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PubMed2002

Causal and pathoplastic risk factors of depression: findings of the Tampere Depression Project.

Factors associated with low self-esteem in non-depressive subjects increase the individual's vulnerability to depression (causal risk factors), and factors correlated to low self-esteem in depressive subjects make the current disorder more severe (pathoplastic risk factors). Using the Rosenberg Self-Esteem Scale and Depression Scale we intended to explore correlates of low self-esteem in non-depressive and depressive subjects in a random sample of 1643 individuals attending community health centres in Central Finland. According to our study, self-esteem in non-depressive men was affected mainly by poor socioeconomic situation; in depressive men particularly low self-esteem was associated with negative family factors. Low self-esteem in non-depressive women was correlated to poor socioeconomic situation, poor health, and negative family factors. In depressive women self-esteem was affected by poor physical and poor mental health. Taking into consideration causal and pathoplastic risk factors, general practitioners can improve recognition of depression. By paying attention to pathoplastic factors, it is possible to improve detection of more severe forms of depression.

Adolescent↗
PubMed1998

Clinical detection of depression among community-based elderly people with self-reported symptoms of depression.

BACKGROUND: Depression is under-diagnosed and under-treated in the primary care sector. The purpose of this study was to determine the association between self-reported indications of depression by community-dwelling elderly enrollees in a managed care organization and clinical detection of depression by primary care clinicians. METHODS: This was a 2-year cohort study of elderly people (n = 3410) who responded to the Geriatric Depression Scale (GDS) at the midpoint of the study period. A broad measure of clinical detection was used consisting of one or more of three indicators: diagnosis of depression, visit to a mental health specialist, or antidepressant medication treatment. RESULTS: Approximately half of the community-based elderly people with self-reported indications of depression (GDS > or = 11) did not have documentation of clinical detection of depression by health providers. Physician recognition of depression tended to increase with the severity of enrollees' self-reported feelings of depression. Men 65-74 years old and those > or = 85 years old were at highest risk for under-detection of depression by primary care providers. CONCLUSIONS: Clinical detection of depression of elderly people living in the community continues to be a problem. The implications of failure to recognize the possibility of depression among elderly White men suggest a serious public health problem.

Aged↗
PubMed2004

Risk factors for geriatric depression: the importance of executive functioning within the vascular depression hypothesis.

BACKGROUND: Results from recent studies addressing the vascular depression hypothesis have been mixed, with cerebrovascular risk factors (CVRFs) predicting depression in some geriatric patients but not in others. The current study seeks to examine executive dysfunction as a potential moderator of the relationship between CVRFs and depressive symptoms. METHODS: Data concerning CVRFs, executive functioning, and depressive symptoms from 77 geriatric rehabilitation patients were incorporated to test the hypothesis that patients with executive dysfunction and greater CVRFs would demonstrate the highest levels of depression over time. CVRFs (diabetes, hypertension, atrial fibrillation) were measured via diagnosis by treating physician. Depression was assessed using the 15-item Geriatric Depression Scale (GDS) at baseline and at 6-month and 18-month follow-ups. Executive functioning was measured at baseline using the Initiation/Perseveration (IP) Subtest of the Mattis Dementia Rating Scale. RESULTS: Multivariate analysis of variance demonstrated a significant statistical interaction between the number of CVRFs and scores on the IP Subtest on depressive symptoms. Patients with two or more CVRFs and lower IP scores demonstrated significantly greater depressive symptoms at baseline and at 18-month follow-up than patients with fewer CVRFs and higher IP scores. The univariate effect at 6 months was not significant. CONCLUSION: The current data suggest that scores on an index of executive functioning may moderate the relationship between CVRFs and depressive symptoms. Interpretation of these findings is provided in the context of the vascular depression hypothesis and related frontostriatal dysfunction. Patients with greater CVRF burden and poor executive functioning may be at particularly high risk for depression.

Aged↗
PubMed2001

Depressive factors and their relationships with other symptom domains in schizophrenia, schizoaffective disorder, and psychotic depression.

Relationships among different symptom domains were investigated in patients with acute exacerbation of schizophrenia with depressive symptoms, psychotic depression, or schizoaffective disorder, depressive subtype. Scores for depression and depressive factors were correlated with positive, negative, and extrapyramidal symptoms within diagnostic categories. No between-group differences in the relationship of different symptom domains could be found, and no substantial relationship between depression and positive symptoms could be revealed in any diagnostic subgroup. Only the retardation factor of depression showed a significant overlap with negative symptoms; depressive core symptoms did not. Core symptoms of depression were independent from other symptoms in all investigated diagnostic groups. Depression seems to represent a heterogeneous symptom domain with unique relationships of components to positive and negative symptoms across nosological borders. A more differentiated assessment, analysis, and treatment of depressive symptoms is therefore recommended for patients with combined depressive and psychotic symptoms.

Adolescent↗
PubMed1998

The Beck Depression Inventory: is it a suitable measure of depression for individuals with traumatic brain injury?

OBJECTIVE: This study examined the relationship between Beck Depression Inventory (BDI) scores and current diagnosis of depression, based on The Structured Clinical Interview for DSM-IV Diagnosis (SCID). DESIGN: Correlation. SETTING: Community-based sample. PARTICIPANTS: 100 individuals with traumatic brain injury (TBI) participated in this study, 25 of whom were diagnosed as depressed and 75 as not depressed at the time of interview. MAIN OUTCOME MEASURES: BDI scores, number of symptoms reported on a symptom checklist and DSM-IV diagnosis of depression. RESULTS: BDI symptoms correlated significantly with the SCID diagnosis of depression (r = .30) but were more strongly related (r = .67) to the number of non-depression-related problems reported, using the TIRR Symptom Checklist, a list of symptoms frequently found post TBI. The BDI had low sensitivity for discriminating depressed from nondepressed individuals (sensitivity = 36% when specificity was set at 80%). These results suggest that for individuals with TBI, high BDI scores may reflect hyperreactivity to post-TBI symptoms to a greater extent than clinical depression. CONCLUSIONS: Further study is needed to (1) understand the physiological, functional, and psychosocial factors that are associated with depression in individuals with TBI; (2) provide the basis for developing better measures of depression; and (3) understand how depression is experienced after TBI.

Adult↗
PubMed2002

Use of the Chinese version of the Beck Depression Inventory for screening depression in primary care.

Many Asian-Americans are unfamiliar with depression and its treatment. When depressed, they generally seek treatment from their primary care physicians and complain about their physical symptoms, resulting in under-recognition and under-treatment of depression. This study evaluates the effectiveness of the Chinese version of the Beck Depression Inventory (CBDI) for screening depression among Chinese-Americans in primary care. A total of 503 Chinese-Americans in the primary care clinic of a community health center were administered the CBDI for depression screening. Patients who screened positive (CBDI > or = 16) were interviewed by a psychiatrist using the Structured Clinical Interview for DSM-III-R, patient version (SCID-I/P) for confirmation of the diagnosis. Patients who screened negative (CBDI < 16) were randomly selected to be interviewed using the depression module of the SCID-I/P. The results of the SCID-I/P interview were used as the standard for evaluating the sensitivity and specificity of the CBDI. A total of 815 Chinese-Americans in a primary care clinic were approached, and 503 completed the CBDI. Seventy-six (15%) screened positive (CBDI > or = 16), and the prevalence of major depression was 19.6% by using extrapolated results from SCID-I/P interviews. When administered by a native-speaking research assistant, the CBDI has good sensitivity (.79), specificity (.91), positive predictive value (.79), and negative predictive value (.91). Despite the commonly believed tendency to focus on physical symptoms rather than depressed mood, Chinese-Americans are able to report symptoms of depression in response to a questionnaire. The CBDI, when administered by research assistants, has good sensitivity and specificity in recognizing major depression in this population. Lack of interest among Chinese-American patients in using the CBDI as a self-rating instrument has limited its use for depression screening in primary care settings.

Adolescent↗
PubMed2004

Quality of depression care in a population-based sample of patients with diabetes and major depression.

OBJECTIVES: Major depression occurs in approximately 11% to 15% of patients with diabetes and is associated with poor glycemic control and adverse medical outcomes. This study examined the rates and predictors of recognition of depression among primary care patients with diabetes and comorbid major depression and the quality of depression care provided during a 12-month period. METHODS: This study used automated utilization, pharmacy, and laboratory data from a health maintenance organization to describe the rate of recognition of depression and quality of care provided for patients with major depression and diabetes in the 12-month period before diagnosis. Major depression was diagnosed based on the Patient Health Questionnaire (PHQ-9) that was included in a mail survey sent to 9063 patients on the Group Health diabetes registry from 9 primary care clinics. RESULTS: Approximately 51% of patients with major depression and diabetes were recognized as depressed by the health care system. Women were more likely to be recognized (odds ratio [OR] 1.58, 95% confidence interval [CI 1.26-1.97]), as were those with dysthymia (OR 3.44, 95% CI 2.08-5.72), panic attacks (OR 1.55, 95% CI 1.19-2.19), patients with more than 7 primary care visits (OR 1.42, 95% CI 1.06-1.91) and patients reporting poor health (OR 1.62, 95% CI 1.04-2.53). Of the 51% of patients with major depression who were recognized, 43% received 1 or more antidepressant prescriptions but only 6.7% received 4 or more psychotherapy sessions during a 12-month period. DISCUSSION: There were large gaps in both recognition and quality of depression care provided to patients with major depression and diabetes within a health maintenance organization system.

Adult↗
PubMed2004

A comparison of sleep and daytime sleepiness in depressed and non-depressed mothers during the early postpartum period.

Taiwanese mothers have identified insufficient sleep as a major manifestation of postpartum depression. Few studies have thoroughly examined the relationship between sleep and depression during the early postpartum period, however. The objectives of this study were to compare the characteristics of both the postpartum sleep and daytime sleepiness of depressed first-time mothers and of their non-depressed counterparts, and to determine the factors that significantly increased mothers' risks of being depressed. A non-probability sample of 163 first-time mothers completed a questionnaire between the 13th and 20th days of the postpartum period. The Center of Epidemiological Studies- Depression and Pittsburgh Sleep Quality Index were used to measure mothers' experiences of depression symptoms and sleep. Daytime sleepiness was estimated in four ways, derived from the Roy Adaptation Model. The results indicated that the depressed mothers had poorer sleep quality than the non-depressed mothers, slept less efficiently, reported more sleep disturbances, and exhibited more daytime dysfunctions. Mothers who frequently perceived their daytime sleepiness to be affected by infant-care performance were more likely to be depressed. The study' s findings support the view that there is a connection between depression and poor sleep among postpartum mothers in Taiwan, and indicate that depressed mothers' experiences of poor sleep are multi-faceted, and not simply a matter of insufficient sleep.

Adaptation, Psychological↗
PubMed2006

Literacy education as treatment for depression in patients with limited literacy and depression: a randomized controlled trial.

BACKGROUND: Individuals with limited literacy and those with depression share many characteristics, including low self-esteem, feelings of worthlessness, and shame. OBJECTIVE: To determine whether literacy education, provided along with standard depression treatment to adults with depression and limited literacy, would result in greater improvement in depression than would standard depression treatment alone. DESIGN: Randomized clinical trial with patients assigned either to an intervention group that received standard depression treatment plus literacy education, or a control group that received only standard depression treatment. PARTICIPANTS: Seventy adult patients of a community health center who tested positive for depression using the 9-question Patient Health Questionnaire (PHQ-9) and had limited literacy based on the Rapid Estimate of Adult Literacy in Medicine (REALM). MEASUREMENTS: Depression severity was assessed with PHQ-9 scores at baseline and at 3 follow-up evaluations that took place up to 1 year after study enrollment. Changes in PHQ-9 scores between baseline and follow-up evaluations were compared between the intervention and control groups. RESULTS: The median PHQ-9 scores were similar in both the intervention and control groups at baseline (12.5 and 14, respectively). Nine-question Patient Health Questionnaire scores improved in both groups, but the improvement was significantly larger in the intervention group. The final follow-up PHQ-9 scores declined to 6 in the intervention group but only to 10 in the control group. CONCLUSIONS: There may be benefit to assessing the literacy skills of patients who are depressed, and recommending that patients with both depression and limited literacy consider enrolling in adult education classes as an adjuvant treatment for depression.

Adult↗
PubMed1998

Depressed and non-depressed mothers with problematic preschoolers: attributions for child behaviours.

OBJECTIVES: This study examines the spontaneous causal attributions made by mothers about their preschool children's problem behaviour and investigates the relationship between causal attributions and maternal depression. DESIGN: Two groups of mothers were compared, a depressed and a non-depressed group, while all women included identified their preschool child as having some problem behaviours. There were 25 women in each group. METHODS: The spontaneous attributions of mothers were assessed from audiotaped interviews using an adaptation of the Leeds Attributional Coding System for the extraction and analysis of attributional statements. RESULTS: Depressed mothers made more spontaneous causal attributions about their children's problem behaviour than did the non-depressed group; and the depressed group perceived these causes as being more stable, more controllable and more personal to the child than their non-depressed counterparts. There was also evidence that depressed mothers made more internal attributions about themselves as the cause of their children's problem behaviour than non-depressed mothers. The study indicates that the personal-to-child dimension is the attributional variable most strongly associated with depression. CONCLUSIONS: This study provides evidence that depressed mothers have attributional biases when compared to non-depressed mothers. The authors suggest that their attributions may mediate coping responses and hence may influence parenting behaviour. The clinical and research implications of the findings are discussed.

Adult↗
PubMed1999

Gender difference in the prevalence of clinical depression: the role played by depression associated with somatic symptoms.

OBJECTIVE: This study tested the hypothesis that female subjects may exhibit a higher prevalence than male subjects of depression associated with somatic symptoms but not a higher prevalence of depression not associated with these other symptoms. METHOD: The author reanalyzed research interview data on major depression from the National Comorbidity Survey, dividing respondents into those who met overall criteria for major depression and exhibited fatigue and appetite and sleep disturbance ("somatic depression") and those who met overall criteria but did not exhibit these somatic criteria ("pure depression"). RESULTS: Female subjects exhibited a higher prevalence than male subjects of somatic depression but not a higher prevalence of pure depression. Somatic depression was associated with a high prevalence of anxiety disorder and, among female subjects, with body aches and onset of depression during early adolescence. CONCLUSIONS: The gender difference in depression may result from a difference in a specific subtype of anxious somatic depression.

Adolescent↗
PubMed2000

Screening for depression in mothers bringing their offspring for evaluation or treatment of depression.

OBJECTIVE: Numerous studies have shown that the highest risk for first onset of depression occurs in women of childbearing years and that there is a strong association between lifetime rates of depressive disorders in mothers and their offspring. This association is found regardless of whether the mother or child is the targeted patient. However, little is known about rates of current depression in mothers who bring their offspring to outpatient clinics for evaluation and/or treatment of depression. This information might be useful in developing intervention strategies. METHOD: One hundred seventeen mothers bringing their offspring for evaluation or treatment for depression were screened with the Patient Problem Questionnaire to determine current symptoms of depression, anxiety disorders, and substance abuse as well as current psychiatric treatment. RESULTS: Thirty-six (31%) of the mothers screened positive on the Patient Problem Questionnaire for a current psychiatric disorder. Sixteen (14%) screened positive for current major depression, 20 (17%) for panic disorder, 20 (17%) for generalized anxiety disorder, two (2%) for alcohol abuse, and one (1%) for drug abuse. In addition, 50 (43%) of the mothers had psychiatric symptoms that did not meet the diagnostic threshold for any of the above disorders. Twenty-six (22%) of mothers expressed suicidal ideation or intent. Only five (31%) of the 16 mothers diagnosed with major depression were currently receiving any psychiatric treatment. CONCLUSIONS: A substantial number of mothers bringing their offspring for evaluation or treatment of depression were themselves currently depressed and untreated. The treatment of depressed mothers may help both the mothers and their depressed offspring.

Alcoholism↗
PubMed2001

Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression.

OBJECTIVE: The association between stressful life events and the onset of major depression decreases as the number of previous depressive episodes increases. How do genetic risk factors for major depression impact on this "kindling" phenomenon? In particular, do those at high genetic risk exhibit an increase in the speed of kindling, or are they "prekindled"? METHOD: Using discrete-time survival analysis, the authors examined the interaction between genetic risk, number of previous depressive episodes, and life event exposure in the prediction of episodes of major depression in female-female twin pairs from a population-based registry. The twins were interviewed four times over a 9-year period, producing 92,521 person-months of exposure. RESULTS: The decline in the association between stressful life events and risk for major depression as the number of previous depressive episodes increased was strongest in those at low genetic risk and was weak to absent in those at high genetic risk. In the absence of previous depressive episodes, those at high genetic risk frequently experienced depressive episodes without major environmental stressors. CONCLUSIONS: Genetic risk factors for depression produce a "prekindling" effect rather than increase the speed of kindling. The "kindled" state, wherein depressive episodes occur with little provocation, may be reached by two pathways: many previous depressive episodes, perhaps driven by multiple adversities, and high genetic risk.

Adult↗
PubMed2006

Exploring the feasibility of a community-based strength training program for older people with depressive symptoms and its impact on depressive symptoms.

BACKGROUND: Depression is a disabling, prevalent condition. Physical activity programs may assist depression management in older people, ameliorate co-morbid conditions and reduce the need for antidepressants. The UPLIFT pilot study assessed the feasibility of older depressed people attending a community-based progressive resistance training (PRT) program. The study also aimed to determine whether PRT improves depressive status in older depressed patients. METHODS: A randomised controlled trial was conducted. People aged > or = 65 years with depressive symptoms were recruited via general practices. Following baseline assessment, subjects were randomly allocated to attend a local PRT program three times per week for 10 weeks or a brief advice control group. Follow-up assessment of depressive status, physical and psychological health, functional and quality of life status occurred post intervention and at six months. RESULTS: Three hundred and forty six people responded to the study invitation, of whom 22% had depressive symptoms (Geriatric Depression Scale, GDS-30 score > or = 11). Thirty two people entered the trial. There were no significant group differences on the GDS at follow-up. At six months there was a trend for the PRT intervention group to have lower GDS scores than the comparison group, but this finding did not reach significance (p = 0.08). More of the PRT group (57%) had a reduction in depressive symptoms post program, compared to 44% of the control group. It was not possible to discern which specific components of the program influenced its impact, but in post hoc analyses, improvement in depressive status appeared to be associated with the number of exercise sessions completed (r = -0.8, p < 0.01). CONCLUSION: The UPLIFT pilot study confirmed that older people with depression can be successfully recruited to a community based PRT program. The program can be offered by existing community-based facilities, enabling its ongoing implementation for the potential benefit of other older people.

Aged↗
PubMed1993

Measurement of hostility, anger, and depression in depressed and nondepressed subjects.

This study examined the relationship between hostility and depression in depressed and nondepressed subjects as well as the reliability and validity of several measures of anger, hostility and depression. Sixty-nine subjects were evaluated for depression using the Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960). These subjects were then administered the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Ergaugh, 1961), Buss-Durkee Hostility Inventory (BDHI; Buss & Durkee, 1957), Hostility and Direction of Hostility Questionnaire (HDHQ; Foulds, Caine, & Creasy, 1960) and the State-Trait Anger Scale (STAS; Spielberger, Jacobs, Russell, & Crane, 1983). Results showed the BDI, STAS-TRAIT, HDHQ, and BDHI to have good temporal stability. Support was found for the convergent validity of all measures of depression, hostility, and anger. Limited discriminant validity was found between measures of anger and hostility and measures of depression. This latter finding was interpreted as lending support for the relationship between hostility and depression rather than as an indication of limited construct validity for the measures. Intercorrelations among hostility, anger, and depression scales offer some support for the hypothesis that depression is linked most strongly with attitudinal versus motoric forms of hostility. However, normative data suggests that both forms of hostility increase with severity of depression. Clinical implications and directions for further research are discussed.

Adult↗
PubMed1999

Identification of depressed patient types in the community and their treatment needs: findings from the DEPRES II (Depression Research in European Society II) survey. DEPRES Steering Committee.

DEPRES II (Depression Research in European Society II), the first in-depth, pan-European survey of depression in the community, provided an opportunity to identify depressed patient types and their treatment needs. Cluster analysis applied to data generated from DEPRES II interviews revealed six depressed patient types with clearly differentiated profiles. The patient type with moderately impaired depression has episodic depression and minimal disability. By contrast, severe depression associated with anxiety presents with chronic symptoms, including anxiety and panic, and causes considerable disruption to normal life and employment. Depression associated with chronic physical problems and depression associated with social problems are characterized by chronic physical illness and relationship or financial difficulties, respectively, and sufferers are pessimistic about recovery. Depression associated with sleep problems is associated with symptoms of tiredness and broken or inadequate sleep, and is commonly caused by stress. Tiredness is also a principal symptom of depression associated with tiredness or fatigue, but sufferers' ability to sleep is unaffected. All patient types would benefit from antidepressant therapy. The depressed patient types identified from the DEPRES II data make intuitive sense, but now need to be tested for face validity in the primary care setting.

Cluster Analysis↗
PubMed2005

[Role of personality in depression of the elderly: difference between early and late life depression].

Personality disorders have been implicated in the occurrence of depression in the elderly. The main purpose of this study was to assess the role of personality disorders in depression of the elderly and to distinguish between early and late onset depression. The study included 48 subjects over 65 years of age from a department of psychiatry, who suffered from a major depressive episode according to the criteria of the DSM-III-R, without bipolar characteristics. The patients were examined at two different times. At the first interview, depression was assessed by the mini-GDS and the CES-D scales, and a cognitive disorder was ruled out by the Mini-Mental State Examination. The patients were then classified in two groups according to the time of the first occurrence of depression, before (early onset depression) or after (late onset depression) 65 years of age. A second evaluation was performed after the cure of the depression. The patients' personality was then assessed using the International Personality Disorder Examination, in its VKP French-translated version, which evaluates personality disorders as defined by the criteria of the DSM-III-R and the ICD-10. The frequency of personality disorders was higher in patients with early-onset depression rather than in those with late onset depression. The most frequent personality disorder was avoiding personality (Cluster C) according to categorical as well as dimensional assessment. "Dependant personality" (Cluster C) was also quite often associated with early-onset depression. However this results should be confirmed by a larger study.

Age of Onset↗
PubMed1997

Suicidality, panic disorder and psychosis in bipolar depression, depressive-mania and pure-mania.

This study was undertaken to assess links between suicidality, panic disorder, psychosis, bipolar depression, depressive-mania and pure-mania. The subjects are a consecutive series of 129 persons with bipolar disorder who were admitted to a university teaching hospital; 53 had bipolar depression, 32 had depressive-mania and 44 had pure-mania. They met the Research Diagnostic Criteria (RDC) for major depressive disorder (bipolar depression), primary mania (pure-mania) or both disorders (depressive-mania) at entry into the study. Suicidality, intra-episode panic disorder (IEPD) and psychotic features were ascertained using structured interviews. Sources of data included a routine clinical interview, serial clinical assessments, the Schedule for Affective Disorders and Schizophrenia (SADS), the Structured Clinical Interview for DSM-III-R and reviews of charts. Multivariate logistic regression analysis was used to determine the strength of the relationships between suicidality, IEPD, psychotic features and the phase of illness. The rates of suicidality (79.3%, 56.3% and 2.3%), IEPD (62.3%, 62.5% and 2.3%) and psychotic features (52.8%, 96.9% and 88.6%) differed significantly between the groups with bipolar depression, depressive-mania and pure-mania. Subjects with bipolar depression and depressive-mania resembled one another with respect to the severity, but not rate of suicidality. They had identical rates of IEPD. Subjects with bipolar depression had a higher probability of being suicidal and a lower probability of being psychotic than persons with either subtype of mania. Pure-mania was distinguished by low rates of suicidality and IEPD. The authors describe directions for prospective studies of the relationships between phase of illness and phenomena in groups of bipolar persons.

Adult↗