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PubMed1987

Recall of parental behavior by acute depressives, remitted depressives, and nondepressives.

The goal of this study was to determine whether depressives' recall of parental behavior is a stable characteristic that persists even during asymptomatic periods. Recall of parental behavior was measured in a large community sample that was followed for one year. Four groups of subjects were formed according to their depression status: depressed, remitted depressed who had a history of depression but were not depressed during the study, cases who became depressed during the follow-up period, and never-depressed subjects. The results were generally consistent with the hypothesis that recalling one's parents as having been rejecting and unloving is not a stable personality characteristic of depression-prone persons. The currently depressed subjects differed as expected from the nondepressed subjects; however, the remitted depressed, regardless of how many past episodes of depression they had, did not differ from the nondepressed controls in their recall of parental behavior. The comparison of controls and cases resulted in an unexpected and difficult-to-interpret Sex X Group interaction. The implication of these findings for cognitive theories of depression are discussed.

Adult↗
PubMed2001

Depressive disorders in elderly Chinese patients in Macau: a comparison of general practitioners' consultations with a depression screening scale.

OBJECTIVE: The objectives of this study were to identify the prevalence of depressive symptomatology in an elderly population using a screening scale; to assess general practitioner (GP) recognition of depression; to determine patient reasons for consultation; and to relate depression to social and demographic factors. METHOD: An analytical cross-sectional study was carried out on a systematic sample of elderly Chinese patients currently resident in Macau, who presented to general practices in December 1997. Data collected included patient demographics, economic and social supports, patient depressive status assessed using the Hospital Anxiety and Depression scale (HAD), reason for attendance, and the reason for the consultation. Clinical records were analysed in order to collect GP-registered morbidity and recent relevant management. RESULTS: Data were collected from 386 elderly Chinese patients of 31 GPs (97% patient response rate). Patients presented with somatic symptoms rather than psychological issues. Using HAD cut-off score of >8, 47% of the population studied were depressed; with a HAD subscale score >11, 26.2% were depressed. Depression was detected more often in women (59%) and being female was associated with depressive status (p = 0.010). Age (greater than 75 years) was also associated with being depressed, as was not having someone to talk to (p = 0.037), and being from low social class (p = 0.050). Not having someone willing to listen to their problems, difficulties and worries, was significantly related to depression (p = 0.041). There were no referrals or antidepressive medications detected in the clinical charts. CONCLUSION: Participants' characteristics such as being over 75 years of age, being female and socially isolated were related to depression. General practitioners can play an important role in the early detection and management of psychological disorders. Although studies on a sample of Chinese patients in Macau cannot be generalized to Chinese populations elsewhere, awareness of somatic presentation of psychological illness is crucial in detecting depression in this and possibly other Chinese populations.

Aged↗
PubMed2001

Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients.

OBJECTIVE: To examine how depressive symptoms, a history of depression, and cognitive functioning contribute to the prediction of rehabilitation efficiency in stroke patients. DESIGN: Consecutive admissions to an acute inpatient rehabilitation program were screened for cognitive functioning and level of depressive symptoms. History of depression was determined by family member interview. Functional status was evaluated at time of admission and discharge. Depressive symptoms, depression history, and cognitive functioning were examined as predictors of length of stay (LOS) and efficiency of utilization of rehabilitation services. SETTING: Acute inpatient rehabilitation hospital. PATIENTS: A total of 348 consecutive stroke admissions to an inpatient program were evaluated for depression and cognitive functioning, of whom 243 patients completed all aspects of the screening. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation progress, measured with the LOS efficiency measure (LOS-EFF) of the FIM instrument, and length of rehabilitation hospital stay. RESULTS: Patients with higher levels of depressive symptoms used rehabilitation services less efficiently than those with lower symptom levels but did not have longer LOSs. History of depression was associated with longer LOS and less efficient use of rehabilitation services. Cognitive impairment did not predict rehabilitation efficiency. CONCLUSIONS: The present study lends further support to the benefits of screening stroke patients at the time of rehabilitation admission for depression and history of depression. Identifying patients who have high levels of depressive symptoms and/or a previous depressive episode will allow more comprehensive assessment and rapid intervention.

Aged↗
PubMed2005

The vascular depression hypothesis: the influence of age on the relationship between cerebrovascular risk factors and depressive symptoms in community dwelling elders.

The current study examined the moderating effect of age on the relationship between cerebrovascular risk factors (CVRF's) and depressive symptoms. Consistent with the broader vascular depression model, it was hypothesized that CVRF's would demonstrate a stronger link to depressive symptoms in the older age groups than among the younger age groups. Data from 2916 adults from the Resources, Stress, and Older Persons Panel Study were utilized. Path analysis was used to estimate direct and indirect effects (via health related symptoms and limitations) of CVRF's on depressive symptoms. Path analyses were estimated separately on four age groups: 50-64 years old, 65-74 years old, 75-84 years old, and 85 years and older. CVRF's and other comorbid medical conditions were highly predictive of health related symptoms and limitations across the four age groups. Health related symptoms and limitations were strongly linked to depressive symptoms and mediated the influence of medical illnesses (both vascular and nonvascular) on depressive symptoms. However, CVRF's exerted a unique effect on depressive symptoms in the oldest-old group (i.e., 85+). Among those over the age of 85, a greater number of CVRF's was associated with more severe depressive symptoms independent of health related symptoms/limitations and other comorbid medical conditions. Health related symptoms and limitations mediated the relationship between CVRF's and depression in individuals under 85. That is, the influence of vascular burden on depression is predominately indirect via health related limitations. But among those over the age of 85, vascular disease had a unique contribution on depression, even after controlling for other comorbid medical illness and health related limitations. This finding supports the vascular depression hypothesis and is consistent with prior work suggesting vascular disease may exert its greatest effect on depression in the context of increasing frailty.

Age Factors↗
PubMedDate not supplied

Predictors of depression 12 months after cardiac hospitalization: the Identifying Depression as a Comorbid Condition study.

OBJECTIVE: To determine characteristics which predict depression at 12 months after cardiac hospitalization, and track the natural history of depression. METHOD: Depressive symptoms were monitored at baseline, 3 and 12 months in a cohort of 785 patients, using the self-report Center for Epidemiological Studies Depression Scale. Multinomial regression analyses of baseline clinical and demographic variables identified characteristics associated with depression at 12 months. RESULTS: Three baseline variables predicted moderate to severe depression at 12 months: depression during index admission, past history of emotional health problems and current smoking. For those who were depressed during cardiac hospitalization, 51% remained depressed at both 3 and 12 months. Persistence was more evident in patients who had moderate to severe depressive symptoms when hospitalized. Mild depression was as likely to persist as to remit. CONCLUSIONS: Three clinically accessible characteristics at the time of cardiac hospitalization can assist in predicting depression at 12 months and may aid treatment decisions. Depressive symptoms persist in a substantial proportion of cardiac patients up to 12 months after hospitalization.

Adolescent↗
PubMed2006

'Justifiable depression': how primary care professionals and patients view late-life depression? A qualitative study.

BACKGROUND: Depression is the commonest mental health problem in elderly people and continues to be underdiagnosed and undertreated. AIM: To explore the ways that primary care professionals and patients view the causes and management of late-life depression. DESIGN: A qualitative study using semistructured interviews. SETTING: One Primary Care Trust in North West England. PARTICIPANTS: Fifteen primary care practitioners comprising nine GPs, three practice nurses, two district nurses and one community nurse; twenty patients who were over the age of 60 and who were participating in a feasibility study of a new model of care for late-life depression [PRIDE Trial: PRimary care Intervention for Depression in the Elderly (a feasibility study in Central Manchester funded by the Department of Health)]. RESULTS: Primary care practitioners conceptualized late-life depression as a problem of their everyday work, rather than as an objective diagnostic category. They described depression as part of a spectrum including loneliness, lack of social network, reduction in function and viewed depression as 'understandable' and 'justifiable'. This view was shared by patients. Therapeutic nihilism, the feeling that nothing could be done for this group of patients, was a feature of all primary care professionals' interviews. Patients' views were characterized by passivity and limited expectations of treatment. Depression was not viewed as a legitimate illness to be taken to the GP. Primary care professionals recognized that managing late-life depression did fall within their remit, but identified limitations in their own skills and capabilities in this area, as well as a lack of other resources to which they could refer patients. CONCLUSION: This study highlights the complicated nature of the diagnosis and management of late-life depression. Protocols for the diagnosis and treatment of depression emphasis the biomedical model which does not fit with the everyday experience of GPs or elderly patients who share the views of primary care professionals that depression is a consequence of social and contextual issues. There is a need for the development of evidence-based provision for older people with depression within primary care, but also a need for elderly patients to be made aware of the legitimacy of presenting low mood and misery to their primary care professional.

Anecdotes as Topic↗
PubMed2006

The overdiagnosis of depression in non-depressed patients in primary care.

BACKGROUND: The underdiagnosis of depression is an important research topic. Nevertheless, overdiagnosis has not been given the importance it deserves by research into the ability of family physicians to diagnose depression correctly. OBJECTIVES: To identify the factors that determine the overdiagnosis of depression by family physicians and to evaluate the clinical significance of this error. DESIGN: Two-phase cross-sectional study. SETTING: Primary care centres in Tarragona (Spain). METHODS: In the first phase, we screened 906 consecutive patients using Zung's self-rating depression scale (SDS). In the second phase, all the 209 patients with a positive screening and 97 patients with a negative screening (1 out of 7 randomly) were given the Structured Clinical Interview for DSM-IV Disorders, a series of questionnaires, and the family physician judged whether depression was present. In the 186 patients for whom there were no criteria of major depression or dysthymia, the association of various variables with the physicians' overdiagnosis of depression was analysed. RESULTS: The rate of diagnosis of depression in non-depressed patients was 26.5% (95% CI: 19.0-33.9). The factors associated independently with overdiagnosis were the SDS score (OR: 1.05; 95% CI: 1.01-1.10), the Global Assessment of Functioning score (OR: 0.95; 95% CI: 0.90-0.99), previous history of depression (OR: 2.66; 95% CI: 1.12-6.30) and presence of generalized anxiety (OR: 0.42; 95% CI: 0.18-0.97). CONCLUSION: Family physicians classify as depressed those patients who do not have the formal signs of depression but who do have antecedents of this disorder or a psychological distress that may be prodromal of future depressive episodes.

Cross-Sectional Studies↗
PubMed1998

Distress, depressive symptoms, and depressive disorder among caregivers of patients with brain injury.

OBJECTIVE: To examine the prevalence and correlates of major depression in caregivers of individuals with moderate to severe traumatic brain injuries. DESIGN: Repeated-measures design involving structured diagnostic interview and self-report of psychological distress administered on two occasions separated by 6 months. SETTING: Three acute care rehabilitation hospitals. SUBJECTS: Fifty-nine caregivers (39 mothers and 20 spouses) of individuals with moderate to severe brain injuries recruited from previous inpatient rosters. All caregivers were currently residing with the person with traumatic brain injury. MAIN OUTCOME MEASURE: The Diagnostic Interview Schedule-Revised [DIS-R] was utilized to assess depression. The Symptom Checklist 90-Revised (SCL 90-R) measured general psychological distress. RESULTS: Forty-seven percent of caregivers initially met diagnostic criteria for depression, and 43% met criteria 6 months later. Nearly two thirds of those who were initially depressed continued to be depressed 6 months later, and 17% of those who were not depressed initially subsequently met criteria for depression. The best predictor of depression was a previous (pre-brain injury) depressive episode. Neither time since injury nor injury severity predicted diagnostic status, and spouses were no more likely to be depressed than were mothers. The SCL 90-R, including its depression scale, showed high specificity but low sensitivity in predicting diagnostic status. CONCLUSIONS: The prevalence of major depression is high in caregivers of individuals with brain injuries. Because depression may interfere with the capacity to provide care and contribute to the rehabilitation process, it is important for clinicians to carefully assess both the current and preaccident affective status of primary caregivers.

Adolescent↗
PubMed1999

DEPRES II (Depression Research in European Society II): a patient survey of the symptoms, disability and current management of depression in the community. DEPRES Steering Committee.

The first pan-European survey of depression in the community (DEPRES I) demonstrated that 17% of the general population suffer from depression (major depression, minor depression, or depressive symptoms). This article describes findings from a second phase of DEPRES (DEPRES II), in which detailed interviews based on a semi-structured questionnaire (78 questions) were conducted with 1884 DEPRES I participants who had suffered from depression and who consulted a healthcare professional about their symptoms during the previous 6 months. The mean time from onset of depression was 45 months, and the most commonly experienced symptoms during the latest period were low mood (76%), tiredness (73%) and sleep problems (63%). During the previous 6 months, respondents had been unable to undertake normal activities because of their depression for a mean of 30 days, and a mean of 20 days of work had been lost to depression by those in paid employment. Approximately one-third of respondents (30%) had received an antidepressant during the latest period of depression. Significantly more respondents given a selective serotonin reputake inhibitor found that their treatment made them feel more like their normal self than those given a tricyclic antidepressant, and fewer reported treatment-related concentration lapses, weight problems, and heavy-headedness (all P < 0.05). Approximately two-thirds of respondents (70%) had received no antidepressant therapy during the latest period of depression, and prescription of benzodiazepines alone, which are not effective against depression, was widespread (17%). There is a need for education of healthcare professionals to encourage appropriate treatment of depression.

Antidepressive Agents↗
PubMed2003

Relation of intelligence and religiosity to depressive disorders in offspring of depressed and nondepressed mothers.

OBJECTIVE: To examine the relation of IQ and religiosity to depressive disorders in adolescents who varied with respect to the chronicity of their mothers' depression history. METHOD: Participants were 240 adolescents first evaluated when they were in 6th grade and then annually for 6 years. Adolescents' depressive diagnoses were assessed initially with the Schedule for Affective Disorders and Schizophrenia for School-Age Children and then annually with the Longitudinal Interval Follow-up Evaluation for children. RESULTS: IQ, but not religiosity, moderated the relation between chronicity of maternal depression and depressive disorders in adolescents. For children of mothers with no or less chronic depression, higher IQ was associated with a lower likelihood of depression; in contrast, for children of mothers with a history of more chronic depression, higher levels of IQ were significantly associated with a greater likelihood of depression. Depressive episodes during grades 7 through 11 predicted lower religious attendance during 12th grade, controlling for prior religiosity. There also was a marginally significant trend for religious attendance in 6th grade to predict lower odds of developing depressive diagnoses during grades 7 through 12. CONCLUSIONS: These results highlight the complex relation between IQ and depression and indicate the possibility of a bidirectional relation between religious attendance and adolescent depression.

Adolescent↗
PubMed2004

Family discord and stress predictors of depression and other disorders in adolescent children of depressed and nondepressed women.

OBJECTIVE: To test the hypothesis that family stress variables are associated with the effects of maternal depression on offspring diagnoses and examined whether such factors may be differentially associated with disorders in offspring of depressed and never-depressed women. METHOD: Eight hundred sixteen mothers and their 15-year-old children in an Australian community completed cross-sectional assessments of mother and youth diagnoses, interviewer-rated and self-reported quality of marital relationship/status, quality of parent-child relationship, and interviews for youth chronic and episodic stress. Women with depression histories were oversampled and included 458 never-depressed and 358 women with current or past major depressive episodes or dysthymic disorder. RESULTS: Significant interaction effects were found between maternal depression and family discord/stress variables such that high levels of environmental risk factors were significantly associated with youth depression in children of depressed women compared with low levels of adverse conditions and were generally less associated with depression in children of nondepressed women. Nondepressive disorders were associated with adverse family and stress factors for both groups of children. CONCLUSIONS: The results are consistent with a multiple risk factor model of depression transmission in high-risk families and suggest a pattern of reactivity to adverse conditions among children of depressed women. The results suggest that psychosocial factors may contribute to diagnoses in offspring of depressed women in community samples.

Adolescent↗
PubMed2005

Screening for major depression in epilepsy with common self-report depression inventories.

PURPOSE: Major depression is a common psychiatric comorbidity in chronic epilepsy that is frequently unrecognized and untreated. A variety of self-report mood inventories are available, but their validity as well as ability to detect major depression in epilepsy remains uncertain. The purpose of this study was to determine the ability of two common depressive symptom inventories to identify major depression in people with epilepsy. METHODS: In total, 174 adult patients with epilepsy underwent standardized psychiatric interview techniques [Mini International Neuropsychiatric Interview (MINI) and Mood Disorders module of the Structured Clinical Interview for DSM-IV Axis I Disorders-Research Version (SCID-I)] to determine the presence of current major depression. Subjects completed two self-report depression inventories [Beck Depression Inventory-II (BDI-II), Center for Epidemiological Study of Depression (CES-D)]. The ability of these self-report measures to identify major depression as identified by the gold standard structured interviews was examined by using diagnostic efficiency statistics. RESULTS: Both the BDI-II and the CES-D exhibited significant ability to identify major depression in epilepsy. All ROC analyses were highly significant (mean area under the curve, 0.92). Mean sensitivity (0.93) and specificity (0.81) were strong, with excellent negative predictive value (0.98) but lower positive predictive value (0.47). CONCLUSIONS: Common self-report depression measures can be used to screen for major depression in clinical settings. Use of these measures will assist in the clinical identification of patients with major depression so that treatment can be initiated.

Adult↗
PubMed2000

Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group.

OBJECTIVES: To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function. DESIGN: A pragmatic multicentre randomised controlled trial, stratified by centre. SETTING: Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom. PARTICIPANTS: 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition. INTERVENTIONS: Six individual sessions of problem solving treatment (n=128), eight group sessions of the course on prevention of depression (n=108), and controls (n=189). MAIN OUTCOME MEASURES: Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function. RESULTS: 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was -2. 63 (95% confidence interval -4.95 to -0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was -1.50 (-4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome. CONCLUSIONS: When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.

Adolescent↗
PubMed2006

Depression vulnerabilities in patients with different levels of depressive symptoms after acute coronary syndromes.

BACKGROUND: Cognitive, behavioral, and interpersonal vulnerabilities have been studied in patients fulfilling diagnostic criteria for major depression and dysthymia. The extent to which these vulnerabilities are present in cardiac patients with mild to moderate depressive symptoms--a risk factor for mortality--is unknown. Moreover, few studies have examined interrelations among depression vulnerabilities. METHODS: A consecutive cohort of 314 patients with acute coronary syndrome completed the Beck Depression Inventory (BDI) and measures of cognitive, behavioral, and interpersonal vulnerabilities (Dysfunctional Attitudes Scale, Pleasant Events Schedule for the Elderly, Dyadic Adjustment Scale, and an inventory of role transitions) within 1 week of hospital admission. Of the patients, 166 were classified as nondepressed (BDI score, 0-4), 91 as mildly depressed (BDI score, 10-16), and 57 as moderately to severely depressed (BDI score, >16). RESULTS: Compared with nondepressed patients, both mildly depressed and moderately to severely depressed patients exhibited higher mean levels of all vulnerabilities as well as a higher prevalence of more than one elevated vulnerability, defined by threshold scores. Vulnerabilities were only minimally interrelated (r = 0.01-0.25), and they were independently associated with mild and moderate depressive symptom status. CONCLUSIONS: This is the first study to show that cognitive, behavioral, and interpersonal depression vulnerabilities are uniquelyassociated with concurrent depressive symptoms. There appeared to be only modest overlap between vulnerabilities, supporting the idea that depression in medically ill patients is a multifaceted phenomenon, even in the presence of minimally elevated depressive symptoms. Longitudinal studies are required before causality and treatment implications can be addressed.

Alcoholism↗
PubMed2004

Neuropathological study of the dorsal raphe nuclei in late-life depression and Alzheimer's disease with and without depression.

OBJECTIVE: Few studies have examined pathological changes in serotonergic neurons in depression, particularly in elderly patients and in elderly patients in which depression occurs in dementia. The authors hypothesized that greater neurofibrillary pathology and fewer serotonergic neurons would be found in the dorsal raphe nuclei in depressed elderly subjects, compared with nondepressed elderly subjects, and in Alzheimer's disease patients with depression, compared to Alzheimer's disease patients without depression. METHOD: In a postmortem study, immunocytochemistry and two-dimensional image analysis were used to measure neuronal density and neuritic pathology in serotonergic neurons in the dorsal raphe nuclei of elderly subjects with primary major depression (N=14), elderly Alzheimer's disease patients with (N=8) and without (N=7) comorbid depression, and nondepressed elderly comparison subjects (N=10). RESULTS: No differences in neuritic pathology or neuronal density were found between the subjects with primary major depression and the nondepressed comparison subjects. The Alzheimer's disease subjects showed markedly fewer serotonergic neurons and associated higher levels of neuritic pathology, compared with the subjects with primary depression and the nondepressed comparison subjects, but the Alzheimer's disease subjects with comorbid major depression did not differ from the Alzheimer's disease subjects without depression on these measures. CONCLUSIONS: The study found no evidence of a loss of serotonergic neurons or of neuritic pathology in the dorsal raphe nuclei in older people with depression, with or without comorbid Alzheimer's disease. These findings suggest that if serotonergic dysfunction occurs in older depressed subjects, it is not due to neuronal loss in the brainstem. Pathophysiological changes may lie elsewhere, such as in the frontal-subcortical circuits.

Aged↗
PubMed1997

Depression in primary care--more like asthma than appendicitis: the Michigan Depression Project.

OBJECTIVE: To explore the relationships between detection, treatment, and outcome of depression in the primary care setting, based upon results from the Michigan Depression Project (MDP). METHODS: A weighted sample of 425 adult family practice patients completed a comprehensive battery of questionnaires exploring stress, social support, overall health, health care utilization, treatment attitudes, self-rated levels of stress and depression, along with the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D), and the Structured Clinical Interview for DSM-III (SCID), which served as the criterion standard for diagnosis. A comparison sample of 123 depressed psychiatric outpatients received the same assessment battery. Family practice patients received repeated assessment of depressive symptoms, stress, social support, and health care utilization over a period of up to 60 months of longitudinal follow-up. RESULTS: The central MDP findings confirm that significant differences in past history, severity, and impairment exist between depressed psychiatric and family practice patients, that detection rates are significantly higher for severely depressed primary care patients, and that clinicians use clinical cues such as past history, distress, and severity of symptoms to "detect" depression in patients at intermediate and mild levels of severity. As well, there is a lack of association between detection and improved outcome in primary care patients. CONCLUSION: These results call into question the assumption that "depression is depression" irrespective of the setting and physician, and they are consistent with a model of depressive disorder as a subacute or chronic condition characterized by clinical parameters of severity, staging, and comorbidity, similar to asthma. This new model can guide further investigation into the epidemiology and management of mood disorders in the primary care setting.

Adolescent↗
PubMed2006

Prevention of anxiety and depression in the age group of 75 years and over: a randomised controlled trial testing the feasibility and effectiveness of a generic stepped care programme among elderly community residents at high risk of developing anxiety and depression versus usual care [ISRCTN26474556].

BACKGROUND: In frail elderly, the effects of depression and anxiety are deep encroaching. Indicated prevention studies, aimed at subjects with subthreshold disorder, have shown that well designed interventions are capable of reducing the incidence of depression and anxiety. In this randomised prevention trial for elderly, living in the community and suffering from subthreshold depression and anxiety, a stepped care programme was put together to be tested versus usual (GP) care. METHODS/DESIGN DESIGN: randomised controlled trial. (See figure 1: organisation chart) together with two other projects, this project is part of a national consortium that investigates the prevention of anxiety and depressive disorders in later life using a stepped care programme. The three projects have their own particular focus. This project is aimed at elderly living in the community.Inclusion: subjects with a high risk for depression and anxiety without clinical evidence of these syndromes. The participants are 75 years of age and over and have subthreshold symptoms of depression and or anxiety: they score above the cut-off point on the self-report Centre for Epidemiologic Studies Depression (CES-D) scale, but the criteria for a major depressive disorder or anxiety disorder (panic disorder, agoraphobia, social phobia, generalized anxiety disorder) according to a validated interview, the Mini International Neuropsychiatric Interview (MINI) are not fulfilled. OUTCOMES: primary outcome: incidence of a depressive or anxiety disorder over a period of two years (MINI); secondary outcome: a positive influence of the intervention, a stepped care programme, on symptoms of depression and anxiety and on quality of life as assessed with the CES D, the HADS A and the SF36 respectively (i.e. stabilisation or improvement of symptoms) [see table 1]. MEASUREMENTS: Take place at baseline and at 3, 6, 9, 12, 18 and 24 months. Trained independent evaluators assess depression and anxiety status, the primary end point (6, 12, 18, 24 months) [see table 2]. DISCUSSION: Late-life depression and anxiety are characterised by high prevalence, unfavourable prognosis, reduced quality of life, excess mortality and substantial societal costs. No health service, however well equipped, will be able to effectively treat all elderly with depression and anxiety. Therefore, development of (cost) effective means to prevent these disorders is very important.

Aged↗
PubMed2004

Autobiographical memory in depressed and non-depressed patients with borderline personality disorder.

OBJECTIVES: The present study investigated the specificity of autobiographical memories among depressed and non-depressed borderline patients, compared with depressed patients and controls. The influence of childhood trauma, intrusions of traumatic events, avoidance of intrusions, dissociation and depression on memory specificity was also studied. METHOD: The Autobiographical Memory Test (AMT), a trauma interview and self-report measures of intrusions, avoidance, depression and dissociation were administered to 83 borderline outpatients, 26 depressed outpatients and 30 controls. RESULTS: Depressed borderline patients and depressed patients reported fewer specific memories than controls. Depressed patients generated fewer specific memories than non-depressed borderline patients. Neither trauma nor traumatic intrusions, avoidance of intrusions or dissociation were related to the specificity of memories. Level of depressive symptoms (BDI) was also not related, but the presence of a depression was. CONCLUSION: In this large sample of outpatients with borderline personality disorder, only the subgroup with a co-morbid diagnosis of depression had trouble remembering specific events from the past. Trauma, intrusions, avoidance of intrusions and dissociation seem to be unrelated to the specificity of autobiographical memories in borderline personality disorder.

Adult↗