li R, Ma Z, Rossi S, Zhu X, Li J. Smaller gray matter volume of hippocampus/parahippocampus in elderly people with subthreshold depression: a cross-sectional study. BMC Psychiatry. 2016;16:219.PubMedPubMedCentralCrossRef

31.

Webb CA, Weber M, Mundy EA, Killgore WD. Reduced gray matter volume in the anterior cingulate, orbitofrontal cortex and thalamus as a function of mild depressive symptoms: a voxel-based morphometric analysis. Psychol Med. 2014;44(13):2833–43.PubMedPubMedCentralCrossRef

32.

Li J, Wang Z, Hwang J, Zhao B, Yang X, Xin S, et al. Anatomical brain difference of subthreshold depression in young and middle-aged individuals. Neuroimage Clin. 2017;14:546–51.PubMedPubMedCentralCrossRef

33.

Zeng Y, Luo T, Xie H, Huang M, Cheng AS. Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses. Complement Ther Med. 2014;22(1):173–86.PubMedCrossRef

34.

Pan Z, Su X, Fang Q, Hou L, Lee Y, Chen CC, et al. The effects of tai chi intervention on healthy elderly by means of neuroimaging and EEG: a systematic review. Front Aging Neurosci. 2018;10:110.PubMedPubMedCentralCrossRef

35.

Yu AP, Tam BT, Lai CW, Yu DS, Woo J, Chung KF, et al. Revealing the neural mechanisms underlying the beneficial effects of tai chi: a neuroimaging perspective. Am J Chin Med. 2018;46(2):231–59.PubMedCrossRef

36.

Nedeljkovic M, Ausfeld-Hafter B, Streitberger K, Seiler R, Wirtz PH. Taiji practice attenuates psychobiological stress reactivity--a randomized controlled trial in healthy subjects. Psychoneuroendocrinology. 2012;37(8):1171–80.PubMedCrossRef

37.

Tao J, Liu J, Liu W, Huang J, Xue X, Chen X, et al. Tai Chi Chuan and Baduanjin increase grey matter volume in older adults: a brain imaging study. J Alzheimers Dis. 2017;60(2):389–400.PubMedPubMedCentralCrossRef

38.

Tao J, Chen X, Egorova N, Liu J, Xue X, Wang Q, et al. Tai Chi Chuan and Baduanjin practice modulates functional connectivity of the cognitive control network in older adults. Sci Rep. 2017;7:41581.PubMedPubMedCentralCrossRef

39.

Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psych Meas. 1977;1(3):385–401.CrossRef

40.

Listed N. Physical activity and cardiovascular health. NIH consensus development panel on physical activity and cardiovascular health. JAMA. 1996;276(3):241–6.CrossRef

41.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.PubMedPubMedCentralCrossRef

42.

Liu SI, Yeh ZT, Huang HC, Sun FJ, Tjung JJ, Hwang LC, et al. Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan. Compr Psychiatry. 2011;52(1):96–101.PubMedCrossRef

43.

Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6(4):278–96.PubMedCrossRef

44.

Jiang L, Wang Y, Zhang Y, Li R, Wu H, Li C, et al. The reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) for Chinese University students. Front Psychiatry. 2019;10:315.PubMedPubMedCentralCrossRef

45.

Li S, Li Y, Lv H, Jiang R, Zhao P, Zheng X, et al. The prevalence and correlates of burnout among Chinese preschool teachers. BMC Public Health. 2020;20(1):160.PubMedPubMedCentralCrossRef

46.

Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med (1960). 2006;166(10):1092–7.CrossRef

47.

Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res. 2002;53(3):737–40.PubMedCrossRef

48.

Tsai PS, Wang SY, Wang MY, Su CT, Yang TT, Huang CJ, et al. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res. 2005;14(8):1943–52.PubMedCrossRef

49.

Jeuring HW, Huisman M, Comijs HC, Stek ML, Beekman AT. The long-term outcome of subthreshold depression in later life. Psychol Med. 2016;46(13):2855–65.PubMedCrossRef

50.

Adams KB, Moon H. Subthreshold depression: characteristics and risk factors among vulnerable elders. Aging Ment Health. 2009;13(5):682–92.PubMedCrossRef

51.

Han S, Cooper JD, Ozcan S, Rustogi N, Penninx B, Bahn S. Integrating proteomic, sociodemographic and clinical data to predict future depression diagnosis in subthreshold symptomatic individuals. Transl Psychiatry. 2019;9(1):277.PubMedPubMedCentralCrossRef

52.

Sadek N, Bona J. Subsyndromal symptomatic depression: a new concept. Depress Anxiety. 2000;12(1):30–9.PubMedCrossRef

53.

Sherita Hill G, Wand GS, Saurabh M, Ihab K, Karen H. Reliability of hypothalamic-pituitary-adrenal axis assessment methods for use in population-based studies. Eur J Epidemiol. 2011;26(7):511–25.CrossRef

54.

Isabelle B, David M, Altman DG, Schulz KF, Philippe R. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295–309.CrossRef

Title: The effectiveness of Tai Chi on the depressive symptom of young adults with subthreshold depression: a study protocol for a randomized controlled trial
Authors: Xiaoting Xie
Jian Song
Jingfang Zhu
Mengyu Han
Youze He
Jia Huang
Jing Tao
Jingsong Wu
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Published in: Trials / Issue 1/2021
Electronic ISSN: 1745-6215
DOI: https://doi.org/10.1186/s13063-021-05054-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effectiveness of Tai Chi on the depressive symptom of young adults with subthreshold depression: a study protocol for a randomized controlled trial

Abstract

Background

Method/design

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method/design

Discussion

Trial registration

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