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PubMed2006

Depressive symptom patterns in patients with chronic schizophrenia and subsyndromal depression.

BACKGROUND: Since subsyndromal depressive symptoms (SDS) are prevalent, under-recognized and clinically important problems in patients with schizophrenia, as well as in the elderly, the association and correlates of SDS in mid-life and older age patients with schizophrenia deserves more investigation. The purpose of this study is to learn more about the occurrence, pattern of symptoms and associated features of subsyndromal depressive symptoms in patients with chronic schizophrenia or schizoaffective disorder. METHOD: The first 165 participants from the "Citalopram Augmentation in Older Adults with Psychoses" (NIH RO1 # 63931) study comprised the sample. Inclusion criteria included: age > or =40, DSM-IV diagnosis of schizophrenia or schizoaffective disorder, outpatient status, >2 DSM-IV symptoms of MDE and Hamilton Depression Rating Scale (HAM-D) score > or =8. Depressive symptoms were assessed using the 17-item version of the HAM-D and the Calgary Depression Rating Scale (CDRS). RESULTS: The most prevalent symptoms cut across several domains of the depressive syndrome: psychological (e.g., depressed mood, depressed appearance, psychic anxiety); cognitive (e.g., guilt, hopelessness, self depreciation, loss of insight); somatic (insomnia, anorexia, loss of libido, somatic anxiety); psychomotor (e.g., retardation and agitation) and functional (diminished work and activities). Participants diagnosed with schizoaffective disorder appeared more depressed, endorsed more intense "guilty ideas of reference" and had higher total CDRS scores than patients diagnosed with schizophrenia. CONCLUSION: This study confirms the high prevalence of depressive symptoms in middle-aged and older persons with schizophrenia and schizoaffective disorder who were selected on the basis of having subsyndromal symptoms of depression.

Adult↗
PubMedDate not supplied

Parental depression and depression in offspring: evidence for familial characteristics and subtypes?

The objectives of this paper were twofold. First, to evaluate in a community sample the age of onset of major depression in adolescents and young adults with and without parental major depression. Second, to examine whether specific clinical characteristics of major depression in adolescents and young adults are associated with elevated rates of major depression among parents. Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal community study of adolescents and young adults. Results are based on 470 subjects who completed the follow-up, for whom diagnostic information for both parents was available, and who reported at least one episode of major depression according to DSM-IV-criteria through second follow-up. Diagnostic assessment in respondents was accomplished by using the standardized Munich-Composite International Diagnostic Interview (M-CIDI). Information on major depression in parents was collected as family history information from the respondents, and additionally from M-CIDI diagnostic interviews with parents of the younger cohort. Both recurrence and impairment as clinical characteristics of major depression in adolescents and young adults were associated with elevated rates of major depression among parents. Age of onset as well as overall higher impairment as clinical characteristics of major depression in youth were associated with elevated rates of parental major depression in the univariate, but not in the multiple, analyses. Our findings suggest that clinical features of major depression may indicate familial subtypes of the disorder, most evident for recurrence and impairment.

Adolescent↗
PubMed2003

Suicidal depressed vs. non-suicidal depressed adolescents: differences in recent psychopathology.

BACKGROUND: Few studies have focused on the differences between two depressed groups of patients in child psychiatry: the suicidal and the non-suicidal adolescent population. As in other countries, depression is one of the most prevalent diagnoses in adolescents in Hungary. AIMS: The present study was designed to determine (a) whether there are specific symptoms to differentiate between two clinical samples of depressed children: patients expressing suicidal behaviour and their peers with no suicide attempts, and (b) if there are significant differences between parents' and adolescents' reports of the same symptoms. METHODS: Using a recently developed semi-structured interview (Diagnostic Evaluation Schedule for Children and Adolescents-Hungarian version, ), 132 symptoms were assessed for two clinical groups of depressed adolescents: a suicidal group (N=54) [corrected], and a non-suicidal group (N=78) [corrected]. The suicidal group had all made an unsuccessful suicide attempt and/or had had frequent suicidal thoughts during the 6 months prior to the study. The non-suicidal group had neither attempted suicide, nor had had suicidal thoughts during the previous 6 months. All cases were selected from a larger sample of 490 consecutively referred new outpatient children over a 1 year period in five psychiatric facilities in Hungary. Only 13-17-year-old adolescents participated in the study. Both samples were identified using operationalised computer algorithm criteria of DSM-IV major depressive disorder episode (MDD) irrespective of the current clinical diagnosis of the patients. The Pearson Chi-square test with Monte Carlo correction was used to evaluate the differences between the suicidal and the non-suicidal depressed samples. RESULTS: Hopelessness, negative self-esteem and violent behaviour were the only significant discriminators between the two study groups according to the parent interviews, with increased problem scores in the suicidal sample compared to the non-suicidal sample. Suicidal depressed adolescents view themselves as more depressed and violent than do non-suicidal depressed individuals and were less anxious about their parents. CONCLUSIONS: The two depressed samples (suicidal vs. non-suicidal individuals) have only very few dissimilarities. There are, however, some essential differences between the parental and adolescent perceptions of the suicidal and depressive symptoms of the adolescent. The findings of the study underscore the necessity of collecting data from both the parent and the adolescent. LIMITATIONS: Cross-sectional, no lifetime psychopathology, referred samples, no blind estimation of the suicidal status of patients.

Adolescent↗
PubMed1997

Major depressive disorder, depressive symptoms, and bilateral hearing loss in hispanic adults.

Studies in non-Hispanic whites have documented higher rates of hearing loss in adults with depression versus those without depression. Data from the Hispanic Health and Nutrition Examination Survey were used to investigate associations between depression and bilateral hearing loss in Cuban-American, Mexican-American, and Puerto Rican adults 20-74 years of age. Pure tone thresholds were calculated by averaging thresholds obtained at 500, 1000, and 2000 Hz separately for each ear. Hearing loss was defined as bilateral pure tone average threshold levels greater than 25 db. Lifetime history of a major depressive episode was assessed by the Diagnostic Interview Schedule, and depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Schedule. Prevalence of overall hearing loss was consistently lower in Hispanics with a history of major depressive disorder than among those without such a history. Odds of hearing impairment was significantly greater among Puerto-Ricans reporting more depressive symptoms versus fewer symptoms. However, no such associations were found among Mexican-Americans or Cuban-Americans. In conclusion, despite the findings in Puerto Ricans with depressive symptoms short of major depression, hearing impaired Hispanics overall do not appear at increased risk of major depressive disorder.

Adult↗
PubMed2001

Bipolar II depression in late life: prevalence and clinical features in 525 depressed outpatients.

BACKGROUND: Late-life bipolar II depression has not been well studied. The aim of the present study was to find the prevalence of late-life (50 years or more) bipolar II depression among unipolar and bipolar depressed outpatients, and to compare it with bipolar II depression in younger patients, looking for differences supporting the subtyping of bipolar II depression according to age at onset. METHODS: Consecutive 525 patients presenting for treatment of a major depressive episode were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. RESULTS: Among patients less than 50 years, 53.4% had bipolar II depression. Among patients 50 years or more, 32.9% had bipolar II depression (significant difference). Atypical features were present in 60.9% of bipolar II patients less than 50 years, and in 26.1% of those 50 years or more (significant difference). Bipolar II patients 50 years or more had significantly higher age at onset than those less than 50 years. Bipolar II and unipolar patients 50 years or more were not significantly different, apart from comorbidity. Bipolar II patients less than 50 years had significantly more atypical features than unipolar ones. LIMITATIONS: Single interviewer, single nonblind assessment, cross-sectional assessment, exclusion of substance abuse and severe personality disorder patients, comorbidity not systematically assessed, modification of DSM-IV duration criterion for hypomania. CONCLUSIONS: Findings suggest that bipolar II depression and atypical features are less common in late life. Differences in age at onset and atypical features support the subtyping of bipolar II depression according to age at onset.

Adult↗
PubMed2001

Measuring depression in women around menopausal age: towards a validation of the Edinburgh Depression Scale.

BACKGROUND: The relationship between menopause and depression is still rather unclear. Studies using different methodology - especially those lacking a clear definition of depression - are hardly comparable. Since the Edinburgh Depression Scale (EDS) is not influenced by (menopause-related) somatic symptoms, the validity of the Dutch version of this instrument was investigated in a large community sample of menopausal women. METHODS: In 951 women, aged between 47 and 56 years, depressive symptomatology was measured using the EDS, together with a syndromal diagnosis of depression using Research Diagnostic Criteria. RESULTS: Twenty-two percent of the subjects had scores of 12 or higher on the EDS. With this cut-off point, depression (major or minor) was detected with a sensitivity of 66%, a specificity of 89%, and a positive predictive value (PPV) of 62%. A cut-off score of 15 or higher detected half of the women with major depression (sensitivity 73%, specificity 93%, PPV 53%). LIMITATIONS: Screening of depressive symptomatology at menopausal age in women of the community can only partly detect women with clinical depression. The relation between menopausal status and depression should preferentially be investigated using a longitudinal rather than a cross-sectional design. CONCLUSIONS: The EDS, which is easy to implement in both community and clinical settings (e.g., General Practice), might be used as an effective screening tool for detecting women at menopausal age who are at risk for depression, followed by clinical evaluation in those with high scores.

Depressive Disorder↗
PubMed2001

Dysphoria: self-devaluative and affective components in recovered depressed patients and never depressed controls.

BACKGROUND: The Interacting Cognitive Subsystems analysis of cognitive vulnerability to depression predicts that subjective experiences of dysphoria in recovered depressed patients will be qualitatively different from those of controls. This study tested this prediction using a new instrument, the Depressed States Checklist. METHODS: Twenty-three recovered recurrently depressed patients and 54 never depressed controls rated the affective and self-devaluative components of a dysphoric experience. RESULTS: Groups reported similar levels of affective component but recovered depressed patients reported higher self-devaluative dysphoric experience. At zero affective component of dysphoria neither group reported any self-devaluative feelings. With increasing affective component of dysphoria, the self-devaluative component increased significantly more in recovered patients than in controls. The ratio of self-devaluative to affective components of dysphoria significantly differentiated recovered depressed patients from controls. CONCLUSIONS: As predicted, dysphoria in recovered depressed patients is qualitatively different from controls in ways that increase vulnerability to major depression. The Depressed States Checklist is a new, brief, measure of cognitive vulnerability to depression that may be particularly useful in large, prospective, epidemiological studies.

Adolescent↗
PubMed2003

Frequency of manic symptoms during a depressive episode and unipolar 'depressive mixed state' as bipolar spectrum.

OBJECTIVE: To report the frequency of intra-episode manic symptoms in depressive episodes, and to evaluate unipolar depressive mixed state (DMS) as bipolar spectrum. METHOD: A total of 958 (863 unipolar, 25 bipolar II, and 70 bipolar I) depressive in-patients were assessed in terms of manic symptoms at admission, and several clinical variables using standardized methods. RESULTS: The frequency of manic symptoms (flight of idea, logorrhea, aggression, excessive social contact, increased drive, irritability, racing thoughts, and distractibility) was significantly higher in bipolar depressives than in unipolar depressives. Unipolar depressives with DMS - defined as having two or more manic symptoms - had more similarities to bipolar depressives than to other unipolar depressives in clinical variables such as onset age, family history of bipolar disorder, and possibly suicidality. CONCLUSION: Depressive mixed state is frequent, particular in bipolar depressives. Unipolar depressives with DMS may be better classified into bipolar spectrum.

Adult↗
PubMed1989

Depression and bulimia: the link between depression and bulimic cognitions.

This study assessed the link between bulimic and depressive cognitions. Twenty-nine bulimics and 16 controls from the general population were first assessed on levels of depression using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory (BDI). Bulimics were significantly more depressed than controls. Bulimics differed significantly from controls on all cognitive measures associated with depression (Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, and Attributional Style Questionnaire), but differences on these measures were nonsignificant when depression, as measured by the BDI, was controlled. Bulimics differed from controls regardless of level of depression on the three scales of the Restraint Inventory, the Rationalization and All-or-None scales of the Thoughts About Eating Inventory, and most of the eight scales of the Eating Disorders Inventory. Bulimics showed more maladaptive thinking associated with depression, but these differences likely reflect the levels of depression for each group. The differences on the measures of cognitive and behavioral symptoms of bulimia remained when the level of depression was controlled statistically. This suggests that although depression can be frequently diagnosed in a bulimic sample, specific maladaptive cognitions and behaviors reflect a distinct disorder (bulimia) and are not simply the expression of an affective disorder.

Adolescent↗
PubMed1994

Childhood depression, stressors and parental depression.

The relationship between depression and stressors and the relationship between depression in children and depression in their parents were investigated. Depressed children aged 7-11 years (n = 20) were compared with clinical non-depressed children (n = 88) and normal children (n = 55). Children, mothers and fathers in the three groups were tested. Measures included the Children's Depression Inventory, Recent Life Events Scale, Stressor Scale and Beck Depression Inventory. The findings showed that children and mothers in the depressed group reported more stressors than other children and other mothers while fathers of children in the depressed group did not report more stressors. The findings also showed that mothers of depressed children were more depressed than mothers of normal children while there were no differences between the scores of fathers in the three groups.

Adolescent↗
PubMed2001

Toward a threshold for subthreshold depression: an analysis of correlates of depression by severity of symptoms using data from an elderly community sample.

PURPOSE: The prevalence of depressive symptoms in elderly adults is high, yet the criteria to identify clinically significant depression may leave many elders undiagnosed and untreated. We explored the demographic and risk factor profiles of two groups, one with more severe depression and one with less severe depression. DESIGN AND METHODS: The data come from the Duke University Established Populations for Epidemiologic Studies of the Elderly (EPESE) baseline survey of 4,162 community-dwelling adults aged 65 or older. RESULTS: The prevalence of depression meeting criteria of the Center for Epidemiologic Studies-Depression scale (CES-D) and sub-threshold depression was 9.1% and 9.9%, respectively. In ordinal logistic regression, both CES-D and subthreshold depression were associated with impairment in physical functioning, disability days, poorer self-rated health, use of psychotropic medications, perceived low social support, female gender, and being unmarried. IMPLICATIONS: Depression appears to exist along a continuum, with demographic and social and physical health predictors of subthreshold depression similar to predictors of depression as defined by the CES-D scale.

Activities of Daily Living↗
PubMed2000

Negative affect, self-report of depressive symptoms, and clinical depression: relation to the experience of chronic pain.

OBJECTIVE: The goal of this study was to examine the relative importance of global affective distress, self-report of depressive symptoms, and presence or absence of major depression to the experience of chronic pain. SETTING: A multidisciplinary pain program at a university medical center was the setting for this study. PATIENTS: Subjects in this study were 211 consecutive patients with chronic pain. OUTCOME MEASURES: Pain duration, compensation, and litigation status were controlled for in the statistical analyses, as each correlated significantly with at least one of the measures of affect. Global affective distress was assessed using the Global Severity Index (GSI) from the Brief Symptom Inventory. The Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale were used as measures of self-report of depressive symptoms. Presence or absence of major depression was based on DSM-IV criteria. RESULTS AND CONCLUSIONS: The GSI, Beck Depression Inventory, and Center for Epidemiological Studies Depression Scale were significantly correlated with each measure of the experience of pain, although clinical depression was only significantly related to self-reported disability and negative thoughts about pain. The self-report measures of depression maintained their relation to the dependent measures when the somatic items from the scales were removed, suggesting that the relations were not spuriously due to the influence of pain symptoms on the scales. When examining the unique contribution of each variable to the experience of pain (by simultaneously controlling for the other measures of affect), the GSI was uniquely related to the sensory and affective components of pain. Self-report of depressive symptoms was more highly related to a measure of the evaluative component of pain and uniquely related to self-reported disability and negative thoughts about pain. The results are discussed within the context of theoretical models of the relation between pain and affect, and suggestions for future research are presented.

Adult↗
PubMed2000

Atypical symptoms of depression in a sample of depressed child and adolescent outpatients.

OBJECTIVE: To examine the presence of symptoms of atypical depression among children and adolescents with a major depressive disorder (MDD). METHOD: One thousand forty-six youths (aged 6-19 years) meeting DSM-III-R criteria for MDD were included in the study. All subjects had presented at an outpatient clinic seeking treatment and were identified as having MDD via clinical interviews using the semistructured Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode (K-SADS-P) with the youngster themselves and a parent/guardian. A diagnosis of atypical depression was derived from the symptoms of depression assessed in the K-SADS-P and required the presence of mood reactivity and at least one the following symptoms: hypersomnia, increased appetite, weight gain, or psychomotor retardation (substituted for leaden paralysis). RESULTS: One hundred sixty-two (15.5%) of the depressed youths met criteria for atypical depression. The symptoms of atypical depression were found to correlate marginally, and the diagnosis of atypical depression had marginal construct validity for both children and adolescents. CONCLUSIONS: The findings from this large sample of depressed children and adolescents suggest that atypical features of depression occur in this age group. However, the diagnosis of atypical depression appears to have only marginal construct validity for both children and adolescents.

Adolescent↗
PubMed2006

Why am I depressed?: An investigation of whether patients' beliefs about depression concur with their diagnostic subtype.

We investigated whether patients' beliefs about the causes of their depression concurred with their diagnostic subtype. Depressed patients (N = 196) attending a tertiary referral clinic completed a questionnaire regarding putative biological and nonbiological causes of their depression. Subtyping diagnoses of melancholic or nonmelancholic depression were made. Patients with nonmelancholic depression were more likely to attribute nonbiological factors as the cause of their depression than those with melancholic depression, whereas patients with melancholic depression were no more likely to attribute biological factors as the cause of their depression. Patients can distinguish differing causes of depression. The implications of the findings for the current classificatory systems of depression are discussed.

Adolescent↗
PubMed2006

A study of the serotonin transporter in the prefrontal cortex in late-life depression and Alzheimer's disease with and without depression.

Previous studies investigating the serotonin transporter (SERT) in depression have been inconsistent and included a large proportion of subjects who had committed suicide. In Alzheimer's disease studies have generally reported a reduction in SERT density but have not compared Alzheimer's disease subjects with and without comorbid major depression. We conducted a post mortem study of SERT density in the prefrontal cortex in normal elderly, a group of elderly depressed subjects and in Alzheimer's disease subjects with and without major depression. A post mortem study comparing SERT density in the prefrontal cortex in elderly controls (n = 10), subjects with major depression (n = 8) and subjects with Alzheimer's disease with (n = 9) and without (n = 5) comorbid major depression. We used autoradiography to measure the density of [3H]CN-IMI binding (non-specific binding determined with citalopram) to the SERT in the prefrontal cortex. We found a marked reduction in specific SERT binding in the prefrontal cortex in Alzheimer's disease subjects compared with both control (P = 0.002) and depressed subjects (P = 0.004) but no difference in SERT binding between depressed and control subjects or between Alzheimer's disease subjects with and without depression. Our study confirms previous reports of a reduction in SERT binding in Alzheimer's disease but indicates this reduction is not greater in Alzheimer's disease subjects who also have had major depression. In a group of subjects more typical of late-life depression we did not identify any alterations in SERT density.

Age of Onset↗
PubMed2005

Depression in Croatian Type 2 diabetic patients: prevalence and risk factors. A Croatian survey from the European Depression in Diabetes (EDID) Research Consortium.

AIMS: To determine the prevalence rate of and risk factors for depression in Croatian Type 2 diabetic patients. METHODS: Depressive mood was examined in 384 randomly selected outpatients with Type 2 diabetes. Center for Epidemiological Studies Depression Scale (CES-D) and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) were used to identify depressive disturbances. The groups with CES-D > or = 16 and < 16 were compared with respect to demographic, psychological and clinical characteristics. Regression analysis was used to determine risk factors for depression. RESULTS: Of the examined patients, 22% had CES-D scores > or = 16, and in 33% of them clinical depression was confirmed by the psychiatric interview. Depressed patients compared with the non-depressed ones reported more diabetes-related problems and poorer well-being (t = 6.71, P < 0.001 and t = 11.98, P < 0.001, respectively). Multiple regression analysis indicated female gender, experienced support and the level of emotional well-being to predict depression (R = 0.74, F = 15.3, P < 0.001). CONCLUSIONS: The obtained data indicate that the prevalence rate in Croatian Type 2 diabetic patients is comparable to findings from other cultural settings. Depressive symptoms can be predicted by psychological rather than disease-related variables. Psychological care for diabetic patients may be necessary to prevent depressive symptomatology.

Croatia↗
PubMed1982

Depressed and nondepressed content self-reference in mild depressives.

The present research investigated the extent to which mild depressives and normals differed in their self-referent processing of personal information. In Experiment 1, these subjects made two types of ratings on depressed (e.g., bleak, dismal) and nondepressed (e.g., loyal, organized) content personal adjectives. Half of the adjectives in each content category were rated for a semantic attribute (Does this word have a specific meaning or relate to a specific situation?), whereas half were rated for degree of self-reference (Does this word describe you?). These ratings were followed immediately by an incidental recall task, in which subjects recalled as many of the adjectives as possible. Consistent with predictions generated from a content-specific self-schema model, normals displayed superior recall for self-referenced nondepressed content adjectives, when compared to recall for self-referenced depressed content adjectives and recall for semantic ratings (both depressed and nondepressed content). In contrast, mild depressives exhibited enhanced self-referent recall for both types of content, when compared to their recall for semantic adjectives. This finding suggested that mild depressives utilize a self-schema which incorporates both depressed and nondepressed content. Experiment 2 explored this suggestion further by substituting an other-referent rating task (Does this word describe Pierre Trudeau?) for the semantic judgment used in Experiment 1. Again, consistent with a content-specific self-schema model, normals displayed superior recall only for self-referenced nondepressed adjectives. Mild depressives, however, showed enhanced self-referent recall, relative to other-referent recall, only for depressed content adjectives. For nondepressed content, mild depressives did not distinguish between the self- and other-referent conditions. This finding hinted that the nondepressed component of the mild depressive's self-schema may operate at a somewhat reduced effectiveness, but only when required to differentiate between self and others.

Adult↗
PubMed1995

Maternal depressive symptoms and depressive symptoms in adolescents.

The relationship between maternal depressive symptoms and rates of adolescent (15-16 years) depressive symptoms was studied in a birth cohort of 934 New Zealand children. There was a clear correlation between maternal depressive symptoms and subsequent depressive symptoms in adolescent females (r = .44) but no association (r = -.01) between maternal depressive symptoms and depressive symptoms in adolescent males. Subsequent analysis suggested that the correlation between maternal depression and depressive symptoms in adolescent females was largely explained by the associations of both measures with a series of social and contextual factors including social disadvantage, marital discord and family adversity. It is concluded that maternal depression is only associated with depression in adolescence insofar as maternal depression is associated with social disadvantage, marital discord or family adversity.

Adolescent↗